Remission of type 2 diabetes in 8 hypogonadal men on long-term testosterone treatment: results from a registry study 
 

KS Haider, A Haider, F Saad



Background: Correcting hypogonadism in men with type 2 diabetes mellitus (T2DM) can be beneficial. 

Aim: To study long-term effectiveness and safety of testosterone undecanoate injections (TU).

Method: 
Registry of hypogonadal men with testosterone ≤12.1 nmol/L since 2004 in a urological setting. 286/776 patients (36.9%) had type 2 diabetes which had been diagnosed and is treated elsewhere (diabetologist).
133 men received TU 1000 mg/12 weeks (T-group) following an initial 6-week interval. Of these, 8 patients stopped their diabetes medication upon decision by the diabetologist. Their HbA1c consistently remained below 6.5%. Patient’s individual data are reported. 

Results:
#1(9): T2DM since 2000, received metformin since 2001, was referred to the urologist with hypogonadism and started TU in 2006 at age 59. Baseline HbA1c 6.8%, baseline HOMA-IR 8.4. From 27 months on TU onward, HbA1c <6.5%. Metformin discontinued after 7 years on TU. BMI reduced under testosterone from 31.3 to 25.5 kg/m2, waist circumference from 96 to 86 cm, weight loss: 18.4%. Last observation after 120 months on TU.

#2(10): Patient with previous myocardial infarction; T2DM since 2002, received metformin since 2004, was referred by cardiologist because of sexual and urinary problems. Diagnosed with hypogonadism, started TU in 2006 at age 57. Baseline HbA1c 7.2%, baseline HOMA-IR 8.5. From 21 months on TU onward, HbA1c <6.5%. Metformin discontinued after 3 years on TU. BMI reduced under testosterone from 28.4 to 25.3 kg/m2, waist circumference from 102 to 94 cm, weight loss: 11%. Last observation after 120 months on TU.

#3(75): T2DM since 2004, metformin since 2004, was referred by family physician because of sexual problems. Started TU in 2007 at age 60. Baseline HbA1c 7.9%, baseline HOMA-IR 2.6. From 45 months on TU onward, HbA1c <6.5%. Metformin discontinued after 2 years on TU. BMI reduced under testosterone from 38.5 to 31.7 kg/m2, waist circumference from 120 to 107 cm, weight loss: 17.5%. Last observation after 120 months on TU.
#4(76): T2DM since 2006, insulin since 2006, was referred by gastroenterologist with hypogonadism. Started TU in 2007 at age 56. Baseline HbA1c 7.1%, baseline HOMA-IR 2.9. From 57 months on TU onward, HbA1c <6.5%. Insulin discontinued after 3 years on TU. BMI reduced under testosterone from 25.4 to 24 kg/m2, waist circumference stable at 92 cm, weight loss: 5.3%. Last observation after 120 months on TU.
 
#5(139): T2DM since 2003, metformin since 2003, insulin since 2005. Referred by family physician because of prostatitis and sexual problems. Gained 5 kg under insulin. Started TU in 2007 at age 63. Baseline HbA1c 9.4%, baseline HOMA-IR 11.7. From 87 months on TU onward, HbA1c <6.5%. Insulin discontinued after 7, metformin after 10 years on TU. BMI reduced under testosterone from 37.1 to 29.3 kg/m2, waist circumference from 110 to 98 cm, weight loss: 21%. Last observation after 117 months on TU.

#6(163): T2DM since 2000, metformin since 2000, insulin since 2006. Referred by family physician because of prostatitis and loss of libido. Gained 7 kg under insulin. Started TU in 2008 at age 68. Baseline HbA1c 9.6%, baseline HOMA-IR 12. From 87 months on TU onward, HbA1c <6.5%. Metformin discontinued after 5, insulin after 9 years on TU. BMI reduced under testosterone from 35.7 to 27.2 kg/m2, waist circumference from 110 to 98 cm, weight loss: 23.9%. Last observation after 180 months on TU.

#7(228): T2DM since 2006, metformin since 2006, insulin since 2007. Referred by family physician because of prostatitis and sexual problems. Gained 11 kg under insulin. Started TU in 2010 at age 52. Baseline HbA1c 8.9%, baseline HOMA-IR 9.4. From 63 months on TU onward, HbA1c <6.5%. Metformin discontinued after 5, insulin after 7 years on TU. BMI reduced under testosterone from 39.6 to 32.2 kg/m2, waist circumference from 113 to 103 cm, weight loss: 18.5%. Last observation after 85 months on TU.

#8 (242): Patient with CAD. T2DM since 2004, metformin since 2004. Referred by cardiologist because of erectile dysfunction. Started TU in 2010 at age 58. Baseline HbA1c 7.2%, baseline HOMA-IR 2.8. From 45 months on TU onward, HbA1c <6.5%. Metformin discontinued after 3 years on TU. BMI reduced under testosterone from 35.2 to 29.1 kg/m2, waist circumference from 107 to 96 cm, weight loss: 17.4%. Last observation after 75 months on TU.

Discussion: 

This is the first report suggesting that long-term testosterone treatment in hypogonadal men may result in remission of T2DM.