The Effects of Testosterone on Blood Pressure in Hypogonadal Men
The Complex Relationship Between Testosterone and Blood Pressure in Hypogonadal Men
As more and more men are looking to turn back the clock by
starting hormone replacement therapy regimens, there are some concerns
regarding the safety and potential for negative side effects from taking
medications to influence hormones, specifically testosterone and estrogen in
hypogonadal men. Testosterone
replacement therapy (TRT) has been widely studied for its benefits in men
with low T, or hypogonadism which is a condition characterized by low
testosterone levels. The range may vary based on age and other factors; however
the typical standard has been between 250-1000 ng/dl. While TRT has been shown
to improve several different aspects of health, including muscle mass,
strength, libido, bone density, and mood, its effects on blood pressure (BP)
still remains a subject of debate amongst those in the medical profession. Patients
often ask us if “taking testosterone will increase their blood pressure?”
Some studies have suggested that TRT may contribute to hypertension, while
others indicate a potential for BP reduction. With conflicting evidence, we
have to ask what’s the evidence and why is there a discrepancy between conclusions?
In the following blog post, we’ll
investigate the findings from multiple studies to provide a comprehensive
overview of the relationship between testosterone and blood pressure in
hypogonadal men and how TRT can either contribute to the increase or decrease
in BP for patients.
Testosterone and Blood Pressure: Conflicting Perspectives
The effects of TRT on BP have been examined in multiple
studies from various researches with differing conclusions. Some reports, such
as those from Geoffrey
Hackett et al., suggest to us that testosterone undecanoate (TU) therapy may
be associated with significant reductions in both systolic and diastolic blood
pressure as well as pulse pressure in hypogonadal men, regardless of whether or
not they are on any antihypertensive therapy. Antihypertensive therapy can include
medications like diuretics, (ACE) Inhibitors, Angiotensin II Receptor Blockers
or beta blockers. In their study, the findings indicate that men who were never
on antihypertensive medications experienced BP reductions of -12.5 mmHg
(systolic), -8.0 mmHg (diastolic), and -6.0 mmHg (pulse pressure) at final
assessment. In contrast, their study showed that the men who did not receive TU
showed increases in blood pressure over time.
However, a randomized controlled trial performed by Olesen et al. presented a completely
different perspective from Hackett. This study found that men with
opioid-induced androgen deficiency who received TRT experienced an average
systolic BP increase of 6.2 mmHg, compared to a 7.0 mmHg decrease in the
placebo group. Notably, men with higher hematocrit levels and elevated body
mass index (BMI) appeared more susceptible to BP increases. These findings
suggest that hematocrit levels may modulate BP responses to TRT but it also
needs to be stated that these patients all had low T that was a result of taking
opioids and not reflective of most typical cases of androgen deficiency. It’s also important to ask what were the patients
testosterone levels PRIO to their opioid dependency? Did they take a Low T test prior or is the
reading of low testosterone post dependency the first time their hormone levels
were checked? We do know that that heroin and opioids will lower testosterone
levels however having a baseline reading that can be validated both before and
after is important for researchers to determine valid conclusions and a
credible hypothesis.
Hematocrit and Its Role in BP Regulation
One of the primary concerns with TRT is its potential to
elevate hematocrit, which can increase blood viscosity and raise BP. Testosterone therapy has been known to cause
secondary erythrocytosis which can cause symptoms of hyperviscosity, such as
headaches, low energy or fatigue, blurry vision and even paresthesias. If a
patient on TRT has hematocrit levels of over 54, they should consider taking
measures such as reducing their dosage of testosterone, staying well hydrated
and in some cases many doctors will even recommend therapeutic phlebotomy. Elevated hematocrit has been identified as an
independent risk factor for stroke, particularly when combined with high blood
pressure. This is the mechanism that explains why some men on TRT can experience
increased BP, as seen in Olesen et al.'s study. However, the findings from
Hackett et al. indicate that hematocrit was not significantly associated with
BP changes in their cohort, suggesting that the relationship may vary based on
individual physiological responses. Factors like genetics, age and overall
health and fitness levels as well as diet and other lifestyle factors could all
potentially influence BP responses to men on TRT and need to be studied further.
Mechanisms Behind Testosterone's BP Effects
Its hard for most people to process why you can have
multiple studies with differing results. The mixed findings regarding TRT and
BP can potentially be attributed to several different physiological mechanisms,
such as:
- Endothelial
Function Improvement: Testosterone has been shown to enhance
endothelial function by reducing oxidative stress and increasing nitric
oxide production, which promotes vasodilation and lowers BP. The endothelium
is the thin layer of cells that line the inside of blood vessels and are
key in regulating vascular health. They help to maintain blood flow,
vascular tone, and overall cardiovascular function.
- Reduction
in Insulin Resistance: Some studies indicate that TRT decreases
insulin resistance, a factor that is often linked to hypertension. Insulin
resistance is a condition where the body's cells become less
responsive to insulin, the hormone that helps to regulate blood sugar
(glucose) levels.
- Aldosterone
Suppression: Testosterone may lower aldosterone levels, by reducing
sodium retention in the body and thus lowering blood pressure. Aldosterone
is a hormone made in the adrenal glands and helps with regulating blood
pressure, sodium (salt), and potassium levels in the body. It is part
of the renin-angiotensin-aldosterone system (RAAS) and works by increasing
sodium and water retention (raising blood pressure), Promoting
potassium excretion through urine and Autonomic Nervous System
Regulation: TRT has been associated with improved autonomic function,
which could contribute to better BP control.
The Impact of TRT on Enhancing the Effects of
Antihypertensive Therapy
TRT’s interaction with antihypertensive medications is
another important consideration for men with BP concerns who may also be on
hormone therapy. The long-term study by Hackett et al. found that for men who
are receiving both TRT and antihypertensive medications, BP reductions were
more pronounced than for those in the placebo group. Additionally, they
reported that 16.4% of men on antihypertensive therapy at baseline discontinued
their medication by the study's end, which suggested an additive or synergistic
effect of TRT on BP regulation based on their conclusions.
Blood Pressure Monitoring and Safety Considerations
Its hard for patients to determine the potential effect that
TRT may have on their BP prior to starting treatment. So, given that the
potential for TRT to both raise and lower BP depending on individual factors,
monitoring by a licensed and experienced healthcare provider is essential. A
solitary BP reading is often unreliable due to natural fluctuations throughout
the day. To get a true idea of one’s blood pressure, there should be multiple
reading throughout the day over a course of several days. For example, the British Hypertension Society
recommends a BP target of <140/90 mmHg, with ambulatory blood pressure
monitoring (ABPM) being the “gold standard “for diagnosing hypertension. TRT
patients should undergo regular BP assessments, including hematocrit monitoring
via blood tests, to mitigate risks associated with elevated blood viscosity.
How To Determine if TRT Will Impact Your Blood Pressure
Unfortunately, as we have seen, the effects of testosterone
on blood pressure in hypogonadal men is both complex and is often influenced by
multiple different factors, which will include things like baseline BP,
hematocrit levels, BMI, and whether a patient is concurrently on
antihypertensive therapy. Men how have taken tests for low T and
have been diagnosed with hypogonadism need to assess their BP as part of determine
the benefits of TRT. While some studies
demonstrate a clear BP-lowering effect of TRT, particularly in men with higher
baseline BP, other studies highlight the potential risk of BP elevation when
taking testosterone, particularly for those patients who already have increased
hematocrit levels. That’s why we recommend individualized monitoring and
patient-specific management strategies for patients on TRT. These are both crucial
steps for optimizing the benefits of TRT while minimizing cardiovascular risks
for patients. By understanding your risk factors an experienced healthcare
provider may also be able to use that information to determine the best protocol
to help ensure you get the most out of your hormone therapy while minimizing
risks.
Learn more
about us at NovaGenix here and see how TRT can impact your life.
