Does TRT raise blood pressure?
Usually a little. TRT blood pressure changes in studies are small on average: the top number rises about 2 to 5 points over a few months. In 2025 the FDA said 24-hour blood pressure studies confirmed a rise with every testosterone product.
Some men rise more than others, and a small average rise can matter for someone whose blood pressure is already high. It’s one of the checks in our guide to TRT side effects, and worth raising when you’re starting TRT.
What do the blood pressure numbers mean?
Blood pressure has two numbers. The top one (systolic) is the pressure when your heart beats. The bottom one (diastolic) is the pressure between beats.
Both are measured in mm Hg, short for millimetres of mercury. A reading of 128/82 means a top number of 128 and a bottom number of 82.
| Category | Top number | Bottom number |
|---|---|---|
| Normal | Under 120 | and under 80 |
| Elevated | 120 to 129 | and under 80 |
| Stage 1 high | 130 to 139 | or 80 to 89 |
| Stage 2 high | 140 or higher | or 90 or higher |
| Needs care now | Over 180 | or over 120 |
These are the American College of Cardiology and American Heart Association categories. The last row comes from the US National Heart, Lung, and Blood Institute. High blood pressure is diagnosed from the average of several careful readings on different days, not one reading.
What did the FDA change on testosterone labels?
For years, some newer testosterone products carried a boxed warning about blood pressure. In 2016 and 2017, 24-hour blood pressure studies of an injectable and an oral product showed rises. In 2018 the FDA asked makers of every testosterone product to run the same kind of study.
In 2025 the FDA reported the results. It said the studies confirmed a rise in blood pressure with all testosterone products. So it added a blood pressure warning to every testosterone label that didn’t already have one.
At the same time, the FDA removed boxed-warning language about heart attacks and strokes. That followed the TRAVERSE trial, which found no extra heart events on testosterone gel. On several labels, the blood pressure warning moved out of the box but stayed in the warnings section.
Older labels such as the one for cypionate now say testosterone can raise blood pressure, which can raise heart risk over time. They tell prescribers to check blood pressure from time to time, especially in men with high blood pressure. They also say testosterone is not recommended when high blood pressure is uncontrolled.
How much does each type of testosterone raise it?
Each newer product ran a 24-hour blood pressure study. A cuff took readings every so often through a whole day and night, before and after a few months on treatment.
| Product (type) | Study length | Average rise, top/bottom | Men who started or changed BP pills |
|---|---|---|---|
| Jatenzo (oral) | 139 days | 4.9 / 2.5 | 7.2% |
| Tlando (oral) | About 16 weeks | 4.3 / 1.4 | 1.4% |
| Xyosted (weekly SubQ) | 12 weeks | 3.9 / 1.5 | 10% in a 1-year study |
| Aveed (long-acting injection) | 16 weeks | 3.1 / 2.0 | 1.4% |
| Testim (gel) | 16 weeks | 2.7 / 1.1 | 2.7% |
| AndroGel 1.62% (gel) | 16 weeks | 1.9 / 1.3 | 2.8% |
| Kyzatrex (oral) | 4 months | 1.7 / 0.6 | 3.2% |
These were single-arm studies, with no placebo group. They also left out men whose recordings weren’t complete. So read the numbers as rough averages, not a promise for you, and not a ranking of products.
“The rise is small on average, but every testosterone product in the FDA’s studies showed one.”
The Jatenzo label adds that average blood pressure had not levelled off by the end of its study. That’s one reason to keep checking after the first few months.
No product label gives data for the common weekly cypionate or enanthate vial. Their labels carry the general class warning instead.
Does the type of testosterone matter?
We can’t say. No study has compared products head to head on blood pressure. The label studies used different men, different lengths and different ways of counting.
The oral products and the weekly SubQ product show some of the larger average rises. But the gels and the long-acting injection rose too. The FDA’s 2025 decision treats the rise as a class effect, meaning it applies to every product.
If you switch products, it’s worth taking a fresh week of home readings. That gives your prescriber a clean before-and-after picture.
What did the TRAVERSE trial show about blood pressure?
TRAVERSE was the largest heart-safety trial of testosterone, with 5,246 men aged 45 to 80. After 36 months, the top number was 1.0 point higher than at the start on testosterone gel. On placebo it was 0.5 lower, a gap of 1.5 points.
TRAVERSE used a gel, so it says less about injections or pills.
The same trial found heart attacks, strokes or heart deaths in 7.0% on testosterone and 7.3% on placebo. So a small rise in blood pressure didn’t show up as more heart attacks over about three years. Our guide to TRT heart risk covers what TRAVERSE does and doesn’t show.
Is the evidence consistent?
Not entirely, which is why the honest answer is “small and variable”. Here’s how different kinds of study compare:
- Placebo-controlled trial in men on opioids: after 6 months, the top number in clinic readings rose 6.2 points on testosterone and fell 7.0 on placebo.
- Placebo-controlled trial of a cream in men aged 50 to 70: 24-hour blood pressure rose with testosterone, by about 3 points in one group.
- A 2007 review of 30 older trials: changes in blood pressure were very small.
- A gel study published in 2025: the top number rose 1.9 points on average, and a drug effect couldn’t be ruled out.
- A registry of men on long-acting injections: blood pressure fell over several years.
Registries follow men in everyday care, so other changes, like weight loss or new pills, can explain what they see. Controlled 24-hour studies are better at spotting a small direct effect. That’s the evidence the FDA used.
Does low testosterone affect blood pressure?
Low testosterone and high blood pressure often go together. The American Urological Association’s guideline notes that men with low testosterone had about 1.6 times the odds of high blood pressure in pooled studies.
That doesn’t prove one causes the other. Both get more common with age and extra weight. But it means many men starting TRT already have high blood pressure, or are close to it.
That’s why a baseline reading matters. Without one, you can’t tell whether a later number is new or was there all along.
Why might testosterone raise blood pressure?
The reason isn’t settled. One clue is hematocrit, the share of your blood made of red cells. Testosterone raises it, and thicker blood may push blood pressure up.
In one oral product study, men whose hematocrit rose most, by 6 to 14 points, had an average rise of 8.3 in the top number. The other men rose by about 2 to 3. In the trial of men on opioids, a 10-point rise in the top number went with a hematocrit rise of 0.3 points.
Not every study found the link. One oral product study saw no connection between hemoglobin and blood pressure.
Labels also mention fluid retention as a possible side effect. Extra fluid in the body can push blood pressure up too. Our page on hematocrit explains how that number is watched.
Who may see a bigger rise?
Some groups tended to rise more in the studies:
- Men already treated for high blood pressure. In 4 of 7 label studies, they had bigger rises in the top number. On AndroGel 1.62%, it was 3.0 points versus 1.2 in men without high blood pressure.
- Men whose hematocrit rises a lot. See the section above.
- Men with diabetes. One oral product label names diabetes and blood pressure treatment as factors linked to bigger rises.
- Men with obesity. In the opioid trial, obesity went with bigger rises.
None of this means you shouldn’t take testosterone. It means your prescriber may want closer checks, and your home readings become more useful.
How should you check your blood pressure at home?
A week of home readings tells your prescriber more than one office check. The American Heart Association says 24-hour monitoring predicts heart problems better than office readings do. Home readings are another way to check outside the clinic.
Here’s the routine it describes:
- Use a validated upper-arm cuff that fits your arm.
- Skip coffee, smoking and exercise for 30 minutes before.
- Sit quietly for 5 minutes, back supported, feet flat, arm resting at heart level.
- Take two readings, 1 minute apart, in the morning before coffee or blood pressure pills.
- Repeat in the evening before bed.
- Do this for about 7 days if you can, and at least 3.
Write every reading down, or log it in an app. Bring the whole list, not just the highest number. Our testosterone level calculator can help you note where each reading falls in your injection cycle.
What helps keep blood pressure in range?
The ACC/AHA guideline lists everyday habits that lower blood pressure for most adults. They help whether or not you’re on TRT:
- Losing extra weight, if you carry some
- Eating more vegetables, fruit and whole grains, with less salt
- Moving most days, such as brisk walking or cycling
- Drinking less alcohol, or none
- Getting enough sleep, and treating sleep apnea if you have it
If your readings creep up, don’t stop or change your testosterone or blood pressure pills on your own. Bring your log to your prescriber. They can look at your levels, your hematocrit and your other medicines together.
When is a blood pressure reading an emergency?
A reading over 180/120 needs attention right away. If you have no symptoms, wait 5 minutes and check again. If it’s still that high, call your healthcare provider.
Call 911 if your reading is over 180/120 and you have any of these:
- Sudden, severe headache
- Chest, back or belly pain
- Shortness of breath
- Numbness or weakness, or trouble speaking
- A sudden change in vision
Don’t wait to see if it comes down on its own.
What should you ask your prescriber about blood pressure?
- Should I take a baseline reading before I start?
- How often do you want me to check at home, and which numbers should I report?
- What does my product’s label say about blood pressure?
- How is my hematocrit, and could it be pushing my blood pressure up?
- If my blood pressure rises, what are the options?
How can you keep track of your blood pressure on TRT?
Blood pressure is easier to read as a trend. Logging each reading with the date, time and day in your injection cycle shows whether it’s creeping up, steady or falling.
TRTracker lets you keep your readings next to your doses and lab results. It doesn’t diagnose anything, so share anything worrying with your prescriber.