Testosterone Injections Effect on Kidneys

by Benjamin Bunting BA(Hons) PGCert

Ben Bunting BA(Hons) PGCert Sports and Exercise Nutrition Level 2 Strength and Conditioning CoachWritten by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.

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As more individuals seek ways to optimize their health and well-being, testosterone injections have become an increasingly popular solution.

But before diving in head first to this treatment plan, it's crucial that we understand its possible impact on kidney health.

Testosterone is an essential hormone in various bodily processes, including muscle growth, bone density and red blood cell production.

While testosterone injections have proven their value for people with low testosterone levels, it's essential to keep in mind their possible adverse impacts on kidneys.

Research suggests that testosterone therapy could have an adverse impact on kidney function, although evidence is limited.

Some studies show an increase in red blood cell count due to testosterone therapy which could put strain on kidneys.

Men considering testosterone therapy must also understand its possible effects on fluid balance in their bodies and potential complications in people with preexisting kidney issues, to make informed decisions regarding this form of therapy.

Consulting healthcare professionals and closely monitoring kidney function is vital in order to make smart decisions about this approach to treatment; doing this ensures they prioritize overall well-being during their journey through testosterone therapy. 

The Role of Testosterone in the Body

Testosterone is both the male sex hormone and an androgen (androgens are steroids that stimulate masculine characteristics), produced in both men and women by their gonads.

Most testosterone production occurs in male testicles. A smaller amount can also be produced in women's ovaries and adrenal glands.

Levels of testosterone in blood vary greatly between individuals; typically reaching its highest point during puberty before gradually decreasing throughout adulthood until finally peaking during pregnancy when levels reach an all-time high!

Testosterone binds to androgen receptors found on muscle and bone cells to regulate their activity and modify gene activity.

Testosterone can also be converted to dihydrotestosterone (DHT) through 5a-reductase, making DHT more potent while still binding to androgen receptors as with testosterone.

When testosterone binds an androgen receptor it changes protein structure which in turn alters how that gene is regulated.

If the gene indicates that cells should produce more muscle tissue, testosterone interacts with proteins to cause them to change shape and grow faster.

Testosterone also plays a part in regulating secondary sexual characteristics, including male hair patterns and deepening voice during puberty.

Adult testosterone plays an essential role in sexual drive and muscle building. Additionally, testosterone may assist with memory retention (particularly spatial intelligence) and improve pain tolerance.

The level of testosterone in the bloodstream is maintained through an intricate feedback loop involving the hypothalamus, pituitary gland, and testicles.

When testosterone levels in the blood exceed certain thresholds, the hypothalamus senses it and this triggers release of gonadotropin-releasing hormone from the pituitary gland.

GnRH then stimulates testicles to produce more testosterone - this negative feedback loop ensures that body's testosterone remains at an appropriate level.

Low levels of testosterone can pose issues to reproductive organs, brain, bones and muscles.

A lack of testosterone may result in decreased muscle mass or an unattractive fatty appearance in your abdomen; additionally it increases your risk for heart disease and diabetes.

Your testosterone levels could be low due to genetic mutations, autoimmune diseases or some health conditions such as polycystic ovarian syndrome or congenital adrenal hyperplasia.

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The Role of the Kidneys in Human Health

The kidneys are two fist-sized organs located on either side of the spine near the bottom of the rib cage, and play many crucial life-supporting roles for our wellbeing, such as filtering waste products out of our bodies, maintaining potassium and sodium balance.

Kidneys are producing hormones to control blood pressure and production of red blood cells, conserving water use efficiently, protecting against high blood pressure that affects 37 million Americans.

They also help conserving energy through conservation strategies, conserving water use efficiency, protecting against heart conditions such as hypertension or providing relief from high blood pressure symptoms that manifest themselves physically in our bodies.

A healthy kidney can filter about one litre of blood every minute, expelling wastes such as creatinine and urea as urine through tiny filtering units called nephrons.

Each kidney contains around one million of these tiny filtering units - each one is comprised of small blood capillaries called glomeruli which filter blood and absorb certain substances while expelling others like protein-forming wastes such as creatinine and urea into urine.

Kidneys play an essential role in maintaining a proper acid-base balance within the body, maintaining an ideal pH range of 7.35 to 7.45. Furthermore, kidneys regulate fluid balance through producing more urine when you drink more or producing less when drinking less.

Kidneys play an essential role in blood clotting, producing hormones to control red blood cell production and other tissues production, and activating a form of vitamin D which assists the body with calcium absorption.

Furthermore, kidneys regulate salt and other electrolytes such as potassium, phosphate, and sodium levels in our bodies' circulation system.

Kidney Disease

The kidneys play an essential role in human health and without them people could experience severe poisoning or even death.

To combat kidney disease it's essential to avoid high-sodium foods, consume lots of fresh fruits and vegetables, limit salt and alcohol consumption as much as possible and maintain regular exercise regimes.

The kidneys are two intricate and powerful organs. No matter the state of one's health, kidneys play an essential role in keeping chemical balance within an individual's body within strict parameters - an impressive feat which explains why a functioning pair cannot exist without one another.

A diet rich in dark leafy greens and oily fish may help safeguard kidneys. Diabetes and high blood pressure are known to wreak havoc with kidney function but injuries and chronic illnesses such as cancer may affect it significantly.

Injuries must be recognized quickly for proper medical assistance as these conditions can seriously impair kidney functionality if present - your doctor will assess your current state and recommend treatments or measures necessary.

Kidney Disease and Low Testosterone

Chronic Kidney Disease (CKD) can impact multiple organs and systems. Complications associated with CKD include hypertension, malnutrition, impaired glucose tolerance and insulin resistance, endocrinological disorders, electrolytes disturbances, anaemia and bone metabolism issues.

Hypogonadism is one of the many endocrinological conditions which occur as part of chronic kidney disease.

Body Composition Disorder is defined as a multifactorial complex of signs and symptoms related to body composition, sexual health and mental wellbeing, metabolic diseases (e.g. lipid and carbohydrate abnormalities) as well as metabolic diseases.

Hypogonadism can be diagnosed when biochemical and clinical criteria as defined by EAU have been fulfilled.

Due to CKD's direct impact on hypogonadism pathophysiology, its prevalence among those living with the condition is higher than among general population; its severity depends on its stage. 

Although research on this subject is still emerging, some data indicate that low testosterone may increase risk of chronic kidney disease in both general population and men with CKD populations.

Also associated with increased all-cause mortality and cardiovascular events among this latter group of men with chronic CKD. 

Testosterone Injections Benefits and Risks

One method for administering androgens to the body is via injections administered intramuscularly or subcutaneously.

A testosterone molecule attached to an ester allows it to penetrate tissue, with subsequent delivery systemically.

Testosterone enanthate and testosterone cypionate formulations are commonly available and both require weekly or biweekly injections in order to maintain stable blood levels and avoid fluctuations.

Testosterone injections are used to supplement low levels of natural testosterone (a sex hormone) due to damage of the testicles or hypogonadism.

They may also be used to treat certain types of breast cancer by blocking estrogen from being released in the body and increasing sex drive and muscle mass in some men with reduced testosterone due to age or other circumstances.

Low testosterone could increase your risk for Alzheimer's disease and some studies indicate it could also contribute to mild cognitive impairment or dementia; more research must be conducted in order to establish whether these are indeed caused by low testosterone.

Studies have demonstrated that testosterone replacement therapy may help lower cholesterol and reduce heart attack risk in older men with low hormone levels, yet it should be remembered that therapy doesn't come without risks; before starting long-term use it's essential to fully comprehend both potential advantages and downsides of treatment.

As part of your medication treatment, it is strongly advised that you receive regular tests to monitor both your blood pressure and cholesterol. This is particularly vital if you are over age 65 as these exams will allow your physician to decide the appropriate dosage and duration.

One study from JAMA Internal Medicine demonstrated that men with low levels of testosterone who received testosterone replacement therapy for three years experienced improved bone density and decreased anemia, and also experienced reduced cardiovascular events like stroke or heart attack as a result of treatment.

One of the more frequent side effects of testosterone cypionate injections is soreness at the site of injection, lasting anywhere from one to three days before subsiding on its own. Your physician may suggest applying topical cream directly onto the area to alleviate discomfort and ease pain.

Before beginning treatment with this medication, inform your physician of any existing medical conditions or allergies, including liver disease; kidney disease; an enlarged prostate; high blood pressure levels due to high calcium blood levels; diabetes; depression or other mental illness; lung problems and high red blood cell count or sleep apnea as well as any unusually fast heartbeats.

Oral Testosterone  

Studies on the adverse effects of testosterone supplementation have been well documented; however, oral testosterone has received mixed attention.

Oral testosterone can be prepared in various forms to ensure reliable system absorption; methyltestosterone (17-alkylated testosterone) can be absorbed through the portal system and cause hepatotoxicity, while testosterone undecanoate (TU), an non-alkylated ester absorbed via intestinal lymphatic system, does not pose as much hepatotoxicity.

Park et al. recorded normal AST and ALT levels with usage, showing no detrimental impact to liver health. 

Testosterone Therapy and Kidney Health 

In this study, testosterone replacement therapy (TRT) did not contribute to progression of kidney disease; rather, its use may provide wide ranging benefits such as EPO-sparing effects and increasing muscle and bone mass with decreased fracture rates while providing better glycemic control among a diabetic population with chronic kideny disease (CKD). 

This later, 2022 study, saw that TRT successfully addressed endocrinological disorders associated with hypogonadism associated with chronic kidney disease; however, testosterone enanthate may result in unstable serum concentration. 

A study published in 2020 concluded that testosterone treatment safely improves QoL as well as testosterone deficiency symptoms in patients with moderate-to-severe CKD and it is also expected to have a good effect on the improvement of anemia, which is also a common condition in CKD. 

Other results indicate that long-term TTh could significantly improve renal function for hypogonadal men compared with slight decline seen without intervention, as well as drastically reducing mortality among cardiovascular patients by almost half.

Let's visit Anabolic Steroids

Anabolic steroids (AAS) are synthetic drugs designed to mimic the action of testosterone and other naturally-occurring hormones such as progesterone, estrogen and prolactin.

When used responsibly under medical supervision, anabolic steroids may increase muscle mass and strength while decreasing side effects.

Individuals who misuse anabolic steroids are known as steroid users; these may include competitive athletes, body builders, recreational weight trainers and individuals involved with fashion or entertainment industries.

AASs can be taken orally, injected, inhaled and applied directly to the skin in various forms; such as tablets, capsules and creams.

Some contain synthetic or natural compounds like dihydroepiandrosterone (DHEA), which is converted to testosterone in the body.

Athletes or bodybuilders often combine oral and injectable anabolic steroids with stimulants, painkillers or growth hormones in a process known as stacking; they believe using multiple drugs at once will produce more positive results while simultaneously minimising side effects.

Abusing steroids can severely compromise a person's health, especially their heart and liver.

Long-term use increases your risk for high blood pressure, stroke, heart disease and other cardiovascular issues; atherosclerosis develops from this, where fat deposits build up on artery walls blocking blood flow to vital organs resulting in heart attacks or even failure.

Boys who use steroids may develop shrunken testicles and reduced sperm count. Additionally, they may grow breasts (gynecomastia) and excessive body hair.

Girls using steroids may grow facial hair or show masculine characteristics; such changes should reversible once the use of the steroids ceases.

Commercial magazines targeted toward body builders may downplay side effects associated with anabolic-androgenic steroids, including liver injury, testicular atrophy, sexual dysfunction, and age-related cardiovascular disease.

An interesting 2006 survey revealed that only 38% of athletes interviewed were aware of any side effects related to anabolic steroids.

Historically, anabolic-androgenic steroids were frequently prescribed to those living with chronic kidney disease (CKD) to treat anemia instead of using erythropoietin injections.

Their dosages for anemia treatment were generally lower than their doping dosages.

But androgens for treating anemia in CKD patients has since been discontinued due to variable erythropoietic responses and adverse side effects as well as more effective and safer therapies such as recombinant erythropoietin.

Anabolic Steroids and Kidney Health

Anabolic-androgenic steroids can have adverse effects on the kidney in various ways, from acute kidney injury and chronic disease, to glomerular toxicity and overexpression of pro-fibrotic mediators (such as TGF-b1) as well as pro-inflammatory cytokines such as TNF-a, IL-1b and IL-6).

These adverse reactions are mediated by pathways including stimulating renin-angiotensin-aldosterone system stimulation; stimulating production of endothelin, producing reactive oxygen species from these pathways, the overproduction of endothelin production. the overexpression of pro-fibrotic and pro-apoptotic mediators (including TGF-b1) as well as producing reactive oxygen species.

Androgens can have multiple adverse side effects that are well-documented and well-known, including acne, virilization, priapism, testicular atrophy, gynecomastia, liver dysfunction, injection-site pain, peliosis hepatitis and hepatocellular carcinoma - but lesser-known effects include kidney dysfunction which often goes undescribed.

Long-term administration of anabolic-androgenic steroids often results in kidney complications.

They range from an elevated serum creatinine level to AKI due to rhabdomyolysis or liver damage (bile acid nephropathy or cholemicnephrosis), or due to renal histological changes like focal segmental glomerulosclerosis (FSGS), tubular atrophy, or interstitial fibrosis.

More than one-third (38.1%) of included studies relating to potential kidney effects of anabolic-androgenic steroids and GH were animal investigations.

Anabolic-androgenic steroids such as testosterone, dihydrotestosterone and nandrolone have been implicated in more prominent renal issues ranging from mild and reversible increases in serum creatinine and blood urine nitrogen levels to irreversible chronic kidney disease (CKD) and FSGS that requires renal replacement therapy through various means.

These include amplifying RAAS, increasing endothelin production, producing reactive oxygen species and contributing to oxidative stress; inducing apoptosis and pro-inflammatory cytokines such as TNF-a, IL-1b and IL-6; over-expressing pro-fibrotic and pro-apoptotic mediators like TGF-b1.

However, kidney involvement in athletes taking anabolic-androgenic steroids should also be partially explained by other independent factors and mechanisms, including high-protein diet (via increase in renal blood flow and GFR), elevated blood pressure (via hypertensive arterionephrosclerosis), bile acid nephropathy secondary to cholestatic jaundice as well as rhabdomyolysis and exogenous vitamin D intoxication and bile acid nephropathy caused by exogenous vitamin D intoxication). 

Conclusion

Testosterone plays an essential role in regulating renal blood flow and pressure by stimulating production of nitric oxide, in addition to being an anabolic hormone responsible for muscle development and fat metabolism.

TRT has been shown to be generally safe for CKD patients with normal kidney function; however, individual responses may differ due to genetic or other factors.

When administering testosterone therapy to individuals with impaired kidney function or impaired renal function, conservative dosing and slow titration is advised along with close monitoring of serum creatinine, hematocrit, blood pressure levels etc.

Though few studies have examined the effects of low testosterone levels on renal function, one showed that hypogonadism was linked to an increased risk of end-stage kidney disease and mortality among hemodialysis patients compared with those with normal levels.

Based on this evidence, researchers concluded that testosterone treatment could effectively treat hepatic steatosis, renal function and overall survival among these individuals.

However, the caveat being anabolic steroid use. Illicit use of hormones can lead to doses being taken that are far beyond what would be prescribed as a way to restore a healthy testosterone balance. 

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