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Endocrine Care: Mathis Grossmann, Merlin C. Thomas, Sianna Panagiotopoulos, Ken Sharpe, Richard J. MacIsaac, Sophie Clarke, Jeffrey D. Zajac, and George Jerums Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes J Clin Endocrinol Metab 2008; 93: 1834-1840 [Abstract] [Full text] [PDF]

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Low testosterone levels in men with type 1 diabetes

Mathis Grossmann, Merlin C. Thomas, Sianna Panagiotopoulos, Ken Sharpe, Richard J. MacIsaac, Sophie Clarke, Jeffrey D. Zajac, and George Jerums   (27 May 2008)

Relation of BMI with testosterone in type 1 and type 2 diabetes

Paresh Dandona, Sandeep Dhindsa, Shehzad Topiwala, Ajay Chaudhuri   (30 April 2008)

Low testosterone levels in men with type 1 diabetes 27 May 2008
Mathis Grossmann , Merlin C. Thomas, Sianna Panagiotopoulos, Ken Sharpe, Richard J. MacIsaac, Sophie Clarke, Jeffrey D. Zajac, and George Jerums Send letter to journal: Re: Low testosterone levels in men with type 1 diabetes mathisg{at}unimelb.edu.au Mathis Grossmann, et al.	We thank Professor Dandona for his interest in our paper (1) and congratulate him and his group for their pioneering work in this field (2, 3). Our observation that low testosterone levels are common in men with type 2 diabetes is consistent with their previous observations (3). We also show that testosterone levels are inversely associated with insulin resistance in both cross-sectional and longitudinal observations in such men (1). In our group with men with type 1 diabetes (T1D) we find, a higher incidence of low calculated free testosterone levels (20%) compared to Tomar’s findings of 6% (2). We agree that these results may be partially related to the fact that our group of men with type 1 diabetes had a higher mean BMI (27 vs 26.1 kg/m2 in Tomar’s study). However, although BMI correlated negatively with total testosterone in our men with T1D (r = -0.321, P = 0.008), there was no correlation (P = 0.2) between BMI and calculated free testosterone. Twenty-eight percent of our T1D population was lean (BMI < 25), 46% overweight (BMI 25-30) and 26% obese (BMI > 30). Moreover a similar proportion of lean, overweight and obese men with T1D had low cFT levels (21%, 19%, and 22%, respectively). Further, we show that low free testosterone levels are independently associated with insulin resistance in men with T1D, similar to men with type 2 diabetes (1). Ultimately, whether testosterone replacement therapy is useful in such men will need to be tested in prospective trials. The interesting hypothesis raised by Danona et al.--whether men with T1D have to be comparatively more obese to have low testosterone levels--deserves further study. References 1. Grossmann M, Thomas MC, Panagiotopoulos S, Sharpe K, Macisaac RJ, Clarke S, Zajac JD, Jerums G 2008 Low testosterone levels are common and associated with insulin resistance in men with diabetes. J Clin Endocrinol Metab 93:1834-1840 2. Tomar R, Dhindsa S, Chaudhuri A, Mohanty P, Garg R, Dandona P 2006 Contrasting testosterone concentrations in type 1 and type 2 diabetes. Diabetes Care 29:1120-1122 3. Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P 2004 Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab 89:5462-5468
Relation of BMI with testosterone in type 1 and type 2 diabetes 30 April 2008
Paresh Dandona, Distinguished Professor SUNY at Buffalo, Sandeep Dhindsa, Shehzad Topiwala, Ajay Chaudhuri Send letter to journal: Re: Relation of BMI with testosterone in type 1 and type 2 diabetes pdandona{at}kaleidahealth.org Paresh Dandona, et al.	We read with great interest the article by Grossmann et al. (1) in which they compare testosterone concentrations of type 1 and type 2 diabetic men and report that 20% of type 1 diabetic and 57% of type 2 diabetic men had low calculated free testosterone concentrations. In fact, the prevalence of low testosterone between the two diabetic patient populations appears to be significantly different (P < 0.001) by the chi-square test. After adjusting for age and BMI, however, they found that the prevalences of low testosterone concentrations in type 1 and type 2 diabetic men were similar. The authors, therefore, conclude that testosterone deficiency is common in men with diabetes, regardless of the type. We want to point out, however, that in a clinical setting, low testosterone would probably not be found equally prevalent since type 1 diabetic men are generally younger and leaner. The mean BMI of type 1 diabetic patients in Grossmann’s study was 27 kg/m2, making it likely that a few of the patients were obese, which could have contributed to the relatively high frequency of hypogonadism (20%) in type 1 diabetic men. The authors also mention that our previous study (2) found that age matched type 1 and type 2 diabetic men had lower prevalences of low testosterone, 6% and 26%, respectively; but we believe that Grossmann’s findings are actually in agreement with ours. In both type 1 and type 2 diabetes, we found that free testosterone concentrations were related negatively with BMI. However, we have also previously published (3) that even lean type 2 diabetic men also have a high prevalence of hypogonadism, 31%. Thus factors other than BMI play a role in the development of hypogonadism in type 2 diabetic men. Consequently, we believe that type 1 diabetic men have to be comparatively more obese to be hypogonadal. References 1. Grossman M, Thomas M, Panagiotopoulos et al; Low Testosterone Levels are Common and Associated with Insulin Resistance in Men with Diabetes. J Clin Endocrinol Metab. 2008 Mar 4; [Epub ahead of print] 2. Tomar R, Dhindsa S, Chaudhuri A, Mohanty P, Garg R, Dandona P 2006 Contrasting testosterone concentrations in type 1 and type 2 diabetes. Diabetes Care 29:1120-1122 3. Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P 2002 Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab 89:5462-5468