Testosterone Treatment for Low Testosterone in Kidney Disease

Inclusion Criteria: * Men between ages of 18-85 years of age * eGFR 15-45 ml/min/1.73m2 by MDRD (Modification of Diet in Renal Disease) equation * Subnormal total serum T concentrations (\<300 ng/dl) on two separate occasions in morning * Symptoms of hypogonadism (as per Endocrine Society guidelines): low libido, erectile dysfunction, fatigue, irritability, depressed mood, poor concentration, increased body fat, decreased muscle bulk, reduced physical performance, sleep disturbance, loss of body hair (15) * Normal iron stores as defined by serum ferritin ≥100 ng/mL and transferrin saturation (TSAT) ≥20%. Exclusion Criteria: * Use of TRT currently or in the past 6 months, including use of over-the-counter androgen containing health supplements (e.g., DHEA) * Hematocrit \>48% (as per Endocrine Society guidelines)(15) * Treatment with erythropoiesis stimulating agents (ESA) * Uncontrolled blood pressure (\>180/100 mm Hg) * Heart Failure, class III or IV * Myocardial infarction, stroke, or heart surgery in the past 3 months * Breast cancer * History of prostate cancer * Prostate specific antigen (PSA) \>4 ng/ml, unless prostate cancer has been ruled out by a urologist (documented in physician notes) * HIV or untreated hepatitis C * Untreated, severe obstructive sleep apnea * Initiated iron replacement in the last 3 months * deep venous thrombosis or pulmonary embolism in the last 3 months * recurrent (more than once) deep venous thrombosis or pulmonary embolism * use of warfarin * Planning to have children in the next one year