Associations between erectile dysfunction, low testosterone, and cardiometabolic risk: an age stratified, propensity-matched cohort study.

Erectile dysfunction (ED) and low testosterone (low T) may serve as early markers of cardiometabolic disease. We conducted a retrospective cohort study using TriNetX, including 3 494 600 U.S. men aged 18-70 years with ED, low T, or both conditions, to evaluate associations with incident diabetes, metabolic syndrome (MetS), cardiovascular disease (CVD), hypertension, and obesity identified using ICD codes. Subgroup analysis assessed the impact of testosterone replacement therapy (TRT) on cardiometabolic outcomes in men with low T. In men aged 41-50 years, low T was associated with increased risk of diabetes (HR 1.89, p < 0.001) and MetS (HR 1.44, p < 0.001). TRT use was associated with decreased risk of diabetes (HR 0.88, p = 0.023). ED was associated with increased risk of CVD across all age groups, including men aged 41-50 years (HR 2.54, p < 0.001). Young men aged 18-30 with both low T and ED exhibited greater risk of obesity (HR 1.49, p < 0.001) and MetS (HR 2.61, p < 0.001) compared with ED alone. These findings suggest that ED and low T represent early clinical indicators of cardiometabolic disease and highlight the importance of early risk stratification in affected men.