METABOLIC SYNDRO ME
Testosterone and the metabolic syndrome – links and solutions Peter Foley GP
With a global epidemic in obesity, time is of the essence to make lasting improvements to patient care. Unsurprisingly, the rate of metabolic syndrome is also rising. Links are being made between low levels of testosterone and an increased risk of metabolic syndrome among men. While there has been a role for the administration of synthetic testosterone, a more holistic approach, whereby patients improve their diet and limit their physical inactivity, can also lead to improved health and reverse the metabolic syndrome. The holistic approach can improve compliance, adherence and lead to lasting change.
© Journal of holistic healthcare
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Having trained in the Peninsula College of Medicine and Dentistry, I pursued a career in general practice while also studying for an MSc in Sports and Exercise Medicine through the University of Bath. I have a passion for the promotion of lifestyle medicine, witness my instagram account (@drpeterjfoley. I write for the world’s largest low-carb website dietdoctor.com and am also on the advisory board for diabetes.co.uk. My MSc research is focused on the role of nutrition and exercise in pre-diabetes.
We are living in a time of worsening global health through a surge in modifiable illness. With reduced levels of daily physical activity and diets high in refined carbohydrate, we are seeing a rise in the rate of metabolic syndrome (MetS) among men globally. The role of testosterone remains crucial for men’s health, and we are continuing to learn more about the links between testosterone and MetS.
Testosterone Introduction Testosterone, the primary male sex hormone, is a naturally occurring androgen, produced in both the testes and adrenal glands, with anabolic and virilising effects, stimulating and controlling the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. Women also produce testosterone, however to a much lesser extent.
Symptoms Symptoms of reduced testosterone include decreased libido and sexual function, fatigue, muscle weakness and memory impairment. With such symptoms, clinicians can often overlook testosterone and focus on more
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common causes such as diabetes, depression or medication side-effects.
Physiology Many studies have shown age-related cross-sectional declines in total and/or Free Testosterone (FT) levels in men (Harman et al, 2001). Correlation studies have shown that visceral fat increases with age, with an inverse correlation between the amount of visceral fat and plasma insulin with levels of testosterone and sexhormone binding globulin (SHBG) (Kupelian et al, 2006). Approximately 50% of men in their 80s will have testosterone levels in the hypogonadal range. Correlation studies cannot distinguish between cause and effect relationships between whether low testosterone induces visceral fat deposition or whether a large visceral fat deposit leads to low testosterone levels. Prospective studies have confirmed that lower endogenous androgens predict central adiposity in men (Rosmond et al, 2003) and that these low testosterone levels are significantly inversely associated with levels of blood pressure, fasting plasma glucose, triglycerides, and body mass index and positively correlated with HDL-cholesterol (Zmuda et al, 1997). A five-year follow- up study of Swedish men
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