Review ArticlesThe Role of Testosterone in Patients With Heart Failure: A Systematic ReviewPark, SoEun BA, Pharm D*; Gale, Stormi E. Pharm D, BCCP†,‡; Watson, Kristin Pharm D, BCCP†,‡Author Information From the *Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD †Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD ‡ATRIUM Cardiology Collaborative, Baltimore, MD. Disclosure: The authors declare no conflict of interest. No funding was received for this work. Correspondence: Kristin Watson, Pharm D, BCCP, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, 20 N. Pine Street Room PH S447, Baltimore, MD 21201. E-mail: [email protected]. Cardiology in Review: May/June 2021 - Volume 29 - Issue 3 - p 156-161 doi: 10.1097/CRD.0000000000000350 Buy Metrics Abstract The consequences of heart failure (HF) remain high despite treatment advances. Deficiency of the anabolic axes is common in HF and is associated with an increased risk of death and worsening functional status. Exogenous testosterone use has been shown to decrease vascular resistance and improve cardiac output. The objective of this systematic review was to assess the efficacy (mortality, hospitalization, cardiac function, and quality of life) and safety of testosterone in HF patients. The Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines were followed. Four electronic databases were searched from inception until November 30, 2019. The initial search yielded 1308 articles, and 10 randomized controlled trials with exogenous testosterone in patients with HF were included after exclusion criteria were applied. One study evaluated the impact of testosterone on mortality and HF hospitalization; no difference was observed compared with placebo. In 5 studies, testosterone use was associated with an improvement in walking distance. In 1 of the 2 studies that evaluated functional status, New York Heart Association class was improved. In 2 out of 4 studies, quality of life was improved with therapy. When reported, testosterone use was not associated with an increase in side effects. Overall, testosterone use has not been shown to reduce the risk of death or HF hospitalization, with inconsistent evidence on the impact of therapy on quality of life. Additional trials are needed before testosterone can be recommended. Patients with HF should receive guideline-directed medical therapy with the assurance that patients are receiving maximum tolerated doses. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.