Testosterone deficiency: a risk factor for heart failure

Testosterone deficiency - a risk factor for heart failure
This review summarizes the available evidence on the role of low testosterone levels (also known as testosterone deficiency syndrome [TDS] or hypogonadism) as a modifiable risk factor for heart failure. It also underlines the benefits and potential side effects of testosterone replacement therapy (TRT) in men suffering from chronic heart failure (CHF).

Key Findings

Key Points

  • TRT has been shown to improve exercise tolerance, lung capacity and muscle strength in patients with CHF
  • It has also been shown to have a positive effect on insulin sensitivity, particularly in the muscles, leading to an increased flow of blood and oxygen to exercising muscle, thus reducing fatigue
  • TRT also has a positive effect on cardiovascular risk factors such as obesity, metabolic diseases and diabetes
  • Some researchers have raised concerns about the use of TRT in testosterone-deficient elderly men with cardiovascular disease and limited mobility, however, there is no evidence of either adverse or positive direct effects of testosterone administration on heart function
Source: Testosterone deficiency in male: a risk factor for heart failure. Giagulli VA, Guastamacchia E, De Pergola G, et al. Endocr Metab Immune Disord Drug Targets 2013;13:92–9.

Background information

CHF is a growing health problem worldwide, the prevalence of which increases with age. TDS (hypogonadism) is characterized by low testosterone levels, especially low levels of which have been linked to the severity of symptoms in men with CHF – 25% of patients with CHF have testosterone levels below the normal range. On the other hand, it is noteworthy that heart failure itself can affect testosterone metabolism. Furthermore, patients affected by metabolic diseases such as diabetes, obesity and metabolic syndrome, which on their own may lead to the onset and progression of CHF, often have low circulating levels of testosterone.


A reduction in circulating testosterone levels may contribute to specific features of CHF such as fatigue, weakness, shortness of breath, weight loss and deterioration in physical condition. TRT is often used to treat men with TDS, and recent evidence suggests that TRT may improve muscle strength and lung capacity in patients with CHF, especially those with TDS. However, large clinical trials are required to assess the long-term effectiveness and safety of TRT in these patients.

Last updated: 2017
G.GM.MH.04.2015.0334