Experts discuss the association between low testosterone and kidney stones

In this video, Austin Thompson and Nannan Thirumavalavan, MD, discuss the background and key findings from the study, “Low Serum Testosterone is Associated with an Increased Risk of First-time Nephrolithiasis in Men Without Testosterone Replacement Therapy.” Thompson is a third-year medical student at Case Western Reserve University in Cleveland, Ohio, and Thirumavalavan is a urologist at University Hospitals in Cleveland, Ohio.

Video Transcript:

Could you describe the background for this work?

Thompson: The background from this work came from looking through the literature. We've known for a long time that as men aged testosterone decreases. But there's some recent articles showing that in younger men as well, we're starting to see low levels of testosterone. We use the AUA definition of below 300 ng/dL. From there, reading about kidney stones, as well, and the prevalence of kidney stones increasing over the years, we started to look to see what link may exist between those 2. What we found in the literature was that there's a lot of discrepancy with studies saying that low testosterone may be associated with kidney stones. There are studies that have not found an association. And then there are studies that have also shown that higher levels of testosterone may also be associated with kidney stones. So, with all that in mind, we felt that the TriNetX database, which is multi-institutional, even includes data from multiple countries, may be a good way to address this discrepancy that you see in the literature, because the ability to really apply good matching categories based on comorbidities, medications, with some of the other larger databases, to my knowledge, you're not able to do and things of that nature.

Thirumavalavan: Certainly, the biggest question that comes out of this is, is it the fact that many of the conditions that cause kidney stones also cause low testosterone, or are associated with it? For example, obesity, high blood pressure, or diabetes, metabolic syndrome, all of that is associated with low testosterone levels and is associated with kidney stones. The sicker you are, the more likely you are to have both of those things. So, the goal with this study is to control for as many of those factors as we can using TriNetX data and see if testosterone is still independently predictive of a first time kidney stone episode.

What were the notable findings from this study?

Thompson: The main finding is that when you look at men with low testosterone, grouped 18 and above, we found that there is an association between low testosterone and kidney stone encounter diagnoses. Then we subgrouped it as well by age cohorts. We also saw that in when 25 and above this association persists. When you look at some of the other studies that have investigated this is that men below the age of 40, no association has been seen with low testosterone and kidney stones. I think that the reason why we may have seen an association in younger men was because the scope of the TriNetX database were able to capture more patients in this younger age group, which may have allowed us to better investigate this association in men under 40.

This transcription has been edited for clarity.

Note: This project was supported in part by the Clinical and Translational Science Collaborative of Northern Ohio, which is funded by the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Science Award grant, UM1TR004528. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.