NEW YORK (Reuters Health) - Testosterone replacement therapy appears to reduce ischemic threshold and improve quality of life in hypogonadal men with coronary artery disease, according to the findings of a small study.

"The size of the benefit on angina is equivalent to the use of a standard anti-anginal drug like a nitrate or calcium channel blocker, but testosterone replacement therapy also improves mood and well-being," senior investigator Dr. Kevin S. Channer told Reuters Health.

Dr. Channer, of Hallamshire Hospital in Sheffield, UK, and colleagues note that two large studies have recently found that low serum testosterone is associated with a number of cardiovascular risk factors. Moreover, there have been reports that testosterone therapy has beneficial and apparently vasodilatory effects in eugonadal men with coronary disease.

To determine whether the testosterone might be even more effective in hypogonadal men with heart problems, the researchers conducted a single blind crossover study of 10 subjects.

They were randomized to injection of 100 mg testosterone/mL or placebo every 2 weeks for 1 month. The findings appear in August issue of Heart.

At baseline, total testosterone level was 4.2 nmol/L and bioavailable testosterone level was 1.7 nmol/L. After 1 month of treatment, total testosterone trough concentration increased to 4.8 nmol/L (p = 0.05). For bioavailable testosterone, the increase was 3.8 nmol/L (p =0.025).

In treadmill testing, the time to 1 mm ST segment depression increased by 74 seconds (p = 0.002). There also was a significant reduction in total cholesterol and serum tumor necrosis factor alpha.

Improvement in angina scoring "only approached significance." However, mood scores assessed by a validated questionnaire "all improved," and "the overall level of patient satisfaction was high."

The researchers conclude that the approach is useful in such patients and provides "further supportive evidence" of the anti- ischemic and anti-inflammatory effect of testosterone.

Furthermore, Dr. Channer added, testosterone "is a natural hormonal product and without significant side effects when used in this low dose."

Heart 2004;90:871-876.

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