Testosterone Replacement Therapy: Effects on Blood Pressure in Hypogonadal Men

Geoffrey Hackett; Amar Mann; Ahmad Haider; Karim S Haider; Pieter Desnerck; Carola S König; Richard C Strange; Sudarshan Ramachandran

doi:10.5534/wjmh.230239

Testosterone Replacement Therapy: Effects on Blood Pressure in Hypogonadal Men

World J Mens Health. 2024 Feb 14. doi: 10.5534/wjmh.230239. Online ahead of print.

Authors

Geoffrey Hackett^{1

2}, Amar Mann³, Ahmad Haider⁴, Karim S Haider⁴, Pieter Desnerck⁵, Carola S König⁶, Richard C Strange⁷, Sudarshan Ramachandran^{3

6

7

8}

Affiliations

¹ School of Biosciences, College of Health and Life Sciences, Aston University, Birmingham, UK.
² Holly Cottage Clinic, Staffordshire, West Midlands, UK. hackettgeoff@gmail.com.
³ Department of Clinical Biochemistry, University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK.
⁴ Urological Practice Dr Haider, Bremerhaven, Germany.
⁵ Department of Engineering, University of Cambridge, Cambridge, UK.
⁶ Department of Mechanical and Aerospace Engineering, Brunel University London, London, UK.
⁷ School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK.
⁸ Department of Clinical Biochemistry, University Hospitals of North Midlands, Staffordshire, UK.

PMID: 38449452
DOI: 10.5534/wjmh.230239

Abstract

Purpose: While testosterone therapy can improve the various pathologies associated with adult-onset testosterone deficiency (TD), Summary of Product Characteristics (SPC) of five testosterone preparations caution that treatment may be associated with hypertension. This paper evaluates the impact of testosterone undecanoate (TU) on blood pressure (BP) in men with adult-onset TD.

Materials and methods: Of 737 men with adult-onset TD in an on-going, observational, prospective, cumulative registry, we studied changes in BP using non-parametric sign-rank tests at final assessment and fixed time points. We used multiple regression analysis to establish factors (baseline BP, age, change/baseline waist circumference [WC] and hematocrit [HCT] and follow-up) potentially associated with BP change in men on TU.

Results: TU was associated with significant reductions in systolic, diastolic BP and pulse pressure, regardless of antihypertensive therapy (at baseline or during follow-up), larger reductions were seen with concurrent antihypertensive therapy. In men never on antihypertensive agents, median changes (interquartile range [IQR]) in systolic BP, diastolic BP and pulse pressure were -12.5 (-19.0, -8.0), -8.0 (-14.0, -3.0), and -6.0 (-10.0, -1.0) mmHg, respectively at final assessment, with only baseline BP values inversely associated with these changes (HCT and WC were not significantly associated). In men not on TU, systolic BP, diastolic BP, and pulse pressure significantly increased. In the TU treated men only 1 of the 152 men (not on antihypertensive agents at baseline) were started on antihypertensives during follow-up. In contrast 33 of the 202 men on antihypertensives (at baseline or follow-up) had the antihypertensive agent discontinued by the end of the follow-up.

Conclusions: TU was associated with lowering of BP during follow-up irrespective of antihypertensive therapy, with greater reductions in men with higher baseline BP. In the context of SPC warnings, our long-term data provide reassurance on the effect of TU on BP.

Keywords: Blood pressure; Hematocrit; Hypogonadism; Testosterone; Waist circumference.

Grants and funding

PID-200078/North Staffordshire Medical Institute/United Kingdom