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Key Takeaways

• Low testosterone is linked to higher blood sugar and type 2 diabetes risk.
• TRT may improve insulin sensitivity and achieve diabetes remission in some men.
• Exercise, sleep, and balanced meals help regulate both blood sugar and testosterone levels.

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Testosterone is the primary male (androgen) hormone that regulates many body functions, primarily managing sex differentiation and development, which results in male characteristics such as male hair patterns, muscle and bone growth, fertility, and the production of red blood cells.¹��

If testosterone levels are too low or drop rapidly with aging, undesirable side effects can occur, such as altered sexual development, lower bone density, reduced muscle mass, increased fat production, and alterations in glucose and insulin metabolism.^1,2��

Researchers have found that there is an association between testosterone levels, fasting glucose levels, and the risk of type 2 diabetes, which is more pronounced in men than women.��

This article explains how testosterone and blood sugar interact and how imbalances can affect proper insulin and glucose metabolism in men. It also discusses the role of testosterone replacement therapy (TRT) in managing testosterone and glucose levels. Learn research-backed lifestyle strategies for managing both blood sugar and testosterone levels.��

Understanding Testosterone and Its Role in the Body

Testosterone is the hormone primarily responsible for the development of male sexual differences and characteristics, including testicular descent, sperm production, and fertility.¹

However, testosterone has essential functions beyond reproductive health, influencing muscle mass, fat production, and metabolism. Testosterone plays a crucial role in promoting bone growth and muscle development during puberty. The hypothalamic-pituitary-gonadal axis regulates testosterone levels throughout the lifespan.¹��

The effects of testosterone are seen as early as the first six weeks of fetal development, then spiking during puberty, and peaking in the 30s with a slow decline afterwards.¹��

As testosterone levels decline with age, men tend to experience a decrease in testicular size (hypogonadism), lower bone density, a decline in muscle mass, and an increase in body fat production. Some men may have less than optimal testosterone levels, accelerating these effects.¹

Researchers have also observed testosterone’s influence on glucose and insulin. Low serum testosterone levels are strongly related to the development of type 2 diabetes and metabolic syndrome in men.²��

Research suggests a complex relationship in that both testosterone and high glucose levels impact each other. Furthermore, excess weight, particularly abdominal fat, has a negative impact on testosterone and glucose levels. Adequate testosterone helps the body to regulate and achieve optimal glucose levels.²

How Testosterone Affects Blood Sugar Levels

After consuming foods or drinks containing carbohydrates, your body breaks them down into glucose. Your body transfers this glucose to the bloodstream, and your blood glucose (blood sugar) level rises after eating.³��

Your pancreas responds by releasing insulin. Insulin is a hormone that helps transport glucose (sugar) from the blood to various cells and body systems that require energy.⁴��

Glucose levels and insulin work together to maintain an appropriate balance of blood sugar levels after eating, allowing energy to be distributed where it is needed.��

However, blood glucose levels can remain elevated due to excessive carbohydrate intake and/or insulin resistance. Insulin resistance occurs when cells don’t respond well to the released insulin, resulting in glucose not being delivered to the cells that require it. The pancreas produces more insulin to help maintain blood sugar levels within normal limits.^3,4��

Over time, the cells cease to respond, leading to high blood sugar (impaired glucose metabolism) and elevated insulin levels.^2,3,4��

Testosterone also influences blood glucose and insulin levels. A 2019 study of 2,775 adults across a wide age span found that men with higher testosterone levels had lower fasting glucose levels and improved insulin sensitivity. Each one-unit increase in testosterone was associated with a 17% lower risk of impaired fasting glucose and a 27% lower risk of type 2 diabetes. Conversely, men with lower testosterone levels had higher rates of impaired glucose metabolism and type 2 diabetes.²��

The Impact of High Blood Sugar on Testosterone Production

The “chicken or egg” metaphor applies to high blood sugar and low testosterone levels, as it’s challenging to determine which of the two events came first or caused the other.��

Currently, researchers recognize that both factors influence each other and can lead to an unhealthy cyclical relationship of low testosterone leading to high blood sugar and high blood sugar levels further reducing testosterone levels.^2,5��

Chronic high blood sugar levels (leading to insulin resistance) may suppress testosterone production, further reducing testosterone levels.⁵��

A large body of research indicates that decreased serum testosterone levels are associated with higher-than-normal glucose levels, impaired fasting glucose levels, and an increased risk of type 2 diabetes.^2,5��

Type 2 diabetes is a progressive disease, making it essential to monitor blood sugar levels regularly and watch for upward trends over time. Keeping an eye on both blood glucose and testosterone levels may help prevent or delay the harmful effects of high blood sugar, insulin resistance, and the onset of type 2 diabetes.

Testosterone Replacement Therapy (TRT) and Glucose Control

A logical next step is to consider testosterone replacement therapy (TRT) to improve insulin sensitivity and glycemic control in men with low testosterone and type 2 diabetes.��

Researchers have found that testosterone treatment can enhance the way insulin works in the body and repair cells in the pancreas.²

Recent treatment guidelines recommend TRT when total testosterone levels are below 8nmol/L; however, researchers indicate the prevalence of abnormal glucose levels in men with higher testosterone levels.⁵

A 2020 study published in Diabetes, Obesity, and Metabolism followed 356 men with type 2 diabetes and low testosterone levels (≤12.1 nmol/L). Those receiving TRT showed improved glycemic control and insulin sensitivity. Over one-third achieved full diabetes remission, while another 46.6% reached normal glucose regulation.��

In contrast, the control group (who did not receive TRT) saw increases in fasting glucose, hemoglobin A1c, and insulin, with no reported remissions or improvements in blood sugar control.⁶��

This study reported no serious adverse effects of long-term (12 years) testosterone replacement therapy (TRT) and fewer deaths than the control group.⁶��

More research is needed to discover how TRT can assist with blood sugar regulation, along with slowed progression (and even remission) of type 2 diabetes, and to ensure there are no long-term risks. Researchers think that testosterone helps preserve β‐cells in the pancreas and optimizes insulin production while reducing inflammation.⁶��

Risks and Considerations of TRT

While TRT may have beneficial effects, potential risks and existing health conditions should be taken into consideration.

Major risk factors of TRT include the following:

• Worsening benign prostate hyperplasia (BPH) or enlarged prostate gland
  
  • Studies have shown that the prostate gland increases in size by 12%, but with no symptom or urinary frequency increase.⁷��
• Exacerbation of prostate cancer in men with untreated prostate cancer on active surveillance⁷
• Possible increased risk of male breast cancer⁷��
• Polycythemia (increased number of red blood cells leading to thickened blood)
  
  • Testosterone increases hemoglobin by up to 5-7%, alleviating anemia in men, with about 20% taking TRT resulting in polycythemia, which could lead to more frequent vascular and heart disease and events (stroke, heart attack, and blood clots). Baseline complete blood counts should be monitored throughout TRT.⁷
• Increased risk of obstructive sleep apnea
  
  • Not fully understood, and there are mixed results from studies where this occurs in men taking TRT.⁷��

Other risk factors include:

• Increased fluid retention and is contraindicated in men with certain types of kidney disease, but is typically mild.
• Infertility due to decreased sperm development (supplemented testosterone prohibits the release of other essential hormones regulating this process)
• Occasionally, excess testosterone is converted to estrogen and may lead to excess breast tissue and abdominal obesity.
• Acne

The most recent research indicates that heart issues are not directly linked to testosterone replacement therapy (TRT); however, regular monitoring of blood counts can provide valuable insights and help your medical provider determine when you need to pause or discontinue TRT.

Expecting TRT to treat high glucose levels, insulin resistance, or type 2 diabetes alone is faulty. Work with your healthcare provider and a dietitian to manage your diabetes using a combination of medications, diet, and exercise alongside testosterone replacement therapy (TRT).��

Lifestyle Strategies to Balance Testosterone and Blood Sugar

Lifestyle changes can also help you achieve better health for your testosterone and blood sugar levels.��

Research has shown that excess abdominal weight, inactivity, and high consumption of simple carbohydrates, such as soda, sweet tea, and processed foods, can make it harder to manage blood sugar levels.²��

Provide actionable tips for men to naturally boost testosterone levels and maintain healthy blood sugar, including:

Regular exercise can help to increase muscle mass and reduce abdominal fat.��

Researchers have found that reducing waist circumference helps lower fasting blood glucose levels. Additionally, higher waist circumference is associated with lower testosterone and higher blood sugar levels.²

Exercising three to four times a week has been associated with a stable elevation in testosterone levels. Research also shows that testosterone temporarily rises after exercise (strength training, interval training, and moderate aerobic exercise) as well.⁸��

Reduce sugar-sweetened beverage intake.

A 2019 study of 545 adult males aged 20 to 39 years found that increased intake of sugary beverages and a body mass index (BMI) greater than 25 were significantly associated with low testosterone levels.⁹��

High intake of sugar-sweetened beverages (1-2 daily)�� is strongly associated with developing type 2 diabetes, one study found up to a 26% greater risk.¹⁰��

Aim for a balanced diet for blood sugar maintenance and healthy hormonal health (including testosterone).^8,11��

The American Diabetes Association (ADA) recommends the Diabetes Plate Method to build balanced meals that support stable blood sugar levels.����

Divide a 9-inch plate into three sections: one-half is non-starchy vegetables, such as lettuce, tomatoes, and broccoli; one-quarter is protein foods such as fish, chicken, and lean beef; and one-quarter is foods with high-fiber carbohydrates such as fruit, sweet potatoes, whole grains, oats, and beans. Beverages include water and other no-calorie, low-sugar drinks.¹¹��

Try incorporating stress management strategies to help reduce the strain health conditions like insulin resistance, diabetes, and hormonal imbalances exert on your body. A 2022 review article shares the strong relationship between stress and insulin resistance.¹²��

Try stress-reducing activities such as mindfulness, being active, volunteering, journaling, mental health counseling, getting support and community, as well as practicing restful sleep.��

Optimize restorative sleep

Restorative sleep is often overlooked as a valuable treatment or management tool for various health conditions.��

A 2022 systematic review investigated the connection between sleep, obesity, and type 2 diabetes. Researcher found that poor sleep, whether due to short duration, deprivation, or frequent waking, can lead to weight gain and increased insulin resistance.¹³��

Some studies have shown that well-rested individuals lost more body weight than those with poor sleep on the same calorie-restricted diet. For most people, aiming for at least seven hours nightly was restorative.¹³��

The Bottom Line

Testosterone and blood sugar levels are closely interconnected. Imbalances in one often exacerbate imbalances in the other.��

Regularly monitoring both testosterone and blood glucose levels, along with lifestyle changes such as increased exercise, balanced eating, stress management, and quality sleep, can help improve metabolic and hormonal health.��

Talk to your healthcare provider about personalized treatment plans that may include testosterone replacement therapy (TRT) or diabetes medications to help reduce the risk of type 2 diabetes and support long-term health.��

Learn More With 91�������’ Expert Advice

Maintaining healthy blood sugar levels, alongside testosterone levels, is essential for long-term health in men.

A continuous glucose monitor (CGM) enables you to track your blood sugar levels in real-time, helping you understand how diet, food choices, hormones, and exercise impact your body and blood sugar levels. These positive changes can help you improve your health, prevent type 2 diabetes, and improve your overall health.

Learn more about glucose levels on 91�������’ blog, written by health and nutrition experts.