Free Testosterone Inversely Linked to Incident Heart Failure in Older Men

Middle aged businessman with chest pain
Middle aged businessman with chest pain
Researchers sought to determine if circulating androgen levels like total and free testosterone are inversely associated with incident heart failure in older men.

Circulating levels of androgens tend to be inversely associated with incident heart failure (HF) among older men, according to research presented at the American Heart Association (AHA) Scientific Sessions 2021, held virtually from November 13 to 15, 2021.

As men age, levels of circulating androgens decline. The change in androgen levels has been associated with diabetes and atherosclerotic cardiovascular disease (ASCVD). There has also been a reported link between low total testosterone (T) and incident HF. However, how the relationship between other circulating androgens associates with incident HF remains unclear.

Researchers from University of California San Francisco assessed serum androgen concentrations among men (N=1061) without ASCVD or HF from the Cardiovascular Health Study sample, using liquid chromatography tandem mass spectrometry and immunoassay. Free T was calculated from total T, sex hormone-binding globulin, and albumin. Androgen levels were associated with risk for HF.

The patients had a mean age of 76±5 years, and over a median of 9.6 years, they collectively had 368 incident HF events.

After adjusting for age, race, BMI, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, use of antihypertensive medications, physical activity, smoking, and alcohol consumption, the investigators observed a significant association between low free T and HF risk (adjusted hazard ratio [aHR], 1.14; 95% CI, 1.01-1.28; P =.03).

After the adjustment, a similar but nonsignificant relationship was observed for total T (aHR, 1.12; 95% CI, 0.99-1.26; P =.07), dihydrotestosterone (aHR, 1.10; 95% CI, 0.97-1.24; P =.14), and sex hormone-binding globulin (aHR, 1.07; 95% CI, 0.95-1.21; P =.25).

This study may have limited power due to sample size.

The findings suggested that low free T was a significant risk factor for incident HF. The trend of low total T, dihydrotestosterone, and sex hormone-binding globulin, although not significant, supported the relationship between androgen deficiency and HF among older men.

“Additional research is needed to determine whether androgen replacement therapy is an effective strategy to lower HF risk in older men,” the study authors said.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Njoroge JN, Tressel W, Biggs ML, et al. Circulating androgen levels and risk of incident heart failure in older men: the Cardiovascular Health Study (CHS). Presented at: AHA Scientific Sessions 2021. Abstract 13083