Dandona Honored for Study of Hypogonadism and its Treatment With Testosterone

By Dirk Hoffman

Dandona, SUNY Distinguished Professor of medicine, is one of the world’s leading experts in the treatment of diabetes and vascular disease. He is also the former chief of endocrinology at the University at Buffalo and the founder of the Diabetes-Endocrinology Center of Western New York, which is sponsored by the Jacobs School of Medicine and Biomedical Sciences and Kaleida Heath. He sees patients at UBMD Internal Medicine.

This new award honors his breadth of research on how testosterone deficiency, which is also called “male hypogonadism,” contributes to reduced response of glucose to insulin, increased insulin resistance and eventually may contribute to the onset of Type 2 diabetes.

The discovery of this syndrome of hypogonadism in Type 2 diabetes was made by Dandona’s group at UB and published in 2004. In 2010, the group demonstrated that 25% of obese males without diabetes have hypogonadism. In 2013, the group demonstrated that testosterone levels are 50 percent lower in obese versus normal boys, and in 2016, the group demonstrated that men with hypogonadism and Type 2 diabetes had 35 percent additional insulin resistance.

“It is a great recognition of our work that we have done over the last two decades in this area,” Dandona says. “We are the world leaders in this, to have shown that one-third of Type 2 diabetics and one-fourth of nondiabetic obese have this problem, which is low testosterone in males.”

“This combination of Type 2 diabetes and obesity, which go together often becomes the single most important cause of male deficiency of testosterone and in the United States alone, there will be about 20 million affected by it and globally, over 150 million people affected by it,” he adds. “So, it is a very important and profound discovery.”

“Beyond that, our work has also shown that when we get testosterone replacement it not only has improvements in sexual function, it causes improvement in metabolic issues as well — it sensitizes the body to insulin, it also reverses prediabetes and it also may reverse diabetes itself in about 35 percent of the patients, which we demonstrated recently in collaboration with our German colleagues after a prolonged period (eight years) of treatment.”

Initially, all of these studies involved Dandona’s patients.

“Eventually, we wanted to look at younger people who have not started families yet, so we did a study on obese boys ages 14-20 and these boys had testosterone levels that were half of normal children,” he says. “Of course, these boys would not be expected to become sexually potent and probably would be infertile as well.”

“More recently along those lines, we did a study on morbidly obese boys and we found that 75 percent of them had low testosterone and in a period of two years when they lost weight after bariatric surgery, their testosterone was normalized and those that regained weight had low testosterone all over again,” Dandona notes. “So, it really is an obesity-based problem, which has to be tackled and of course, diabetes adds on top of that.”

There are other major areas in which Dandona’s team has made fundamental discoveries. They discovered that insulin is a direct vasodilatory, anti-inflammatory and has anti-atherogenic effects. These effects contribute to cardioprotection in acute myocardial infarction. Dandona received the Pharmacia/Pfizer Award of the Endocrine Society for this work. The team also demonstrated that carbohydrate and fat rich macronutrients induce oxidative stress and inflammation. They have now also discovered that fruits and dietary fiber neutralize the inflammation caused by macronutrients.

More recently, the team has also pioneered the use of drugs licensed for use in Type 2 diabetes in Type 1 diabetes. Dandona was the principal investigator in the global trial of dapagliflozin in Type 1 diabetes. This trial resulted in the licensing of its use in Type 1 diabetes in the UK, Europe and Japan.

At the age of 80, Dandona still conducts two full clinics a week, Mondays and Thursdays, where he sees between 25 and 30 patients, along with his fellows

“I am doing this on telemedicine. I am doing this from home since COVID-19 came; with my age I do not want to make myself vulnerable to COVID-19,” he says.

“Actually, COVID-19 has made a tremendous contribution to telemedicine,” Dandona notes. “We hadn’t thought of doing this sort of thing before, but now we can choose which patients need to come physically to the clinic and which patients can be managed from home.”

A 2010-11 recipient of the UB Presidential Award for Faculty Excellence, Dandona received a doctorate from Oxford University, where he was a Rhodes scholar. He earned his medical degree from All India Institute of Medical Sciences in New Delhi, the leading medical school in India for the last nearly 70 years. Dandona received the President of India Gold Medal for graduating as the top student.

Dandona says he came to Buffalo from England because he “was looking for the right place to come to and somebody told me Buffalo was looking for a head of endocrinology. Since there was no academic endocrinology here at the time, I chose to come here, and we established everything from scratch.”

“And now we have built up the largest clinical center for endocrinology and diabetes in upstate New York,” he notes. “Our fellowship program was built up from zero to the largest in the United States. It has been a great journey. Ninety fellows have graduated from our program and they are spread all over the United States.”

“During this time, we have published more papers than anyone else in the Department of Medicine — about 450 papers with all kinds of fundamental discoveries and so on.”

Dandona is extremely proud of his team’s work.

“Our standards of care are probably the finest in the world. Since 1997, we have not had any case of major amputation in our patients. We are the only center in the world that can claim that,” he says. “Since 2001, we have not had end stage kidney failure or dialysis if they come to us with reasonable kidney function.”

“So, our clinical care team has done extremely well.”

Dandona accepted his award at the Androgen Society’s 2023 annual meeting, held in Dallas, Texas, where he was the keynote speaker.