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- ACE, angiotensin converting enzyme
- BDI, Beck depression inventory
- BNP, brain natriuretic peptide
- CHF, chronic heart failure
- CT, computed tomography
- MLHF, Minnesota living with heart failure
- PSA, prostate specific antigen
- SWT, shuttle walk test
Chronic heart failure (CHF) is a disabling disease characterised by exercise intolerance and dyspnoea. Disease progression arises from prolonged neurohormonal and pro-inflammatory cytokine activation and is associated with a metabolic shift favouring catabolism, vasodilator incapacity, and loss of skeletal muscle bulk and function. In men, androgens are important determinants of anabolic function and physical strength. Androgens also possess anti-inflammatory and vasodilatory properties. In addition, testosterone has been shown to augment cardiac output acutely in men with CHF.1,2 Low plasma concentrations of testosterone have been described in men with CHF, and correlate positively with cardiac output.3 It was hypothesised that relative hypotestosteronaemia could contribute to clinical features of muscle wasting and exercise intolerance, inflammatory cytokine activation and impaired vasodilatation, and progression of heart failure. This pilot study sought to determine whether testosterone treatment could improve exercise capacity and symptoms in male patients with CHF.
Twenty ambulant male patients (median age 62 years, range 44–81), with CHF of at least six months duration and no other malignant or debilitating disease, took part in a randomised, double blind, placebo controlled trial of testosterone (Sustanon 100, Organon Laboratories, Cambridge, UK) or placebo treatment (1 ml 0.9% saline, Martindale Pharmaceuticals, Romford, UK) given by intramuscular injection every two weeks for 12 weeks. Informed consent was obtained and the study was approved by the local research ethics committee. Subjects had at least moderate impairment of left ventricular systolic function (mean (SD) ejection …
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