TNF and Insulin resistance: These changes are secondary to chronic metabolic complications of diabetes including chronic hyperglycemia, insulin resistance, and dyslipidemia which initiate an inflammatory response as demonstrated by positive testicular immune staining for TNFα and a significant increase in serum TNFα and IL6 (Kwon and Pessin, 2013; Long et al., 2018; Barsiah et al., 2019).