Thursday, April 19, 2012

Testosterone vs Heart Failure Part 2

I started writing this blog back in November 2010 as an extension of the physician education for which I was responsible during my tenure w/my previous employer.  Little did I realize that my November 28, 2010 post on testosterone & heart failure would be the all-time favorite in terms of times viewed (twice that of the 2nd most viewed) for whatever reason.  In any case, if you've followed along, you know I like to look for trends rather than flukes, assuming the science & statistics behind the trend will hold water (see my posts this past Monday & Tuesday).

I mention this because I stumbled upon a meta-analysis (published 2 days ago online prior to print) of 4 trials involving 198 patients w/heart failure, average 67yo of whom 84% were men, in which testosterone therapy (regardless of route of administration) demonstrated improvement in exercise capacity, whether measured by 6 minute walk, incremental shuttle walk or maximal oxygen uptake (VO2max) after up to 52 weeks of therapy compared to placebo.  

Obviously the statistics are a bit complicated but the conclusion is consistent w/my quick review from 18 months ago.  More importantly, no negative cardiovascular events were noted.  In summary, we have 4 small, short randomized controlled trials demonstrating cause & effect in a small, select population over a short period of time.  We would obviously like larger, longer, randomized double-blind, placebo-controlled studies before recommending testosterone supplementation to the masses, but this is a nice start.  

Far be it for me not to mention this meta-analysis to my patients on maximal medical management who are not candidates for procedural interventions.  But before adding this way off-label usage of testosterone to your heart failure armamentarium, make sure you (or your doc) are familiar with the intricacies & subtleties surrounding the use of this drug (hormone).  And if your doc has a question, just have him/her contact me (or just read my posts on testosterone).




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