World J Mens Health.  2020 Jan;38(1):68-77. 10.5534/wjmh.180052M.

Long-Term Testosterone Therapy in Type 2 Diabetes Is Associated with Decreasing Waist Circumference and Improving Erectile Function

• Hackett G
• Cole N
• Mulay A
• Strange RC
• Ramachandran S

• KMID: 2465411
• DOI: http://doi.org/10.5534/wjmh.180052M

Abstract

PURPOSE
To describe the 4-year metabolic follow-up results from the BLAST study.
MATERIALS AND METHODS
Baseline hemoglobin A1c (HbA1c), weight, and waist circumference (WC) data were recorded in 185 men recruited for the BLAST randomised controlled trial (RCT) and erectile function (EF) scores were also available in an additional 48 men screened for the RCT. Intra/inter-group associations between these parameters and testosterone replacement therapy (TRT) were assessed at 1) end of the RCT (30 weeks), 2) open-label phase (82 weeks), and 3) final assessment via non-parametric statistics.
RESULTS
Improvement in HbA1c and weight at the end of the RCT and open-label phase in men on TRT was not maintained long-term. The convergence in HbA1c could have been due to incentivised care with HbA1c targets. Interestingly those on TRT at final assessment required fewer anti-diabetic agents. The weight increase in routine care may have been due to changes in diabetes medication or an increase in lean muscle mass. WC continued to decrease in men on TRT indicating possible reduction in visceral fat. Improvement in EF scores continued with long-term TRT, this was abolished when TRT was discontinued.
CONCLUSIONS
This study hints at benefits in glycaemic control, weight and WC, and long-term RCTs studying mechanisms of benefit and clinical outcomes are necessary. Our results also show that EF scores continued to improve with long-term TRT, even beyond the 6 months that we previously reported in the BLAST RCT.

Keyword

Diabetes mellitus, type 2; Erectile dysfunction; Hypogonadism; Testosterone

MeSH Terms

Diabetes Mellitus, Type 2
Erectile Dysfunction
Follow-Up Studies
Humans
Hypogonadism
Intra-Abdominal Fat
Male
Testosterone*
Waist Circumference*
Testosterone

Figure

• 

  Fig. 1 Patient recruitment for the BLAST randomised controlled trial (RCT). Of the 857 men screened 199 men took part in the BLAST RCT evaluating changes in metabolic parameters and sexual function scores after 30 weeks of testosterone replacement therapy compared with placebo. IIEF: international index of erectile function, TT: total testosterone, SHBG: sex hormone-binding globulin, HbA1c: hemoglobin A1c, PSA: prostate specific antigen, T2DM: type 2 diabetes, FT: free testosterone, TU: testosterone undecanoate, P: placebo, T: testosterone.

• 

  Fig. 2 Changes in hemoglobin A1c (HbA1c) (low testosterone [low T]/treated and low T/untreated men) during the 30-week BLAST randomised controlled trial, open-label (30–82 weeks), and normal care (post 82 weeks) phases. The low T/treated group were further stratified into low T/treated/stopped and low T/treated/continuous groups depending on whether testosterone replacement therapy was continued or not. The number of drugs prescribed to control diabetes in each group is also shown. SE: standard error.

• 

  Fig. 3 Change in weight (low testosterone [low T]/treated and low T/untreated men) during the 30-week BLAST randomised controlled trial, open-label (30–82 weeks), and normal care (post 82 weeks) phases. The low T/treated group were further stratified into low T/treated/stopped and low T/treated/continuous groups depending on whether testosterone replacement therapy was continued or not. SE: standard error.

• 

  Fig. 4 Change in waist circumference (WC) (low testosterone [low T]/treated and low T/untreated men) during the 30-week BLAST randomised controlled trial, open-label (30–82 weeks), and normal care (post 82 weeks) phases. The low T/treated group were further stratified into low T/treated/stopped and low T/treated/continuous groups depending on whether testosterone replacement therapy was continued or not. SE: standard error.

• 

  Fig. 5 Changes in international index of erectile function (IIEF) erectile function (EF) (low testosterone [low T]/treated and low T/untreated men) during the 30 week BLAST randomised controlled trial (RCT), open-label (30–82 weeks), and normal care (post 82 weeks) phases in men recruited to the BLAST RCT and those screened with baseline IIEF EF scores. The low T/treated group were further stratified into low T/treated/stopped and low T/treated/continuous groups. SE: standard error.

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