4.10.0.0 Low Testos­terone_ in Men

Rec­om­men­da­tion

4.17 In men with di­a­betes who have symp­toms or signs of hy­pog­o­nadism, such as de­creased sex­u­al de­sire (li­bido) or ac­tiv­i­ty, or erec­tile dysfunc­tion, con­sid­er screen­ing with a morn­ing serum testos­terone level. B

Mean lev­els of testos­terone are lower in men with di­a­betes com­pared with age-‍matched men with­out di­a­betes, but obe­si­ty is a major con­founder (72,73). Treat­ment in asymp­tomat­ic men is con­tro­ver­sial. Testos­terone re­place­ment in men with symp­tomat­ic hy­pog­o­nadism may have beneļ¬ts in­clud­ing im­proved sex­u­al func­tion, well-‍being, mus­cle mass and strength, and bone den­si­ty (74). In men with di­a­betes who have symp­toms or signs of low testos­terone (hy­pog­o­nadism), a morn­ing total testos­terone should be mea­sured using an ac­cu­rate and re­li­able assay. Free or bioavail­able testos­terone lev­els should also be mea­sured in men with di­a­betes who have total testos­terone lev­els close to the lower limit, given ex­pect­ed de­creas­es in sex hor­mone–bind­ing glob­u­lin with di­a­betes. Fur­ther test­ing (such as luteiniz­ing hor­mone and fol­li­cle-‍stim­u­lat­ing hor­mone lev­els) may be need­ed to dis­tin­guish be­tween pri­ma­ry and sec­ondary hy­pog­o­nadism.