Recent studies have suggested that testosterone improves exercise tolerance, insulin resistance and muscle strength in male subjects with CHF. Clinicians, however, have been reluctant to undertake testosterone supplementation in women because of its potential indirect link with breast cancer.
The abstract authors, Dr Giuseppe Caminiti and colleagues from the Cardiovascular Research Unit at IRCCS in Rome, set out to evaluate the effects of long-term testosterone administration in 34 elderly female patients (mean age 77) with advanced heart failure. In the study 18 women were randomised to receive testosterone (through a transdermal patch) and 16 to placebo. A transdermal patch was used because it allows treatment to be stopped more easily than with intramuscular administration. All treatment was given in addition to maximal medical therapy.
Results at six months showed that the primary endpoint of the six-minute walking test (6MWT) produced significant improvements in women treated with testosterone compared with those receiving placebo (p=0.002). In addition, quadriceps maximal isometric voluntary contractions (MVC), a standardised tool for the measurement of muscle strength, also showed significant improvements in the testosterone group compared to placebo (p=0.003). Brachial artery flow mediated dilation (BAD), a marker of vascular damage often seen in heart failure, also significantly improved (p=0.010) and HOMA-R (a test evaluating insulin resistance) was significantly reduced in the treatment group compared to placebo (p=0024).
The physical and social MacNew questionnaire (which evaluates how physical, emotional and social functioning and daily activities are affected by heart disease) also showed significant improvements in the testosterone group compared with placebo, with P=0.030 for the physical side and P=0.012 for the social side.
“Testosterone administration in women with heart failure seems to have similar benefits to that seen in men, and shows significant benefits in quality of life,” said principal investigator Giuseppe Marazzi. He added that, while testosterone appears to be a safe treatment, larger studies are needed before wider use of the therapy can be considered. The group is also planning additional studies to explore the mechanisms underlying testosterone's beneficial effects in heart failure.
Heart Failure Matters
Resources for patients & doctors: visit the Heart Failure Association of the ESC Society of Cardiology patient website, http://www.heartfailurematters.org/