Testosterone in renal transplant patients: effect on body composition and clinical parameters
Clinical studies have demonstrated that, after renal transplantation (TX), testosterone deficiency (TD) at the time of the procedure is independently associated with lower survival of the patient and graft. However, data between TD and the functional CAG polymorphism of the androgen receptor promoter (AR) are discordant. We investigated the prevalence of TD and its association with body composition, biochemical parameters, the Aging Males’ Symptoms rating scale (AMS) domains and AR polymorphism.
In 112 TX patients, we assessed the AMS, biochemical/hormonal (FSH/LH/TT) anthropometric/bioimpedance analysis parameters, and AR CAG polymorphism of AR by gene sequencing.
Median values of total testosterone (TT) were 340 ng/dl and 52% of TX patients were affected by TD. Significant correlations between TT and FSH and FSH and LH (p = 0.005, p < 0.0001, respectively) were found. TD patients had lower estimated glomerular filtration rate (eGFR) and hemoglobin (Hb) (p = 0.034, p = 0.022 respectively) and showed higher values of C-reactive protein (p = 0.023) and fat tissue index/adipose tissue mass (p = 0.034 and p = 0.021, respectively), and lower values of serum albumin (p = 0.003) and high-density lipoprotein-cholesterol (p = 0.038) levels. Significant differences were found in the number of patients on mammalian target of rapamycin inhibitors immunosuppressant therapy (p = 0.045). Logistic regression analysis did not show any correlation between age, AMS scores, TT or CAG repeat length, gonadotropins, time of the transplant, and dialysis.
Our results suggest that in TX recipients an appropriate sexual hormonal evaluation should be performed, as we found a high prevalence of TD. However, further studies are needed to clarify the association between TD and patient and graft survival.
KeywordsHypogonadism Testosterone deficiency Renal transplantation Androgen receptor polymorphism
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants enrolled in the study.
- 5.Carrero JJ, Kyriazis J, Sonmez A, Tzanakis I, Qureshi AR, Stenvinkel P, Saglam M, Stylianou K, Yaman H, Taslipinar A, Vural A, Gok M, Yenicesu M, Daphnis E, Yilmaz (2012) MI. Prolactin levels, endothelial dysfunction, and the risk of cardiovascular events and mortality in patients with CKD. Clin J Am Soc Nephrol 7:207–215CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Kupelian V, Page ST, Araujo AB, Travison TG, Bremner WJ, McKinlay JB (2006) Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in non-obese men. J Clin Endocrinol Metab 91:843–850CrossRefPubMedGoogle Scholar
- 12.Khaw KT, Dowsett M, Folkerd E, Bingham S, Wareham N, Luben R, Welch A, Day N (2007) Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European Prospective Investigation into Cancer in Norfolk (EPICNorfolk) Prospective Population Study. Circulation 116:2694–2701CrossRefPubMedGoogle Scholar
- 17.Panach-Navarrete J, Martínez-Jabaloyas JM & DE-SDT study group (2017) The influence of comorbidities on the aging males’ symptoms scale in patients with erectile dysfunction. The Aging Male. https://doi.org/10.1080/13685538..1298585
- 18.Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Krämer BK, Neumayer HH, Stahl R, Pietrzyk M, Krüger B, Pfalzer B, Bourbigot B, Campbell S, Whelchel J, Eris J, Vitko S, Budde K, RADA2307 Study Group (2005) Graft function, cardiovascular risk factors, and sex hormones in renal transplant recipients on an immunosuppressive regimen of everolimus, reduced dose of cyclosporine, and basiliximab. Transplant Proc 37:1601–1604CrossRefPubMedGoogle Scholar
- 29.Arnaud L, Nordin A, Lundholm H, Svenungsson E, Hellbacher E, Wikner J, Zickert A, Gunnarsson I (2017) Effect of Corticosteroids and Cyclophosphamide on Sex Hormone Profiles in Male Patients With Systemic Lupus Erythematosus or Systemic Sclerosis. Arthritis Rheumatol 69:1272–1279CrossRefPubMedGoogle Scholar
- 31.Navaneethan SD, Vecchio M, Johnson DW, Saglimbene V, Graziano G, Pellegrini F, Lucisano G, Craig JC, Ruospo M, Gentile G, Manfreda VM, Querques M, Stroumza P, Torok M, Celia E, Gelfman R, Ferrari JN, Bednarek-Skublewska A, Dulawa J, Bonifati C, Hegbrant J, Wollheim C, Jannini EA, Strippoli GF (2010) Prevalence and Correlates of Self-Reported Sexual Dysfunction in CKD: A Meta-analysis of Observational Studies. Am J Kidney Dis 56:670–685CrossRefPubMedGoogle Scholar
- 34.Tirabassi G, Cignarelli A, Perrini S, Delli Muti N, Furlani G, Gallo M, Pallotti F, Paoli D, Giorgino F, Lombardo F, Gandini L, Lenzi A, Balercia G (2015) Influence of CAG Repeat Polymorphism on the Targets of Testosterone Action. Int J Endocrinol2015:298107Google Scholar