Metabolic correlates of biochemically low total testosterone among men participating in a national WHO STEPS survey in Kazakhstan

Abstract Introduction Low total testosterone in men is associated with adverse metabolic health, but population-based data from Central Asia remain limited. Aim To estimate the prevalence of biochemically low total testosterone and examine its anthropometric, sociodemographic, behavioral, and metabolic correlates among men in Kazakhstan. Methods We conducted a cross-sectional analysis of a national WHO STEPS survey performed in Kazakhstan from May to October 2025. Among 3,198 eligible men aged 18–69 years, 3,083 had total testosterone measurements suitable for analysis. Survey weights, stratification, and clustering were incorporated in design-based analyses. The primary outcome was total testosterone <8 nmol/L; thresholds of <10 and <12 nmol/L were examined in sensitivity analyses. The primary logistic model included age, BMI, and HbA1c; total testosterone was also analysed continuously after logarithmic transformation. Results The observed proportion with total testosterone <8 nmol/L was 5.1% (156/3,083), and the survey-weighted prevalence was 5.3% (95% CI 4.4–6.2%). In the primary model (n=2,959), overweight (aOR 2.05, 95% CI 1.15–3.64), obesity (aOR 4.58, 95% CI 2.41–8.69), prediabetes-range HbA1c (aOR 2.39, 95% CI 1.49–3.82), and diabetes-range HbA1c (aOR 3.49, 95% CI 1.91–6.38) were associated with low testosterone. For men aged 60–69 versus 18–29 years, the age-only OR was 1.84 (95% CI 1.03–3.29), whereas after adjustment for BMI and HbA1c the aOR was 0.65 (95% CI 0.31–1.36). In continuous models, overweight and obesity were associated with 15.0% and 24.8% lower testosterone, respectively; prediabetes-range and diabetes-range HbA1c were associated with 19.0% and 24.5% lower testosterone. Associations with obesity and dysglycemia remained positive using the <10 and <12 nmol/L thresholds. Conclusion In men aged 18–69 years participating in a national WHO STEPS survey, biochemically low total testosterone was consistently associated with excess adiposity and HbA1c-defined dysglycemia. The age association changed direction after metabolic adjustment and was not statistically significant. These findings describe biochemical associations and should not be interpreted as a diagnosis of clinical hypogonadism. Registration Clinical trials gov identifier NCT06953180; registered May 1, 2025.