Approximately 25% of men with type 2 diabetes mellitus (T2DM) have hypogonadotropic hypogonadism. Although there is a paucity of trials evaluating testosterone therapy in relation to T2DM, there have been recent studies highlighting possible additional benefits of its use in men with T2DM. Our study aims to evaluate the effects of long-term testosterone therapy on A1c in men with co-occurring T2DM. We identified 12,125 military beneficiaries with dual diagnoses of T2DM and hypogonadism from 2005-2018. Roughly 10.5% (1,125) met inclusion criteria: testosterone treatment ≥5 years and available pre-treatment and post-treatment clinical values (A1c, serum testosterone, and BMI). Patients were categorized as follows based on testosterone adherence rates: Group 1 (≥75%; n=72), Group 2 (50-74%; n=172), Group 3 (25-49%, n=266), Group 4 (<25%; n=762). All groups showed improvement in BMI over time, although it was more substantial in Group 1. Pre- and post-treatment BMI values were 33.7 kg/m2 vs. 32.8 kg/m2 for Group 1 (-0.93 kg/m2), 33.7 kg/m2 vs. 33.5 kg/m2 for Group 2 (-0.2 kg/m2), 34.1 kg/m2 vs. 33.8 kg/m2 for Group 3 (-0.3 kg/m2), 33.8 kg/m2 vs. 33.4 kg/m2 for Group 4 (-0.4 kg/m2). Pre- and post-treatment A1c values were 6.8% vs. 6.6% for Group 1 (-0.18%), 7% vs. 7.1% for Group 2 (+0.11%), 7% vs. 7.3% in Group 3 (+0.3%), and 7.4% vs. 7.6% in Group 4 (+0.25%). Thus, the A1c improvement in Group 1 was statistically significant when compared to Group 3 (p=0.045) and Group 4 (p=0.047). Despite improvement in BMI for all groups, only Group 1 showed improvement in A1c. This speaks to the potential effect of testosterone on A1c specifically, irrespective of BMI, as evidenced by the glycemic benefit only seen in those with the highest adherence rates.


C. Jenkins: None. J.M. Tate: None. J.L. Wardian: None. A. Rittel: None. I. Folaron: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at