Myths and Truths of Growth Hormone and Testosterone in Heart Failure

Heart failure is a chronic clinical syndrome with very poor prognosis. Despite being on optimal medical therapy, many patients still experience debilitating clinical symptoms and have poor quality of life. In recent years, there is great interest in anabolic hormone replacement therapy—namely, growth hormone and testosterone— as an adjunctive therapy in patients with advance heart failure. It has been observed that low levels of growth hormone and testosterone have been associated with increased mortality and morbidity in patients with heart failure. Animal studies and clinical trials have shown promising clinical improvement with hormonal supplementation. Growth hormone has been shown to increase ventricular wall mass, decrease wall stress, increase cardiac contractility, and reduce peripheral vascular resistance, all of which helps to enhance cardiac function resulting in improvement in clinical symptoms. Likewise, testosterone has been shown to improve hemodynamic parameters via reduction in peripheral vascular resistance and increased coronary blood flow through vasodilation thereby improving functional and symptomatic status. To date, growth hormone and testosterone therapy have shown largely positive benefits with minimal adverse effects. However, large, randomized, controlled trials are still needed to assess long-term safety and efficacy.