Low-Dose Transdermal Testosterone Therapy Improves Angina Threshold in Men With Chronic Stable Angina

TLDR

Androgens are thought to induce coronary vasodilation. The study aimed to assess the clinical impact of long‑term low‑dose testosterone in men with angina. Forty‑six men with stable angina were randomized to 5 mg/day transdermal testosterone or placebo for 12 weeks, with exercise‑test ischemia, hormone levels, and quality‑of‑life assessed. Testosterone doubled androgen levels and significantly prolonged exercise time to 1‑mm ST depression, with greater benefit in men with low baseline testosterone, and improved pain perception and physical role limitation without adverse effects.

Abstract

Background —Experimental studies suggest that androgens induce coronary vasodilatation. We performed this pilot project to examine the clinical effects of long-term low-dose androgens in men with angina. Methods and Results —Forty-six men with stable angina completed a 2-week, single-blind placebo run-in, followed by double-blind randomization to 5 mg testosterone daily by transdermal patch or matching placebo for 12 weeks, in addition to their current medication. Time to 1-mm ST-segment depression on treadmill exercise testing and hormone levels were measured and quality of life was assessed by SF-36 at baseline and after 4 and 12 weeks of treatment. Active treatment resulted in a 2-fold increase in androgen levels and an increase in time to 1-mm ST-segment depression from (mean±SEM) 309±27 seconds at baseline to 343±26 seconds after 4 weeks and to 361±22 seconds after 12 weeks. This change was statistically significant compared with that seen in the placebo group (from 266±25 seconds at baseline to 284±23 seconds after 4 weeks and to 292±24 seconds after 12 weeks; P =0.02 between the 2 groups by ANCOVA). The magnitude of the response was greater in those with lower baseline levels of bioavailable testosterone ( r =−0.455, P <0.05). There were no significant changes in prostate specific antigen, hemoglobin, lipids, or coagulation profiles during the study. There were significant improvements in pain perception ( P =0.026) and role limitation resulting from physical problems ( P =0.024) in the testosterone-treated group. Conclusions —Low-dose supplemental testosterone treatment in men with chronic stable angina reduces exercise-induced myocardial ischemia.