Low testosterone in men with type 2 diabetes is an important, yet under-recognized issue. This health condition contributes to a vicious cycle of weight gain & low blood sugar levels. Some studies find that around 25–40% of men with type 2 diabetes have low testosterone, about twice the rate of men without diabetes.
In this blog, we will explain how low testosterone develops, how it shows up, the link with type 2 diabetes, and how the two conditions can be managed together.
What is low testosterone & why should you care?
Testosterone is a key male sex hormone- it plays vital roles in sexual function, mood, muscle mass, fat distribution, bone health, and metabolic regulation. In men with Type 2 diabetes, low testosterone levels are common. This matters not only for sexual health but also for metabolic health. According to the American Diabetes Association, men with type 2 diabetes are about twice as likely to have low testosterone as men without diabetes.
Explore the Symptoms of Low Testosterone
Here are the main symptoms you should be aware of, especially in the context of type 2 diabetes.
Reduced Sex Drive & Erectile Function
A decline in libido (sex drive) and problems achieving or maintaining erections are classic signs of testosterone deficiency. In practice, this means you might notice less interest in sexual activity, fewer spontaneous erections (for example, in the morning), and perhaps more difficulty getting or sustaining erections.
Fatigue
Low energy, more tiredness, reduced drive to do things- all of these reflect reduced testosterone. It is harder to tell when diabetes is present, because fatigue also comes with poor blood‑sugar control. But when fatigue is combined with other signs of hormone deficiency, low testosterone should be considered.
Loss of body hair or beard growth
Testosterone supports hair growth (body hair, underarms, facial hair/beard). A drop in testosterone leads to thinning body hair, slower beard growth, or less robust facial hair.
Loss of lean muscle mass
Testosterone helps maintain lean muscle. When it’s low, men may lose muscle mass (especially in arms/legs/torso) and find their strength dropping. With T2DM (Type 2 Diabetes Mellitus), muscle loss is especially relevant because muscle is a key site for glucose uptake and insulin sensitivity.
Weight gain or obesity
Although we think of testosterone problems causing muscle loss, the flip side is that low testosterone is sometimes associated with increased fat accumulation, especially visceral (around the abdomen) fat. This contributes to weight gain or obesity, and the increased fat further suppresses testosterone in a vicious cycle.
Depression
Low testosterone affects mood: more low mood, irritability, loss of motivation, sometimes mild depression or apathy. Because diabetes also contributes to mood changes, it is easy to attribute symptoms to “just diabetes,” but if other signs (sexual, muscle, hair) are present, a hormonal evaluation may be warranted.
The link between type 2 diabetes and low testosterone
Here we dig into how and why these two conditions go hand‑in‑hand, and how each can worsen the other.
A common comorbidity
Men with T2DM have a much higher likelihood of low testosterone. Obesity is a strong risk factor for both T2DM and low testosterone. Excess fat suppresses testosterone by converting it via aromatase to estrogens. It impairs the testicular function and reduces sex‑hormone binding globulin (SHBG), among other pathways.
This creates a vicious cycle: obesity → T2DM → low testosterone → increased fat/less muscle → worse insulin resistance → worse diabetes → lower testosterone.
Insulin Resistance
One key driver of T2DM is insulin resistance- the body’s tissues don’t respond well to insulin, so glucose remains high. Low testosterone is associated with reduced insulin sensitivity.
Mechanistically, testosterone helps regulate muscle mass, fat distribution, and even expression of glucose transporter‑4 (GLUT4) in muscle and adipose tissue, which is crucial for glucose uptake.
Chronic hyperglycemia & metabolic stress
When blood sugar remains high over time (chronic hyperglycemia), it causes inflammation, oxidative stress, and metabolic imbalance. These processes impair the hypothalamic‑pituitary‑gonadal axis (which governs testosterone production) and damage testicular function.
How to manage low testosterone in men with type 2 diabetes
Since these issues are interconnected, management needs to be comprehensive.
1. Consult with Specialists
If you are a man with type 2 diabetes and you notice any of the symptoms listed above, then it is worthwhile to talk with expert providers of Twenty-One Medical. Here you will get the best testosterone replacement therapy for both diabetic and non-diabetic patients.
We will order morning fasting testosterone levels (total and possibly free testosterone), check SHBG, and look for other causes of hypogonadism.
2. Lifestyle Modifications
These are foundational. Weight loss, regular physical activity, improved sleep, a healthy diet, limiting alcohol, and quitting smoking all help not only diabetes control but also testosterone levels. Strength training helps build muscle, which enhances insulin sensitivity, and reducing fat helps lessen the suppression of testosterone.
3. Consider medication/ testosterone therapy
After lifestyle changes, if the hormone level remains low and symptoms persist, testosterone replacement therapy may be considered. But the decision must take into consideration the risk of type 2 diabetes in men with low testosterone. It’s important to emphasize that testosterone treatment is not a substitute for diabetes care or lifestyle change. It is part of a comprehensive plan.
4. Personalized Treatment Plan
Since these men often have multiple comorbidities (obesity, cardiovascular risk, sleep apnea, dyslipidemia), the treatment plan must be tailored. For example, medications for diabetes that help weight loss (such as GLP‑1 receptor agonists) may improve both glycaemic control and, indirectly, testosterone levels by reducing fat. Emerging research suggests this may be a useful adjunct. Based on your symptoms, lab reports, and health goals, Twenty-One Medical provides personalized TRT plans for you.
5. Monitoring is key
Once treatment begins (whether lifestyle, diabetes‑medication optimization, or testosterone therapy), regular monitoring is essential. That includes testosterone levels, glycaemic markers (HbA1c, fasting glucose), lipid profile, blood pressure, body composition, and screening for adverse effects of Hormone Replacement Therapy (HRT).
Final Thoughts
If you are a man living with type 2 diabetes and you’re finding that your sex drive has fallen, you’re more tired than usual, gaining abdominal fat despite efforts, losing muscle, or feeling down, it’s worth asking your medical provider about testosterone. The interplay between low testosterone and diabetes is real. If it is left unchecked, it can worsen both your hormone health and metabolic health. Consult with an expert, provides as Twenty-One Medical, to get customized treatment plans and improve overall quality of life.