Patients with testosterone deficiency syndrome and type 2 diabetes.

The prevalence of diabetes mellitus (DM) is increasing worldwide for all ages due to population growth, aging, and increased prevalence of obesity and physical inactivity. Sexual dysfunction and in particular erectile dysfunction (ED) are frequent complications of DM. In patients with DM, ED can be considered as a useful sign of silent myocardial ischemia. A large body of evidence also supports a strong association between DM, cardiovascular risk (CV) and testosterone deficiency syndrome. Despite this evidence, the screening of ED and hypogonadism in the diabetic population remains poorly implemented. In addition, data regarding the role of testosterone replacement therapy (TRT) for glycometabolic control and CV risk remains contradictory. In the present paper we have reviewed the available evidence and based our discussion on data derived from a specific clinical case. Hypogonadism is frequently observed in subjects with type 2 DM (T2DM) and especially those complaining of ED. Obesity and insulin-resistance are probably the most important pathogenetic factors involved, and, according to the current guidelines, subjects with T2DM should be screened for hypogonadism. TRT is the first line option in hypogonadal subjects with ED, however, the possible role of TRT in improving glycometabolic control and CV outcomes needs to be confirmed through longer and larger studies.