The DOI matches its Crossref record; 37 of the 37 references it cites were found in a registry or an index; none of the 20 sources its claims cite is checked for support yet.
Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes
Abstract
Context: Low testosterone levels are common in men with type 2 diabetes and may be associated with insulin resistance. Objective: We investigated prevalence of testosterone deficiency and the relationship between testosterone and insulin resistance in a large cohort of men with type 2 and type 1 diabetes. Design: The study was a cross-sectional survey of 580 men with type 2 diabetes and 69 men with type 1 diabetes. A subgroup of 262 men with type 2 diabetes was then reassessed after a median of 6 months. Results: Forty-three percent of men with type 2 diabetes had a reduced total testosterone, and 57% had a reduced calculated free testosterone. Only 7% of men with type 1 diabetes had low total testosterone. By contrast, 20.3% of men with type 1 diabetes had low calculated free testosterone, similar to that observed in type 2 diabetes (age-body mass index adjusted odds ratio = 1.4; 95% confidence interval = 0.7–2.9). Low testosterone levels were independently associated with insulin resistance in men with type 1 diabetes as well as type 2 diabetes. Serial measurements also revealed an inverse relationship between changes in testosterone levels and insulin resistance. Conclusions: Testosterone deficiency is common in men with diabetes, regardless of the type. Testosterone levels are partly influenced by insulin resistance, which may represent an important avenue for intervention, whereas the utility of testosterone replacement remains to be established in prospective trials.
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Written from the paper’s full text.
TL;DR
In a single-center cross-sectional survey, testosterone deficiency was common in men with diabetes: 43% of men with type 2 diabetes had low total testosterone and 57% had low calculated free testosterone, while 20.3% of men with type 1 diabetes had low calculated free testosterone. Low testosterone indices were independently associated with insulin resistance in both diabetes types, and longitudinal changes in testosterone were inversely related to changes in insulin resistance in a type 2 diabetes subgroup.
Key findings
- Among men with type 2 diabetes, 43% had low total testosterone (<10 nmol/L) and 57% had low calculated free testosterone (<0.23 nmol/L); among men with type 1 diabetes, 7% had low total testosterone but 20.3% had low calculated free testosterone, similar to age- and BMI-adjusted men with type 2 diabetes (adjusted odds ratio 1.4; 95% CI 0.7–2.9).
- Low total testosterone in type 2 diabetes was independently associated with insulin resistance by HOMA-IR (odds ratio 1.2; 95% CI 1.0–1.4), and calculated free testosterone was independently associated with insulin sensitivity in type 2 diabetes (partial correlation coefficient −0.10; P = 0.02) and with eGDR in type 1 diabetes (P = 0.04).
- In 262 men with type 2 diabetes reassessed after a median of 6 months, the change in total testosterone was inversely related to the change in HOMA-IR (P = 0.01), and the change in calculated free testosterone was inversely correlated with the change in HOMA-IR (P = 0.03).
- The prevalence of low calculated free testosterone approximately doubled per decade of age in type 2 diabetes (adjusted odds ratio 2.0; 95% CI 1.4–2.4) and in type 1 diabetes (adjusted odds ratio 2.4; 95% CI 1.4–3.9).
Methods
- Cross-sectional survey of 580 men with type 2 diabetes and 69 men with type 1 diabetes at a single clinic; 6 men with type 2 diabetes were excluded from statistical analysis, and a randomly selected subgroup of 262 men with type 2 diabetes was reassessed after a median of 6 months (range 1–15 months).
- Fasting blood samples were drawn between 0800 and 1000 h; total testosterone was measured by Access assay, SHBG by Immulite, and calculated free testosterone was derived using Vermeulen’s formula. Low total testosterone was defined as <10 nmol/L and low calculated free testosterone as <0.23 nmol/L.
- Insulin resistance was estimated by HOMA-IR in type 2 diabetes and by eGDR in type 1 diabetes; analyses used logistic regression, multiple regression, ANOVA, analysis of covariance, and nonparametric tests as appropriate.
Limitations
- The paper states that it did not obtain a detailed symptomatology history, so the biochemical testosterone deficiency may not represent a true hypogonadal state; it also states that a single low testosterone level is inadequate for diagnosing hypogonadism because of variability, and on repeat testing 27% of men with low total testosterone and 33% with low calculated free testosterone had normal levels.
- The paper states that longitudinal changes in testosterone in type 1 diabetes remain to be explored and that the utility of testosterone replacement remains to be established in prospective trials.
- Evident from the text: the study was observational and single-center, with a tertiary referral cohort that had longstanding diabetes and high complication prevalence, which may limit generalizability and cannot establish causality.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only 7% of men with type 1 diabetes had low total testosterone.”
- Also stated in: § Prevalence of testosterone deficiency in men with type 1 diabetes · plain
“Few men with type 1 diabetes had low TT (7.2%, P Ͻ 0.001, vs. type 2 diabetes, Fig. 1).”
- Also stated in: § Statistical analysis · plain
“Low TT (Ͻ10 nmol/liter) (%) 7% 43% 42%”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Abstract
Strength:plain· not yet calibratedn = 69Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § Prevalence of testosterone deficiency in men with type 1 diabetes · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“57% had a reduced calculated free testosterone”
- Also stated in: § Discussion · plain
“57% had low cFT levels”
- Also stated in: § Statistical analysis · plain
“Low cFT (Ͻ0.23 nmol/liter) (%) 20% 57% 60%”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After adjusting for age, body mass index (BMI), and other confounding factors, the frequency of low TT levels remained significantly higher in men with type 2 diabetes when compared with those with type 1 diabetes (adjusted odds ratio ϭ 4.0; 95% CI ϭ 1.5-10.7;P ϭ 0.005).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Prevalence of testosterone deficiency in men with type 1 diabetes
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For each decade of life, the prevalence of low cFT levels effectively doubled (adjusted odds ratio for low cFT levels ϭ 2.4; 95% CI ϭ 1.4 -3.9).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Prevalence of testosterone deficiency in men with type 1 diabetes
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“This frequency of low TT levels in men with type 1 diabetes was not significantly greater than observed in reproductively normal young men (21).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Prevalence of testosterone deficiency in men with type 1 diabetes
What the sources say
- Not checked yetcites [21] Sikaris, 2005, Reproductive hormone reference intervals for healthy fertile young men: evaluation of automated platform assays., J Clin Endocrinol Metab source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As in men with type 2 diabetes, the major predictor of cFT levels in individuals with type 1 diabetes was age (Fig. 2B).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Prevalence of testosterone deficiency in men with type 1 diabetes
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, when SHBG was included in the model, this difference between type 1 and type 2 diabetes was eliminated (P ϭ 0.16).”
- Also stated in: § Discussion · plain
“When SHBG was included into the model, this difference between type 1 and type 2 diabetes was eliminated (P ϭ 0.16).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Prevalence of testosterone deficiency in men with type 1 diabetes
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“20.3% of men with type 1 diabetes had low calculated free testosterone”
- Also stated in: § Prevalence of testosterone deficiency in men with type 1 diabetes · plain
“one in five men with type 1 diabetes had low cFT levels (20.3%, Fig. 1)”
- Also stated in: § Statistical analysis · plain
“Low cFT (Ͻ0.23 nmol/liter) (%) 20% 57% 60%”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Prevalence of testosterone deficiency in men with type 1 diabetes · plain
In the paper
“insulin resistance (as estimated by the HOMA-IR equation) (23) was independently associated with low TT levels (odds ratio ϭ 1.2; 95% CI ϭ 1.0 -1.4), after adjusting for age, BMI, treatment regimens, and other potentially confounding variables.”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Testosterone indices and insulin resistance
What the sources say
- Not checked yetcites [23] Wallace, 2004, Use and abuse of HOMA modeling., Diabetes Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The inverse association between cFT levels and age (Fig. 2B) was significantly stronger that that observed for TT (P Ͻ 0.01)”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Prevalence of testosterone deficiency in men with type 2 diabetes
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 6
- Probably not a substantial claim. 10
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“finding that 27 and 33% of individuals with low TT and cFT levels respectively had levels in the normal range when retested.”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At the second analysis, the prevalence of testosterone deficiency defined by low TT levels (Ͻ10 nmol/liter) was not significantly different from obtained at the first estimation (39 vs. 42%, P ϭ 0.2), and there was a strong correlation between estimations (r 2 ϭ 0.73, Fig. 3A).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Changes in testosterone levels over time
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“whereas the utility of testosterone replacement remains to be established in prospective trials.”
- Also stated in: § Discussion · hedged
“Although there is a strong rationale for testosterone replacement, the balance of benefits and risks is currently unknown and still to be defined by large and long-term clinical trials.”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Abstract
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Discussion · hedged
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“possibly because of the age-associated rise in SHBG (Fig. 2C).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Prevalence of testosterone deficiency in men with type 2 diabetes
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“None of these men received testosterone therapy.”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Changes in testosterone levels over time
Strength:plain· not yet calibratedn = 262Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Interpretation of our study is therefore limited because we did not obtain a detailed record of symptomatology history.”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All men gave written informed consent, and the study was approved by the Human Research Ethics Committee, Research Ethics Unit, Austin Health.”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Cross-sectional survey
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“However, testosterone may have deleterious actions on prostate disease, sleep apnea, and possibly cardiovascular risk (35).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Discussion
What the sources say
- Not checked yetcites [35] Rhoden, 2004, Risks of testosterone-replacement therapy and recommendations for monitoring., N Engl J Med source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Consequently, the appropriate clinical response to this emerging problem remains to be determined.”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“previous studies have reported an association of loss of weight in obese insulinresistant men with increased testosterone levels (30).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Discussion
What the sources say
- Not checked yetcites [30] Niskanen, 2004, Changes in sex hormone-binding globulin and testosterone during weight loss and weight maintenance in abdominally obese men with the metabolic syndrome., Diabetes Obes Metab source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Certainly, testosterone replacement can improve performance, mood, and libido in men with hypogonadism (22) and augments insulin sensitivity (11,15).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Discussion
What the sources say
- Not checked yetcites [22] Bhasin, 2006, Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline., J Clin Endocrinol Metab [Erratum (2006) 91:1995–2010] source
- Not checked yetcites [11] Kapoor, 2006, Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes., Eur J Endocrinol source
- Not checked yetcites [15] Simon, 2001, Androgen therapy improves insulin sensitivity and decreases leptin level in healthy adult men with low plasma total testosterone: a 3-month randomized placebo-controlled trial., Diabetes Care source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The strengths of this study include the large number subjects, inclusion of a large cohort of patients with type 1 diabetes, measurement of serum testosterone levels at the appropriate time of day (early morning), accurate assays for total and free testosterone levels, and longitudinal follow-up in a substantial number of men with type 2 diabetes.”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Indeed, reduced SHBG has been suggested as a surrogate marker for insulin resistance (33).”
§ Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes > Discussion
What the sources say
- Not checked yetcites [33] Jayagopal, 2003, The biological variation of testosterone and sex hormone-binding globulin (SHBG) in polycystic ovarian syndrome: implications for SHBG as a surrogate marker of insulin resistance., J Clin Endocrinol Metab source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
The cohort of men attending a single tertiary referral clinic is representative of men with diabetes generally.
“in a large, unselected cohort of men with type 1 or type 2 diabetes presenting at a single center”
“large unselected cohort of men presenting to a single tertiary referral center”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“In fact, multiple studies confirmed the association between low or inappropriate T levels in men and T2D and obesity [167–170].”
From Role of sex hormone-binding globulin in the free hormone hypothesis and the relevance of free testosterone in androgen physiology (2022) · cites this paper as [168]
In the citing paper
“A longitudinal study in 265 men with a baseline hemoglobin A1c of 7.6% reported an inverse relationship between changes in glycemic control and testosterone levels.”
From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [35]
In the citing paper
“In those whose glycemic control improved over time, testosterone increased, whereas in those whose control worsened, testosterone decreased (35).”
From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [35]
In the citing paper
“Approximately, 50% of older (age >40 years) male patients with type 2 diabetes mellitus (DM2) have decreased testosterone (T) levels”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Overall hs-CRP median is below both reported subgroup medians
MajorThe reported hs-CRP medians for men with and without low TT are 7.7 and 4.5, respectively. The overall type 2 diabetes median in Table 1 is 3.0, which cannot be below both subgroup medians if these are the same cohort.
“higher hs-CRP levels (median 7.7 vs. 4.5, P Ͻ 0.01)”
“hs-CRP (IU/ml) 1.5 (0.2-11.5) 3.0 (0.2-192) 2.9 (0.2-58)”
Macrovascular disease prevalence differs from Table 1
MinorThe results describe macrovascular disease in one third of men with type 2 diabetes, but Table 1 reports 42% for that group.
“One third of men with type 2 diabetes had documented macrovascular disease”
“Macrovascular disease (%) 16% 42% 40%”
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Metadata
- Authors
- Grossmann, M., Thomas, M. C., Panagiotopoulos, S., Sharpe, K., MacIsaac, R. J., Clarke, S., Zajac, J. D., & Jerums, G.
- Affiliations
- The University of Melbourne (AU)
- Baker Heart and Diabetes Institute (AU)
- Corresponding author
- Grossmann, Mathis
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-05-01
- Volume
- 93
- Issue
- 5
- Pages
- 1834-1840
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1975633687
- Semantic Scholar
- 02f5d7f00e960755b4687b5424387d4da02771b3
- Cited by
- 468
- References
- 37
- Citations by year
- 2026: 22 · 2025: 22 · 2024: 22 · 2023: 23 · 2022: 28 · 2021: 24 · 2020: 23 · 2019: 15 · 2018: 24 · 2017: 33 · 2016: 34 · 2015: 30 · 2014: 41 · 2013: 31 · 2012: 30
- FWCI
- 15.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Keywords
- androgen deficiency, insulin resistance, type 2 diabetes, type 1 diabetes, men, free testosterone, total testosterone, testosterone replacement therapy, prevalence
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Humans, Insulin Resistance, Male, Middle Aged, Sex Hormone-Binding Globulin, Testosterone
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