title: Steroids in adult men with type 1 diabetes: a tendency to hypogonadism.
abstract: OBJECTIVE
  To compare steroids and their associations in men with type 1 diabetes and healthy control subjects.
  
  
  METHODS
  We studied 52 adult men with type 1 diabetes without microvascular complications, compared with 53 control subjects matched for age and BMI. Steroids and their binding globulins were assessed in a single venous blood sample and a 24-h urine sample.
  
  
  RESULTS
  In adult men with type 1 diabetes, total testosterone did not differ from healthy control subjects, but sex hormone-binding globulin (SHBG) (42 [14-83] vs. 26 [9-117] nmol/l, P < 0.001), cortisol-binding globulin (CBG; 0.87 +/- 0.17 vs. 0.73 +/- 0.10 nmol/l, P < 0.001), and cortisol levels (0.46 +/- 0.16 vs. 0.39 +/- 0.14 nmol/l, P < 0.01) were higher. The free testosterone index was lower (60 [17-139] vs. 82 [24-200], P < 0.001), and the calculated free testosterone was slightly lower (497 [115] vs. 542 [130], P < 0.064), but the pituitary-gonadal axis was not obviously affected in type 1 diabetes. The calculated free serum cortisol was not different, and 24-h urinary free cortisol excretion was lower in type 1 diabetes (121 [42-365] vs. 161 [55-284] nmol/24 h, P < 0.009). Testosterone was mainly associated with SHBG. Estimated portal insulin was a contributor to SHBG in control subjects but not in type 1 diabetes. Cortisol was associated with CBG. HbA(1c) contributed to CBG in men with diabetes but not in control subjects, whereas estimated portal insulin did not contribute.
  
  
  CONCLUSIONS
  Adult men with fairly controlled type 1 diabetes without complications who are treated with subcutaneous insulin have a tendency to hypogonadism, as reflected by lower free testosterone levels in the presence of similar total testosterone levels and higher SHBG levels.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands. ew.vandam@vumc.nl
authors.forename: Eveline W C M
authors.initials: EW
authors.lastname: van Dam
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Dekker
authors.forename: Eef G W M
authors.initials: EG
authors.lastname: Lentjes
authors.forename: Fred P T H M
authors.initials: FP
authors.lastname: Romijn
authors.forename: Yvo M
authors.initials: YM
authors.lastname: Smulders
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Post
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
authors.forename: H Michiel J
authors.initials: HM
authors.lastname: Krans
mesh_terms: D000328:Adult; D017668:Age of Onset; D000728:Androgens / Q000097:blood*; D002352:Carrier Proteins / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology; D004967:Estrogens / Q000097:blood; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007006:Hypogonadism / Q000453:epidemiology*; D007328:Insulin / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*; D013739:Testosterone / Q000097:blood*
chemical_list: D000728:Androgens; D002352:Carrier Proteins; D004967:Estrogens; D007328:Insulin; D012738:Sex Hormone-Binding Globulin; C027091:cortisol binding globulin; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D006854:Hydrocortisone