TRT can sometimes lead to an increase in blood pressure, known as hypertension. Understanding the causes, risk factors, and management strategies can help mitigate this potential side effect.

Causes of Hypertension on TRT

• Water Retention: Increased testosterone levels can lead to additional water retention in the body, which can subsequently raises blood pressure.
• Elevated Estrogen Levels: Testosterone can convert to estrogen through a process called aromatisation. Elevated estrogen levels can further contribute to water retention, exacerbating hypertension.
• Poor Cardiovascular Fitness: Individuals with poor cardiovascular fitness are more prone to experiencing elevated blood pressure on TRT. A less conditioned heart and circulatory system may struggle to handle the increased blood volume and pressure caused by water retention. The heart has to work harder to pump blood through less elastic and more constricted blood vessels, leading to higher blood pressure levels. Regular cardiovascular exercise is essential to enhance the heart’s efficiency and the overall flexibility of blood vessels, helping to mitigate this side effect.

Risk Factors

Individuals with the following conditions are more susceptible to experiencing increased blood pressure while on TRT:

• Poor Cardiovascular Fitness: Lack of regular physical activity weakens the heart and blood vessels, making it harder for the body to manage increased fluid volumes.
• Poor Metabolic Health: Conditions such as insulin resistance and obesity can impair the body's ability to regulate blood pressure effectively.
• High Body Fat Levels: Excess body fat, especially around the abdomen, is associated with higher blood pressure and increased water retention.
• Anxiety: Chronic stress and anxiety can lead to sustained increases in blood pressure and may amplify the hypertensive effects of TRT.