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Testosterone gel increases left ventricular mass

Presented by
Dr Elizabeth Hutchins, UCLA, USA
AHA 2019
Testosterone Cardiovascular Trial
Dr Elizabeth Hutchins (UCLA, USA) reported the first-ever, double-blind, randomised controlled trial to measure the effect of testosterone therapy on left ventricular (LV) mass in humans. The multicentre, placebo-controlled Testosterone Cardiovascular Trial reported that treating hypogonadism in older men with testosterone gel boosted their LV mass by 3.5% within 1 year [1].

Dr Hutchins presented new findings on the effect of treatment with 1% topical testosterone gel (AndroGel) on body surface area–indexed LV mass. Men over the age of 65 with low serum testosterone (n=123) were randomised to apply either testosterone gel or placebo. Coronary CT angiography was performed at baseline, and again after 1 year. The study cohort was complex and had significant comorbidities; >80% of the men were above age 75, half were obese, >65% had hypertension, and 30% had diabetes.

Serum testosterone was measured every 3 months in all participants. Testosterone levels in the men assigned to the testosterone gel arm rapidly normalised and remained stable in the normal range for the full 12-month study period, whereas the placebo-treated participants continued to manifest low testosterone levels throughout the study period.

In the testosterone gel arm, participants’ LV mass indexed to body surface area rose by 3.5%, from an average of 71.5 g/m2 at baseline to 74.8 g/m2 at 1 year (P=0.033), whereas no changes were detected in the LV mass of the placebo group. No changes were observed in the left or right atrial or ventricular chamber volumes in either arm.

Given evidence from animal and observational human studies that increased LV mass can be associated with increased mortality, Dr Hutchins concluded that topical testosterone application should be prescribed to patients cautiously and after careful consideration.

1. Hutchins E, et al. Randomized controlled trial of testosterone treatment on left ventricular mass in older men with low testosterone. FS.AOS.04, AHA Scientific Sessions 2019, 14-18 November, Philadelphia, USA.

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