Oct. 16, 2000 -- Conventional medical wisdom takes another drubbing with a report out of the U.K. suggesting that some men with chest pain from chronic stable angina can get some relief and have a better quality of life if they take low doses of the male hormone testosterone. The study is reported in the Oct. 17 issue of Circulation: Journal of the American Heart Association.
Angina is a sharp pain in the chest, back, jaw, or arm that comes on with exercise and goes away with rest. It is caused when the heart gets too little oxygen to function properly, which can occur when one or more of the arteries that bring oxygen-rich blood to the heart are narrowed or blocked.
Researchers have long thought that sex hormones play a role in protecting us from -- or disposing us to -- heart disease. For example, estrogen, the primary female sex hormone, probably protects women from heart disease, as evidenced by the fact that heart disease rates rise sharply among women who are past the age of menopause (when estrogen levels drop off) and who aren't taking estrogen replacement therapy.
Testosterone, on the other hand, is thought to be bad for the old ticker. "Worldwide, men are twice as likely to die from coronary heart disease than women, who appear to be protected by ... estrogens," write Katherine M. English, MBChB, and colleagues from the University of Sheffield, Barnsley District Hospital, and University of Liverpool, all in the U.K.
The authors also note that athletes who use high levels of anabolic steroids -- synthetic hormones that build muscles quickly -- are at increased risk for sudden cardiac death, a finding that suggests that high levels of male hormones may be harmful to the heart and/or the blood vessels that feed it. Male hormones also can contribute to cancer of the prostate gland; in fact, one of the main forms of treatment for men with advanced prostate cancer is to keep the tumor in check by depriving it of hormones with drugs.
But as English and her colleagues show in their study, men with angina who wore skin patches that delivered small daily doses of testosterone could exercise without pain longer and generally felt better than men with angina who wore a dummy (nonmedicated) patch.
The authors suggest that testosterone supplements may improve symptoms of angina by relaxing the walls of blood vessels leading to the heart, thereby allowing more blood to reach the organ. They say that the hormone also may contribute to feelings of well-being in these patients.
"Many of the men in the study had low or borderline levels of testosterone. When it was restored to normal levels, they felt better, had more strength, and were in a better mood," according to English in a written statement.
The testosterone patches did not appear to contribute to the risk of prostate cancer in the study subjects, the authors say.
Men in the treatment group also showed marked improvements in all quality-of-life measures, including pain perception, despite the fact that they had the same number of pain episodes as men who received the nonmedicated patch.
"Patients with long-term problems learn to cope with angina at a certain level," according to English in the written statement. "The men probably noticed an improvement and began to push themselves to do more daily activities, accepting a certain level of angina."