Type 2 diabetes mellitus (T2D) is a chronic condition experienced by millions of people worldwide. It is characterized by insulin resistance and elevated blood sugar levels. While the underlying cause is actually an accumulation of too much fat in the liver and pancreas, this cause and its treatment by significant weight loss is under-appreciated. Instead people have turned to pharmacological (drug) solutions for their T2D. And at the top of the list is the drug metformin. This go-to medication is praised for its ability to improve insulin sensitivity and reduce glucose production in the liver. It is a cornerstone drug for doctors tasked with diabetes management.
Metformin has a pretty clean profile, with few side effects and high efficacy. In fact, some people have endorsed the use of metformin by healthy people for its anti-aging effects. However, evidence has emerged from several studies that there is an unintended consequence of using metformin for men—a significant reduction in testosterone levels. Oops. This side effect can impact energy, libido, muscle mass, and overall well-being, adding to the already complicated hormone milieu caused by T2D. Let’s dive into the evidence and discuss what your options are if you find yourself or a loved one in this situation.
Testosterone Dropped in Every Single Man in This 3-Month Study
Three studies demonstrate compelling evidence of metformin’s impact on testosterone levels in men with T2D. The first, a 2024 study found in Clinical Traditional Medicine and Pharmacology (DOI: 10.1016/j.ctmp.2024.200167), was conducted in Dehradun, India. This prospective observational study compared 30 men with T2D taking metformin to 30 non-diabetic men. After three months, every man in the metformin group had a significant drop in serum testosterone levels compared to the non-diabetic group. The researchers noted that this reduction could contribute to low sex drive and erectile dysfunction, negatively affecting quality of life. The research group also explored some traditional medicinal plants as potential therapies to counteract this effect. Maybe there is a way to lessen the side effects of metformin naturally?
Now, when an effect is universal like that (every single man) you know there is an issue. Usually in a group there are few outliers, where things didn’t go according to the theory being tested. But this study showed a result in every single man. That is an impressive result in the wrong direction.
Testosterone Drops Within One Month in This Study
A second study, published in Diabetes Care in 2021 (DOI: 10.2337/dc20-1558), focused on men newly diagnosed with T2D. This study found that after just one month of metformin treatment, participants had significantly lower testosterone levels compared to a control group not taking the medication. This rapid drop in testosterone, even though blood glucose control did work, is devastating. And the results are consistent across these studies. Is metformin actually a good idea?
Lower Testosterone and Worse Erectile Function Linked to Metformin in This Study
A third study, published in Journal of Clinical and Diagnostic Research in 2016, further supports these findings and adds in a group taking a different drug. This cross-sectional study examined 64 men, divided into three groups: 34 treated with metformin, 30 treated with sulfonylurea (another diabetes medication), and 27 healthy non-diabetic men as controls. The results were again striking and consistent: men on metformin had significantly lower total testosterone, free testosterone, and bioavailable testosterone compared to both the sulfonylurea group and the control group. Additionally, their scores on the Sexual Health Inventory for Men (SHIM), which measures erectile function, were quite a bit lower. This links the low testosterone levels directly to poor sexual function as an outcome. In contrast, sulfonylurea-treated patients showed higher testosterone levels and better sexual function. So, the link was very likely due to metformin, not an artifact of this particular study.
Is Testosterone Important to You?
Yes, testosterone is very important to your vitality. Testosterone is a critical. It influences not just sexual health but also energy levels, muscle maintenance, mood, and overall vitality. If you have T2D, you are already at higher risk for low testosterone because of insulin resistance and inflammation. If you add in a drug like metformin that lowers your testosterone even further—well, that just a big step in the wrong direction. Your quality of life can plummet. Everything from fatigue, reduced libido, erectile dysfunction and loss of muscle mass contribute to lower quality of life. “Thanks Doc!”
Why Isn’t The Link Between Metformin and Low Testosterone Widely Known?
It’s surprising that this side effect isn’t more widely discussed. A quick search for “metformin and testosterone” primarily yields academic articles, not patient-friendly blogs or mainstream health articles. This suggests that awareness among the general public—and even some healthcare providers—remains low. If you’re a man taking metformin, your doctor may not have mentioned the potential for reduced testosterone, leaving you unaware of why you might be feeling less energetic or experiencing changes in your sex drive.
What Are Your Options to Lessen Impact of Metformin?
So, what can you do if you’re concerned about metformin’s impact on your testosterone? First, don’t stop taking your medication without consulting your doctor—metformin is effective for controlling blood sugar, and abrupt changes can harm your health. Instead, have a frank, open conversation, if possible, with your healthcare provide about your concerns. Maybe you should start by measuring your testosterone levels. Maybe you aren’t like those other men in the studies and you are OK. Maybe you can switch to another medication, like sulfonylureas which have less of an effect on testosterone levels. Maybe you can take some herbal supplements that will help boost testosterone levels.
The Best Option—Reverse Your Diabetes Now
The best option, of course, is to reverse your diabetes. If you are tired of being tired, overweight, stuck with diabetic complications coming your way, you can take action. Drugs will help you manage your blood sugar, but they will not bring you good health. The drugs will just lead to further complications and stronger drugs in the future.
What you really need to do is to lose a significant amount of weight, about 35 pounds according to Professor Roy Taylor, to reverse the pathology in your liver and pancreas. Within 7 days your fasting blood sugar could be normal and your response to eating carbohydrates can normalize in about 8 weeks. So, in 90 days or less you could be symptom free and on your way to a whole new level of energy, vitality and a bright, healthy future. We have many testimonies showing that such results are quite possible.
You don’t have to do it alone—surround yourself with a supportive community, whether it’s friends, family, or a health coach. If you want personalized guidance, consider working with a professional who can tailor a plan to your needs, minimizing frustration and maximizing results. You don’t have to settle for managing your diabetes, you can kick it to the curb for good.
Summing It Up
In conclusion, even though metformin is a powerful tool for managing T2D, it has been shown repeatedly to lower testosterone in men. If you want less muscle mass, lower vitality, lower sex drive, and erectile dysfunction, sign up for metformin. It will probably deliver those negative effects for you. But you can make the switch and reverse your diabetes. So, make a plan, get supportive people around you for accountability, and take action, one step at a time, to break free from chronic disease. Don’t settle. Don’t compromise. Be an overcomer.