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Testosterona; síndrome metabólica; fatores de risco cardiovascular; sensibilidade insulínica; melito melito diabetes insulínica; sensibilidade cardiovascular; risco de fatores metabólica; síndrome Testosterona; Descritores ; ; cardiovascular risk factors; sensitivity; sensitivity; insulin factors; risk cardiovascular syndrome; metabolic Testosterone; Keywords Arq Bras EndocrinolMetab.2009;53/8 do tratamento com testosterona são muito encorajadores. centes e, se o diabetes melito for visto no contexto da síndrome metabólica, os resultados atuais tosterona em homens hipogonádicos sobre a homeostase da glicose são limitados, mas convin diabetes e aterosclerose. Até agora, os estudos relacionados aos efeitos da normalização da tes homenshipogonádicos reverte parte do perfil desfavorável de risco para o desenvolvimento de senvolvimento de síndrome metabólica e de diabetes melito. A administração de testosterona a metabólica,me baixosquevezuma níveistestosterona de estãoassociados predizemou de o agora evidências de que a hipotestosteronemia deveria ser um elemento na definição da síndro dora de hormônios sexuais (SHBG) predizem maior incidência de síndrome metabólica. Existem homenscarcinomacompróstata. de Baixos testosterona níveisde globulina totale transporta em androgênica privação peladramaticamente ilustrado 2, tipo diabetes de aumentado risco tosterona plasmática e sensibilidade à insulina, e níveis baixos de testosterona se associam com trombogênico. Estudos epidemiológicos transversais relataram uma correlação direta entre tes (triglicerídeoselevados, baixos níveis de HDL-colesterol), além deum estado pró-inflamatório e dislipidemiahipertensãoglicose,resistênciaarterialvisceral,insulínica,intolerânciae sidade à obe são:síndrome mortalidadecardiovasculares.componentesprincipais da e morbidadeOs agrupamentoum fatoresde riscode quepredispõem diabetesao melito tipoaterosclerose2, e é metabólica síndrome lipídico. metabolismo A no glicose da homeostase na significativo pel longoúltimasdasAo três décadas, tornou-se evidentetestosterona aque desempenha pa um R of testosteronetreatmentareveryencouraging. and if convincing, but limited, are on men hypogonadal in testosterone of tion for the development of diabetes and atherosclerosis. So far, studies on the effects of normaliza- Administration of testosterone to hypogonadal men reverses part of the unfavorable risk profile of and syndrome metabolic the of development the predict or with sociated as- are testosterone of levels low since syndrome metabolic the of definition the in element an be should hypotestosteronemia that evidence is syndrome. There metabolic the of incidence carcinoma. Lower total testosterone and sex -binding globulin (SHBG) predict a higher type 2 one and insulin sensitivity, and low testosterone levels are associated with an increased risk of testoster plasma correlationbetween direct reporteda have studies epidemiological sectional Cross- state. thrombogenic and pro-inflammatory a and cholesterol), lipoprotein high-density of levels low , (elevated and pressure blood raised intolerance, cose glu- resistance, insulin , visceral are syndrome the of mortality.components main The tors predisposing to . lipid fac- and risk homeostasis of glucose clustering a is syndrome metabolic The Over the last three decades, it has become apparent that testosterone plays a significant role in Abstr Saad Farid e síndrome metabólica emhomens O papeldatestosterona nodiabetesmelitotipo2 and metabolic syndrome in men The esumo diabetes mellitus , dramatically illustrated by deprivation in men with diabetes prostate mellitus, dramatically illustrated by androgen deprivation role of testosterone in a ct 1 diabetes mellitus type 2, atherosclerosis and cardiovascular morbidity and is viewed in the context of the metabolic syndrome, the present results Arq Bras Endocrinol Metab. 2009;53(8):901-7 Arq Bras Endocrinol Metab. 2009;53(8):901-7 diabetes mellitus diabetes diabetes mellitus. diabetes ------Medicine, Ajman, UAE Medical UniversitySchool of , Germany andGulf 1 review Accepted onOct/8/2009 Received on Aug/18/2009 [email protected] Geb. S101, 09, 226 D-13342 Berlin, Germany c/o Bayer Schering Pharma AG, Scientific Affairs BU Primary Care/Men’s Healthcare Farid Saad Correspondence to: Bayer Schering Pharma AG, 901

Copyright© ABE&M todos os direitos reservados. Copyright© ABE&M todos os direitos reservados. Testosterone indiabetesmellitus 902 F INTRODUCTION cation tobringthesenewinsights totheirattention. edu- physician substantial require deficiency. androgen will it So, of treatment and diagnosis in experienced not often are diabetes with men treat who Physicians treatment. its to approach traditional the in velopment type 2 in elderly men, this would be a de- revolutionary of management the in successful be to out turn would testosterone of administration with intervention an If assumption. this of confirmation in are results first The complications. its of array wide the and 2 type diabetes with men in control metabolic the of improvement the to contribute might levels terone testos- circulating of normalization whether test to ted and that being clinical testosterone conduc- studies are circulating of values hypogonadal have often diabetes 2 type with men elderly that is conclusion The Med. Pub- in available literature the and publications recent own from derived men elderly in mainly processes; lic data and insights of the of role in testosterone metabo- 2 type in ne abandoned. are beliefs these before education physician thorough require will it and rooted deeply are beliefs traditional cancer prostate and of . But these that testosterone is a significant factor in the etiology of is and no there not evidence cardio-protective are analysis has proven both assumptions wrong. the between most the obvious sexes. difference Careful as testosterone with steroids, sex circulating of profiles in difference the to attributed been has difference sex death nary rates are higher in men than in women. This - coro age any at that so ages, all at persists relationship This Japan. in like area incidence low a in or ) UK/ in (like area incidence high a in whether world the of areas all in true is This women. in is it as men in high as twice least at is CHD from Mortality women. to compared as men in (CHD) disease of coronary prevalence higher significantly the for accounting disease cardiovascular for factor risk a as perceived is testosterone Additionally,cancer. prostate treatment for method successful a is patients eligible in ablation androgen that experience clinical the from presumed cancer, prostate in factor etiological an is that testosterone are hormone the of connotations Further ning. - testostero of role the on focuses contribution This ne that subserves reproductive and sexual functio- sexual and reproductive subserves that ne - hormo the is testosterone clinician, average the or in men. It presents new presents It men. in mellitus diabetes ibts mellitus diabetes drome, There is an interdependence between the metabolic syn approach.integral an require male,aging the of health overall the improve to and, etiology not their in are disparate entities these that evidence growing is there regardedas distinct diagnostic/therapeutic entities, but were dysfunction, erectile and symptoms tract urinary MET men, which help them to make responsible decisions. nosisand treatment oftestosterone deficiency in elderly diag for guidelinesformulated haveorganizations nal occurrence in elderly men. Meanwhile several professio proven testosterone deficiency, but the latter is not a rare lidreasonfortestosterone treatment elderlyof a menis hasbeen underestimated, if not dismissed. The only so maleaging pathophysiologythe thetestosterone offor of relevance the long too for But men. elderly for all cure- a not is testosteronetreatmentthat obvious is It integral approach to the health problems of elderly men. ment of testosterone deficiency is to become part of that treat and Diagnosis approach.integral and prehensive com more a allowsthat contextclinical a in placed be recent insights, the health problems of elderlythese men With must (1). men aging in testosterone of patterns asatherosclerosis, , of metabolism. Liver is highly, significantly and perturbation a to due disorders metabolic induces and drainage venous portal via liver the into acids fatty free noted60yearsago. obesity wasalready abdominal of significance the and ago, years 80 than more described was it attention, wide receives rently cur syndrome metabolic the Although countries. ping develo- in more even and world, western the in both rapidly increases syndrome metabolic of incidence The mortality.and morbidity of increase severe a in results syndrome metabolic the important, Most symptoms. of cluster this with associated also are symptoms, tract urinary lower and dysfunction erectile as such sorders, di- medical Other hypertension. and dyslipidemia tes, diabe- 2 type overt or tolerance glucose impaired cose, glu- obesity,fasting abdominal of impaired occurrence me is an insulin with syndrome resistance simultaneous - syndro metabolic The syndrome. metabolic the from Most elderly men presenting with diabetes type 2 suffer TUS LLI ME BETES DIA Until a decade ago, the ailments of elderly men, such Central or visceral obesity causes increased inflow of ABOLIC SYNDROME diabetes mellitus type 2, erectile dysfunction, and TYPE 2ANDH Arq BrasEndocrinol Metab.2009;53/8 diabetesmellitus , lower, ------Arq BrasEndocrinolMetab. 2009;53/8 year follow-up) fasting glucose and insulin levels as well (8- long-term with correlation testosterone total baseline between inverse significant a demonstrated fornia Cali- in based Study Rancho-Bernardo The diabetes. developed later who men middle-aged in factors risk independent both were resistance) insulin with ciated asso- is (which SHBG and testosterone total of levels low that shown have (MRFIT) Trial Intervention tor Male Aging Study Massachusetts (MMAS) and the Multiple Risk Fac- The (2,5). life later in diabetes 2 type and syndrome metabolic the both of development the for factor risk independent an is testosterone low that studies population longitudinal several from evidence epidemiological persuasive is There men. in diabetes 2 type of development predict levels testosterone low that shown have studies prospective large several tion, 2 diabetes (RR, 0.58; 95% type CI, 0.39 to 0.87) of (4). In addi- risk lower 42% a had ng/dL) 449.6-605.2 shown that men with levels higher (range, testosterone have studies Prospective increased. is mellitus diabetes of probability the testosterone, plasma low with men In -53.6). to -99.4 [CI], interval confidence 95% dL; ng/ -76.6 difference, (mean diabetes 2 type with men in lower significantly was level testosterone that cated review and meta-analysis of cross-sectional studies indi- systematic A (3). instance, for with, to due artifact no This hemoglobin. glycosylated and levels testosterone between association inverse an the- is re and (2,3), diabetes of history a without men to compared levels testosterone lower have diabetes with Men patients. of group this in diabetes and levels rone testoste- between relationship inverse an is there me, - syndro metabolic the with men in studies to Similarly TUS LLI ME BETES DIA TESTOSTERONE INMESUFFERINGFROM of levels (CRP). C-reactive higher with associated are liver of Elevations accumulation. fat hepatic increase may and uptake glucose mediated insulin peripheral in decrease a cause may compartment visceral the in by secreted and syndrome. metabolic the and resistance insulin of pathogenesis the in factor important an as attention gained has disease liver fatty nonalcoholic or steatosis Hepatic syndrome. metabolic fatty should be included in the definition of syndrome. The question raised is whether nonalcoholic linearly correlated with all components of the metabolic

2 diabetes(7). type with men in serum and obesity levels, rone testoste- serum with associated appears polymorphism repeat CAG Androgen testosterone. of levels lower show BMI high a with diabetes 1 type with men that observation the by confirmed is assumption This diabetes. 2 type with men in lower are testosterone tal to- of levels plasma consequently, and, (SHBG) bulin glo- binding hormone sex and levels insulin between relationship inverse an is There 2). type in high and 1 type in (low insulin of levels circulating in differences normal levels) (6). This was difference attributed sub- to the have (who 2 type and levels) normal have (who matestosterone levels between men with diabetes type 1 risk doesnotdependonadiposity. tertile. third the that in MMAS the of those support findings These the in those to comparison in diabetes prevalent have to likely more times four proximately ap- were testosterone total not but bioavailable or free either of tertile lowest the in initially men those that adiposity,and showed race/ethnicity age, for justment (NHANES III), in a population of 1,413 men after ad- cently, the Third National Health and Nutrition survey Re- obese. initially not were who men in diabetes and low testosterone is a risk factor for metabolic syndrome tes. Importantly, the MMAS has provided evidence that velopment of the Metabolic Syndrome as well as diabe- de- the predict also levels SHBG and testosterone low that shown has study Finnish A intolerance. glucose as chorionic . This may be a model a be may This gonadotropin. chorionic human and cell of administration by generated testosterone the Leydig inhibit the on present are receptors Leptin other. the on levels leptin and hand one the on mass fat and index mass body between correlation a exist to seems there men, In levels. adiposity testosterone decreased and between association the in factor a be may pokines of which leptin is a prominent member. Leptin cytokines/adi - so-called the potential, regulatory with molecules secreting and producing cell, endocrine an as functions cell fat the that demonstrated been has it years, recent In testosterone. of synthesis depress ght the question has arisen whether itself mi- levels, testosterone lower-than-normal have often me While men with diabetes and/or the metabolic - syndro SYNTHESI OFTESTOSTERONE? DOES THEADIPOSEISSUESUPPRESS Interestingly,significant plas adifference in isthere Testosterone indiabetesmellitus 903 -

Copyright© ABE&M todos os direitos reservados. Copyright© ABE&M todos os direitos reservados. TESTOSTERONE BEPREVTEDORERSED? 904 decline age-related the to contributes significantly ase dise- the that insight is there increasingly But process. this in factor main the is aging that concluded studies early the of One levels. testosterone circulating of ne decli - age-related the in factors inherent probably are synthesis testosterone of process steroidogenic the of impairments and cell Leydig the of stimulation LH of endocrine functioning that lead to a diminished efficacy - neuro in changes age-related the above, indicated As C metabolic the syndrome. of effects harmful the reduce will loss weight Obviously, testosterone. plasma lower/higher insulin levels, with lower/higher SHBG levels and with higher/lower with associated are weight body in ases men with the metabolic syndrome, increases and - decre In levels. testosterone low to leads depot fat visceral ge lar a whether or deposition fat visceral induces SHBG testosterone/low low whether correlates the between relationships effect and cause the unravel stu- cannot dies Correlation hypogonadotropic. be to appears 2 with the associated of hypogonadism nature the why explain may This (9). obesity modulating the hypogonadal state prevailing in morbid cal ratio of LH, may represent an additional mechanism with a decreased ratio of the biological to immunologi- isoforms, LH inactive) (biologically acidic less of lease - re the in increase selective with LH, of altered men, obese morbidly tes- In production. tosterone testicular of stimulation strong less a producing thus unaffected, is frequency pulse LH the while (LH) hormone luteinizing of amplitude pulse attenuated an ceptors ontheLeydigcell(8). - re insulin are there since directly the maybe cell, by Leydig testosterone impair might sistance, inleptin,andvice-versa. which leadstoanincrease levels insulin increase overfeeding and Feeding levels. found that insulin is an important determinant of leptin and testosterone levels on the other. More studies have hand one the on leptin and adiposity,insulin between correlation negative a found that studies by supported obesity. was of finding case This the is as high, are vels tion by when circulating leptin le- - produc testosterone of stimulation effective less a for Testosterone indiabetesmellitus AN THEAG-RELA It has also been found in obese men that there is there that men obese in found been also has It - re insulin in encountered as , TED ECLINEOF type mellitus diabetes - of androgen levelswithaging(11-13). of androgen decline the redress or prevent partially might ) and plasma testosterone, and changes in lifestyle (/ syndrome metabolic the of features between sociations as- found have studies Numerous (10). testosterone of bolic sequelsofdiabetesmellitus. meta- the on and control glycemic on effects favorable provide may testosterone of administration that prove to studies are there far, so limited is homeostasis cose glu- on testosterone of levels circulating of malization and reversal of the metabolic syndrome (13). better results than diet and exercise on glycemic control regimenato dietof and exercise produced significantly showedconvincinglymentestosteroneaddition thatof type 2 diabetes (17). A recent study in newly diagnosed with men hypogonadal in control glycemic improved and index) model homeostatic by measured (as tance resis insulinreduced testosteronetherapyreplacement olderyearsthan30diabeteswitholdtype 2 found that tration to 24 hypogonadal men (10 treated with insulin) cent study analyzing the effects of testosterone adminis or no effect on glycemic control (15,16), but a more re men with type 2 diabetes and hypogonadism found little studiesreplacingtestosteronecontrast,twoin By (14). non-blindedwas study thisalthough control, glycemic improvestestosteronereplacementalsothat shown has diabetes 2 type with menhypogonadal in studysity. A ces insulin levels and in men with obe redu testosteronesensitivity. Furthermore,insulin ves impro men hypogonadal in Testosteronesubstitution WITH ADMINISTRA polysis in adipose tissues. In the phosphoinositide cas- phosphoinositide the In tissues. adipose in polysis li- to leading lipase hormone-sensitive activate would steroid sex by cascade cAMP the of vation Acti- mechanisms. nongenomic and genomic both tissues by adipose in function their out carry hormones steroid Sex direct. be could actions their so tissues, se adipo- in receptors androgen and receptors gesterone - pro receptors, are there It that known now tissues. is adipose of distribution and accumulation metabolism, the in involved are hormones steroid Sex ON FA EFFECTS OFTESTOSTERONADMINISTRA So, while the evidence for powerful effects of nor of effects powerful for evidence the while So, TUS LLI ME BETES DIA T ISSUEANDLIPIDMET TION FTESTOSTEROETOME Arq BrasEndocrinol Metab.2009;53/8 ABOLISM TION ------Arq BrasEndocrinolMetab. 2009;53/8 lymphocytes. from production inhibits directly also Testosterone axis. testis hypothalamic-pituitary- the on cytokines inflammatory of action suppressive the of result a as levels tosterone immune the system. , infection and traumareduce tes- on effect immunosuppressive an exerts Testosterone IL- atheroprotective. are contrast, and 10 By atherogenesis. in involved are IL-6 and IL-1 asTNFα, such cytokines Pro-inflammatory TESTOSTERONE ANDINFLAMMA (-0.085 mmol/L, CI: -0.017 to -0.003) (18). non-aromatizable were when or baseline at T-values mean higher with studies in only found was (HDL)-cholesterollipoprotein density high of duction density lipoprotein (LDL)-cholesterol. A significantre lower baseline T concentrations, with no change in low with men in especially -0.10), to -0.37 (CI: mmol/L ght. Testosterone also reduced total cholesterol by 0.23 weibodychangein baselinenoover and increase4.4) 1.6 kg (CI: 0.6-2.6), corresponding to +2.7% (CI: 1.1- ofmass free fatin increase riationinitialanfat, ofbody total body fat, corresponding to -6.2% (CI: 9.2-3.3) va of2.5-0.6) (CI: kg 1.6 of reduction a showedposition com body on men and middle-aged to tration trials evaluating theof testosteroneeffects (T) adminis wasobserved. indiastolicbloodpressure decrease and an improvement of insulin sensitivity; in addition, a ral fat mass, a decrease of fasting glucose and lipid levels duration of 8-9 months leads to a decrease of the visce- restoring testosterone levels to midnormal values with a study,administration this In testosterone depot. fat ral femoral fat and, maybe, mobilizes lipids from the visce- in so less and tissue adipose abdominal subcutaneous and causes a rapid of more turnover triglycerides in the activity lipase lipoprotein and uptake bits study,clinical inhi- testosterone that shown be could it a In demonstrated. convincingly been has pathway ted receptor-media- androgen an through lineage pogenic lineage and into inhibiting the their adi- differentiation myogenic the to commitment their promoting by cells ting lineage determination in mesenchymal pluripotent - regula in testosterone of role The differentiation. and be involved in the control of preadipocyte proliferation tivation of protein kinase C. Their activation appears to formed as second messengers ultimately causing the ac- cade, diacylglycerol and 1,4,5-trisphosphate are rcn mt-nlss f admzd controlled randomized of meta-analysis recent A TOR Y ST A TE - - - - - require further investigation. further require that states coagulation and inflammatory on tosterone tes- of effects interesting are Clearly, rise. there or low needed to determine whether adiponectin are levels remain studies Longer-term mass. fat in reduction initial reflect may and study short-term a was This profile. ne terone on other components of the atherogenic cytoki- level of this cytokine is opposite to the of effects testos- -10 (19). cytokine anti-atherogenic the increased and IL-1β and TNFα serum suppressed therapy testosterone disease gonadal men of whom the heart majority had coronary hypo- of study a In men. hypogonadal non-diabetic in shown been have men these in replacement tosterone tes- of effects Similar tissue. adipose in reduction via mediated be potentially may effect This levels. nectin levels. Testosterone did reduce leptin serum and adipo- CRP or IL-6 TNFα, on effect no had replacement ne - testostero men, diabetic of study the In men. diabetic non- in case the also is This levels. CRP and IL-6 with correlate inversely levels testosterone baseline 2, type diabetes from suffering men deficient testosterone IL-10. In of levels raised and levels IL6 not but IL-1β, and TNFα serum reduced disease heart coronary with n te eaoi snrm (13). syndrome a from evident as time over persistent are effects These metabolic the and mellitus diabetes diagnosed newly with men of study a in profiles lipid on testosterone of administration of effects favorable the by corroborated further is testosterone of role The and triglycerides and a decrease in HDL-cholesterol (20). there is an increase of serum cholesterol, LDL-cholesterol men, these testosterone. serum In of declineprofound and acute rather a in carcinoma, resulting prostatefor treatment ablation androgen receiving men in vations obser by demonstrated is profile risk in difference this levels. terone cholesterol were lower in men with lower serum testos- HDL- serum of values and higher were insulin plasma 2-hour and fasting B, LDL-cholesterol, cholesterol, total triglycerides, Serum men. adult sed non-disea- healthy, in factors risk cardiovascular and Stu- dy), there appeared to Telecombe an association of testosterone (The study epidemiological large a In TESTOSTERONE ANDLIPIDS Adiponectin is atheroprotective and the drop in the and the drop Adiponectin is atheroprotective Administration of testosterone to hypogonadal men The fact that testosterone is a significant factor in factor significant a is testosterone that fact The Testosterone indiabetesmellitus 905 -

Copyright© ABE&M todos os direitos reservados. Copyright© ABE&M todos os direitos reservados. 906 administration occursinfrequently.des oftestosterone but this is dose-dependent and with more modern mo- hematocrit, the of elevation an be may administration testosterone of effect side A far. so diabetes with men of in risk performed hypercoagulability.been have studies No higher a carries state hypogonadal a manner, minogen activator (tPA) In this is positively correlated. plas- tissue whereas levels testosterone with correlated negatively are all and VII Factor (PAI-1), 1 type inhibitor activator plasminogen of testoste- levels rone, of levels low with men In state. coagulable hyper a with associated are testosterone of levels Low CO up to9.5years(21). treatment testosterone receiving men of study a in ted exercise (13). These effects are persistent as demonstra- and diet of effects the above and over pressure blood on testosterone of effects beneficial also established tus of onset recent and syndrome metabolic with men to administration testosterone of study zed of testosterone months administration. A single-blind randomi- nine after attained was effect maximum (25). The decreased pressure blood diastolic and systolic both months, 15 over undecanoate testosterone teral - paren with treatment receiving men 122 of study a In levels. pressure blood on effect beneficial a also found osteoporosis with men for treatment testosterone of effects the investigating study Another (24). cols. and sure in abdominally obese men was published by Marin - pres blood on treatment testosterone of effect vorable fa- a demonstrate to study first The (23). levels terone testos- circulating of decrease drastic a experience who cancerand withGnRH-agonistsforprostate treatment ries, in as men observed who receive androgen ablation - arte large of stiffening the be may explanation the of Part (22). review for hypertrophy ventricular left and ciated with higher blood pressure, left ventricular mass, asso- are men in testosterone of levels Lower blood pressure. and testosterone of levels circulating between relationship inverse an is there that syndrome tabolic me- on studies epidemiological from evidence is There TESTOSTERONE ANDBLOODPRESSURE THE ASSOCIA noate forupto9.5years(21). undeca- testosterone parenteral receiving men of study Testosterone indiabetesmellitus AGULA TION TION BETWEEPLASMALEVSF diabetes melli- diabetes - only requires prudence in clinical management. It justified. malignancies prostate of risk the increases testosteronethatfearthe administration elderlymento tobe supported by rigorous scientific testing. Neither is ce in cardiovascular morbidity and mortality appears not cardiovascular disease, explaining the male preponderan beliefheldlongtestosteronethat adversehason effects visceralrableoneffectsadiposity lipid profiles.and The rone levels may improve insulin sensitivity and have favo in number, but hold promise. Normalization of testoste ventionstudies inmenwith disease accelerating morbidity and mortality (32). Inter its sequelae:its expressingmenmetabolicofthe itself in syndrome and Its deficiency leads to a serious deterioration of the healtha life-style hormone for those men seeking eternal youth. tosterone is no longer a marginal hormone. Neither is it medicineendocrinologymodernandin that tessay to tothe causality of the relationship. It is no exaggeration answerspotential providestudies Interventionvincing. (age-related) disease than the calendar age of men is con testosteronelevels with aging isaccounted forrather by cause-relationships,evidencethebut declinethat the in a predictor of mortality in elderly men (27-31). studies have found that low testosterone levels constitute vitalhormone formen’shealth. Recent epidemiological to change their mind-set and accept that testosterone is a sexual and reproductive functioning. Physicians will have no essential role to play in male physiology other than on pathology(26). pid metabolism,andcardiovascular li- homeostasis, glucose in key-player a is testosterone now need to familiarize themselves with the insight that they physicians, most to obvious been has functioning reproductive/sexual male for testosterone of nificance undergone a development. revolutionary While the sig- the (patho)physiological functions of have testosterone about thinking and understanding the times, recent In CONCLUSIOS 1. REFERENCES this article was reported. to relevant interest of conflict potential other No testosterone. partial with regard to recommendations on the administrationim of and unbiased are paper this in expressed views the author, themanufacturer of testosterone products. In the opinion of the Disclosure: biul, pdmooia suis ant unravel cannot studies epidemiologicalObviously, testosterone had that believed firmly was itEarlier, drome: areview. JSteroidBiochem MolBiol. 2009;114(1-2):40-3. syn- metabolic the in testosterone F,of Saad L. role Gooren The the author is an employee of Bayer-Schering Pharma, diabetesmellitus Arq BrasEndocrinol Metab.2009;53/8 diabetesmellitus type 2 and atheroscleroticand 2 type arelimited ------Arq BrasEndocrinolMetab. 2009;53/8 3. 2. 16. 15. 14. 13. 12. 11. 10. 9. 8. 7. 6. 5. 4.

drome andtype2diabetes.Front HormRes. 2009;37:74-90. Jones RD, Stanworth TH. syn- Testosteroneobesity,metabolic in male type2diabetics.EndocrRes. 2005;31(2):139-48. in load glucose after response insulin acute and effectiveness, glucose sensitivity, insulin on supplement testosterone of effect CT,He al. CH, YangThe et Hsieh Hung TC, SW,YJ, Kuo CH, Lee Endocrinol. 2006;189(3):595-604. J deficiency. androgen partial with men diabetic type-2 aging in of inflammatory cytokines by circulating antigen-presenting cells Androgen-replacement therapy depresses the ex vivo production Corrales JJ, Almeida M, Burgo R, Mories MT, Miralles JM, Orfao A. androgen deficiency.partial AgingMale.2003;6(1):1-7.and obesity visceral diabetes, 2 type with men in tation VG. Christov supplemen- Testosterone Z, Boneva MA, Boyanov tosterone. J [Epubaheadofprint]. Androl. 2009. with newly diagnosed type 2 diabetes and subnormal plasma tes- reverses men improvesin and control syndrome glycaemic metabolic the testosterone transdermal plus exercise and diet with treatment 52-WeekF,LJ. Saad Gooren AE, Heufelder MC, Bunck bolic syndrome:arandomized trial.JAMA 2004;292(12):1440-6. meta- the in inflammation vascular of endothelial markers and on dysfunction diet Mediterranean-style a of Effect al. et G, no F,PaloGiugliano Di C, M, Ciotola R, Marfella K, Esposito Giuglia- Cardiovasc Prev[Epubaheadofprint] Rehabil. 2009. J Eur syndrome. metabolic without or with patients overweight thrombotic and vascular remodelling in biomarkers hypertensive inflammatory,on pro- programme training sequential a of Effect C. AV,Gregori V,Gaddi Borghi Di M, Bove AF,G, Cicero Derosa 2007;92(2):549-55. Metab. Endocrinol Clin J men. in decline testosterone serum to factors lifestyle and health, aging, of contributions relative The JB. TravisonMcKinlay Kupelian V,AB, O’Donnell AB, Araujo TG, Clin Endocrinol Metab.2000;85(12):4603-10. J men. obese in hormone luteinizing hormone-releasable gonadotropin-releasing of ratio immunological to biological and half-life plasma decreased with associated is isoforms basic ting circula- of preponderance A al. et E, VeldhuisJD, Zambrano JC, Lopez-Alvarenga D, Soderlund A, Olivares C, Castro-Fernandez Endocrinol Metab. 2005;90(5):2636-41. Clin J men. in secretion testosterone cell Leydig in decrease a with associated is resistance insulin Increasing al. et Dwyer AA, M, Hardin ValassiN, PitteloudE, D, Elahi YialamasM, 2 type with diabetes. EurJEndocrinol.2008;159(6):739-46. men in leptin serum and obesity levels, tosterone tes- serum with associated is polymorphism repeat CAG ceptor re- Androgen Jones TH. KS, Channer D, Kapoor RD, Stanworth tes Care.2008;31(10):2013-7. Diabe- diabetes. with patients young in concentration tosterone S, P.Dhindsa Dandona A, Chandel TopiwalaA, Chaudhuri S, Tes- JAndrol. resistance. and insulin 2009;30(1):23-32. 2diabetes de- Type II. testosterone of ficiency: side dark The A. Guay F, Saad AM, Traish and meta-analysis.JAMA.review 2006;295(11):1288-99. systematic a diabetes: 2 type of risk and hormones sex Song EL, Ding endogenous Y,of differencesSex S. Malik Liu VS, ne in men with type 2 diabetes. Diabetes Care. 2009;32(4):541-6. associated with lower total but not bioavailable or free testostero Stanworth RD, Kapoor D, Channer KS, Jones TH. therapy is - 32. 31. 30. 29. 28. 27. 26. 25. 24. 23. 22. 21. 20. 19. 18. 17. drol. 2009;30(1):10-22. J dysfunction. erectile and syndrome Metabolic I. deficiency: An - Traish AM, Guay A, Feeley R, Saad F. The dark side of testosterone (InCHIANTI) study. Arch InternMed.2007;167(20):2249-54. Area Chianti the in aging the men: older in mortality 6-year and hormones anabolic of levels low between Relationship al. et EJ, Metter SM, Ling S, GP,F,Bandinelli Ceda Lauretani M, Maggio 2008;93(1):68-75. Metab. Endocrinol Clin tes- J men. serum older in mortality Low and tosterone J. Bergstrom E, Barrett-Connor GA, Laughlin Population Study. Circulation.2007;116(23):2694-701. ve investigation into cancer in Norfolk (EPIC-Norfolk) Prospective prospecti- European men: in cancer and disease, cardiovascular causes, all to due mortality and testosterone Endogenous al. et Khaw KT, Dowsett M, Folkerd E, Bingham S, Wareham N, Luben R, Med. 2006;166(15):1660-5. Intern Arch veterans. male in mortality and testosterone serum Low DR. Kivlahan KL, Matsumoto Sloan MM, AM, Shores 2004;52(12):2077-81. Soc. Geriatr Am J unit. rehabilitation geriatric a in men of preliminary study with a risk: associated mortality increased is and testosterone function decreased Low DR. Matsu - Kivlahan KI, AM, Brodkin moto DA, Gruenewald VM, Moceri MM, Shores Int J Androl. 2009;32(5):431-41. tus, can testosterone be regarded as a new therapy for diabetes? melli- diabetes and deficiency testosterone between association Corona G, Mannucci E, Forti G, Maggi M. Following the common Med. 2007;4(2):497-501. Sex J only. testosterone with treated hypogonadism late-onset with men in function F.sexual SaadYassin of AA, Improvement 1993;1(4):245-51. Res. Obes men. obese abdominally of treatment al. Androgen et Marin P, Holmang S, Gustafsson C, Jonsson L, Kvist H, Elander A, receive androgen-deprivation therapy. Cancer. 2006;106(3):581-8. who carcinoma prostate with men in resistance insulin and mia Basaria S, Muller DC, Carducci MA, Egan J, Dobs AS. Hyperglyce- [Epubaheadofprint] sis. 2009. Atherosclero- process. atherosclerotic the of, mediators the and for, factors risk on F.testosterone JonesSaad of TH, effects The Androl. 2007;9(3):291-7. J Asian undecanoate. testosterone parenteral long-acting novel nhel F, et al. More than eight hands-on years’ experience with the Jocke- SchubertM, F,SaadM, A, Kamischke Zitzmann Yassin A, Aging Male.2007;10(4):189-96. diabetes. with cancer prostate advanced with men in factors risk biochemical cardiovascular on and control glycaemic on vation Haidar A, Yassin A, Saad F, Shabsigh R. Effects of androgen depri- Eur JEndocrinol.2007;156(5):595-602. adipocytokines on protein in and hypogonadalC-reactive men with type 2 diabetes. therapy replacement testosterone The TH. Jones of KS, effect Channer R, Stanworth S, Clarke D, Kapoor analysis. ClinEndocrinol(Oxf).2005;63(3):280-93. meta- a men: middle-aged in profile lipid serum and metabolism composition, body on testosterone of Effects al. et A, dori Isi- V, Bonifacio D, Gianfrilli EA, Greco E, Giannetta AM, Isidori hypogonadal men withtype2diabetes.EurJEndocrinol.2006;154(6):899-906. in hypercholesterolaemia and adiposity visceral control, glycaemic resistance, insulin improves therapy cement Kapoor D, Goodwin E, Channer KS, Jones TH. Testosterone repla- Testosterone indiabetesmellitus 907

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