Evidence question

PubMed sourcedAbstract-based analysisUpdated Sep 2026Human reviewedUpdated Aug 2026

Evidence / Cardiometabolic Risk

CoverageCardiometabolic Risk

Does testosterone therapy affect blood pressure?

Reviewed by Neal Rouzier, MD, Preventive Medicine · Aug 2026

Updated Aug 2026·14 studies analyzed·2 core studies·Applies to: hypogonadal men

Bottom line

Testosterone effects on blood pressure are modest and inconsistent across trials. Monitoring blood pressure remains part of routine TRT follow-up, especially with fluid retention or erythrocytosis.[1–6]

Evidence confidence

Evidence Confidence

Limited
LimitedModerateHigh

The available studies are limited in design quality, directness, or consistency, so scientific certainty remains limited.

Key uncertainty. Dedicated hypertension-powered TRT trials are limited.

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Also asked

TRT and blood pressure▼

TRT and blood pressure effects are modest and inconsistent across trials. Monitor blood pressure during follow-up, especially if fluid retention or erythrocytosis develops.

Does testosterone raise blood pressure?▼

Evidence is mixed. Some studies show modest blood pressure increases with TRT through fluid retention or increased erythrocytosis; others show no significant effect. Blood pressure monitoring is standard.

Can men with hypertension take TRT?▼

Hypertension is not an absolute contraindication to TRT. Optimize blood pressure control before starting, monitor closely, and reassess if blood pressure worsens after initiation.

hematocrit blood pressure TRT▼

Elevated hematocrit from TRT-driven erythrocytosis can raise blood viscosity and contribute to blood pressure increases. Monitoring hematocrit and blood pressure together during TRT is appropriate.

TRT hypertension▼

Testosterone effects on blood pressure are modest and inconsistent across trials. Monitoring blood pressure remains part of routine TRT follow-up, especially with fluid retention or erythrocytosis.

Testosterone BP effects▼

Testosterone effects on blood pressure are modest and inconsistent across trials. Monitoring blood pressure remains part of routine TRT follow-up, especially with fluid retention or erythrocytosis.

Body of evidence

Clinical Evidence Brief

RAGMD analyzed 5 relevant studies.

Overall finding

2 studies address venous thromboembolism, with weighted findings showing no meaningful effect. 1 study addresses sleep-related cognitive symptoms, with weighted findings showing a positive association. 2 studies address blood pressure, with weighted findings showing unclear findings. 2 randomized or systematic-review reports and 3 observational studies address treatment.

Evidence by outcome

Direction: ↑ Favors treatment / reassuring · ↓ Harm signal · ↔ No clear effect · ± Mixed · ↗ Observational link · ? Unclear

No clear effect

Venous thromboembolism

moderate · 2 studies

2 studies address venous thromboembolism, with weighted findings showing no meaningful effect. This is an objectively measured outcome. This is a hard clinical endpoint.

Objectively measured · Hard clinical endpoint

Studies

PMID 37326322PMID 26205547
Positive link

Sleep-related cognitive symptoms

moderate · 1 study

1 study addresses sleep-related cognitive symptoms, with weighted findings showing a positive association.

Mixed measurement

Studies

PMID 34536053
Unclear

Blood pressure

limited · 2 studies

2 studies address blood pressure, with weighted findings showing unclear findings. This is an objectively measured outcome. This is a surrogate endpoint and does not by itself prove a hard clinical outcome.

Objectively measured · Surrogate endpoint

Studies

PMID 34999717PMID 31495240

Magnitude / clinical importance

High-influence studies did not show a meaningful treatment effect on the primary outcome.

Absence of a meaningful effect is not the same as proof of no effect in every subgroup.

Agreement across studies

Findings are mostly consistent with minor variation after weighting by design, quality, and directness.

Supports main conclusion: 1 · Neutral / mixed: 4 · Credible conflicting: 0

Study counts describe the landscape; RAGMD weights studies according to design, quality, and directness.

Conflicting findings

In men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was noninferior to placebo with respect to the incidence of major adverse cardiac e…

Risks & harms

3 studies report safety-relevant findings. Design mix: Randomized controlled trial, Study design not clearly classified, Narrative review. Rare-event inference should not rest on underpowered trials alone.

Who this applies to

Most studies included hypogonadal men.

What remains uncertain

  • Dedicated hypertension-powered TRT trials are limited.
  • Dedicated hypertension-powered TRT trials are limited.

Clinical takeaway

Monitor blood pressure at baseline and follow-up on testosterone therapy, especially when hematocrit rises or fluid retention occurs. Adjust antihypertensive therapy as needed rather than stopping TRT solely for modest BP changes.

No clear effect

Venous thromboembolism?

No meaningful effect

moderate[37326322 · 26205547]

Positive link

Sleep-related cognitive symptoms?

A positive association

moderate[34536053]

Unclear

Blood pressure?

Unclear findings

limited[34999717 · 31495240]

2 randomized or systematic-review reports and 3 observational studies address treatment. Weighted treatment findings show a positive association.

2 RCT / systematic review · 3 observational

Large randomized trials strongly influence the conclusion

2 landmark studies with randomized or systematic-review designs strongly inform this conclusion.

Supporting studies provide additional context

12 supporting studies add context beyond the core evidence base.

Regimen & duration

Observational and supporting studies provide context and do not outrank higher-appropriateness designs.

Long-term uncertainty

Study quality or consistency across available evidence limits certainty.

5 analyzed studies

Strongest evidence

The New England journal of medicine2023

Landmark studyPMID 37326322

Cardiovascular Safety of Testosterone-Replacement Therapy.

In men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was noninferior to placebo with respect to the incidence of major adverse cardiac events. (Funded by AbbVie and others; TRAVERSE ClinicalTrials.gov number, NCT03518034.).

RCT
Evidence
Relevance

Supporting literature

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia.

Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial.

Serious Adverse Effects of Extended-release Niacin/Laropiprant: Results From the Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE) Trial.

+9 more

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