Testosterone, Diabetes, Blood Pressure and NCDs: Can TRT Help?

In family medicine I see the same picture again and again: a man aged 40–60 with belly fat, blood sugar starting to rise, blood pressure creeping up, snoring, and saying, "I've had no interest in sex lately." When we test his hormones, they are often low. The next question is whether topping up testosterone will make these conditions better. Based on current evidence, the answer is that it may help partly, but it is not a shortcut.

Why chronic disease and low testosterone often go together

• Belly fat contains a lot of the enzyme aromatase, which converts testosterone to oestrogen, and inflammatory substances from fat suppress the signals from the brain (read hormone imbalance in men).
• Insulin resistance makes the liver produce less SHBG, so total testosterone looks low, even though in some men free testosterone is still adequate (see SHBG).
• Sleep apnoea, which is common in people with obesity, suppresses hormones further.
• In the other direction, low testosterone reduces muscle, increases fat and lowers insulin sensitivity.

Studies have found that about 1 in 3 men with type 2 diabetes have low testosterone. The EAU guideline therefore recommends considering and testing for it in men with diabetes or obesity who have symptoms.

1. 1
   Belly fatMore aromatase; inflammatory signals suppress the brain
2. 2
   Insulin resistanceThe liver makes less SHBG
3. 3
   Sleep apnoeaSuppresses hormone a further layer
4. 4
   Low testosteroneLess muscle, more fat, less insulin sensitivity

About 1 in 3 men with type 2 diabetes has low testosterone.

Weight loss: the first treatment that really works

A meta-analysis by Corona and colleagues (Eur J Endocrinol, 2013) found that weight loss raises testosterone in proportion to the amount of weight lost, with weight-loss surgery giving the largest effect. The Endocrine Society's 2026 statement stresses that in overweight men with no other identified cause, weight loss should be the first option.

Today, GLP-1 receptor agonists, used to treat diabetes and obesity, can produce substantial weight loss, and testosterone has been reported to rise as weight falls. These medicines must be used as assessed and prescribed by a doctor. Read the details, cautions and side effects in GLP-1 weight-loss pens.

TRT and diabetes: what the evidence says

The two studies differ in who took part, the form of testosterone and whether a lifestyle programme was included. The fair conclusion is that TRT may add some benefit for certain men with genuinely low testosterone who are also changing their lifestyle, but it should not yet be used to prevent or treat diabetes directly. Diabetes medication must be continued as before.

TRT, blood pressure and the heart

• TRAVERSE did not find that TRT increased heart attacks or strokes in men at high cardiovascular risk, but it did find slightly more irregular heart rhythm (atrial fibrillation), blood clots in the lung and acute kidney injury.
• In 2025 the US FDA required all testosterone products to carry a warning that they may raise blood pressure.
• Men who already have high blood pressure therefore need it well controlled before starting, and must check it regularly during treatment (see TRT side effects).

A claim that needs correcting

Some older sources say "balanced hormones = fewer NCDs + slower ageing". That goes beyond the evidence. What TRT can genuinely do in men with low testosterone is help sex drive, mood, energy, anaemia and body composition to a moderate degree. Extending life, slowing ageing or reducing heart disease have not been proven by any study.

A whole-person care plan for men with chronic disease

1. Control the main conditions well: blood sugar, blood pressure and cholesterol, with the medicines your doctor prescribes.
2. Aim to lose about 5–10% of your weight at first, through diet, exercise and medication when indicated.
3. Get checked and treated for sleep apnoea.
4. Do resistance exercise at least 2 days a week, plus 150 minutes of aerobic exercise a week.
5. Review any medicines that suppress testosterone.
6. Have a fasting morning hormone test if you have symptoms, and consider TRT if levels are genuinely and persistently low.

Detailed day-to-day guidance is in supporting testosterone through sleep, diet and exercise.

1. 1Control main diseaseGlucose, blood pressure, lipids, with prescribed medicines
2. 2Lose 5-10% weightDiet, exercise, medicines when indicated
3. 3Protect sleepTest and treat sleep apnoea
4. 4ExerciseResistance 2 days/week + 150 minutes aerobic
5. 5Test hormonesIf symptomatic; consider TRT if repeatedly truly low

Endocrine Society (2026): if overweight with no other cause, weight loss is the first choice.

When to see a doctor, and how the clinic can help

See a doctor if you have diabetes, high blood pressure or belly fat together with lower sex drive, poor erections or tiring easily. Go to hospital straight away (or call 1669, Thailand's medical emergency number) if you have chest pain or tightness, breathlessness, or weakness in an arm or leg.

At Dr. Kris Clinic, as a family physician I can look after your chronic conditions and your sexual health together: testing hormones at the right time, planning weight loss and considering hormone or other treatment as clinically appropriate. Consultations are available at the clinic or online, in English.