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Oestradiol replacement treatment and glucose homeostasis in two men with congenital aromatase deficiency: evidence for a role of oestradiol and sex steroids imbalance on insulin sensitivity in men.
[aromatase deficiency]
The
role
of
sex
steroids
in
glucose
and
insulin
metabolism
in
men
remains
unclear
.
To
investigate
the
effects
of
sex
steroids
and
oestrogen
on
insulin
sensitivity
in
men
,
we
studied
two
male
adults
with
aromatase
deficiency
(
subject
1
and
subject
2
)
.
The
effects
of
transdermal
oestradiol
(
tE
(
2
)
)
treatment
at
different
dosages
on
insulin
sensitivity
were
studied
before
tE
(
2
)
treatment
(
phase
1
)
,
and
after
6
months
(
phase
2
)
and
12
months
of
tE
(
2
)
treatment
(
phase
3
)
by
means
of
homeostasis
model
assessment-
insulin
resistance
(
HOMA-IR
)
and
Quantitative
Insulin
Sensitivity
Check
Index
(
QUICKI
)
,
insulin
tolerance
test
(
ITT
)
,
and
oral
glucose
tolerance
test
(
OGTT
)
.
The
latter
was
performed
only
in
subject
1
,
as
subject
2
suffered
from
Type
2
diabetes
.
The
restoration
of
normal
serum
oestradiol
led
to
improved
insulin
sensitivity
,
as
shown
by
changes
in
HOMA-IR
and
QUICKI
.
The
ITT
provided
evidence
of
improved
insulin
sensitivity
during
tE
(
2
)
treatment
.
Insulin
secretion
after
OGTT
was
reduced
during
tE
(
2
)
treatment
in
subject
1
.
After
12
months
of
tE
(
2
)
treatment
,
insulin
sensitivity
was
improved
compared
with
in
phases
1
and
2
.
The
study
suggests
a
direct
involvement
of
oestrogens
in
insulin
sensitivity
,
and
supports
a
possible
role
of
oestradiol
:
testosterone
ratio
,
which
may
be
as
influencial
as
the
separate
actions
of
each
sex
steroid
on
glucose
homeostasis
.
