Abstract
Low testosterone level is common in men with metabolic syndrome and it occurs even more frequently if the man suffers from type 2 diabetes at the same time. In its pathogenesis, an important role is played by increased levels of inflammation mediators, and also by insulin and leptin resistance and inhibitory effects of leptin on Leydig cells.
A routine examination of testosterone levels is indicated in every man with type 2 diabetes mellitus. Low testosterone level may manifest by decreased libido, erectile dysfunction, fatigue and depressive moods.
Testosterone substitution therapy is indicated only in patients with symptoms of hypogonadism. The therapy primarily improves libido, erectile dysfunction tends to be less affected.
Metabolic changes during testosterone substitution are insignificant and they are not an indication for therapy. Risks of testosterone replacement therapy are few; it is necessary to monitor prostate health and haematocrit.
The follow-up examinations should be standardised.