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Can testosterone therapy show signs of remissions in chronic kidney diseases?

testosterone therapy and ckd

What is CKD

Our kidney is a vital organ which continuously and silently removes the wastes from the blood by filtering, the waste substances then are passed out through the urine.

We call those conditions as chronic kidney disease ( CKD ) or sometimes as chronic kidney failures when the kidney gradually loses its ability to function properly.

As the kidney function deteriorates to some dangerous levels, the waste products cannot be fully flushed out of the body through the urine. Such wastes, extra fluids as well as electrolytes start building up in the body itself. 

In the preliminary stages of CKD the patients may not even have any noticeable symptoms so that it can be reported to a doctor. But as the CKD proceeds the symptoms become prominent affecting the daily life of the patient.

Modern medical science is not yet fully equipped to restore the functioning of the failed kidney. The available treatments can only try to slow down the advancement of kidney failure.

Through regular dialysis, in which the blood is filtered artificially, the patient can be survived. But the process has to be continued lifelong.

Replacement of kidney can give some lease of life but it involves suppression of immunity by prescribing immunosuppressant medicines.

Other complications which may be caused due to CKD are 

  • Fluid retention: as the kidney fails to remove fluids you will notice swelling of legs and arms and even in the lungs.
  • Hyperkalemia in which a sudden surge in the levels of potassium in the blood occurs which may be life threatening.
  • Weakening of bones or fractures in bones 
  • Heart ailments
  • Reduced immunity making you prone to infections

 A multidimensional approach is being envisaged to find a suitable method to cure or remit the symptoms of CKD. One observation of the medical professionals hints about sex diparity of CKD.

It has been found that CKD progresses rapidly in men compared to women. The mortality rate is also more among the men with CKD at pre-dialysis stages of CKD. This has raised a question among the researchers whether testosterone has any role in kidney diseases.

In the absence of definitive proof regarding the interrelationship between the levels of testosterone and CKD, studies are being carried out through clinical trials on selected genetic groups and by using statistical models such as bi-directional Mendelian Randomization. This approach is adopted to find unconfounded estimates while using data from UK Biobank.

One study was carried out on white British whites numbering to 212,079 British Women as well as 179,916 British Men.

The association of testosterone levels with CKD was tried to be evaluated by tests such as albuminuria, eGFR, hemoglobin, HDL etc.

Single nucleotide polymorphism or SNPs were used for the prediction. Association of kidney function with serum testosterone has been tried to establish by the application of eGFR related SNPs to the testosterone.

Retrospection

Though some evidences prove that there may be a role of androgens in determining the longevity depending on the sex, but no conclusive proof of the same could be found.

Some clinical trials have shown that in some cases of testosterone therapy, it induced renal failures. In a controlled trial which was done among 48 participants for six months, the results indicated reduction of eGFR rate with testosterone therapy.

In some other studies the opinion came out that higher levels of testosterone is associated with a lowered rate of mortality among men CKD patients.

In this backdrop mendelian randomization using SNPs only provides us with an unconfounded relationship of CKD with levels of testosterone.

The methodology used was with univariable MR and multivariable MR. All efforts are made to exclude SNPs with confounders such as physical activities, effects of smoking, drinking alcohol etc. all such confounded SNPs have been dropped from the study.

The conclusions drawn from the detailed study are:

  • Levels of testosterone do affect kidney function diseases, but the association is very much sex-specific. It is possible that testosterone might be an underlying reason for CKD in men. But the same is not true for the women.
  • On the contrary the kidney functions which are predicted genetically are not associated with serum testosterone levels.
  • Any beneficial effects of testosterone on CKD could not be established. Some observations of increased dietary protein which can be related to increased levels of testosterone in men has been found to enhance CKD. On the contrary, medications such as satin which lowers the levels of testosterone showed beneficial effects of lowering CKD.

The study has opened up a new avenue in the research of finding a viable treatment for CKD. More detailed studies and research are still to be done for further enlightenment in the field of association of testosterone and CKD.

What is the optimum level of serum testosterone in men

The testosterone levels are checked by testing blood. The testosterone level is considered as normal when it falls in the range of 300 to 1000 nanograms per deciliter or ng/dl. But doctors also warn that sometimes a level of testosterone below 300 ng/dl should not be considered as a warning signal. Often men above 40 may show a lowered level of testosterone.

Even if the testosterone is in the lower segment of say 200 to 300 ng/dl there is no need to worry if you are living a good life.

But when it is associated with symptoms as below you may need to see a doctor.

  • Low levels of sexual drive and desire
  • Lowered bone-density
  • Declining muscle mass
  • Reduced strength
  • Fatiguing condition
  • Low levels of energy
  • Depressed sorts of feeling

The reasons of low levels of testosterone can be many 

  • Raised blood pressure
  • Raised cholesterol level
  • Obesity
  • Diabetes
  • Effects Of medications
  • Unknown reasons

Sustaining the level of testosterone

It seems that low levels of testosterone have some association with obesity or being overweight. By shedding 10% of excess pounds may show significant improvement in the levels of testosterone. The means of reducing weight such as dieting, exercising, quitting smoking and drinking alcohol etc have its effects on enhancing the testosterone levels.

It is also presumed that good and fulfilling sleep at night as well as getting yourself free from the tentacles of stress by some means like meditation and engagement in creative activities or even by socializing can reduce stress.

Reference: 

  1. http://biobank.ctsu.ox.ac.uk/crystal/
  2. http://www.nealelab.is/uk-biobank/
  3. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01594-x