Can testosterone (tran) cause Minimal Change Disease (MCD) or kidney problems?

Testosterone and Kidney Disease: No Evidence for Causing IgA Nephropathy or Minimal Change Disease

There is no evidence in the medical literature that testosterone or transgender hormone therapy causes IgA nephropathy or minimal change disease (MCD). The available guidelines and research do not establish any causal relationship between testosterone therapy and these specific kidney conditions.

Testosterone Therapy and Kidney Health

Testosterone replacement therapy (TRT) has several well-documented potential side effects, but kidney diseases like IgA nephropathy and MCD are not among them:

Known Side Effects of Testosterone Therapy

• Erythrocytosis: One of the most common side effects (3-18% with transdermal administration, up to 44% with injections) 1
• Fluid retention: Rarely of clinical significance 1
• Cardiovascular effects: Current evidence suggests neutral or possibly beneficial effects 1
• Lipid alterations: Most studies show minimal changes with physiologic replacement doses 1
• Prostate-related concerns: Monitoring required but rarely clinically significant 1
• Skin reactions: Variable incidence depending on administration method 1
• Testicular atrophy/infertility: Common but usually reversible 1

Kidney-Related Considerations

While testosterone therapy has not been linked to MCD or IgA nephropathy, there are important kidney-related considerations:

1. Chronic Kidney Disease (CKD) and Testosterone Levels:

   • Reduced testosterone concentration is common in CKD patients due to hypothalamic-pituitary-gonadal axis dysfunction 2
   • Testosterone deficiency in CKD is associated with:
     • Reduced muscle mass and strength
     • Bone mineralization disorders
     • Development of sarcopenia and protein energy wasting
     • Progression of atherosclerosis
     • Increased mortality rate

2. Monitoring Recommendations:

   • Regular monitoring of kidney function is prudent in patients on testosterone therapy, though not specifically for MCD or IgA nephropathy
   • Monitoring should include total testosterone, hematocrit, PSA, and digital rectal examination 3

Minimal Change Disease (MCD)

MCD is characterized by:

• Intense proteinuria leading to edema and intravascular volume depletion 4
• No visible alterations by light microscopy and effacement of foot processes by electron microscopy 4
• Accounts for approximately 15% of idiopathic nephrotic syndrome in adults 4

Causes and Risk Factors for MCD

• The exact cause remains unknown 4
• Immunologic dysregulation and podocyte modifications are thought to play key roles 4, 5
• Several mechanisms have been proposed, including:
  • Oxidative damage
  • Overexpression of Th2 cytokines
  • Role of T/Treg/B cells and various cytokines 5

No established connection exists between testosterone therapy and MCD development in the medical literature.

Clinical Approach to Suspected Kidney Disease in Patients on Testosterone

If a patient on testosterone therapy presents with symptoms suggestive of kidney disease:

1. Evaluate for proteinuria and hematuria

   • Urinalysis and urine protein quantification
   • Serum creatinine and estimated glomerular filtration rate (eGFR)

2. Consider standard treatment for MCD if diagnosed

   • Prednisone is the mainstay of therapy for MCD 1, 6
   • For steroid-sensitive MCD, a short-term steroid regimen may be effective 6
   • Second-line immunosuppression may be needed for frequent relapses 4

3. Medication review

   • While testosterone is not implicated in MCD or IgA nephropathy, review all medications for potential nephrotoxicity
   • Consider that other medications may be the cause of kidney issues

Conclusion

Based on current medical evidence, there is no established causal relationship between testosterone therapy and the development of IgA nephropathy or minimal change disease. Patients receiving testosterone therapy should undergo standard monitoring, but specific concerns about these kidney conditions should not preclude appropriate hormone therapy when indicated.