TRT and Blood Pressure: What You Need to Know

If you’re thinking about testosterone replacement therapy (TRT), chances are you’re hoping for stronger muscles and bones, a fitter body, or a rejuvenated sex drive. So it may come as a shock when your doctor wants to talk to you about how it might affect your blood pressure.

TRT’s effect on blood pressure isn’t straightforward. While it’s possible that taking testosterone may have some impact on blood pressure, the research is mixed and suggests that certain people may be at a higher risk than others. ¹

Plus, it’s important to weigh the risks against the benefits of taking testosterone. Low testosterone raises your risk of central obesity, metabolic syndrome, and type 2 diabetes, all of which increase the risk of cardiovascular disease.² Some observational studies suggest that men with low testosterone have a higher risk of dying from cardiovascular causes than those with healthier levels.³

Here’s what researchers and physicians say about the real connection between TRT and blood pressure.

About the Experts
Joshua Calvert, M.D., MPH, a board-certified urologist who practices in Tennessee.

Does TRT Raise Blood Pressure?

Some studies suggest that TRT can raise blood pressure, but other research has found no link. ^{4 5} One 2024 study in the World Journal of Men’s Health even suggests the opposite: Researchers found that TRT was associated with lower blood pressure in a group of more than 700 men with low testosterone. ⁶

Why TRT might impact blood pressure is uncertain. Testosterone boosts the production of red blood cells, so some experts suspect this could thicken blood and raise blood pressure. ⁷ Another theory says that water retention—a known possible side effect of TRT—may be the culprit. ⁸ Retaining fluid can increase blood volume, which puts extra pressure on blood vessel walls and raises blood pressure.

The relationship between testosterone and blood pressure

Testosterone isn’t just the primary male sex hormone—it plays a role in multiple body systems, including the cardiovascular system. As noted above, testosterone triggers red blood cell production. It also affects blood vessel dilation and blood flow.^{9 10} Though it’s less clear how, testosterone may also help support proper kidney function ¹¹, which helps regulate the body’s water/salt balance—another factor that impacts blood pressure.

Blood pressure is how much force your blood exerts on your blood vessel walls as your heart beats and relaxes. It’s measured by two numbers:

• Systolic (the first number): the pressure on your blood vessels when your heart pumps.
• Diastolic (the second number): the pressure when your heart relaxes between beats.

Here’s how the American Heart Association categorizes healthy and unhealthy ranges:

Does TRT cause high blood pressure?

While some research suggests TRT may slightly increase blood pressure, other studies find no effect. Plus, an increase in blood pressure isn’t the same as developing high blood pressure (also known as hypertension).

For example, if your blood pressure is 114/70 and the systolic (top number) rises by three points, you’d still be in the normal range.

That said, TRT can increase the risk of developing secondary polycythemia, a condition where the blood has an abnormally high concentration of red blood cells. ¹² This thickens the blood, making it flow more sluggishly, which raises blood pressure. ¹³

Many factors increase your risk of hypertension. Some, like genetics and age, are beyond your control. Others—like eating a diet high in salt, trans and saturated fats, excessive alcohol consumption, and inactivity—you can address.

Whether TRT affects your blood pressure depends on a mix of factors. One 2024 randomized controlled trial published in the journal Hypertension found that men with obesity or already high hematocrit levels (a measure of red blood cell concentration) were more likely to experience blood pressure increases while on TRT. ¹⁴

Can I Take TRT If I Already Have High Blood Pressure?

You may be able to take TRT if you have high blood pressure as long as your doctor monitors your blood pressure and other biomarkers carefully. “Your doctor should assess cardiovascular risks, ensure blood pressure is controlled, and follow up regularly for hematocrit, lipids, and cardiovascular status,” says urologist Joshua Calvert, M.D.

How to monitor blood pressure while on TRT

You can check your blood pressure while on TRT with an at-home blood pressure monitor. Cuff-style monitors are typically more accurate than wrist blood pressure monitors.

Some best practices for accurate readings:

• Take your blood pressure at the same time(s) every day.
• Sit upright in a chair with your feet on the floor (no leg crossing) and with the arm you’re using supported by the chair arm or a desk or table
• Wait five minutes in this position to relax before you measure.
• Take two readings one minute apart.
• Log your results. This lets you and your doctor spot any patterns.

How to Lower High Blood Pressure on TRT

Calvert recommends managing high blood pressure before starting TRT. In many cases, this can be done with simple lifestyle changes.

Exercise regularly

Regular aerobic exercise is one of the most effective ways to lower blood pressure. It can also strengthen your heart, lower your weight, and curb stress, all of which can help lower your blood pressure.

If you’re new to exercise, start slow and build up to 150 minutes per week of moderate-intensity activities like walking, swimming, biking, dancing, or jogging. If you prefer higher-intensity workouts, aim for 75 minutes per week of running or interval training.

Eat more whole foods

Diets rich in whole foods—such as the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet—have been shown to lower blood pressure. These eating plans emphasize whole grains, fresh fruits and vegetables, and lean proteins while limiting high-sodium foods that can raise blood pressure.

Manage stress

Stress hormones can make your heart beat faster and your blood vessels constrict, which, over time, may contribute to high blood pressure. Be proactive: Plan your day to reduce overwhelm, carve out time to unwind, and avoid unnecessary stressors when possible (like leaving early to dodge rush-hour traffic). Mindfulness practices—such as gratitude exercises and meditation—can also help keep stress in check.

Get enough sleep

If you’re regularly getting less than seven hours of sleep per night, it could be driving up your blood pressure. Sleep disorders like sleep apnea, restless leg syndrome, and insomnia—or simply burning the candle at both ends—can contribute to hypertension. Prioritize sleep by addressing any underlying medical conditions, creating a wind-down routine, and cutting off electronics at least an hour before bed.

Ask your doctor about supplements

Magnesium keeps blood vessel walls strong. A 2021 review of 49 clinical trials found that taking 600 mg or more of magnesium daily could lower blood pressure. However, too much magnesium can cause diarrhea, nausea, and cramping. It can also interact with prescription medications like antibiotics, PPIs, diuretics, and some medications for osteoporosis, so be sure to talk to your doctor before starting.