When asked “Does taking testosterone cause high blood pressure?” it’s important to understand that the relationship between testosterone and blood pressure is complex. The causes and effects can vary among individuals. Some studies suggest that testosterone may have a vasodilatory effect, potentially leading to a lowering of blood pressure, whereas, other studies have indicated that high levels of testosterone might be associated with an increase in blood pressure. It's hard for scientists to study the effects of testosterone on blood pressure because there are so many risk factors, including family history, age, gender, cholesterol, blood sugar, obesity, smoking, exercise, stress levels, occupational hazards diet, and personality to name a few.
Fortunately, there is a large amount of scientific literature that we can research to help us learn more about the relationship. For example, the Journal of the American Heart Association. Back in 2021, published an important article titled “Association of Serum Testosterone and Luteinizing Hormone With Blood Pressure and Risk of Cardiovascular Disease in Middle‐Aged and Elderly Men” which concluded that:
” Lower total testosterone could be a promising risk marker for prevalent hypertension. Both low and high levels of testosterone are associated with greater cardiovascular risk. Primary hypogonadism may be a risk marker for major cardiovascular diseases in men with severe hypertension”
So researchers are trying to determine what are the risk factors and what are the optimal hormone levels for men to improve and maintain cardiovascular health.
The amount of testosterone in the body and the dosage administered through testosterone replacement therapy can affect its impact on blood pressure. Several studies have shown there is a negative impact on cardiovascular health when men have low testosterone and estradiol levels. There is also a link that shows an increase in blood pressure for men who are taking too high of a dose. The benefits to cardiovascular health appear to be in an optimized range which can vary from one patient to the next, highlighting the importance of having an experienced physician. In a study titled “Testosterone and Secondary Hypertension: New Pieces to the Puzzle” published in the National Library of Medicine, it states that:
“genetic background might determine the pro-hypertensive effects of testosterone.” They also state that “one could hypothesize that cells derived from animals (or humans) with a genetic predisposition to arterial hypertension will respond to a greater degree to testosterone, showing greater increases in reactive oxygen species production and insufficient induction of “protective” NADPH oxidase subunit Nox4, resulting in an overall greater oxidative stress burden.”
So, men with hypogonadism will have a greater response to testosterone than men with higher testosterone levels who take exogenous androgens. This seems consistent with the findings that anabolic steroid users are at a higher risk of developing complications from abuse than a hypogonadal male taking therapeutic doses.
The relationship between testosterone and vasodilation (the widening of blood vessels) in men is complex and not fully understood. Testosterone is a sex hormone that plays a crucial role in several physiological processes, including those related to cardiovascular functions. While the vasodilatory effects of testosterone have been suggested in some studies, the mechanisms and the overall impact on cardiovascular health aren’t entirely clear. However, there is evidence that suggests testosterone may play an important beneficial role in lowering BP in hypogonadal men. Published in the Harvard Medical Schools journal called Harvard Health Publishing, an article titled “Testosterone and the heart” published on March 1, 2010 states:
“Men who undergo androgen-deprivation therapy develop abnormally stiff arteries. In men with atherosclerosis and normal testosterone levels, short-term treatment with testosterone improves vascular reactivity and blood flow.” This seems to be completely in line with other similar studies that have been independently conducted showing improved blood flow in men with andropause or hypogonadism.
More research needs to be done; however, it seems to be the case that testosterone when used in certain patients can improve the smooth muscles of the vascular system, which can improve cardiovascular health and blood flow. In another article titled “Testosterone Induces Vascular Smooth Muscle Cell Migration by NADPH Oxidase and c-Src–Dependent Pathways” published in AHA Journals, they hypothesized that:
“testosterone stimulates generation of reactive oxygen species (ROS) and migration of vascular smooth muscle cells” They concluded that “testosterone may have a wide range of effects in the vascular system and can be particularly important in males, especially in patients with augmented testosterone levels, cardiovascular diseases, and arterial hypertension.”
In a different study published in the Journal of Hypertension titled “Blood pressure and endogenous testosterone in men an inverse relationship” by Khaw, Kay-Tee; Barrett-Connor, Elizabeth, they found that:
“Out of 1132 men aged 30–79 years, those with hypertension, categorically defined as systolic blood pressure (SBP) <160mmHg and/or diastolic blood pressure (DBP) <95 mmHg had significantly lower testosterone levels than non-hypertensives.”
So, it would appear that hypogonadal men are at a greater risk of developing hypertension and thus logically men on TRT may be able to lower blood pressure when monitored and prescribed appropriately
Some of the other potential vasodilatory effects of testosterone in men may include, Nitric Oxide Production: Testosterone may influence the production of nitric oxide (NO), a molecule known to promote vasodilation. NO relaxes the smooth muscle cells in blood vessels, leading to increased blood flow. Endothelial Function: Testosterone might affect the endothelium, the inner lining of blood vessels. Healthy endothelial function is essential for vasodilation and maintaining blood vessel integrity. Reduced Vasoconstriction: Testosterone may influence the balance between vasodilation and vasoconstriction, helping to maintain optimal blood vessel tone.
One of the potential side effects of TRT can be increased production of red blood cells. An elevated red blood cell count is a condition known as polycythemia, which can contribute to an increase in blood pressure through several different mechanisms. It can be tracked by testing your hematocrit levels which is the measure of the proportion of red blood cells in your blood compared to the total volume of blood. Normal hematocrit levels can vary slightly depending on factors such as age, sex, and health status, but generally, men will have levels between 38 to 51% with women being lower at 35-45%. Excess red blood cells in the bloodstream can affect blood viscosity (thickness) and may influence blood pressure as a result. With a higher concentration of red blood cells, the viscosity of the blood increases. Understanding hematocrit levels on TRT is an important function of the healthcare provider.
Thickened or more viscous blood requires more force to pump through the blood vessels, contributing to elevated blood pressure. Higher blood viscosity can also impede the smooth flow of blood through the arteries and capillaries. This increased resistance to blood flow can lead to higher pressure within the blood vessels. It's important to note that polycythemia can be caused by various factors, including underlying medical conditions such as polycythemia vera, chronic hypoxia (low oxygen levels), or smoking. Treatment for elevated red blood cell count and its associated effects on blood pressure will often depend on addressing the underlying cause. Individuals with concerns about elevated red blood cell count and its potential impact on blood pressure should consult with a healthcare professional. Monitoring and managing conditions that contribute to polycythemia are crucial for overall cardiovascular health. An experienced physician can help with prescribing an appropriate dose which will help to mitigate the risks associated with TRT and red blood cell production.
Anyone considering TRT should be aware of the potential cardiovascular risks and consult with an experienced healthcare professional. They will ensure that there is regular monitoring of hormone levels, hematocrit, and red blood cell production to make sure that all are within healthy ranges. Ultimately, the relationship between testosterone and blood pressure is multifaceted, and further research is needed to completely understand the mechanisms and possible risks associated with testosterone replacement therapy, and how it can affect blood pressure. Any decisions regarding testosterone therapy should be made in consultation with a qualified healthcare provider who can assess individual health factors, prescribe the needed blood tests and provide personalized advice.
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