Gianatti EJ, et al. - In view of the epidemiological studies consistently illustrating lowered serum testosterone as a common finding among men with established type 2 diabetes and it as a valuable predictor for future diabetic risks and heightened mortality, researchers undertook this review summarizing the current evidence concerning the association between endogenous testosterone and type 2 diabetes, the mechanisms that could mediate this relationship and the influence of exogenous testosterone treatment in men with type 2 diabetes. Although this work highlights a necessity for large, well-designed clinical trials, in view of the lack of knowledge concerning the benefit–risk ratio of testosterone treatment, no recommendation could be made regarding routine serum testosterone testing or testosterone treatment of asymptomatic men with type 2 diabetes. Based on the findings they suggest limiting a trial of testosterone treatment in symptomatic men with low testosterone to carefully selected men following discussion of the lack of high-level evidence concerning long-term benefits and risks of treatment. Based on observations, they recommend physician to account following points when managing men with low testosterone levels and type 2 diabetes: Erectile dysfunction and symptoms of hypogonadism should be explored in men with type 2 diabetes; Routine screening is not recommended for low testosterone level in asymptomatic men with type 2 diabetes; Screening for testosterone levels should be offered to men with type 2 diabetes and symptoms or signs of hypogonadism; An individualized clinical work-up is recommended for symptomatic men with type 2 diabetes and very low testosterone in order to assess the underlying organic hypothalamic–pituitary–testicular pathology; Asymptomatic men with type 2 diabetes and low testosterone level should be provided counselling to decrease weight, and optimize diabetes control through diet and lifestyle modification and anti-hyperglycemic therapies as indicated; Testosterone replacement therapy should be offered routinely to asymptomatic men with type 2 diabetes and low testosterone levels; If testosterone therapy is provided to men with type 2 diabetes, monitoring and management strategy will be the same as provided to any other hypogonadal man by current clinical practice guidelines.