Correlation Between Serum Testosterone Levels and Erectile Dysfunction Severity in Pakistani Men Aged 40-65 Years

Background Erectile dysfunction (ED) is a prevalent and multifactorial condition affecting men worldwide, with potential hormonal underpinnings such as testosterone deficiency playing a critical role. Understanding the strength of the association between serum testosterone and ED severity in Pakistani men is essential to inform targeted diagnostic and therapeutic strategies. Objective This study aims to evaluate the correlation between serum total testosterone levels and the severity of ED (measured by the International Index of Erectile Function-5 (IIEF-5)) among Pakistani men aged 40-65 years attending a tertiary care outpatient clinic. Materials and methods In this cross-sectional analytical study, we enrolled 110 men aged 40-65 years presenting with ED at the Institute of Kidney Diseases of Medical Teaching Institution (MTI) - Hayatabad Medical Complex, Peshawar, between 1 January and 30 June 2025. ED severity was assessed using the validated IIEF-5. In the morning (8-10 AM), fasting blood samples were collected for the measurement of serum total testosterone using a chemiluminescent immunoassay. Spearman's rank correlation was used to assess the relationship between testosterone levels and IIEF-5 scores. ANOVA (and the complementary Kruskal-Wallis test) were used to evaluate differences in testosterone across ED severity categories. Results The mean age was 54.2 ± 6.7 years, and the mean serum testosterone level was 365.4 ± 102.7 ng/dL. Patients with mild, moderate, and severe ED (32.7%, 38.2%, and 29.1% of the sample, respectively) had mean IIEF-5 scores of 20.4, 13.5, and 7.2, and corresponding testosterone levels of 432.8, 362.1, and 278.6 ng/dL, respectively (all p < 0.0001). A strong positive correlation between testosterone and IIEF-5 score was found (Spearman's ρ = 0.615, p < 0.0001). Conclusions Serum total testosterone shows a strong and significant positive correlation with ED severity in this outpatient Pakistani male cohort. These findings support the inclusion of hormonal evaluation in ED workups, particularly when clinical suspicion of hypogonadism exists.