AMA News Reports Breakthrough In Diabetes

Edward Lichten, M.D.,PC
180 East Brown Street
Birmingham, MI 48009 
248.593.9999

 

OVERVIEW: Testosterone Injections which have been available since before the F.D.A. was formed in 1939, are the newest and most powerful treatment in the war on diabetes, says Edward Lichten, M.D. of Birmingham, Michigan as reported in the American Medical News, November 13, 2006 page 32-34..

Control of Diabetes in Men Lichten says, is as simple as an injection of testosterone weekly to the diabetic, obese, hypertensive, high cholesterol and triglyceride laden, pre-cardiac disease-ridden male.  You will start to note improvement in glycemic (sugar) control in as little as 4 days with the maximum effect being reached in 4 months.  The most severe out-of-control diabetic can be converted from a major risk hazard based on glycogenated hemoglobin (HgB-A1c) of up to 18 to a very respectable lower risk 7-8 HgB-A1c in 20 weeks.  Complications associated with too tight control, using the short acting insulin instead of long-acting, missing meals and missing dosages of insulin do not strongly impinge the outcome demonstrated by Dr. Lichten in the videos from some of his success stories. "Expect that with repeated injections, the body both accumulates testosterone stores and acclimates to releasing glycogen as glucose to prevent low sugars hypoglycemia) thereby preventing most risks of  diabetic coma and death. Testosterone is a miracle drug, inexpensive, readily available and superior to even insulin for half the diabetic population (men)."

Which men are affected? As Lichten reported in the Wayne State University supported pilot study in 1997 and EL Ding at Harvard published in 3/2006 in JAMA, all diabetic men are testosterone deficient. This same deficiency applies to men with heart disease, obesity, high triglycerides and hypertension.  Adding back testosterone is not only logical, it makes perfect biological sense.  Doctors already add back thyroid to those with low thyroid, estrogen and progesterone to women in the menopause, and testosterone to men whose testicles are underdeveloped-- so why exclude diabetic men? Science is clear-- add back the testosterone to raise the serum to normal physiological levels and observe the positive changes for the testosterone deficient, and incidentally diabetic male.

How does it work? Lichten is one of the first to recognize that testosterone is a most potent insulin sensitizer working to make the insulin available 'more potent.'  It differs from prescription medications like glyburide, Actos and Avandia by not only sensitizing the cell to take in more sugar, but it works to allow the release of glycogen to glucose to prevent the blood sugar drops.  "It is an energy stimulant- moving sugar into and out of the cell to meet the male's ever varying needs." There is nothing like testosterone.

Is it painful? Since the needle used in testosterone injections are a little larger, they are injected into the buttock or the anterior-lateral thigh once weekly. The combination of testosterones is predicated by the doctors' need to balance the needs for testosterone and restrict the conversion to estrogen which will block testosterone effectiveness.  Rarely will anyone experience much discomfort from the injections. However for some unusually pain-sensitive individuals, applying an ice pack or topical anesthetic prior to the injections may be necessary.

What about side effects? The dose of testosterone used for diabetic  purposes is 1- 2x greater than the routine testosterone replacement dosage.  These dosages have not been linked to any significant side effect due to the fact that even large doses do not elevate the serum levels above routine physiologic levels.  The most common side effect of testosterone is an increase in a sense of well-being, reversal of anemia, improved mental attitude, increased muscle strength and better sex. The risk of prostate cancer is really a factor of low testosterone not high testosterone.  Patients are routinely monitored for their blood counts, prostate specific antigen, and glycogenated hemoglobin every 3 months when stable.

Any contraindications? We do not give injections to men with prostate or testicular cancer histories until cleared by their urologist.  Testosterone is the key hormone for men and is reported as beneficial in the prevention of Alzheimer's disease, Crohn's, osteoporosis, muscle wasting as well as stroke and heart attacks.

Alternatives: For those who have trouble with weekly injections, there is an FDA approved testosterone pellet that can be implanted in the buttock tissue monthly. These Testopel pellets are inserted in less than a minute and offer a stable, constant release that simplifies compliance. These are Dr. Lichten's treatment of choice.


Summary Position (from Kapoor): IT WORKS!
OBJECTIVE: Low levels of testosterone in men have been shown to be associated with type 2 diabetes, visceral adiposity, dyslipidaemia and metabolic syndrome. We investigated the effect of testosterone treatment on insulin resistance and glycaemic control in hypogonadal men with type 2 diabetes. DESIGN: This was a double-blind placebo-controlled crossover study in 24 hypogonadal men (10 treated with insulin) over the age of 30 years with type 2 diabetes. METHODS: Patients were treated with i.m. testosterone 200 mg every 2 weeks or placebo for 3 months in random order, followed by a washout period of 1 month before the alternate treatment phase. The primary outcomes were changes in fasting insulin sensitivity (as measured by homeostatic model index (HOMA) in those not on insulin), fasting blood glucose and glycated haemoglobin. The secondary outcomes were changes in body composition, fasting lipids and blood pressure. Statistical analysis was performed on the delta values, with the treatment effect of placebo compared against the treatment effect of testosterone. RESULTS: Testosterone therapy reduced the HOMA index (-1.73 +/- 0.67, P = 0.02, n = 14), indicating an improved fasting insulin sensitivity. Glycated haemoglobin was also reduced (-0.37 +/- 0.17%, P = 0.03), as was the fasting blood glucose (-1.58 +/- 0.68 mmol/l, P = 0.03). Testosterone treatment resulted in a reduction in visceral adiposity as assessed by waist circumference (-1.63 +/- 0.71 cm, P = 0.03) and waist/hip ratio (-0.03 +/- 0.01, P = 0.01). Total cholesterol decreased with testosterone therapy (-0.4 +/- 0.17 mmol/l, P = 0.03) but no effect on blood pressure was observed. CONCLUSIONS: Testosterone replacement therapy reduces insulin resistance and improves glycaemic control in hypogonadal men with type 2 diabetes. Improvements in glycaemic control, insulin resistance, cholesterol and visceral adiposity together represent an overall reduction in cardiovascular risk.

 


Martin's Video Interview

 


Two Million new diabetics are identified every year

 

 

Medical References

Eric L. Ding, BA; Yiqing Song, MD, ScD; Vasanti S Mali, MSc; Simin Liu MD.  Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Diabetes. JAMA 2006;295:1288-1299. Cross-sectional studies indicated that testosterone level was significantly lower in men with type 2 diabetes ....Similarly, prospective studies showed that men with higher testosterone levels (range, 449.6-605.2 ng/dL) had a 42% lower risk of type 2 diabetes

Shores MM. Low Serum testosterone and mortality in male veterans. Arch Intern Med. 2006 Aug 14;166(15):1660-5. After adjusting for age, medical morbidity, and other clinical covariates, low testosterone levels continued to be associated with increased mortality (hazard ratio, 1.88; 95% CI, 1.34-2.63; P<.001)

 

 

 

EUROPEAN ARTICLE 2006  TESTOSTERONE in DIABETIC MEN
paralleling Lichten's pilot study of 1997-1999

Kapoor D , Goodwin E , Channer KS , Jones TH.  Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity &  hypercholesterolaemia in hypogonadal men with type 2 diabetes.

European Journal of  Endocrinology, 154(6): 899-906   2006