New patients joining the Science&Human online testosterone replacement therapy (TRT) community have excellent questions when assessing the best testosterone replacement therapy for them: “What is testosterone therapy going to look like in my body’s unique context, and does testosterone therapy have side effects that might interact with any other pre-existing conditions I might have?” For men with type 2 diabetes the answers may surprise you! First let’s talk about the condition of low testosterone (hypogonadism) and then we will explore the specific approaches to TRT that are best for type 2 diabetics. Get a blood test with Science&Human today, and see if you’re a good candidate for testosterone replacement therapy yourself by clicking here!
Benefits of Testosterone Replacement Therapy (TRT)
Testosterone therapy has been used to treat patients who have the condition of hypogonadism since the early 1960s. Hypogonadism results from a chronic androgen deficiency, which can be genetic or occur later in life, with all sorts of variations depending on the associated symptoms. [1] Testosterone deficiency is common in men with type 2 diabetes mellitus.
Testosterone becomes estradiol through a process called aromatisation, which happens around fat tissue. Diabetic men have more adipocytes (cells for storing fat in connective tissue), so their testosterone levels can drop and become suppressed because they have a greater aromatization process turning their T to estradiol, which then causes them to get hypogonadism. Low testosterone levels can, in turn, increase insulin resistance, fat retention, and vascular problems. In an example of the results of low testosterone’s interaction with type 2 diabetes, there is a study of hypogonadal men with type 2 diabetes who were monitored while having to go through androgen deprivation therapy to manage cancer. These men saw a sharp withdrawal of testosterone and a corresponding increase in insulin resistance. [2]
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Testosterone Replacement Therapy and Type 2 Diabetes
There is good news for men who have both type 2 diabetes and also have hypogonadism! Testosterone Replacement Therapy is likely to improve control over blood sugar levels and insulin. [3] TRT reducing insulin resistance has been studied since 1992 and there are three studies which showed TRT reduced insulin resistance. The reason for TRT’s assistance with type 2 diabetes’ insulin resistance is that testosterone stimulates the muscles and fat tissues to uptake sugar via the Glut4 insulin transporter, which then carries sugar to the insulin receptors. Men with type 2 diabetes show reduced Glut4 levels, but testosterone likely elevates Glut4 levels. So, essentially men with type 2 diabetes can invigorate their glucose uptake cycle by increasing their testosterone levels with TRT.
There are also some other interesting benefits of TRT surrounding reduction of fat. Diabetic men have greater adipocytes which makes it easier for them to gain fat, but Testosterone Replacement Therapy has been shown to reduce fat significantly. A European study [4] found that men lost fat especially around the waist, and their overall percentage of body fat was reduced. They also found that TRT decreases leptin and adiponectin levels in men with type 2 diabetes and hypogonadism. TRT also helpfully reduces triglyceride levels, though there is inconsistent evidence about if TRT will assist with cholesterol levels. However, in a study showing an example of the opposite situation, where men’s androgens were suppressed, LDL (the type of cholesterol you want lower levels of) levels were higher and HDL (helpful cholesterol) were lowered. That implies that androgens are important for lowering LDL and raising HDL.
Is Testosterone Therapy Safe for Type 2 Diabetics?
Many new Science&Human clients ask: “Is testosterone replacement therapy dangerous? Does testosterone therapy have side effects? What are the benefits of TRT?” For men with type 2 diabetes, androgen replacement therapy is likely to be overall helpful for managing insulin resistance. However there is a specific protocol requirement for type 2 diabetics, surrounding a common hair loss medication for men usually paired with TRT. During testosterone replacement therapy the high testosterone will have a side effect of male pattern baldness, so many non-diabetic patients take DHT blockers (such as finasteride and minoxidil) to stop this side effect. However, for men with type 2 diabetes it is not a good idea to take DHT blockers while doing TRT. DHT may cause hair loss, but it is likely that testosterone turning into DHT could be part of the even more important for health uptake cycle of glucose. Ordering blood work from Science&Human will give you an in-depth readout of 20+ markers that can help move you forward on your journey to finding your ultimate body balance.
FAQs
What is hypogonadism, and why is it relevant to men with type 2 diabetes?
Hypogonadism is a medical condition characterized by low testosterone levels, often due to chronic androgen deficiency. It can be congenital or develop later in life and is particularly common in men with type 2 diabetes. This is because diabetic men typically have more fat tissue, which increases the conversion of testosterone into estradiol through a process called aromatization. As testosterone is converted, levels drop further, contributing to insulin resistance and fat gain, thereby worsening diabetic symptoms. Recognizing hypogonadism is key to managing overall metabolic health in diabetic men.
How can testosterone replacement therapy (TRT) help men with type 2 diabetes?
Testosterone Replacement Therapy can significantly benefit men with type 2 diabetes by improving insulin sensitivity and helping the body manage blood sugar levels more effectively. TRT stimulates glucose uptake by enhancing the function of the Glut4 insulin transporter in muscle and fat tissue. Since diabetic men often have reduced Glut4 levels, TRT essentially reinvigorates this sugar uptake mechanism, supporting better glycemic control. This makes TRT more than just a hormone treatment—it becomes a strategic metabolic intervention.
Can TRT actually help reduce body fat in diabetic patients?
Yes, several studies have shown that TRT contributes to fat loss, especially in men with type 2 diabetes and low testosterone. The therapy helps reduce overall body fat and specifically targets visceral fat around the waist, which is particularly harmful in diabetic patients. Additionally, TRT has been shown to lower leptin and adiponectin levels—two hormones involved in fat storage and metabolism—further enhancing fat reduction outcomes. This effect not only supports healthier body composition but can also reduce inflammation and cardiovascular risk.
Is testosterone therapy safe for diabetic men?
For most men with type 2 diabetes and diagnosed hypogonadism, testosterone therapy is considered safe and beneficial when medically supervised. It can support metabolic improvements, energy levels, and muscle mass. However, safety depends on following proper protocols, including regular monitoring of hormone levels, blood markers, and potential interactions with other medications. One important consideration is avoiding certain hair-loss drugs like DHT blockers, which could interfere with glucose uptake mechanisms crucial for diabetic men.
What are the risks of taking DHT blockers like finasteride during TRT for diabetic men?
While many men undergoing TRT take DHT blockers to reduce hair loss, these medications are not recommended for diabetic men. This is because the conversion of testosterone into DHT (dihydrotestosterone) may play an important role in glucose metabolism. Blocking DHT could inadvertently reduce the effectiveness of TRT in improving insulin sensitivity. For men with type 2 diabetes, it’s crucial to weigh aesthetic concerns like hair loss against potential disruptions to their metabolic improvements.
How can I know if I’m a good candidate for testosterone therapy?
The first step is to get a comprehensive blood test, such as the panel offered by Science&Human, which includes over 20 hormone and metabolic markers. This test can reveal whether you have low testosterone levels and whether your current health status—including insulin resistance, lipid levels, and other indicators—suggests that you could benefit from TRT. Personalized consultation based on your test results will help ensure the treatment is tailored to your unique health profile and goals.
Are there any cardiovascular risks associated with TRT for diabetic men?
While earlier concerns suggested testosterone therapy might increase cardiovascular risks, newer research indicates that TRT—when properly prescribed and monitored—may actually reduce some of those risks in diabetic men by improving lipid profiles, reducing fat, and enhancing insulin sensitivity. However, every patient’s situation is different. Regular follow-up, blood testing, and communication with your medical provider are essential to minimizing any risks and ensuring heart health while on TRT.
What ongoing monitoring is required during TRT, especially for diabetic patients?
Men on TRT—particularly those with type 2 diabetes—should have regular blood work to monitor testosterone levels, estradiol, lipid profiles, glucose control (HbA1c), and markers of kidney and liver function. These checks ensure that therapy remains effective and safe over time. Monitoring also helps detect any unwanted side effects early, such as polycythemia (increased red blood cells) or hormonal imbalances. Science&Human provides access to expert-guided lab tests and follow-up consults to keep your treatment personalized and responsive to your needs.
References(1) ODPRN Comprehensive Research Plan: Testosterone Replacement Therapy: (2) Metabolic effects of testosterone replacement therapy on hypogonadal men with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials, 2013 (3) Testosterone level in men with type 2 diabetes mellitus and related metabolic effects: A review of current evidence, 2014 (4) The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes |
