Effects of testosterone on exercise capacity in postmenopausal women with stage B heart failure

Asymptomatic individuals with stage B heart failure (HF) often have reduced exercise capacity. As exogenous testosterone may have favorable skeletal muscle and vasculature effects, this study investigated whether transdermal testosterone improves exercise capacity in women with stage B HF.

In this single-center, double-blind, randomized, placebo-controlled crossover trial involving women aged ≥55 years with stage B HF (defined as cardiac remodeling and/or diastolic dysfunction) and reduced exercise capacity (<100% age-predicted peak oxygen uptake V˙O_2peak]), participants were randomly allocated to transdermal testosterone 5 mg/day or identical placebo for 4 months with cross-over after a 4-week washout. The primary outcome was change in V˙O_2peak. Secondary outcomes included changes to cardiac structure and function assessed by echocardiography and cardiac magnetic resonance imaging, and subjective quality of life.

Thirty-eight participants (median age 72 years, range 60-80 years; median body mass index 33.2 kg/m² [P25-P75 28.7-35.9 kg/m²]) completed the study. Testosterone treatment increased circulating serum testosterone concentrations and was well tolerated, with no adverse treatment-related events. Testosterone treatment had no significant effect on V˙O_2peak (β = -0.05, 95% confidence interval = -0.74, 0.65, p = 0.897), cardiac structure or indices of cardiac function, or quality of life.

Transdermal testosterone treatment did not improve exercise capacity in postmenopausal women with stage B HF.