A complete list of the TransplantLines Investigators can be found in the appendix.


Posttransplantation diabetes mellitus (PTDM) effects up to 30% of all kidney transplant recipients (KTR). Recent studies in mice found that sufficient androgen levels are necessary for β-cell health and adequate insulin secretion. This raises the question whether a similar relationship might be present in KTR. Hence, we hypothesized that dihydrotestosterone and testosterone are associated with the development of PTDM in male KTR.


We conducted a post hoc analyses of a prospective single-center cohort study including adult male KTR with a functioning graft ≥1 year posttransplantation. Androgen levels were assessed by liquid chromatography–tandem mass spectrometry. Development of PTDM was defined according to the American Diabetes Association’s criteria.


We included 243 male KTR (aged 51 ± 14 years), with a median dihydrotestosterone 0.9 (0.7–1.3) nmol/L and testosterone of 12.1 (9.4–15.8) nmol/L. During 5.3 (3.7–5.8) years of follow-up, 28 KTR (11.5%) developed PTDM. A clear association was observed, as 15 (19%), 10 (12%), and 3 (4%) male KTR developed PTDM in the respective tertiles of dihydrotestosterone (P = 0.008). In Cox regression analyses, both dihydrotestosterone and testosterone as continuous variables were inversely associated with the risk to development PTDM, independent of glucose and HbA1c (hazard ratio [HR] 0.31 [95% CI 0.16–0.59], P < 0.001; and HR 0.32 [95% CI 0.15–0.68], P = 0.003, respectively).


Our results suggest that low androgen levels are a novel potential modifiable risk factor for the development of PTDM in male KTR.

Clinical trial reg. no. NCT02811835, clinicaltrials.gov

This article contains supplementary material online at https://doi.org/10.2337/figshare.16566963.

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