Screening for hypogonadism in diabetes 2008/9: Results from the Cheshire Primary Care cohort

Aim: There is increasing awareness of hypogonadism in men with type 2 diabetes but limited data from Primary Care. Subjects and methods: The anonymised records of 6457 male patients aged 18-80 years with diabetes were accessed. Within the last 2 years 391 men (6.0% of total) underwent measurement of serum testosterone. Data search was performed through the centralised data facility afforded by EMIS ®, the majority GP systems provider in Cheshire. Results: 4.4% of type 2 diabetes men screened were frankly hypogonadal with a serum total testosterone of less than 8.0 nmol/l. For borderline hypogonadism (serum total testosterone 8-11.99 nmol/l) the proportion of type 2 diabetes men rose to 32.1%. Age adjusted mean (geometric) testosterone was lower in men with type 2 diabetes (13.6 nmol/l 95%CI: 13.1-14.2) vs type 1 diabetes (17.9 nmol/l; 95%CI 15.2-21.0), F = 10.3; p = 0.0014. For those screened age adjusted body mass index (BMI) was greater in type 2 diabetes at 30.7 (30.1-31.3) vs 28.4 (26.1-30.6) kg/m 2 in type 1 diabetes (F = 4.3; p = 0.04). Multiple linear regression analysis indicated that there was a statistically significant interaction (P = 0.014) between BMI and diabetes type in their relation with log testosterone. For persons with type 1 DM and type 2 DM, testosterone can be expected to decrease by 6% (P = 0.002) and by 1% (P = 0.002) respectively, for every one unit increment in BMI. Conclusions: There is manifestly a subset of men with diabetes and androgen deficiency who could benefit from testosterone replacement. BMI has an independent influence on androgen status. © 2012 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.