Editorial Review The vulnerable man: impact of testosterone deficiency on the uraemic phenotype

Testosterone deficiency or hypogonadism is a common finding in men undergoing dialysis, to a great extent a consequence of the failing kidney per se. Testosterone res-toration in hypogonadism is common practice among en-docrinologists. However, there is currently little awareness of this condition among both uremic patients and nephrol-ogists, and in many cases, testosterone deficiency remains unscreened and untreated. This review article summarizes our current understanding of the role of testosterone deficiency at the crossroad of cardiometabolic compli-cations of patients with chronic kidney disease. Pathways discussed include, among others, the plausible role of tes-tosterone deficiency in the development of anaemia and ESA hyporesponsiveness, muscle catabolism, endothelial dysfunction, cognitive dysfunction, decreased libido, car-diovascular disease and mortality. As there are limited sources to guide decision-making, we also review existing testosterone replacement therapy studies in the context of CKD as well as considerations for side and adverse effects. This review makes a case for consideration of screening and better management of hypogonadism in men undergoing dialysis