Comparison of Triglyceride–Glucose (TyG) Index and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) Index in Prediction of Male Hypogonadism

Several studies have shown the association between decreased insulin sensitivity and the risk of male hypogonadism. Homeostatic model assessment of insulin resistance (HOMA-IR) is a well-established marker of decreased insulin sensitivity. The triglyceride–glucose index (TyG), calculated as ln (fasting triglyceride (mg/dL) ×  fasting glucose (mg/dL)/2), was recently suggested to be a cheaper and a reliable surrogate marker to detect insulin resistance (IR). Our aim was to compare the performance of those two indexes in the prediction of male hypogonadism. The data on 192 men from infertile couples (18–50 years; sperm concentration <20 x 10⁶/mL) and 199 population-based matched controls collected during the years 2009–2012 (baseline) were evaluated retrospectively. Half of these subjects (72 subfertile men and 122 controls) were reinvestigated 5–10 years later (median year (range): 7 (5–10)). The patients receiving any hormonal therapy were excluded. Hypogonadism was defined as fasting, morning serum testosterone below 12 nmol/L. In receiver operating characteristic curve analysis, the optimal diagnostic cutoff values for baseline HOMA-IR and TyG to predict MetS at re-examination were 2.68 (Area Under Curve (AUC) = 0.886, p < 0.001) and 8.60 (AUC = 0.816, p  < 0.001), respectively. Moreover, in binary logistic regression analysis performed on the whole cohort using these thresholds for high values of HOMA-IR and high TyG, the odds-ratios (ORs) for hypogonadism were 6.48 (95% Confidence Interval (CI): 3.77–11.2; p  < 0.001) and 3.58 (95% CI: 2.17–5.94; p  < 0.001), respectively. Even though high HOMA-IR levels provided better risk estimates, high TyG was also highly related to the risk of hypogonadism. These markers can be utilized to identify men being at high risk of hypogonadism.