Testosterone and abnormal glucose metabolism in an inner-city cohort

Background: Low testosterone (T) has been associated with insulin resistance and diabetes mellitus (DM) among men in population-based studies. These studies included racially diverse men, but did not target for inclusion individuals with opiate use, Hepatitis C Virus (HCV) infection, or Human Immunodeficiency Virus (HIV) infection, which disproportionately affect inner-city populations and may alter the relationship between T and DM. Methods: The association between free T (FT) and abnormal glucose metabolism was studied among male participants in the Study of HIV, Injection Drug Use, Nutrition, and Endocrinology (SHINE). Logistic regression was used to examine the relationship between log FT and both insulin resistance and prediabetes/DM. Results: Of 175 men, 43 (24.6%) had low levels of FT (< 52 pg/ml). There were more men in the low FT group on methadone maintenance (39.5% vs. 15.2%, P=. 0.001), but there was no difference in FT by HIV or HCV status. Overall, 23 men (13.1%) had prediabetes/DM, which was unrelated to FT (odds ratio (OR) of prediabetes/DM for each log increase in FT = 0.56, 95% Confidence Interval (CI) = 0.13-2.41). FT was also not related to insulin resistance. Conclusions: The prevalence of hypogonadism was high in this inner-city cohort and was associated with methadone use. However, low FT was not related to insulin resistance or prediabetes/DM. Continued work to identify diabetes risk factors among inner-city populations will help determine targets for intervention to reduce diabetes incidence. Treatment trials of testosterone to reduce diabetes among hypogonadal men may be of particular relevance to opiate users, many of whom are hypogonadal.