The hypothalamo-pituitary-testicular axis is susceptible to significant pathophysiological alterations in chronic renal failure, leading to delayed pubertal maturation. The study included nineteen male patients >10 years old with ESRD, on regular hemodialysis, also twenty children as controls. Serum testosterone level was found significantly lower in patients. LH peak and LH/FSH peak was found lower in studied patients in comparison to controls with a significant positive correlation found between them and (Kt/V) and serum albumin levels.