Materials and Methods
After obtaining the Institutional Board approval of the XXX Local Ethics Committee, this prospective study was conducted among patients at outpatient urology clinics at four centers (A Hospital, B University, C Hospital and D City Hospital). Written informed consent was obtained. After a power analysis, a total of 285 sexually active men with complete data from 298 participants were included in the study. Patients with incomplete data (n = 3), active neurological disorders (n = 4), unwilling to participate (n = 1), end-stage renal failure (n = 1), those with a history of total thyroidectomy (n = 2) and patients with urogenital cancer surgery (n = 2) were excluded from the study. Patients with sexual dysfunction who met or did not meet the MeTS criteria, those who applied to the urology clinic with complaints of sexual dysfunction and those who were referred from Internal Medicine and Endocrinology clinics were included in the study. Participants were given the Turkish-validated 15-items long-form of the International Index of Erectile Dysfunction (IIEF) questionnaire to fill under a urologist’s supervision. Erectile function was assessed using the IIEF 1-5 and 15th items; sexual satisfaction, orgasmic function, sexual desire and general satisfaction were assessed using the IIEF 6-8th, 9-10th, 11-12th 13-14th items, respectively. Participants with IIEF 1–5 and 15 scores ≥26 were defined as non-ED patients, those with IIEF 1–5 and 15 score = 22–25 were mild ED, IIEF 1–5 and 15 scores = 17–21 were mild-to-moderate ED, IIEF 1–5 and 15 scores = 11–16 were moderate ED, and IIEF 1–5 and 15 scores = 0–10 were defined as severe ED. The BMI was calculated using the kg/m2 formula. Waist circumference measurement was performed at the level of the umbilicus. The mean age of the patients and comorbidities, including hypertension and diabetes mellitus, medications, smoking and alcohol habits, and ED duration, were recorded. The VAI was calculated using [(WC / 39.68) + (1.88 x BMI)] x TG / 1.03 x 1.31 / HDL male sex-specific formula [9]. The mean sexual satisfaction, orgasm, desire and general satisfaction scores were calculated. Among the participants, 96 patients with MeTS criteria were defined as Group 1 and 189 with no MeTS criteria were defined as Group 2. Using the enzyme‐linked immunosorbent assay (ELISA), single hormonal analysis for total testosterone (T), prolactin (PRL), estradiol (E2) tests were performed from morning fasting venous blood samples when needed. Aromatase activity was calculated using the T/E2 formula where available [11]. The mean VAI, erectile function score, sexual satisfaction, orgasm, desire and overall satisfaction scores were statistically compared between the groups.