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Exogenous testosterone treatment consistently reduces fat mass, increases muscle mass and improves insulin resistance in some studies, but the majority of currently available randomized controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s) do not report a consistent glycaemic benefit. In men with diabetes, testosterone treatment effects on androgen deficiency\u2010like clinical features are inconsistent, and effects on sexual dysfunction may be attenuated compared with men without diabetes. The long\u2010term risks of testosterone treatment in older men without medical disease of the hypothalamic\u2013pituitary\u2013testicular axis are not known. Current <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s are not definitive, owing to their small size, short duration and enrolment of men with mostly relatively good baseline glycaemic control not specifically selected for the presence of androgen deficiency symptoms. Although large, well\u2010designed clinical trials are needed, given the benefit\u2013risk ratio of testosterone treatment is not well understood, routine serum testosterone testing or testosterone treatment of asymptomatic men with Type 2 diabetes is currently not recommended. Carefully selected, symptomatic men with low testosterone who are informed of the lack of high\u2010level evidence regarding the long\u2010term benefits and risks of this approach may be offered a trial of testosterone treatment in combination with lifestyle measures, weight loss and optimization of comorbidities.<\/jats:p>","DOI":"10.1111\/dme.13977","type":"journal-article","created":{"date-parts":[[2019,4,21]],"date-time":"2019-04-21T13:44:22Z","timestamp":1555854262000},"page":"174-186","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Testosterone deficiency in men with Type 2 diabetes: pathophysiology and treatment"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5219-3241","authenticated-orcid":false,"given":"E. 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