What is the relationship between testosterone supplements and hypertension (HTN)?

From the Guidelines

Testosterone supplements may increase the risk of hypertension (HTN) in some individuals.

Relationship between Testosterone Supplements and Hypertension

• The evidence suggests that testosterone therapy may be associated with an increased risk of cardiovascular events, including hypertension, although the relationship is not fully understood and more research is needed 1.
• A study published in the Annals of Internal Medicine found that the FDA has warned about the potential risks of testosterone therapy, including increased blood pressure, and has required manufacturers to conduct a controlled clinical trial to evaluate the effects of testosterone therapy on cardiovascular outcomes 1.
• Another study published in the Mayo Clinic Proceedings found that some studies have reported an increased risk of cardiovascular adverse outcomes, including hypertension, in men treated with testosterone replacement therapy, while others have found no increased risk 1.
• However, a study published in the New England Journal of Medicine found that the existing evidence suggests a neutral or possible beneficial effect of testosterone replacement therapy on cardiovascular disease, including hypertension 1.
• The American Urological Association (AUA) guideline on the evaluation and management of testosterone deficiency states that it cannot be stated definitively whether testosterone therapy increases or decreases the risk of cardiovascular events, including hypertension, and recommends that clinicians counsel patients about the potential risks and benefits of testosterone therapy 1.

Key Points

• Testosterone therapy may be associated with an increased risk of hypertension, but the relationship is not fully understood.
• More research is needed to determine the effects of testosterone therapy on cardiovascular outcomes, including hypertension.
• Clinicians should counsel patients about the potential risks and benefits of testosterone therapy, including the possible increased risk of hypertension.

From the FDA Drug Label

Cardiovascular Disorders: Myocardial infarction, stroke Vascular Disorders: Venous thromboembolism Hypertension was observed in pregnant female rats and their offspring exposed to doses approximately twice those used for testosterone replacement therapy.

The relationship between testosterone supplements and hypertension (HTN) is that hypertension was observed in animal studies, specifically in pregnant female rats and their offspring, at doses approximately twice those used for testosterone replacement therapy 2. However, this information is based on animal data and may not directly apply to humans. Additionally, the label mentions cardiovascular disorders, including myocardial infarction and stroke, as well as vascular disorders, such as venous thromboembolism, but does not explicitly state a direct relationship between testosterone supplements and hypertension in humans.

From the Research

Relationship Between Testosterone Supplements and Hypertension

The relationship between testosterone supplements and hypertension (HTN) is complex and has been studied in various research papers.

• Testosterone supplements may have differential effects on men depending on age, cardiovascular and metabolic status, and dose and whether given long-term or short-term 3.
• Lower total testosterone could be a promising risk marker for prevalent hypertension, and both low and high levels of testosterone are associated with greater cardiovascular risk 4.
• There is an inverse association between endogenous testosterone and blood pressure, and low plasma testosterone is associated with increased risk of major cardiovascular events in middle-aged hypertensive men 5.

Effects of Testosterone Replacement Therapy on Blood Pressure

Testosterone replacement therapy (TRT) has been shown to have varying effects on blood pressure in hypogonadal men.

• TRT with testosterone undecanoate (TU) was associated with significant reductions in systolic, diastolic blood pressure, and pulse pressure, regardless of antihypertensive therapy 6.
• The effects of TRT on blood pressure may be influenced by factors such as baseline blood pressure, age, and changes in waist circumference and hematocrit 6.
• The relationship between testosterone and cardiovascular disease is not fully understood, and more research is needed to determine the effects of TRT on cardiovascular risk 7.

Key Findings

• Testosterone supplements may increase mean arterial pressure (MAP) in young male spontaneously hypertensive rats, but decrease MAP in old male spontaneously hypertensive rats 3.
• Total testosterone, free testosterone, and sex hormone-binding globulin are inversely associated with the prevalence of hypertension 4.
• Testosterone is independently and inversely associated with central pulse pressure, wave reflections, and left ventricular mass in hypertensive men 5.
• TRT with TU may lower blood pressure in hypogonadal men, with greater reductions in men with higher baseline blood pressure 6.