title: Prevalence of low testosterone levels in men with type 2 diabetes mellitus: a cross-sectional study.
abstract: BACKGROUND
  A high prevalence of low serum testosterone (LST) in men with type 2 diabetes have been reported worldwide. The aim of this study was to determine the prevalence and associated factors of LST in men with type 2 diabetes.
  
  
  METHODS
  This was a cross-sectional study, conducted among 1,089 men (aged 30-70 years) with type 2 diabetes who consecutively attended a major diabetes center in Amman, Jordan, between August 2008 and February 2009. The patients' demographic characteristics were collected using a prestructured questionnaire. Duration of diabetes, smoking habits, presence of retinopathy, neuropathy, and nephropathy were collected from the medical records. All participants were asked to complete the Androgen Deficiency in Ageing Male (ADAM) questionnaire. Venous blood sample was collected to test for total testosterone (TT), free testosterone (FT), sex hormone binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), serum lipids, and glycosylated hemoglobin (HbA1c). LST was defined as TT <3 ng/ml.
  
  
  RESULTS
  Overall, 36.5% of patients with diabetes had TT level <3 ng/ml and 29% had symptoms of androgen deficiency. Of those with serum testosterone level <3 ng/ml, 80.2% had symptoms of androgen deficiency, 16.9% had primary hypogonadism (HG), and 83.1% had secondary HG. Univariate analysis showed a significant relationship between age, income, education, body mass index (BMI), smoking, duration of diabetes, diabetic nephropathy, diabetic neuropathy, and HbA1c. Multivariate logistic regression analysis indicated age, income, BMI, and diabetic neuropathy as the independent risk factors of LST.
  
  
  CONCLUSIONS
  The prevalence of LST among men with type 2 diabetes is high. Age, income, BMI, and diabetic neuropathy were found to be the independent risk factors for LST.
authors.affiliation: Department of Endocrinology and Diabetes, Diabetes Education Unit, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Al Hayek
authors.affiliation: Department of Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Yousef S
authors.initials: YS
authors.lastname: Khader
authors.affiliation: National Center of Diabetes, Endocrinology and Genetics, Amman, Jordan.
authors.forename: Sahar
authors.initials: S
authors.lastname: Jafal
authors.affiliation: National Center of Diabetes, Endocrinology and Genetics, Amman, Jordan.
authors.forename: Nahla
authors.initials: N
authors.lastname: Khawaja
authors.affiliation: Research Center, Medical Affairs, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia.
authors.forename: Asirvatham A
authors.initials: AA
authors.lastname: Robert
authors.affiliation: National Center of Diabetes, Endocrinology and Genetics, Amman, Jordan.
authors.forename: Kamel
authors.initials: K
authors.lastname: Ajlouni
keywords: Diabetes mellitus; low serum testosterone; prevalence