The management approach for a 50-year-old man with type 2 DM and obesity presenting with low libido and biochemical profile consistent with hypogonadotropic hypogonadism.
Hypogonadotropic hypogonadism (HH) is impaired gonadal function as a result of pituitary or hypothalamic dysfunction, as opposed to a primary gonadal pathology (hypogonadotropic hypogonadism). It is defined as sex hormone deficiency including arrested or delayed puberty, along with biochemical findings of reduced sex hormone levels, as well as inappropriately low FSH and LH (Fraietta et al 2013). With regards prevalence, it is a rare condition, affecting approximately 1 in 10,000 individuals at a high estimate (Fraietta et al 2013).
Aetiology of HH (secondary) may be classified as either organic (classic) or functional (Bhasin et al 2018; Corona et al 2018). Organic hypogonadism ensues from an acquired structural or destructive lesion involving hypothalamo-‐pituitary axis or maybe congenital (Bhasin et al 2018). On the other hand, functional cause of HH is due to potentially reversible aetiology that suppress the release of gonadotropins (Bhasin et al 2018). This classification is shown in table 1 in the appendix.
In our case we are dealing with hypogonadism in respect of diabetes, hence we need to review the effects of testosterone on insulin.
Potential mechanism of testosterone action on cellular insulin sensitivity and glucose homeostasis. Testosterone increases insulin receptor expression and IRS expression and phosphorylation, this in turn enhances cellular response to insulin (Lee et al 2005).
There are several different models and methods that studied the effects of androgen, in some studies, it is noted that higher testosterone levels are associated with increased insulin resistance. For example in polycystic ovary syndrome, with high levels of testosterone, there are at higher risk of diabetes. In contrast, increased insulin resistance was found in both hypogonadotropic and hypogonadotropic men with hypoandrogenism, in Klinefelter’s syndrome and in Idiopathic gonadotropin deficiency (Lee at al 2005).
Insulin resistance is one of the important factors to consider in cases that leads to clinically established type 2 diabetes mellitus. In addition, men with type 2 diabetes have relative
hypogonadism. Therefore, supplementation with testosterone might play a role in improving both insulin resistance and hypogonadism (Pitteloud et al 2005).
Full essay here: Hypogonadism in Type 2 Diabetes Case Study