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Testosteron und das metabolische Syndrom

Testosterone and the metabolic syndrome

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Zusammenfassung

Die zentrale Adipositas als wesentlicher kardiovaskulärer Risikofaktor wie auch das metabolische Syndrom und der Typ-2-Diabetes mellitus sind mit niedrigen Testosteronspiegeln assoziiert. In Einklang mit diesen Daten zeigen Untersuchungen bei Patienten unter einer androgenablativen Therapie wegen eines Prostatakarzinoms einen negativen Effekt dieser Therapie auf die Insulinsensitivität und die Fettmasse. Die Wirkungen einer Testosterontherapie in physiologischen Dosen scheint geringere Wirkung auf Parameter des Fettstoffwechsels zu haben. Supraphysiologische Testosteronspiegel können jedoch HDL-Spiegel senken. Bezüglich der glykämischen Kontrolle bei Typ-2-Diabetikern sind die Daten aktuell noch nicht einheitlich. Negative Effekte auf die glykämische Kontrolle bei Typ-2-Diabetikern sind jedoch nicht berichtet. Zwei Studien haben jedoch durchaus eine positive Wirkung von Testosteron auf die glykämische Kontrolle bei Typ-2-Diabetikern. Eine abschließende Bewertung der Bedeutung einer Testosterontherapie beim metabolischen Syndrom und Typ-2-Diabetes mellitus ist aktuell noch nicht möglich. Erst größere randomisierte prospektive Studien werden zeigen, ob eine Testosterontherapie beim metabolischen Syndrom oder Typ-2-Diabetes hilfreich sein kann. Jedoch scheint die Gabe von Testosteron bei hypogonadalen Männern mit metabolischem Syndrom eine viel versprechende Therapieoption zur Verbesserung der metabolischen Kontrolle zu sein.

Abstract

Abdominal obesity as a key cardiovascular risk factor as well as metabolic syndrome and type 2 diabetes mellitus are associated with low testosterone levels. In line with these facts, investigations of patients undergoing androgen ablation therapy for prostate cancer have shown a negative effect of this treatment approach on insulin sensitivity and body fat mass. The effects of physiological doses of testosterone seem to have less impact on the parameters of lipid metabolism. However, supraphysiological levels of testosterone can lower HDL levels. At present data on glycemic control in patients with type 2 diabetes are not yet uniform, but negative effects on glycemic control in type 2 diabetics have not been reported. In fact two studies were able to demonstrate a positive effect of testosterone on glycemic control in patients with type 2 diabetes. It is currently not yet possible to conclusively evaluate the significance of testosterone treatment in patients with metabolic syndrome and type 2 diabetes mellitus. Only larger, randomized prospective trials will show whether testosterone therapy is helpful in metabolic syndrome or type 2 diabetes. However, administration of testosterone in hypogonadal men with metabolic syndrome appears to be a promising treatment option to improve metabolic control.

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  1. Klinik II für Innere Medizin, Universität zu Köln, Köln, Deutschland

    M. Schubert

  2. Klinik für Innere Medizin, Evangelisches Krankenhaus Herne, Wiescherstraße 24, 44623, Herne, Deutschland

    F. Jockenhövel

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  1. M. Schubert
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Correspondence to F. Jockenhövel.

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Schubert, M., Jockenhövel, F. Testosteron und das metabolische Syndrom. Urologe 49, 47–50 (2010). https://doi.org/10.1007/s00120-009-2198-7

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