Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Effect of testosterone replacement therapy on sexual function and glycemic control among hypogonadal men with type 2 diabetes mellitus


We investigated the effect of testosterone replacement therapy (TRT) on glycemic control and sexual function among hypogonadal men with type 2 diabetes mellitus (T2DM). From the EARTH study, 86 patients (47 in the TRT and 39 in the non-TRT groups) with a diagnosis of T2DM were extracted. We collected data on waist circumference, body mass index, body fat volume, free testosterone, hemoglobin (Hb), fasting blood sugar, and hemoglobin A1c (HbA1c) at baseline and after 12 months. Aging Male Symptoms (AMS) score and International Prostate Symptom Score were obtained. Sexual function was assessed by questions 15 (sexual ability), 16 (morning erections), and 17 (sexual desire) of AMS subscores. The TRT group received intramuscular testosterone enanthate (250 mg) injections every 4 weeks for 12 months. Body fat percentage, Hb, and HbA1c were significantly improved in the TRT group. In addition, sexual ability and frequency, and sexual desire showed a significant improvement in the TRT group after 1 year TRT. On the other hand, any parameters including glycemic control and sexual functions were not significantly improved in non-TRT groups. One-year TRT can improve sexual function and glycemic control among hypogonadal men with T2DM.

This is a preview of subscription content

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1


  1. 1.

    Matheus AS, Tannus LR, Cobas RA, Palma CC, Negrato CA, Gomes MB. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens. 2013;2013:653789.

    Article  Google Scholar 

  2. 2.

    Schouten BW, Bohnen AM, Bosch JL, Bernsen RM, Deckers JW, Dohle GR, et al. Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study. Int J Impot Res. 2008;20:92–99.

    CAS  Article  Google Scholar 

  3. 3.

    Guo W, Liao C, Zou Y, Li F, Li T, Zhou Q, et al. Erectile dysfunction and risk of clinical cardiovascular events: a meta-analysis of seven cohort studies. J Sex Med. 2010;7:2805–16.

    Article  Google Scholar 

  4. 4.

    Shigehara K, Konaka H, Ijima M, Nohara T, Narimoto K, Izumi K, et al. The correlation between highly sensitive C-reactive protein levels and erectile function among men with late-onset hypogonadism. Aging Male. 2016;19:239–43.

    CAS  Article  Google Scholar 

  5. 5.

    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.

    CAS  Article  Google Scholar 

  6. 6.

    Wang C, Nieschlag E, Swerdloff RS, Behre H, Hellstrom WJ, Gooren LJ, et al. ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. Aging Male. 2009;12:5–12.

    Article  Google Scholar 

  7. 7.

    Lunenfeld B, Mskhalaya G, Kalinchenko SY. Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men—a suggested update. Aging Male. 2013;16:143–50.

    Article  Google Scholar 

  8. 8.

    Mazur A, Westerman R, Werdecker A, Mueller U. Testosterone and type 2 diabetes in men. Aging Male. 2014;17:18–24.

    CAS  Article  Google Scholar 

  9. 9.

    Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009;5:427–48.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Hisasue S. Contemporary perspective and management of testosterone deficiency: modifiable factors and variable management. Int J Urol. 2015;22:1084–95.

    Article  Google Scholar 

  11. 11.

    Jones TH, Arver S, Behre HM, Buvat J, Meuleman E, Moncada I, et al. Testosterone replacement in hypogonadal men with type 2 diabetes and/or metabolic syndrome (the TIMES2 study). Diabetes Care. 2011;34:828–37.

    CAS  Article  Google Scholar 

  12. 12.

    Konaka H, Sugimoto K, Orikasa H, Iwamoto T, Takamura T, Takeda Y, et al. Effects of long-term androgen replacement therapy on the physical and mental statuses of aging males with late-onset hypogonadism: a multicenter randomized controlled trial in Japan (EARTH Study). Asian J Androl. 2016;18:25–34.

    CAS  Article  Google Scholar 

  13. 13.

    Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus, Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, Araki E, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. J Diabetes Investig. 2010;1:212–28.

    Article  Google Scholar 

  14. 14.

    Iwamoto T, Yanase T, Horie H, Namiki M, Okuyama A. Late-onset hypogonadism (LOH) and androgens: validity of the measurement of free testosterone levels in the diagnostic criteria in Japan. Int J Urol. 2009;16:168–74.

    CAS  Article  Google Scholar 

  15. 15.

    Al Hayek AA, Khader YS, Jafal S, Khawaja N, Robert AA, Ajlouni K. Prevalence of low testosterone levels in men with type 2 diabetes mellitus: a cross-sectional study. J Family Community Med. 2013;20:179–86.

    Article  Google Scholar 

  16. 16.

    Malavige LS, Jayaratne SD, Kathriarachchi ST, Sivayogan S, Fernando DJ, Levy JC. Erectile dysfunction among men with diabetes is strongly associated with premature ejaculation and reduced libido. J Sex Med. 2008;5:2125–34.

    Article  Google Scholar 

  17. 17.

    Sasaki H, Yamasaki H, Ogawa K, Nanjo K, Kawamori R, Iwamoto Y, et al. Prevalence and risk factors for erectile dysfunction in Japanese diabetics. Diabetes Res Clin Pract. 2005;70:81–89.

    Article  Google Scholar 

  18. 18.

    De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S. et al. QuED (Quality of Care and Outcomes in Type 2 Diabetes) Study Group. Longitudinal assessment of quality of life in patients with type 2 diabetes and self-reported erectile dysfunction. Diabetes Care. 2005;28:2637–43.

    Article  Google Scholar 

  19. 19.

    Furukawa S, Sakai T, Niiya T, Miyaoka H, Miyake T, Yamamoto S, et al. Depressive symptoms and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: the Dogo Study. Int J Impot Res. 2017;29:57–60.

    CAS  Article  Google Scholar 

  20. 20.

    Vickers MA, Satyanarayana R. Phosphodiesterase type 5 inhibitors for the treatment of erectile dysfunction in patients with diabetes mellitus. Int J Impot Res. 2002;14:466–71.

    CAS  Article  Google Scholar 

  21. 21.

    Park K, Ku JH, Kim SW, Paick JS. Risk factors in predicting a poor response to sildenafil citrate in elderly men with erectile dysfunction. BJU Int. 2005;95:366–70.

    Article  Google Scholar 

  22. 22.

    Hackett G, Cole N, Saghir A, Jones P, Strange RC, Ramachandran S. Testosterone undecanoate improves sexual function in men with type 2 diabetes and severe hypogonadism: results from a 30-week randomized placebo-controlled study. BJU Int. 2016;118:804–13.

    CAS  Article  Google Scholar 

  23. 23.

    Dhindsa S, Ghanim H, Batra M, Kuhadiya ND, Abuaysheh S, Sandhu S, et al. Insulin resistance and inflammation in hypogonadotropic hypogonadism and their reduction after testosterone replacement in men with type 2 diabetes. Diabetes Care. 2016;39:82–91.

    Article  Google Scholar 

  24. 24.

    Algeffari M, Jayasena CN, MacKeith P, Thapar A, Dhillo WS, Oliver N. Testosterone therapy for sexual dysfunction in men with Type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Med. 2018;35:195–202.

    CAS  Article  Google Scholar 

  25. 25.

    Zumoff B, Strain GW, Miller LK, Rosner W, Senie R, Seres DS, et al. Plasma free and non sex-hormone-binding-globulin-bound testosterone are decreased in obese men in proportion to their degree of obesity. J Clin Endocrinol Metab. 1990;71:929–31.

    CAS  Article  Google Scholar 

  26. 26.

    Blaya R, Thomaz LD, Guilhermano F, Paludo Ade O, Rhoden L, Halmenschlager G, et al. Total testosterone levels are correlated to metabolic syndrome components. Aging Male. 2016;19:85–89.

    CAS  Article  Google Scholar 

  27. 27.

    Francomano D, Lenzi A, Aversa A. Effects of five-year treatment with testosterone undecanoate on metabolic and hormonal parameters in ageing men with metabolic syndrome. Int J Endocrinol. 2014;2014:527470.

    Article  Google Scholar 

  28. 28.

    Janjgava S, Zerekidze T, Uchava L, Giorgadze E, Asatiani K. Influence of testosterone replacement therapy on metabolic disorders in male patients with type 2 diabetes mellitus and androgen deficiency. Eur J Med Res. 2014;19:56.

    Article  Google Scholar 

  29. 29.

    Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–26.

    CAS  Article  Google Scholar 

  30. 30.

    Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res. 2005;17:307–31.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Kazuyoshi Shigehara.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shigehara, K., Konaka, H., Kato, Y. et al. Effect of testosterone replacement therapy on sexual function and glycemic control among hypogonadal men with type 2 diabetes mellitus. Int J Impot Res 31, 25–30 (2019).

Download citation


Quick links