Hormonal

In normogonadal men, low plasma levels of free testosterone and SHBG do not independently predict insulin resistance, beta-cell dysfunction, or hepatic glucose output; their association with metabolic risk is mediated entirely by adiposity.

For men with normal testosterone levels, low T is not the independent cause of insulin resistance. The observed link between low T and metabolic risk is driven by obesity, particularly truncal fat. Focusing on reducing abdominal adiposity is more effective for improving insulin sensitivity than attempting to raise testosterone levels through therapy, provided baseline levels are normal.