The Role of Testosterone Therapy in Managing Type 2 Diabetes for Men and Women

By Dr. David Samadi

The most recent data on type 2 diabetes is startling but true: According to the Centers for Disease Control and Prevention (CDC), approximately 38.4 million people in the United States had diabetes in 2021. This includes 29.7 million diagnosed cases and an estimated 8.7 million undiagnosed cases, making up 11.6% of the US population. Additionally, the CDC estimates that 22.8% of adults with diabetes are undiagnosed, meaning they meet the clinical criteria for the disease but are unaware of their condition or have not reported having diabetes.

Diabetes is a prevalent health issue both in the United States and globally. This condition affects the body’s ability to properly utilize digested food, making it difficult to process carbohydrates and fats efficiently. The primary indicator of diabetes is elevated blood sugar (glucose) levels. Normally, blood sugar is regulated by insulin, a hormone produced by the pancreas.

Unfortunately, elevated blood sugars that remain high for long periods of time, can lead to serious health complications including heart disease, reduced kidney functioning, loss of vision, and neuropathy which is poor circulation, especially in the extremities that could lead to amputation. 

While there are multiple medications used to treat type 2 diabetes, a 2023 study suggests that testosterone therapy might be of benefit for people with type 2 diabetes and obesity.

Study Insights

Researchers analyzed data from an international audit focused on testosterone deficiency in men with type 2 diabetes. The study found that testosterone replacement therapy (TRT) improved blood sugar control in men for up to two years. The audit included 37 centers from countries such as the UK, Germany, Canada, New Zealand, South Africa, Malaysia, and Vietnam, covering 428 subjects with an average age of 71.

The Link Between Testosterone and Type 2 Diabetes

The researchers proposed that the decrease in a person’s hemoglobin A1C (a blood test that measures the average amount of blood sugar levels over a 2-to-3-month period) observed in the subjects was due to testosterone’s ongoing effect on reducing insulin resistance and body fat.

Two decades ago, researchers discovered a connection between low testosterone levels in men and the prevalence of type 2 diabetes. It is estimated that 40% of men diagnosed with this disease also have low testosterone levels. Low testosterone is associated with higher risks of heart disease, osteoporosis, and psychological issues, and it doubles the risk of death in men with type 2 diabetes.

Benefits of Testosterone Therapy

Officials from the Association of British Clinical Diabetologists (ABCD) noted that multiple studies have shown TRT could benefit men with testosterone deficiency who also have type 2 diabetes, obesity, and other related health issues. TRT has been shown to:

  • Reduce insulin resistance
  • Lower HbA1c and cholesterol levels
  • Decrease obesity and mortality rates
  • Improve quality of life and sexual function

However, the adoption of TRT has been slow, partly due to conflicting findings about its cardiovascular risks. Recent large-scale studies have shown no significant changes in cardiovascular events such as heart attacks or stroke between testosterone and placebo groups. Despite this, many endocrinologists and diabetologists remain unaware of using testosterone therapy for treating diabetes. 

Findings from the Testosterone Study

The ABCD audit included anonymized data from both new and retrospective patients treated with TRT, as well as those with testosterone deficiency who were not treated. The goal was to assess TRT’s real-world benefits and safety on various health parameters, including blood sugar control, obesity, heart health, and diabetes complications.

Patients received testosterone via gels and long-acting intramuscular injections. According to TRT guidelines, patients should be reviewed every 3, 6, and 12 months after starting therapy and then yearly.

One key finding was that a lack of muscle mass can lead to insulin resistance and increase the risk of type 2 diabetes. Traditional treatments for insulin resistance include low-carbohydrate diets, metformin, and strength training. This study suggests that monitoring and potentially treating low testosterone levels could be an essential additional approach for men with type 2 diabetes.


Testosterone therapy (TRT) could be a valuable tool in managing type 2 diabetes and related health issues. Ongoing research and audits, like the one conducted by ABCD, are crucial to understanding which patients benefit most from TRT and ensuring its safe and effective use in clinical practice.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911. 

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