Endocrine Abstracts

Background: Male hypogonadism is defined by low circulating testosterone level associated with signs and symptoms of testosterone deficiency. Although the bidirectional link between hypogonadism and cardiovascular disease has been clarified recently, the association between testosterone and chronic heart failure (CHF) is more controversial.

Methods: We critically review published studies relating to testosterone, hypogonadism, and CHF and provide practical clinical information on the correct diagnosis and treatment of male hypogonadism in patients with CHF.

Results: In general, the published studies are extremely heterogeneous, they frequently have not adhered to hypogonadism guidelines, and they suffer from many intrinsic methodological inaccuracies; therefore, the data have low-quality evidence. Nevertheless, by selecting the very few studies that are methodologically robust, we show that the prevalence of testosterone deficiencies (30-50%) and symptomatic hypogonadism (15%) in men with CHF is significant. Low testosterone correlates with CHF severity, NYHA class, exercise functional capacity, and a worsened clinical prognosis and mortality. The interventional studies on testosterone treatment in men with CHF are inconclusive, but promising in suggesting beneficial effects on exercise capacity, NYHA class, metabolic health, and cardiac prognosis.

Discussion: We suggest that clinicians should measure the testosterone levels of men with CHF who have symptoms of a testosterone deficiency and/or conditions that predispose to hypogonadism, such as obesity and diabetes. These patients - if diagnosed as hypogonadal - could benefit from the short- and long-term effects of TRT, which include improvements to both the cardiological prognosis and systemic outcomes. Further studies with a strong collaboration between cardiologists and endocrinologists are warranted.