Blood Pressure on TRT: What Actually Raises It
BLOOD PRESSURE ON TRT: WHAT ACTUALLY RAISES IT
Blood pressure on TRT usually rises a little. In February 2025 the FDA said ambulatory monitoring studies confirmed a blood pressure increase with all testosterone products, class wide. The same update removed boxed warning language about heart events, based on TRAVERSE.
So does TRT raise blood pressure? On average, by a few points. This guide shows how much by product, what drives the bigger rises, who is at risk and what to monitor. Every figure comes from a PubMed abstract, the FDA or the gel label, listed at the end. Related: high hematocrit on TRT.
Blood pressure on TRT in three numbers
Three numbers frame blood pressure on TRT: the average rise, the rise when hematocrit climbs, and the heart outcome result.
24 hour systolic rise on gel at 16 weeks
From the AndroGel 1.62% label, section 5.5 (AndroGel label).
Systolic rise when hematocrit rose most
Top quarter of hematocrit change on an oral product (PMID 34191621).
Major heart events, testosterone vs placebo
TRAVERSE, 5,246 men at high heart risk (PMID 37326322).
Figures come from PubMed abstracts, the FDA class wide labeling update of February 2025 and the AndroGel 1.62% label. Where no study gives a number, we say so.
What this guide to blood pressure on TRT covers
Does TRT raise blood pressure? The FDA position and the monitoring studies.
TRT blood pressure by product: gel, patch and oral capsules.
What drives bigger rises: hematocrit, body weight and existing hypertension.
Not covered
Blood pressure medication choices. Those belong to your doctor.
Does TRT raise blood pressure? The FDA answer
Yes, on average. In February 2025 the FDA required class wide labeling changes for testosterone products (FDA, February 2025).
Ambulatory monitoring studies confirmed an increase in blood pressure with all testosterone products. Labels without a blood pressure warning received one (FDA, February 2025).
In practice, every testosterone label now carries a blood pressure warning, whatever the form.
The same update added TRAVERSE results to all labels and removed boxed warning language about adverse cardiovascular outcomes (FDA, February 2025).
In TRAVERSE, major heart events occurred in 7.0 percent of men on testosterone gel and 7.3 percent on placebo (PMID 37326322).
TRT blood pressure by product
Several products were tested with 24 hour monitoring, which captures blood pressure through the day and night. Rule of thumb: that beats a single office reading.
| Product | Systolic rise | Diastolic rise | Source |
|---|---|---|---|
| Gel 1.62%, 16 weeks | 1.9 mm Hg | 1.3 mm Hg | AndroGel label |
| Gel, men on BP pills | 3.0 mm Hg | 2.2 mm Hg | AndroGel label |
| Nightly patch, 16 weeks | 3.5 mm Hg | Not in abstract | PMID 38876182 |
| Oral undecanoate, 4 months | 3.8 mm Hg | 1.2 mm Hg | PMID 34191621 |
These were separate studies in different men, so the numbers are not a head to head ranking. The patch study found larger changes in men who already had hypertension (PMID 38876182).
In the oral study, awake systolic pressure rose 5.2 mm Hg and sleep systolic 4.3 mm Hg (PMID 34191621).
About 48 percent of the men in that oral study already had hypertension (PMID 34191621). In the patch study, changes were larger in the daytime than at night (PMID 38876182).
What actually raises blood pressure on TRT
The strongest signal in the studies is hematocrit, the share of your blood made of red cells.
In 138 men on an oral product, hematocrit rose by 3.2 points on average (PMID 34191621).
Men in the top quarter of hematocrit rise, 6 to 14 points, had the largest systolic rise, about 8.3 mm Hg. The other quarters averaged 1.9 to 3.3 mm Hg (PMID 34191621).
A placebo controlled trial tested men with low testosterone caused by opioid treatment. At 6 months, office systolic pressure was 13.2 mm Hg higher on TRT than on placebo (PMID 38088425).
Part of that gap came from the placebo group: their pressure fell 7.0 mm Hg while the TRT group rose 6.2 (PMID 38088425).
In that trial, higher blood pressure on TRT was linked to higher hematocrit. Baseline BMI, hematocrit and hemoglobin amplified the daytime rise (PMID 38088425).
| Driver | What the study found | Source |
|---|---|---|
| Rising hematocrit | Top quarter: about 8.3 mm Hg systolic rise | PMID 34191621 |
| Higher baseline hematocrit and hemoglobin | Amplified the daytime rise | PMID 38088425 |
| Obesity (higher BMI) | Amplified the daytime rise | PMID 38088425 |
| Existing hypertension | Larger rises on gel and patch | AndroGel label; PMID 38876182 |
Why some studies show blood pressure falling on TRT
Not every study shows a rise. A long running registry of 737 men on long acting testosterone undecanoate injections reported falling blood pressure (PMID 38449452).
In men never on blood pressure pills, median systolic pressure fell 12.5 mm Hg and diastolic 8.0 mm Hg by the final visit (PMID 38449452).
Men not on testosterone in the registry saw blood pressure rise (PMID 38449452).
The registry also reported bigger reductions in men who started with higher blood pressure (PMID 38449452). That pattern can also reflect regression to the mean, a common effect in observational data.
Only 1 of 152 treated men not on blood pressure pills started them during follow up. And 33 of 202 men on blood pressure pills had them stopped (PMID 38449452).
This was an observational registry, not a randomized trial. Men chose their treatment, and weight loss and other changes can drive blood pressure down.
| Study type | Finding | Strength |
|---|---|---|
| FDA review of ambulatory studies | Increase with all products | Regulator, class wide |
| Placebo controlled trial | Office systolic 13.2 mm Hg higher on TRT (PMID 38088425) | Randomized |
| Observational registry | Systolic fell 12.5 mm Hg (PMID 38449452) | Observational |
TRT blood pressure and heart events
A rise of a few points raises a fair question: does it turn into heart attacks or strokes? The best data comes from TRAVERSE.
TRAVERSE enrolled 5,246 men aged 45 to 80 with heart disease or high heart risk. Major heart events occurred in 7.0 percent on testosterone gel and 7.3 percent on placebo (PMID 37326322).
The trial did find more atrial fibrillation, acute kidney injury and pulmonary embolism on testosterone (PMID 37326322).
In the patch study, cardiovascular adverse events were rare, under 2 percent, and none were serious. The authors said the rise may not be clinically meaningful for heart events (PMID 38876182).
Who should watch TRT high blood pressure most
| Group | Why | Source |
|---|---|---|
| Men with uncontrolled hypertension | Gel not recommended in this group | AndroGel label |
| Men already on BP pills | Larger rise on gel: 3.0/2.2 mm Hg | AndroGel label |
| Men whose hematocrit climbs | Largest systolic rises | PMID 34191621 |
| Men with obesity | Amplified daytime rise | PMID 38088425 |
The gel label states that the product is not recommended for men with uncontrolled hypertension (AndroGel label).
Rule of thumb: get blood pressure under control before starting, not after. A few points matter more when you start high.
How to monitor blood pressure on TRT
Rule of thumb: one office reading can mislead. All the product numbers above came from 24 hour monitoring.
| When | What | Why |
|---|---|---|
| Before starting | Home readings for a week, morning and evening | Your baseline |
| First months | Home readings a few days each week | Rises appeared within 16 weeks (AndroGel label; PMID 38876182) |
| With every blood test | Compare blood pressure with hematocrit | They rose together (PMID 34191621) |
| After any dose or form change | Repeat a week of readings | Different forms gave different rises |
The 16 week window comes from the gel and patch studies (AndroGel label; PMID 38876182). The rest of the plan is rule of thumb.
What to do if blood pressure rises on TRT
These steps follow the drivers in the studies. Dose, form and medication changes belong to your prescriber.
1. Confirm it. Rule of thumb: a week of home readings beats one high office number.
2. Check hematocrit. The biggest rises went with the biggest hematocrit gains (PMID 34191621).
3. Review the dose and form. Rises differed by product in separate studies (AndroGel label; PMID 38876182, 34191621).
4. Work on weight. Higher BMI amplified the rise on TRT (PMID 38088425).
5. Treat blood pressure if needed. The gel label reports men already on blood pressure pills in its monitoring study (AndroGel label).
6. Keep the log going. Rule of thumb: after any change, a fresh week of readings shows whether TRT blood pressure has settled.
Blood pressure on TRT: frequently asked questions
Does TRT raise blood pressure?
On average, a little. The FDA said in 2025 that ambulatory studies confirmed an increase with all testosterone products (FDA, February 2025).
How much does testosterone raise blood pressure?
In 24 hour monitoring, systolic rose 1.9 mm Hg on gel (AndroGel label). It rose 3.5 mm Hg on a patch (PMID 38876182) and 3.8 mm Hg on an oral capsule (PMID 34191621).
Why does TRT raise blood pressure?
Hematocrit is the strongest signal. Men with the biggest hematocrit rise had about an 8.3 mm Hg systolic rise (PMID 34191621).
Can I start TRT if I have high blood pressure?
The gel label says it is not recommended in uncontrolled hypertension (AndroGel label). Controlled blood pressure is a discussion with your prescriber.
Does TRT cause heart attacks?
In TRAVERSE, major heart events occurred in 7.0 percent on testosterone and 7.3 percent on placebo (PMID 37326322).
Can TRT lower blood pressure?
One observational registry reported falling blood pressure on testosterone undecanoate (PMID 38449452). Randomized and monitored data show small rises.
Which form of TRT raises blood pressure least?
In separate studies, gel raised 24 hour systolic 1.9 mm Hg (AndroGel label), a patch 3.5 (PMID 38876182) and an oral capsule 3.8 (PMID 34191621).
How often should I check blood pressure on TRT?
Rule of thumb: daily for a week before starting, then a few days a week in the first months, and with every blood test.
Sources and further reading
Every figure on this page comes from one of the 7 sources below. That is the FDA labeling update, the AndroGel 1.62% label and 5 papers checked against PubMed on 27 October 2026. Advice marked rule of thumb is practical guidance without a study behind it. Reference links are dofollow to support open science.
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More from the TRT series
Four pages that sit next to blood pressure on TRT.
Final Educational Note
This article is educational and is not medical advice. It reports what the FDA, the testosterone gel label and published studies say about blood pressure on testosterone therapy. Any change to dose, form or blood pressure medication belongs to your prescriber.
Very high readings, chest pain, severe headache or vision changes need urgent care. More guides sit on the TRT and hormones hub. Read more on the about page and in the full disclaimer.
