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Functional Hypogonadism: Diabetes Mellitus, Obesity, Metabolic Syndrome, and Testosterone

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Testosterone

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Abstract

Low blood testosterone levels are found more frequently in patients with type 2 diabetes mellitus, obesity, and metabolic syndrome than in the general population, as shown by epidemiological studies. All these conditions are associated with insulin resistance, and there is a two-way relationship between them, and low testosterone levels: not only the metabolic disorder can lead to hypogonadism, but also testosterone deficiency can contribute to type 2 diabetes mellitus, obesity, and metabolic syndrome. Besides the sexual symptoms of loss of libido, erectile dysfunction, and absence of morning erections, low testosterone levels are associated with an increase in adipose tissue and a decrease in muscle mass, not only because testosterone induces differentiation of pluripotent mesenchymal cells into myocytes and inhibit conversion into adipocytes, but also low testosterone levels favor incorporation of triglycerides in fat cells due to inhibition of lipoprotein lipase activity. Most of the deaths in type 2 diabetes, obesity, and metabolic syndrome are due to cardiovascular diseases, and there is an increase of these disorders in men with low testosterone levels. There is consistent scientific evidence that testosterone replacement in hypogonadal patients can lessen the risk factors for cardiovascular diseases and decrease mortality. On the other hand, functional hypogonadism can be reversed by weight loss and better control of diabetes. The few studies that link testosterone replacement to an increase in cardiovascular death present methodological severe issues and are not confirmed by a careful meta-analysis.

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Authors and Affiliations

  1. State Institute of Diabetes and Endocrinology, Rio de Janeiro, Brazil

    Ricardo Martins da Rocha Meirelles

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  1. Ricardo Martins da Rocha Meirelles
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Correspondence to Ricardo Martins da Rocha Meirelles .

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  1. Department of Internal Medicine - Division of Endocrinology and Metabolism, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil

    Alexandre Hohl

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da Rocha Meirelles, R.M. (2023). Functional Hypogonadism: Diabetes Mellitus, Obesity, Metabolic Syndrome, and Testosterone. In: Hohl, A. (eds) Testosterone. Springer, Cham. https://doi.org/10.1007/978-3-031-31501-5_8

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  • DOI: https://doi.org/10.1007/978-3-031-31501-5_8

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