Testosterone replacement therapy and exercise training in males with low testosterone status and heart failure.

Background: This cross-sectional study aimed to assess the effect of low testosterone (LT) status on functional capacity, quality of life, cardiac structure and function in males with moderate or severe stable heart failure (HF). Methods: 40 male patients with HF (ejection fraction (EF)% <45%) with low serum total testosterone (TT) <12 nmol / L (n =20, 71.9 + 10.11 yrs) and normal range TT (n = 20, 66.9 +/- 11.98 yrs) were recruited from a specialist HF clinic. The primary outcome, functional capacity, was assessed by the 6 min shuttle walk test. Health related quality of life (HRQoL) data was assessed using a licensed version of the SF36 Version 2. Additionally, Beck Depression Inventory (BDI), Minnesota Living with Heart Failure questionnaire (MLHFQ) and Androgen Deficiency in the Ageing Male (ADAM) questionnaire data was collected. Cardiac characteristics were assessed using detailed echocardiography analysis. Blood samples were taken for assessment of NT pro BNP. Results: Normal testosterone (NT) patients demonstrated a significantly higher 6 min walk distance (429.00 +/- 126.94 m; 257.65 + 65 m, p<0.01) when compared to LT. LT patients showed significantly worse indices of quality of life using the SF36 V2 questionnaire. General health component (31.84 + 2.85 v 59.44 + 3.24, p<0.05), overall physical component score (41.39 + 17.03 v 69.69 + 19.71, p<0.01) and overall mental component score (54.88 + 17.52 v 72.36 + 16.58, p<0.01) higher in the NT group. There were very few cardiac changes and no differences in MLHFQ or BDI score between the groups. Conclusion: This is the first study to compare important prognostic outcomes in matched patients with HF and low testosterone. Additionally, this is the first paper to report significantly adverse HRQoL in male patients with low testosterone and HF when compared to normal range testosterone counterparts. LT in HF is associated with reduced functional capacity, together with attenuated general, physical and mental components of quality of life. Further research is warranted to assess the impact of testosterone supplementation onthese important prognostic outcomes in male patients with HF and low testosterone status.