What do central obesity, high blood pressure, and low testosterone have in common?
These are all characteristics of metabolic syndrome.
Presenting with these issues puts people on a slippery slope toward cardiovascular disease and Type II Diabetes. The diagnostic criteria for metabolic syndrome include high insulin and high blood sugar, increased body mass, high triglycerides, high blood pressure, and low high-density lipoprotein (HDL).
With your male patients, you should monitor for hypogonadism, or low testosterone, which is emerging as a central feature of metabolic syndrome. Individuals with hypogonadism have an increased likelihood of experiencing a cardiovascular event. Unfortunately, hypogonadism is underdiagnosed in primary care.
Nearly 35% of Americans have metabolic syndrome and 50% of Americans over the age of 60 have metabolic syndrome. In fact, some researchers suggest that patients with signs of low testosterone (such as those with erectile dysfunction), seeking treatment for sexual dysfunction, are lucky because it presents an opportunity to address their overall metabolic health—before it’s too late.
Though it can be costly, it’s important to evaluate for hormone insufficiency in people with metabolic syndrome. Regardless of what diseases we associate it with, metabolic syndrome could be indicative of a wider spread imbalance across your patient’s hormone systems.
There are different categories of hormones to consider.
With a patient exhibiting signs of metabolic syndrome, you’ll investigate hormone levels like insulin and those produced by the thyroid and adrenal glands. Up until recently, sex hormones like progesterone, estrogen, and testosterone have existed in a diagnostic silo apart from metabolic ones. Physicians have tended to approach metabolic syndrome with a narrow focus on mitigating the symptoms associated with Type II Diabetes.
A diagnosis is like opening a door. It’s not the end of the process, but the beginning.
Once you’ve identified parts of a system that need rebalancing, you should evaluate the whole. Unfortunately, that often mean a lot of tests, but there are strategic ways to check the whole system without putting too much financial pressure on patients.
For instance, you could track cortisol levels and testosterone levels, imbalances in both are commonly seen with blood sugar irregularities.
It’s also not uncommon for physicians to choose a known diagnosis over continuing to evaluate.
If insulin resistance is observed, then physicians often assume the patient has Type II Diabetes. Instead of some hasty diagnoses, we need to broaden the scope of the assessment once metabolic syndrome or Type II Diabetes is detected.
If the patient is demonstrating insulin resistance, take a look at their testosterone levels. They could be low, too. Identifying and treating low testosterone can have a huge impact on your patient’s quality of life. People really feel the difference when you can normalize their testosterone levels.
Many healthcare practitioners have long documented the correlation they’ve observed in patients with ED that also have metabolic/blood sugar issues. Recognizing this connection and considering it when crafting a care plan could make all the difference for those patients that are experiencing this crossover of testosterone/blood sugar imbalance.
The debate lives on about whether insulin resistance decreases testosterone, low testosterone increases insulin resistance, or both. Ultimately, it seems like a systemwide breakdown in metabolic, hormonal, and endothelial function.
The outcome is metabolic syndrome, cardiovascular dysfunction, hormone imbalance, and vascular abnormalities. Given that we don’t know what causes what, addressing both metabolic and hormonal imbalance is a wise strategy. Additionally, some research has found a connection between increased testosterone levels and increased insulin sensitivity, which is a good thing for Type II Diabetics regardless.
Treating blood sugar abnormalities in your patients may help normalize their hormone levels and vice versa. The Mediterranean Diet has been shown to reduce blood sugar, insulin, blood lipids, blood pressure, and improve erectile function. Patients with blood sugar imbalance may also benefit from a hormone work-up. Restoring normal hormones can improve metabolic syndrome and CVD and diabetes. Clinicians can support a patient’s internal physiology to improve metabolic, hormonal, and vascular function using natural agents in conjunction with lifestyle factors.
A holistic look at your patient’s health is always encouraged. It’s tempting to jump to a diagnosis and care plan when you find symptoms associated with blood sugar imbalances. Instead of stopping there, work with your patient to thoroughly evaluate and address the broader issue of their hormone health.
[1] Plant Foods for Human Nutrition, June 2007, Volume 62, Issue 2: 59–63