Which is better to predict erectile dysfunction and male sexual function in the context of metabolic syndrome: Triglyceride-Glucose Index or Visceral Adiposity Index? A Retrospective Cross-sectional Study

Abstract Background:Male sexual function is influenced by various factors, including metabolic disorders such as metabolic syndrome (MetS) and insulin resistance. We aimed to investigate the effects of two metabolic indices, the triglyceride-glucose (TyG) index and the visceral adiposity index (VAI), on erectile function and other aspects of male sexual function. Methods: A total of 400 men having erectile and ejaculatory dysfunction were included. Age, body weight and waist circumference (WC) were calculated and comorbidities and contributing factors such as diabetes mellitus, hypertension, atherosclerotic disease, smoking, and alcohol use were recorded. Hormonal analysis was performed using the enzyme-linked immunosorbent assay (ELISA) for total testosterone, prolactin, and estradiol. The male sex-specific VAI was calculated using the [(WC/39.68)+(1.88xMI)]x(TG/1.03)x(1.31/HDL) formula. The TyG index was calculated logarithmic formula: Ln (fasting triglycerides) x (fasting glucose) / 2] (9). The participants were given the Turkish-validated 15-item long-form of the International Index of Erectile Dysfunction (IIEF) questionnaire to fill. Ejaculatory function was assessed using male sexual health questionnaire (MSHQ) consisting of four questions. The participants completed the 21-item Beck Depression Inventory. Kolmogorov-Smirnov and Chi-square tests were used for normal distribution of continuous and categorical variables, respectively. The ROC analysis was used to evaluate the predictive abilities of TyG and VAI cut-off values for ED risk. Statistical significance was set at p < 0.05. Results: Both the TyG index and the VAI were significantly associated with ED. A higher TyG index and VAI were associated with an increased risk of ED. The presence of MetS further worsened sexual function, with lower scores in sexual satisfaction, orgasm, desire, and general satisfaction. The TyG index and VAI demonstrated similar predictive abilities for ED, as indicated by their respective area under the curve rates. Additionally, patients with MetS had poorer ejaculation quality compared to those without MetS. Conclusions: These findings highlight the potential of the TyG index and VAI as convenient tools for predicting and assessing sexual dysfunction in men, particularly in the context of metabolic disorders. Early detection and intervention for metabolic syndrome and insulin resistance may help mitigate their negative impact on male sexual function.