Testosterone replacement therapy appears safe and improves survival in CKD with hypogonadism: Study

A recent study published in The World Journal of Men’s Health revealed that among men with chronic kidney disease (CKD) and hypogonadism, testosterone replacement therapy (TRT) was associated with improved survival without increasing the risk of cardiovascular events, prostate cancer, or dementia. These findings support TRT as a potentially safe option in this high-risk group, though further prospective studies are needed.

Testosterone deficiency is a common but often underrecognized condition among men with moderate to advanced CKD. It has been closely associated with symptoms like fatigue, frailty, reduced muscle mass, and even cognitive decline. While TRT has long been considered a potential treatment to address these complications, concerns about its long-term safety in terms of heart disease and cancer risk in vulnerable populations like CKD patients is still lingering.

Thus, this retrospective cohort study used data from the TriNetX Global Collaborative Network which included men aged 18 to 80 diagnosed with CKD stages 3 to 5 and hypogonadism. The patients were divided into two groups, where one received TRT within 6 months of diagnosis and the other did not.

Using propensity score matching based on demographics, existing health conditions, and laboratory values, this study found two closely matched groups of 1,545 patients each, with similar kidney function (average estimated glomerular filtration rate of 47.7 mL/min/1.73 m²).

Over a median follow-up period of 3.7 years, the findings of this study revealed observable survival benefit. Men who received TRT had a 22% lower risk of death from any cause when compared to those who did not receive the therapy. The study found no significant differences between the two groups in rates of stroke, heart attack, heart failure, or prostate cancer. Also, there was no increased risk of neurodegenerative conditions like vascular dementia or Alzheimer’s disease.

These findings challenge longstanding safety concerns surrounding TRT in high-risk populations. While testosterone therapy has historically been approached with caution due to fears of cardiovascular complications or cancer promotion, this study points to the risks which may not be elevated in men with CKD.

More dedicated probing and randomized clinical trials are imperative to confirm these findings and better guide clinical decision-making. Overall, the findings of this study offers hope for improved quality of life and survival in this high-risk group of CKKD patients with testosterone deficiency.

Reference:

Merlino, L., Rainone, F., Tollitt, J., Kalra, M. J., Williford, S., Rusconi, F., Battini, G. G., Dunne, R. A., Hackett, G., & Kalra, P. A. (2026). Safety of testosterone therapy in chronic kidney disease: A propensity score-matched cohort study. The World Journal of Men’s Health, 44(e24). https://doi.org/10.5534/wjmh.250333