The Prevalence of Male
Hypotestosteronism in Type 2
Diabetics in a Southwest Virginia
Population
Dr. Eric Hofmeister
Dr. 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
224 male patients with ≥ 1 serum testosterone
127 excluded (no gluc/A1c)
97 patients with measured testosterone +
documented A1c or glucose > 125
38 excluded (DM1, steroids..)
59 patients with measured testosterone + T2DM
Results
 41/59 (69.5%) have low T with
T2DM
 18/59 (31.5%) have normal T with
T2DM
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Demographics
Mean patient age
54.5
Mean BMI
33.6
Mean testosterone
207
Mean A1c
7.9
Mean serum glucose
144
Concomitant Conditions
Opioid use
39 %
(16/41)
Hypothyroidism
32 %
(13/41)
Oral hypoglycemics
73 %
(30/41)
Insulin therapy
41 %
(17/41)
CVD/CAD/MI
37 %
(15/41)
Tobacco smoking
37 %
(15/41)
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
4
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 circumference
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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%
4
Low Testosterone &
Cardiovascular Disease
 Multiple, conflicting studies… the bad:
 Some studies report an increased risk of nonfatal 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
4
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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