Testosterone Replacement in Men With Diabetes and Obesity
Condition: Hypogonadism
MeSH terms: Hypogonadism
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to examine the effect of having testosterone deficiency in men
      with diabetes and with obesity. The study will also evaluate the effect of testosterone
      therapy. This will be done by comparing the changes in several body response indicators
      following treatment with testosterone in diabetic or obese-non diabetic men with low
      testosterone levels and comparing them to diabetic or obese-non diabetic men with low
      testosterone who are not treated with testosterone.
    

Detailed description: 
      Hypogonadotropic hypogonadism (HH) occurs in approximately one-third of obese and type 2
      diabetic men. Considering that there are 24 million diabetic and 100 million obese people, of
      which half are males, obesity and type 2 diabetes potentially constitute the major cause of
      hypogonadism in the population. We hypothesize that 1) HH in obese and type 2 diabetic men is
      associated with decreased insulin sensitivity, increased fat tissue mass, decreased lean body
      mass, increased inflammatory and oxidative stress, impaired sexual function and depressed
      mood as compared to diabetic and obese men with normal testosterone concentrations; and that
      2) testosterone replacement for 24 weeks in men with HH leads to an improvement in these
      parameters. Our proposed study would be the first prospective, randomized trial to
      comprehensively evaluate the effect of HH on insulin sensitivity, body composition,
      inflammatory and oxidative indices in obese and type 2 diabetic subjects and the effect of
      six months of T replacement on these parameters. The study will have 2 arms (obese and type 2
      diabetic arm) with 120 subjects in Diabetes arm and 80 subjects in obese arm. Half of men in
      each arm will have HH and half men will have normal testosterone concentrations(eugonadal
      men). Insulin sensitivity will be assessed by hyperinsulinemic-euglycemic clamps.
      Subcutaneous fat mass and lean body mass will be measured by DEXA and intra-abdominal
      (visceral) fat mass by MRI. All subjects will undergo hyperinsulinemic-euglycemic clamp, MRI,
      DEXA and give blood and urine samples (for measurement of inflammatory and oxidative stress)
      at baseline. Men with HH will then be randomized to receive testosterone or placebo gel for a
      total of 24 weeks. These men will undergo hyperinsulinemic-euglycemic clamps and give blood
      and urine samples for inflammation and oxidative stress at 4 weeks and 24 weeks. MRI and DEXA
      examinations will be carried out at 24 weeks again in men with HH. The primary endpoint of
      the study is to define a difference in whole body glucose uptake during
      hyperinsulinemic-euglycemic clamps between hypogonadal and eugonadal diabetes patients at
      baseline and an increase in glucose uptake in HH subjects after treatment with testosterone
      for 24 weeks. 30 subjects per group(testosterone and placebo gel each) will provide adequate
      power (0.8) to detect a significant difference of 10% in whole body glucose uptake. Therefore
      there will be 60 men with HH in each arm in diabetes group. For baseline comparisons, 60 men
      with normal testosterone concentrations will also be needed in each arm. We will recruit 40
      obese patients in each arm. Thus there will be 120 diabetic men and 80 obese men in the
      study.
    

Intervention name(s): testosterone; placebo
Intervention type(s): Drug; Drug
Intervention description(s): intramuscular every 2 weeks; saline intramuscular every 2 weeks
Intervention MeSH terms: Testosterone
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: diabetes; hypogonadism; obesity; testosterone; insulin sensitivity; inflammation