The Prevalence of Male Hypotestosteronism in Type

2 Diabetics in a Southwest Virginia Population

Dr. Eric HofmeisterDr. Christopher Bishop

Background

Several studies have demonstrated a high prevalence of hypotestosteronism in males with T2DM.

The Hypotestosteronism in Males (HIM) study reported the prevalence of hypogonadism in males with T2DM to be 50%

The HIM Study

2162 eligible men > 45 years visiting primary care practices in the United States

Serum testosterone assessment by a single morning blood draw

Hypogonadism defined as total testosterone level < 300 ng/dL with one or more symptoms

Prevalence of hypogonadism in males with T2DM was 50%

Hypothesis

The prevalence of male hypotestosteronism within our local Southwest Virginia population is greater than 50%

Objective

Determine the Prevalence of hypotestosteronism in males with type II diabetes mellitus (T2DM) within a local population in Southwest Virginia.

Design

Non-randomized retrospective analysis 13 months Data Analysis of all type 2 diabetic males

that had received a total testosterone assessment

Methods

Solstas Lab Database All patients that had received a total

testosterone level assessment over a 13 month period

Utilized a T2DM inclusion / exclusion criteria to determine sample population

Methods

T2DM males assessed for the presence of hypotestosteronism by chart review (Allscripts Database) of a documented total serum testosterone level of less than 300 ng/dL

Excluded if no documentation of prior serum total testosteronism < 300 ng/dL

Determined percentage of T2DM males with a total testosterone level < 300 ng/dL

Inclusion / Exclusion Criteria

Male of any age Type II Diabetes A1C > 6.5 or fasting

blood glucose > 126 mg/dL Exclude No documented A1C or fasting

blood glucose level documentation, Hx of Type I Diabetes, chronic steroid use, or Hx of hypopituitarism

Sample Analysis

127 excluded (no gluc/A1c)

38 excluded (DM1, steroids..)

Results

41/59 (69.5%) have low T with T2DM

18/59 (31.5%) have normal T with T2DM

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Demographics

144Mean serum glucose

7.9Mean A1c

207Mean testosterone

33.6Mean BMI

54.5Mean patient age

Concomitant Conditions

37 % (15/41)Tobacco smoking

37 % (15/41)CVD/CAD/MI

41 % (17/41)Insulin therapy

73 % (30/41)Oral hypoglycemics

32 % (13/41)Hypothyroidism

39 % (16/41)Opioid use

Discussion

Prevalence of T2DM in US high (26 million) and increasing– Increasing incidence of hypotestosteronism ?

No current recommendations regarding screening for low testosterone in males

Low testosterone associated with insulin resistance and T2DM independent of age, race, BMI

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Discussion

Testosterone supplementation therapy shown in multiple studies to improve: – insulin resistance/utilization– Hemoglobin A1c– serum glucose– DBP– Total, HDL, & LDL cholesterol– increase lean body mass, decrease fat mass,

waist circumference4

Low Testosterone & Cardiovascular Disease

Multiple, conflicting studies… the good: Several studies show an inverse relationship

between cardiovascular disease and testosterone level– T2DM patients with high-normal testosterone have

lower risk (25%) of acute MI vs lowest 25%

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Low Testosterone & Cardiovascular Disease

Multiple, conflicting studies… the bad: Some studies report an increased risk of non-

fatal MI in middle-age and elderly patients with pre-existing heart disease given testosterone replacement– National Institute for Aging study– Veterans’ studies (JAMA, NEJM): 26% vs 20%

risk of veterans for MI, stroke, and/or death

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Testosterone Therapy Risks

Increased PSA.. worsening BPH Hematopoiesis hyperviscocity Gynecomastia Worsening male breast CA ? OSA/insomnia Decreased spermatogenesis Increased or decreased heart disease?

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Testosterone Therapy and Prostate Cancer

No evidence between exogenous testosterone and increase incidence or progression of prostate CA

Current evidence based largely on Huggins & Hodges study (1941). Several studies since 1941 have refuted that evidence… however ???

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Final Discussion

Higher prevalence of hypotestosteronism in SWVA T2DM patients vs. nationally?

Should we screen? Should we recommend therapy?

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