The metabolic syndrome (MS) is comprised of various medical conditions that confer increased risk of diabetes and cardiovascular disease. The pathophysiologic components of MS include glucose abnormality, obesity or increased waist circumference, increased blood pressure, and hyperlipidemia. There is an increased risk of hypogonadism in men with MS and its individual components, including insulin resistance, considered by some to be at the core of MS. Hypogonadism may even predict MS. These factors are interwoven and impact overall health, including sexual dysfunction. One interesting and important question is whether treating hypogonadism with testosterone replacement will ameliorate the pathological components of MS.