Testosterone and Diabetes

1. Testosterone and Diabetes Sara Dempsey Doctor of Pharmacy Candidate LECOM School of Pharmacy Part 2 of 3

2. Diabetes and Low Testosterone

3. Diabetes and Low Testosterone: Cause and effect • Type 2 diabetes can cause low testosterone • Men with type 2 diabetes have been seen to have low serum testosterone levels • Type 2 diabetes is often associated with obesity • Inverse relationship between body mass index (BMI) and concentration of testosterone • High BMI is associated with suppression of sex hormone binding globulin (SHBG) • Suppression of SHBG leads to lower testosterone levels Wang, C. "Low Testosterone AssociatedWith Obesity and theMetabolic Syndrome Contributes to Sexual Dysfunction and Cardiovascular Disease Risk inMen With Type 2 Diabetes." Diabetes Care. 34.July (2011): 1669-75. Print.

4. “Testosterone Concentrations in Diabetic and Nondiabetic Obese Men” • Study objective • Establish the prevalence of decreased serum testosterone levels in obese patients and patients with type 2 diabetes • Conclusion • Testosterone concentrations were seen to be lower in obese men versus nonobese men • Decreased free testosterone concentration seen in 40% of non diabetic obese men • Decreased free testosterone concentration seen in 50% diabetic obese men • Diabetic men regardless of weight had lower testosterone concentration compared to nondiabetic men • Increase in insulin resistance may be responsible for these results Dhindsa, S. "Testosterone Concentrations in Diabetic and Nondiabetic Obese Men." Diabetes Care. 33. (2010): 1186-92. Print.

5. Foods, drugs, and exercise: their effecton testosterone levels

6. Foods that may lower testosterone • Sugar (glucose) • Following an oral glucose tolerance test, testosterone levels decreased in 73 of the 74 men regardless of their diabetes status • Licorice • After consuming licorice for seven days serum testosterone levels were seen to decrease in men aged 22-24. • Alcohol • Use of alcohol has been associated with decrease in LH and testosterone levels • Soy? • Mixed results on whether soy decreases testosterone levels have been seen "Testosterone decreases after ingestion of sugar (glucose)." The Endocrine Society. N.p., 12 Jun 2009. Web. 20 Jan 2013. <http://www.endo-society.org/media/ENDO-09/Testosteronedecreasesafteringestionofsugar.cfm>. Emanuele, M. "Alcohol and the Male Reproductive System." National Institute on Alcohol Abuse and Alcoholism. National Institutes of Health. Web. 20 Jan 2013. <http://pubs.niaaa.nih.gov/publications/arh25-4/282-287.htm>. Armanini, D. "Reduction of Serum Testosterone in Men by Licorice." N Engl J Med. 341. (1999): 1158. Print. Goodin , S. "Clinical and biological activity of soy protein powder supplementation in healthy male volunteers.." Cancer Epidemiol Biomarkers Prev.. 16.4 (2007): 829-33. Print. Maskarinec, G. "Serum prostate-specific antigen but not testosterone levels decrease in a randomized soy intervention among men." European Journal of Clinical Nutrition. 60. (2006): 1423-29. Print.

7. Food additives effect on testosterone • Propylparaben • Used as a flavor additive in food • A study in rats where propylparaben was administered for 4 weeks resulted in lowered serum testosterone levels • Butylparaben • Used as a flavor additive in food • A study in rats where butylparaben was administered for 8 weeks resulted in lowered serum testosterone levels Oishi, S. "Effects of butylparaben on the male reproductive system in rats." Toxicol Ind Health . 17.31 (2001): n. page. Print. Oishi, S. "Effects of propyl paraben on the male reproductive system." Food and Chemical Toxicilogy. 40.12 (2002): 1807-13. Print.

8. Drugs that can lower testosterone • Drug classes • Opiates • Beta blockers • Antipsychotics • Anticonvulsants • Systemic Corticosteroids • Other specific drugs • Digoxin • Cimetidine • Flutamide Drug-induced male sexual dysfunction. Pharmacist's Letter/Prescriber's Letter 2006;22(9):220907.

9. Does exercise affect testosterone? • Studies have found that testosterone levels increase with exercise • “Acute hormonal responses to submaximal heavy resistance and explosive exercise in men and women” • Serum testosterone levels were seen to increase during resistance exercise • “Exercise increases serum testosterone and sex hormone binding globulin levels in older men” • Men aged 66-76 years old participated in moderately intensive exercise • Testosterone levels were seen to increase due to an increase in SHBG. Linnamo, V. "Acute hormonal responses to submaximal and maximal heavy resistance and explosive exercises in men and women.." J Strength Cond Res.. 19.3 (2005): 566-71. Abstract. Zmuda, J. "Exercise increases serum testosterone and sex hormone-binding globulin levels in older men.." Metabolism. 45.8 (1996): 935-9. Abstract.

10. Weight loss from exercise: effect on testosterone • Study showed that along with diet modifications, exercise has shown to increase testosterone levels • Patients exercised 150 minutes per week • Twelve month follow up showed prevalence of hypogonadal men was reduced from 20.4% to 11.1% • From baseline, an increase in testosterone levels up to 15% was seen • Men lost an average of 17 lbs • Correlation between increase in testosterone is likely related to weight loss induced by exercise and diet Melville, N. "Medscape Medical News." Low Testosterone Levels Can Improve With Weight Loss, Exercise. N.p., 26 Jun 2012. Web. 20 Jan 2013. <http://www.medscape.com/viewarticle/766459>.

11. Testosterones effect on exercise • Having low testosterone can affect exercise ability • Low testosterone has physical implications on the body including • Body fat increase • Decrease in muscle strength • Lower energy levels "Mayo Clinic." Testosterone therapy: Key to male vitality?. Mayo Foundation for Medical Education and Research, 10 Apr 2012. Web. 20 Jan 2013. <http://www.mayoclinic.com/health/testosterone-therapy/MC00030>.