AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2640-1045/156
Urology resident, Urology & Nephrology Research center, Hamedan University of Medical Sciences, Hamedan, Iran.
*Corresponding Author: Farshad Banouei, Urology resident, Urology & Nephrology Research center, Hamedan University of Medical Sciences, Hamedan, Iran.
Citation: Farshad Banouei, (2023), Urinary Stone Formation and Testosterone Supplementation: Insights from a Cross-sectional Study in Athletes, J. Endocrinology and Disorders, 7(6): DOI:10.31579/2640-1045/156
Copyright: © 2023, Farshad Banouei. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 24 August 2023 | Accepted: 06 September 2023 | Published: 20 September 2023
Keywords: Athletes; Crystalluria; Testosterone; Urolithiasis
Introduction: The use of exogenous testosterone has become increasingly prevalent in sports fields, raising concerns about its potential risks and benefits.
Methods & Materials: This study aimed to investigate the effects of testosterone supplementation on stone formation in the urinary tract and urine composition. A total of 1080 athletes participated in a two-year cross-sectional study, with 495 individuals receiving testosterone supplementation and 585 individuals serving as non-users. Blood and urine samples were collected, and CT scans were performed to assess stone presence.
Results: The results revealed a significant increase in crystalluria among testosterone users compared to non-users (38.2% vs. 2.7%, p=0.004). Imaging findings also showed a higher incidence of abnormal results in testosterone users (25.2% vs. 4.3%, p=0.0017), with kidney calcification, pelvic and calyceal stones, ureteral stones, and bladder stones observed.
Conclusion: However, further metabolic studies are required to establish a definitive cause-and-effect relationship between testosterone use and stone formation. This study sheds light on the potential risks associated with exogenous testosterone use and highlights the need for evidence-based recommendations in sports and athletic performance.
In recent decades, various sports fields worldwide have undergone significant changes, accompanied by a growing trend in the use of supplements and chemical drugs. The prescription of testosterone has witnessed a substantial increase, primarily driven by revisions in professional recommendations. Concerns have been raised regarding a potential link between testosterone therapy and a higher risk of conditions such as cardiovascular disease, thromboembolic events, obstructive sleep apnea, benign prostatic hyperplasia, and prostate cancer. On the other hand, there is also a suggestion that testosterone therapy could serve as a beneficial treatment option for managing prediabetes. As a result, extensive ongoing discussions are taking place regarding the appropriate candidates for testosterone therapy among individuals with hypogonadism.
Indeed, the utilization of androgenic steroids has emerged as a worldwide epidemic, with a cumulative global lifetime prevalence of 6.4 percent in men and 1.6 percent in women [1]. However, the administration of testosterone can result in numerous side effects, such as metabolic alterations, hormonal imbalances in the pituitary gland, thrombotic events, and elevated blood concentrations, among others [2-4].
One of the prevalent and significant practices is the utilization of steroids, particularly by athletes and bodybuilders [5].
Despite extensive research conducted on the impact of testosterone on the urinary system, several aspects remain unclear. In certain studies, a correlation has been observed between testosterone levels and the development of urinary stones, while in others, this association has been contradicted. [6-9].
In certain studies, conducted on animal models, it has been observed that higher serum testosterone levels were found in cases where urinary tract stones were present. However, the cause-and-effect relationship of this association has not been definitively established. Furthermore, in some other studies, this relationship has been contradicted [10].
In light of the growing prevalence of exogenous testosterone use among athletes, it has become imperative to investigate its effects on stone formation within the urinary tract and its potential impact on urine composition. The findings from previous studies have provided insights into the subject, indicating a correlation between elevated serum testosterone levels and the presence of urinary tract stones in animal models. However, the exact cause-and-effect relationship behind this association remains uncertain.
To address these knowledge gaps, our study aims to delve deeper into the effects of exogenous testosterone use on stone formation within the urinary tract. By analyzing urine samples and conducting comprehensive examinations, we seek to uncover any alterations in urine compounds that may be influenced by exogenous testosterone administration. This research is crucial in shedding light on the potential risks and implications associated with the increasing trend of exogenous testosterone use among athletes.
Through meticulous data collection, rigorous analysis, and adherence to ethical guidelines, our study endeavors to contribute to the existing body of knowledge surrounding the effects of exogenous testosterone on the urinary system. By gaining a better understanding of these effects, we can inform medical professionals, athletes, and policymakers about the potential consequences and provide evidence-based recommendations regarding the use of exogenous testosterone in sports and athletic performance.
In this cross-sectional study, we investigated a total of 1374 professional and non-professional bodybuilding athletes. At the outset, the participants were provided with comprehensive explanations regarding the study's objectives, and written consent was obtained from each individual. Subsequently, blood samples were collected to measure testosterone levels, electrolytes, and complete blood cell counts. Urine samples were examined for the presence of crystalluria, evidence of urinary stones, and other metabolic disorders. Additionally, a CT scan of the abdomen and pelvis, without contrast but with reconstruction of Coronal sections, was performed to detect the presence of stones in the kidney, ureters, bladder, and ureter.
Patients with pre-existing metabolic issues, abnormal testosterone levels during the initial measurement, indications of stones or metabolic disorders in urinalysis, and those with other factors predisposing them to stone formation were excluded from the study. Ultimately, a total of 1126 patients were included, and 1080 patients successfully completed the study.
During the two-year study duration, patients engaged in regular exercise while maintaining adequate hydration. Efforts were made to minimize external factors that could contribute to stone formation. Among the participants, 495 individuals received a dosage of 100 mg of testosterone enanthate every two weeks, while the remaining 585 individuals did not receive any testosterone supplementation. It's important to note that the use of other oral supplements and multivitamins was identical between the two groups, and the researcher played no role in determining whether or not athletes used testosterone. The study was conducted in an observational manner.
After the two-year period, patients underwent re-examination. This involved the collection of blood samples to assess testosterone levels, electrolytes, and complete blood cell counts. Urine samples were analyzed for evidence of crystalluria, and a CT scan of the abdomen and pelvis, without contrast, was performed to identify the presence of stones in the kidney, ureters, bladder, and ureter.
To analyze the results obtained from the patient surveys in this study, participants were categorized into two groups: testosterone users and testosterone nonusers. Data collected were analyzed using SPSS version 27 software, with a significance level set at P=0.05.
The average age and weight of patients in both groups were comparable, showing minimal differences.
Regarding the examination of complete blood counts (CBC) in the patients, approximately 45.6% of testosterone users exhibited disorders, primarily characterized by elevated blood hematocrit levels, an anticipated side effect of exogenous testosterone use.
In the second examination, urine samples from patients revealed that 2.7% of non-testosterone users showed a disorder in U.A., defined as the presence of crystals in the urine. However, this rate increased to 38.2% among testosterone users, which was statistically significant (P=0.004).
Furthermore, the testosterone user group experienced a significant increase in testosterone levels, as expected due to frequent usage.
The noteworthy and thought-provoking aspect of this study lies in the examination of imaging results following testosterone administration. Abnormal imaging findings were observed in 4.3% of non-testosterone users, whereas 25.2% of testosterone users displayed abnormal results, demonstrating statistical significance (P=0.0017). Among the patients with abnormal imaging results after testosterone administration, 43% exhibited evidence of mild kidney calcification, 27% had stones in the pelvis and calyces, 22% had stones in the ureter, and 8% had bladder stones. Table 1 presents the results of the investigations conducted on the two groups of testosterone users and non-users.
| With Testosterone | Without Testosterone | Parameter |
| 495 | 585 | Patients Number |
| 27.9 | 28.3 | Age Mean(years) |
| 76.03 | 74.54 | Weight Mean(kg) |
| 98/2 | 93/7 | Male/Female (percent) |
| 100 | 100 | Normal CBC in first study (percent) |
| 45.6 | 98 | Normal CBC in second study (percent) |
| 100 | 100 | Normal U.A in first study (percent) |
| 61.8 | 97.3 | Normal U.A in second study (percent) |
| 100 | 100 | Normal testosterone level in first study(percent) |
| 54.8 | 98.6 | Normal testosterone level in second study(percent) |
| 100 | 100 | Normal Imaging in first study(percent) |
| 74.8 | 95.7 | Normal Imaging in second study(percent) |
Table1: Data of patients in brief
Currently, despite numerous studies conducted worldwide on the association between testosterone and the formation of urinary stones, this relationship remains ambiguous.
Several studies have demonstrated that urolithiasis or the formation of renal stones is three times more frequent in males and decreases with age in correlation with serum testosterone levels. These findings suggest a potential role played by male sex hormones in this process. Animal models have indicated that androgens exert a promoting action, while estrogens exhibit an inhibitory effect on kidney stone formation. These observations highlight the need for further investigation to determine the specific role of serum testosterone in the development of renal stones.(11).
However, another study revealed that urolithiasis was observed in intact male rats but not in female rats. Interestingly, when male rats were castrated and fed with ethylene glycol, the occurrence of renal stones decreased significantly from 71.4% to 14.3%. These compelling findings strongly suggest that serum testosterone levels play a crucial role in the formation of urolithiasis.(12).
Although in the analysis of the results of this study, the obtained data were expected and consistent with the results of other studies, but in the examination of imaging, the results were very thought-provoking. The high prevalence of stones in athletes who consume testosterone can be a proof of the positive effect of testosterone on the process of stone formation, although the increase in calcium levels seen in the consumption of testosterone can be a proof of this claim, but a definitive opinion on this matter requires metabolic studies. It is mostly based on an animal example.
This study was conducted on athletes whose normal metabolic process has slight differences from normal people in the society, which can be considered as a confounding factor in examining the role of testosterone in stone formation, for example, in these people, the basal metabolism are higher and the amount of uric acid production and excretion are also higher, which is considered as an effective factor in stone formation.
This study demonstrated that testosterone users have a higher incidence of crystalluria and a greater prevalence of stone formation compared to non-users. However, to establish a conclusive standpoint, additional research and metabolic studies on animal models are necessary.
All costs of this study were paid by the researcher, and no financial support was received from any government or non-governmental entity.
There is no conflict of interest in this study.
We would like to thank all colleagues, especially the respected members of the psychiatry department who assisted us in conducting this research by providing their opinions.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
