The risk of type 2 diabetes (T2D) increases dramatically for men after you hit 50. This often coincides with a change in lifestyle—maybe you’re doing a little less exercise, or maybe monitoring your food intake a little less carefully.
While most people know that their lifestyle can play a significant role in the development of T2D, it’s less well known that diabetes often causes problems with your sexual health.
The tricky part is working out if T2D, lifestyle factors, or a combination of both, are creating problems with your sexual health. Damage to nerves and blood vessels, and bladder problems caused by diabetes, can increase the likelihood of developing erectile dysfunction (ED), retrograde ejaculation (semen that flows back into the bladder) and balanitis (a common infection that occurs at the head of the penis). When linked with T2D, these aren’t diseases in themselves—they’re physical conditions that can be a symptom of diabetes.
Studies have shown that being overweight carries an increased risk of developing T2D1. What’s not certain is if, and by how much, also having low testosterone influences the development of diabetes in overweight men.
Losing weight reduces the risk of T2D, and also increases natural testosterone levels, but could giving men extra testosterone to boost their natural levels further reduce their risk of diabetes? This is one of the questions that the Testosterone for Diabetes Mellitus (T4DM) clinical trial, due to report this year, aims to answer.
The Role of Testosterone in Diabetes and Sexual Health – the T4DM Study
The T4DM project, a world-first Australian clinical study, has seen researchers trialling a combination of weight reduction strategies and testosterone supplements to determine if the two, when used together, can reduce the rate of T2D.
Other overseas studies2 have shown that on their own, testosterone supplements can encourage a mild improvement in sexual function, but do not significantly improve other diabetes symptoms or other health issues.
It is hoped that this trial will show a way forward to improving men’s sexual health, and decrease the chance of them developing T2D, as they get older.
What does this mean for you?
We’re awaiting the results of the T4DM trial, but if you’re having any problems with your sexual health, it’s important to talk to your GP. Conditions like ED can be an indicator of other health problems, such as diabetes—a bit like the ‘check engine’ light in your car going off.
For more information go to the diabetes and reproductive health page. You’ll find a downloadable fact sheet and video to watch at the bottom of the page.he New England Journal of Medicine, 374:611-624 . https://www.nejm.org/doi/full/10.1056/NEJMoa1506119
 Gyawali P, Martin SA, Heilbronn LK, et al. (2018) The role of sex hormone-binding globulin (SHBG), testosterone, and other sex steroids, on the development of type 2 diabetes in a cohort of community-dwelling middle-aged to elderly men. Acta Diabetol. 55(8):861-872.
 Peter J. Snyder, M.D., Shalender Bhasin, M.D., Glenn R. Cunningham, M.D., Alvin M. Matsumoto, M.D., Alisa J. Stephens-Shields, Ph.D., Jane A. Cauley, Dr.P.H., Thomas M. Gill, M.D., Elizabeth Barrett-Connor, M.D., Ronald S. Swerdloff, M.D., Christina Wang, M.D., Kristine E. Ensrud, M.D., M.P.H., Cora E. Lewis, M.D., M.S.P.H., et al., for the Testosterone Trials Investigators*: “Effects of Testosterone Treatment in Older Men”, (2016) T