Obesity, low testosterone levels and erectile dysfunction

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Abstract

Obesity is an important risk factor for many common diseases including cardiovascular disease (CVD), type 2 diabetes, cancer and erectile dysfunction (ED). Adipose tissues produce a number of adipokines and cytokines, which affect endothelial and metabolic function resulting in insulin resistance and the metabolic syndrome (risks factors for CVD). Both ED and metabolic syndrome improve with a reduction in body mass index (BMI). The relationships among obesity, metabolic syndrome, ED, sex hormone-binding globulin (SHBG) and serum total and free testosterone levels are complex and often confusing to the physician. It is known that BMI is inversely proportional to serum total testosterone concentrations; low serum SHBG levels in obesity contribute to the low serum total testosterone. Recent studies show that BMI is also inversely proportional to free testosterone concentration. The characteristic low serum testosterone concentrations observed in obese men are also present in men with the metabolic syndrome and type 2 diabetes mellitus. A small proportion of men with ED have hypogonadism; however, the proportion increases if these men are obese with manifestations of the metabolic syndrome or type 2 diabetes mellitus. ED is a common symptom in patients with type 2 diabetes who also have low testosterone levels. This review describes the relationships between low serum testosterone concentrations and ED in obese patients and those with metabolic syndrome and type 2 diabetes mellitus.

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References

  1. 1

    Flegal KM, Carroll MD, Ogden CL, Johnson CL . Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723–1727.

  2. 2

    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM . Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006; 295: 1549–1555.

  3. 3

    Flegal KM, Graubard BI, Williamson DF, Gail MH . Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298: 2028–2037.

  4. 4

    Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL . Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes 1998; 22 (1OSA Epidemiology; Body Comp and Ageing): 39–47.

  5. 5

    Baker JL, Olsen LW, Sorensen TI . Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 2007; 357: 2329–2337.

  6. 6

    Bibbins-Domingo K, Coxson P, Pletcher MJ, Lightwood J, Goldman L . Adolescent overweight and future adult coronary heart disease. N Engl J Med 2007; 357: 2371–2379.

  7. 7

    Glass AR, Swerdloff RS, Bray GA, Dahms WT, Atkinson RL . Low serum testosterone and sex-hormone-binding-globulin in massively obese men. J Clin Endocrinol Metab 1977; 45: 1211–1219.

  8. 8

    Allen NE, Appleby PN, Davey GK, Key TJ . Lifestyle and nutritional determinants of bioavailable androgens and related hormones in British men. Cancer Causes Control 2002; 13: 353–363.

  9. 9

    Gapstur SM, Gann PH, Kopp P, Colangelo L, Longcope C, Liu K . Serum androgen concentrations in young men: a longitudinal analysis of associations with age, obesity, and race. The CARDIA male hormone study. Cancer Epidemiol Biomarkers Prev 2002; 11 (10 Part 1): 1041–1047.

  10. 10

    Jensen TK, Andersson AM, Jorgensen N, Andersen AG, Carlsen E, Petersen JH et al. Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men. Fertil Steril 2004; 82: 863–870.

  11. 11

    Svartberg J . Epidemiology: testosterone and the metabolic syndrome. Int J Impot Res 2007; 19: 124–128.

  12. 12

    Allan CA, Strauss BJ, McLachlan RI . Body composition, metabolic syndrome and testosterone in ageing men. Int J Impot Res 2007; 19: 448–457.

  13. 13

    Kapoor D, Aldred H, Clark S, Channer KS, Jones TH . Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care 2007; 30: 911–917.

  14. 14

    Sethi JK, Vidal-Puig AJ . Thematic review series: adipocyte biology. Adipose tissue function and plasticity orchestrate nutritional adaptation. J Lipid Res 2007; 48: 1253–1262.

  15. 15

    Shoelson SE, Lee J, Goldfine AB . Inflammation and insulin resistance. J Clin Invest 2006; 116: 1793–1801.

  16. 16

    Guzik TJ, Mangalat D, Korbut R . Adipocytokines—novel link between inflammation and vascular function? J Physiol Pharmacol 2006; 57: 505–528.

  17. 17

    Qureshi K, Abrams GA . Metabolic liver disease of obesity and role of adipose tissue in the pathogenesis of nonalcoholic fatty liver disease. World J Gastroenterol 2007; 13: 3540–3553.

  18. 18

    Batsis JA, Nieto-Martinez RE, Lopez-Jimenez F . Metabolic syndrome: from global epidemiology to individualized medicine. Clin Pharmacol Ther 2007; 82: 509–524.

  19. 19

    Pi-Sunyer X . The metabolic syndrome: how to approach differing definitions. Med Clin North Am 2007; 91: 1025–1040, vii.

  20. 20

    Wu X, Hoffstedt J, Deeb W, Singh R, Sedkova N, Zilbering A et al. Depot-specific variation in protein-tyrosine phosphatase activities in human omental and subcutaneous adipose tissue: a potential contribution to differential insulin sensitivity. J Clin Endocrinol Metab 2001; 86: 5973–5980.

  21. 21

    Wajchenberg BL . Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 2000; 21: 697–738.

  22. 22

    Guzik TJ, Mangalat D, Korbut R . Adipocytokines—novel link between inflammation and vascular function? J Physiol Pharmacol 2006; 57: 505–528.

  23. 23

    Sethi JK, Vidal-Puig AJ . Thematic review series: adipocyte biology. Adipose tissue function and plasticity orchestrate nutritional adaptation. J Lipid Res 2007; 48: 1253–1262.

  24. 24

    Oh DK, Ciaraldi T, Henry RR . Adiponectin in health and disease. Diabetes Obes Metab 2007; 9: 282–289.

  25. 25

    Lara-Castro C, Fu Y, Chung BH, Garvey WT . Adiponectin and the metabolic syndrome: mechanisms mediating risk for metabolic and cardiovascular disease. Curr Opin Lipidol 2007; 18: 263–270.

  26. 26

    Behre CJ . Adiponectin, obesity and atherosclerosis. Scand J Clin Lab Invest 2007; 67: 449–458.

  27. 27

    Kadowaki T, Yamauchi T . Adiponectin and adiponectin receptors. Endocr Rev 2005; 26: 439–451.

  28. 28

    Guzik TJ, Mangalat D, Korbut R . Adipocytokines—novel link between inflammation and vascular function? J Physiol Pharmacol 2006; 57: 505–528.

  29. 29

    Correia ML, Rahmouni K . Role of leptin in the cardiovascular and endocrine complications of metabolic syndrome. Diabetes Obes Metab 2006; 8: 603–610.

  30. 30

    Guzik TJ, Mangalat D, Korbut R . Adipocytokines—novel link between inflammation and vascular function? J Physiol Pharmacol 2006; 57: 505–528.

  31. 31

    Guzik TJ, Mangalat D, Korbut R . Adipocytokines—novel link between inflammation and vascular function? J Physiol Pharmacol 2006; 57: 505–528.

  32. 32

    Pittas AG, Joseph NA, Greenberg AS . Adipocytokines and insulin resistance. J Clin Endocrinol Metab 2004; 89: 447–452.

  33. 33

    Guzik TJ, Mangalat D, Korbut R . Adipocytokines—novel link between inflammation and vascular function? J Physiol Pharmacol 2006; 57: 505–528.

  34. 34

    Kalyani RR, Dobs AS . Androgen deficiency, diabetes, and the metabolic syndrome in men. Curr Opin Endocrinol Diabetes Obes 2007; 14: 226–234.

  35. 35

    Elin RJ, Winters SJ . Current controversies in testosterone testing: aging and obesity. Clin Lab Med 2004; 24: 119–139.

  36. 36

    Tchernof A, Despres JP . Sex steroid hormones, sex hormone-binding globulin, and obesity in men and women. Horm Metab Res 2000; 32: 526–536.

  37. 37

    Giagulli VA, Kaufman JM, Vermeulen A . Pathogenesis of the decreased androgen levels in obese men. J Clin Endocrinol Metab 1994; 79: 997–1000.

  38. 38

    Schneider G, Kirschner MA, Berkowitz R, Ertel NH . Increased estrogen production in obese men. J Clin Endocrinol Metab 1979; 48: 633–638.

  39. 39

    Castro-Fernandez C, Olivares A, Soderlund D, Lopez-Alvarenga JC, Zambrano E, Veldhuis JD et al. A preponderance of circulating basic isoforms is associated with decreased plasma half-life and biological to immunological ratio of gonadotropin-releasing hormone-releasable luteinizing hormone in obese men. J Clin Endocrinol Metab 2000; 85: 4603–4610.

  40. 40

    Isidori AM, Caprio M, Strollo F, Moretti C, Frajese G, Isidori A et al. Leptin and androgens in male obesity: evidence for leptin contribution to reduced androgen levels. J Clin Endocrinol Metab 1999; 84: 3673–3680.

  41. 41

    Tsai EC, Matsumoto AM, Fujimoto WY, Boyko EJ . Association of bioavailable, free, and total testosterone with insulin resistance: influence of sex hormone-binding globulin and body fat. Diabetes Care 2004; 27: 861–868.

  42. 42

    Nielsen TL, Hagen C, Wraae K, Brixen K, Petersen PH, Haug E et al. Visceral and subcutaneous adipose tissue assessed by magnetic resonance imaging in relation to circulating androgens, sex hormone-binding globulin, and luteinizing hormone in young men. J Clin Endocrinol Metab 2007; 92: 2696–2705.

  43. 43

    Chen RY, Wittert GA, Andrews GR . Relative androgen deficiency in relation to obesity and metabolic status in older men. Diabetes Obes Metab 2006; 8: 429–435.

  44. 44

    Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Salonen R et al. Sex hormones, inflammation and the metabolic syndrome: a population-based study. Eur J Endocrinol 2003; 149: 601–608.

  45. 45

    Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Valkonen VP et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care 2004; 27: 1036–1041.

  46. 46

    Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Valkonen VP et al. The metabolic syndrome and smoking in relation to hypogonadism in middle-aged men: a prospective cohort study. J Clin Endocrinol Metab 2005; 90: 712–719.

  47. 47

    Makhsida N, Shah J, Yan G, Fisch H, Shabsigh R . Hypogonadism and metabolic syndrome: implications for testosterone therapy. J Urol 2005; 174: 827–834.

  48. 48

    Pasquali R . Obesity, fat distribution and infertility. Maturitas 2006; 54: 363–371.

  49. 49

    Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Salonen R et al. Sex hormones, inflammation and the metabolic syndrome: a population-based study. Eur J Endocrinol 2003; 149: 601–608.

  50. 50

    Pitteloud N, Hardin M, Dwyer AA, Valassi E, Yialamas M, Elahi D et al. Increasing insulin resistance is associated with a decrease in Leydig cell testosterone secretion in men. J Clin Endocrinol Metab 2005; 90: 2636–2641.

  51. 51

    Pitteloud N, Mootha VK, Dwyer AA, Hardin M, Lee H, Eriksson KF et al. Relationship between testosterone levels, insulin sensitivity, and mitochondrial function in men. Diabetes Care 2005; 28: 1636–1642.

  52. 52

    Yialamas MA, Dwyer AA, Hanley E, Lee H, Pitteloud N, Hayes FJ . Acute sex steroid withdrawal reduces insulin sensitivity in healthy men with idiopathic hypogonadotropic hypogonadism. J Clin Endocrinol Metab 2007; 92: 4254–4259.

  53. 53

    Singh AB, Hsia S, Alaupovic P, Sinha-Hikim I, Woodhouse L, Buchanan TA et al. The effects of varying doses of T on insulin sensitivity, plasma lipids, apolipoproteins, and C-reactive protein in healthy young men. J Clin Endocrinol Metab 2002; 87: 136–143.

  54. 54

    Corona G, Mannucci E, Petrone L, Ricca V, Balercia G, Mansani R et al. Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res 2006; 18: 190–197.

  55. 55

    Corona G, Mannucci E, Petrone L, Balercia G, Paggi F, Fisher AD et al. NCEP-ATPIII-defined metabolic syndrome, type 2 diabetes mellitus, and prevalence of hypogonadism in male patients with sexual dysfunction. J Sex Med 2007; 4 (4 Part 1): 1038–1045.

  56. 56

    Corrales JJ, Burgo RM, Garca-Berrocal B, Almeida M, Alberca I, Gonzalez-Buitrago JM et al. Partial androgen deficiency in aging type 2 diabetic men and its relationship to glycemic control. Metabolism 2004; 53: 666–672.

  57. 57

    Dhindsa S, Prabhakar S, Sethi M, Bandyopadhyay A, Chaudhuri A, Dandona P . Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab 2004; 89: 5462–5468.

  58. 58

    Kapoor D, Aldred H, Clark S, Channer KS, Jones TH . Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care 2007; 30: 911–917.

  59. 59

    Tomar R, Dhindsa S, Chaudhuri A, Mohanty P, Garg R, Dandona P . Contrasting testosterone concentrations in type 1 and type 2 diabetes. Diabetes Care 2006; 29: 1120–1122.

  60. 60

    Esposito K, Giugliano F, Ciotola M, De SM, D'Armiento M, Giugliano D . Obesity and sexual dysfunction, male and female. Int J Impot Res 2008; 20: 358–365.

  61. 61

    Kupelian V, Shabsigh R, Araujo AB, O'donnell AB, McKinlay JB . Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study. J Urol 2006; 176: 222–226.

  62. 62

    Kostis JB, Jackson G, Rosen R, Barrett-Connor E, Billups K, Burnett AL et al. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol 2005; 96: 313–321.

  63. 63

    Fung MM, Bettencourt R, Barrett-Connor E . Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study. J Am Coll Cardiol 2004; 43: 1405–1411.

  64. 64

    Billups KL, Bank AJ, Padma-Nathan H, Katz S, Williams R . Erectile dysfunction is a marker for cardiovascular disease: results of the minority health institute expert advisory panel. J Sex Med 2005; 2: 40–50.

  65. 65

    Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB . Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol 2000; 163: 460–463.

  66. 66

    Guzik TJ, Mangalat D, Korbut R . Adipocytokines—novel link between inflammation and vascular function? J Physiol Pharmacol 2006; 57: 505–528.

  67. 67

    Pittas AG, Joseph NA, Greenberg AS . Adipocytokines and insulin resistance. J Clin Endocrinol Metab 2004; 89: 447–452.

  68. 68

    Lee KK, Berman N, Alexander GM, Hull L, Swerdloff RS, Wang C . A simple self-report diary for assessing psychosexual function in hypogonadal men. J Androl 2003; 24: 688–698.

  69. 69

    Steidle C, Schwartz S, Jacoby K, Sebree T, Smith T, Bachand R . AA2500 testosterone gel normalizes androgen levels in aging males with improvements in body composition and sexual function. J Clin Endocrinol Metab 2003; 88: 2673–2681.

  70. 70

    Wang C, Swedloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. Testosterone Gel Study Group. J Clin Endocrinol Metab 2000; 85: 2839–2853.

  71. 71

    Wang C, Cunningham G, Dobs A, Iranmanesh A, Matsumoto AM, Snyder PJ et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab 2004; 89: 2085–2098.

  72. 72

    Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

  73. 73

    Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 2000; 30: 328–338.

  74. 74

    Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, McKinlay JB . Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology 2000; 56: 302–306.

  75. 75

    Shabsigh R, Perelman MA, Lockhart DC, Lue TF, Broderick GA . Health issues of men: prevalence and correlates of erectile dysfunction. J Urol 2005; 174: 662–667.

  76. 76

    Chung WS, Sohn JH, Park YY . Is obesity an underlying factor in erectile dysfunction? Eur Urol 1999; 36: 68–70.

  77. 77

    Fung MM, Bettencourt R, Barrett-Connor E . Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study. J Am Coll Cardiol 2004; 43: 1405–1411.

  78. 78

    Riedner CE, Rhoden EL, Ribeiro EP, Fuchs SC . Central obesity is an independent predictor of erectile dysfunction in older men. J Urol 2006; 176 (4 Part 1): 1519–1523.

  79. 79

    Shiri R, Koskimaki J, Hakama M, Hakkinen J, Huhtala H, Tammela TL et al. Effect of life-style factors on incidence of erectile dysfunction. Int J Impot Res 2004; 16: 389–394.

  80. 80

    Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB . Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med 2003; 139: 161–168.

  81. 81

    Travison TG, Shabsigh R, Araujo AB, Kupelian V, O'donnell AB, McKinlay JB . The natural progression and remission of erectile dysfunction: results from the Massachusetts Male Aging Study. J Urol 2007; 177: 241–246.

  82. 82

    Esposito K, Giugliano F, Di PC, Giugliano G, Marfella R, D'Andrea F et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004; 291: 2978–2984.

  83. 83

    Kupelian V, Shabsigh R, Travison TG, Page ST, Araujo AB, McKinlay JB . Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study. J Urol 2006; 176 (6 Part 1): 2584–2588.

  84. 84

    Zohdy W, Kamal EE, Ibrahim Y . Androgen deficiency and abnormal penile duplex parameters in obese men with erectile dysfunction. J Sex Med 2007; 4: 797–808.

  85. 85

    Bansal TC, Guay AT, Jacobson J, Woods BO, Nesto RW . Incidence of metabolic syndrome and insulin resistance in a population with organic erectile dysfunction. J Sex Med 2005; 2: 96–103.

  86. 86

    Bal K, Oder M, Sahin AS, Karatas CT, Demir O, Can E et al. Prevalence of metabolic syndrome and its association with erectile dysfunction among urologic patients: metabolic backgrounds of erectile dysfunction. Urology 2007; 69: 356–360.

  87. 87

    Kupelian V, Shabsigh R, Araujo AB, O'donnell AB, McKinlay JB . Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study. J Urol 2006; 176: 222–226.

  88. 88

    Corona G, Mannucci E, Schulman C, Petrone L, Mansani R, Cilotti A et al. Psychobiologic correlates of the metabolic syndrome and associated sexual dysfunction. Eur Urol 2006; 50: 595–604.

  89. 89

    Corona G, Mannucci E, Petrone L, Schulman C, Balercia G, Fisher AD et al. A comparison of NCEP-ATPIII and IDF metabolic syndrome definitions with relation to metabolic syndrome-associated sexual dysfunction. J Sex Med 2007; 4: 789–796.

  90. 90

    Hijazi RA, Betancourt-Albrecht M, Cunningham GR . Gonadal and erectile dysfunction in diabetics. Med Clin North Am 2004; 88: 933–945, xi.

  91. 91

    Corona G, Mannucci E, Petrone L, Ricca V, Balercia G, Mansani R et al. Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res 2006; 18: 190–197.

  92. 92

    Zitzmann M, Faber S, Nieschlag E . Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab 2006; 91: 4335–4343.

  93. 93

    Mikhail N . Does testosterone have a role in erectile function? Am J Med 2006; 119: 373–382.

  94. 94

    Kapoor D, Aldred H, Clark S, Channer KS, Jones TH . Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care 2007; 30: 911–917.

  95. 95

    Katznelson L, Finkelstein JS, Schoenfeld DA, Rosenthal DI, Anderson EJ, Klibanski A . Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism. J Clin Endocrinol Metab 1996; 81: 4358–4365.

  96. 96

    Page ST, Amory JK, Bowman FD, Anawalt BD, Matsumoto AM, Bremner WJ et al. Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab 2005; 90: 1502–1510.

  97. 97

    Snyder PJ, Peachey H, Hannoush P, Berlin JA, Loh L, Lenrow DA et al. Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab 1999; 84: 2647–2653.

  98. 98

    Snyder PJ, Peachey H, Berlin JA, Hannoush P, Haddad G, Dlewati A et al. Effects of testosterone replacement in hypogonadal men. J Clin Endocrinol Metab 2000; 85: 2670–2677.

  99. 99

    Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. J Clin Endocrinol Metab 2000; 85: 2839–2853.

  100. 100

    Friedl KE, Jones RE, Hannan CJJ, Plymate SR . The administration of pharmacological doses of testosterone or 19- nortestosterone to normal men is not associated with increased insulin secretion or impaired glucose tolerance. J Clin Endocrinol Metab 1989; 68: 971–975.

  101. 101

    Basu R, Dalla MC, Campioni M, Basu A, Nair KS, Jensen MD et al. Effect of 2 years of testosterone replacement on insulin secretion, insulin action, glucose effectiveness, hepatic insulin clearance, and postprandial glucose turnover in elderly men. Diabetes Care 2007; 30: 1972–1978.

  102. 102

    Liu PY, Wishart SM, Celermajer DS, Jimenez M, Pierro ID, Conway AJ et al. Do reproductive hormones modify insulin sensitivity and metabolism in older men? A randomized, placebo-controlled clinical trial of recombinant human chorionic gonadotropin. Eur J Endocrinol 2003; 148: 55–66.

  103. 103

    Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91: 1995–2010.

  104. 104

    Marin P, Holmang S, Jonsson L, Sjostrom L, Kvist H, Holm G et al. The effects of testosterone treatment on body composition and metabolism in middle-aged obese men. Int J Obes Relat Metab Disord 1992; 16: 991–997.

  105. 105

    Kapoor D, Goodwin E, Channer KS, Jones TH . Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2006; 154: 899–906.

  106. 106

    Kapoor D, Clarke S, Stanworth R, Channer KS, Jones TH . The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2007; 156: 595–602.

  107. 107

    Marin P, Oden B, Bjorntorp P . Assimilation and mobilization of triglycerides in subcutaneous abdominal and femoral adipose tissue in vivo in men: effects of androgens. J Clin Endocrinol Metab 1995; 80: 239–243.

  108. 108

    Singh R, Artaza JN, Taylor WE, Gonzalez-Cadavid NF, Bhasin S . Androgens stimulate myogenic differentiation and inhibit adipogenesis in C3H 10T1/2 pluripotent cells through an androgen receptor-mediated pathway. Endocrinology 2003; 144: 5081–5088.

  109. 109

    Malkin CJ, Pugh PJ, Jones RD, Kapoor D, Channer KS, Jones TH . The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol Metab 2004; 89: 3313–3318.

  110. 110

    Kapoor D, Clarke S, Stanworth R, Channer KS, Jones TH . The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2007; 156: 595–602.

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Acknowledgements

This review was supported by Endocrinology and Metabolism Training Grant (T32 DK007571) and the General Clinical Research Center at Harbor UCLA (RR MO1 00425).

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Correspondence to C Wang.

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Keywords

  • body mass index
  • androgens
  • metabolic syndrome
  • type 2 diabetes mellitus
  • hypogonadism
  • sexual dysfunction

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