Testosterone: a promising adjuvant for a failing heart?

Abstract

Among the chronic diseases which occur with advancing age, chronic heart failure (CHF) remains one of the leading causes of morbidity and mortality worldwide. In patients with nonedematous cachetic heart failure, the neuroendocrine activation creates an imbalance between the anabolism/catabolism and that explains the pathophysiology and symptomatology of CHF. Therefore cardiac cachexia has been identified as an independent prognostic factor in HF. There is overall anabolic hormone deficiency including testosterone which explains the inflammatory cytokine activation and ventricular remodelling in HF. Replacement of physiological doses of testosterone as an immune modulating therapeutic modality has shown promising results. Although, the evidence to demonstrate that the level of testosterone as an independent prognostic marker in these patients are conflicting.

Objective: The objective of this review is to summarize the evidence available on the prognostic implications of testosterone hormone in male patients with CHF.

Search strategy and selection criteria: Data for this review were identified by searches of PubMed with the search terms “androgens” or “sex hormones” or “testosterone” in combination with the terms “heart failure” or “chronic heart failure” and “congestive cardiac failure” or in “men”. Relevant articles not identified with the search strategy described above, but referenced in the bibliographies of these papers could also be included.