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Testosterone Deficiency and Other Testicular Disorders in Kidney Disease

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Endocrine Disorders in Kidney Disease

Abstract

Testosterone deficiency is frequent among men with chronic kidney disease (CKD). Aberrations at all levels of the hypothalamic-pituitary-gonadal (HPG) axis contribute to testicular dysfunction and low testosterone levels in CKD. Testosterone levels decline as CKD progresses with further reductions in the estimated glomerular filtration rate (eGFR). Both CKD and low serum total testosterone concentrations are independent predictors of mortality risk, and combined evaluation of the GFR and circulating testosterone improves mortality risk stratification even further. Testosterone deficiency may have important clinical implications with regard to sexual dysfunction, anemia, loss of muscle mass and function, mobility, well-being, and health-related quality of life. Patients with CKD also suffer from high rates of erectile dysfunction and decreased fertility. Hypogonadism associated with CKD is seldom improved with the initiation of hemodialysis alone, but impairment of the HPG axis and sexual dysfunction are often improved by renal transplantation. In healthy hypogonadal men with normal renal function, testosterone replacement improves sexual desire, erectile function, sexual activity, muscle mass and maximal voluntary strength, as well as bone mineral density and bone quality. Randomized clinical trials are needed to determine the efficacy and safety of administering testosterone replacement therapy in patients with CKD.

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Disclosures

Dr. Goldman has no commercial or financial conflicts of interest to disclose.

Dr. Bhasin has received research grants from the National Institute on Aging, the National Institute of Nursing Research, the Foundation for the NIH, the Patient-Centered Outcomes Research Institute, AbbVie, Transition Therapeutics, and Metro International Biotechnology; he has consulted for AbbVie and Novartis and has equity interest in FPT, LLC.

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  1. Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA

    Anna L. Goldman & Shalender Bhasin

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  1. Anna L. Goldman
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  2. Shalender Bhasin
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Correspondence to Anna L. Goldman .

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Editors and Affiliations

  1. Division of Nephrology and Hypertension, Departments of Medicine and Public Health, University of California Irvine, School of Medicine, Orange, CA, USA

    Connie M. Rhee

  2. Division of Nephrology and Hypertension, Departments of Medicine, Pediatrics, Public Health, and Nursing Sciences, University of California Irvine, School of Medicine, Orange, CA, USA

    Kamyar Kalantar-Zadeh

  3. Division of Endocrinology, Diabetes, and Hypertension, Departments of Medicine and Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Gregory A. Brent

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Goldman, A.L., Bhasin, S. (2019). Testosterone Deficiency and Other Testicular Disorders in Kidney Disease. In: Rhee, C., Kalantar-Zadeh, K., Brent, G. (eds) Endocrine Disorders in Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-97765-2_9

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