TRT and Blood Pressure
Testosterone Replacement Therapy (TRT) and Cardiovascular Health
Testosterone Replacement Therapy (TRT) may be prescribed to men diagnosed with clinically confirmed testosterone deficiency. Treatment options include injections, transdermal gels, patches, or oral formulations.
While many men report improvements in energy, mood, and sexual function when therapy is medically indicated, its effects on the cardiovascular system, particularly blood pressure, remain an important area of ongoing research.
Understanding the Relationship Between TRT and Blood Pressure
Testosterone influences several physiological pathways that can affect vascular tone, blood volume, and red blood cell production.
Because of this, TRT may impact blood pressure differently among individuals. Current clinical evidence shows mixed results, with studies reporting both reductions and elevations in blood pressure, depending on the treatment population and formulation used.
Evidence from Clinical Studies
1. Possible Blood Pressure Reduction
Some studies have observed improvements in blood pressure among men with low testosterone.
For instance, research involving men treated with testosterone undecanoate (TU) found that both systolic and diastolic blood pressure decreased over time.
These findings suggest that, in certain cases, TRT may support cardiovascular function by improving vascular health, possibly due to enhanced nitric oxide activity or better metabolic control.
(Reference: PubMed – Study on testosterone undecanoate and blood pressure reduction in hypogonadal men)
2. Potential for Blood Pressure Elevation
Other studies, however, report an increase in blood pressure during testosterone therapy.
In a trial involving opioid-treated men with secondary hypogonadism, TRT was associated with higher office blood pressure readings compared to placebo.
The study also noted a link between rising haematocrit levels (increased red blood cell concentration) and blood pressure elevation, suggesting that TRT-related changes in blood viscosity could contribute to this effect.
(Reference: PubMed – Study on TRT and blood pressure increase in opioid-induced hypogonadism)
3. Neutral or Minimal Effects
Some investigations have found no meaningful changes in blood pressure.
A 16-week study assessing transdermal testosterone systems reported no clinically significant differences in average 24-hour blood pressure measurements.
This suggests that cardiovascular responses to TRT can vary widely depending on the route of administration, dose, and baseline patient characteristics.
(Reference: PubMed – Study on transdermal testosterone and blood pressure outcomes)
Factors That Influence Blood Pressure Responses
The variability in blood pressure changes during TRT can be influenced by several factors:
Baseline cardiovascular status: Men with elevated blood pressure before therapy may see greater reductions compared to those with normal readings.
Haematocrit levels: Testosterone can stimulate red blood cell production; high haematocrit is associated with increased blood viscosity, which may elevate blood pressure.
Formulation and dosage: Injectable preparations such as testosterone undecanoate have sometimes been associated with blood pressure reductions, while other formulations (e.g., gels or oral forms) may have neutral effects.
Fluid retention: TRT may cause mild sodium and water retention, which can temporarily increase blood volume and blood pressure in some individuals.
Clinical Considerations and Monitoring
Individualised therapy: TRT should always be tailored to each patient’s medical history, cardiovascular profile, and treatment goals.
Regular monitoring: Blood pressure, haematocrit, and other cardiovascular markers should be checked periodically throughout therapy.
Dose adjustments: If blood pressure increases or haematocrit rises above the normal range, your doctor may modify the dosage or review treatment frequency.
Lifestyle factors: Maintaining a healthy weight, regular exercise, limiting sodium intake, and avoiding excessive alcohol can help support cardiovascular stability during TRT.
This information is provided for educational purposes only and does not replace professional medical advice, diagnosis, or treatment.
All testosterone therapy should be prescribed and monitored by an AHPRA-registered medical practitioner following comprehensive assessment and regular follow-up testing.
Individual cardiovascular responses vary, and any concerns about blood pressure or heart health should be discussed directly with your doctor.