Unveiling the Link Between Low Testosterone and Worsening Heart Failure Symptoms: A Literature Review
DOI:
https://doi.org/10.32734/sumej.v8i3.19752Keywords:
heart failure, low testosterone level, worsening symptomsAbstract
Background: Heart failure can result from a variety of factors, including hypertension, coronary artery disease, diabetes, obesity, smoking, and genetic predispositions. Research indicates that testosterone levels are markedly lower in patients with heart failure compared to healthy individuals, suggesting that low testosterone may play a role in the onset or progression of heart failure. Objective: This review endeavors to examine the impact of low testosterone levels on the clinical manifestations of heart failure patients. Methods: A literature review was conducted across three databases, Google Scholar, PubMed, and Science Direct, employing the keywords "testosterone" and "heart failure." The search was further refined through specific inclusion and exclusion criteria, culminating in data from eight international journals. Results: Testosterone deficiency was associated with deteriorated outcomes in men diagnosed with HFpEF, with lower testosterone levels corresponding to more severe symptoms and diminished quality of life. It influences myocardial contractility, energy metabolism, apoptosis, and cardiac remodeling processes. Conclusion: Men suffering from heart failure with concomitant low testosterone levels are generally observed to have increased mortality rates and less favorable prognoses.
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Baman JR, Ahmad FS. Heart failure. JAMA. 2020;324(10):1015. doi:10.1001/jama.2020.13310
Schwinger RHG. Pathophysiology of heart failure. Cardiovasc Diagn Ther. 2021;11(1):263-76. doi:10.21037/cdt-20-302
Buda V, Prelipcean A, Cozma D, et al. An up-to-date article regarding the particularities of drug treatment in patients with chronic heart failure. J Clin Med. 2022;11(7):2020. doi:10.3390/jcm11072020
Boytsov SA. Chronic heart failure: evolution of etiology, prevalence, and mortality over the past 20 years. Ter Arkh. 2022;94(1):5-8. doi:10.26442/00403660.2022.01.201317
Zhu A, Andino J, Daignault-Newton S, et al. What is a normal testosterone level for young men? Rethinking the 300 ng/dL cutoff for testosterone deficiency in men 20–44 years old. J Urol. 2022;208(6):1295-301. doi:10.1097/JU.0000000000002928
Kumar R, Nigam P. Serum testosterone levels in heart failure [Internet]. 2015 [cited 2025 May 23]. Available from: https://api.semanticscholar.org/CorpusID:55844430
Saitoh M, Ebner N, von Haehling S, et al. Therapeutic considerations of sarcopenia in heart failure patients. Expert Rev Cardiovasc Ther. 2018;16(2):133-42. doi:10.1080/14779072.2018.1424542
Jeppesen EA, Dimmeler A, Pieske B, et al. Deficiencies in circulating testosterone and dehydroepiandrosterone sulphate, and depression in men with systolic chronic heart failure. Eur J Heart Fail. 2010;12(9):966-73.
Wehr E, Pilz S, Boehm BO, et al. Low free testosterone is associated with heart failure mortality in older men referred for coronary angiography. Eur J Heart Fail. 2011;13(5):482-8. doi:10.1093/eurjhf/hfr007
Wu HY, Wang XF, Wang JH, et al. Testosterone level and mortality in elderly men with systolic chronic heart failure. Asian J Androl. 2011;13(5):759-63. doi:10.1038/aja.2011.26
dos Santos MR, Sayegh ALC, Groehs RVR, et al. Testosterone deficiency increases hospital readmission and mortality rates in male patients with heart failure. Arq Bras Cardiol. 2015;105(3):256-64. doi:10.5935/abc.20150078
Florvaag A, Oberle V, Fritzenwanger M, et al. Testosterone deficiency in male heart failure patients and its effect on endothelial progenitor cells. Aging Male. 2012;15(3):180-6. doi:10.3109/13685538.2012.702361
Stout M, Tew GA, Doll H, et al. Testosterone therapy during exercise rehabilitation in male patients with chronic heart failure who have low testosterone status: a double-blind randomized controlled feasibility study. Am Heart J. 2012;164(6):893-901. doi:10.1016/j.ahj.2012.09.016
Mirdamadi A, Garakyaraghi M, Pourmoghaddas A, et al. Beneficial effects of testosterone therapy on functional capacity, cardiovascular parameters, and quality of life in patients with congestive heart failure. Biomed Res Int. 2014;2014:392432. doi:10.1155/2014/392432
Yoshihisa A, Suzuki S, Sato Y, et al. Relation of testosterone levels to mortality in men with heart failure. Am J Cardiol. 2018;121(11):1321-7. doi:10.1016/j.amjcard.2018.01.052
Navarro-Peñalver M, Pérez-Martínez MT, Gómez-Bueno M, et al. Testosterone replacement therapy in deficient patients with chronic heart failure: a randomized double-blind controlled pilot study. J Cardiovasc Pharmacol Ther. 2018;23(6):543-50. doi:10.1177/1074248418784020
Hamam A, Abou-Omar M, Rabah H, et al. Worsening effect of testosterone deficiency on males with heart failure with preserved ejection fraction. BMC Endocr Disord. 2022;22(1):1249. doi:10.1186/s12902-022-01249-3
Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM.. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015. February 90 2: 224– 51.
Herati AS, Cengiz C, Lamb DJ.. Assays of Serum Testosterone. Urol Clin North Am. 2016. May 43 2: 177– 84.
Charbit B, Christin-Maître S, Demolis JL, et al. Effects of testosterone on ventricular repolarization in hypogonadic men. Am J Cardiol 2009;103:887 90.
Nielsen JB, Graff C, Pietersen A, et al. J-shaped association between QTc interval duration and the risk of atrial fibrillation: results from the Copenhagen ECG study. J Am Coll Cardiol 2013;61:2557–64.
Jones RD, English KM, Pugh PJ, et al. Pulmonary vasodilatory action of testosterone: evidence of a calcium antagonistic action. J Cardiovasc Pharmacol 2002;39:814–23.
Cairr~ ao E, Alvarez E, Santos-Silva AJ, Verde I. Potassium channels are involved in testosterone-induced vasorelaxation of human umbilical artery. Naunyn-Schmiedeberg’s Arch Pharmacol 2008;376:375–83
Golden KL, Marsh JD, Jiang Y, Moulden J. Acute actions of testosterone on contractile function of isolated rat ventricular myocytes. Eur J Endocrinol 2005;152:479–83.
Ceballos G, Figueroa L, Rubio I, et al. Acute and nongenomic effects of testosterone on isolated and perfused rat heart. J Cardiovasc Pharmacol 1999;33:691–7.
Goodale T, Sadhu A, Petak S, et al. Testosterone and the heart. Methodist Debakey Cardiovasc J. 2017;13(2):68-72. doi:10.14797/mdcj-13-2-68
Enina TN, Kuznetsov VA, Soldatova AM. [Testosterone and congestive heart failure]. Kardiologiia. 2022;62(7):61-7. doi:10.18087/cardio. 2022.7.n1242
Dumitrascu AR, Diaconu R, Donoiu I. Testosterone and depression in men with heart failure [Internet]. Eur J Cardiovasc Nurs. 2023 [cited 2025 May 23]. Available from: https://api.semanticscholar.org/CorpusID:260297747
Diaconu R, Donoiu I, Mirea O, et al. Testosterone, cardiomyopathies, and heart failure: a narrative review. Asian J Androl. 2021;23(4):348-56. doi:10.4103/aja.aja_80_20
Rothman MS, Wierman ME. Testosterone and cardiovascular disease in men. Aging Health. 2007;3(3):375-81. doi:10.2217/1745509X.3.3.375
Gencer B, Bonomi M, Adorni MP, et al. Cardiovascular risk and testosterone – from subclinical atherosclerosis to lipoprotein function to heart failure. Rev Endocr Metab Disord. 2021;22(2):257-74. doi:10.1007/s11154-021-09628-2
Di Lodovico E, Facondo P, Delbarba A, et al. Testosterone, hypogonadism, and heart failure. Circ Heart Fail. 2022;15(7):e008755. doi:10.1161/CIRCHEARTFAILURE.121.008755
Michos ED, Budoff MJ. Testosterone: therapeutic or toxic for the cardiovascular health of men? Lancet Health Longev. 2022;3(6):e368-9. doi:10.1016/S2666-7568(22)00115-5
Maganty A, Kovac R, Ramasamy R. The putative mechanisms underlying testosterone and cardiovascular risk [Internet]. 2019 [cited 2025 May 23]. Available from: https://api.semanticscholar.org/CorpusID:260519807
Busic Z, Culic V. Central and peripheral testosterone effects in men with heart failure: an approach for cardiovascular research. World J Cardiol. 2015;7(9):504-12. doi:10.4330/wjc.v7.i9.504
Mulhall JP, Trost LW, Brannigan RE, Kurtz EG, Redmon JB, Chiles KA, Lightner DJ, Miner MM, Murad MH, Nelson CJ, Platz EA, Ramanathan LV, Lewis RW. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018 Aug;200(2):423-432.
Sizar O, Leslie SW, Schwartz J. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 25, 2024. Male Hypogonadism.
Miller J, Britto M, Fitzpatrick S, McWhirter C, Testino SA, Brennan JJ, Zumbrunnen TL. Pharmacokinetics and relative bioavailability of absorbed testosterone after administration of a 1.62% testosterone gel to different application sites in men with hypogonadism. Endocr Pract. 2011 Jul-Aug;17(4):574-83.
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