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.
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
Call (425) 455-1700 for your FREE phone consult now!
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{ 8 comments… read them below or add one }
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!
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
Dr. Barry,
I believe you have got it backwards. LH is for Test production. FSH is for sperm production.
Thanks John, typo fixed.
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.
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:
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
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
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