title: Testosterone supplementation in heart failure: a meta-analysis.
abstract: BACKGROUND
  Low testosterone is an independent predictor of reduced exercise capacity and poor clinical outcomes in patients with heart failure (HF). We sought to determine whether testosterone therapy improves exercise capacity in patients with stable chronic HF.
  
  
  RESULTS
  We searched Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (1980-2010). Eligible studies included randomized controlled trials (RCTs) reporting the effects of testosterone on exercise capacity in patients with HF. Reviewers determined the methodological quality of studies and collected descriptive, quality, and outcome data. Four trials (n=198; men, 84%; mean age, 67 years) were identified that reported the 6-minute walk test (2 RCTs), incremental shuttle walk test (2 RCTs), or peak oxygen consumption (2 RCTs) to assess exercise capacity after up to 52 weeks of treatment. Testosterone therapy was associated with a significant improvement in exercise capacity compared with placebo. The mean increase in the 6-minute walk test, incremental shuttle walk test, and peak oxygen consumption between the testosterone and placebo groups was 54.0 m (95% CI, 43.0-65.0 m), 46.7 m (95% CI, 12.6-80.9 m), and 2.70 mL/kg per min (95% CI, 2.68-2.72 mL/kg per min), respectively. Testosterone therapy was associated with a significant increase in exercise capacity as measured by units of pooled SDs (net effect, 0.52 SD; 95% CI, 0.10-0.94 SD). No significant adverse cardiovascular events were noted.
  
  
  CONCLUSIONS
  Given the unmet clinical needs, testosterone appears to be a promising therapy to improve functional capacity in patients with HF. Adequately powered RCTs are required to assess the benefits of testosterone in this high-risk population with regard to quality of life, clinical events, and safety.
authors.affiliation: St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Toma
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Erin E
authors.initials: EE
authors.lastname: Coglianese
authors.forename: Venkatesan
authors.initials: V
authors.lastname: Vidi
authors.forename: Samip
authors.initials: S
authors.lastname: Vasaiwala
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bakal
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D017079:Exercise Tolerance / Q000187:drug effects / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D013739:Testosterone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013739:Testosterone