Andrological Dysfunction Signals Increased Cardiometabolic Risk: An Age Stratified, Propensity-Matched Cohort Study

Andrological dysfunction is traditionally considered within the domain of sexual health, but emerging evidence suggests that it may serve as an early marker for cardiometabolic disease. Utilizing the TriNetX database, we conducted a retrospective cohort study to evaluate the association between erectile dysfunction (ED), low testosterone (low T), and the subsequent development of diabetes, metabolic syndrome (MetS), cardiovascular disease (CVD), hypertension, and obesity. Men were stratified by decade of age (18–30, 31–40, 41–50, 51–60, 61–70) and categorized into cohorts based on diagnoses of ED, low T and both conditions. Subgroup analysis assessed the impact of testosterone replacement therapy (TRT) on outcomes in men with low T. Low T was associated with increased risk of developing all outcomes in all age group except for CVD and hypertension in the 18–30 year old group. TRT was associated with decreased risk of diabetes (HR 0.877, p = 0.023). ED was associated with increased risk of CVD, hypertension and diabetes in all age groups. Young men aged 18–30 with both low T and ED exhibited greater risk of developing obesity and MetS compared to those with ED alone. These findings suggest that andrological dysfunction may represent an early clinical indicator of cardiometabolic disease.