Objectives: Testosterone deficiency has been associated with depressive symptoms, which may be improved by replacement therapy. Patients with chronic heart failure have a high prevalence of depression, which is associated with early mortality in these patients. Men with heart failure may also have low plasma levels of testosterone, which could contribute to depressed mood. In a clinical study investigating whether testosterone treatment benefits men with heart failure, patients were assessed for depressive symptoms.
Methods: Plasma levels of total and bio-available testosterone were measured between 0800 and 0900 in 48 men with stable chronic heart failure. Depressive symptoms were assessed using the Beck Depression Inventory (BDI) and heart failure symptoms were assessed using the Minnesota Living with Heart Failure (MLHF) questionnaire. Ejection fraction (EF) and fractional shortening (FS) were measured by echocardiography. 20 subjects were subsequently randomised to receive testosterone (Sustanon100) or normal saline (1ml) by fortnightly intramuscular injection in a 3 month double-blind study.
Results: Mean EF was 33.6 plus/minus 9.7% and FS was 24.9 plus/minus 8.0%. There was a strong relationship between BDI and MLHF score (r=0.73, p<0.001). There was also an inverse association between BDI score and FS (r=-0.30, p=0.04). There was no relationship between plasma levels of testosterone and BDI score, MLHF score, EF or FS. In patients receiving testosterone treatment (baseline plasma level 12.7 ± 7.1nmol/L), there was a significant improvement in both BDI score (from 7.3 ± 7.3 to 5.7± 6.0, p=0.03) and MLHF score (from 34.5 ± 29.3 to 26.5 ± 25.3, p=0.05), with no effect on cardiac function.
Conclusion: Depressive symptoms in men with chronic heart failure do not appear to be related to endogenous testosterone levels. However, administration of exogenous testosterone may improve both depressive and heart failure-related symptoms in these patients.