Celebrate the Facts!
Testosterone augmentation for men is the province of pop-up clinics with billboard advertisements advertising a return to virility and youth to an increasingly older and overweight population of American men. Testosterone supplementation in many cases also offers a cure for Type-2 diabetes and associated maladies.
In Type-2 diabetes, cells develop resistance to insulin raising blood sugar causing the pancreas gland to make more insulin. Eventually, the pancreas can’t keep up and the person’s blood sugar continues to rise, leading to prediabetes and Type-2 diabetes. The incidence of Type-2 diabetes is in most part caused by the huge levels of consumption of sugars in cheap industrial foods and the conditioning of Americans to consume such surrogates for food.
About 10% (34 million) of Americans have diabetes and somewhere close to 95% of them have Type-2 diabetes. Type-2 diabetes causes attendant diseases including cardiovascular disease, peripheral neuropathy, stroke, infections leading to amputations, chronic renal failure, and blindness. Another 88 million Americans have blood sugar levels high enough to qualify as prediabetic and likely will be diagnosed at some point in their lives with Type-2 diabetes. Not only is this a huge public health problem it also represents an enormous future cost in medical care required by the diseased population.
Change in the prevalence of Type-2 diabetes would require significant alterations to lifestyle, food consumption, food distribution particularly to areas not served by real food, and education. None of these would be easy, and to implement all in concert seems hopeless given the state of public health in the United States. The United States leads the world in percentage of Gross Domestic Product expended for medical care but trails the developed world in important health indicators – a topic for another investigation.
Type-2 diabetes is associated with the consumption of ersatz industrial food laden with manmade sugars distributed through massive marketing, production, distribution, and sales networks that have displaced more nutritious alternatives. Obesity is the biggest risk factor for Type-2 diabetes as it accounts for almost 85% of the overall risk and the current global spread of the disease. Poor people eat cheap food, and so the prevalence of Type-2 diabetes is inordinately distributed to the people in the United States who are least-served by its massive industrial-medicine delivery system.
Per standard industrial-medicine practice, the current treatments are initially oral prescriptions of prescribed pharmaceuticals. These drug regimens are imperfect because they fail to maintain stable glucose levels, and result in associated hypoglycemia, weight gain, and bone loss. Over time, these drugs tend to lose their efficacy and so a person who is diagnosed with Type-2 diabetes continues down an almost-inevitable road to insulin injection.
In a recent meta-analysis, the National Institutes of Health (NIH) concluded there is strong epidemiologic evidence for testosterone deficiency as an important risk factor of Type-2 diabetes in men and that high levels of free testosterone were significantly associated with decreased risk. Numerous long-term studies, also published by the NIH, and other reviews and meta-analyses, have provided evidence to support the association between testosterone deficiency and increased cardiovascular and all-cause mortality, although evidence for a pathogenic link is lacking.
Testosterone decreases insulin resistance: normalizing blood sugar levels and mitigating (in men with low testosterone levels), if not eliminating, the problem. There is no strong evidence testosterone supplementation causes an excess risk of health problems provided there is adequate medical surveillance such as monitoring to maintain proper hormonal levels.
Testosterone supplementation is mostly delivered through clinics advertising reversal of aging, improved virility, and weight loss. As in all industrial medicine delivery systems, this is market-driven and the science follows. Actual numbers are hard to find, but it appears American men are spending over $2 billion a year in testosterone replacement therapy. One may reasonably infer these services are mainly acquired mostly by affluent white men and the men who could most benefit by testosterone supplementation do not have access to such treatment.
Although conspiracy theorists would postulate a link between ‘big pharma’ and suppression of testosterone supplementation to make money such foolishness is dismissed immediately. Industrial medicine education does not instruct physicians in alternative management of disease and general and so it is the lack of knowledge and understanding of the practice that limits the management of Type-2 diabetes with testosterone supplementation. Smoking cessation, weight reduction, reduction of sugars and industrial food, and exercise have also been shown to improve insulin sensitivity and should be used to mitigate the disease.
Although the science is sound, the current practice for Type-2 diabetes does not feature testosterone supplementation. A search of the American Diabetes Association’s website does uncover some brief information on testosterone, but that information includes no discussion of the use of testosterone supplementation to treat Type-2 diabetes. The Mayo Clinic Type-2 diabetes page is silent on testosterone.
Testosterone supplementation in many cases could help mitigate Type-2 diabetes but it is only one aspect of managing the problem and improving public health. The United States would benefit by a thorough discussion of the disease: future costs for health care could be substantially reduced and the welfare of millions of Americans could be improved.
Evaluations of studies of testosterone and insulin resistance is offered at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793809/. A second intriguing discussion is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305869/. Information on testosterone sales can be found at https://www.drugwatch.com/testosterone/. The American Diabetes Association discussion of testosterone can be found at https://diabetes.org/resources/men/low-testosterone. The Mayo Clinic discussion of recommended treatments is presented at https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199.
Michael Donnelly investigates societal concerns with an untribal approach - to limit the discussion to the facts derived from primary sources so the reader can make more informed decisions.