Testosterone Treatment in Men With Chronic Kidney Disease

Inclusion criteria

• Men between ages of 18-85 years of age
• eGFR 15-45 ml/min/1.73m2 by MDRD (Modification of Diet in Renal Disease) equation
• Subnormal total serum T concentrations (\<300 ng/dl) on two separate occasions in morning
• Symptoms of hypogonadism (as per Endocrine Society guidelines): low libido, erectile dysfunction, fatigue, irritability, depressed mood, poor concentration, increased body fat, decreased muscle bulk, reduced physical performance, sleep disturbance, loss of body hair (15)
• Normal iron stores as defined by serum ferritin ≥100 ng/mL and transferrin saturation (TSAT) ≥20%.

Exclusion criteria

• Use of TRT currently or in the past 6 months, including use of over-the-counter androgen containing health supplements (e.g., DHEA)
• Hematocrit \>48% (as per Endocrine Society guidelines)(15)
• Treatment with erythropoiesis stimulating agents (ESA)
• Uncontrolled blood pressure (\>180/100 mm Hg)
• Heart Failure, class III or IV
• Myocardial infarction, stroke, or heart surgery in the past 3 months
• Breast cancer
• History of prostate cancer
• Prostate specific antigen (PSA) \>4 ng/ml, unless prostate cancer has been ruled out by a urologist (documented in physician notes)
• HIV or untreated hepatitis C
• Untreated, severe obstructive sleep apnea
• Initiated iron replacement in the last 3 months
• deep venous thrombosis or pulmonary embolism in the last 3 months
• recurrent (more than once) deep venous thrombosis or pulmonary embolism
• use of warfarin
• Planning to have children in the next one year