Only two percent of men experience actual testosterone deficiency symptoms. These include loss of sexual desire and erectile dysfunction. At low values, muscle mass also decreases, while abdominal fat increases. If left untreated, bone density decreases and the body produces fewer red blood cells.
Affected people feel listless, their ability to concentrate decreases and they have problems sleeping. Anyone who notices such signs speaks to the family doctor. After ruling out other causes, he will refer you to a specialist. By the way: From the age of four decades, the testosterone levels in every man drop, but with chronic conditions such as type 2 diabetes it falls faster.
Types of deficiency and therapy
“Type 2 diabetics are particularly affected by the functional testosterone deficiency that is associated with chronic diseases,” explains Professor Dr. Michael Zitzmann, diabetologist and senior physician at the Center for Reproductive Medicine and Andrology at the University Hospital in Münster. Insulin sensitivity and testosterone production are mutually dependent. The expert: “The male hormone increases insulin sensitivity directly through receptor effects and indirectly through the positive effect on body fat percentage and muscle mass.” This means that testosterone promotes better blood sugar levels. Diabetics who have been shown to have a testosterone deficiency can therefore benefit from testosterone therapy. Body weight, insulin resistance and the likelihood of bone fractures decrease.
Doctors only recommend testosterone replacement therapy when those affected have both low blood values and typical symptoms. They prescribe two dosage forms most frequently: depot injections are injected into the muscle every ten to 14 weeks. The depot continuously releases testosterone. Testosterone gels are applied to the shoulders or chest once or twice a day, preferably in the morning. This simulates the body’s own production, which decreases over the course of the day.
Hormone replacement does not work immediately
“The likelihood of transferring testosterone through close physical contact is low,” says Zitzmann. Nevertheless, manufacturers recommend covering the treated areas of skin with clothing or cleaning them before close physical contact. “Mood and sexual desire increase after just one to two months of therapy. Further effects occur after up to six months.”
In addition to the correct dosage and application, possible side effects of hormone replacement therapy should also be discussed with the doctor treating you. However, if done correctly, it is considered to be well tolerated. Breast enlargement, acne, hair loss and certain blood value changes can sometimes occur.
In addition, men with advanced prostate cancer should not receive the therapy. According to current knowledge, hormone replacement therapy does not increase the risk of developing prostate cancer at all. But the doctor who prescribes and monitors the therapy is best informed about all this.
You can do that yourself
In addition to hormone replacement therapy, patients can make lifestyle adjustments themselves. The following applies to type 2 diabetics: lower blood sugar (HbA1c value) and body weight, reduce alcohol, exercise regularly and eat a balanced diet. The diabetologist Professor Dr. Michael Zitzmann: “The replacement therapy is not a long-term solution. If the patients have significantly reduced their weight after two years, an attempt can be made to avoid it.”