Keywords: Testosterone, Smoking, Diabetes Mellitus, Cardiovascular Diseases

Aim:

Testosterone deficiency and smoking are both associated with increased cardiometabolic risk in men with type 2 diabetes mellitus (T2DM). This study purposed to evaluate whether the association between testosterone levels and cardiometabolic risk varies according to the level of daily smoking.

Method:

This retrospective, single-center study included 130 smoker men aged 40–60 years with T2DM who attended a smoking cessation clinic. Ethical approval and institutional permission were obtained from Gaziosmanpaşa Training and research hospital in 2025. Cardiometabolic risk (CMR) was calculated using a composite index based on lipid parameters and anthropometric measures.Moderation analysis was performed to determine whether smoking modifies the relationship between testosterone and CMR.Statistical analyses were conducted using Jamovi software, and a p value <0.05 was considered statistically significant.

Results:

The participants ( 52.7 ± 6.7 years aged) had a mean total testosterone of 4.30 ± 1.66 ng/mL, a high cardiometabolic burden, with a mean triglyceride level of 211 ± 138 mg/dL and a mean CMR score of 3.45 ± 2.74.Correlation analysis showed negative associations between age-CMR (r = −0.407, p < 0.001) and Testosterone level-CMR (r = −0.211, p = 0.024). Daily cigarette consumption was positively correlated with CMR (r = 0.199, p = 0.036) and negatively correlated with testosterone (r = −0.184, p = 0.041).Moderation analysis revealed that the interaction between testosterone levels-daily cigarette consumption was not significant(β ≈ 0, p = 0.986), indicating no moderating effect of smoking on the testosterone–CMR relationship. However, daily cigarette consumption was positively associated with CMR (β = 0.041, p = 0.021),whereas testosterone levels were not independently associated with CMR (p = 0.193).

Conclusions:

Daily smoking does not modify the association between testosterone and cardiometabolic risk in andropausal men with T2DM. However, smoking remains an independent predictor of increased cardiometabolic risk, highlighting the need for smoking cessation as a key modifiable lifestyle factor.