Long-term benefits of testosterone replacement therapy on angina threshold and atheroma in men

Introduction: In short-term studies, testosterone replacement therapy has been shown to protect male subjects from exercise-induced ischaemia and modify cardiovascular risk factors such as insulin resistance, fat mass and lipid profiles. Methods: This randomised parallel group controlled trial was designed to assess the treatment effect of testosterone therapy (Nebido) compared with placebo in terms of exercise-induced ischaemia, lipid profiles, carotid intima-media thickness (CIMT) and body composition during 12 months treatment in men with low testosterone levels and angina. Results: A total of 15 men were recruited but 13 (nZ13) reached adequate duration of follow-up; seven were treated with testosterone and six with placebo. Testosterone increased time to ischaemia (129G48 s versus 12G18, PZ0.02) and haemoglobin (0.4G0.6 g/dl versus K0.03G0.5, PZ0.04), and reduced body mass index (K0.3 kg/m 2 versus 1.3G1, PZ0.04) and triglycerides (K0.36 G0.4 mmol/l versus 0.3G1.2, PZ0.05). The CIMT decreased in the testosterone group more than placebo, but full between group analyses suggested this was only a statistical trend (K0.5G0.1 vs K0.09G0.06, PZ0.16). There were no significant effects on serum prostate specific antigen, total or high-density lipoprotein cholesterol; or on mood and symptom scores as assessed by Seattle Angina Score and EuroQol. Conclusion: The protective effect of testosterone on myocardial ischaemia is maintained throughout treatment without decrement. Previously noted potentially beneficial effects of testosterone on body composition were confirmed and there were no adverse effects.