The Role of Testosterone in Patients With Heart Failure: A Systematic Review

Abstract

The consequences of heart failure (HF) remain high despite treatment advances. Deficiency of the anabolic axes is common in HF and is associated with an increased risk of death and worsening functional status. Exogenous testosterone use has been shown to decrease vascular resistance and improve cardiac output. The objective of this systematic review was to assess the efficacy (mortality, hospitalization, cardiac function, and quality of life) and safety of testosterone in HF patients. The Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines were followed. Four electronic databases were searched from inception until November 30, 2019. The initial search yielded 1308 articles, and 10 randomized controlled trials with exogenous testosterone in patients with HF were included after exclusion criteria were applied. One study evaluated the impact of testosterone on mortality and HF hospitalization; no difference was observed compared with placebo. In 5 studies, testosterone use was associated with an improvement in walking distance. In 1 of the 2 studies that evaluated functional status, New York Heart Association class was improved. In 2 out of 4 studies, quality of life was improved with therapy. When reported, testosterone use was not associated with an increase in side effects. Overall, testosterone use has not been shown to reduce the risk of death or HF hospitalization, with inconsistent evidence on the impact of therapy on quality of life. Additional trials are needed before testosterone can be recommended. Patients with HF should receive guideline-directed medical therapy with the assurance that patients are receiving maximum tolerated doses.

Major adverse cardiovascular events associated with testosterone treatment: a pharmacovigilance study of the FAERS database

“…In general, MACE-related signals generated by TT were stronger than those generated by TD, but were weaker than their counterparts generated by patients with DM and hypertension. These findings indicated that TT may improve the cardiac output, as suggested by previous publications ( Pugh et al, 2004 ; Park et al, 2021 ), potentially benefiting ischemic myopathy. However, it may have a negative impact on cardiac failure caused by congestive reasons, indicating that the effects of testosterone on the heart are complex and context-dependent; while it seems to have no significant effect on cardiac arrhythmia-related MACEs, although animal models suggest that androgen increases the risk of hydro-electrolytic and autonomic imbalances, but did not alter the vascular or cardiac function or morphology ( Salimi et al, 2020 ).…”

Recommendations on the diagnosis, treatment and monitoring of testosterone deficiency in men

“…A big systematic review including 10 randomized controlled trials showed TTh in patients with heart failure (HF) was not associated with an increase in mortality or HF hospitalization rate [167]. Moreover, Oni et al demonstrated in a large observational cohort of male veterans with previous myocardial infarction (MI), normalization of TT levels with TTh was associated with decreased all-cause mortality compared with those with non-normalized TT levels and the untreated group.…”

Serum testosterone level correlates with left ventricular hypertrophy in older women

“…Recently, particular attention has been focused on HF patients. In this group, testosterone supplementation is considered as an additional way of pharmacological treatment to improve cardiac health, but the results are still inconclusive, even with reported possible deterioration of heart function (17)(18)(19)(20).…”