Does Testosterone Increase Blood Pressure?

Physician-reviewed TRT education

Does Testosterone Increase Blood Pressure?

Yes, testosterone therapy can raise blood pressure in some men. The average increase may be modest, but FDA now requires blood-pressure warnings across testosterone products and recommends periodic monitoring.

Medically reviewed by Dr. Timothy Mackey
Medical Director · Updated October 2026

What did the FDA change about testosterone and blood pressure?

FDA reviewed postmarketing ambulatory blood-pressure monitoring studies and concluded that testosterone products can increase blood pressure. The agency required product-specific blood-pressure information and a new class-wide warning for products that did not already carry one.

Current testosterone labeling advises clinicians to measure blood pressure periodically and notes that testosterone products are not recommended for men with uncontrolled hypertension.

Can I take testosterone if I have high blood pressure?

Often, yes, if your blood pressure is controlled. Current testosterone labeling advises against use in men with uncontrolled hypertension, not in everyone with a hypertension diagnosis.

Before starting TRT, a physician should:

• Confirm your blood pressure with repeat readings, not a single office value
• Make sure existing hypertension is treated and controlled
• Check a baseline CBC/hematocrit
• Ask about sleep apnea, kidney disease and other cardiovascular risk factors

After starting, blood pressure should be rechecked periodically, especially in the first few months and after any dose or formulation change.

How much can blood pressure increase?

The amount varies by product and patient. In one ambulatory blood-pressure study of testosterone gel 1.62%, average 24-hour systolic blood pressure increased by about 1.9 mm Hg at 16 weeks. That average is small, but individual responses can be larger, especially in people who already have hypertension, diabetes or other cardiovascular risk factors.

This is why blood pressure should be followed rather than assumed to remain unchanged.

Does TRT increase heart-attack or stroke risk?

The TRAVERSE trial enrolled more than 5,000 men with hypogonadism and preexisting or elevated cardiovascular risk. Major adverse cardiovascular events occurred at similar rates in the testosterone and placebo groups, establishing noninferiority for the primary cardiovascular endpoint.

TRAVERSE did identify higher rates of some adverse events, including atrial fibrillation, acute kidney injury and pulmonary embolism, so the study should not be interpreted as proving that testosterone has no cardiovascular risks.

FDA subsequently removed the older boxed-warning language about increased major cardiovascular events while separately strengthening blood-pressure warnings.

For the wider evidence, read Is Long-Term Testosterone Therapy Safe? and our TRT evaluation and treatment guide.

Why can testosterone raise blood pressure?

The mechanism is probably multifactorial. Testosterone can influence sodium and fluid retention, vascular tone, sympathetic activity and red-blood-cell production. Different formulations may produce different peak concentrations and physiologic effects.

Blood pressure can also rise for reasons unrelated to testosterone, including weight gain, sleep apnea, alcohol use, kidney disease, stress, diet, medications and underlying essential hypertension.

Is hematocrit the main reason blood pressure rises on TRT?

Not necessarily. Testosterone can raise hemoglobin and hematocrit, and excessive erythrocytosis may contribute to cardiovascular risk, but blood-pressure changes can occur independently of hematocrit.

Both should be monitored. See our detailed guide to hematocrit on testosterone therapy.

Can low testosterone cause high blood pressure?

Low testosterone and high blood pressure often show up together, but that does not prove one causes the other. They share the same drivers: excess body fat, insulin resistance, type 2 diabetes, poor sleep and obstructive sleep apnea.

Treating low testosterone is not a treatment for hypertension. If you have both, each condition needs its own evaluation and plan.

Can testosterone lower blood pressure?

Observational studies have sometimes found lower testosterone levels in men with hypertension, and some older physiologic studies suggested favorable vascular effects of testosterone. Those findings do not establish testosterone therapy as a treatment for high blood pressure.

TRT should not be prescribed to lower blood pressure. Hypertension should be evaluated and treated on its own merits.

Who should be especially careful?

Extra caution is appropriate in men with uncontrolled hypertension, significant cardiovascular disease, kidney disease, obstructive sleep apnea, obesity, diabetes, high hematocrit or multiple cardiovascular risk factors. These conditions do not automatically rule out TRT, but they increase the importance of appropriate evaluation and follow-up.

How should blood pressure be monitored on TRT?

Blood pressure should be checked before treatment and periodically afterward. Home readings can be useful when obtained with a validated upper-arm cuff and proper technique.

If readings rise consistently after starting or changing testosterone, the clinician should review the dose, formulation, timing, weight, sleep apnea, fluid retention, other medications and overall cardiovascular risk rather than assuming the change is unrelated.

How can I keep blood pressure down while on testosterone?

• Track it at home. Use a validated upper-arm cuff, seated and rested, and take two readings at the same time of day. Bring the log to follow-up visits.
• Keep testosterone in the physiologic range. Higher-than-needed doses add risk without added benefit. Don’t adjust your dose or schedule on your own.
• Watch hematocrit. Thicker blood adds cardiovascular strain, so CBC monitoring stays part of follow-up.
• Get screened for sleep apnea if you snore, wake unrefreshed or have daytime sleepiness. It raises blood pressure on its own.
• Address the basics: weight, sodium, alcohol and regular exercise.
• Review other medications and supplements. NSAIDs, decongestants, stimulants and some “pre-workout” products can raise blood pressure.
• Take blood-pressure medication as prescribed. Starting TRT is not a reason to stop it.

What happens if blood pressure rises after starting TRT?

The correct response depends on severity. Options may include confirming the readings, addressing lifestyle contributors, treating hypertension, reducing testosterone exposure, changing the formulation or reassessing whether TRT remains appropriate.

Do not abruptly stop or change a prescription without discussing it with the prescriber unless urgent medical care is needed.

Does a higher TRT dose increase blood-pressure risk?

Supraphysiologic testosterone exposure can increase adverse effects and is not the goal of replacement therapy. The safest approach is an individualized dose that achieves appropriate physiologic levels and symptom benefit without unnecessary exposure.

See our guide to normal TRT dosing.

Frequently asked questions

Can testosterone cause hypertension?

It can contribute to higher blood pressure in some men. Whether it causes persistent hypertension depends on the individual and other risk factors.

Should I stop TRT if my blood pressure increases?

Not automatically. Confirm the readings and contact the prescribing clinician. A treatment adjustment or separate hypertension treatment may be appropriate.

Is TRT safe if I already have high blood pressure?

It may be appropriate when hypertension is controlled and the overall risk-benefit assessment supports treatment. Current labeling advises against testosterone use in men with uncontrolled hypertension.

Does testosterone cypionate raise blood pressure?

FDA considers increased blood pressure a class-wide testosterone risk, so injectable products are included. The degree of change varies between patients.

What blood pressure is too high for TRT?

There is no single universal cutoff in TRT guidelines that applies to every clinical situation, but uncontrolled hypertension should be addressed before or during therapy. Urgent or severely elevated readings require prompt medical evaluation regardless of TRT status.

How much does testosterone raise blood pressure?

It varies by product and person. In one ambulatory study of testosterone gel, average 24-hour systolic pressure rose about 1.9 mm Hg after 16 weeks. Individual increases can be larger, which is why readings should be tracked.

What is a normal blood pressure on TRT?

The same targets apply as for anyone else. Under ACC/AHA categories, normal is below 120/80. Readings of 130/80 or higher fall in the hypertension range and should be discussed with your physician.

How can I lower my blood pressure while on testosterone?

Confirm the readings at home. Then work with your prescriber on the dose, hematocrit, sleep apnea, weight, sodium, alcohol and any other medications that raise blood pressure. Some men also need blood-pressure medication.

Medical sources

• FDA: Class-Wide Testosterone Labeling Changes
• TRAVERSE: Cardiovascular Safety of Testosterone-Replacement Therapy
• Ambulatory Blood Pressure Study of Testosterone Gel
• American Urological Association: Testosterone Deficiency Guideline

This article is educational and does not replace individualized medical advice. Seek urgent medical care for severely elevated blood pressure or symptoms such as chest pain, severe shortness of breath, neurologic deficits or other emergencies.