This article was reviewed by Felix Gussone, MD.
Key Takeaways:
- While healthy testosterone levels may help support normal blood vessel and cardiovascular function, very low or very high testosterone can disrupt this balance.
- TRT may slightly raise blood pressure in some men. This is often related to increased red blood cell production (hematocrit) or fluid retention, particularly with higher doses or preexisting heart issues.
- Regular checks of blood pressure, hematocrit, and overall cardiovascular health help ensure safe and effective testosterone therapy.
Testosterone and blood pressure have a delicate relationship. On the one hand, testosterone may help your blood vessels relax, thereby supporting normal blood pressure, especially when levels are in a healthy range.
But on the other hand, as T levels increase from testosterone replacement therapy (TRT), some guys may experience an indirect increase in blood pressure levels.
It’s a bit of a Goldilocks situation: The goal is not too little and not too much, but just right. Healthy testosterone levels are the goal for many reasons — not only to help address symptoms of low T, but also to support your cardiovascular health without tipping the scales in the other direction.
Below, explore the link between the two, and how to help prevent or manage high blood pressure while optimizing your testosterone levels.
How Are Testosterone and Blood Pressure Related?
Testosterone, the predominant male hormone (androgen), has many important roles in men’s health.
Not only is it responsible for things like body composition, drive, red blood cell production, bone density, a deeper voice, body hair, and male secondary characteristics, but testosterone has some cardiovascular effects as well.
When it comes to blood pressure, there are numerous factors involved in keeping it under control: how strong your heart pumps, the flexibility and diameter of your blood vessels, how much blood is circulating, and constant hormonal signals.
For instance, your blood vessels can get narrower or wider to influence blood flow and pressure. Your kidneys manage the fluid volume and balance of electrolytes in your body, which affects blood pressure.
And various hormones play a role, including testosterone. Let’s take a closer look at how your T levels might influence your blood pressure.
Possible Underlying Mechanisms
Testosterone doesn’t directly affect blood pressure, but it might have indirect influences through several mechanisms that may create conditions for blood pressure to rise.
Red Blood Cell Production
Testosterone is a stimulator of erythropoietin (EPO), a hormone made by your kidneys when oxygen levels are low in your body. It tells bone marrow to produce more red blood cells (erythrocytes), which transport oxygen.
When T levels are elevated, either naturally or from TRT, this can increase red blood cell (RBC) count and, consequently, increase hematocrit, the percentage of red blood cells in your total blood volume.
If red blood cells are particularly elevated, this can lead to thicker (more viscous) blood. Thicker blood becomes more difficult to move smoothly through your blood vessels, and more pressure is needed to do so. In this case, an increase in blood viscosity can increase blood pressure.
If RBCs are too high (called polycythemia), this can be a risk factor for hypertension and other cardiovascular issues, including an increased risk of blood clots, heart attacks, and strokes.
When this happens as a result of TRT, it’s called secondary polycythemia or secondary erythrocytosis.
This is why regularly monitoring bloodwork and hematocrit levels is important for someone on TRT.
Fluid Retention
Though not as common, testosterone may also influence the balance of water in your body. Some guys starting hormone therapy report hanging onto more fluid than usual, which could temporarily increase blood volume and blood pressure.
What the Research Says
Many studies have been conducted to better understand the risks involved with men on TRT and high blood pressure.
For instance, the Testosterone Trials (T Trials) were a series of seven trials among 788 men with a mean age of 72 who had low testosterone. The studies examined the effects of TRT on various health outcomes, including cardiovascular health.
Researchers found no significant increase in cardiovascular events (like a heart attack or stroke) or in blood pressure among men using TRT versus placebo. However, this research was only done for around a year; we need larger and longer studies.
A 2023 trial examined the cardiovascular effects of TRT among 5,246 men ages 45 to 80 who had preexisting or a high risk of cardiovascular disease and diagnosed hypogonadism. Researchers concluded that testosterone treatment was no worse than a placebo in terms of causing serious heart events.
It’s important to note that this particular study was funded by a major pharmaceutical company that makes testosterone products. After reviewing this trial and other evidence, the Food and Drug Administration (FDA) removed earlier label language suggesting a possible increased risk of serious cardiovascular events and added new warnings that testosterone products can increase blood pressure.
Overall, the general consensus is that most men who have clinically diagnosed testosterone deficiency can safely use TRT under medical supervision and careful monitoring for cardiovascular side effects like high blood pressure.
Who Is Most Susceptible?
Testosterone may not have the same effects in the body of every guy. While there’s limited data that TRT increases cardiovascular risks, some men may be more at risk for blood pressure changes than others, such as:
- Men with preexisting hypertension. If your blood pressure is already high before starting TRT, you may be at a higher risk of it becoming harder to control.
- Men with a history of cardiovascular diseases. Some studies suggest possible heart-related benefits of testosterone, while others have raised concerns. It’s especially important to discuss the pros and cons with your healthcare provider.
- Older men. Testosterone levels naturally drop as you get older, and rates of cardiovascular disease and high blood pressure go up. While some forms of TRT can benefit older men by improving muscle mass and quality of life, they may also have stiffer blood vessels, which may increase their risk of higher blood pressure on TRT.
- Guys taking high doses. Doses of testosterone that raise hormone levels far above what’s considered normal, which is more often seen in non-medical uses like bodybuilding, come with a higher risk of side effects, including high blood pressure.
Whatever the case, careful monitoring of blood pressure in higher-risk groups is important before and during TRT.
TRT and Blood Pressure: Before and During Treatment
Testosterone can be a helpful option for improving quality of life and overall well-being for many men diagnosed with low T. But like any medical intervention, it carries potential risks, and it’s important to monitor for side effects.
Before Starting TRT
Before you start TRT, your provider will help you make sure it’s a good option for you and assess your risk factors for things like high blood pressure and other cardiovascular concerns.
They’ll check things like:
- Your baseline blood pressure, to determine whether it’s normally stable or already elevated before adding TRT.
- Comprehensive blood work, which includes:
- Free and total testosterone
- A complete blood count (CBC) to measure hematocrit
- Your blood lipids (cholesterol)
- Liver and kidney function tests
- hormone-binding globulin (which influences testosterone availability)
- Prostate-specific antigen (PSA) for middle-aged or older guys (as this can also rise while on TRT).
- Cardiovascular risk factors, like whether you smoke and a family history of heart disease.
- Existing health conditions that might be pertinent, like heart disease, sleep apnea, hypertension, or benign prostatic hyperplasia (BPH).
Monitoring During TRT
Once you start TRT, your provider will discuss what regular monitoring looks like for you and when you need to come in to check the following:
- Blood pressure levels
- Serum testosterone levels
- Hematocrit
- New or worsening symptoms, like headaches, dizziness, swelling, changes in sleep
- Other blood markers, like liver enzymes, PSA, and cholesterol
Managing Blood Pressure While on TRT
If your blood pressure becomes an issue while you’re on TRT, that doesn’t automatically mean you have to stop treatment, but it does require addressing it. Some of the factors your doctor might consider include:
- Adjusting your dose
- Changing the administration method
- Adding an antihypertensive medication
Your lifestyle habits are also key to helping lower blood pressure. This includes optimizing your diet by replacing ultra-processed foods with healthier options, reducing your sodium intake, and increasing your potassium intake by eating plenty of fruits and vegetables.
Moving your body regularly, getting enough sleep, and managing your stress are also important, whether you’re on TRT or not.
If your blood pressure remains stubbornly high despite lifestyle changes and medications, your healthcare provider may decide that TRT is not the best option for you. In some cases, men may instead be treated with other medications such as selective estrogen receptor modulators (like enclomiphene) to help increase testosterone levels. These treatments are typically used off-label and also require careful monitoring. Learn more about the possible effects in our guide to whether enclomiphene raises blood pressure.
Signs of High Blood Pressure
While staying vigilant about how your body is responding to TRT is essential, it’s also important to know what symptoms to look for that may indicate your blood pressure is creeping upward.
Hypertension is often called a “silent killer” because it presents without obvious signs at first. However, warning signs eventually become more noticeable as blood pressure worsens.
The only way to know your blood pressure numbers is to monitor them, which can be done at home with a blood pressure cuff (not just in a clinician’s office).
But be aware of these common symptoms of high blood pressure:
- Severe headache
- Shortness of breath with minimal exertion
- Unexplained nosebleeds
- General fatigue, confusion, or trouble concentrating
- Blurred or double vision
- Chest discomfort
- Pulsating in your neck, ears, or chest
Seek immediate medical attention if you have any of these symptoms, especially if you have more than one, as you could be having a hypertensive crisis, a severe elevation in blood pressure that can be deadly.
The Bottom Line
Maintaining healthy testosterone levels, particularly in middle-aged or older men with clinically diagnosed hypogonadism, can offer benefits, including improved energy, mood, bone density, muscle mass, and intimate function.
But like any medication, testosterone therapy carries potential risks, and its influence on blood pressure is a key consideration. Understanding your personal risks, monitoring for symptoms, adhering to medical advice, and communicating with your provider are essential.
FAQs
Can testosterone therapy cause high blood pressure?
It’s possible, especially if testosterone levels rise too high or red blood cell counts increase significantly. However, most men on medically supervised TRT maintain stable blood pressure levels.
Does testosterone therapy lower blood pressure for some men?
In some men with low testosterone and endothelial dysfunction, restoring testosterone to a normal range may improve blood vessel function and could modestly lower blood pressure. However, the research is mixed, and this isn’t guaranteed.
What should I monitor while on testosterone therapy?
You should regularly monitor your blood pressure at home and have your hematocrit and testosterone levels checked by your healthcare provider. They may also want to check on your liver function, cholesterol, and PSA levels, depending on your age and health profile.
Are certain men more at risk for blood pressure changes with TRT?
Yes. Men with preexisting hypertension or cardiovascular disease or those on high doses of testosterone are more likely to experience blood pressure changes.
What can I do if my blood pressure goes up while on TRT?
Always communicate your symptoms and work with your provider, who may recommend adjusting your dose. It’s also important to manage contributing factors like diet, sodium intake, and stress. Sometimes, simple lifestyle changes or medication adjustments can help without stopping TRT.
Related:
- Average Testosterone Levels by Age
- How to Increase Your Testosterone Without Affecting Your Fertility
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This article originally appeared on Hims.com and was syndicated by MediaFeed.org.
