Testosterone replacement therapy improves metabolic parameters in hypogonadal men with type 2 diabetes but not in men with coexisting depression: the BLAST study
Abstract
INTRODUCTION: The association between testosterone deficiency and insulin resistance in men with type 2 diabetes is well established and current endocrine society guidelines recommend the measurement of testosterone levels in all men with type 2 diabetes or erectile dysfunction. AIM: We report the first double-blind, placebo-controlled study conducted exclusively in a male type 2 diabetes population to assess metabolic changes with long-acting testosterone undecanoate (TU). METHODS: The type 2 diabetes registers of seven general practices identified 211 patients for a 30-week double-blind, placebo-controlled study of long-acting TU 1,000 mg followed by 52 weeks of open-label use. Because of the established impact of age, obesity, and depression on sexual function, these variables were also assessed for influence on metabolic parameters. MAIN OUTCOME MEASURE: Changes in glycated hemoglobin (HbA1c) and the level of testosterone at which response are achieved. RESULTS: Treatment with TU produced a statistically significant reduction in HbA1c at 6 and 18 weeks and after a further 52 weeks of open-label medication most marked in poorly controlled patients with baseline HbA1c greater than 7.5 where the reduction was 0.41% within 6 weeks, and a further 0.46% after 52 weeks of open-label use. There was significant reduction in waist circumference, weight, and body mass index in men without depression, and improvements were related to achieving adequate serum levels of testosterone. There were no significant safety issues. CONCLUSIONS: Testosterone replacement therapy significantly improved HbA1c, total cholesterol, and waist circumference in men with type 2 diabetes. Improvements were less marked in men with depression at baseline, and therapeutic responses were related to achieving adequate serum testosterone levels. Current advice on 3- to 6-month trials of therapy may be insufficient to achieve maximal response. Patients reported significant improvements in general health.
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A compelling number of clinical studies demonstrated that TRT led to improvement in glycemic control and insulin sensitivity, whereas some failed to confirm these observations.
“A compelling number of clinical studies demonstrated that TRT led to improvement in glycemic control and insulin sensitivity (4, 5, 37, 42), whereas some failed to confirm these observations (43).”
From Effects of liraglutide on obesity-associated functional hypogonadism in men (2019) · cites this paper as [37]
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- Authors
- Hackett, G., Cole, N., Bhartia, M., Kennedy, D., Raju, J., Wilkinson, P., & the BLAST Study Group
- Affiliations
- Good Hope Hospital (GB)
- Wilkinson Associates Radnet , Herts , UK
- Corresponding author
- Hackett, Geoffrey
- ORCID
- Hackett, Geoffrey
- Venue
- The Journal of Sexual Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-03-01
- Volume
- 11
- Issue
- 3
- Pages
- 840-856
- ISSN
- 1743-6095 (ISSN-L)
- 1743-6109
- OpenAlex
- W1614492335
- Cited by
- 168
- References
- 61
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 10 · 2023: 13 · 2022: 10 · 2021: 13 · 2020: 18 · 2019: 12 · 2018: 21 · 2017: 12 · 2016: 13 · 2015: 21 · 2014: 16
- FWCI
- 13.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Sexual Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- testosterone replacement therapy, testosterone undecanoate, hypogonadism, type 2 diabetes, depression, insulin resistance, HbA1c, waist circumference, body mass index, serum testosterone levels, sexual function, erectile dysfunction
- MeSH terms
- Adult, Aged, Androgens, Body Composition, Delayed-Action Preparations, Depressive Disorder, Diabetes Mellitus, Type 2, Double-Blind Method, Glycated Hemoglobin, Humans, Hypogonadism, Erectile Dysfunction, Insulin Resistance, Male, Middle Aged, Obesity, Testosterone, Body Mass Index, Young Adult
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