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Steroids in Adult Men With Type 1 Diabetes

A tendency to hypogonadism

¹ Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, the Netherlands
² Department of Internal Medicine, VU Medical Centre, Amsterdam, the Netherlands
³ Institute for Research and Medicine, VU Medical Centre, Amsterdam, the Netherlands
⁴ Department of Clinical Chemistry, Leiden University Medical Center, Leiden, the Netherlands
⁵ Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands

OBJECTIVE—To compare steroids and their associations in men with type 1 diabetes and healthy control subjects.

RESEARCH DESIGN AND METHODS—We studied 52 adult men with type 1 diabetes without microvascular complications, compared with 53 control subjects matched for age and BMI. Steroids and their binding globulins were assessed in a single venous blood sample and a 24-h urine sample.

RESULTS—In adult men with type 1 diabetes, total testosterone did not differ from healthy control subjects, but sex hormone–binding globulin (SHBG) (42 [14–83] vs. 26 [9–117] nmol/l, P < 0.001), cortisol-binding globulin (CBG; 0.87 ± 0.17 vs. 0.73 ± 0.10 nmol/l, P < 0.001), and cortisol levels (0.46 ± 0.16 vs. 0.39 ± 0.14 nmol/l, P < 0.01) were higher. The free testosterone index was lower (60 [17–139] vs. 82 [24–200], P < 0.001), and the calculated free testosterone was slightly lower (497 [115] vs. 542 [130], P < 0.064), but the pituitary-gonadal axis was not obviously affected in type 1 diabetes. The calculated free serum cortisol was not different, and 24-h urinary free cortisol excretion was lower in type 1 diabetes (121 [42–365] vs. 161 [55–284] nmol/24 h, P < 0.009). Testosterone was mainly associated with SHBG. Estimated portal insulin was a contributer to SHBG in control subjects but not in type 1 diabetes. Cortisol was associated with CBG. HbA_1c contributed to CBG in men with diabetes but not in control subjects, whereas estimated portal insulin did not contribute.

CONCLUSIONS—Adult men with fairly controlled type 1 diabetes without complications who are treated with subcutaneous insulin have a tendency to hypogonadism, as reflected by lower free testosterone levels in the presence of similar total testosterone levels and higher SHBG levels.

Abbreviations: CBG, cortisol-binding globulin • DHEA, dehydroepiandrosterone • DHEAS, DHEA-sulfate • FSH follicle-stimulating hormone • LH, luteinizing hormone • SHBG, sex hormone–binding globulin • WHR, waist-to-hip ratio

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