Treatment of hypogonadism in men with chronic kidney disease

Hypogonadism is common among men with chronic kidney disease, but few studies have directly assessed the effects of testosterone replacement in this population. Limited information suggests that androgen replacement may improve libido and sexual function among men who are frankly hypogonadal. However, the threshold for normal sexual function is in the lower end of the normal range. Increasing serum testosterone above this level does not appear to have beneficial effects on sexual functioning. On the other hand, at least among healthy men, the dose-response curve for anabolic effects of testosterone administration appears to extend to testosterone levels on the high end of the normal range or above. Small studies have suggested that androgen treatment has anabolic effects among end-stage renal disease patients, even in the absence of hypogonadism. Androgens have potential side effects, and some preinitiation and subsequent assessment and monitoring are recommended to minimize these adverse effects. Recommendations for healthy older men appear to be reasonable for patients with chronic kidney disease. More research is needed to measure the effects of androgen therapy on various symptoms of hypogonadism as well as on overall quality of life, physical functioning, and survival among patients with chronic kidney disease.