Dear Diabetes Health, I am 57 years old. About five years ago, I saw my doctor because I was feeling tired. My waist size was up, and I was not interested in sex. I almost never got an erection. The doctor diagnosed type 2 diabetes and put me on metformin. He also prescribed Viagra, which helped sometimes, but not all the time.
My last A1c was 7.3%, but my sex drive is still missing in action. The Viagra isn’t working anymore. It’s difficult for my wife, and I don’t like it either. I don’t want to have injections in my penis or stuff like that, but I’m feeling really down about this. Do you have any advice for me? – Jim in Michigan
Dear Jim, We’re not doctors, but you have the classic symptoms of low testosterone. Feeling tired and sad, gaining fat, and losing interest in sex all point to problems with testosterone, or “T,” as it’s often called. You should get tested because there are medical and self-care things that you can do to increase your T levels. The good news is that these things are very good for diabetes, too.
Men with diabetes are more than twice as likely as other men to have low T levels. In fact, more than 50 percent of men with diabetes have low T levels. According to Professor Evan David Rosen, M.D., Ph.D., this is not simply due to aging testicles. There is a connection between type 2 (possibly type 1 as well) and low T.
According to urology professor Abraham Morgentaler, “Normal T is helpful for diabetes control. T therapy increases muscle mass and lowers body fat, and both of these changes are helpful with blood sugar control. This supports the idea that normalizing T may be helpful for diabetes.” Studies show that raising T levels lowers insulin resistance, improves cholesterol levels, and reduces abdominal fat in men with type 2 diabetes.
What to Do About Low T
Consider testosterone replacement therapy (TRT). According to Wayne Hellstrom, M.D., of Tulane University Medical Center, TRT comes in several forms. The most common treatment in the United States is a gel applied daily to the skin of the upper arms and shoulders. Other forms of treatment are skin patches, intramuscular injections, and implantable pellets. They may or may not be covered by your insurance.
For men, the most significant side effect of T therapy is that, if they already have prostate cancer, T might make it grow faster. Any man starting on T therapy should be tested for prostate cancer first. T therapy does NOT, however, seem to increase your chances of getting cancer in the first place.
According to the healthcare media site Medicinenet.com, other common side effects include acne, nausea, headache, and hair loss. Less common but more severe effects include edema (swelling), depression, dizziness, and breast enlargement.
Not Just for Men
According to experts at About.com, testosterone therapy can help women, too. Author Tracee Cornforth writes that, “androgens [male hormones such as testosterone] are produced naturally by the ovaries and the adrenal glands. Testosterone is an important factor in women’s health before and after menopause.” Like men, women can experience better mood, more energy, and increased sexual desire and function (including “enhanced orgasm”) with T therapy. Cornforth’s article says that testosterone may also help with osteoporosis. “Studies indicate that [hormone treatment] stimulates bone formation as well as preventing bone loss.”
Mayo Clinic researcher Sandhya Pruthi, M.D., says, however, to start with estrogen first. “If a woman experiences reduced sex drive, depression, and fatigue after [menopause], estrogen therapy may be recommended. If estrogen isn’t effective, low-dose testosterone therapy may be another option.” So testosterone shouldn’t be given unless estrogen has first been brought to normal, as we wrote about last month.
T side effects for women include acne and excess facial hair. Less common side effects include lowering of the voice, enlargement of the clitoris, and mood or personality changes.
Natural Ways to Boost T
Improving your diabetes self-care might be the best way to raise your T levels. In an article called “Maintaining Healthy Levels of Testosterone,” Dr. Richard Cohen, a bodybuilding specialist, writes that diet, exercise, and stress reduction are key to raising T levels.
Cohen recommends a diet with moderate protein and fat, emphasizing fish oils and vegetable fats. He advises exercising hard, but not for too long. “Both the lack of physical activity and excessive physical activity (over-training) will result in decreased levels of testosterone,” he says. So strength-building exercises of short duration are best for raising T. And don’t forget that building strength might lower insulin resistance as well.
Cohen says that reducing or managing stress might be most important of all. This makes sense to us. If your body is worried about surviving, it won’t have energy for sex, so why bother with testosterone? For the same reason, you need to get enough rest if you want to have enough T. Here are some tips on stress reduction from one of our columns.
People have been looking for herbs to improve sexual function for thousands of years. One that actually has some evidence for raising T levels is Tribulus terrestris, an Indian herb popular with Eastern European athletes. Another is a herb called Eurycoma longifolia, or Tongkot Ali, its Malaysian name. Malaysian research shows enhanced sexual behavior and erections in rats given Tongkot, although not as much as in rats who received injections of testosterone. Both herbs appear safe, and there are many others.
We encourage you to look at this holistically. Getting an erection isn’t the point. You also want to have the desire and the energy to do things that make you and your wife feel good. Taking steps that improve your energy, desire, and mood may also improve your diabetes control, and vice versa. But start by getting your T level checked!