Assessment of erectile dysfunction in 965 Azerbaijani men: associations with BMI, testosterone, and vitamin D levels

Erectile dysfunction (ED) is a common male sexual disorder with significant psychosocial and physiological impacts. While modifiable risk factors such as body mass index (BMI), serum testosterone, and vitamin D levels have been linked to ED, regional data from the Caucasus, including Azerbaijan, are limited.

This retrospective cohort study included 965 Azerbaijani men aged 35-75 years who presented with symptoms suggestive of ED between 2019 and 2024. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5). An IIEF-5 score of ≤21 was considered as ED. Serum total testosterone, 25-hydroxyvitamin D [25(OH)D] levels, and BMI were evaluated. Correlations and multivariate logistic regression analyses were conducted to identify independent factors associated with IIEF-5-defined ED in symptomatic men.

Among men presenting with ED-related symptoms, 54.4% met the IIEF-5 criteria for ED. Obesity (BMI ≥30 kg/m2) was present in 46.1% of participants and significantly more common in men with ED (58.3% vs 31.6%, p<0.001). Total testosterone levels <10 nmol/L were observed in 54.7% of men with ED vs 46.1% without (p=0.008). Spearman analysis showed inverse correlations between IIEF-5 scores and BMI (r = -0.316, p<0.001), and a positive correlation with testosterone (r = 0.108, p<0.001). No associations were found between 25(OH)D levels and ED. In multivariate analysis, obesity remained an independent factors associated with IIEF-5-defined ED (OR: 2.969, 95% CI: 2.27-3.88, p<0.001).

Obesity and low testosterone levels are significantly associated with ED in Azerbaijani men presenting with ED related symptoms. In contrast, vitamin D status was not an independent predictor. These findings underscore the importance of addressing weight and hormonal health in ED management strategies.