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. 2014 Nov 3;6(2):112–123. doi: 10.1111/jdi.12288

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© 2014 The Authors. Journal of Diabetes Investigation published by Asian Association of the Study of Diabetes (AASD) and Wiley Publishing Asia Pty Ltd

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Dysregulation of the hypothalamic-pituitary-gonadal axis due to genetic-environmental interactions can lead to low testosterone causing changes in body composition resulting in insulin resistance and low grade inflammation to increase cardiovascular risk. This abnormal metabolic milieu can alter level of sex hormone binding globulin to reduce the bioavailability of testosterone. Reduced erythropoiesis due to low testosterone may be associated with activation of cell cycle signaling pathways such as angiotensin II to further increase cardiovascular risk. On the other hand, variability in assay standards can confound the accuracy and interpretation of free and total testosterone level. FSH, follicular stimulating hormone; LH, luteinizing hormone; LHRH, luteinizing-hormone-releasing hormone; TGF-β, transforming growth factor-beta.