A recent study published in Sexual Medicine from the Kaohsiung Armed Forces General Hospital in Taiwan aimed to determine whether free testosterone levels in men with erectile dysfunction (ED) are associated with cardiometabolic disease. The study contained 3,909 men with ED from Taiwan (province of China), between 2010 and 2021.
The researchers note the relationship between ED and cardiovascular disease (CVD) and the relationship between low testosterone and cardiometabolic diseases, which increase the risk of CVD. If the relationship between testosterone and cardiometabolic diseases persists in men with ED, there are implications for testosterone as a potential predictor of CVD in this cohort.
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Erectile dysfunction is the inability to attain or maintain an erection firm enough for sexual intercourse. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), erectile dysfunction has roots in the nervous, endocrine and vascular systems. The study’s author, Bing-Tau Chen, notes that 60% of Taiwanese men have chronic illness diagnoses, highlighting the intersectional nature of the disorder. Risk factors for ED include conditions such as type 2 diabetes, hypertension and chronic kidney disease, the use of medications that treat blood pressure, depression, or ulcers, physical factors such as drinking, smoking and obesity, and psychological factors.
All 3,909 participants submitted a medical history, which included the severity of their ED symptoms. Diabetes was measured by fasting blood glucose and HbA1c [a blood test to diagnose type 2 diabetes). Other metrics included body weight, blood pressure, height, waist circumference and blood lipid profiles. Testosterone was measured via blood sample. The cohort was divided into two groups: hypogonadal or with low testosterone (<350ng/dL), and eugonadal or with normal testosterone (≥350ng/dL).
Investigating the data, the authors identified significant differences between the hypogonadal and eugonadal groups. The hypogonadal group was 2.7 years older, and had a waist circumference of 4.5cm greater and a body mass index (BMI) of 1.8kg/m² greater. The laboratory data revealed a greater prevalence of multiple metrics in the hypogonadal group, including diabetes (40.1% vs. 24.0% eugonadal), hypertension (46.1% vs. 29.6% eugonadal), and dyslipidemia (64.9% vs. 51.7% eugonadal). Hypogonadal men also exhibited significantly higher triglycerides and fasting blood glucose. There was also a higher frequency of major adverse cardiological events in the hypogonadal group. Notably, ED severity was not significantly different between the two groups.
The strongest relationship was found between hypogonadism and obesity. Age demonstrated the second-strongest association with low testosterone followed by diabetes and then by hypertension. This illustrates a relationship between testosterone levels and CVD risk factors within the context of ED. The authors posited that measuring testosterone in ED patients can be used as a screening tool for CVD risk.
To provide context from another Asian market, GlobalData epidemiologists predict 156 million total prevalent cases of erectile dysfunction in China in 2025. This is in comparison to more than 18 million diagnosed prevalent cases of obesity, more than 29 million diagnosed prevalent cases of type 2 diabetes, and more than 243 million total prevalent cases of hypertension in Chinese men in 2025. Further research to determine whether the prevalence of these cardiometabolic conditions is different in men without erectile dysfunction can serve to illustrate whether hypogonadism alone is a predictor of health, or whether it should be taken together with the presence of ED for CVD risk.
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