Low serum testosterone (LST) and symptoms of androgen deficiency occur regularly among South African men with type 2 diabetes mellitus (T2DM), a study conducted by UKZN’s Dr Imran Paruk has revealed.
Titled: “Prevalence of Low Testosterone Levels in South African Men With Type 2 Diabetes Attending an Outpatient Diabetes Clinic”, the study aimed to determine the prevalence of LST and its association with metabolic parameters among men over the age of 18 with T2DM attending outpatient diabetes clinics at Prince Mshiyeni Hospital and Inkosi Albert Luthuli Hospital in Durban.
Paruk recently presented his cross-sectional observational study at the College of Health Sciences’ Annual Research Symposium.
‘Testosterone is an important hormone in men required for maintaining good health and sexual function,’ said Paruk. ‘Deficiency can have consequences such as low libido, low mood, loss of erections and significantly impair quality of life.’
Paruk screened diabetic men for symptoms of testosterone deficiency and also measured testosterone levels. ‘75 % of the diabetic men were noted to have symptoms of androgen deficiency and low testosterone was found in 17%,’ said Paruk.
Patients completed a self-administered questionnaire (Ageing Male’s Symptom Scale) which was available in English and isiZulu. Morning testosterone, leutenizing hormone, and sex-hormone binding globulin were measured along with lipids and HbA1c.
LST was defined as a calculated free-testosterone level below the reference range. ‘Control subjects were sourced from non-diabetic male employees working at the hospital. As expected, free-testosterone levels declined with age and an inverse correlation between age and free-testosterone was noted,’ explained Paruk.
The results showed a high prevalence of LST seen in 17% of men and a high frequency of androgen deficiency symptoms noted in 75% of men.
He said symptoms were also prevalent in diabetic men under the age of 40 years where a prevalence of 38% was found, ‘Men with T2DM had a significantly lower total and free-testosterone compared to control subjects. LST was associated with higher waist circumference. However, there was no association with symptoms of androgen deficiency or metabolic profile including HbA1c and serum lipids.’
Paruk identified an inverse correlation between total testosterone and waist circumference, body mass index and serum triglycerides. ‘The findings of this study are consistent with that seen elsewhere in the world and highlight the need for more local research in this area,’ said Paruk.
His study recommends that an enquiry into the symptoms of androgen deficiency be considered for all men with diabetes since the prevalence was high. ‘This can be done easily with a standard questionnaire before entering the doctor’s room.’
According to Paruk, health care practitioners treating men with diabetes should be aware of the high prevalence of low serum testosterone levels in this population and test in the appropriate circumstances such as when the patient has signs and symptoms consistent with androgen deficiency.
Paruk is currently working on his PhD research titled: “The effects of Metabolic Surgery in South African Patients”. ‘It will hopefully provide valuable data on the experiences locally,’ he said.