Understanding the Impact of Diabetes on Male Fertility | Milann The Fertility Specialist




How diabetes affects male fertility?

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There are two main types of diabetes.

Type 1 diabetes can begin at any age but often starts in childhood or young adulthood. If you have type 1 diabetes, your body can’t make enough insulin, and you must take extra insulin every day.
About 85% of people with diabetes have type 2 diabetes. Type 2 diabetes is linked to diet, lack of exercise, being overweight, and family history. If you have type 2 diabetes, your pancreas doesn’t produce enough insulin, and the insulin it does produce doesn’t work properly. This means your body can’t control its blood sugar level
Type 1 diabetes cannot be prevented. However, type 2 diabetes can be prevented by a healthy lifestyle, including regular physical activity, a balanced diet, and keeping weight in a range that’s healthy for you.
The effects of diabetes mellitus include long-term damages, dysfunctions, and failures of various organs. An important complication of diabetes is the disturbance in the male reproductive system. Glucose metabolism is an important event in spermatogenesis. Moreover, glucose metabolism is also important for maintaining basic cell activity, as well as specific functions, such as motility and fertilization ability in mature sperm. Diabetic disease and experimentally induced diabetes both demonstrated that either type 1 diabetes or type 2 diabetes could have detrimental effects on male fertility, especially on sperm quality, such as sperm motility, sperm DNA integrity, and ingredients of seminal plasma. Epigenetic modifications are essential during spermatogenesis. The epigenetic regulation represents chromatin modifications including DNA methylation, histone modifications, remodelling of nucleosomes and the higher-order chromatin reorganization and noncoding RNAs. If spermatogenesis is affected during the critical developmental window, embryonic gonadal development, and germline differentiation, environmentally -induced epigenetic modifications may become permanent in the germline epigenome and have a potential impact on subsequent generations through epigenetic transgenerational inheritance. Diabetes may influence the epigenetic modification during sperm spermatogenesis and that these epigenetic dysregulations may be inherited through the male germline and passed onto more than one generation, which in turn may increase the risk of diabetes in offspring.
Diabetes causes male infertility in three ways:
Causes erectile dysfunction-by affecting the health of small blood vessels and lowering testosterone levels
Lowers sex drive-by lowering testosterone levels
Reduces ejaculate volume-by affecting the small nerves that control ejaculation and by lowering testosterone levels
Indeed, this patient had all three issues at the same time along with a low testosterone level. Fortunately, these symptoms are fairly easy to correct with oral medications:
Erectile dysfunction- Viagra, Cialis or Levitra can restore erections
Sex drive and low testosterone-Selective estrogen receptor modulators (i.e. off label use of clomiphene citrate) can correct testosterone deficiency
Ejaculate volume is low because it is emptying backwards into the bladder instead of forward into the penis. This can be treated with over the counter cold medication (alpha agonists) to restore the normal direction of ejaculate flow.
If diabetes isn’t detected, or it isn’t controlled, it can reduce your lifespan.
Diabetes can cause blindness, kidney failure, nerve damage, reduced blood circulation and can increase the chance of heart attack and stroke. If you have diabetes, you also have a higher chance of developing sexual and reproductive health problems, including:
  • Erectile dysfunction
  • Low levels of testosterone
  • Low sex drive
  • Semen flowing back into the bladder (retrograde ejaculation)
  • Inflammation of the head of the penis (balanitis).
Speaking to a doctor about sexual and reproductive health problems is particularly important if you have diabetes. You can talk with your doctor about lifestyle changes or other ways to control your blood sugar levels. Your doctor might refer you to a specialist or sexual therapist if it’s suitable for you.

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