This grabbed my attention big time recently.
Testosterone has been shown to play a significant role in chronic kidney disease (CKD) risk. Researchers have speculated on this connection for years because women consistently show a higher prevalence of CKD than men.
And CKD has exploded over the last 30 years. We’re talking about a roughly 44% increase.
Now, here’s the kicker. Over that same time frame, testosterone levels have been steadily falling. Coincidence? Maybe not.
What the Data Used to Suggest
In animal studies, testosterone often looked harmful to the kidneys. Findings included:
- Glomerular damage
- Kidney fibrosis
- Proteinuria
- Hypertension
Not good. And for years, that data fueled suspicion around testosterone therapy.
What Human Data Now Shows
A recent meta-analysis turned the old assumptions on their head. Men with low testosterone had:
- 1.4-fold increased risk of CKD
- 2-fold increased risk of all-cause mortality
- 2.4-fold increased risk of cardiovascular mortality
That’s a massive shift from the “testosterone hurts the kidneys” story we’ve been told.
Why Testosterone is Protective
So what’s really going on here? Testosterone actually benefits the kidneys by:
- Reducing inflammation and modulating cytokines
- Improving insulin resistance, weight gain, and cardiovascular risks
- Dilating blood vessels and improving renal blood flow
- Protecting against renal ischemia
Pretty incredible, right?
In fact, the authors concluded that hypogonadism itself should be considered a marker for CKD and CVD risk.
My Favorite Takeaway
The researchers wrote:
“Future studies are needed to investigate whether low serum testosterone is detrimental for the kidney and if testosterone replacement therapy could effectively and safely prevent these outcomes.”
van der Burgh et al., 2022
That’s huge. From their lips to God’s ears.
Clinical Considerations for Providers
Here’s the important nuance: TRT is safe for patients with CKD. But if you’re initiating therapy, make sure they’re monitored carefully.
- Track fluid shifts with daily weights
- Check blood pressure consistently
- Watch for lower extremity edema
With those precautions in place, TRT not only looks safe — it looks like a potential therapy for preventing disease progression.
Conclusion: The Old Story is Wrong
Low testosterone increases risk for CKD, cardiovascular disease, and all-cause mortality. TRT is not the villain. It may be one of the most powerful tools we have to protect renal health.If you want to feel confident explaining this to your patients and applying it in real-world practice, this is exactly the kind of training we dig into inside the HRTU Master Course.
