Androgen deficiency in heart failure

Androgen deficiency is a hormonal disorder that is frequently observed in advanced chronic conditions. A reduction of androgen blood levels may be cause or consequence of the disease, or both. Typical symptoms, such as fatigue or muscle weakness, may be particularly aggravated in heart failure, and disease severity may be indirectly affected by low levels of androgen. Recently, androgen replacement therapy has been suggested as a new treatment option of heart failure symptoms, and placebo-controlled pilot trials showed a modest improvement of physical performance. However, testosterone replacement in elderly patients is not without risks, and the benefit-risk ratio for such adjunct treatment is unclear. This review focuses on the general effects of androgens on the cardiovascular system and outlines expected benefits and suspected side effects of testosterone replacement therapy in patients with heart failure.