What’s the relationship between diabetes and low testosterone?

Diabetes rarely shows up alone. Heart disease, kidney problems, and sight loss all sit on the list of things people with diabetes are told to watch out for. Low testosterone is rarely mentioned, but it should be.

Here’s what the research says about the link between diabetes and low testosterone, and what you can do about it.

Low testosterone and type 2 diabetes

Type 2 diabetes is closely tied to obesity, insulin resistance, and impaired glucose control. If you have it, you’re twice as likely to have low testosterone as a man who doesn’t.¹

The relationship runs both ways. Men with low testosterone are also at higher risk of going on to develop type 2 diabetes.² Carrying excess weight makes both more likely, which is one reason weight and low testosterone are so closely connected.

Type 1 diabetes and testosterone: is there a link?

Type 1 diabetes works differently. The body doesn’t produce enough insulin, rather than resisting the insulin it makes, and there’s no proven link to low testosterone.

If anything, the evidence points the other way. One study of adolescents and young men with type 1 diabetes found their total testosterone was higher on average than in men without the condition (694.6 versus 554.1 ng/dL).³ That was a single small study in a young age group, so should be taken with a pinch of salt. But if you have type 1 and your levels come back low, it’s worth looking for another cause.

How can I boost my levels of testosterone if I have diabetes?

There are ways to support healthy testosterone levels that help your diabetes at the same time.

1. Blood sugar control

In men, testosterone and insulin sensitivity move together: the higher your testosterone, the more sensitive to insulin you tend to be.⁴ So when testosterone is low, blood sugar can climb higher after a meal and take longer to settle than it would for someone with normal levels.

Getting blood sugar under control is the foundation everything else sits on, through both lifestyle and the medication you’ve been prescribed.

2. Diet

Leafy green vegetables are good for blood sugar, and they’re a useful source of magnesium. In one small trial, magnesium supplementation raised testosterone levels in both athletes and sedentary men.⁵ Oily fish is another sensible addition, with barely any carbohydrate.

Ashwagandha comes up a lot in this conversation. There’s some evidence that ashwagandha supports testosterone, and early laboratory work suggests its active compounds may lower blood glucose.⁶ That second effect is worth raising with your doctor before you start, because a supplement that lowers blood sugar alongside diabetes medication needs managing.

3. Lifestyle changes

High-intensity exercise and strength training increase testosterone levels and improve insulin sensitivity. For type 2 diabetes that combination is one of the most effective routes to remission, and for type 1 it helps with blood sugar control.

Lowering stress helps on both fronts too. Cortisol, the stress hormone, has been shown to suppress circulating testosterone,⁷ and stress pushes blood sugar up. Easy to say and harder to do, so it’s worth reading up on practical ways to manage stress with diabetes.

4. Testosterone treatment

If your testosterone is genuinely low, treating it may do more than lift your energy.

In a real-world registry study, 356 men with low testosterone and type 2 diabetes were followed for 11 years. All of them received standard diabetes care, and half also received testosterone treatment. In the treated group, 34% went into diabetes remission and 47% achieved normal glucose regulation, alongside better HbA1c and fewer deaths, strokes, and diabetic complications. Neither remission nor any improvement in glucose or HbA1c was seen in the untreated group.⁸ Registry data can’t prove cause and effect on its own, but the size of that gap is hard to ignore.

The T4DM trial put the question to a stricter test. Of 19,022 men screened, 1,007 overweight or obese men were randomly assigned to testosterone or a placebo alongside a lifestyle programme. Two years in, 12% of the testosterone group had type 2 diabetes, compared with 21% on the placebo.⁹

One thing worth being clear about: testosterone isn’t licensed or recommended as a treatment for diabetes. Testosterone replacement therapy is for men with diagnosed low testosterone, and any decision to start it should come from a conversation with a clinician who has your blood results in front of them.

The numan take

Diabetes and low testosterone feed each other. High blood sugar and excess weight drag testosterone down, and low testosterone makes blood sugar harder to control. The useful part is that the same actions help on both sides: getting your weight and blood sugar down, training with weights, sleeping properly, and treating low testosterone if that’s what your results show.

If you have diabetes and you’ve been feeling flat, low on energy, or not yourself, check your testosterone levels with a simple blood test. If they come back low, find out whether TRT could be right for you.

References:

^{1 American Diabetes Association. Low testosterone. https://diabetes.org/healthy-living/sexual-health/low-testosterone}

^{2 Ding, E. L., Song, Y., Malik, V. S., & Liu, S. (2006). Sex differences of endogenous sex hormones and risk of type 2 diabetes: A systematic review and meta-analysis. JAMA, 295(11), 1288–1299. https://doi.org/10.1001/jama.295.11.1288}

^{3 Kang, J., Choi, H. S., Choi, Y. H., Oh, J. S., Song, K., Suh, J., Kwon, A., Kim, H.-S., & Chae, H. W. (2021). Testosterone levels in adolescents and young men with type 1 diabetes and their association with diabetic nephropathy. Biology, 10(7), 615. https://doi.org/10.3390/biology10070615}

^{4 Lutz, S. Z., Wagner, R., Fritsche, L., et al. (2019). Sex-specific associations of testosterone with metabolic traits. Frontiers in Endocrinology, 10, 90. https://doi.org/10.3389/fendo.2019.00090}

^{5 Cinar, V., Polat, Y., Baltaci, A. K., & Mogulkoc, R. (2011). Effects of magnesium supplementation on testosterone levels of athletes and sedentary subjects at rest and after exhaustion. Biological Trace Element Research, 140(1), 18–23. https://doi.org/10.1007/s12011-010-8676-3}

^{6 Gorelick, J., Rosenberg, R., et al. (2015). Hypoglycemic activity of withanolides and elicitated Withania somnifera. Phytochemistry. https://pubmed.ncbi.nlm.nih.gov/25796090/}

^{7 Cumming, D. C., Quigley, M. E., & Yen, S. S. C. (1983). Acute suppression of circulating testosterone levels by cortisol in men. The Journal of Clinical Endocrinology & Metabolism, 57(3), 671–673. https://doi.org/10.1210/jcem-57-3-671}

^{8 Haider, K. S., Haider, A., Saad, F., Doros, G., Hanefeld, M., Dhindsa, S., Dandona, P., & Traish, A. (2020). Remission of type 2 diabetes following long-term treatment with injectable testosterone undecanoate in patients with hypogonadism and type 2 diabetes: 11-year data from a real-world registry study. Diabetes, Obesity and Metabolism. https://doi.org/10.1111/dom.14122}

^{9 Wittert, G., Bracken, K., Robledo, K. P., et al. (2021). Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM): A randomised, double-blind, placebo-controlled, 2-year, phase 3b trial. The Lancet Diabetes & Endocrinology, 9(1), 32–45. https://doi.org/10.1016/S2213-8587(20)30367-3}