Nephrolithiasis and low serum testosterone are common issues seen by urologists; however, research exploring the relationship between the two is limited. Thompson et al. should be commended for their effort to evaluate these two pathologies [1]. The metabolic derangements in stone formers can be traced to a wider breadth of comorbidities, of which, endocrinopathies such as testosterone therapy seem to be involved.

The authors use the TriNetx Research Network to evaluate the association of first-time nephrolithiasis risk in men with low serum testosterone and normal testosterone levels. As expected, they found that the incidence of first-time nephrolithiasis increases with age; however, there is an elevated risk in men with low testosterone who are not on testosterone therapy. The authors came to this conclusion through the evaluation of their cohort of 527,114 men selected using ICD 10 N20.0 codes for nephrolithiasis with division into groups of >300 ng/dl and <300 ng/dl for testosterone levels in line with the American Urological Association’s guidelines [2].