Effects of testosterone treatment, with and without exercise training, on ambulatory blood pressure in middle‐aged and older men

Abstract

Context With age, testosterone (T) and physical activity levels often decline in parallel. The effect of combining T treatment and exercise training on ambulatory blood pressure (ABP) is unclear. Objective To assess T and exercise effects, alone and in combination, on ABP in men aged 50–70 years, waist circumference ≥ 95 cm and low‐normal serum T (6–14 nmol/L), without organic hypogonadism. Design A 2 × 2 factorial randomised, placebo‐controlled study. Intervention Randomization to daily transdermal AndroForte5® (Testosterone 5.0%w/v, 100 mg in 2 ml) cream (T), or matching placebo (P) (double‐blind), and to supervised exercise (Ex) or no additional exercise (NEx), for 12 weeks. Results Average 24‐h systolic blood pressure (SBP) increased with T treatment (testosterone*time, p = .035). Average 24‐h SBP increased in T+Ex (T+Ex:+3.0 vs. P+NEx: −3.0 mmHg, p = .026) driven by day‐time changes (T+Ex:+3.5 vs. P+NEx: −3.0 mmHg, p = .026). There was an effect of T for 24‐h average diastolic blood pressure (DBP, testosterone*time, p = .044) driven by the decrease in P+Ex (P+Ex: −3.9 vs. T+NEx: −0.5 mmHg, p = .015). Night‐time DBP was lower with exercise (P+Ex: −4.0 vs. P+NEx: +0.7 mmHg, p = .032). The effect of exercise to lower night‐time DBP was not apparent in the presence of T (T+Ex: −0.4 vs. P+NEx: +0.7 mmHg, p > .05). Ex increased average 24‐h pulse pressure (PP, exercise*time, p = .022), largely during daytime hours (exercise*time, p = .013). Conclusions There was a main effect of T to increase 24‐h SBP, primarily seen when T was combined with Ex. Exercise alone decreased 24‐h and night‐time DBP; an effect attenuated by T. BP should be carefully assessed and monitored, when prescribing T treatment to middle‐aged and older men, especially when combined with exercise training.

Blood pressure responses to testosterone therapy are amplified by hematocrit levels in opioid-induced androgen deficiency: a double-blind, randomized, placebo-controlled trial

“…The largest observational study examining the effect of TRT (IPASS) found after injectable testosterone therapy a beneficial effect on BP with a small reduction of SBP and DBP of 2.1 and 1.1 mmHg, respectively [30]. Although most TRT studies have not reported an increase in BP during testosterone treatment, recent studies examining the effect of oral TRT on 24hABPM report an increase in SBP in the range of 3–5 mmHg [31–34], which is similar to the findings of our study. A recent large randomized study conducted among men with increased cardiovascular risk and total testosterone levels less than 10.4 nmol/l investigated the effects of TRT with a follow-up period of 33 months [35].…”

“…Although most TRT studies have not reported an increase in BP during testosterone treatment, recent studies examining the effect of oral TRT on 24hABPM report an increase in SBP in the range of 3-5 mmHg [31][32][33][34], which is similar to the findings of our study. A recent large randomized study conducted among men with increased cardiovascular risk and total testosterone levels less than 10.4 nmol/l investigated the effects of TRT with a follow-up period of 33 months [35].…”

Impact of Water and Land-Based Exercise Training on Risk Factors and Vascular Function in Middle-Aged and Older Men and Women

“…It is perhaps germane that testosterone deficiency increases with age in men (35). Although studies indicate that resistance or circuit weight training is beneficial in older men with lower testosterone levels (36)(37)(38), it remains unclear whether walking exercise is a sufficient stimulus to induce skeletal muscle hypertrophy (22,39,40) and whether these effects may be more pronounced when comparing sexes. Despite a larger impact of training on lean mass in women, visceral fat mass decreased more in men, albeit from a higher starting level.…”

Testosterone, cognitive decline and dementia in ageing men

“…It is possible that larger and longer clinical trials may be required, and that route of administration of testosterone and differences in pharmacokinetics may be relevant [ 34 ]. It is also possible that combining testosterone with a lifestyle intervention, may provide a more informative clinical trial strategy [ 98 , 111 , 112 ].…”