Sven Wombwell
Article by: Sven Wombwell
Estimated 8 minutes read
Quick summary
A global study led by the Association of British Clinical Diabetologists (ABCD) suggests that Testosterone Replacement Therapy (TRT) may significantly benefit men with type 2 diabetes. Initial findings show that TRT can reduce blood sugar levels and improve insulin resistance. While concerns about TRT's cardiovascular risks have been put to rest, more research is needed to determine the therapy's full potential. This study offers hope for better diabetes management and could be a game-changer in the field.

Exciting news has emerged from the 2023 Annual Meeting of The European Association for the Study of Diabetes (EASD) in Hamburg. A study has revealed Testosterone Replacement Therapy (TRT) might be a game-changer for people with type 2 diabetes. The data from a worldwide survey of TRT in men with type 2 diabetes could impact the lives of millions. But before we dive into these findings announced in Hamburg, let's first understand what causes type 2 diabetes and how testosterone and diabetes are connected.

What Causes Type 2 Diabetes?

In the United States, the statistics are alarming. More than 70 million adults are obese, while an additional 99 million are overweight. To compound the issue, over 37 million Americans already have diabetes, and a further 96 million are in the prediabetes stage. 

These stats result from a combination of unhealthy dietary choices, insufficient physical activity, and excess weight. Collectively, this puts millions at risk of developing type 2 diabetes. While the precise cause is not entirely clear, it typically results from genetic, lifestyle, and environmental factors.

Understanding Type 2 Diabetes: Causes and Risk Factors

Insulin Resistance:

One of the central elements of type 2 diabetes is insulin resistance. Insulin is a hormone that helps regulate blood sugar (glucose) levels by allowing cells to use glucose for energy. In people with insulin resistance, cells don't respond effectively to insulin, which leads to higher blood sugar levels.


There is a strong genetic link to type 2 diabetes. Your risk may be higher if you have a family history of the condition. Specific genes can increase susceptibility to insulin resistance and diabetes.

Obesity, Testosterone and Diabetes:

Obesity often leads to insulin resistance. Excess body weight, particularly visceral fat around the abdomen, is a significant risk factor for type 2 diabetes. Fat cells, especially abdominal fat, release chemicals that interfere with the body's ability to use insulin effectively. Visceral fat, low testosterone and diabetes are closely linked.

Visceral fat cells also convert testosterone into estradiol, reducing testosterone levels. This decline in testosterone causes more fat to develop, worsening this conversion cycle and creating a challenging hurdle to weight loss.

Physical Inactivity:

A sedentary lifestyle and lack of physical activity increase the risk of developing type 2 diabetes. Regular exercise helps burn fat, helps the body use insulin more efficiently and maintain healthy blood sugar levels. 

Unhealthy Diet:

Rather worryingly, ultra-processed foods make up a staggering 73% of the US food supply. A high-calorie diet made up of processed and sugary food contributes to obesity and insulin resistance. 

Overeating sugar and unhealthy fats often leads to diabetes. Things are now so bad that there is even a word for it. The Standard American Diet (SAD). This typical SAD diet is high in calories, salt, refined carbs, sugars, and fats and lacks many nutrients found in whole foods.

Age, Testosterone and Diabetes:

Low testosterone and diabetes are more common with age. While type 2 diabetes can occur at any age, it is more common in older adults, particularly those over 45. This is due to a natural decline in testosterone levels as men age.

Gestational Diabetes:

Some women develop gestational diabetes during pregnancy. Having gestational diabetes increases the risk of developing type 2 diabetes later in life.

High Blood Pressure:

Hypertension (high blood pressure) increases the risk of type 2 diabetes. Hypertension and type 2 diabetes share several common risk factors, such as obesity, a sedentary lifestyle, and poor dietary habits. These risk factors contribute to the development of both conditions. For instance, excess body weight, especially around the abdomen, can increase the risk of both hypertension and type 2 diabetes.


Black African, African Caribbean, South Asian (Indian, Pakistani, Bangladeshi), and Hispanic individuals face a higher risk of type 2 diabetes.

Other Health Conditions:

Conditions like polycystic ovary syndrome (PCOS) and metabolic syndrome can increase the risk of diabetes.

While these factors contribute to developing type 2 diabetes, they don't guarantee that someone will develop it. Lifestyle modifications, like maintaining a healthy weight, being physically active, and following a balanced diet, significantly reduce the risk.

For men with diabetes or prediabetes, the promising news from the 2023 EASD Annual Meeting in Hamburg is encouraging. Let's look at what they have found. 

Unlocking the Impact of TRT: Findings from a Worldwide Study 

There's growing excitement about testosterone and diabetes, particularly TRT and its effect on type 2 diabetes. This excitement stems from an audit conducted on 37 TRT centers in eight countries. This audit conducted by the Association of British Clinical Diabetologists (ABCD) gathered data from these clinics and TRT's effect on diabetes. But what did they find? 

TRT: Transforming the Landscape of Type 2 Diabetes Treatment

The data suggests that TRT reduces blood sugar levels over time. Moreover, it shows that TRT has lasting effects on insulin resistance and fat reduction. It also effectively decreases HbA1c, a measure of average blood sugar levels over the past 2-3 months. The findings have not yet been published in a peer-reviewed journal, but the signs are very positive.

This research offers initial insights into whether TRT could positively influence diabetes and obesity, a topic wrongly shrouded in controversy.

Twenty years ago, researchers established a connection between low testosterone levels in men and type 2 diabetes. About 40% of men with type 2 diabetes suffer from testosterone deficiency. Low T also adversely affects cardiovascular health, osteoporosis, and psychological well-being.

Numerous studies have shown that TRT could benefit men with testosterone deficiency, type 2 diabetes, obesity, and other cardiometabolic disorders. TRT has demonstrated the potential to reduce insulin resistance, cholesterol, obesity, and mortality while improving quality of life and sexual function.

With all these benefits, it seems unbelievable that doctors and patients aren't more aware of the power of TRT.

Testosterone and Diabetes Safety

Despite mounting evidence of TRT's benefits, its adoption has been slow, partly because of conflicting findings on cardiovascular risks. However, a recent large, multicenter randomized trial on the cardiovascular safety of TRT produced a reassuring result. There was no significant difference in major cardiovascular events between the testosterone-treated and placebo groups. Essentially, this study reaffirmed the safety and effectiveness of TRT. Testosterone therapy does not cause heart attacks.

Professor Hugh Jones from Barnsley Hospital in the UK, who spearheaded the study, acknowledges that despite solid evidence, the use of testosterone therapy among providers remains low. Furthermore, many providers remain unaware of the significant connection between testosterone and diabetes. Ultimately, millions of men could miss out on a treatment that could not only change but save their lives.  

The International Audit: Investigating TRT's Real-World Benefits

The ABCD audit allows for data input from new and retrospective patients who have started TRT—also those with testosterone deficiency who remain untreated. The audit also aims to assess the benefits and safety of TRT. It focuses on evaluating its impact on symptoms, blood sugar control, weight, heart health, and diabetes-related issues.

34 centers in 8 countries, including the UK, Germany, Canada, New Zealand, South Africa, Malaysia, and Vietnam, have joined the audit. They have a total of 428 patients, with an average age of 71 years.

The patients in the audit use testosterone gels and injections, with regular reviews following TRT guidelines. After 3, 12, and 24 months of TRT treatment, preliminary results show significant reductions in blood glucose levels with few side effects.

Professor Jones suggests we need more data from a larger group to determine who will benefit most from testosterone therapy. These findings also provide the foundation for family doctors to talk to type 2 diabetes patients about their symptoms. The results from this audit should give them the confidence to diagnose and treat testosterone deficiency properly.

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The Future of Diabetes Management: TRT as a Game-Changer

In summary, this groundbreaking international audit offers newfound hope for men with type 2 diabetes and prediabetes. TRT's potential to improve glycemic control and manage elements of diabetes and obesity could mark a massive milestone in diabetes management. The future appears promising, with TRT emerging as a game-changer in the fight against type 2 diabetes.

[2] Review: Testosterone and the metabolic syndrome - Vakkat Muraleedharan, T. Hugh Jones, 2010 ( 
[3] Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels | Neurology | JAMA | JAMA Network; Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men | European Heart Journal | Oxford Academic (
[4] Cardiovascular Safety of Testosterone-Replacement Therapy | NEJM
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