‘Exciting finding’ indicates T2D benefits
from long-term testosterone therapy
LAGUNA NIGUEL, CALIF. – Long-term testosterone therapy (Tth) completely prevents pre-diabetes progression to type 2 diabetes (T2D) among men with hypogonadism, according to a recent study that also indicates that it improves glycemia, lipids, and Aging Males’ Symptoms (AMS) scale scores.
The research published in March in Diabetes Care is deemed “an exciting finding” by
Ji Hyun Chun, PA-C, BC-ADM, president of the American Society of Endocrine Physician Assistants (ASEPA).
Chun---who is affiliated with OptumCare Medical Group, Laguna Niguel, Calif., and is a faculty member of Metabolic & Disease Summit (MEDS)---notes that the observational study concludes that Tth offers potential for men with pre-diabetes and hypogonadism, and looks for validations from future research.
“I would love to see the study replicated in other studies and settings to draw conclusions which can further guide us on this topic matter,” he says. “We would especially need a well-designed randomized-controlled trial so we have a better matched placebo group.”
As the study, which involved 316 men with pre-diabetes and symptoms of hypogonadism, notes that pre-diabetes represents a window of opportunity for intervention to prevent T2D, Chun suggests that this “window” can best be utilized through careful screening for potential hypogonadism, and appropriate work-ups.
“Keep in mind,” he urges, “that ‘active’ testosterone (free and/or bio-available testosterone) levels need to be checked in this setting. Many patients with dysglycemia are overweight or obese, which lowers sex-hormone binding globulin (SHBG), and thereby have lower total testosterone, but might have normal ‘active’ testosterone levels.”
Chun adds that “another important point mentioned in the study is the presence of symptoms of hypogonadism in treatment decision-making.”
“If patients with pre-diabetes have true hypogonadism (biochemical and symptomatic), and other reversible causes are ruled out,” he says, “Tth may improve their metabolic health and help them from progressing to overt diabetes.”
While Chun calls this research and its conclusion “an exciting finding from an observational study,” he also urges caution.
“As in any study results,” Chun says, “one should carefully review the study setting (in this case, an observational study that was non-blinded, non-randomized, not propensity matched, and funded by industry) and acknowledge its strength (i.e., real-world data) and weakness before drawing a conclusion.”
One aspect of the study is its mention of the importance of weight loss, as pre-diabetics are urged to aim at 10% weight loss, with Tth yielding nearly that (9%).
“As we have seen the overlap of obesity and diabetes,” Chun says, “we know that weight management is the cornerstone in managing metabolic syndrome regardless of its stage (euglycemia, prediabetes, diabetes). It is very intriguing to see this significant improvement in weight, and more importantly, its sustainability in this particular registry. I am curious on what is different in this population other than the Tth that led to this significant weight benefit.”
“We all know,” he adds, “that just going on testosterone would not drop someone's weight. We have to give adequate guidance on the needed lifestyle intervention to achieve that. It is plausible to think that Tth would make patients with symptomatic hypogonadism feel better, and have more energy to increase their physical-activity levels, and would be more likely to keep and build lean muscles with exercise and thereby improve their metabolic health.”
Chun also asserts that “discussing this needed lifestyle intervention and setting the right expectation by nurse practitioners (NPs) and physician assistants (PAs) is very important.”
He concludes, too, that, in wake of this study, “there certainly will be an increase in interest and requests from patients in both checking testosterone and using testosterone. Unlike other chronic disease states (i.e., diabetes, hypertension, dyslipidemia, osteoporosis) where patients’ perceived risks outweigh benefits, it is exactly the opposite in hypogonadism---patients are more willing to get on treatment. It is left to us to carefully listen to our patients’ symptoms, concerns, and expectations and guide them to what's best for their overall health.”
CITATION: Aksam Yassin, Ahmad Haider, et. al. Testosterone Therapy in Men With Hypogonadism Prevents Progression From Prediabetes to Type 2 Diabetes: Eight-Year Data From a Registry Study. Diabetes Care. Published online March 18, 2019. http://care.diabetesjournals.org/content/early/2019/03/12/dc18-2388