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| Conference 2003 |  |
DIABETES AND TESTOSTERONE Dr. Tom Trinick, Consultant Chemical Pathologist and Physician, Ulster Community and Hospitals
Trust, The Ulster Hospital, Belfast, UK. Central obesity is recognised as a main risk factor for ischaemic heart
disease and type 2 diabetes and both central obesity and type 2 diabetes are rising
rapidly in the developed world. The co-existence of central obesity, raised blood
lipids, raised blood pressure and impaired glucose tolerance is known as the metabolic
syndrome. One well recognised concomitant of the metabolic syndrome is a peripheral
resistance to the effects of insulin and a number of metabolic consequences seem
to flow from that finding. Indeed a number of other hormonal changes have been
shown to occur in the metabolic syndrome such as an increase in serum glucocorticoids
levels. In view of these metabolic disruptions, there is interest in determining
if androgens are linked with these changes of the metabolic syndrome, either as
a cause or consequence of the metabolic syndrome.1 Serum testosterone
in men has been shown to decrease with age.2 Some work has suggested that there may be a link between increasing peripheral
resistance to insulin, increased insulin levels, central obesity and lower androgen
levels in men. For example the Massachusetts male aging study looked prospectively
at 1,156 men over a 7-10 year period. Diabetes at follow up was predicted by lower
levels of free testosterone and sex hormone binding globulin. The odds ratio for
future diabetes was 1.58 for a decrease of 1 SD in free testosterone (4 ng/dl)
and 1.89 for a 1 SD decrease in SHBG (16 nmol/l). This suggests that low levels
of testosterone and SHBG may play a role in the development of insulin resistance
and type 2 diabetes.3 So it is not clear how obesity, type 2 diabetes and reductions in androgens
are linked but there does seem to be an interaction. There is further debate about
the effects of testosterone replacement on glucose metabolism and the effects
of testosterone on atherogenicity. 1. Marin P, Arver S. Androgens and abdominal obesity. Ballieres Clin Endocrinol
Metab 1998; 12: 441-451. 2. Perry HM. The endocrinology of aging. Clin Chem 1999; 45: 1369-1376. 3. Stellato et al. Testosterone, sex hormone-binding globulin, and the
development of type 2 diabetes in middle-aged men: prospective results from the
Massachusetts male aging study. Diabetes Care 2000; 23: 490-494. Dr. Tom Trinick, BSc, FRCP, FRCPI, FRCPE, FRCPath., MD. Consultant Chemical Pathologist and Physician, Ulster Community and Hospitals
Trust, The Ulster Hospital, Dundonald, Belfast, BT16 1RH, UK. Email: tom.trinick@ucht.n-i.nhs.uk Dr Trinick trained in Medicine at Queens University, Belfast and obtained
an intercalated BSc in Pathology. He spent a year in Pathology then moved to Medicine
and obtained his Membership of the Royal College of Physicians. He then trained
locally and in Newcastle-upon-Tyne in Clinical Biochemistry and Metabolic Medicine,
culminating in his Membership of the Royal College of Pathologists. During this
time he submitted a thesis for his MD entitled ‘Pathophysiological aspects
of diet in diabetes mellitus and normal man’. He works at the Ulster Community
and Hospitals Trust as a General Physician and Consultant Chemical Pathologist. He has been Chairman of Medical Staff at the Ulster Hospital, chairs the
Regional Audit Committee and the Medical Advisory Committee of the Eastern Health
and Social Service Board. | |