Acute haemodynamic effects of testosterone in men with chronic heart failure

Aims Anabolic therapy with testosterone may be useful in the treatment of wasting associated with chronic heart failure but little is known about its cardiovascular actions. The aim of this study was to determine the acute haemodynamic effects of testosterone administration in men with heart failure. Methods and results Twelve men with stable chronic heart failure were enrolled in a double-blind, randomised, placebo-controlled, cross-over trial. Subjects were given testosterone 60mg or placebo via the buccal route and central haemodynamics were monitored over 6h, using a pulmonary flotation catheter. Subjects received the second treatment on day 2 and haemodynamic monitoring was repeated. Treatment was well tolerated. Compared with placebo, testosterone treatment resulted in a relative increase in cardiac output (⁠ \(p{<}0.0001\) ⁠, ANCOVA), with maximum treatment effect after 180min (10.3±4.6% increase from baseline, \(p=0.035\) ⁠; 95% CI 0.8–19.8). This was accompanied by reduction in systemic vascular resistance compared with baseline (⁠ \(p{<}0.0001\) ⁠, ANCOVA), with maximum treatment effect also at 180min (−17.4±9.6% from baseline, \(p=0.085\) ⁠; 95% CI −37.3 to +2.6). These maximal changes coincided with the peak elevation in serum bio-available testosterone. There was no significant change in any other haemodynamic parameter measured. Conclusions Administration of testosterone increases cardiac output acutely, apparently via reduction of left ventricular afterload.