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Nandrolone decanoate, also known as nandrolone caprinate, is an alkylated anabolic steroid that is used to treat renal insufficiency anemia and as an adjunct in the treatment of senile and postmenopausal osteoporosis. In 1960, it was described as having a longer duration of action and a stronger anabolic effect than nandrolone and other esters.

The decanoate salt form of nandrolone, an androgenic, anabolic, and erythropoietin-stimulating analogue of testosterone. In responsive tissue, such as the prostate, seminal vesicles, scrotum, penis, larynx, hair follicles, muscle, and bone, nandrolone enters the cell and binds to and activates specific nuclear androgen receptors. The activated hormone receptor complex then moves into the nucleus and binds to androgen response elements (ARE) in the promoter region of the genes that are being targeted. Here, the complex encourages the expression of genes that are necessary for keeping male characteristics. Similarly to testosterone’s negative feedback mechanism, nandrolone decanoate suppresses luteinizing hormone (LH) secretion. By increasing the production of erythropoietic stimulating factors, this agent also stimulates the production of erythropoietin.

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Men’s hypogonadism symptoms and signs vary depending on the stage of development and duration of the condition. Reduced libido, erectile dysfunction, oligospermia and infertility, osteopenia, and, to some extent, osteoporosis and anemia are probably caused by hypogonadism, low testosterone levels, and hyperprolactinemia in adults with ESKD.70% to 80% of men with CKD and ESKD report experiencing erectile dysfunction.214 Other risk factors for erectile dysfunction include age, diabetes, hypertension, dyslipidemia, smoking, and anxiety. A low percentage of motility, a low sperm count, or complete azoospermia are all typical findings from sperm analysis. Erectile dysfunction can be exacerbated by diuretics, antihypertensive, antidepressant, and histamine H2 blocker medications, which are frequently prescribed to patients with CKD. Autonomic nervous system dysfunction, which is a frequent finding in patients with CKD (especially those with diabetes mellitus), likely also contributes to sexual abnormalities in CKD.216 Disturbances in the pelvic autonomic nervous system can decrease sensation and arousal of stimuli during sexual activity.215 Other drugs, such as spironolactone, ketoconazole, glucocorticoids, and cimetidine, can directly interfere with the synthesis of The intricate neurologic axis that is necessary for achieving an adequate erection can also be disrupted by autonomic neuropathy.

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Sarcopenia may be exacerbated by uremic hypogonadism. Endogenous testosterone in men with CKD stages 3 to 4 emerged as an important determinant of both muscle mass and strength.220 Interventional studies with nandrolone decanoate (a testosterone synthetic agonist) in dialysis populations have shown significant improvements in muscle mass and strength, as well as in nutritional status.221,222 Testosterone is known to exert a stimulatory effect on erythropoiesis223 by inducing the growth of differentiated stem cells and enhancing clinical introduction of recombinant human EPO (rhEPO) in 1989, androgens were the primary pharmacologic intervention for correcting the anemia of ESKD. As a result, testosterone deficiency has been proposed as an additional cause of anemia in ESA-nave nondialyzed male patients with CKD and as an additional cause of resistance to ESAs in men treated with ESA undergoing HD.226In addition, studies evaluating changes in the health-related quality of life in response to rhEPO therapy have noted significant improvements in physical and social functioning, overall mental health, and satisfaction with sexual activity.230 Studies evaluating changes in the health-related quality of life in response to rhEPO therapy have also noted significant improvements in these areas.228,229 Correction of anemia, improved sense of well-being, and direct endocrine effects may play a role in this result.180