Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.
Do-Eun Lee, MD, has been practicing medicine for more than 20 years, and specializes in diabetes, thyroid issues and general endocrinology. She currently has a private practice in Lafayette, California.
Type 2 diabetes (T2D) is a complex chronic condition that develops when the body loses its ability to use and produce the hormone insulin properly. As a result, the body does not regulate blood sugar efficiently. Chronically high blood sugar levels are toxic to blood vessels and organs, such as the eyes, kidneys, and heart.
Your specific symptoms will depend on the affected organ. For example, eye damage may lead to blurry or double vision, and kidney damage may lead to more frequent urination.
Research shows that men are more likely than women to develop type 2 diabetes, underscoring the importance of looking out for early signs unique to men, such as erectile dysfunction and retrograde ejaculation, and taking steps to prevent diabetes in this high-risk population.
This article addresses the risks and complications of type 2 diabetes in men.
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According to the Centers for Disease Control and Prevention (CDC), 1 in 10 people—nearly 40 million adults in the United States—are living with type 2 diabetes. There potentially are many people who are unknowingly living with type 2 diabetes or prediabetes.
Type 2 diabetes is most common in men and women older than 45 years old, but diabetes rates are increasing in all populations, including children, teens, and young adults.
Leading public health associations such as the American Public Health Association and CDC have deemed type 2 diabetes a public health crisis.
Men are at particularly high risk—the prevalence of type 2 diabetes in men is 14.6% compared to 9.1% in women—because they carry more belly fat. Belly fat is a known primary risk factor for type 2 diabetes. It promotes insulin resistance which decreases the efficiency of insulin delivery in the body. Over time, the pancreas produces higher and higher amounts of insulin until it cannot.
Also, men tend to develop type 2 diabetes at a younger age than women. While the exact cause is unknown, the primary reason points to higher amounts of abdominal fat compared to women, although biological, sociocultural, economic, and lifestyle factors play an important role as well.
Of note, obesity is the greatest risk factor for type 2 diabetes.
Waist circumference—a measure of abdominal adiposity (excess fatty tissue in the body)—along with measures of visceral fat (fat around your organs like the heart and liver) have been shown to be superior to the body mass index (BMI) calculation in predicting diabetes in men.
Below are potential complications of type 2 diabetes in men.
Men with type 2 diabetes are more likely to have trouble getting or maintaining an erection, a condition called erectile dysfunction (ED).
ED is very common in men with type 2 diabetes. In fact, one study reports that over half of men with type 2 diabetes also report having ED.
Chronically high blood sugar levels are toxic to the nerves and blood vessels of the body. Damage to the nerves (autonomic neuropathy) and blood vessels (atherosclerosis) affects muscle and nerve function.
Damage to the autonomic nerves that control the body's automatic responses—such as the nerves of the penis that help give rise to an erection during sexual arousal—along with the narrowing of blood vessels in the penis from atherosclerosis is the leading cause of ED.
Controlling your diabetes with a combination of lifestyle modifications and medications, such as insulin and/or metformin, are key to preventing and treating ED.
Common oral medications in the phosphodiesterase-5 enzyme (PDE-5) inhibitor drug class—such as Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil)—are first-line medications for ED.
They work by relaxing the muscles of the penis and promoting blood flow by blocking PDE-5, an enzyme that restricts blood flow. Managing other medical conditions like high blood pressure and high cholesterol are also likely to help improve your ED symptoms.
Of note, if oral medications and lifestyle changes do not relieve your ED symptoms, your healthcare provider may recommend other options such as:
Medical treatment for ED should always be done under the guidance of a healthcare professional.
Diabetic autonomic neuropathy (DAN)—the primary and most serious form of ANS dysfunction—occurs when the nerves that control the automatic functions of the body become damaged and stop functioning properly.
DAN may affect your blood pressure, heart rate, temperature control, and even sweating.
Organ systems throughout the body that may be affected include:
There is no one-size-fits-all treatment for DAN.
DAN affects the entire body.
Treatment is based on the organ that is most affected by nerve damage, therefore, you may be on a number of medications aimed at treating your diabetes (and any other underlying conditions), and managing your specific symptoms.
Retrograde ejaculation is a common symptom of T2D that is characterized by semen entering the bladder instead of out through the penis during orgasm.
Oftentimes, retrograde ejaculation has no symptoms except for cloudy urination after sex and more rarely, difficulty having a child, which is a sign of infertility.
Research has shown that men with diabetes not only have a lower sperm count but also may have a higher likelihood of damaged sperm due to epigenetic changes to sperm DNA and disturbances in glucose metabolism.
Therefore diabetes that is not well managed can have a detrimental effect on male fertility, even in the absence of ED.
Type 2 diabetes can cause urologic problems in men, including:
If you have type 2 diabetes, managing your blood sugar with a combination of lifestyle modification centered around diet and exercise and medication will be the best way to avoid serious medical complications.
Meeting with a diabetes counselor can help you to formulate a plan that works best for you. This plan may include:
In addition to attending regular appointments with a healthcare professional, connecting with support groups and discussing your diabetes journey with family and friends may also provide you with the support and encouragement you need to best adapt to these new lifestyle changes.
Men are more likely than women to develop type 2 diabetes, underscoring the importance of looking out for early signs unique to men, such as erectile dysfunction and retrograde ejaculation, and taking steps to prevent diabetes in this high-risk population.
Type 2 diabetes can impact anyone, no matter your age, weight, or eating habits. Getting routine wellness visits to a trusted healthcare provider is one of the best ways to develop a health plan aimed at lowering your risk of diabetes.
Men are more likely than women to develop type 2 diabetes—underscoring the importance of looking out for early signs unique to men, such as erectile dysfunction and retrograde ejaculation—and they are also more likely to develop type 2 diabetes earlier in life.
Erectile dysfunction is one of the most common medical complications due to type 2 diabetes. Even more, high blood sugar levels can affect glucose metabolism and lead to genetic changes in sperm, lowering the number and quality of sperm in ejaculation.
Centers for Disease Control and Prevention. Diabetes and men.
Centers for Disease Control and Prevention. National diabetes statistics report.
Centers for Disease Control and Prevention. Type 2 diabetes.
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Abe, M., Fujii, H., Funakoshi, S. et al. Comparison of body mass index and waist circumference in the prediction of diabetes: a retrospective longitudinal study. Diabetes Ther 12, 2663–2676 (2021). doi:10.1007/s13300-021-01138-3
Kouidrat, Y. High prevalence of erectile dysfunction in diabetes: a systematic review and meta‐analysis of 145 studies. Diabetic Medicine. July 18, 2017. doi:10.1111/dme.13403
MedlinePlus. Diabetic nerve problems.
MedlinePlus. Retrograde ejaculation.
Ding GL, Liu Y, Liu ME, et al. The effects of diabetes on male fertility and epigenetic regulation during spermatogenesis. Asian J Androl. 2015;17(6):948-953. doi:10.4103/1008-682X.150844
National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, sexual, and bladder problems.
National Institute of Diabetes and Digestive and Kidney Diseases. Managing diabetes.
Shamard Charles, MD, MPH is a public health physician and journalist. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.
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