Metabolic and Atherogenic Thresholds in the Severity of Erectile Dysfunction: The Dominant Role of the Triglyceride-Glucose Index.

Background

This study aimed to investigate the association between metabolic and atherogenic indices and erectile dysfunction (ED) severity, and to compare their diagnostic performance in predicting severe ED.

Methods

This retrospective study included 221 men with ED between January 2025 and January 2026. ED severity was assessed using the International Index of Erectile Function-5 (IIEF-5). The triglyceride-glucose (TyG) index, atherogenic index of plasma (AIP), Castelli Risk Index-1 and -2, and atherogenic coefficient (AC) were calculated from routine laboratory parameters. Correlation, logistic regression, and ROC analyses were performed.

Results

Patients with severe ED (n = 57) had significantly higher triglyceride, fasting glucose, TyG, and AIP levels and lower high-density lipoprotein cholesterol (HDL) levels than those with mild-to-moderate ED (all p < 0.05). TyG (ρ = 0.369, p < 0.001) and AIP (ρ = 0.359, p < 0.001) were positively correlated with severe ED. In the multivariable model, the TyG index remained associated with severe ED after adjustment for AIP, age, BMI, total testosterone, and the TyG-by-testosterone interaction (OR: 4.354, 95% CI: 1.668-11.364; p = 0.003). Total testosterone was not independently associated with severe ED (p = 0.510), and the TyG-by-testosterone interaction was not significant (p = 0.281). ROC analysis showed that TyG had the best predictive performance (AUC: 0.743).

Conclusions

The TyG index showed discrimination for IIEF-5-defined severe ED and may have value as a complementary metabolic risk-stratification parameter.