The connection between low testosterone and how it affects a man’s long-term health

The links between testosterone deficiency (low T) and other medical conditions afflicting men have long been debated among researchers. The question has been, is low T an indicator of poor health leading to chronic health issues, or is it the other way around?  Are men with poor health more likely to develop and suffer from low T caused by medical conditions?

Low testosterone and chronic health conditions

The associations between men with low T having other conditions like diabetes, obesity, metabolic syndrome, and heart disease appear to be interrelated. Results from a study published in the World Journal of Men’s Health found the following information that may uncover a connection:

For men aged 45 and older who had low T:

  • Had a 2.4 times greater likelihood of obesity
  • Had a 2.1 times greater likelihood of diabetes
  • Had a 1.8 times greater likelihood of hypertension

At this time, it is unknown if men who develop obesity, diabetes, or hypertension, are caused by low T. Not all men with these medical conditions necessarily have a diagnosis of testosterone deficiency.  Therefore, before conclusions can be made, more research will be needed to verify what sort of connection there may be associated between these diseases and low T.

In the meantime, here’s a look at possible links between chronic conditions and men with low T:

Obesity and low testosterone

Men with obesity are much more likely to also have low T and vice versa – men with low T are more likely to be obese.

The factor that appears to link these two conditions together is estrogen. The more fat cells a man has, the more these cells will metabolize testosterone due to the hormone estrogen. Another contributing factor is the more weight a man gains, the more it reduces sex hormone binding globulin (SHBG), which results in less free testosterone, which simply means testosterone that is unattached to proteins. SHBG is a protein responsible for carrying testosterone around in the blood. The less SHBG is produced, the less free testosterone there is available.

Diabetes and low testosterone

Men diagnosed with diabetes have twice the rate of insufficient testosterone levels than men without diabetes. A study published in The Journal of Clinical Endocrinology & Metabolism found that 43% of men with type 2 diabetes had low testosterone levels, and 57% had low free testosterone levels. 

The reason why testosterone levels are impacted by type 2 diabetes is due to insulin sensitivity and glycemic control. When the body’s ability to respond to insulin is compromised, insulin resistance can occur. Men with insulin resistance will struggle to achieve adequate glycemic control, which means good control of managing their blood sugar levels. 

Men impacted by insulin resistance tend to have low total and free testosterone. In addition, men with high levels of SHBG will have worse glycemic control causing low testosterone. 

Heart Disease and low testosterone

As men grow older, it’s natural for testosterone levels to dwindle and physical activity to take a nosedive. Each of these phenomena results in declines in the health and functioning of arteries raising the risk for heart disease.

Since low T is associated with insulin resistance, obesity, and diabetes, these issues negatively impact cardiovascular health.  For example, people with diabetes have two to four times higher rates of atherosclerosis or hardening of the arteries. 

Metabolic Syndrome and low testosterone 

Metabolic syndrome is defined as a group of conditions that, when they happen all at once, places a person at a much higher risk for heart attacks, strokes, and other serious health problems. Men with these conditions, which include obesity, hypertension, diabetes, and abnormal lipid levels, have metabolic syndrome. 

What is the connection between low T and metabolic syndrome? The connection appears to be related to how total testosterone deficiency predicts central obesity and visceral fat accumulation surrounding internal organs like the liver. It’s also been shown that men with low free testosterone and SHBG levels have a higher risk for developing metabolic syndrome. 

How should low T be treated?

Before any man resorts to taking supplements or other ‘treatments,’ he finds online, he must be diagnosed by his healthcare professional. There are several symptoms possibly indicating if a man has low T:

  • Reduced sex drive
  • Erectile dysfunction
  • Loss of body hair and a thinning beard
  • Fatigue
  • Loss of lean muscle mass
  • Weight gain
  • Feeling depressed or unmotivated

To diagnosis low testosterone accurately, a doctor will order a blood test to check the levels of total and free testosterone. If a man is found to have low T, the best treatment is testosterone replacement therapy (TRT). TRT can be administered through injections, pellets, gels, or patches.  These options are determined by a man and his doctor deciding which method is best.  All men on TRT must have their levels of testosterone periodically checked about every 3 to 6 months. 

Following these recommended guidelines is the right way to treat low T safely and effectively. 


Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911. 

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