Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes
Open accessAbstract
Men with obesity, the metabolic syndrome, and type 2 diabetes have low total and free testosterone and low sex hormone–binding globulin (SHBG). Conversely, the presence of low testosterone and/or SHBG predicts the development of metabolic syndrome and type 2 diabetes. Visceral adiposity present in men with low testosterone, the metabolic syndrome, and/or type 2 diabetes acts through proinflammatory factors. These inflammatory markers contribute to vascular endothelial dysfunction with adverse sequelae such as increased cardiovascular disease (CVD) risk and erectile dysfunction. This review focuses on the multidirectional impact of low testosterone associated with obesity and the metabolic syndrome and its effects on erectile dysfunction and CVD risk in men with type 2 diabetes. Whenever possible in this review, we will cite recent reports (after 2005) and meta-analyses. ### Epidemiological studies of low testosterone, obesity, metabolic status, and erectile dysfunction Epidemiological studies support a bidirectional relationship between serum testosterone and obesity as well as between testosterone and the metabolic syndrome. Low serum total testosterone predicts the development of central obesity and accumulation of intra-abdominal fat (1–3). Also, low total and free testosterone and SHBG levels are associated with an increased risk of developing the metabolic syndrome, independent of age and obesity (1–3). Lowering serum T levels in older men with prostate cancer treated with androgen deprivation therapy increases body fat mass (4). Conversely, high BMI, central adiposity, and the metabolic syndrome are associated with and predict low serum total and to a lesser extent free testosterone and SHBG levels (1–3,5). Because obesity suppresses SHBG and as a result total testosterone concentrations, alterations in SHBG confound the relationship between testosterone and obesity. Low total testosterone or SHBG levels are associated with type 2 diabetes, independent of age, race, obesity, and criteria for diagnosis of diabetes (6,7). In longitudinal studies, low serum total and free testosterone …
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Testosterone has a role in sexual function, muscle and bone mass, and mood.
“given the role of testosterone in a number of physical and psychological conditions such as sexual function [74], muscle and bone mass [75], and mood [76].”
From Impact of Five Nights of Sleep Restriction on Glucose Metabolism, Leptin and Testosterone in Young Adult Men (2012) · cites this paper as [74]
Few randomized, double-blind placebo controlled trials and a meta-analysis of RCT studies have not confirmed that TRT reduces body weight in obese men.
“few randomized, double-blind placebo controlled trials and a meta-analysis of RCT studies (38) have not confirmed those encouraging results (15, 39, 40).”
From Effects of liraglutide on obesity-associated functional hypogonadism in men (2019) · cites this paper as [39]
Obesity and diabetes are associated with low SHBG, which may lower total testosterone levels.
“Both obesity and diabetes are associated with low SHBG, which may lower total testosterone levels.18,36”
From Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study (2017) · cites this paper as [18]
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References 62 · Cited by 366
- Authors
- Wang, C., Jackson, G., Jones, T. H., Matsumoto, A. M., Nehra, A., Perelman, M. A., Swerdloff, R. S., Traish, A., Zitzmann, M., & Cunningham, G.
- Affiliations
- University of California, Los Angeles (US)
- London Bridge Hospital (GB)
- Barnsley Hospital (GB)
- University of Washington (US)
- Mayo Clinic (US)
- Weill Cornell Medicine (US)
- Boston University (US)
- University Hospital Münster (DE)
- Baylor College of Medicine (US)
- Corresponding author
- Wang, Christina
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2011-06-17
- Volume
- 34
- Issue
- 7
- Pages
- 1669-1675
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3120209
- OpenAlex
- W2000266060
- Cited by
- 366
- References
- 62
- Citations by year
- 2026: 9 · 2025: 20 · 2024: 25 · 2023: 19 · 2022: 22 · 2021: 23 · 2020: 25 · 2019: 21 · 2018: 37 · 2017: 32 · 2016: 30 · 2015: 35 · 2014: 29 · 2013: 18 · 2012: 16
- FWCI
- 2.99
- 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)
- Funders
- Eli Lilly and Company
- GlaxoSmithKline
- 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, obesity, metabolic syndrome, type 2 diabetes, erectile dysfunction, cardiovascular risk, sex hormone-binding globulin, visceral fat, inflammation, endothelial dysfunction, abdominal obesity, androgen deprivation therapy
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Erectile Dysfunction, Male, Obesity, Risk, Sexual Dysfunction, Physiological, Sex Hormone-Binding Globulin, Testosterone, Metabolic Syndrome
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