Can you Take Testosterone with High Blood Pressure?

Can You Take Testosterone with High Blood Pressure?

High blood pressure affects millions of men, often overlapping with low testosterone ("low T") symptoms like fatigue, reduced libido, and muscle loss. Many wonder if testosterone replacement therapy (TRT) is safe or if it worsens hypertension. 

The short answer: Yes, many men with controlled high blood pressure can safely take TRT, but it requires careful evaluation, monitoring, and management. Recent evidence and guidelines as of 2026 emphasize individualized assessment rather than blanket avoidance.

Understanding the Link Between TRT and Blood Pressure

TRT restores testosterone to normal physiologic levels in men to help alleviate symptoms. Testosterone influences vascular function, red blood cell production, fluid balance, and the way the kidneys regulate the body, renin-angiotensin systems, factors that can affect blood pressure.

Let’s take a look at a few studies on the relationship between these two factors. 

The TRAVERSE trial (published 2023, with ongoing follow-ups) studied over 5,200 hypogonadal men aged 45 to 80 with high cardiovascular risk. It found no increase in major adverse cardiovascular events (heart attack, stroke, CV death) with TRT versus placebo. However, it did note a small increase in blood pressure.

In February 2025, the FDA removed prior boxed warnings about elevated heart-attack  risk but added warnings about potential blood pressure increases, which could contribute to long-term problems if unmanaged. However, in the case of Lucidity, TRT usage is always managed on an ongoing basis.  

Meanwhile, conversely, some smaller studies report that TRT can lower blood pressure in certain men, such as those with metabolic syndrome (or pre-diabetes), possibly via improved insulin sensitivity and body composition. 

TRT is not contraindicated due to high-blood pressure in current guidelines (AUA, Endocrine Society, EAU). Instead, uncontrolled hypertension or recent major CV events are relative concerns.

When TRT May Be Safe with High Blood Pressure

Many clinicians prescribe TRT to men with hypertension if:

• Blood pressure is well-controlled.

• There have been no recent cardiovascular events.

• There have been no untreated conditions exacerbating blood pressure, including things like severe sleep apnea, which TRT can sometimes worsen. 

• Thorough pre-TRT workup: Baseline blood pressure measurement.

Benefits often outweigh risks for symptomatic low T. Improved energy, mood, libido, muscle mass, and potentially better metabolic health, which indirectly supports blood pressure control.

Potential Risks and How They Relate to Hypertension

• Blood pressure elevation - Modest in most, but clinically relevant in borderline cases. Mechanisms include increased hematocrit and sodium retention. Hermatocrit simply means thicker blood.

• Polycythemia (elevated red blood cells) - This sometimes occurs with TRT, can thicken blood and strain the heart and blood vessels, indirectly raising blood pressure or blood clot risk, however this is rare and can be managed carefully by a physician. 

• Other cardiovascular signals - Higher atrial fibrillation or pulmonary embolism in some trials, though no causing no increase in overall major adverse cardiovascular events.

• Formulation differences - Injections/topicals often show smaller blood pressure changes than some orals 

Monitoring and Management Strategies

Several steps should be taken by a doctor before TRT is prescribed, which include getting lab draws done to evaluate a variety of factors in the body. 

• Pre-TRT - Confirm hypogonadism, which just means that the body is producing testosterone at lower than desirable levels. Assess blood pressure control, optimize hypertension meds.

• During TRT - Patients are encouraged to track blood pressure at home to trend any changes. It may also be recommended to track hematocrit on an ongoing basis.

• Adjustments - If blood pressure rises significantly, the dose may be lowered or the formulation switched or blood pressure medication may be introduced.

• Lifestyle Synergy - Weight loss, exercise, low-sodium diet, and sleep apnea treatment enhance TRT benefits and mitigate blood pressure risks.

Which Patients Should Avoid or Delay TRT?

• Those with uncontrolled hypertension.

• Anyone with a major recent cardiovascular event.

• Patients with severe, untreated sleep apnea. 

• Patients with a high blood clot risk or with other red flags, including those with a very high hematocrit baseline. 

In these cases, prioritize blood pressure optimization first until it’s under control!

Numerous benefits of having a balanced endocrine system, including healthy testosterone levels, can include faster muscle growth, weight loss, anxiety reduction, and others.  

Final Thoughts: Personalized Decisions in 2026

As of 2026, research tells us that TRT is safe for appropriately selected men, sometimes even in those with hypertension. Testosterone replacement therapy may actually reduce hypertension in men in cases where hypertension is exacerbated by high anxiety. 

TRT is also far safer in cases in which the patient is continually monitored by a doctor, as is the case with Lucidity Health. 

The focus in general has shifted from old fears of broad cardiovascular harm to targeted risks, like modest blood pressure increases and meanwhile, the benefits of testosterone therapy treatment are numerous.

It should not be considered safe to self-medicate or to buy testosterone from the gray or black market. The risks skyrocket without pre-screening and medical oversight. 

We encourage readers to reach out to us for more information or to get a lab draw done to determine whether TRT may be right for them. With proper management, testosterone replacement therapy can vastly improve one’s quality of life.