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Testosterone and High Blood Pressure

Low Testosterone and High Blood Pressure Seattle

There has been some debate about testosterone and high blood pressure. This article focuses on recent research, my clinical insights, and common sense.

High blood pressure is a major contributor to increased stroke and heart attach risk. This is simple physics. Viscous fluids behave differently under different pressures.

If you put thick fluid through tubing at high pressure, over time it can damage the tubing. Any plumber can understand this problem. That is why it is important to take a holistic approach when balancing hormones and individualize the treatment.

Alert! Learn more: Testosterone & Heart Disease, Heart Attacks, & Stroke Risk

The fact that testosterone levels decline with age and blood pressure tends to increase with age leads me to believe that testosterone therapy may help decrease blood pressure in some patients and this is what I’ve seen.

Getting In Touch With Your Feminine Side

Estrogen levels in men tend to increase with age due to a number of factors like increased body fat (the enzyme that converts testosterone to estrogen is in body fat). Men with diabetes or insulin resistance tend to convert more testosterone to estrogen than other men leading to a poor testosterone to estrogen ratio.

In an Italian study of 452 men, insulin resistance was highly correlated with increased estrogen levels in older men.1 This can lead to a downward spiral for some men because increases in estrogen production cause the body to decrease testosterone production due to a feedback loop.

The decrease in testosterone production due to increased estrogen levels may be the body’s way of protecting itself from excess estrogen. Yes, men produce a little estrogen and its good for us but when it increases too much it can cause problems.

In a meta study that pulled data from studies between 1969 and 2011, researchers found lower testosterone levels and higher estrogen levels increased the risk of heart disease and death from heart disease.2

A poor testosterone to estrogen ratio increased heart disease risk and death from heart disease in men. They also found that testosterone replacement therapy improved heart function.

Testosterone Therapy and High Blood Pressure

Testosterone THERAPY is very different from testosterone ABUSE. The heart is a muscle and it makes sense that muscles need ADEQUATE (not excessive) testosterone to function properly.

In testosterone ABUSE, men can have severe side-effects such as breast enlargement and increased heart risks. This is partly due to the fact that very high levels of testosterone cause VERY high levels of estrogen that are difficult to address.

Erectile Dysfunction and High Blood Pressure

Erectile dysfunction in some men may be due to excess estrogen causing a “leakiness” of the penis.3 The technical term is venous-leakage. Men are lucky in some ways because our erections can be an indicator of good health or health problems. Thus, looking for the cause of an erection problem is always a good thing.

It is no surprise that men with erectile dysfunction often have other signs and symptoms of heart and blood flow problems. In a major review of the data from several studies, researchers found that erectile dysfunction may be an early warning sign of future heart problems.13

The good news is that when we treat the cause (ie reduce estrogen levels or improve the testosterone:estrogen ratio) many patients notice an improvement in their overall quality of life and general health. Testosterone therapy in Seattle & Bellevue

Stroke Risk and Low Testosterone

Low testosterone also increases your risk of stroke or TIA (transient ischemic attack) if you’re over 70 years of age.8 Even if you are in the “normal” range, but on the lower end of normal, you are at increased risk for a stroke based on a 2009 study of 3443 men.

Testosterone can increase red blood cell synthesis. In men with low numbers of red blood cells this can be a good thing. In men with too many red blood cells there is a simple solution: donate blood every 3 months. This will help thin the blood and reduce stroke risk.

Women, before menopause, have a lower stroke risk than men. After menopause, women’s stroke risk equals that of men. This is likely due to the fact, at least in part, that women are no longer thinning their blood monthly after menses cease following menopause. Thus, donating blood can be a good thing for reasons beyond blood banks’ needs.

Sleep Apnea and Testosterone Therapy

Is testosterone therapy helpful to obese men with severe obstructive sleep apnea? Men with sleep apnea often have high blood pressure, weight gain, fatigue, erectile dysfunction, and high blood pressure.

A recent placebo-controlled study of 65 obese men found many benefits in just 18 weeks. These benefits included improved insulin sensitivity, reduced liver fat, decreased stiffness of blood vessels, improved oxygen uptake, and increased muscle mass.4

So is testosterone replacement therapy (TRT) safe in patients with obstructive sleep apnea (OSA)? This study concluded, YES:

“Cautionary statements about TRT in OSA appear frequently in the TRT literature and guidelines, despite lack of convincing evidence that TRT causes and/or aggravates OSA. Also, there is a lack of consistency in the findings connecting TRT to OSA. It is evident that the link between TRT and OSA is weak, based on methodological issues in many of the studies, and most studies involved small numbers of men. Further studies in this area are needed.”5

Sleep apnea, which means means difficulty breathing during sleep, can certainly increase the risk of heart problems and related issues. Sleep apnea may further decrease testosterone levels so addressing this can be important to help you find optimal health but treatments like the CPAP machine (helps with sleep apnea) only partially increase testosterone levels.6

I have had many patients come to my clinic suffering from low testosterone despite using the CPAP to improve sleep. Patients with sleep apnea may be at increased risk of heart attack.

Heart Attacks and Low Testosterone

A 2009 study in Japan showed that lower testosterone levels were related to increased heart attack risk in middle-aged men.7 Interestingly, atenolol, a high blood pressure medication, can lower testosterone levels which increases heart disease risk. Valsartan appears to be a better option as it has less chance of causing erectile dysfunction and is less likely to lower testosterone levels.

Vitamin T Helps With Weight Loss In Young And Old

Science Daily reviews recent research by Farid Saad, PhD that was presented at The Endocrine Society’s 90th Annual Meeting in San Francisco:

“All 95 men in the studies (ages 34 to 69 years) had the metabolic syndrome. To receive this diagnosis, patients must have three of the following five risk factors: increased waist circumference (abdominal fat), low HDL (“good”) cholesterol, high triglycerides (fats in the blood), high blood pressure, and high blood sugar.

The first study showed that testosterone treatment significantly reduced waist circumference, total cholesterol, LDL (“bad”) cholesterol, triglycerides, and body mass index (a measure of body fat). Treatment also increased “good” cholesterol. Improvements were progressive over 12 months, indicating that benefits may continue past a year, Saad said.

In the second study, the researchers divided the patient population into three groups by age: less than 57 years, 57 to 63 years, and more than 63 years. They found that the oldest men had similar improvements in metabolic risk factors to the youngest men.

Additionally, the investigators looked at the degree of testosterone deficiency before treatment. This beginning level of testosterone deficiency did not predict the beneficial outcome, they found. Men whose subnormal testosterone levels were not as low as the others had similar improvements in metabolic risk factors to men with the lowest levels, according to Saad.” Full Article

TAKE HOME MESSAGE: Testosterone therapy, when done correctly, reduces your risk of heart disease and improves heart function (the heart is a muscle).9,10,11

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References on next page

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{ 36 comments… read them below or add one }

Kris March 4, 2014 at 7:25 pm

After 3 weeks of injecting test c, my blood pressure goes up and I feel very very very bad. Restricted breathing,tremendous pressure in my head, pain around my eyes and just feel really bad.really bad. And my neck starts hurting really bad. The neck pain lasts for months after i stop injecting.I know, see a dr.
Well three drs have told me to stop taking it but can offer no explanations.can u offer ANY insight, please

Reply

Dr. Barry Wheeler March 9, 2014 at 11:02 pm

Kris,

You need to contact your doctor asap to get your heart health assessed. It is likely you are taking too big of doses and would possibly tolerate lower doses more frequently but this should be done under the close supervision of an experienced physician. Has anyone checked your estrogen or testosterone levels while you were taking the testosterone injections?

Best of luck,
Dr. Barry

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Tony January 10, 2014 at 1:48 am

Something strange has been going on for years; when I give myself my testosterone injection; I become so fatigued I must sleep for about 16 hours and it used to be much worse. The fatigue takes a couple days to wear completely off.

I take high dose morphine for chronic pain. I’m also pre-Diabetic and control with diet and test my blood daily.. I recently saw a unusually glucose reading so now I’m of the belief that the injection is causing some kind of brief huge spike in my glucose level. I will monitor very close with my next injection. How is this possible because T is suppose to lower glucose level? It’s been a mystery to every Doctor. I’m so fatigued I can’t muster the ambition to open a can of food for my dog when this happens. I don’t understand it but it’s very real. Has anyone else heard of fatigue like this with testosterone?

Reply

Dr. Barry Wheeler January 30, 2014 at 2:43 am

Hi Tony,

Has anyone checked your estrogen (estradiol) level? Many men who are pre-diabetes convert too much of their testosterone to estrogen.

There are different forms of testosterone and sometimes its good to take a break of switch it up to regain the initial benefits. I suggest you ask your doctor about switching to daily testosterone propionate injections. Supplementing with l-carnitine has also been helpful to some men who feel like the benefit has worn off.

Be sure to talk to your doctor before changing any of your treatments.

Best of luck,
Dr. Barry

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Roger December 5, 2013 at 11:06 am

hello im a 62 year old male, I came to the Philippines 14 years ago , im a disabled combat veteran , I had many injurys , broken neck gun shot wound bullet went threw my stomac out my hip, I have suffered from P T S D that has gotten better, I take anziety meds for this and I had a blood clot in each leg had surgery to get rid o f the small viens in my legs , I wear stocking up to my knees ! when I came to the Philippines I weighed 140 lbs at 511 I went up to 222 after 10 years of staying in the gym , I got lazy 3 years ago and stoped the gym for awhile, what a mistake I did not have problems with getting hard I went back to the gym after a year and then got a blood clot in my left leg I stoped and was on comadine I took it for a year they did the surgery went back to the gym , got sick with gastritis they said had a lot to do with me drinking soo many protein shakes and drinking way to much brown sugar everything was off my alt , my sugar , cholesterol, I went to the doctors , I had to quit milk , protein shakes , my liver was producing bile and acid that was eating into my stomac,, that caused me to get gastritis with that pain and all of these thing off, I had my blood pressure go realy high, I was sick it hurt soo much , now I have to be carful what I eat ! so im finaly back in the gym after many stops all of my blood is fine , my heart rate is around 60 from all the working out I have done , my blood pressure was up a year ago its been normal !l my blood pressure was around 130 over 80 somtime 120 over 80 but compared to before when I got sick much better, I got some androgel I was not getting hard , so ive been taking it not even a full pump the doctors here don’t know much about it I took two halp mumps yesterday and last night I dident sleep well and I had a head ace my wife took my blood pressure it was 145 over 90 maybe I should not of taken the other half pump and maybe not a night ??? anyway, I got al my blood work finaly straitened out, now I need to take somting to help my e d im sorry this is long, but the doctors here don’t realy know much, my urologist wanted to give me a shot of nebido but once its in your body , its there until it wears off, im afraid of my anziety and all thouse feeling that may cause me to have a panic attach ! after my blood, sugar, alt , being off I stoped almost all sugar , I started drinking lots of water every day , I have hypertension medicine they thought I would have to take for life , but after I got all the blood work straitened out my blood pressure went back to normal 130 over 80 and has stayed that way !! sorry im just wondering about the androgel ! I can buy nebido here with no doctors prescription !! can you help this ? any advice is more than welcome sorry if I have spelled everything write , im not a spelling bee !!!! thanks Roger

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Dr. Barry Wheeler December 15, 2013 at 11:55 pm

Hi Roger,

Without seeing you in my clinic there is no specific advice I can give you. It is important to take your medications as prescribed by your doctor and if you’re concerned about any thing you should get a second opinion or ask your doctor for a referral to a specialist. Nebido® is a long acting form of injectable testosterone. It contains testosterone undecanoate. The concern, as you stated, is that if you do get a side effect the medication will remain in your system for several weeks to months.

One thing I suggest you request from your doctor is lab testing to check your estradiol (estrogen) levels. Elevated estrogen levels may increase the risk of a heart attack or stroke. I checked an male patient’s estrogen, who was referred to me by another doctor prescribing topical testosterone, and his estrogen was twice the high end of the normal range. Many doctors are unaware that testosterone converts to estrogen and I imagine you are not trying to get in touch with your feminine side.

Also, some men benefit more from lower doses of topical testosterone. Sometimes rotating the locations where it is applied on a daily basis can improve absorption. Much of the topical testosterone we apply travels through the lymphatic system so it can be difficult to monitor with blood testing.

That is interesting that your blood pressure improved after you started drinking more water and eating no sugar. Maintaining proper hydration and stable blood sugar are two keys to wellness. high blood sugar causes damages to the blood vessels in our bodies via a process called glycosylation. Dehydration causes the blood to become thicker and puts excess wear and tear on the body’s plumbing (blood vessels).

Also talk to you doctor before drinking excessive water or changing your medications. Some men should not increase their water intake and should talk to their doctors first.

Cheers,
Dr. Barry

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M.B. December 5, 2013 at 3:20 am

Does taking medication for HBP decreases your testosterone levels?

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Dr. Barry Wheeler December 8, 2013 at 10:40 pm

Hi M.B.,

Yes, some high blood pressure medications have been shown to cause testosterone levels to decline in men. Some anti-hypertensive medications may be less likely to cause low testosterone than others.

“These results suggest that atenolol induces a worsening of sexual activity and a reduction of testosterone, whereas valsartan does not worsen sexual activity and does not change testosterone levels.”1

Please talk to your doctor before changing or discontinuing any of your medications.

Cheers,
Dr. Barry

  1. Effect of antihypertensive treatment with valsartan or atenolol on sexual activity and plasma testosterone in hypertensive men.Fogari R, Preti P, Derosa G, Marasi G, Zoppi A, Rinaldi A, Mugellini A. Eur J Clin Pharmacol. 2002 Jun;58(3):177-80. Epub 2002 May 1.

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Tony P January 10, 2014 at 3:32 pm

I can tell you for a fact that taking opiod medication for pain can lower your Testosterone level. My level was 26!! And my Pain Management didn’t even know about the relation. Told me T was another Doctor’s responsibility. Of course I finally figured it out on my on after a year in bed and my hair was gone from my chest and no more shaving required. LOL

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Tony P January 10, 2014 at 3:37 pm

Sorry for being off topic. I would think beta blockers could reduce T. Does anyone know if Inderal LA has affected T level?

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Dr. Barry Wheeler January 30, 2014 at 2:58 am

“Plasma testosterone decreased in captopril treated rats but propranolol had a greater effect.”

Effects of antihypertensive drugs on angiotensinase activities in the testis of spontaneously hypertensive rats. Segarra AB, Prieto I, Villarejo AB, Banegas I, Wangensteen R, de Gasparo M, Vives F, Ramírez-Sánchez M. Horm Metab Res. 2013 May;45(5):344-8. doi: 10.1055/s-0032-1329988. Epub 2012 Dec 7.

Henry November 17, 2013 at 11:43 pm

I have high blood presure and low total testostertone (276) 53 years old. I;m taking a new blood pressure meds, and Dr prescibed androgel gel. way to exspensive. I heard that takin the prescribtion it stops your body from producing testosternone? Is there a supplement I can take with high blood pressure and for low testertone? thanks

Reply

Dr. Barry Wheeler November 26, 2013 at 12:45 am

Hi Henry,

There are a number of ways to increase your natural production of testosterone but they typically all become less effective as we get older and our testicles, etc. become less productive due to the aging process. There is a lab test to measure the signal from your brain to your testicles that can be done. A simple blood draw sent to the lab can be used to measure your luteinizing hormone (LH) levels. This will help your doctor determine the best medication or supplement. Your doctor could also measure your free testosterone levels. Most the supplements on the market are designed to increase your free testosterone levels and decrease the conversion of your testosterone to estrogen.

Some of these “testosterone booster” supplements can be quite expensive and may contain substances that are not FDA approved or are dangerous for YOUR body. That’s why its important to have doctor supervision when using these and to make sure you get proper lab testing for safety and efficacy. I suggest you talk to your doctor and ask him to check your LH, free testosterone, and estrogen levels. That will help him help you find the most effective treatment options.

Best of luck,
Dr. Barry

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sky November 15, 2013 at 3:32 pm

Dear Doctor Barry,
I appreciate your rational and informative advice for easy understanding of different conditions.
I was advised to use testogel 5 gm daily. It gave good results. But after about one month my blood pressure rose and I started having prepatual headache. After some adjustments trials; now my doctor has brought down to 2.5 gm gel once a week. My BP and headaches have since been reduced considerably though not finished totally. I feel OK generally.
Please advise.
regards
sky

Reply

Dr. Barry Wheeler November 19, 2013 at 12:05 am

Hi Sky,

It sounds like that dose was too high for you. Keep working with your doctor to figure out what’s going on.

Just so you know, the human body produces about 5-10milligrams of testosterone per day naturally when we are younger. The dose you were taking was 5 grams, which is 5000 milligrams. That dose is about 1000x what the body “natually” makes. It is unlikely you were absorbing all this testosterone but it is difficult to say what was happening without doing lab testing. Topical testosterone is difficult to monitor in with blood testing because it seems to mostly travel through the lymphatic system because it is applied to the skin. I have seen some men taking topical testosterone have VERY high levels of estrogen. Also, the skin converts a large amount of testosterone to dihydrotestosterone (DHT).

Because topical testosterone builds up in the skin it make some time for levels to reduce when they get too high. I suggest you ask your doctor to check your testosterone and estrogen levels and discuss your other treatment options, such as low dose injection (much easier to monitor in blood).

Best of luck,
Dr. Barry

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Greg November 2, 2013 at 11:40 pm

Dr. Wheeler,

I;m 45 year old guy who had become pretty desperate to feel better and regain my life the past few years. Exploring this option after anti-depressants did nothing for me, 6 weeks ago I tested at Testosterone=218 Free T=5.4 Estradiol 10.3. Using your clinic’s protocol, after 2 weeks, I started to feel incredible.It seemed like a new life. At week 6, just before my blood draw last week, I felt like I was going “flat” again. I lost a lot of the energy I had, and also developed high BP and tightness in my chest. I feel like I’ve felt often in the past, with a pretty high sense of irritability and physical anxiety.

My results from the draw taken just before weekly injection were T=1000 Free T 26.6 Estradiol 31.4. Blood results normal. This seems like a dramatic jump, especially considering it’s at the low point of my weekly injection cycle. Could it be the change I’m feeling is a result of being TOO high?Should I have emphasized this dramatic feeling/symptom shift more to my (great) doctor at your clinic? Should I talk to him about altering my dosage downward? We did decide to do biweekly injections, totaling the same amount for the week but I’m now wondering if I should take a smaller dose once/week?! I do plan to talk to him again, and the level of care at your clinic is simply amazing, but I’m curious about your general perspective on this aspect of treatment ranges and wondering if patients can go too high and negate the positive effects of treatment. I’m an info and research hound so the more I learn, the better!

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Dr. Barry Wheeler November 6, 2013 at 6:25 pm

Hi Greg,

Please contact our clinic right away as we have a number of approaches that can help you regain the benefits of your testosterone therapy. Also, please contact your primary care doctor immediately about the tightness in your chest.

Testosterone therapy can help reduce anxiety. Testosterone has been shown to be “anxiolytic,” which means it reduces anxiety. In a study on mice, “this effect of increased testosterone was mediated via the androgen receptor as flutamide blocked the anxiolytic effect of exogenous testosterone.1” They used a drug to block androgen receptors and they found that this caused the testosterone to lose its anxiety reducing effect in mice. Other studies have shown a connection between low testosterone and depression, with untreated men with low t having higher levels of depression, anger, fatigue, and confusion (these symptoms often improve with low t treatment when SSRIs give poor results) and testosterone replacement therapy decreases anger, nervousness, and irritability.2,3,4

In general, some guys will notice benefit immediately from testosterone therapy and then notice a decrease in benefit over time. This is often due to a decrease or down-regulation of androgen receptors, in my opinion. The problem with weekly or twice weekly or even three times a week injections of testosterone cypionate is that it can cause sustained levels of testosterone that don’t decrease and rise daily. The rise and fall of testosterone levels can help maintain adequate androgen receptors. When testosterone levels decline androgen receptors will likely increase in response. The solution is typically easy: switch to daily topical or injectable testosterone. We typically use testosterone propionate for daily injections as it will typically allow the levels to rise and fall the most during a 24 hour period without causing levels to be too high or low.

Please call our clinic to discuss your options.

Cheers,
Dr. Barry

Readers: All treatments must be supervised by a licensed physician.

  1. The anxiolytic effect of testosterone in the rat is mediated via the androgen receptor. Hodosy J, Zelmanová D, Majzúnová M, Filová B, Malinová M, Ostatníková D, Celec P. Pharmacol Biochem Behav. 2012 Aug;102(2):191-5. doi: 10.1016/j.pbb.2012.04.005. Epub 2012 Apr 21.
  2. Testosterone replacement therapy improves mood in hypogonadal men: a clinical research center study. Wang C, Alexander G, Berman N, Salshian B, Davidson T, McDonald V, Steiner B, Hull L, Callegari C, Swerdloff RS. J Clin Endocrinol Metab 1996; 81:3578– 3583
  3. A long-term, prospective study of the physiologic and behavioral effects of hormone replacement in untreated hypogonadal men. Burris A, Banks S, Carter S, Davidson J, Sherins R. J Androl 1992; 13:297–304
  4. Testosterone replacement therapy for hypogonadal men with SSRI-refractory depression. Seidman SN, Rabkin JG. J Affect Disord 1998; 48:157–161

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John October 29, 2013 at 7:46 pm

Dr. Barry,

Hi,
I’ve been on testosterone therapy for the last month and a half and everything has been great. The only thing is that I’m noticing my heart is beating a bit faster and my blood pressure is not 140/100 vs the normal 120/80 that I use to be at.

Can testosterone therapy cause high blood pressure?

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Dr. Barry Wheeler November 4, 2013 at 7:23 am

Hi John,

You need to contact your doctor right away and let them know your blood pressure may be increased. There are a number of potential causes of an increase in blood pressure so its important to discuss this with your primary care doctor.

In general, we have seen testosterone replacement therapy (TRT) improve blood pressure in patients and this is backed up by several studies and reviews of research over the past few years.

“TRT in men with [testosterone deficiency] has consistently shown a decrease in fat mass and simultaneous increase in lean mass. T is a vasodilator and in long-term studies, it was shown to reduce blood pressure. There is increasing evidence that T treatment improves insulin sensitivity and lipid profiles. T may possess anti-inflammatory and anti-coagulatory properties and therefore TRT contributes to reduction of carotid intima media thickness. We suggest that T may have the potential to decrease CVD risk in men with androgen deficiency.”1

Cheers,
Dr. Barry

  1. Androgen therapy in men with testosterone deficiency: can testosterone reduce the risk of cardiovascular disease? Saad F. Diabetes Metab Res Rev. 2012 Dec;28 Suppl 2:52-9. doi: 10.1002/dmrr.2354.

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adam August 18, 2013 at 6:00 pm

Dr. Wheeler,

I am 28 yo and I have been experiencing unusual fatigue for about two years. I am ok waking up the morning but in the course of the day, I start to feel very tired.
I did not really know what was going on and kind of ignored it until lately I started losing my erections during sex. I went to a doctor and my physical was normal, all thyroid, liver, etc…was normal. My testosterone levels was just below 300. I checked it again and it was still around 270. Everything else was normal (FSH/TSH/LH, etcc). My doctor said there is no pathologic condition and I just fall on the lower end of normal. He refused to prescribe me any medications saying that my symptoms were very nonspecific.

I don’t know much about medicine but I don’t feel like living the rest of my life like this. Is there anything you’d recommend?

Reply

Dr. Barry Wheeler August 20, 2013 at 6:04 pm

Hi Adam,

Did your doctor check your free testosterone level? Often times the total testosterone level looks normal and the free testosterone level is too low. I suggest you also request a test to check your cortisol and free T3 levels as these are typically missed by most doctors and are important aspects of maintaining energy levels during the day. Testosterone and cortisol rise in the morning and then thyroid increases in the afternoon. TSH is one of the most worthless lab tests for assessing thyroid in my opinion. Maybe you need a second opinion from another doctor.

Pathology is when it gets really bad and waiting till then is unnecessary as your quality of life will be affected. I suggest you request your doctor check your prolactin, free testosterone, estradiol, free T3, and free T4 levels.

Cheers,
Dr. Barry

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clover August 13, 2013 at 3:11 pm

Dear Dr. Barry, thanks for this very informative post. I am on medicine for hypertension (average 150/90) and after decided to go to the doctor after almost 10 years of severe night sweats, she sent me to do a blood test for testosterone. The results came 8. They called me to book an appointment cause I need treatment for my low testosterone. When I got to the GP (UK) he told me he can’t give me testosterone injections just because I have night sweats. Of course, after the doctor sent me to do the blood test I start reading about low testosterone symptoms and it seemed I had a lot of them (lack of living the life, not in the mood to go outside, sleep disorder, frustrated and irritated all the time, night sweats, i could go 1 number but not able for the second one with my partner, etc). When I told my doctor I have a lot of symptoms of low tes he told me i’m joking. He said he can’t prescribe me injections and to discuss with the other doctor who sent me to do the blood test. I told him there are patches, gels and other ways for testosterone but he said in his books there’s no other way other than injections.

Now I feel im dealing with different knowledge in each doctors. What do you suggest? Is my 8 testosterone now so low? Could this affect my high blood pressure? Btw, visiting someone in the hospital, I asked a nurse to measure my BP and it was 158/95 and she said its perfect. She then showed me a list of bad/good BP and the range was 100-180 systolic which she said is a good BP.

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Dr. Barry Wheeler August 13, 2013 at 5:30 pm

Hi Clover,

It definitely sounds like you need a second opinion from a doctor more experienced in low testosterone treatment and high blood pressure. I imagine your blood pressure is higher when you are at your doctor’s office so checking it at home when you’re relaxed would be something to consider talking to your doctor about.

There are a number of different opinions about testosterone and blood pressure and in my experience every patient is different. Some patients with higher blood pressure do very well with topical testosterone or injection and their blood pressure actually reduces with testosterone therapy. Testosterone is essential for nitric oxide (NO) production which relaxes the blood vessels. Testosterone can act like a diuretic in some men and lead to dehydration which can increase blood pressure. If you can find a knowledgeable doctor that would be something to discuss as well. In my experience patients who don’t tolerate testosterone injection due to increases in blood pressure will typically tolerate topical testosterone creams.

Also, perhaps you should remind your doctor that the heart is a muscle and testosterone supports muscle health. Many doctors use a cookbook approach and that will increase the risk of side effects and decrease potential benefits. We individualize every patient’s treatment.

Cheers,
Dr. Barry

Reply

clover August 13, 2013 at 9:17 pm

Thank you for your quick answer. I don’t have the white coat blood presure, I was found with high blood presure last year in october when I went to emergency due to some pain in the left side of my chest. Doctor gave me some pills for blood pressure but I took them just for one month, cause I thought it will be gone after the treatment. Then in december (I was a heavy coke drinker, around 6-8l per day) I switched to diet coke caffeine free and realized it was causing me big problems with my sleep more than diet coke was causing. Then I went back to doctor and he told me I will have to take these pills for the rest of my life, cause blood pressure doesn’t go away like that. Since then, I bought an omron and check my BP all the time, so it’s not high just when I go to see the doctor. However, I don’t understand why the hospital had margins of 100-180 systolic and I need to take pills for my 150 systolic BP.

The doctor who refuse to give me the treatment with testosterone told me he’s going to send me an appointment to the hospital to check my night sweats, he refuse to think there is a problem with my testosterone. And the other doctor, when I went to see her and told her about my night sweats (I didn’t know or mention anything about testosterone) she just sent me to do the blood test for testo. So it’s very weird how one doctor find a cure for my sweats and the other one refuse to give me the treatment.

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Alastair July 9, 2013 at 4:27 pm

Hi doctor I have been on testogel for about 8 months and have had good results to start with ,sex drive went through the roof then started to drop of to appoint where it’s back to pre gel and blood pressure has gone up .could this be due to estrogen convertion , amd what do you recomend to prevent convertion happening.i am 55y old have some sleep issues . Interested in any thoughts

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Dr. Barry Wheeler July 12, 2013 at 9:53 pm

Hi Alastair,

It could be related to too much estrogen or it could be something else. Topical testosterone can sometimes stop absorbing if applied in the same location daily. In terms of estrogen production, the only way to know for sure is a blood test for estradiol, one of the major forms of estrogen. Tell your doctor about your sleep issues and ask him about sleep apnea and getting a sleep study done. We usually use prescription medications to reduce the conversion of estrogen to testosterone, such as aromatase inhibitors. There are herbal approaches as well but without labs you never know if its really working or not. Come into our clinic or ask your doctor before taking or changing your medications.

Cheers,
Dr. Barry

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Larry C. May 2, 2013 at 7:57 am

Dr Barry, I’d like to chat with you about Angrogel lowering my BP. and getting off it my BP went back up.

Where can I reach you ? or email me with my email address and I’ll send you my cell #. My Drs here in San Diego are being a little unreasonable, and I’d like to talk to someone who might understand the connection.

Thanks
Larry

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Dr. Barry Wheeler May 3, 2013 at 11:24 pm

Hi Larry,

In some men, depending on the type of testosterone used and other factors such as conversion to estrogen, the blood pressure may increase or decrease. Generally, we see blood pressures decrease. When blood pressures increase it if often from dehydration but there are certainly other possible causes.

Based on human physiology we would generally expect blood pressure to decrease because optimal testosterone levels support nitric oxide production. Nitric oxide (NO) send the signal to blood vessels to relax and expand. This is why they give nitric oxide to patients having heart attacks often because it improves blood flow rapidly. Also, in the penis nitric oxide is essential to being to have an erection and testosterone therapy can certainly help with this as well.

Every patient is different and I wish I could give you a one-size fits all response but the truth is that the treatment must be unique and based on your needs and response to testosterone therapy.

Please feel free to call our clinic for a quick phone consult at (425) 455-1700. We can discuss treatment in general and if you want to discuss more specific treatment options you would need to come into the clinic for an eval.

Cheers,
Dr. Barry

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charlie December 9, 2012 at 12:48 am

I was using Androgel 1% for three weeks and felt great. After three weeks at a scheduled doctor’s appointment, I was told that my blood pressure was high and that I needed to monitor it. This was not the same doctor who had prescribed the Androgel for me (because of a low testosterone count). I stopped the Androgel use immediately because it was the only change that I had made in my life and suspected it may be causing my hypertension. What do you think? I would love to go back to using it since it made me feel so much better, ten years younger, but I am concerned that it is the cause. Thanks.

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Dr. Barry Wheeler February 21, 2013 at 2:32 am

Charlie,

Testosterone supports vasodilation through the nitric oxide pathway. Vasodilation means relaxes the blood vessels. Nitric oxide is what they give people when they are having a heart attack to dilate the blood vessels and testosterone supports your body’s natural production of nitric oxide.

These are just a few things you should bring up with your doctor about testosterone and your blood pressure:

  1. Did your doctor check your estrogen levels? Estrogen can increase sex hormone binding globulin and cause edema which can lead to increased blood pressure. Edema means fluid retention such as swelling in the ankles.
  2. Did your doctor check other hormones like cortisol, thyroid, and growth hormone? All these hormones balance with each other and when one increases the others can increase or decrease.
  3. Did your doctor check your blood pressure only one time in his office? Generally, when I am unsure about someone’s blood pressure I will have them monitor it when they are home before changing their treatment drastically. I had a patient who had high blood pressure when he donated blood but that was because he drove through traffic drinking a red bull.
  4. Did your doctor talk to you about dehydration? This time of year many people are dehydrated due to indoor heating and dry air.
  5. Please don’t answer any of the above questions but ask your doctor. I’m just giving some general information and every patient is different. It sounds like you need to go back to the doctor who prescribed your testosterone.

    Be Well,
    Dr. Barry

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Karen October 5, 2012 at 8:59 am

Testosterone helps sperm production in men, as well as causing and maintaining secondary male sex characteristics such as growth of facial hair and deepening of the voice of boys during puberty. While testosterone is generally considered a male hormone, the ovaries in women also produce small amounts of testosterone, which helps female sexual desire and the maintenance of healthy bones and muscles. To avoid having a low testosterone, you must avoid smoking, moderate drinking of alcohol, healthy diet, regular exercise and have sexual intercourse at least once a week! Thanks for the post by the way!

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Dr. Barry Wheeler October 6, 2012 at 3:20 am

Karen,

Thanks for your post. FSH is the hormone that stimulates sperm production and LH is the hormone that testosterone production. Interestingly, I have found hCG to improve male fertility although it is more known for its LH-like functions (helps increase testosterone production).

Men and women really do have yin and yang like differences all the way down to the hormones. Men have more testosterone and a little estrogen and women have more estrogen and a little testosterone. Testosterone can convert to estrogen and vice-versa. Men, as we age, tend to convert more of our testosterone to estrogen and this can give the appearance that we are getting in touch with our feminine side but this can cause problems for us (ie erectile dysfunction).

Life is all about maintaining balance it appears. When we are in our 20′s most of us are the most balanced hormonally as we will ever be in our lives. Maintaining these hormone levels with proper nutrition and exercise may greatly extend not only the quantity of the years we live, but also the quality.

There is a myth that you may have been led to believe. Testosterone is NOT created by exercise but rather testosterone is required to be able to exercise. Intense exercise can improve growth hormone levels and I highly recommend you read the book “PACE: the 12 minute workout”, by Al Sears, MD.

Dr. Barry

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John March 26, 2013 at 7:18 pm

Dr. Barry,

I believe you have got it backwards. LH is for Test production. FSH is for sperm production.

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Dr. Barry Wheeler March 26, 2013 at 10:36 pm

Thanks John, typo fixed.

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ronnie July 2, 2013 at 11:38 pm

I just started using Androgel but my head hurts and I feel sick, my. blood pressure is
up, what doou think I should do Iam taking 4 meds.

Dr. Barry Wheeler July 8, 2013 at 10:18 pm

Hi Ronnie,

You need to contact the doctor who prescribed your testosterone as soon as possible. I cannot comment on your specific situation as every patient is different. It may be related to the testosterone or totally unrelated.

Dr. Barry

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