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\title{Serum Testosterone Levels in Type 2 Diabetes Mellitus Patients}
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             \author[1]{Abhishek  Vadher}

             \author[2]{Oluseyi  Abidoye}

             \author[3]{Bhargav  Muppaneni}

             \author[4]{Sarah Walter  John}

             \author[5]{Abhishek  Vadher}

             \author[6]{Rono  Korra}

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\date{\small \em Received: 6 December 2017 Accepted: 2 January 2018 Published: 15 January 2018}

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\begin{abstract}
        


Introduction: There is a high prevalence of low serum testosterone in type 2 diabetes mellitus patients. In this study, we tried to determine the level of serum testosterone in type 2 diabetes mellitus patients. Methods: A total of 241 patients were taken in the study. Out of this, 121 patients had type 2 diabetes mellitus and 120 were normal. For diagnosis of diabetes HbA1c level of ? 6.5 was taken. Serum testosterone levels were measured in all the participants. Results: The mean age of the participants was 46.95 ± 6.89 in diabetic patients and 45.86 ± 5.45 in the controls. The mean serum testosterone levels in the diabetes population was 312 ± 14.6 ng/dl and in the control population was 678 ± 17.5ng/dl. On applying chi square test, the p value was calculated to be 0.02. This shows the difference is statistically significant. Conclusion: Type 2 diabetes mellitus is associated with low levels of serum testosterone levels.

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{I. Introduction}]{I. Introduction}\par
t is estimated that 285 million people worldwide are affected by diabetes mellitus. By 2030, around 438 million people will be affected by diabetes mellitus. About 66\% of this population is in low to middle income countries \hyperref[b0]{(1)}. As compared to western population, Asian population has a much higher tendency to develop diabetes. This occurs at a younger age, at lower degrees of obesity and a much higher rate given for the same amount of weight compared to Western population \hyperref[b1]{(2)}.\par
Totaltestosterone is largely determined by circulating sex hormone binding globulin. In normal As shown in the table above, the baseline characteristics of all the participants are showed in the  
\section[{II. Materials and Methods}]{II. Materials and Methods}\par
A total of 121 patients were taken in the study who consistently attended the diabetes clinic from May 2017 to May 2018 were taken in the study. 120. For diagnosis of diabetes HbA1c level of ? 6.5 was taken. Serum testosterone levels were measured in all the participants. All calculations were done statistically. P value of <0.05 was considered to be statistically significant. Many studies have reported that there is a high prevalence of low serum testosterone in men with type 2 diabetes mellitus  {\ref (3, 4, and 5)}. Some studies have also showed a co-relation between reduced total testosterone and insulin resistance and then subsequent development of diabetes mellitus \hyperref[b5]{(6,}\hyperref[b7]{7)}. The symptoms of low serum testosterone are loss of libido, erectile dysfunction, reduced muscle mass, low energy, increased adiposity \hyperref[b9]{(8,}\hyperref[b10]{9)}. 40 ± 6.7. Average height was 168 ±5.3cm in the diabetic patients and 170 ± 4.2cm in the normal population. Average weight was 73 ± 6.5kgs in the diabetic patients and 69 ± 7.4 in the normal population. 66 patients with diabetes never smoked while 72 participants in the normal population were non-smokers. The number of former smokers in the diabetic patients and normal pupation was 12 and 10 respectively. Current smokers are 43/121 in the diabetic patients and 38/120 in the normal population. 39 patients in the diabetic population were hypertensives and 118 were normotensives. 2 patients were hypertensive in the normal population and 92 were normotensive. 17 patients had dyslipidaemia and 104 did not have dyslipidaemia in the diabetic population. 14 participants had dyslipidaemia and 106 participants did not have dyslipidaemia in the normal population. Mean duration of diabetes was 5.6 ± 1.67. Mean HbA1c was 7.8 ± 0.8 in the diabetic population and 4.7 ± 0.3 in the normal population. Serum testosterone level in the diabetic population was 312±14.6 ng/dl. In the normal population, it was 678±17.5ng/dl. After applying student t test, the p value was calculated to be 0.02. This is less than 0.05 which shows that the difference in the two group is significant and not due to chance. 
\section[{III. Results}]{III. Results} 
\section[{IV. Discussion}]{IV. Discussion}\par
Many studies have shown that about 25\% of patients with type 2 diabetes mellitus have low serum testosterone levels. About 4\% have subnormal testosterone concentrations with high FSH and H \hyperref[b11]{(10)}. Some studies have also shown that low serum testosterone is associated with diabetes related sexual dysfunction.\par
A study from Australia showed that 43\% of type 2 diabetes patients have total testosterone levels less than  {\ref 10 (11)}. A study from United Kingdom showed that 355 men with type 2 diabetes mellitus have total testosterone levels of less than 8 and 25\% had symptoms of hypogonadism associated with 8-12 total testosterone \hyperref[b14]{(12)}. 33.2\% type 2 diabetes patients had hypogonadism in a study in Egypt \hyperref[b15]{(13)}. A study from Brazil also showed that free testosterone and total testosterone levels were low in type 2 diabetes patients \hyperref[b16]{(14)}. The Endocrine society also recommends measuring the levels of testosterone of patients with type 2 diabetes on a regular basis \hyperref[b17]{(15,}\hyperref[b18]{16)}. Many cross-sectional and longitudinal studies have showed that with the increase in age the level of total testosterone reduces in men \hyperref[b19]{(17,}\hyperref[b21]{18,}\hyperref[b22]{19)}.\par
Many studies have also showed a co-relation between BMI and low serum testosterone levels in type 2 diabetes mellitus. However, these studies are controversial. Some studies have showed that the association between BMI and serum testosterone is significant \hyperref[b23]{(20,}\hyperref[b24]{21)}. On the contrary, there is also a study that has showed no co-relation between BMI and low testosterone \hyperref[b25]{(22)}.\par
There are many limitations of this study. It is a cross-sectional study and so we could not find the trend of the serum testosterone levels in the participants. From our study and conclusion, we can strongly say that an early universal screening program can help in diagnosis of low serum testosterone levels and testosterone supplementation can be started accordingly. We recommend that all patients of type 2 diabetes mellitus undergo screening for serum testosterone. A hormonal baseline can also be established for comparison in future follow-ups. 
\section[{V. Conclusion}]{V. Conclusion}\par
Type 2 diabetes mellitus is associated with low levels of serum testosterone levels in our study population with a p value significance of 0.02.\begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.69\textwidth}P{0.005555555555555556\textwidth}P{0.013333333333333332\textwidth}P{0.003333333333333333\textwidth}P{0.035555555555555556\textwidth}P{0.0044444444444444444\textwidth}P{0.09777777777777777\textwidth}}
\multicolumn{6}{l}{men, 54\% testosterone is bound to albumin and other}\tabcellsep \\
\multicolumn{6}{l}{proteins, 44\% is bound to sex hormone binding globulin}\tabcellsep \\
\multicolumn{6}{l}{and 2\% is in unbound state. Some studies believe that low levels of serum testosterone are associated with changes in the levels of FSH and LH. There is an ongoing controversy about whether the low serum levels}\tabcellsep Year 2018\\
of\tabcellsep serum\tabcellsep testosterone\tabcellsep are\tabcellsep associated\tabcellsep with\tabcellsep 21\\
\multicolumn{6}{l}{hypogonadotropic hypogondotrophoism or not. The study by Ali et all showed that in patients with diabetic neuropathy, low serum testosterone levels were associated with low FSH and low LH. In this study, we tried to find a co-relation between levels of serum testosterone and type 2 diabetes mellitus.}\tabcellsep Volume XVIII Issue III Version I\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep D D D D ) F\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep (\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep Medical Research\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep Global Journal of\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{© 2018 Global Journals}\tabcellsep \end{longtable} \par
 
\caption{\label{tab_0}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.48847402597402595\textwidth}P{0.19594155844155844\textwidth}P{0.16558441558441558\textwidth}}
\tabcellsep Diabetic\tabcellsep Normal\\
\tabcellsep Patients\tabcellsep Population\\
Age (yrs)\tabcellsep 42 ±5.7\tabcellsep 40 ±6.7\\
Height (cm)\tabcellsep 168 ±5.3\tabcellsep 170 ±4.2\\
Weight (kg)\tabcellsep 73 ±6.5\tabcellsep 69 ±7.4\\
Smoking : Never\tabcellsep 66\tabcellsep 72\\
Smoking : Former\tabcellsep 12\tabcellsep 10\\
Smoking: Current\tabcellsep 43\tabcellsep 38\\
Hypertension: Yes\tabcellsep 39\tabcellsep 2\\
Hypertension: No\tabcellsep 118\tabcellsep 92\\
Dyslipidaemia : Yes\tabcellsep 17\tabcellsep 14\\
Dyslipidaemia: No\tabcellsep 104\tabcellsep 106\\
Duration of Diabetes\tabcellsep 5.6 ±1.67\tabcellsep \\
Mean HbA1c\tabcellsep 7.8 ±0.8\tabcellsep 4.7 ±0.3\end{longtable} \par
 
\caption{\label{tab_1}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.329375\textwidth}P{0.24437499999999998\textwidth}P{0.159375\textwidth}P{0.116875\textwidth}}
\tabcellsep Type 2 Diabetes\tabcellsep Control\tabcellsep P Value\\
Serum\tabcellsep \tabcellsep \tabcellsep \\
Testosterone\tabcellsep 312±14.6\tabcellsep 678±17.5\tabcellsep 0.02\\
Levels (Ng/Dl)\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}Table 2 :}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\end{bibitemlist}
 			 		 	 
\end{document}
