The Pituitary-Testicular Axis in Men with Chronic Renal Failure

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Abstract
We studied the effects of uremia on the pituitary-testicular axis in 35 men with creatinine clearances less than 4 ml per minute per 1.7 m2. We found significant elevation (P<0.001) of plasma luteinizing hormone and follicle-stimulating hormone (P<0.005) and subnormal levels of testosterone (P<0.005). Testicular histology revealed severe spermatogenic damage. Human chorionic gonadotropin produced a subnormal testosterone response. The initial response of plasma luteinizing hormone and follicle-stimulating hormone to luteinizing-hormone-releasing hormone was normal, but their subsequent decline was prolonged. The suppression of plasma luteinizing hormone levels by testosterone propionate was normal, but the nadir occurred late; the elevated plasma luteinizing hormone level was due to reduced metabolic clearance and increased production. Chronic renal failure interferes with testicular steroid production and spermatogenesis. (N Engl J Med 296:1245–1249, 1977)