Statin Therapy Is Associated With Lower Total but Not Bioavailable or Free Testosterone in Men With Type 2 Diabetes
Open accessAbstract
OBJECTIVE: There is a high prevalence of hypogonadism in men with type 2 diabetes. This will lead to an increase in assessments of hypogonadism. Statins could potentially decrease testosterone levels by reducing the availability of cholesterol for androgen synthesis. We compared testosterone levels and hypogonadal symptoms with statin use in a cross-sectional study of 355 men with type 2 diabetes. RESEARCH DESIGN AND METHODS: Total testosterone, sex hormone–binding globulin (SHBG), and estradiol were measured by an enzyme-linked immunosorbent assay. Bioavailable testosterone was measured by the modified ammonium sulfate precipitation method. Free testosterone was calculated using Vermeulen's formula. Symptoms of hypogonadism were assessed using the Androgen Deficiency in the Aging Male questionnaire. RESULTS: Statins were associated with lower total testosterone (11.9 vs. 13.4 nmol/l, P = 0.006) and a trend toward lower SHBG (29.4 vs. 35.3 nmol/l, P = 0.034) compared with no treatment. Bioavailable testosterone, free testosterone, estradiol, and hypogonadal symptoms were not affected. Subanalysis showed that atorvastatin was associated with reduced total testosterone (11.4 vs. 13.4 nmol/l, P = 0.006) and a trend toward reduced SHBG (27.6 vs. 35.3 nmol/l, P = 0.022) compared with no treatment, and there was an apparent dose-response effect with the lowest levels of total testosterone seen in men treated with ≥20 mg atorvastatin (9.6 nmol/l, P = 0.017). Simvastatin use was not associated with significant reductions in testosterone or SHBG levels. CONCLUSIONS: Assessing androgen status using total testosterone in men with type 2 diabetes treated with statins, particularly atorvastatin, may potentially lead to diagnostic error. Levels of bioavailable testosterone or free testosterone are recommended for the assessment of hypogonadism in this group if total testosterone levels are borderline.
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Administration of statins is associated with a decrease in SHBG.
“Administration of statins is associated with a decrease in SHBG [110, 111].”
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 [111]
The Results report a trend toward lower SHBG in statin-treated men with type 2 diabetes, but say it did not reach statistical significance. The Conclusions specify that the trend was seen with atorvastatin, while simvastatin was not significantly associated with lower SHBG; the observational study also cannot establish that administering statins caused a decrease. (LLM, conf=0.87)
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Narinx, N., David, K., Walravens, J., Vermeersch, P., Claessens, F., Fiers, T., Lapauw, B., Antonio, L., & Vanderschueren, D. (2022) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-022-04562-1 · Cited by 96 · see citing works
- Authors
- Stanworth, R. D., Kapoor, D., Channer, K. S., & Jones, T. H.
- Affiliations
- Barnsley Hospital NHS Foundation Trust (GB)
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- Corresponding author
- Jones, T. Hugh
- ORCID
- Jones, T. Hugh
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2008-12-29
- Volume
- 32
- Issue
- 4
- Pages
- 541-546
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2660443
- OpenAlex
- W2043457648
- Cited by
- 88
- References
- 3
- Citations by year
- 2024: 6 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 2 · 2019: 7 · 2018: 3 · 2017: 6 · 2016: 3 · 2015: 6 · 2014: 3 · 2013: 6 · 2012: 9
- FWCI
- 5.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- statins, testosterone, type 2 diabetes, male hypogonadism, atorvastatin, simvastatin, sex hormone-binding globulin, bioavailable testosterone, free testosterone, estradiol, androgen deficiency, diagnostic errors, cholesterol
- MeSH terms
- Atorvastatin, Adult, Aged, Biological Availability, Diabetes Mellitus, Type 2, Estradiol, Heptanoic Acids, Humans, Male, Middle Aged, Pyrroles, Sex Hormone-Binding Globulin, Testosterone, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Simvastatin
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