4.3 Clinical recommendations and considerations
This systematic review highlights the importance of testosterone in
relation to the electrophysiological function of the heart and makes a
strong case for increasing our level of clinical consideration for
testosterone as an important factor when deciding therapeutic options
and susceptibility for arrhythmogenesis. There are many medications used
in the treatment of both common and life-threatening conditions that
have QT prolonging effects (eg. anti-arrhythmics, anti-depressants,
anti-psychotics etc. – Table 3 ) (75). Hence, recognizing
whether these patients are in testosterone deficient state becomes very
important to reduce their risk of arrhythmogenesis (Figure 2 ).
For instance, special considerations should be taken with patients
undergoing androgen depravation therapy, gender transition from male to
female and patients with genetic and those with medical conditions that
lower their testosterone levels (eg. primary or secondary hypogonadism,
liver disease) (13,25,40).
Currently there are no guidelines to perform ECGs prior to starting a
potentially arrhythmogenic therapy. Additionally, there are no
recommendations in regards to how patient should be counselled regarding
the risk of arrhythmia development (78). It is our recommendations to
assess for risk factors of QT prolongation before starting potentially
arrhythmogenic therapies, if there is any suspicion for a testosterone
deficient state. We encourage clinicians to perform routine ECGs before
starting potentially arrhythmogenic therapies, especially on patients
who may have risk factors for arrhythmogenesis and/or low testosterone
(79) (Figure 4 ). For patients starting a QT prolonging
medication, the British Medical Journal – Drug and Therapeutics
Bulletin recommends a baseline ECG and another ECG once the drug has
reached steady state (78). This paper also encourages us to keep looking
into the effects of testosterone as a protective hormone against
arrhythmogenesis, and its therapeutic potential. Some limitations that
should be noted include the omission of gray literature and the
exclusion of papers in other languages than English or Spanish.