title: Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes.
abstract: OBJECTIVE
  Men with type 2 diabetes are known to have a high prevalence of testosterone deficiency. No long-term data are available regarding testosterone and mortality in men with type 2 diabetes or any effect of testosterone replacement therapy (TRT). We report a 6-year follow-up study to examine the effect of baseline testosterone and TRT on all-cause mortality in men with type 2 diabetes and low testosterone.
  
  
  METHODS
  A total of 581 men with type 2 diabetes who had testosterone levels performed between 2002 and 2005 were followed up for a mean period of 5.81.3 S.D. years. mortality rates were compared between total testosterone 10.4nmol/l (300ng/dl; n=343) and testosterone 10.4nmol/l (n=238). the effect of TRT (as per normal clinical practise: 85.9% testosterone gel and 14.1% intramuscular testosterone undecanoate) was assessed retrospectively within the low testosterone group.
  
  
  RESULTS
  Mortality was increased in the low testosterone group (17.2%) compared with the normal testosterone group (9%; P=0.003) when controlled for covariates. In the Cox regression model, multivariate-adjusted hazard ratio (HR) for decreased survival was 2.02 (P=0.009, 95% CI 1.2-3.4). TRT (mean duration 41.6±20.7 months; n=64) was associated with a reduced mortality of 8.4% compared with 19.2% (P=0.002) in the untreated group (n=174). The multivariate-adjusted HR for decreased survival in the untreated group was 2.3 (95% CI 1.3-3.9, P=0.004).
  
  
  CONCLUSIONS
  Low testosterone levels predict an increase in all-cause mortality during long-term follow-up. Testosterone replacement may improve survival in hypogonadal men with type 2 diabetes.
authors.affiliation: Robert Hague Centre for Diabetes and Endocrinology, Barnsley Hospital NHSFT, Gawber Road, Barnsley S75 2EP, UK.
authors.forename: Vakkat
authors.initials: V
authors.lastname: Muraleedharan
authors.forename: Hazel
authors.initials: H
authors.lastname: Marsh
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Kapoor
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Channer
authors.forename: T Hugh
authors.initials: TH
authors.lastname: Jones
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D048909:Diabetes Complications / Q000188:drug therapy* / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000188:drug therapy*; D007124:Immunoenzyme Techniques; D053208:Kaplan-Meier Estimate; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013739:Testosterone / Q000172:deficiency* / Q000627:therapeutic use*; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D013739:Testosterone