SEX-HORMONES AND DIABETES

Diabetes is associated with alterations in gonadal dysfunction in both men and women. A number of studies have indicated that men with diabe tes have a decline in total and free testosterone levels. This is due to a failure of hypothalamic-pituitary function to adequately drive te stosterone secretion as well as a defect in testicular steroidogenesis , The possibility is raised that testosterone would have salutary effe cts in men with diabetes. In particular, testosterone appears to inhib it leptin production and thus may decrease insulin resistance. In wome n, the major effect of diabetes appears to be on the ovary. Zn rodents , diabetes results in a decrease in ovulation, In humans, rodents, and swine, diabetes in females is associated with hyperandrogenicity and a decline in estradiol levels, Diabetes also appears to produce resist ance to some of the effects of estradiol, In contrast to males, in fem ales hyperandrogenicity is associated with insulin resistance. Oral co ntraceptives and postmenopausal estrogen replacement do not appear to have any major positive or negative effects on carbohydrate metabolism . Hormonal changes in both men and women with diabetes mag lead to a d ecline in libido and a loss of the quality of the erection in men and vaginal dryness that mag be associated with dyspareunia in women.