Association between cardiometabolic index and testosterone among adult males: a cross-sectional analysis from National Health and Nutrition Examination Survey 2013-2016.

Background: Cardiometabolic index (CMI) is a well-promising indicator for predicting obesity-related diseases. Testosterone decline and deficiency importantly affect men's health, and may be associated with obesity and excessive deposition of visceral adipose tissue. We aimed to explore the association between CMI and serum testosterone in US adult males.

Methods: The present cross-sectional study was conducted among adult males with complete data about CMI and testosterone in 2013-2016 National Health and Nutrition Examination Survey (NHANES). CMI was calculated as follows: triglyceride (TG) (mmol/L)/high-density lipid-cholesterol (HDL-C) (mmol/L) × waist-to-height ratio (WHtR). Multivariable regression and subgroup analyses were conducted to explore the association between CMI and testosterone.

Results: We included 2,209 male participants for the final analysis. After adjusting for confounders, CMI was found to show a negative correlation between testosterone [minimally adjusted model: β=-10.56, 95% confidence interval (CI): -12.76, -8.36, P<0.001, fully adjusted model: β=-0.04 (-4.88, 4.81), P=0.99]. Multivariate-adjusted beta also showed testosterone levels were significantly lower in the two highest CMI groups (Q3, Q4) compared to the lowest group (Q1). In the subgroup populations, the relationship between CMI and testosterone was affected by age, race, education level, hypertension, and smoking status (P-interaction <0.05). Furthermore, receiver operating characteristic (ROC) curve analysis indicated that triglyceride-glucose-body mass index (TyG-BMI) (0.67, 95% CI: 0.65, 0.70) was the best predictor of low testosterone (results), although CMI was comparable in its predictive value (0.68, 95% CI: 0.65, 0.71).

Conclusions: Higher CMI scores were associated with lower testosterone levels in adult males in the United States, with this correlation being influenced by factors such as age, race, education level, hypertension, and smoking status. CMI was comparable to other metabolic indexes for predicting testosterone deficiency, although TyG-BMI was the best overall predictor.