Myths and Truths of Growth Hormone and Testosterone Therapy in Heart Failure

Cam T Nguyen; Alistair Aaronson; Ryan P Morrissey; Megha Agarwal; Robert D Willix; Ernst R Schwarz

Disclosures

Expert Rev Cardiovasc Ther. 2011;9(6):711-720. 

In This Article

Conclusion

Growth hormone and testosterone supplementation have shown promising effects in patients with HF despite numerous small, short-term clinical trials showing mixed results. Selected patients may benefit from supplementation in addition to conventional therapy, in particular patients with documented hormonal deficiency (below or in the low-normal range). Patients with suspected GH resistance may warrant pretreatment screening prior to supplementation to adjust dosing and possible direct IGF-1 administration in addition to GH. However, from our knowledge, there are no direct studies with both GH and IGF-1 supplementation in HF, thus recommendations cannot be made regarding this dual therapeutic approach.

Minimal data exist for combined therapy of GH and testosterone in the setting of HF. The studies using combined GH and testosterone supplementation were mostly conducted in older men with testosterone and IGF-1 in lower ranges of normal. One study showed promising effects on the improvement of body composition and muscle performance,[92] while another study found no change in function, mood and body composition.[93] However, the latter study observed improvements in balance and muscle IGF-1 gene expression. Future studies investigating combined GH and testosterone therapy in patients with HF would be warranted in order to assess possible synergistic effects, which may be advantageous over monotherapy.

Testosterone treatment has been shown to exert beneficial effects in both men and women with HF with few adverse effects. In our patients with advanced HF and other comorbid conditions, we routinely screen for and treat testosterone deficiency. Approximately 20–30% of our HF patients, those with ventricular assist devices and patients with postorthotopic heart transplantation status, have received supplemental testosterone at some point. Anecdotally, the patients have improved nutritional status as well as improved functionality and sense of well being. Although our patients appear to show some clinical improvement with testosterone therapy, we currently do not have conclusive data to recommend testosterone therapy in HF patients. Despite the promising role of hormonal supplementation in HF, larger, long-term, randomized clinical trials are warranted to further assess efficacy and safety of manipulation of the hormonal imbalance in patients with chronic HF.

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