Background-The role of testosterone on the development of coronary artery disease in men is controversial. The evidence that men have a greater incidence of coronary artery disease than women of a similar age suggests a possible causal role of testosterone. Conversely, recent studies have shown that the hormone improves endothelium-dependent relaxation of coronary arteries in men. Accordingly, the aim of the present study was to evaluate the effect of acute administration of testosterone on

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... cise-induced myocardial ischemia in men. Methods and Results-After withdrawal of antianginal therapy, 14 men (mean age, 58Ϯ4 years) with coronary artery disease underwent 3 exercise tests according to the modified Bruce protocol on 3 different days (baseline and either testosterone or placebo given in a random order). The exercise tests were performed 30 minutes after administration of testosterone (2.5 mg IV in 5 minutes) or placebo. All patients showed at least 1-mm ST-segment depression during the baseline exercise test and after placebo, whereas only 10 patients had a positive exercise test after testosterone. Chest pain during exercise was reported by 12 patients during baseline and placebo exercise tests and by 8 patients after testosterone. Compared with placebo, testosterone increased time to 1-mm ST-segment depression (579Ϯ204 versus 471Ϯ210 seconds; PϽ0.01) and total exercise time (631Ϯ180 versus 541Ϯ204 seconds; PϽ0.01). Testosterone significantly increased heart rate at the onset of 1-mm ST-segment depression (135Ϯ12 versus 123Ϯ14 bpm; PϽ0.01) and at peak exercise (140Ϯ12 versus 132Ϯ12 bpm; PϽ0.01) and the rate-pressure product at the onset of 1-mm ST-segment depression (24 213Ϯ3750 versus 21 619Ϯ3542 mm Hgϫbpm; PϽ0.05) and at peak exercise (26 746Ϯ3109 versus 22 527Ϯ5443 mm Hgϫbpm; PϽ0.05). Conclusions-Short-term administration of testosterone induces a beneficial effect on exercise-induced myocardial ischemia in men with coronary artery disease. This effect may be related to a direct coronary-relaxing effect. (Circulation. 1999;99:1666-1670.)