Low testosterone may exacerbate the risk for atherosclerotic complications in men with type 2 diabetes, according to research published in the Journal of Clinical Endocrinology & Metabolism.

“Our study indicates a strong association between low testosterone concentration and the severity of atherosclerotic plaques as well as other key atherosclerotic markers in middle-aged men with type 2 diabetes,” study author Javier Mauricio Farias, MD, of the Hospital Universitario Sanatorio Guemes in Buenos Aires, Argentina, said in a press release.

“The results of our study advance our understanding of the interplay between low testosterone and cardiovascular disease in patients with diabetes.”

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For their study, Dr. Farias and colleagues conducted a cross-sectional study evaluating atherosclerotic disease markers in 115 male patients. Participants were aged younger than 70 years and had type 2 diabetes and serum testosterone levels that were normal (≥3.5 ng/mL; 79 patients) or low (<3.5 ng/mL; 36 patients).

Compared with individuals with normal testosterone levels, those with low testosterone levels were more likely to have carotid artery intima-media thickness (IMT) of 0.1 cm or greater (80% vs. 39%; OR=6.41; 95% CI, 2.5-16.4; P<.0001), atherosclerotic plaques (68.5% vs. 44.8%; OR=2.60; 95% CI, 1.12-6.03; P<.0001), endothelial dysfunction (80.5% vs. 42.35; OR=5.77; 95% CI, 2.77-14.77; P<.003) and higher highly sensitive C-reactive protein levels (2.74 mg/dL vs. 0.89 mg/L; P<.0001).

After multivariable adjustment, low total testosterone level was found to be independently associated with greater carotid IMT (OR=8.43; 95% CI, 2.5-25.8) and endothelial dysfunction (OR=5.21; 95% CI, 1.73-15.66), but not with the presence of atherosclerotic plaques (OR, 1.77; 95 percent CI, 0.66 to 4.74).

“Low testosterone is associated with more advanced atherosclerotic disease markers in middle-aged patients with type 2 diabetes,” the researchers wrote.

“We still need to determine whether testosterone is directly involved in the development of atherosclerosis or if it is merely an indicator of advanced disease,” Farias said. “This study is a stepping stone to better understanding the risks of cardiovascular events in men who have both low testosterone and type 2 diabetes.”

One author disclosed financial ties to pharmaceutical and medical device companies.


  1. Farias JM et al. J Clin Endocrinol Metab. 2014;doi:10.1210/jc.2014-2585.