Diabetes in Men: Signs and Risk Factors

Why Diabetes in Men Deserves a Separate Conversation

Diabetes is often discussed in gender-neutral terms, but the way it develops, presents, and progresses in men carries important sex-specific differences that affect how it should be identified, managed, and prevented. Diabetes in men is associated with a distinctive set of signs — including sexual health consequences, hormonal disruption, and cardiovascular complications — that are often underreported or misattributed to aging rather than to blood glucose dysregulation. Men are also diagnosed with diabetes at lower body weights and BMIs than women, tend to delay seeking medical care (missing early diagnosis opportunities), and face substantially higher rates of cardiovascular disease complications from diabetes than their female counterparts. Our guide on what is diabetes provides the foundational overview; this article focuses on the aspects of diabetes that are specific to men — from sex-specific symptoms and risk factors to management priorities that address the full spectrum of diabetes’ impact on male health.

Diabetes in Men: The Numbers Approximately 15.3 million men in the United States have diagnosed diabetes — a prevalence slightly higher than in women. Men develop Type 2 diabetes at a lower BMI than women on average, because men tend to accumulate more visceral (intra-abdominal) fat relative to their total body fat, and visceral fat is a more potent driver of insulin resistance than subcutaneous fat. Men are also more likely to be undiagnosed: they have lower rates of routine health screenings and are more likely to delay seeking care for symptoms they attribute to stress or aging.

Signs of Diabetes in Men: What Is Often Missed

The classic diabetes symptoms — excessive thirst, frequent urination, fatigue, and blurred vision — apply to men as they do to all adults. However, several signs of diabetes occur specifically in men, or present with a pattern or severity in men that is distinctive enough to warrant specific discussion:

Erectile dysfunction (ED): Erectile dysfunction is 2–3 times more prevalent in men with diabetes than in men without it, and it often precedes the diabetes diagnosis by years. The mechanisms are multiple and overlapping: diabetic neuropathy impairs the nerve signals required for erection; reduced nitric oxide production from endothelial dysfunction impairs vasodilation of penile arteries; low testosterone (common in men with Type 2 diabetes) reduces libido and erectile function; and poor glycemic control directly damages both the nerves and blood vessels involved in the erectile response. Studies show that ED is present in approximately 50% of men with diabetes aged 55 and older. Many men with undiagnosed diabetes attribute their ED to stress or aging rather than recognizing it as a potential signal of metabolic disease. ED in a man under 60 with risk factors for diabetes should prompt blood glucose screening.
Low testosterone (hypogonadism): Type 2 diabetes and insulin resistance are strongly associated with reduced testosterone levels in men — through mechanisms that include adipose tissue conversion of androgens to estrogens (aromatization), adipocytokine-driven suppression of hypothalamic-pituitary signaling, and direct effects of insulin resistance on Leydig cell function in the testes. Symptoms of low testosterone — reduced libido, fatigue, decreased muscle mass, increased body fat, mood changes, and difficulty concentrating — overlap significantly with the general symptoms of poorly controlled diabetes. Low testosterone both contributes to insulin resistance and results from it, creating a bidirectional relationship that can perpetuate metabolic dysfunction if not addressed. Testosterone levels should be assessed in men with Type 2 diabetes who have symptoms suggestive of hypogonadism.
Urinary symptoms beyond frequent urination: Beyond the osmotic diuresis that causes frequent urination in all people with uncontrolled diabetes, men with diabetes are at increased risk of urinary tract infections (which are less common in men than women without diabetes but become significantly more prevalent when blood glucose is elevated), bladder dysfunction from diabetic autonomic neuropathy (producing incomplete emptying, weak stream, or overflow incontinence), and an increased risk of urologic complications that require medical evaluation.
Yeast infections (balanitis): Excess glucose in urine creates a favorable environment for fungal overgrowth on the skin of the genitals — producing a condition called balanitis (inflammation of the glans penis), characterized by redness, itching, and discharge under the foreskin or on the glans. Recurrent balanitis in a man who is not previously known to have diabetes should prompt blood glucose testing, as it is a recognized presenting feature of undiagnosed Type 2 diabetes.

middle-aged man checking his blood glucose level as part of routine diabetes monitoring — Regular blood glucose monitoring is essential for men with diabetes to detect patterns that affect energy, sexual health, and cardiovascular outcomes.

Risk Factors for Diabetes in Men

Men share the general diabetes risk factors with women — family history, overweight and obesity, physical inactivity, age, and high-risk ethnicity — but several risk factors operate differently or more prominently in men:

Visceral fat accumulation: Men tend to accumulate fat preferentially in the abdominal (visceral) compartment rather than the subcutaneous compartment, even at moderate body weights. Since visceral fat is metabolically active and directly drives insulin resistance, men develop significant insulin resistance at lower total body weight and BMI than women — explaining why men are diagnosed with diabetes at lower BMIs. Our guide on belly fat and diabetes risk covers the mechanisms in detail.
Lower health-seeking behavior: Studies consistently show that men are less likely than women to attend routine health checkups, less likely to report symptoms to a doctor, and more likely to delay diagnosis. This avoidance behavior means diabetes progresses longer before being detected in men, and men are more likely to present with complications at diagnosis.
Alcohol consumption: Heavy alcohol consumption — which is more common in men than women — raises caloric intake, promotes visceral fat accumulation, impairs liver glucose regulation, and can directly impair beta cell function in chronic cases. Men who drink heavily are at significantly elevated Type 2 diabetes risk.
Sleep apnea: Obstructive sleep apnea is approximately twice as prevalent in men as in women and is strongly associated with insulin resistance and Type 2 diabetes — through mechanisms including intermittent hypoxia that activates the sympathetic nervous system and raises cortisol, sleep fragmentation that impairs glucose metabolism, and the obesity that underlies both conditions. Men with untreated sleep apnea have substantially higher rates of prediabetes and Type 2 diabetes than those without it.
Shift work and irregular sleep schedules: Circadian rhythm disruption from night shift work — which affects a higher proportion of male-dominated industries — impairs glucose metabolism and raises Type 2 diabetes risk. Our guide on hormones and blood sugar covers the cortisol and insulin rhythm disruption mechanisms involved.

Diabetes and Cardiovascular Disease in Men

Cardiovascular disease is the leading cause of death in men with diabetes, and the cardiovascular risk conferred by diabetes is substantially higher in younger men than in age-matched women without diabetes — because women have protective estrogenic effects on cardiovascular function that attenuate (but do not eliminate) their diabetes-related cardiovascular risk until menopause. Men with diabetes have approximately 2–4 times higher rates of heart attack and stroke compared to men without diabetes, and the combination of diabetes with other cardiovascular risk factors that are common in men (hypertension, dyslipidemia, smoking, physical inactivity) produces multiplicative rather than additive risk increases. Our guide on metabolic syndrome and diabetes covers the cluster of risk factors — abdominal obesity, high triglycerides, low HDL, hypertension, and elevated glucose — that frequently co-occur in men with Type 2 diabetes and drive accelerated cardiovascular disease. Blood pressure management (target below 130/80 mmHg) and lipid management (statin therapy in most men with diabetes over 40) are at least as important as glycemic control for cardiovascular event prevention in men with diabetes. Our guide on what is insulin resistance covers the endothelial and vascular mechanisms that link insulin resistance to cardiovascular risk.

How Men Can Reduce Their Diabetes Risk

The evidence-based approaches to reducing Type 2 diabetes risk in men are the same as for the general population, but several strategies deserve emphasis given men’s specific risk profile:

Reduce visceral fat through resistance training and aerobic exercise: Resistance training is particularly effective at reducing visceral fat and improving insulin sensitivity in men, because it builds skeletal muscle mass which serves as the primary site of insulin-stimulated glucose disposal. Our guide on sedentary lifestyle and blood sugar covers how physical activity improves blood glucose metabolism.
Prioritize routine health screening: Men who have risk factors for diabetes but are not being routinely screened should ask for a fasting glucose or A1C at their next medical appointment. Our guide on prediabetes causes and prevention covers who should be screened and how often.
Manage sleep and address sleep apnea: Men who snore loudly, have witnessed breathing pauses during sleep, or experience excessive daytime sleepiness should discuss sleep apnea screening with their doctor — as treating obstructive sleep apnea improves insulin sensitivity and reduces diabetes risk independently of weight change.
Limit alcohol and avoid heavy drinking: Moderating alcohol intake — limiting to no more than 2 drinks per day as per general guidelines, and ideally less in people with or at risk for diabetes — reduces the caloric and metabolic burden that heavy drinking places on glucose regulation.

Diabetes and Sexual Health in Men: A Deeper Look

The intersection of diabetes and sexual health in men is more complex than the commonly discussed link between erectile dysfunction and poor blood flow. The full impact of diabetes on male sexual function encompasses neurological, vascular, hormonal, and psychological dimensions that together substantially reduce sexual quality of life in men with poorly controlled diabetes:

Retrograde ejaculation: Diabetic autonomic neuropathy can damage the internal urethral sphincter, causing semen to travel backward into the bladder rather than out of the urethra during orgasm — a condition called retrograde ejaculation. Men may notice cloudy urine after orgasm and absent or reduced ejaculatory volume. It is not dangerous but can cause infertility and is a signal of significant autonomic nerve damage from diabetes. Retrograde ejaculation in a man without a prior diagnosis of diabetes warrants blood glucose testing.

Reduced libido: Low testosterone — common in men with Type 2 diabetes — directly reduces sexual desire, making the issue not purely mechanical (as in erectile dysfunction from vascular causes) but also motivational. The combination of low libido, ED, and fatigue creates a compound impact on sexual health that requires addressing the hormonal component (testosterone assessment) as well as the vascular and neurological ones.

Psychological factors: The diagnosis and management of diabetes imposes significant psychological burdens — anxiety about complications, depression related to chronic disease, performance anxiety specifically around sexual function — that independently impair sexual function through central nervous system mechanisms. Men with diabetes and depression have particularly high rates of sexual dysfunction, and addressing the psychological component of sexual health is as important as treating the physiological drivers. Our guide on fatigue and blood sugar problems covers the overlap between blood sugar dysregulation and the mood and energy impacts that affect sexual health in men with diabetes.

The management of sexual dysfunction in men with diabetes begins with optimizing blood glucose control — improved glycemic control can reverse early stages of erectile dysfunction and improve testosterone levels — but often requires additional interventions. PDE5 inhibitors (sildenafil, tadalafil) are effective for erectile dysfunction in most men with diabetes. Testosterone replacement therapy is appropriate for men with confirmed hypogonadism who have symptoms and consistently low testosterone levels (confirmed on two separate fasting morning measurements). Men experiencing sexual health issues related to diabetes should discuss them openly with their healthcare provider, as these complications are both common and treatable — but are underreported because many men feel embarrassed to raise them.

Diabetes and Muscle Mass: A Concern Specific to Men

Skeletal muscle plays a central role in glucose metabolism — it is the primary site of insulin-stimulated glucose uptake, accounting for approximately 75–80% of post-meal glucose disposal. This makes muscle mass a critical metabolic asset in diabetes management, and the loss of muscle mass (sarcopenia) from aging, physical inactivity, or the catabolic effects of chronically elevated blood glucose directly worsens insulin resistance and glucose control. For men — who rely more heavily on lean muscle mass as a proportion of body composition than women — the interplay between diabetes and muscle is particularly significant.

Poorly controlled diabetes in men impairs muscle protein synthesis, accelerates muscle protein breakdown, and causes muscle wasting through multiple mechanisms: elevated cortisol (from the stress response to poor glucose control), reduced IGF-1 (insulin-like growth factor), low testosterone (which is both anabolic and anti-inflammatory), and direct glucotoxicity of chronically elevated blood glucose on muscle cell function. The result is that men with poorly controlled diabetes lose muscle mass faster than those with well-controlled diabetes — which in turn worsens insulin resistance and makes glucose control harder, creating a cycle of metabolic deterioration. Our guide on weight gain and insulin resistance covers how body composition changes drive metabolic dysfunction in ways that are particularly relevant to men.

Resistance training is the most effective intervention for preserving and building muscle mass in men with diabetes, and its metabolic benefits extend beyond the direct glucose-lowering effect of acute muscle contractions. Regular resistance training (2–3 sessions per week of compound exercises targeting major muscle groups) increases muscle mass, upregulates GLUT4 glucose transporter expression in muscle cells, improves insulin sensitivity for 24–48 hours per session, and supports testosterone levels — addressing multiple components of the metabolic dysfunction associated with Type 2 diabetes in men simultaneously. Men with diabetes who are not currently doing resistance training should discuss it with their diabetes care team as a core component of their management plan, not simply as an optional add-on to aerobic exercise.

Men, Diabetes, and Mental Health: Breaking the Silence

Men with diabetes face elevated rates of depression, anxiety, and diabetes distress — yet are significantly less likely than women to report psychological symptoms, seek mental health treatment, or discuss emotional difficulties with their healthcare providers. Research shows that men with diabetes who experience depression have substantially worse glycemic control, higher rates of diabetes complications, higher healthcare costs, and higher mortality compared to men with diabetes without depression — making the detection and treatment of mental health conditions a medical priority, not a secondary concern. The unique barriers men face in acknowledging and addressing psychological distress from diabetes include culturally reinforced expectations of self-reliance, stigma around mental health care, and a tendency to externalize psychological distress through behaviors (increased alcohol use, social withdrawal, risk-taking) rather than reporting them as symptoms. Healthcare providers caring for men with diabetes should proactively screen for depression and anxiety using validated tools and address psychological barriers to diabetes management as part of comprehensive care. Our guide on Type 2 diabetes symptoms and diagnosis covers the broader symptom picture that provides context for recognizing when psychological symptoms may be linked to blood sugar dysregulation.

The Most Actionable Step for Men at Risk The most important thing a man with risk factors for diabetes can do — excess weight, family history, physical inactivity, age over 45, or any of the specific male risk factors discussed above — is to get a fasting glucose or A1C test. Most men who develop Type 2 diabetes have had detectable prediabetes for 5–10 years before diagnosis, during which lifestyle intervention could have prevented or delayed the disease. A single blood test can determine whether you are in the normal range, the prediabetes range, or the diabetes range — and that information determines what actions to take. For men who avoid routine medical appointments, many pharmacies now offer A1C testing without a doctor’s visit. The test takes minutes; the potential benefit is decades of better health outcomes.

Diabetes Complications That Are More Common or Severe in Men

While diabetes complications affect both men and women, several complications occur with higher frequency or greater severity in men with diabetes:

Cardiovascular disease: Men with diabetes have significantly higher absolute rates of cardiovascular events (heart attack and stroke) than women with diabetes at similar ages, because men start at a higher baseline cardiovascular risk and diabetes further amplifies that risk. The combination of abdominal obesity, dyslipidemia (high triglycerides, low HDL), hypertension, and elevated glucose — common in men with Type 2 diabetes — creates a cardiovascular risk burden that requires aggressive management of all risk factors, not just blood glucose. Our guide on family history and diabetes risk covers how genetic cardiovascular and diabetes risk compound in high-risk men.
Diabetic kidney disease: Men develop diabetic kidney disease (diabetic nephropathy) at higher rates than women and progress to end-stage renal disease more rapidly. Annual screening for early kidney damage through urine albumin testing is essential for men with diabetes. Blood pressure control — particularly with ACE inhibitors or ARBs that have specific kidney-protective properties — is a cornerstone of nephropathy prevention and progression slowing in men.
Peripheral arterial disease and foot complications: Peripheral arterial disease (PAD), which reduces blood flow to the legs and feet, is more prevalent in men than women with diabetes and significantly raises the risk of diabetic foot ulcers, poor wound healing, and lower extremity amputation. Our guide on slow wound healing and diabetes covers the mechanisms by which impaired circulation and nerve damage combine to make foot wounds in men with diabetes particularly serious. Annual comprehensive foot examinations, daily foot inspection, and appropriate footwear are essential preventive measures.
Neuropathy: Peripheral and autonomic neuropathy affect men and women with diabetes equally in terms of prevalence, but the consequences of autonomic neuropathy — including erectile dysfunction, retrograde ejaculation, bladder dysfunction, and orthostatic hypotension — have uniquely significant impacts on men that are described in more detail throughout this guide. Our guide on tingling feet and diabetes covers the peripheral neuropathy symptoms that are the most common neuropathic complaint in men with diabetes.

Understanding which complications carry particular importance for men with diabetes helps prioritize the monitoring and preventive interventions that deserve the most attention. Men with diabetes who are not currently receiving annual foot examinations, urine albumin testing, eye examinations, and cardiovascular risk assessment should discuss these screening gaps with their healthcare provider — because complication prevention and early detection dramatically improve long-term outcomes and quality of life. Our guide on age and Type 2 diabetes risk provides additional context on how the complication risk profile changes as men with diabetes age.

Sources: American Diabetes Association. “Standards of Medical Care in Diabetes.” Diabetes Care 2024. | CDC — National Diabetes Statistics Report 2022. | NIDDK — Risk Factors for Type 2 Diabetes. | Mayo Clinic — Type 2 Diabetes Risk Factors. | Corona G, et al. “Diabetes mellitus and male sexual dysfunction.” Andrology 2020.