Can Testosterone Therapy Decrease Blood Pressure? Uncovering the Science Behind Hormones and Heart Health

Introduction

Testosterone therapy has become one of the most discussed treatments in modern medicine. Over the last two decades, the use of testosterone prescriptions has grown as more men are diagnosed with low testosterone levels, a condition often called hypogonadism. This rise in treatment has also raised important questions about safety, especially how testosterone may affect the heart and blood vessels. One of the most debated questions is whether testosterone therapy can lower blood pressure, a key factor in heart health. Understanding this connection is important because high blood pressure, also known as hypertension, is one of the leading causes of heart disease and stroke worldwide.

Testosterone is a natural hormone made mostly in the testes in men and in smaller amounts in the ovaries and adrenal glands in women. It plays a major role in many body functions. These include building muscle, producing red blood cells, supporting bone strength, and regulating sex drive. As men age, testosterone levels naturally decline. This drop can also happen earlier in life due to certain medical conditions, medications, or lifestyle factors. Low testosterone is linked to fatigue, reduced muscle mass, depression, and weight gain. For many men, testosterone therapy is used to bring hormone levels back into the normal range and to improve these symptoms.

While testosterone therapy can improve quality of life for men with low levels, it also raises important health questions. The heart and blood vessels are especially sensitive to hormonal changes. Some studies have suggested that testosterone therapy may improve blood pressure by relaxing blood vessels, reducing fat around the abdomen, and improving insulin sensitivity. Other research, however, has shown neutral effects or even small increases in blood pressure in certain groups of men. This mixed evidence has led to confusion among patients and doctors. As a result, blood pressure is now one of the most closely watched outcomes in testosterone therapy studies.

The importance of this question becomes even clearer when considering the impact of hypertension worldwide. According to the World Health Organization, more than one billion people live with high blood pressure. It is often called the “silent killer” because it can cause serious damage to the body without obvious symptoms. High blood pressure puts strain on the heart, arteries, kidneys, and brain. Over time, this strain increases the risk of heart attack, stroke, kidney failure, and other serious diseases. Even a small reduction in blood pressure can lead to a meaningful decrease in the risk of these health problems. If testosterone therapy can lower blood pressure in certain groups, it could have important benefits for long-term health. On the other hand, if it raises blood pressure, it may put patients at greater risk. For this reason, doctors and researchers are working hard to better understand the link between testosterone therapy and blood pressure.

Another factor that adds complexity is the type of testosterone therapy used. Testosterone can be delivered through several methods, including injections, gels, patches, and small pellets placed under the skin. Each method affects hormone levels in slightly different ways. For example, injectable forms may lead to higher peaks and lower troughs in testosterone levels, while gels provide a more steady release. These differences may influence how therapy affects blood pressure. In addition, each patient’s age, health history, and other medical conditions can change the way therapy works. This makes it difficult to apply the same findings to all men.

Public interest in testosterone therapy has also been shaped by advertising and popular culture. Direct-to-consumer marketing, especially in the United States, has promoted testosterone as a solution for fatigue, sexual problems, and aging. Brand names such as AndroGel® have become widely recognized. While these treatments are approved for specific medical conditions, they have also raised concerns about overuse or use without proper medical supervision. When therapy is started without clear medical need, the balance between benefits and risks becomes less predictable. Blood pressure is one of the most important risks that must be watched closely in such cases.

In medical research, testosterone therapy is now studied not only for its effect on symptoms of low testosterone but also for its broader impact on metabolic health. Many men with low testosterone also have obesity, type 2 diabetes, or metabolic syndrome. These conditions are closely tied to high blood pressure. Early findings suggest that testosterone therapy may improve body composition by reducing fat and increasing lean muscle. These changes could help lower blood pressure indirectly. Still, large and long-term clinical trials are needed to confirm these effects and to separate short-term improvements from long-term outcomes.

The connection between testosterone therapy and blood pressure is therefore both complex and important. It involves understanding the role of hormones in the cardiovascular system, the risks of hypertension, and the possible benefits of therapy in men with low testosterone. The question is not only about whether therapy lowers or raises blood pressure but also about which men are most likely to benefit or face risks. Because of this, doctors recommend careful testing and monitoring when testosterone therapy is used. Patients are usually advised to check blood pressure regularly and to follow up with blood tests and medical exams during treatment.

This article will examine the current science in detail. It will answer the most common questions asked about testosterone therapy and blood pressure, explore the biological mechanisms involved, and review what medical guidelines say about safety. By uncovering the science behind hormones and heart health, it will provide a clear and balanced look at one of the most important questions in modern men’s health: Can testosterone therapy decrease blood pressure?

What Is Testosterone Therapy?

Testosterone therapy, also called testosterone replacement therapy (TRT), is a medical treatment designed to raise low testosterone levels back to a normal and healthy range. Testosterone is the main male sex hormone. It plays an important role in many body functions, such as maintaining muscle mass, bone strength, red blood cell production, sex drive, and mood balance. When the body does not make enough testosterone, symptoms such as fatigue, decreased muscle strength, loss of sexual desire, irritability, or even depression may appear. In some cases, long-term low testosterone can also increase the risk of conditions like obesity, type 2 diabetes, and heart disease.

Why Testosterone Therapy Is Used

The most common reason testosterone therapy is prescribed is hypogonadism, a medical condition where the testes or pituitary gland do not make enough testosterone. Hypogonadism may be caused by genetic problems, injuries, certain infections, or cancer treatments that damage the testicles. It can also occur when the brain does not send enough signals to stimulate testosterone production.

Another reason testosterone therapy is prescribed is for age-related low testosterone. As men get older, their natural testosterone levels slowly decrease, usually starting after age 30. For some men, this drop is small and causes no major symptoms. For others, the decline is more noticeable and may cause tiredness, weight gain, reduced strength, or loss of sexual function. Testosterone therapy may be offered when these symptoms are significant and blood tests confirm low hormone levels.

It is important to separate medical testosterone therapy from performance enhancement use. Medical therapy aims to restore normal levels in men who are deficient. In contrast, some athletes or bodybuilders misuse testosterone or anabolic steroids to build muscle or improve sports performance, often taking doses much higher than medical therapy. Misuse can cause serious health risks such as heart damage, liver problems, infertility, and psychiatric changes.

Forms of Testosterone Therapy

Doctors can prescribe testosterone in several different forms, and each works in a different way:

1. Injections
   • Testosterone injections are one of the most common forms. They are usually given into a muscle every 1 to 4 weeks, depending on the type. Some newer injections last longer, up to 10–12 weeks.

   • Injections may cause a rise in testosterone soon after the shot, followed by a gradual drop before the next dose. Some men notice mood or energy swings during this cycle.

2. Gels and Creams
   • Testosterone gels are applied directly to the skin once daily, often on the shoulders, upper arms, or abdomen. The hormone is absorbed through the skin and enters the bloodstream.

   • Popular prescription gels include brands such as AndroGel® and Testim®. These products provide more stable levels than injections, but users must be careful to avoid skin contact with others after applying the gel, since testosterone can transfer by touch.

3. Patches
   • Testosterone patches are worn on the skin, usually changed once a day. They deliver a steady dose of hormone into the body.

   • Some men may develop skin irritation at the patch site, which limits use for certain patients.

4. Pellets
   • Small solid pellets containing testosterone can be inserted under the skin of the hip or buttock during a minor in-office procedure.

   • The pellets slowly release testosterone over 3 to 6 months. This method avoids the need for daily or weekly dosing, but requires a minor surgical procedure for placement and removal.

5. Oral and Buccal Tablets
   • Some forms of testosterone can be taken by mouth, though traditional oral testosterone is rarely used because it can harm the liver.

   • Newer buccal tablets stick to the gum or inner cheek and release testosterone gradually.

6. Nasal Gel
   • A nasal gel form of testosterone has also been developed. It is applied inside the nostrils two to three times a day. While convenient for some men, the frequent dosing schedule can be less appealing.

Each method has benefits and drawbacks. Doctors consider the patient’s age, medical history, lifestyle, and personal preference when recommending a specific form.

Monitoring During Therapy

Testosterone therapy is not a “set and forget” treatment. Regular monitoring is necessary to ensure safety and effectiveness. Blood tests are performed before therapy begins and at regular intervals afterward to check testosterone levels, red blood cell counts, liver function, and prostate health. Blood pressure and cholesterol are also often monitored.

Testosterone therapy is a medical treatment used to restore hormone levels in men who have low testosterone, most often due to hypogonadism or age-related decline. It is available in several forms, including injections, gels, patches, pellets, and tablets. Each option has unique advantages and disadvantages, and treatment requires careful medical supervision. When used correctly under medical guidance, testosterone therapy can improve quality of life and health outcomes for men with confirmed deficiency.

How Does Testosterone Affect the Cardiovascular System?

Testosterone is often called the “male hormone,” but it plays many roles beyond sexual function. One of the most important areas influenced by testosterone is the cardiovascular system, which includes the heart and blood vessels. Understanding how testosterone interacts with the cardiovascular system helps explain why doctors are studying its effects on blood pressure and heart health.

Testosterone and Blood Vessels

Blood vessels are lined with a thin layer of cells called the endothelium. These cells release substances that control whether blood vessels relax or tighten. Testosterone has been shown to affect this layer in several ways:

• Endothelial function: Testosterone can stimulate the release of nitric oxide, a chemical that signals blood vessels to widen. Wider blood vessels allow blood to flow more easily, which lowers resistance and may reduce blood pressure.

• Smooth muscle effects: Blood vessels are surrounded by smooth muscle. Testosterone may help these muscles relax, which also supports healthy blood flow.

• Arterial stiffness: Studies suggest that men with low testosterone often have stiffer arteries. Stiff arteries make it harder for the heart to pump blood and increase the risk of high blood pressure. Testosterone therapy has been linked in some cases to more flexible arteries.

Nitric Oxide Pathway

Nitric oxide is a powerful natural vasodilator, meaning it opens up blood vessels. Testosterone can boost the activity of an enzyme called nitric oxide synthase, which helps the body produce more nitric oxide. When nitric oxide levels increase, blood vessels relax, circulation improves, and the heart does not need to work as hard to push blood through the body.

This pathway is also important in conditions like erectile dysfunction, where poor blood vessel relaxation limits blood flow. Medications such as Viagra® work through similar nitric oxide mechanisms, although testosterone acts more broadly in the cardiovascular system.

Effects on Circulation and Blood Flow

Healthy blood circulation depends on the flexibility of arteries and the ability of vessels to adapt to changes in blood demand. Testosterone may help maintain good circulation by:

• Improving blood vessel responsiveness.

• Supporting the balance of chemicals that control vessel widening and narrowing.

• Preventing excessive clot formation by influencing platelet activity.

Good circulation reduces the strain on the heart and supports the delivery of oxygen and nutrients to organs and tissues.

Influence on the Heart Muscle

Research suggests that testosterone affects not only blood vessels but also the heart muscle itself. Testosterone may improve the contractility, or strength of pumping, of heart cells. In men with low testosterone, reduced hormone levels are linked with weaker heart function and higher risks of heart failure. However, too much testosterone or misuse of anabolic steroids can put extra stress on the heart, showing the importance of balanced levels.

Metabolic Connections to the Heart

Testosterone also interacts with metabolism, which indirectly influences cardiovascular health. Low testosterone is associated with:

• Increased body fat, especially around the abdomen.

• Lower muscle mass.

• Higher insulin resistance, which can lead to type 2 diabetes.

All of these changes contribute to higher risks of high blood pressure and heart disease. When testosterone therapy improves body composition—by reducing fat and increasing muscle—there can be secondary benefits for heart and blood vessel health.

Protective vs. Risk Effects

It is important to note that testosterone’s effects on the cardiovascular system are complex. While many studies show potential protective effects, others raise concerns:

• Potential protective actions: Improved vessel relaxation, reduced arterial stiffness, better circulation, and enhanced heart function.

• Possible risks: Testosterone therapy may increase red blood cell production, leading to thicker blood and higher clot risk. It may also cause fluid retention, which can raise blood pressure in some individuals.

These mixed effects mean that testosterone’s influence on cardiovascular health can differ between people, depending on their baseline health, hormone levels, and other conditions.

Testosterone has wide-reaching effects on the cardiovascular system. It influences how blood vessels relax, how arteries stay flexible, and how the heart muscle contracts. By boosting nitric oxide, testosterone helps blood flow more freely, which may reduce strain on the heart. At the same time, testosterone affects body fat, muscle, and metabolism, all of which tie into blood pressure and heart risk.

However, the picture is not simple. Testosterone therapy may bring benefits for some men with low levels, but it can also increase certain risks if not carefully monitored. This balance explains why doctors continue to study testosterone closely in connection to blood pressure and overall cardiovascular health.

Can Testosterone Therapy Lower Blood Pressure?

Blood pressure is one of the most important measures of heart and blood vessel health. When blood pressure is high, the heart has to work harder to pump blood, and this increases the risk of heart attack, stroke, and kidney problems. Because of this, researchers have studied whether testosterone therapy can lower blood pressure in men with low testosterone. The results are interesting but also somewhat mixed, and understanding them requires looking at both the science and the evidence from clinical studies.

What the Research Shows

Several clinical trials and observational studies have looked at how testosterone therapy affects blood pressure. Many studies suggest that testosterone replacement therapy (TRT) can lead to small reductions in both systolic blood pressure (the top number) and diastolic blood pressure (the bottom number). In some men, these reductions are enough to move blood pressure closer to the healthy range.

For example, research published in journals such as The Aging Male and Endocrine Connections has found that men with low testosterone who received treatment showed improvements not only in their hormone levels but also in their blood pressure readings. In some cases, reductions of around 5–10 mmHg in systolic pressure were seen, which is clinically meaningful. Even a drop of 5 mmHg in systolic pressure can reduce the risk of stroke and heart attack over time.

However, not all studies agree. Some trials have found little to no change in blood pressure when men received testosterone therapy, especially if they already had normal blood pressure at the start. This shows that the benefit may be strongest in men who have both low testosterone and high blood pressure or other risk factors like obesity and metabolic syndrome.

Different Forms of Therapy

The way testosterone is given seems to make a difference. Injectable forms of testosterone, such as testosterone cypionate or testosterone enanthate, may cause changes in blood pressure that are less predictable. These injections create high peaks and low valleys of hormone levels in the bloodstream. Sometimes, this can lead to fluid retention, which may raise blood pressure in certain men.

On the other hand, transdermal forms such as testosterone gels (for example, AndroGel® or Testim®) or patches often provide more stable hormone levels. Studies suggest that these steadier forms of therapy may lead to more consistent improvements in blood pressure and overall heart function. Long-acting testosterone undecanoate injections, used in some countries, have also been associated with gradual and sustained improvements in blood pressure.

Possible Explanations for Blood Pressure Reduction

There are several ways testosterone therapy may help lower blood pressure:

1. Vasodilation (widening of blood vessels): Testosterone can stimulate the production of nitric oxide in blood vessels. Nitric oxide helps blood vessels relax and widen, which lowers resistance and reduces pressure.

2. Improved body composition: Testosterone therapy often increases muscle mass and reduces fat mass, especially visceral fat around the abdomen. Because excess fat is strongly linked with high blood pressure, reducing fat can improve cardiovascular function.

3. Better insulin sensitivity: Low testosterone is often connected with insulin resistance, which plays a role in high blood pressure and metabolic syndrome. Improving insulin sensitivity may help lower blood pressure indirectly.

4. Reduced inflammation: Some studies show that testosterone replacement lowers markers of chronic inflammation, which can harm blood vessels and contribute to hypertension.

When Testosterone Therapy May Not Lower Blood Pressure

It is important to note that not all men experience lower blood pressure with testosterone therapy. In some men, especially those with certain medical conditions, therapy may lead to increased blood pressure. This is often due to fluid retention, increased red blood cell counts (erythrocytosis), or the use of high doses. Men with untreated sleep apnea, severe kidney disease, or heart failure may be more likely to experience blood pressure increases rather than decreases.

Because of this, guidelines recommend careful monitoring of blood pressure during therapy. Blood pressure should be checked before starting treatment and then at regular intervals, especially in the first year of therapy.

How Long It Takes to See Results

Most studies show that improvements in blood pressure, when they do occur, are gradual. Changes may be seen after three to six months of therapy, and benefits often continue as treatment is maintained. Long-term studies, lasting several years, suggest that men who stay on testosterone therapy may experience lasting reductions in blood pressure as part of broader improvements in heart and metabolic health.

Testosterone therapy can lower blood pressure in some men, especially those with low testosterone and related health problems such as obesity or metabolic syndrome. The amount of improvement varies between individuals and depends on the form of therapy, the presence of other medical conditions, and how the body responds. While some studies show clear benefits, others show little change, and in rare cases blood pressure can even rise. This is why medical supervision, regular monitoring, and individualized treatment plans are essential.

Does Low Testosterone Increase the Risk of High Blood Pressure?

High blood pressure, also called hypertension, is one of the biggest risk factors for heart disease and stroke. Researchers have found that men with low testosterone often have a higher chance of developing high blood pressure. This connection does not mean that low testosterone directly causes high blood pressure in every man, but the two conditions are linked in several important ways.

Low Testosterone and Hypertension: What Studies Show

Several studies have shown that men with low testosterone levels are more likely to also have high blood pressure. In large population studies, men with testosterone levels below the normal range often had a higher rate of hypertension compared to men with healthy levels. This pattern has been seen in different countries and age groups, suggesting a strong relationship.

For example, researchers have noted that men with low testosterone often have more risk factors for heart disease, including obesity, insulin resistance, and poor cholesterol profiles. Since these conditions are also closely linked to high blood pressure, it is possible that low testosterone makes the body more vulnerable to developing hypertension over time.

The Overlap With Metabolic Syndrome

One of the strongest connections between low testosterone and high blood pressure is metabolic syndrome. Metabolic syndrome is a group of conditions that include:

• Extra fat around the waist

• High blood sugar or insulin resistance

• High triglycerides

• Low HDL (“good”) cholesterol

• High blood pressure

Men with low testosterone are more likely to develop metabolic syndrome. In fact, low testosterone is now considered both a marker and a contributing factor for this condition. When metabolic syndrome develops, blood vessels become stiffer and less able to relax. This raises blood pressure and increases the risk of heart disease.

In addition, men with metabolic syndrome often carry more visceral fat, which is fat stored deep inside the belly around organs. This type of fat is very active in producing hormones and chemicals that can cause inflammation. Inflammation damages blood vessels and makes them less flexible, which raises blood pressure even more.

Obesity and Weight Gain

Low testosterone is closely tied to obesity, especially central obesity (fat stored in the abdomen). Testosterone normally helps regulate fat distribution and supports lean muscle mass. When testosterone levels drop, men often gain more body fat and lose muscle. Extra fat tissue, especially belly fat, puts more strain on the cardiovascular system.

Fat tissue also produces more of a hormone called leptin. High leptin levels can overstimulate the sympathetic nervous system, which increases heart rate and blood vessel tension. This effect can directly contribute to higher blood pressure.

Insulin Resistance and Blood Sugar Problems

Another reason low testosterone and high blood pressure are linked is insulin resistance. Insulin resistance means the body does not use insulin effectively, leading to higher blood sugar levels. Men with low testosterone are at higher risk of developing type 2 diabetes, which itself is a major risk factor for hypertension.

When blood sugar levels remain high, blood vessels become damaged. The inner lining of the vessels, called the endothelium, becomes less able to produce nitric oxide. Nitric oxide is a chemical that relaxes blood vessels. Without enough nitric oxide, vessels stay tighter, which raises blood pressure.

Vascular Dysfunction

Testosterone has direct effects on blood vessels. Healthy testosterone levels help the arteries relax and stay flexible. When testosterone is low, blood vessels can become stiffer and less responsive. This vascular dysfunction makes it harder for the body to adjust blood flow and pressure during stress or activity. Over time, this stiffness increases resting blood pressure.

Inflammation and Hormonal Imbalance

Low testosterone is also associated with higher levels of inflammatory markers in the blood. Inflammation can damage the arteries and promote plaque buildup. In addition, low testosterone may allow other hormones, such as cortisol (the “stress hormone”), to become more active. High cortisol levels are linked with higher blood pressure and worse cardiovascular outcomes.

Men with low testosterone are more likely to develop high blood pressure. The reasons include weight gain, insulin resistance, metabolic syndrome, inflammation, and direct effects on the blood vessels. While not every man with low testosterone will develop hypertension, the risk is clearly higher. Understanding this link helps explain why testosterone therapy is being studied not only for hormone replacement but also for its potential effects on cardiovascular health.

What Mechanisms Explain Testosterone’s Effect on Blood Pressure?

Testosterone does more than shape male characteristics such as muscle mass and body hair. It also acts inside blood vessels, the kidneys, fat tissue, and even the nervous system. These actions can influence blood pressure in both helpful and harmful ways. Understanding these pathways gives a clearer picture of why some men may see a drop in blood pressure with testosterone therapy, while others may not.

Blood Vessel Relaxation and Nitric Oxide

One of the most studied effects of testosterone is its ability to help blood vessels relax. This process is called vasodilation. Healthy arteries need to expand and contract so blood can move smoothly. Testosterone can trigger the release of nitric oxide, a natural chemical that tells the muscle layer in the vessel wall to relax.

• When nitric oxide levels rise, arteries widen.

• Wider arteries reduce resistance, which can lower blood pressure.

• This mechanism is similar to how some blood pressure medications work.

However, this effect may depend on the balance of testosterone in the body. Very low levels of testosterone may weaken nitric oxide activity, while extremely high levels, such as those seen with misuse of anabolic steroids, can impair vessel function instead of improving it.

Kidney Function and Sodium Balance

Blood pressure is strongly controlled by the kidneys, which manage how much salt and water stay in the body. Testosterone appears to influence this process.

• Some studies show testosterone may increase the kidneys’ ability to remove sodium. Less sodium in the bloodstream helps lower fluid volume, which reduces pressure inside blood vessels.

• On the other hand, testosterone can also stimulate systems that cause the body to hold on to salt and water, especially at high doses. This effect may explain why some men on therapy notice swelling in the ankles or mild fluid retention.

The impact on the kidneys seems to depend on both dose and individual differences in hormone sensitivity.

Effects on Fat Distribution and Obesity

Excess body fat, especially around the waist, is a well-known risk factor for high blood pressure. Low testosterone levels often lead to increased fat mass and reduced muscle. Testosterone therapy can shift this balance.

• It helps reduce visceral fat, which is the fat stored deep in the abdomen that strongly raises cardiovascular risk.

• Less abdominal fat improves insulin sensitivity, decreases inflammation, and reduces strain on blood vessels.

• With more lean muscle and less fat, the heart does not need to work as hard to pump blood, which may contribute to lower blood pressure.

This indirect pathway shows how hormones, weight control, and blood pressure are tightly connected.

Inflammation and Blood Vessel Health

Chronic low-grade inflammation damages blood vessels over time. It makes arteries stiffer and less able to expand. Testosterone has been shown in some studies to reduce levels of certain inflammatory markers in men with low hormone levels.

• Lower inflammation may restore healthier blood vessel flexibility.

• Improved vessel elasticity can lead to better regulation of blood pressure.

Still, the anti-inflammatory effect is not seen in every study. More research is needed to confirm how strong and long-lasting this pathway is.

Influence on the Nervous System

The autonomic nervous system plays a key role in blood pressure by controlling heart rate and vessel contraction. The sympathetic branch of this system is responsible for the “fight or flight” response, which raises blood pressure by tightening vessels and speeding up the heartbeat.

Evidence suggests testosterone may reduce excessive sympathetic activity:

• This calming effect can lower resting blood pressure.

• At the same time, too much testosterone may overstimulate the system, raising pressure instead.

This dual effect highlights the importance of maintaining testosterone within the normal range.

Red Blood Cell Production

Another indirect mechanism involves the production of red blood cells. Testosterone stimulates bone marrow to make more red cells. While this improves oxygen delivery to muscles, it also makes the blood thicker, a condition called erythrocytosis.

• Thicker blood flows less easily through vessels.

• This can increase vascular resistance and, in some men, raise blood pressure.

For this reason, regular monitoring of blood counts is recommended during testosterone therapy.

The overall effect depends on the individual’s baseline health, hormone levels, age, kidney function, and dose of therapy.

Testosterone interacts with the body in several ways that connect directly to blood pressure. It can open blood vessels, support kidney salt balance, decrease belly fat, and reduce inflammation. These actions may help lower blood pressure. At the same time, testosterone can also thicken the blood, cause water retention, or over-activate certain nerves, which may push pressure upward. Because of these mixed effects, the outcome of therapy is not the same for every person. Careful monitoring by healthcare providers remains important for safety and effectiveness.

Are There Risks of High Blood Pressure with Testosterone Therapy?

Testosterone therapy is widely used to treat men with low testosterone, but it is important to understand that not every effect is positive. While some studies show that testosterone therapy can lower blood pressure in certain men, other research has found that it may increase blood pressure in specific cases. These mixed results make it necessary to look carefully at the risks. Several factors, including the type of testosterone treatment, how the body responds, and changes in blood composition, all play a role in whether blood pressure may rise.

Evidence from Studies Showing Neutral or Hypertensive Effects

Large clinical studies have not always agreed on the blood pressure outcomes of testosterone therapy. Some trials found no major changes in blood pressure, while others recorded mild increases. For example, certain groups of men receiving therapy showed higher systolic pressure (the top number in a reading) after several months.

Researchers believe that these differences may be due to how patients were selected. Men with existing heart disease or kidney disease may be more sensitive to changes in blood pressure. In contrast, younger men or those without chronic health conditions often show neutral or slightly improved blood pressure. This suggests that the health background of each patient makes a big difference in risk.

Influence of Formulation Type

Not all testosterone treatments affect the body in the same way. Injections, gels, patches, and implants can lead to different hormone levels in the bloodstream.

• Injectable testosterone (such as testosterone cypionate or testosterone enanthate) often produces high peaks of testosterone shortly after the shot, followed by low levels before the next dose. These strong ups and downs can stress the cardiovascular system. Some studies suggest that injectable forms may be more likely to cause fluid retention and mild rises in blood pressure.

• Transdermal gels or patches deliver testosterone through the skin in smaller, steadier amounts. Because hormone levels remain more stable, they may have a lower risk of causing blood pressure spikes.

• Pellets implanted under the skin release testosterone slowly for several months. This method usually creates steady hormone levels, but in some cases, pellets can still raise blood counts and lead indirectly to higher blood pressure.

The choice of formulation can therefore influence how much blood pressure changes during treatment. Doctors often monitor patients more closely if injectable testosterone is used.

Fluid Retention and Its Role

One of the main ways testosterone therapy may increase blood pressure is through fluid retention. Testosterone can affect kidney function by making the body hold on to sodium and water. When extra fluid builds up in the blood vessels, blood pressure can rise.

Fluid retention is often mild, but in men who already have heart failure or kidney disease, it may become more serious. Swelling in the legs, weight gain, and shortness of breath are signs that fluid is building up. In these cases, testosterone therapy might worsen high blood pressure or strain the heart.

Erythrocytosis and Thickened Blood

Another important risk factor is erythrocytosis, which means the body makes too many red blood cells. Testosterone therapy stimulates bone marrow to produce red blood cells. While this can improve oxygen delivery, it also makes the blood thicker. Thick blood does not flow as easily through blood vessels, which can lead to increased blood pressure.

Men on injectable testosterone often show higher rates of erythrocytosis compared with those using gels or patches. If blood counts rise too much, doctors may recommend lowering the testosterone dose or performing therapeutic phlebotomy, a procedure that removes some blood to reduce thickness.

Individual Variability and Risk Groups

The risk of higher blood pressure with testosterone therapy is not the same for everyone. Men with certain health conditions face more challenges:

• Older men may be more sensitive to changes in blood volume and blood thickness.

• Men with kidney disease may not handle extra fluid well, leading to faster rises in blood pressure.

• Men with untreated sleep apnea are more likely to develop erythrocytosis, raising cardiovascular risk.

• Those already diagnosed with hypertension may see further increases that require adjustments in blood pressure medication.

Because of these differences, testosterone therapy is not considered a one-size-fits-all treatment. Regular medical follow-up is essential.

Importance of Monitoring

To reduce risks, professional guidelines recommend checking blood pressure and blood counts at the start of therapy and at regular intervals afterward. If blood pressure begins to rise, doctors may adjust the type of testosterone, lower the dose, or pause treatment. Patients are also advised to manage lifestyle factors such as diet, weight, exercise, and alcohol use, which all affect blood pressure.

Monitoring ensures that therapy provides the intended benefits—such as improved energy, muscle strength, and mood—without creating dangerous side effects for the heart and blood vessels.

Testosterone therapy can sometimes increase blood pressure, mainly through fluid retention and higher red blood cell counts. The risk depends on the form of therapy used, the patient’s age, and existing health conditions. Injectable testosterone seems to carry higher risks compared to gels or patches. Careful medical supervision, regular testing, and individualized treatment decisions help reduce these risks. For men with certain health problems, especially those related to the heart, kidneys, or blood pressure, testosterone therapy requires special caution.

How Does Testosterone Therapy Interact with Other Heart Health Factors?

Testosterone therapy does not only affect blood pressure. It also touches many other parts of heart health, such as cholesterol, body fat, and blood sugar control. The way testosterone works in the body is complex, and its impact depends on age, overall health, and the type of treatment used. Understanding these connections helps explain why testosterone therapy may be helpful for some men but risky for others.

Cholesterol and Blood Fats

Cholesterol and other blood fats (called lipids) are closely linked to heart disease and blood pressure. Some studies show that testosterone therapy can improve certain parts of the lipid profile:

• HDL cholesterol (the “good” cholesterol): Testosterone therapy sometimes lowers HDL levels. This is important because HDL helps clear cholesterol from arteries. Lower HDL may not be ideal for heart protection.

• LDL cholesterol (the “bad” cholesterol): In some studies, testosterone therapy has been linked to small decreases in LDL levels, which may reduce plaque buildup in blood vessels.

• Triglycerides: Testosterone treatment may lower triglycerides, which are another type of fat in the blood that can increase heart disease risk when high.

The overall picture is mixed. While lower triglycerides and LDL can help, the possible drop in HDL may cancel out some of the benefit. Doctors often recommend that cholesterol levels be checked regularly in men receiving testosterone therapy, especially if they already have heart disease or high cholesterol.

Weight, Fat, and Muscle

Testosterone plays a major role in how the body stores fat and builds muscle. Low testosterone often leads to higher body fat, especially around the waist. Extra fat in this area, also called visceral fat, is strongly linked to high blood pressure, diabetes, and heart disease.

Testosterone therapy can:

• Reduce fat mass, especially in the abdomen.

• Increase lean muscle mass.

• Improve body composition, which may make the heart work more efficiently.

Even modest changes in fat and muscle can improve how the body handles blood sugar and cholesterol. These changes may also lead to small improvements in blood pressure, since less fat and more muscle usually reduce strain on the heart.

Insulin Sensitivity and Diabetes

Insulin is the hormone that helps the body use sugar for energy. When the body does not respond well to insulin, blood sugar levels rise. This is called insulin resistance, and it is a key factor in type 2 diabetes and heart disease.

Low testosterone is often linked to insulin resistance. Men with low testosterone are more likely to develop diabetes. Research shows that testosterone therapy may:

• Improve insulin sensitivity, making it easier for the body to use sugar.

• Lower fasting blood sugar and hemoglobin A1c, which are measures of long-term blood sugar control.

• Reduce the risk of developing diabetes in some men.

Better blood sugar control helps protect the heart and blood vessels, and it may reduce high blood pressure caused by metabolic problems. For this reason, testosterone therapy may be especially helpful for men with both low testosterone and type 2 diabetes.

Arterial Plaque and Blood Vessels

Testosterone also affects the lining of blood vessels, known as the endothelium. Healthy endothelium helps blood vessels stay flexible and regulate blood flow. Inflammation or damage to this lining can lead to plaque buildup, called atherosclerosis.

Some studies suggest testosterone therapy may reduce inflammation and improve blood vessel function. In animal studies and small human trials, testosterone was shown to improve the release of nitric oxide, a natural chemical that relaxes blood vessels and lowers blood pressure. However, other studies raise concerns that testosterone might speed up plaque growth in certain groups of men, especially older men with existing heart disease.

This shows why monitoring is important. While testosterone therapy can improve vessel health in some, it may not be safe for all patients.

Overall Interaction with Heart Health

The interaction between testosterone therapy and heart health is not simple. On one hand, therapy may help by:

• Reducing belly fat.

• Improving insulin sensitivity.

• Lowering triglycerides and sometimes LDL cholesterol.

• Supporting blood vessel function.

On the other hand, possible risks include:

• Lower HDL cholesterol.

• Increased red blood cell production, which can thicken the blood and raise clot risk.

• Potential acceleration of arterial plaque in vulnerable men.

Because of these mixed effects, doctors usually recommend regular monitoring of blood pressure, cholesterol, blood sugar, and hematocrit (a measure of red blood cells) during therapy.

Testosterone therapy interacts with many parts of heart health, not just blood pressure. It can improve body composition, blood sugar control, and certain blood fats, which may all benefit the heart. At the same time, it carries possible risks that need careful supervision. The balance between benefit and risk depends on the individual’s health history, age, and treatment plan.

Who Might Benefit Most from Blood Pressure Improvements with Testosterone Therapy?

Testosterone therapy has become an important treatment for men who have low levels of this hormone. While the main goal of testosterone therapy is to restore normal hormone levels and improve symptoms like fatigue, low muscle mass, and reduced libido, research also shows possible effects on blood pressure. However, not every man will have the same response. Certain groups of people may experience more improvement in blood pressure than others. Understanding who may benefit the most helps doctors decide when therapy may offer both hormonal and cardiovascular advantages.

Men with Hypogonadism and High Blood Pressure

Hypogonadism is a medical condition in which the body does not produce enough testosterone. Men with this condition often experience weight gain, decreased muscle mass, low energy, and changes in mood. Many also develop high blood pressure, partly because low testosterone can affect blood vessel function and metabolism.

Research suggests that men with diagnosed hypogonadism who receive testosterone therapy often see improvements in vascular health. Testosterone can help relax blood vessels by increasing nitric oxide production, a chemical that widens arteries. This improved blood flow may lower blood pressure in men who had high readings before treatment. Clinical studies have shown that restoring testosterone to normal levels can lead to modest reductions in both systolic and diastolic blood pressure, especially when therapy is continued for several months or more.

Men with Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that includes high blood pressure, abdominal obesity, high blood sugar, and abnormal cholesterol levels. Men with metabolic syndrome have a much higher risk of heart disease and type 2 diabetes. Low testosterone is also very common in this group.

Testosterone therapy may improve several features of metabolic syndrome at the same time. By reducing fat mass and increasing lean muscle, therapy can help improve body composition. Better muscle mass increases insulin sensitivity, meaning the body can use glucose more effectively. These changes reduce strain on the heart and blood vessels. In clinical observations, men with metabolic syndrome who received testosterone therapy often had decreases in blood pressure alongside weight loss and improved blood sugar control. This makes them one of the groups most likely to benefit from both hormonal replacement and cardiovascular improvement.

Men with Obesity-Related Hypertension

Obesity is one of the strongest risk factors for high blood pressure. Extra fat, especially around the abdomen, increases strain on the heart, stiffens blood vessels, and raises inflammation in the body. At the same time, obesity is often linked with low testosterone levels, because fat tissue increases the conversion of testosterone into estrogen.

When obese men with low testosterone start therapy, several positive changes can occur. They may lose fat mass, especially visceral fat that surrounds internal organs. They may also gain muscle mass, which improves metabolism and energy use. These changes together lower vascular resistance, reduce stress on the kidneys, and help bring blood pressure down. Some studies even suggest that the degree of blood pressure reduction may be greater in obese men compared to men with normal body weight, likely because they have more risk factors that can be improved at once.

Age-Related Differences

Testosterone levels naturally decline with age, and older men are more likely to experience both low testosterone and high blood pressure. The question of whether older men benefit from testosterone therapy in terms of blood pressure is complex.

Some studies show that older men with very low testosterone can experience moderate blood pressure improvements after treatment. However, older men may also have more underlying health conditions, such as kidney disease, diabetes, or advanced vascular damage. These conditions can limit the extent of improvement or even increase certain risks, such as fluid retention or thickening of the blood (erythrocytosis). Because of this, older men may require more careful monitoring. They may benefit if therapy is prescribed for true hypogonadism and not simply for normal age-related decline. In this group, blood pressure improvement is possible but less predictable.

Key Considerations for Benefiting Groups

While men with hypogonadism, metabolic syndrome, and obesity-related hypertension are the most likely to see improvements, success depends on careful medical evaluation. Blood pressure reduction is usually modest rather than dramatic, and therapy is not a substitute for standard hypertension treatment. The benefits are best seen when testosterone therapy is combined with healthy lifestyle changes such as weight management, physical activity, and a balanced diet.

Doctors also consider which form of therapy is used. Injectable testosterone may have different effects on fluid balance compared to gels or patches. Because fluid retention can increase blood pressure in some men, monitoring is essential. Men who respond well often show improvements not only in blood pressure but also in energy, strength, mood, and overall quality of life.

Not every man will see the same cardiovascular benefit from testosterone therapy, but certain groups appear more likely to experience improvements in blood pressure. These include men with hypogonadism, men with metabolic syndrome, and obese men with hypertension. Older men may benefit too, though responses vary more widely due to other health conditions. In all cases, therapy should be supervised by a healthcare professional with regular monitoring of blood pressure, blood counts, and cardiovascular health. For these groups, testosterone therapy may provide not only hormonal balance but also a measurable benefit for heart and vascular health.

What Do Medical Guidelines Say About Testosterone Therapy and Blood Pressure?

Testosterone therapy is becoming more common, especially for men with low testosterone levels linked to aging or medical conditions. Because testosterone can affect the cardiovascular system, many people want to know what the official medical guidelines say about its safety, especially when it comes to blood pressure. Medical organizations around the world have studied this question and have issued recommendations to help doctors and patients use testosterone therapy more safely.

Guidance from the Endocrine Society

The Endocrine Society is one of the most trusted groups for hormone-related health. In its clinical practice guidelines, it states that testosterone therapy can be considered for men with confirmed low testosterone, also called hypogonadism. The society stresses that testosterone should only be given to men who have both symptoms of low testosterone and laboratory results showing low hormone levels.

When it comes to blood pressure, the Endocrine Society does not list high blood pressure alone as a reason to avoid therapy. However, it advises doctors to be careful in men with cardiovascular disease or those at high risk. Monitoring is strongly recommended. Doctors are encouraged to check blood pressure regularly before and during treatment. If blood pressure rises or other cardiovascular issues appear, therapy may need to be adjusted or stopped.

Recommendations from the American Urological Association (AUA)

The American Urological Association also provides clear instructions about testosterone therapy. According to its guidelines, therapy is not recommended for men who have uncontrolled heart failure, recent heart attack, or stroke. These conditions can make the body more sensitive to changes in blood volume and pressure.

The AUA highlights that testosterone therapy may improve metabolic health, such as reducing fat mass and improving insulin sensitivity. These changes could help lower blood pressure in some men. Still, because therapy may also increase red blood cell counts and lead to fluid retention, careful follow-up is required. The AUA advises that doctors measure hematocrit, blood pressure, and other cardiovascular markers at baseline, then again three to six months after starting therapy, and then once a year.

Insights from the European Society of Cardiology (ESC)

The European Society of Cardiology focuses heavily on heart and blood vessel health. While it does not publish guidelines specifically for testosterone replacement alone, it often addresses hormones in the context of cardiovascular risk. The ESC states that testosterone therapy should be approached with caution in men who have significant cardiovascular disease.

The ESC also notes that men with obesity, type 2 diabetes, or metabolic syndrome may sometimes benefit from testosterone therapy, since it may improve waist circumference, body fat distribution, and blood sugar control. These changes may indirectly lower blood pressure. However, the society warns that large, long-term studies are still lacking, so decisions should be individualized.

Monitoring Requirements Across Guidelines

All major guidelines agree that testosterone therapy requires close medical monitoring. Monitoring usually includes:

• Blood pressure checks: At baseline, during the first months of therapy, and regularly afterward.

• Hematocrit tests: To measure the concentration of red blood cells, since too many can thicken the blood and raise pressure.

• Lipid profile and glucose checks: To understand the effect on cholesterol, triglycerides, and blood sugar.

• Prostate health evaluation: Since testosterone can affect prostate growth.

Monitoring helps detect early warning signs. If blood pressure rises significantly, or if red blood cell counts become too high, therapy may need to be paused or adjusted.

Safety Precautions and Contraindications

Guidelines also identify certain groups of men who should not receive testosterone therapy. Contraindications include:

• Prostate or breast cancer

• Severe untreated sleep apnea

• Uncontrolled heart failure

• Very high hematocrit levels at baseline

These conditions could worsen with testosterone treatment. While high blood pressure alone is not a strict contraindication, men with severe or uncontrolled hypertension should stabilize their blood pressure before beginning therapy.

Medical guidelines show a balanced view of testosterone therapy and blood pressure. The therapy is not automatically ruled out for men with hypertension. In fact, some men may see improvements if testosterone corrects underlying hormonal imbalances that contribute to metabolic problems. Still, there are risks, especially fluid retention and increased blood thickness, which can raise blood pressure in some individuals.

The common thread in all guidelines is monitoring and caution. Testosterone therapy should only be used in men with proven low levels, prescribed under medical supervision, and followed with regular checks. For men with heart disease or high blood pressure, the decision should be individualized, weighing potential benefits against possible risks.

What Are the Limitations of Current Research?

The question of whether testosterone therapy lowers blood pressure is still not fully answered. While many studies show promising results, there are important gaps in the research. Understanding these limitations helps explain why doctors remain cautious and why guidelines recommend careful monitoring.

Short Duration of Most Studies

Many clinical trials on testosterone therapy last only a few months to two years. This short follow-up period is important because blood pressure and heart disease develop slowly over time. High blood pressure can take decades to damage the heart, kidneys, and blood vessels. A one-year study may not capture these long-term changes.

For example, some trials show that testosterone therapy improves blood pressure in the first year. However, it is unclear if the benefit continues after five or ten years of use. Without longer studies, researchers cannot be sure whether the initial improvements are temporary or lasting. This lack of long-term data is one of the biggest challenges in understanding the true cardiovascular effects of testosterone.

Variability in Therapy Formulations and Doses

Testosterone therapy can be given in many forms: injections, skin gels, patches, or implantable pellets. Each method delivers testosterone differently. Injections often produce high peaks and low valleys in hormone levels. Gels and patches may provide steadier levels but are sometimes absorbed poorly through the skin.

This variation makes it difficult to compare studies. One trial using injections may show a different effect on blood pressure than another trial using gels. The dose also matters. A high dose may raise red blood cell counts and cause fluid retention, which can increase blood pressure. A lower, carefully managed dose may avoid these effects. Because different studies use different products and dosing schedules, it is hard to combine results into one clear answer.

Underrepresentation of Older Men with Health Problems

Many trials focus on younger or middle-aged men with low testosterone but without serious medical problems. These participants may respond differently than older men with heart disease, diabetes, or kidney problems. Since hypertension and low testosterone often occur together in older adults, this group is very important to study.

Unfortunately, men over 65 with multiple health conditions are often excluded from clinical trials. This is done for safety reasons, but it leaves a gap in knowledge. The very people most likely to need testosterone therapy and have high blood pressure are not always represented in the research. As a result, doctors must be cautious when applying trial results to older patients.

Differences in How Outcomes Are Measured

Not all studies measure blood pressure in the same way. Some use office blood pressure readings, while others use 24-hour ambulatory monitoring. Office readings can be influenced by stress (sometimes called "white coat effect"), which may not reflect real daily blood pressure. Ambulatory monitoring is more accurate but less commonly used.

In addition, some studies focus only on systolic blood pressure (the top number), while others also include diastolic (the bottom number). This makes comparisons harder and can lead to conflicting conclusions.

Potential Bias in Industry-Sponsored Research

Some studies on testosterone therapy are funded by pharmaceutical companies that make testosterone products such as AndroGel® or Testim®. While industry funding does not mean results are false, it can create bias. Trials may be designed to highlight benefits while downplaying risks. Independent research without ties to manufacturers is important for building trust in the results.

At present, a large number of high-quality, independent studies are still lacking. More unbiased trials are needed to confirm whether the effects seen in smaller studies are reliable.

Need for Large, Long-Term Cardiovascular Outcome Studies

Most existing studies look at short-term changes in blood pressure, cholesterol, or blood sugar. Very few have tracked major cardiovascular outcomes such as heart attacks, strokes, or heart failure over many years. These outcomes matter most when deciding if a therapy truly protects the heart.

The TRAVERSE trial, one of the largest to date, is starting to provide more answers. But even with this progress, many questions remain about whether testosterone therapy lowers the risk of heart disease or makes it worse in some men. Without large outcome studies, the overall safety picture is incomplete.

The science on testosterone therapy and blood pressure is promising but not yet conclusive. Small and medium-sized studies suggest benefits in some men, especially those with metabolic problems. However, the lack of long-term, large-scale, and independent trials makes it difficult to be certain. Until these research gaps are filled, doctors and patients must rely on careful monitoring and individualized decisions.

Conclusion

The connection between testosterone therapy and blood pressure is complex, and research continues to uncover new insights. Testosterone is more than a hormone that affects sexual health and muscle growth. It also plays an important role in the cardiovascular system, body composition, and metabolic health. Because blood pressure is closely tied to these systems, scientists have looked carefully at how restoring testosterone levels might influence it.

Studies show that men with low testosterone often have higher rates of high blood pressure, obesity, insulin resistance, and metabolic syndrome. These conditions all increase strain on the heart and blood vessels. Some research suggests that when testosterone levels are very low, the blood vessels become stiffer, and the inner lining of arteries does not release enough nitric oxide. Nitric oxide is a chemical that helps blood vessels relax and widen. Without enough of it, pressure in the arteries can rise. This means that, for some men, low testosterone may contribute to high blood pressure and other heart risks.

Testosterone therapy can improve several of these factors. In some studies, men receiving testosterone replacement therapy showed modest reductions in blood pressure, especially when therapy was continued for a year or more. Improvements were also linked to reduced fat mass, increased lean muscle, and better insulin sensitivity. By helping the body use sugar more effectively and reducing belly fat, testosterone therapy may lower strain on the blood vessels. Some evidence also suggests that testosterone increases the ability of arteries to relax, which can contribute to small decreases in both systolic and diastolic blood pressure.

However, not every study shows the same results. Some trials report no major changes in blood pressure, while others raise concerns that certain forms of testosterone therapy may increase the risk of higher blood pressure in a subset of patients. Injections, for example, can sometimes cause spikes in hormone levels, which may lead to fluid retention or an increase in red blood cell count, a condition called erythrocytosis. Both fluid buildup and thicker blood can place added pressure on the heart and circulation. This is why regular monitoring is always recommended during therapy.

Guidelines from expert medical groups such as the Endocrine Society and the American Urological Association emphasize careful follow-up. Men on testosterone therapy should have their blood pressure, red blood cell levels, and cardiovascular health checked on a regular basis. This monitoring ensures that potential benefits, such as improved energy, better body composition, and possibly lower blood pressure, are not outweighed by risks. Safety is especially important for older men or for those who already have heart disease, kidney disease, or uncontrolled hypertension.

Another limitation is that many studies are short-term, lasting only months to a few years. Long-term research is still needed to know whether testosterone therapy consistently lowers blood pressure in the general population of men with low testosterone. In addition, most trials exclude men with very high cardiovascular risk, meaning results may not apply to those with advanced heart disease or multiple health conditions. Because of this, current knowledge should be seen as promising but incomplete.

The science makes it clear that testosterone therapy should not be used as a main treatment for high blood pressure. Proven treatments such as lifestyle changes, diet, exercise, and in some cases medications remain the standard approach for managing hypertension. Testosterone therapy is best viewed as a treatment for clinically low testosterone that may also bring additional health benefits, including possible modest improvements in blood pressure for some men.

In conclusion, testosterone therapy may support better heart health in men with true testosterone deficiency by improving vascular function, reducing fat, and enhancing metabolism. While some men may experience slight reductions in blood pressure, others may see little to no change, and a few may develop increases. The impact depends on factors such as age, overall health, type of therapy, and how closely treatment is monitored. As research grows, clearer answers will emerge. For now, the safest approach is cautious optimism, with close medical supervision and regular monitoring to ensure therapy supports health without adding new risks.

Research Citations

Hackett, G., Mann, A., Haider, A., Haider, K. S., Desnerck, P., König, C. S., Strange, R. C., & Ramachandran, S. (2024). Testosterone replacement therapy: Effects on blood pressure in hypogonadal men. World Journal of Men’s Health, 42(4), 749–761.

Traish, A. M., Haider, A., Doros, G., & Saad, F. (2013). Long-term testosterone therapy in hypogonadal men ameliorates components of the metabolic syndrome: An observational, long-term registry study. International Journal of Clinical Practice, 68(3), 314–329.

Saad, F., Haider, A., Doros, G., et al. (2020). Differential effects of 11 years of long-term injectable testosterone undecanoate therapy on anthropometric and metabolic parameters in hypogonadal men with normal weight, overweight, and obesity. International Journal of Obesity.

Traish, A. M., Haider, A., Doros, G., & Saad, F. (2017). Long-term testosterone therapy improves cardiometabolic function and reduces risk of cardiovascular disease in men with hypogonadism: A real-life observational registry study. Journal of Cardiovascular Pharmacology and Therapeutics, 22(1), 97–108.

Saad, F., Haider, A., Haider, K. S., Doros, G., & Traish, A. M. (2019). Accompanying hypertension and hemodynamic parameter improvements in long-term testosterone therapy in hypogonadal men. Journal of Endocrinological Studies, 3(Supplement 1), SUN-083.

Efros, M. D., et al. (2024). Ambulatory blood pressure parameters among men with hypogonadism treated with testosterone transdermal therapy: A 24-hour monitoring study. Endocrine Practice, 30(Supplement), 847.

Weber, M. A., Aslam, S., Efros, M. D., Chan, A., Khan, N., Li, X., Dubcenco, E., & Miller, M. G. (2024, October 9). Single-arm study of testosterone gel replacement therapy and ambulatory blood pressure outcomes in men with hypogonadism. Andrology. Advance online publication. https://doi.org/10.1111/andr.13779

Lincoff, A. M., et al. (2023). Cardiovascular safety of testosterone-replacement therapy: Effects of the oral testosterone undecanoate Kyzatrex on ambulatory blood pressure in hypogonadal men. New England Journal of Medicine.

Nguyen, C. P., et al. (2021). Testosterone therapy for the treatment of age-related hypogonadism: Ambulatory blood pressure changes. Postgraduate Medicine.

de Silva, N. L., et al. (2024). Cardiovascular disease and testosterone therapy in male hypogonadism. Annals of the New York Academy of Sciences.

Questions and Answers

Q1: Can testosterone therapy lower blood pressure in men?
Some studies suggest that testosterone therapy may modestly reduce blood pressure, particularly in men with low testosterone, but results vary depending on individual health conditions.

Q2: How does testosterone therapy influence blood pressure?
Testosterone may improve blood vessel relaxation (vasodilation) and reduce vascular resistance, which can help lower blood pressure in certain cases.

Q3: Does testosterone therapy always decrease blood pressure?
No, testosterone therapy does not always lower blood pressure. For some men, it may have little effect, and in rare cases, it could raise blood pressure.

Q4: Is the blood pressure–lowering effect of testosterone therapy significant?
The reduction, when present, is usually modest—often just a few points in systolic and diastolic pressure—rather than a dramatic drop.

Q5: Can testosterone therapy improve cardiovascular health overall?
Testosterone therapy may improve certain cardiovascular markers, like vascular function and cholesterol profiles, but the overall effects on heart health and blood pressure remain under investigation.

Q6: Does low testosterone contribute to high blood pressure?
Yes, low testosterone is linked with metabolic syndrome, obesity, and insulin resistance, all of which can contribute to elevated blood pressure.

Q7: Is testosterone therapy safe for men with high blood pressure?
Men with high blood pressure should only start testosterone therapy under medical supervision. Blood pressure should be monitored regularly during treatment.

Q8: Can lifestyle changes combined with testosterone therapy further reduce blood pressure?
Yes. Exercise, weight management, reduced salt intake, and healthy eating can enhance the potential blood pressure–lowering effects of testosterone therapy.

Q9: Do all studies agree that testosterone therapy lowers blood pressure?
No. Some studies show benefits, while others show no change. The effect may depend on age, baseline testosterone levels, and overall health.

Q10: Should testosterone therapy be prescribed specifically to lower blood pressure?
No. Testosterone therapy is prescribed to treat low testosterone symptoms, not as a primary treatment for high blood pressure, though it may have secondary benefits in some patients.