Theodorakis Nikolaos, Kreouzi Magdalini, Hitas Christos, Anagnostou Dimitrios, Kollia Zoi, Vamvakou Georgia, Nikolaou Maria
Department of Cardiology & 65+ Clinic, Sismanogleio-Amalia Fleming General Hospital, 14, 25 Th Martiou Str., 15127, Melissia, Greece.
School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527, Athens, Greece.
Hormones (Athens). 2025 Apr 15. doi: 10.1007/s42000-025-00658-y.
Heart failure (HF), a leading cause of morbidity and mortality, is characterized by a complex pathophysiology involving neurohormonal activation, metabolic dysregulation, and multiple hormonal deficiency syndrome (MHDS). MHDS is common in HF, affecting up to 90% of patients, and is associated with worse outcomes. This systematic review aims to evaluate the efficacy and safety of testosterone replacement therapy (TRT) in the management of HF.
We conducted a comprehensive search of PubMed, the Cochrane Library, and ClinicalTrials.gov for randomized controlled trials (RCTs) examining TRT in HF patients up to September 15, 2024. Studies were included if they involved human subjects aged 18 or older with a confirmed diagnosis of HF and had a follow-up period of at least 4 weeks. We excluded reviews, animal studies, observational studies, and trials without randomization.
Our search yielded 653 records, of which 12 studies met the inclusion criteria. Key findings include significant improvements in muscle strength and aerobic capacity as well as increases in lean muscle mass and decreases in fat mass in certain trials. Additionally, improvements in insulin sensitivity and shortening of the QT interval were reported. TRT did not consistently affect blood pressure, lipid profiles, or heart rate, nor did it lead to any serious adverse effects.
While TRT has demonstrated potential benefits in HF patients, particularly in improving physical function and metabolic profiles, the current evidence is limited by small sample sizes and short follow-up periods. Larger event-driven RCTs evaluating hard endpoints are needed to determine whether TRT should be integrated into standard HF therapies.
心力衰竭（HF）是发病和死亡的主要原因，其病理生理过程复杂，涉及神经激素激活、代谢失调和多种激素缺乏综合征（MHDS）。MHDS在HF患者中很常见，影响高达90%的患者，并与更差的预后相关。本系统评价旨在评估睾酮替代疗法（TRT）在HF治疗中的疗效和安全性。
我们对PubMed、Cochrane图书馆和ClinicalTrials.gov进行了全面检索，以查找截至2024年9月15日研究HF患者TRT的随机对照试验（RCT）。纳入的研究需涉及年龄在18岁及以上、确诊为HF的人类受试者，且随访期至少为4周。我们排除了综述、动物研究、观察性研究和非随机试验。
我们的检索共获得653条记录，其中12项研究符合纳入标准。主要发现包括在某些试验中肌肉力量和有氧运动能力显著改善，瘦肌肉量增加，脂肪量减少。此外，还报告了胰岛素敏感性的改善和QT间期的缩短。TRT并未持续影响血压、血脂或心率，也未导致任何严重不良反应。
虽然TRT已在HF患者中显示出潜在益处，特别是在改善身体功能和代谢状况方面，但目前的证据受样本量小和随访期短的限制。需要更大规模的评估硬终点的事件驱动型RCT来确定TRT是否应纳入标准HF治疗。
