Remission of type 2 diabetes in a hypogonadal man under long-term testosterone therapy

Abstract

In daily practice, clinicians are often confronted with obese type 2 diabetes mellitus (T2DM) patients for whom the treatment plan fails and who show an inadequate glycemic control and/or no sustainable weight loss. Untreated hypogonadism can be the reason for such treatment failure. This case describes the profound impact testosterone therapy can have on a male hypogonadal patient with metabolic syndrome, resulting in a substantial and sustained loss of body weight, pronounced improvement of all critical laboratory values and finally complete remission of diabetes.

Learning points: Hypogonadism occurs frequently in men with T2DM.In case of pronounced abdominal fat deposition and T2DM, the male patient should be evaluated for testosterone deficiency.Untreated hypogonadism can complicate the successful treatment of patients with T2DM.Under testosterone therapy, critical laboratory values are facilitated to return back to normal ranges and even complete remission of diabetes can be achieved.

Figure 1

Total testosterone normalized under testosterone therapy. The graph shows trough levels, measured at the end of an interval and prior to the following injection.

Figure 2

(A) Waist circumference of 110 cm at baseline decreased to 98 cm in month 114. (B) Body mass index of 37.1 kg/m² at baseline decreased to 29.6 kg/m² in month 114.

Figure 3

(A) HbA_1c – baseline value of 9.4% decreased down to 6.1% in month 114. (B) HOMA-IR – baseline value of 11.7 declined to 2.8 in month 102.

Figure 4

HDL increased and LDL decreased over time. LDL/HDL ratio of 3.3 at baseline normalized to 1.4 in month 114.