Diagnosis and Effectiveness of Treatment of Male Hypogonadism in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Objective: Variations exist in the diagnosis and management of male hypogonadism in patients with type 2 diabetes mellitus (T2DM). These variations necessitated the need to review the diagnosis and effectiveness of treatment of male hypogonadism in patients with T2DM. The objective of the study was to systematically review the approach to the diagnostic workup and treatment of male hypogonadism in patients with T2DM.

Methods: This was a systematic review and meta-analysis of randomized controlled trials. A systematic search was done using PubMed/Medline, Embase, Google Scholar, and the Cochrane Central Library. This was followed by a manual evaluation of the literature. Two independent reviewers used a standardized data extraction tool to obtain data from the included studies in the review. Articles were pooled, and statistical meta-analysis was conducted using RevMan-5 version 5.a.4 software.

Results: The global prevalence of hypogonadism ranged from 4.4% to 80.4%. Twelve studies were included in the analysis to find the best diagnostic option for hypogonadism. Three studies used a total testosterone (TT) level of <11 nmol/L to diagnose hypogonadism, 5 used a TT level of <12 nmol/L, and 2 studies each used free testosterone levels of <11.8 pg/mL and <6.5 ng/L. From the analysis, studies that used a TT level of <11 nmol/L had the best glycemic control [pooled standardized mean difference (SMD)=−0.65, 95% CI (−0.95)-(−0.35), P < .001 (with low heterogeneity: Q=2.83; I 2=29%)]. Seven studies were analyzed to find the best treatment option for male hypogonadism. Three of these used intramuscular testosterone undecanoate, 3 used transdermal testosterone gel, and 1 used intramuscular testosterone enanthate. However, the use of TT gel was found to be the best treatment option as it produced pooled SMD (95% CI) that is most precise with the lowest P-value (P < .001) and absence of heterogeneity (Cochran Q-test=1.11; I 2=0%).

Conclusion: Male hypogonadism is best diagnosed using a serum TT of <11 nmol/L. The best treatment option for hypogonadal men with T2DM was daily TT gel.

Cite this article as: Sabir AA, Bello MM, Danmadami MA. Diagnosis and effectiveness of treatment of male hypogonadism in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Endocrinol Res Pract. 2024;28(1):27-36.