The Link Between Testosterone And Blood Sugar/Insulin Sensitivity

By Dr. Jim Fox DC

What do central obesity, high blood sugar, high blood lipids, high blood pressure, and low testosterone have in common?

These are characteristics of metabolic syndrome, which is on a slippery slope toward cardiovascular disease and type II diabetes. Diagnostic criteria for metabolic syndrome are high insulin and high blood sugar, increased body mass, high triglycerides, high blood pressure, and low high-density lipoprotein (HDL).1

Importantly, hypogonadism, or low testosterone, is emerging as a central feature of metabolic syndrome.1-3 It increases cardiovascular events and is underdiagnosed in primary care.2

It’s important to consider hormone insufficiency in your patients with metabolic syndrome. And this is no easy task because 35% of Americans are said to have metabolic syndrome and 50% of Americans over the age of 60 have metabolic syndrome!4 In fact, some researchers suggest that patients with signs of low testosterone (such as those with erectile dysfunction), seeking treatment for sexual dysfunction, are lucky because it presents an opportunity to address their overall metabolic health- before it’s too late.

Anecdotally, many healthcare practitioners have long documented in their patient population the correlation they’ve observed in patients with ED that also have metabolic/blood sugar issues. Recognizing this connection and considering it when crafting a care plan could make all the difference for those patients that are experiencing this cross over of testosterone/blood sugar imbalance.

It is still debated whether insulin resistance decreases testosterone, low testosterone increases insulin resistance, or perhaps it’s both (see Figure 1). Ultimately, it seems like a system-wide breakdown in metabolic, hormonal, and endothelial function. The outcome is metabolic syndrome, cardiovascular dysfunction, hormone imbalance, and vascular abnormalities. Given that we don’t know what causes what, it stands to reason that addressing both metabolic imbalance and hormonal imbalance is a wise strategy in these patients.


Figure 1. One hypothesis for how low testosterone interacts with metabolic syndrome and cardiovascular disease by Traish and colleagues.1

Treating blood sugar abnormalities in your patients may help normalize their hormone levels and vice versa. Nutritional supplements can shift the balance of hormones and chemical signals that may underlie metabolic disorders. The Mediterranean Diet reduced blood sugar, insulin, blood lipids, blood pressure, and improved erectile function.1 Your patients with blood sugar imbalance may also benefit from a hormone work-up. Restoring normal hormones can improve metabolic syndrome and CVD and diabetes. Clinicians can support a patient’s internal physiology to improve metabolic, hormonal, and vascular function using natural agents in conjunction with lifestyle factors.

  1. Traish AM, Guay A, Feeley R, Saad F. The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. Journal of andrology. 2009;30(1):10-22.
  2. Somani B, Khan S, Donat R. Screening for metabolic syndrome and testosterone deficiency in patients with erectile dysfunction: results from the first UK prospective study. BJU international. 2010;106(5):688-690.
  3. Guay AT. The emerging link between hypogonadism and metabolic syndrome. Journal of andrology. 2009;30(4):370-376.
  4. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA. 2015;313(19):1973-1974.