Testosterone levels and kidney health: Low count could increase risk of kidney stones in men

Many men associate low testosterone with fatigue, low libido, and mood swings, but few realise it could also be linked to kidney stones. Research shows a growing connection between testosterone deficiency and an increased risk of stone formation.

Kidney stones form when minerals in the urine become concentrated and crystallise. What’s less known is how testosterone, a hormone commonly tied to male reproductive health, plays a role in this process. "Testosterone doesn’t just impact libido, it also influences fat metabolism, muscle mass, and the chemical makeup of urine," says Dr Sanjay Prakash J, Consultant Microsurgical Andrologist & Urologist, Asian Institute of Nephrology and Urology, Chennai.

He adds, “As testosterone levels dip, especially in men over 40 or those with diabetes or obesity, the balance of substances like citrate (a stone-preventing compound) and calcium oxalate (a stone-forming compound) shifts, increasing stone risk.

Also read | Causes, symptoms and treatment of kidney stones: Check salt intake, avoid chicken, drink lot of water

Here’s why low testosterone could be raising your risk of kidney stones:

• Reduced citrate levels in urine: Citrate binds with calcium in the urine, preventing the formation of crystals. “Citrate is like nature’s kidney stone shield. Men with low testosterone often have diminished citrate levels, removing this natural safeguard. When testosterone falls, the shield weakens,” says Dr Prakash.

• Increased presence of stone-forming minerals: Low testosterone has been linked to higher urinary levels of calcium oxalate and uric acid, two major components in kidney stones. “This mineral overload can tip the scale towards stone formation, particularly if water intake is also low,” he informs.

• Underlying metabolic syndrome aggravates risk: Conditions like obesity, insulin resistance, and type 2 diabetes, which frequently coexist with low testosterone, can intensify the risk of stones. “There’s a metabolic storm at play here. Hormonal imbalance fuels stone risk, and vice versa,” says Dr Prakash.

• Inflammation and hormonal disruption: Chronic low testosterone contributes to systemic inflammation. “This can alter kidney function and further disrupt the delicate mineral balance in urine. Inflammation is also a known player in the genesis of uric acid stones,” he says.

• Testosterone therapy: Some early evidence suggests testosterone replacement therapy (TRT) may help mitigate the risk. “In select patients, testosterone therapy may restore urinary chemistry to a more balanced state. But it must be carefully prescribed, as it’s not suitable for everyone,” says Dr Prakash.

• Recurring stones could signal hormone imbalance: Men who suffer frequent kidney stones, especially alongside symptoms like fatigue, weight gain, or mood issues, should consider a hormonal evaluation. “Testosterone testing isn’t just for sexual health. It’s an important piece of the kidney stone puzzle too,” suggests Dr Prakash.