Prediabetes is associated with an increased risk of testosterone deficiency, independent of obesity and metabolic syndrome.
OBJECTIVE
The association between type 2 diabetes and low testosterone has been well recognized. However, testosterone levels in men with prediabetes have been rarely reported. We aimed to investigate whether prediabetes was associated with an increased risk of testosterone deficiency.


METHODS
This study included 1,306 men whose sex hormones was measured during a medical examination. Serum total testosterone and sex hormone-binding globulin were measured; free and bioavailable testosterone concentrations were calculated by Vermeulen's formula. Prediabetes was defined by impaired fasting glucose (IFG), impaired postprandial glucose (IPG), or glycated hemoglobin (HbA1c) 5.7%-6.4%. Logistic regression was performed to obtain the odds ratios (OR) for subnormal total testosterone (<300 ng/dL) or free testosterone (<6 ng/dL) in prediabetic and diabetic men compared with normoglycemic individuals, while adjusting for age, BMI, waist circumference, and metabolic syndrome (MetS).


RESULTS
Normoglycemia, prediabetes, and diabetes were diagnosed in 577 (44.2%), 543 (41.6%), and 186 (14.2%) men, respectively. Prediabetes was associated with an increased risk of subnormal total testosterone compared to normoglycemic individuals (age-adjusted OR=1.87; 95%CI=1.38-2.54). The risk remained significant in all multivariate analyses. After adjusting for MetS, the OR in prediabetic men equals that of diabetic patients (1.49 versus 1.50). IFG, IPG, and HbA1c 5.7%-6.4% were all associated with an increased risk of testosterone deficiency, with different levels of significance in multivariate analyses. However, neither prediabetes nor diabetes was associated with subnormal free testosterone in multivariate analyses.


CONCLUSIONS
Prediabetes is associated with an increased risk of testosterone deficiency, independent of obesity and MetS. After adjusting for MetS, the risk equals that of diabetes. Our data suggest that testosterone should be measured routinely in men with prediabetes.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Chen-Hsun
CH
Ho
Hong-Jeng
HJ
Yu
Chih-Yuan
CY
Wang
Fu-Shan
FS
Jaw
Ju-Ton
JT
Hsieh
Wan-Chung
WC
Liao
Yeong-Shiau
YS
Pu
Shih-Ping
SP
Liu
D001786:Blood Glucose; D003430:Cross-Sectional Studies; D004198:Disease Susceptibility; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000175:diagnosis; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000175:diagnosis; D016017:Odds Ratio; D011236:Prediabetic State / Q000209:etiology*; D012307:Risk Factors; D013739:Testosterone / Q000097:blood* / Q000172:deficiency*
D001786:Blood Glucose; D012739:Gonadal Steroid Hormones; D013739:Testosterone