Testosterone Supplementation in Heart Failure

Abstract

Background-Low testosterone is an independent predictor of reduced exercise capacity and poor clinical outcomes in patients with heart failure (HF). We sought to determine whether testosterone therapy improves exercise capacity in patients with stable chronic HF. Methods and Results-We searched Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (1980Trials ( -2010. Eligible studies included randomized controlled trials (RCTs) reporting the effects of testosterone on exercise capacity in patients with HF. Reviewers determined the methodological quality of studies and collected descriptive, quality, and outcome data. Four trials (nϭ198; men, 84%; mean age, 67 years) were identified that reported the 6-minute walk test (2 RCTs), incremental shuttle walk test (2 RCTs), or peak oxygen consumption (2 RCTs) to assess exercise capacity after up to 52 weeks of treatment. Testosterone therapy was associated with a significant improvement in exercise capacity compared with placebo. The mean increase in the 6-minute walk test, incremental shuttle walk test, and peak oxygen consumption between the testosterone and placebo groups was 54.0 m (95% CI, 43.0 -65.0 m), 46.7 m (95% CI, 12.6 -80.9 m), and 2.70 mL/kg per min (95% CI, 2.68 -2.72 mL/kg per min), respectively. Testosterone therapy was associated with a significant increase in exercise capacity as measured by units of pooled SDs (net effect, 0.52 SD; 95% CI, 0.10 -0.94 SD). No significant adverse cardiovascular events were noted. Conclusions-Given the unmet clinical needs, testosterone appears to be a promising therapy to improve functional capacity in patients with HF. Adequately powered RCTs are required to assess the benefits of testosterone in this high-risk population with regard to quality of life, clinical events, and safety. (Circ Heart Fail. 2012;5:315-321.)

Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline

“…19,20 However, evidence regarding a beneficial or harmful effect of testosterone replacement therapy on hard outcomes such as myocardial infarction, stroke and sudden cardiac death is lacking. The results of several large meta-analyses have generally not supported a causal role between testosterone treatment and cardiovascular events.…”

Does testosterone supplementation increase PDE5-inhibitor responses in difficult-to-treat erectile dysfunction patients?

“…Accordingly, T administration has demonstrated beneficial effects on vascular reactivity, inflammation, cytokines profile, molecular adhesion, insulinresistance, lipid profile and surrogate markers of atherosclerosis [18]. Furthermore, chronic TRT improves anginal symptoms to cardiac stress test and represents a promise in the treatment of heart failure associated with hypogonadism [19]. It is our opinion that TRT is the correct option for hypogonadal men with ED independently from the presence of frailty or cardiovascular risk factors.…”

Testosterone and the Heart

“…No significant adverse CV events were noted. 28 Further studies are needed to evaluate the clinical effects of TRT in CHF, but testosterone appears to be a promising therapeutic option for patients with CHF. Thus, a large clinical trial would be warranted to determine the value of TRT in this patient group.…”