title: Update on the safety of testosterone therapy in cardiac disease.
abstract: BACKGROUND
  Testosterone has been used for decades in the treatment of men with hypogonadism and women with low libido. More recently, it has been used in patient populations with cardiac disease and, in particular, in those patients with heart failure. The benefits of testosterone supplementation have been demonstrated in the literature, but there is also concern that testosterone supplementation may not be benign, especially when administered to achieve supraphysiological levels, e.g., to improve athletic performance.
  
  
  METHODS
  This review seeks to address the link between testosterone levels and cardiac disease while discussing the safety concerns of testosterone supplementation in clinical practice. Randomized controlled trials, systematic reviews and meta-analyses that were obtained through a literature search of the Medline database are discussed in this paper.
  
  
  CONCLUSIONS
  Ultimately, the definitive role of testosterone in cardiovascular disease remains contentious, but testosterone may have niche roles in certain conditions, such as advanced heart failure and cardiac cachexia. Testosterone has been used safely, and we believe may continue to be used safely, in men with cardiac disease when achieving physiological levels, with adequate monitoring of prostate specific antigen and hematocrit levels during the course of treatment per established clinical guidelines. Testosterone might exert beneficial effects on physical capacity and functioning as well as overall outcomes in patients with chronic heart failure.
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 6215, Los Angeles, CA 90048, USA.
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Aaronson
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morrissey
authors.forename: Cam T
authors.initials: CT
authors.lastname: Nguyen
authors.forename: Robert
authors.initials: R
authors.lastname: Willix
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Schwarz
mesh_terms: D000728:Androgens / Q000009:adverse effects / Q000627:therapeutic use; D000818:Animals; D002986:Clinical Trials as Topic; D006331:Heart Diseases / Q000188:drug therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D013739:Testosterone / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D000728:Androgens; D013739:Testosterone