Renal disease

Men with chronic renal failure exhibit many features of classical androgen deficiency including gynecomastia, impotence, testicular atrophy, impaired spermato-genesis and infertility as well as somatic disorders of bone, muscle and other androgen-responsive tissues (Handelsman 1985; Handelsman and Dong 1993; Handelsman and Liu 1998). Yet there is little information on androgen replacement therapy in patients with end-stage renal disease, during dialysis or after renal transplantation. Only a single randomised controlled study has examined androgen replacement therapy in uremic men (van Coevorden et al. 1986). Nineteen regularly hemodialysed men were randomised to receive either oral testosterone undecanoate (240 mg daily) or placebo for 12 weeks. Although libido and sexual activity increased, hemoglobin was unchanged and no other androgen effects on bone, muscle, cognition and well-being were reported. Future studies examining physiological replacement therapy using testosterone patches or gels would be of interest since transdermal testosterone has similar pharmacokinetics in uremic as in hypogonadal men (Singh etal. 2001).

Pharmacological androgen therapy has been evaluated in a randomised placebo-controlled trial of nandrolone decanoate in dialysed patients (Johansen etal. 1999). Twenty-nine patients were randomised by sequential allocation to nandrolone decanoate (100 mg intramuscularly each week, n = 14) or saline placebo (n = 15) for 6 months. Lean body mass (measured by DEXA), timed walking and stair-climbing speed were all increased, self-reported fatigue fell but there was no change in handgrip strength. Peak oxygen consumption was also increased at three months, but not significantly so by the end of the sixth month. Larger placebo-controlled clinical studies of longer duration are needed to determine whether the impressive short-term benefits are sustainable and/or improve survival.

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