Does testosterone replacement therapy increase blood pressure? In this article, we will look at some of the research behind blood pressure and testosterone replacement therapy. I also will add some of my clinical experience on using testosterone replacement therapy and its effect on blood pressure.
If you are interested in understanding how testosterone replacement therapy affects blood pressure, keep reading.
Testosterone Replacement Therapy and Blood Pressure?
In my clinical experience and the research I looked at for this article, testosterone replacement therapy does not increase blood pressure. It is very unlikely that TRT increases blood pressure. It is much more likely that it decreases blood pressure. We will look at the research studies that support this and my clinical experience.
I have treated many patients for low testosterone and there are a few exceptions to this. So we want to take a close look at those to make sure you avoid any high blood pressure situations. Let's look at some of these studies first and then look at some of the exceptions with testosterone replacement therapy and the potential for increasing blood pressure.
The first study was actually an observational study. They followed men with testosterone deficiency over a five year period. These men were taking testosterone therapeutically for their hypogonadism or testosterone deficiency. This study also looked at other parameters too like blood sugar and cholesterol. They found that there was a sustained reduction in the systolic and diastolic blood pressure gradual over time. On average the systolic started at 153 and went down to 137. Technically they started as hypertensive and then went into the normal range. The 137 systolic blood pressure is still a little bit high but not as bad. The same was true for the diastolic, it gradually came down over time. So that seems to be a positive association of testosterone replacement therapy and blood pressure. We can say for sure it is not increasing blood pressure.
If anything maybe something else changed in their lifestyle or habits to improve blood pressure but clearly the testosterone didn't have a negative effect. It was an observational study not randomized placebo-controlled or anything like that. After the sustained reduction over the two years, they continued to follow them for three more years. The blood pressure reduction maintained at that lower level for the remaining three years.
Another study looked at arterial stiffness to assess this question. The more stiff the arteries, the higher the blood pressure. It was a small study but they did find that arterial stiffness improved with normalization of the deficient testosterone levels. Then a final small study looked at the effect of testosterone on endothelial function. This is similar to looking at the arterial stiffness but it was a different study. In this study they assessed the endothelium in men before treatment, three months after treatment and then another assessment in three more months. They found that testosterone either did not affect the endothelial function or actually improved it slightly.
Taking all this information together, it does look like testosterone really does not have a negative effect of testosterone. Add that with my clinical experience, I don't typically see changes in blood pressure in a negative way. Doing a little research on this topic, it looks like it is not fully known as not enough studies have been done. To be safe make sure you know if you do have a blood pressure issue and check it regularly after starting testosterone replacement therapy.
Theoretical Causes of High Blood Pressure From TRT
There are some theoretical TRT causes of high blood pressure. If these are not being monitored or addressed, you can potentially have a problem with higher blood pressure. For instance, testosterone can increase blood pressure through increasing the amount of red blood cells that are produced. This is known as secondary polycythemia. In some people testosterone replacement therapy causes the red blood cell quantities to go up and the concentration overall in the blood to increase. This thickens the blood, causing potentially more volume in the overall system, which can cause the pressure in that contained system to increase. This is a theoretical concern. I do monitor these things closely in my patients. If it's happening then we have them take care of it through a blood donation.
Testosterone can also increase estrogen. If the estrogen gets too high, this can be a problem because estrogen actually causes our bodies to retain sodium. We all know that sodium can increase blood pressure. As your body retains more sodium it also retains more fluid. Similar to increasing the volume with the red blood cell increase, the increased water increases the pressure in the artery. These are two theoretical concerns which are easily adjusted for through close monitoring and taking appropriate action.
That should help answer the question does testosterone replacement therapy increase blood pressure. If you have a specific question about anything related to testosterone blood pressure, drop it in the comment section below.
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