Testicular defect: the primary abnormality in gonadal dysfunction of uremia.

Gonadal dysfunction is a common problem in end-stage renal disease. We decided to test the ability of the male gonads to respond to exogenous stimuli. The patients receiving chronic hemodialysis showed abnormally low levels of total testosterone and free testosterone in the presence of normal testosterone-binding globulin. Furthermore, the exogenous administration of human chorionic gonadotropin failed to elicit a normal response from the male gonads of hemodialyzed patients. Although basal serum prolactin levels are elevated, we do not believe that elevation is of the magnitude expected to produce testicular failure. Thus we believe that the primary testicular failure is part of the uremic syndrome, and is not corrected by dialysis.