Fifty‐ two—Week Treatment With Diet and Exercise Plus Transdermal Testosterone Reverses the Metabolic Syndrome and Improves Glycemic Control in Men With Newly Diagnosed Type 2 Diabetes and Subnormal Plasma Testosterone
Abstract
ABSTRACT: Men with the metabolic syndrome (MetS) and type 2 diabetes (T2D) often have low testosterone levels. Elevating low testosterone levels may improve features of the MetS and glycemic control. In a single blind, 52‐week randomized clinical trial, the effects of supervised diet and exercise (D&E) with or without transdermal testosterone administration on components of the MetS in hypogonadal men with the MetS and newly diagnosed T2D were assessed. A total of 32 hypogonadal men (total testosterone <12.0 nmol/L) with newly diagnosed T2D and with the MetS as defined by the Adult Treatment Panel III and the International Diabetes Federation received supervised D&E, but 16 received it in combination with testosterone gel (50 mg) once daily (n = 16). No glucose‐lowering agents were administered prior to or during the study period. Outcome measures were components of the MetS as defined by the Adult Treatment Panel III and the International Diabetes Federation. Serum testosterone, glycosylated hemoglobin (HbA 1c), fasting plasma glucose, high‐density lipoprotein cholesterol, triglyceride concentrations, and the waist circumference improved in both treatment groups after 52 weeks of treatment. Addition of testosterone significantly further improved these measures compared with D&E alone. All D&E plus testosterone patients reached the HbA 1c goal of less than 7.0%; 87.5% of them reached an HbA 1c of less than 6.5%. Based on Adult Treatment Panel III guidelines, 81.3% of the patients randomized to D&E plus testosterone no longer matched the criteria of the MetS, whereas 31.3% of the D&E alone participants did. Additionally, testosterone treatment improved insulin sensitivity, adiponectin, and high‐sensitivity C‐reactive protein. Addition of testosterone to supervised D&E results in greater therapeutic improvements of glycemic control and reverses the MetS after 52 weeks of treatment in hypogonadal patients with the MetS and newly diagnosed T2D.
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A small, uncontrolled study found that testosterone treatment augmented the reductions in central adiposity and insulin resistance achieved with lifestyle.
“While a small, uncontrolled study found that testosterone treatment augmented the reductions in central adiposity and insulin resistance achieved with lifestyle;118”
From Lowered testosterone in male obesity: Mechanisms, morbidity and management (2014) · cites this paper as [118]
The addition of testosterone gel to lifestyle changes resulted in greater improvements of glycemic control and insulin sensitivity.
“The addition of testosterone gel to the lifestyle changes resulted in greater improvements of glycemic control and insulin sensitivity [22].”
From Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy (2020) · cites this paper as [22]
The same lifestyle intervention significantly improved glycemic control in those men.
“Heufelder et al. found that a lifestyle intervention (supervised diet and exercise) during 52 weeks significantly improved testosterone concentrations and glycemic control in 16 hypogonadal men with metabolic syndrome and newly diagnosed type 2 diabetes.”
From Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy (2020) · cites this paper as [22]
A lifestyle intervention (supervised diet and exercise) during 52 weeks significantly improved testosterone concentrations in 16 hypogonadal men with metabolic syndrome and newly diagnosed type 2 diabetes.
“Heufelder et al. found that a lifestyle intervention (supervised diet and exercise) during 52 weeks significantly improved testosterone concentrations and glycemic control in 16 hypogonadal men with metabolic syndrome and newly diagnosed type 2 diabetes.”
From Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy (2020) · cites this paper as [22]
Effects of testosterone on glycemic control become evident only after 3-12 months.
“Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3–12 months.”
From Onset of effects of testosterone treatment and time span until maximum effects are achieved (2011) · cites this paper as [43]
High-density lipoprotein cholesterol increases after 3 months, increasing further during 12 months, after 6 months, or close to 1 year, with continuous increase over 24 months.
“An increase was found to occur after 3 months increasing further during 12 months (43), after 6 months, (35) or close to 1 year (44). Continuous increase was observed over 24 months (32).”
From Onset of effects of testosterone treatment and time span until maximum effects are achieved (2011) · cites this paper as [43]
HbA1c declines after 3 months of testosterone treatment, with further decrease after 12 months.
“A decline in HbA1c was observed after 3 months (31, 36, 43) with further decrease after 12 months (43).”
From Onset of effects of testosterone treatment and time span until maximum effects are achieved (2011) · cites this paper as [43]
Serum glucose is reduced after 3 months of testosterone administration in men with impaired glucose tolerance.
“Several studies indicate that upon testosterone administration, serum glucose is reduced after 3 months in men with impaired glucose tolerance (31, 36, 43).”
From Onset of effects of testosterone treatment and time span until maximum effects are achieved (2011) · cites this paper as [43]
Serum proinsulin and insulin decrease after 3 or 6 months of testosterone treatment, and HOMA-IR decreases after 3 or 6 months.
“A decrease in serum proinsulin and insulin was noted after 3 months (43) or 6 months (45), and a decrease in homeostasis model assessment index of insulin resistance (HOMA-IR) after 3 months (36) or 6 months (45–47).”
From Onset of effects of testosterone treatment and time span until maximum effects are achieved (2011) · cites this paper as [43]
Testosterone administration decreases C-reactive protein after 3 weeks and after 3 months.
“A decrease in C-reactive protein (CRP) was observed after 3 weeks (63) and in other studies after 3 months (32, 43).”
From Onset of effects of testosterone treatment and time span until maximum effects are achieved (2011) · cites this paper as [43]
A rise in prostate-specific antigen levels is found after 3 months in some studies and only after 12 months in others.
“Other studies have found a rise of PSA levels after 3 months (40), some only after 12 months (43).”
From Onset of effects of testosterone treatment and time span until maximum effects are achieved (2011) · cites this paper as [43]
Combination of testosterone replacement therapy and lifestyle measures is superior to lifestyle measures alone in increasing insulin sensitivity, glycemic control, muscle mass and reducing liver fat.
“Only few studies to date reported that combination of TRT and LSM is superior to LSM alone in increasing insulin sensitivity, glycemic control, muscle mass and reducing liver fat (4, 5).”
From Effects of liraglutide on obesity-associated functional hypogonadism in men (2019) · cites this paper as [4]
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 [4]
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- Authors
- Heufelder, A. E., Saad, F., Bunck, M. C., & Gooren, L.
- Affiliations
- Bayer (Germany) (DE)
- Gulf Medical University (AE)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Gooren, Louis
- Venue
- Journal of Andrology
- Publisher
- Wiley
- Published
- 2009-11-12
- Volume
- 30
- Issue
- 6
- Pages
- 726-733
- ISSN
- 0196-3635 (ISSN-L)
- 1939-4640
- OpenAlex
- W2132592917
- Cited by
- 349
- References
- 26
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 8 · 2023: 11 · 2022: 25 · 2021: 19 · 2020: 18 · 2019: 12 · 2018: 19 · 2017: 23 · 2016: 23 · 2015: 29 · 2014: 36 · 2013: 32 · 2012: 23
- FWCI
- 18.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Andrology (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- transdermal testosterone, hypogonadism, metabolic syndrome, type 2 diabetes, diet and exercise, glycemic control, HbA1c, insulin sensitivity, adiponectin, C-reactive protein, newly diagnosed diabetes, testosterone gel
- MeSH terms
- Administration, Cutaneous, Adult, Blood Glucose, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Insulin Resistance, Cholesterol, HDL, Male, Testosterone, Triglycerides, Exercise, Metabolic Syndrome, Waist Circumference
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