Profile and Role of Serum Hypothalamic-Pituitary-Testicular-Axis Hormones on Sexual Function of Older Men with Type-2 Diabetes


  • Babatunde Ishola Gabriel Adejumo Department of Medical Laboratory Science, University of Benin, Benin-City, Nigeria
  • Grace Umahi-ottah Department of Physiology, Ebonyi State University, Abakaliki, Nigeria.
  • fidelis oyakhire Department of chemical pathology ,Irrua Specialist Teaching Hospital,Irrua, Edo State, Nigeria
  • Olufunke Victoria Aiyegbusi Department of Nursing Science, College of Health Sciences, Joseph Ayo Babalola University, Ikeji Arakeji, Osun state, Nigeria
  • Uchechukwu Dimkpa Physiology Department, Nnewi Campus, Nnamdi Azikiwe University, Awka, Nigeria
  • Oladimeji Nasiru Abdulrahman Department of Medical Laboratory Science, College of Health Technology, Offa, Kwara state, Nigeria
  • Emmanuel Ojeideleko Akhaumere Department of Chemical pathology, National Hospital, Abuja, Nigeria
  • Simon Uzor Department of Medical Laboratory Science, Ebonyi State University, Abakaliki, Abonyi state, Nigeria



Little information is available on the complex endocrinology of sexual dysfunction, which is frequently associated with ageing and diabetes. We wanted to examine the serum profile of hypothalamic-pituitary-testicular-axis (HPTA) hormones and how they relate to sexual function in older men with type-2 diabetes. This study included 74 participants (44 type-2 diabetics and 30 healthy controls). The enzyme-linked immunosorbent assay (ELISA) method was used to measure serum levels of total testosterone (Te), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL). Compared to controls, diabetic patients had significantly higher FSH and PRL levels but lower Te levels. Testosterone was found to be significantly correlated with sexual intercourse frequency (p<0.01), erectile function, and libido (p< 0.001). We discovered significant (p < 0.001) relationships between libido, penile erection, and FSH, as well as between PRL and libido (p< 0.05). When compared to the other hormones, testosterone had the strongest associations with the frequency of sexual intercourse (p< 0.05), libido (p< 0.05), and penile erection (p< 0.01). Our findings indicated that HPTA hormones might have a significant influence on sexual functions in type-2 diabetic patients, with Te being the most important HPTA hormone influencing sexual functions in diabetic patients. This study, therefore, helps to clarify the complex endocrinology and physiology of the sexual dysfunction frequently observed in older men with type-2 diabetes and also supports the use of testosterone replacement therapy in older diabetic adults.


Almihy, N.F., Eissa, E.A., Amer, E.R., El-Assal, M. (2015). Diabetes mellitus link with hypogonadism in male patients with type 2 diabetes mellitus aged 40-50 years. Benha Medical Journal; 32: 29-35.

American Diabetes Association (2013). Diagnosis and Classification of Diabetes Mellitus. Diabetes Care; 36 (Suppl 1): s67 – s74.

Baccetti, B., Marca, A., Piomboni, P., Capitani, S., Bruni, E., Petraglia, F., De Leo, V. (2002). Insulin-dependent diabetes in men is associated with hypothalamo-pituitary derangement and with impairment in semen quality. Human Reproduction;17 (10):2673–2677.

Ballister, J., Carmen Munoz, M., Dominguez, J., Rigau, T., Guinovart, J., Rodriguez-Gil, J. (2004). Insulin-Dependent Diabetes Affects Testicular Function by FSH-and LH-Linked Mechanisms. Journal of Andrology; 25: 705-719.

Berinder, K., Nystrom, T., Hoybye, C., Hall, K., Hulting, A.L. (2011). Insulin sensitivity and lipid profile in prolactinoma patients before and after normalization of prolactin by dopamine agonist therapy. Pituitary; 14: 199 207.

Caronia, L.M., Dwyer, A.A., Hayden, D., Amati, F,. Pitteloud, N., Hayes, F.J. (2013). Abrupt decrease in serum testosterone levels after an oral glucose load in men: implications for screening for hypogonadism. Clinical Endocrinology; 78: 291–296.

Caticha, O., Norato, D.Y., Tambascia, M.A., Santana, A., Stephanou, A., Sarlis, N.J. (1996). Total body zinc depletion and its relationship to the development of hyperprolactinemia in chronic renal insufficiency. Journal Endocrinology Investigation; 19: 441–448.

Cleveland Clinic Sexual dysfunction. Cleveland Clinic medical professional (2015). Available at on the 18th August, 2020.

Corradi, P.F., Corradi, R.B.& Greene, L.W. (2016). Physiology of the Hypothalamic Pituitary Gonadal Axis in the Male. Urologic Clinics of North America; 43: 151-162.

Deshpande, A.D., Harris-Hayes, M., Schootman, M. (2008). Epidemiology of diabetes and diabetes related complications. Physiology Therapy; 88(11): 1254-64.

Dhindsa, S., Prabhakar, S., Sethi, M., Bandyopadhyay, A., Chaudhuri, A., Dandona, D. (2005). Frequent occurrence of hypogonadism in type 2 Diabetes. Journal of Clinical Endocrinology Metabolism; 90: 1903

Emmanuelle, M., & Emmanuelle, M.A. (1997). Endocrine System. Alcohol Health Res World; 21(1): 53–64.

Ewing, D.J. (2011). Sexual dysfunction in diabetic men. Practical Diabetes International; 2(2): 6-9.

Foster, R.S., Mulcahy, J.J., Callaghan, J.T., Crabtree R., Brashear D. l. (1990). Role of serum prolactin determination in evaluation of impotent patient. Urology; 36: 499–501.

Gades, N.M., Jacobson, D.J., McGree, M.E., St Sauver J.L., Lieber M.M., Nehra A., Girman C.J., Klee G.G., Jacobsen S.J. (2008). The associations between serum sex hormones, erectile function, and sex drive: The Olmsted County Study of Urinary Symptoms and Health Status among Men. Journal of Sex Medicine; 5(9): 2209-2220.

Gandhi, J., Dagur, G., Warren, K., Smith, N., Khan, S.A. (2016). Effect of Diabetes Mellitus on Sexual Arousal and Intercourse. Translate Biomedice; 7: 2; 5-7.

George, J.T., Veldhuis, J.D, Tena-Sempere, M., Millar, R.P., Anderson, R.A. (2013). Exploring the pathophysiology of hypogonadism in men with type 2 diabetes: Kisspeptin-10 stimulates serum testosterone and LH secretion in men with type 2 diabetes and mild biochemical hypogonadism. Clinical Endocrinology (Oxf); 79: 100–104.

Gerra, G., Manfredini, M., Somaini, L., Maremmani, I., Leonardi, C., Donnini, C. (2016). Sexual dysfunction in men receiving methadone maintenance treatment: clinical history and psychobiological correlates. European Addiction Research; 22(3): 163-175

Gianatti, E.J., Grossman, M. (2020). Testosterone deficiency in men with Type 2 diabetes: pathophysiology and treatment. Diabetic Medicine; 37(2): 174 – 186.

Griffin, J.E., Wilson, J.D. (1997). Disorders of the testes. In Fauci AS, Martin JB, Braunwald E, Kaspar DL, Isselbacher KJ, Hauser SI eds, Harrison’s Principles of Internal Medicine, 1997.

Hair, W.M., Gubbay, O., Jabbour, H.N., Lincoln, G.A. (2002). Prolactin receptor expression in human testis and accessory tissues: localization and function". Molecular Human Reproduction; 8(7): 606–11. doi:10.1093/molehr/8.7.606.

Hairing, R., Baumeister, S.E., Volzke, H., Dorr, M., Felix, S.B., Kroemer, H.K., Nauck, M., Wallaschofski, H. (2011). Prospective association of low total testosterone concentrations with an adverse lipid profile and increased incident dyslipidemia. European Journal of Cardiovascular Prevention and Rehabilitation; 18: 86–96.

Hirsch, I.H. (2019). Male Hypogonadism.In Male Reproductive Endocrinology and Related Disorders. MSD Manual. Accessed on 2nd September, 2020.

Hong, C.Y., Park, J.H., Ahn, R.S., Im, S.Y., Choi, H.S., Soh, J., Mellon, S.H., Lee, K. (2004). Molecular mechanism of suppression of testicular steroidogenesis by proinflammatory cytokine tumor necrosis factor alpha. Molecular and Cellular Biology; 24: 2593–2604.

Kizilay, F., Gali, E.E., Serefoglu, E.C. (2017). Diabetes and sexuality. Sexual Medicine Review; 5(1): 45-51. DOI:

LaPensee, C.R., Horseman, N.D., Tso, P., Brandebourg, T.D., Hugo, E.R., Ben Jonathan, N. (2006). The prolactin deficient mouse has an unaltered metabolic phenotype. Endocrinology; 147: 4638 45

Lue, T.F., Brant, W.O., Shindel, A., Bella, A.J. (2000). Sexual Dysfunction in Diabetes. In: Feingold KR, Anawalt B, Boyce A., editors. Endotext (Internet). South Dartmouth (MA):, Inc.; -. Available from: Assessed 18th August, 2020.

Lyons, D.J., Hellysaz, A., Broberger, C. (2012). Prolactin regulates tuberoinfundibular dopamine neuron discharge pattern: Novel feedback control mechanisms in the lactotrophic axis. Journal of Neuroscience; 32: 8074 83.

McCrory, M.A., Nommsen-Rivers, L.A., Mole, P.A., Lo¨ nnerdal, B., Dewey, K.G. (1999). Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. American Journal Clinical Nutrition; 69: 959–967’

Mitsuhashi, K., Senmaru, T., Fukuda, T., Yamazaki, M., Shinomiya, K., Ueno, M., Kinoshita, S., Kitawaki, J., Katsuyama, M., Tsujikawa, M. (2016). Testosterone stimulates glucose uptake and GLUT4 translocation through LKB1/AMPK signalling in 3T3-L1 adipocytes. Endocrine; 51: 174–184.

Mooradian, A.D, Morley, J.E, Billington, C.J., Slag, M.F., Elson, M.K., Shafer, R.B. (1985). Hyperprolactinaemia in male diabetics. Postgraduate Medical Journal; 61(711): 11–14.

Moretto, V.L., Ballen, M.O., Goncalves, T.S., Kawashita, N.H., Stoppiglia, L.F., Veloso, R.V., Latorraca, M.Q., Martins, M.S., Gomes-da-Silva, M.H. (2011). Low-protein diet during lactation and maternal metabolism in rats, ISRN Obstetrictics Gynecology; 87650

Natah, T.M., Wtwt, M.A., Al-Saadi, H.K., Al-Saadi, A.H., Farhood, H.F. (2013). Study the levels of adiponectin, FSH, LH and sex hormones in Type 2 diabetes (NIDDM) Journal of Biology, Agriculture and Healthcare; 3: 172-81.

O'Connor, D.B., Lee, D.M., Corona, G., Forti G., Tajar A., O'Neill T.W., Pendleton N., Bartfai G., Boonen S., Casanueva F.F., Finn J.D., Giwercman A., Han T.S., Huhtaniemi I.T., Kula K., Labrie F., Lean M.E., Punab M., Silman A.J., Vanderschueren D., Wu F.C. (2011). The relationships between sex hormones and sexual function in middle-aged and older European men. Journal of Clinical Endocrinology Metabolism; 96(10): E1577–1587.

Onah, C.E, Meludu,S.C, Dioka C.E, Onuegbu J.A, Amah U.K, Olisekodiaka M.J, Okwara J.E, Onah C.F, Ezeugwunne I.P.(2013). Pattern of male sex hormones in type 2 diabetic patients in Nnewi, South Eastern Nigeria. IOSR Journal of Dental and Medical Sciences, 10 (4): 65-70.

Penson, D.F & Wessells, H. (2004). Erectile Dysfunction in Diabetic Patients. Diabetes Spectrum; 17(4): 225-230.

Rasheed, H.A., Al-Kuraishy, H.M., Al-Gareeb, A.I., Hussien, N.R, and Al-Nami, M.S. (2019). Effects of diabetic pharmacotherapy on prolactin hormone in patients with type 2 diabetes mellitus: Bane or Boon. Journal of Advance Pharmacology Technology Research; 10(4): 163–168.

Rezvani, M.R., Saadatjoo, S.A., Sorouri, S. & Fard, M.H. (2012). Comparison of Serum Free Testosterone, Luteinizing Hormone and Follicle Stimulating Hormone Levels in Diabetics and Non-Diabetics Men- a Case-Control Study. Journal of Research in Health Sciences;12(2): 98-100.

Rosen, E.D. (2004). Low testosterone in Type 2 Diabetes: A hidden epidemic.; Available at article&id=2324. Assessed on 17/9/2020.

Saller C.F., Saller L.A. (1980). Glucose suppresses basal firing and haloperidol-induced increases in the firing rate of central dopaminergic neurons. Science; 210: 1269.

Sato,K., Iemitsu, M., Aizawa, K., Ajisaka, R. (2008)Testosterone and DHEA activate the glucose metabolism-related signalling pathway in skeletal muscle. American Journal of Physiology: Endocrinology and Metabolism; 294 E961–E968.

Schmitt, C.S., Rhoden, E.L., Almeida, G.L. (2011). Serum levels of hypothalamic-pituitary-testicular axis hormones in men with or without prostate cancer or atypical small acinar proliferation. Clinics; 66(2):183-187.

Seethalakshmi, L., Menon, M., Diamond, D. (1987). The effect of streptozotocin-induced diabetes on the neuroendocrine-male reproductive tract axis of the adult rat. Journal of Urology; 138:190-194.

Senmaru, T., Fukui, M., Okada, H., Mineoka, Y., Yamazaki, M., Tsujikawa, M., Hasegawa, G., Kitawaki, J., Obayashi, H., Nakamura, N. (2013). Testosterone deficiency induces markedly decreased serum triglycerides, increased small dense LDL, and hepatic steatosis mediated by dysregulation of lipid assembly and secretion in mice fed a high-fat diet. Metabolism-Clinical and Experimental; 62: 851–860.

Stanworth, R.D., & Jones, T.H. (2009a). Testosterone in obesity, metabolic syndrome and type 2 diabetes. Front Hormone Research; 37: 74-90.

Stanworth, R.D., Kapoor, D., Channer, K.S., Jones, T.H. (2009b). Statin therapy is associated with lower total but not bioavailable or free testosterone in men with type 2 diabetes. Diabetes Care; 32(4): 541-6.

Sussman, E.M., Chudnovsky, A., Niederberger, C.S. (2008). Hormonal evaluation of the infertile male: has it evolved? Urology Clinical North America; 35: 147-55, DOI. 10.1016/j.ucl.2008.01.010.

Tekaa, S., Kindeb, S., Dedefob, G., Mudicand, K., Tarekegn, G.(2019). Hypogonadism and associated risk factors in male patients with type 2 diabetes mellitus attending the diabetic clinic of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. Journal of Endocrinology, Metabolism and Diabetes of South Africa; 24(1):16–22.

Trajanovska, A.S., Vujovic, V., Ignjatova, L., Janicevicivanovska, D., Cibisev, A. (2013). Sexual dysfunction as a side effect of hyperprolactinemia in methadone maintenance therapy. Medical Archieve; 67(1): 48

Tsai, E.C, Boyko, E.J., Leonetti, D.L., Fujimoto, W.Y(2000). Low serum testosterone level as a predictor of increased visceral fat in Japanese-American men. International Journal Obesity Relation Metabolism Disorder; 24: 485 – 491.

Tsai, E.C., Matsumoto, A.M., Fujimoto, W.Y., Boyko, E.J. (2004). Association of bioavailable, free, and total testosterone with insulin resistance: influence of sex hormone-binding globulin and body fat. Diabetes Care; 27: 861–868.

Ujah, G.A., Nna, V.U., Agah, M.I., Omue, L.O., Leku, C.B., Osim, E.E. (2017). Effect of quercetin on cadmium chloride-induced impairments in sexual behaviour and steroidogenesis in Wistar rats. Andrologia; 50(2). doi: 10.1111/and.12866.

United State Institutes of Health. (2019). SEER Training Modules, Male Sexual response and Hormonal Control, National Cancer Institute. Day 10 Month April Year 2019 (of access)

Watanobe, H., Hayakawa, Y. (2003). Hypothalamic interleukin-1 beta and tumor necrosis factor-alpha, but not interleukin-6, mediate the endotoxin-induced suppression of the reproductive axis in rats. Endocrinology; 144: 4868–4875.

Xiaoxia, W., Tongzhang, X., Xiaofan, J., Lina, Z., Li, L., Fuli, M., Xianbo, Z., Jie, Z., Qi, P., Lixin, G. (2017). A cross-sectional study on the associations of insulin resistance with sex hormone, abnormal lipid metabolism in T2DM and IGT patients. Medicine; 96(26): e7378.

Yeap, B.B., Chubb, S.A., Hyde, Z., Jamrozik, K., Hankey, G.J., Flicker, L., Norman, P.E. (2009). Lower serum testosterone is independently associated with insulin resistance in non-diabetic older men: the Health In Men Study. European Journal of Endocrinology; 161: 591–598.

Zeitlin, S.I. & Rajfer, J. (2000). Hyperprolactinemia and Erectile Dysfunction. Review Urology Winter; 2(1): 39–42.




How to Cite

Adejumo, B. I. G., Umahi-ottah, G., oyakhire, fidelis, Aiyegbusi, O. V., Dimkpa, U., Abdulrahman, O. N., Akhaumere, E. O., & Uzor, S. (2023). Profile and Role of Serum Hypothalamic-Pituitary-Testicular-Axis Hormones on Sexual Function of Older Men with Type-2 Diabetes. Medical Laboratory Technology Journal, 9(1).




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