Testosterone Decreases Erythropoietin Stimulating Agent Use in Men on Hemodialysis

Objective: Erythropoiesis stimulating agents (ESAs) are required in most of the patients with end-stage renal disease (ESRD) for treatment of anemia. Subnormal testosterone concentrations are very common in men with ESRD. Since testosterone is erythropoietic, testosterone replacement therapy (TRT) has the potential to increase hemoglobin and decrease ESA usage in hypogonadal men with ESRD. Methods: We reviewed charts of men on hemodialysis with subnormal testosterone concentrations at a dialysis center. The hemoglobin concentrations and ESA doses (adjusted for hemoglobin and body weight) of those who were treated with TRT (n = 10) were compared with those who did not receive TRT (n = 10). Results: The average duration of TRT was 18 ± 2 weeks. Hemoglobin concentrations increased by 1.2 ± 1.3 g/dL in the treated group but did not change in the untreated group (p = 0.02 for comparison between groups). ESA doses decreased by 20% in the TRT group but did not change in the untreated group (p = 0.03 for comparison between groups). Four out of the 10 men in the TRT group were no longer on ESAs by the end of the study, whereas all men in the untreated group continued to require ESAs throughout the study. Conclusion: TRT increases hemoglobin concentrations and reduces the requirement of ESAs in men with subnormal testosterone concentrations on hemodialysis.