Testosterone Replacement Therapy: Effects on Blood Pressure in Hypogonadal Men

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

Abstract

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. 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. 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. 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. [Abstract copyright: Copyright © 2024 Korean Society for Sexual Medicine and Andrology.]

Citation

Hackett, G., Mann, A., Haider, A., Haider, K. S., Desnerck, P., König, C. S., …Ramachandran, S. (in press). Testosterone Replacement Therapy: Effects on Blood Pressure in Hypogonadal Men. The World Journal of Men's Health, 42, https://doi.org/10.5534/wjmh.230239

• Journal Article Type: Article
• Acceptance Date: Nov 5, 2023
• Online Publication Date: Feb 14, 2024
• Deposit Date: Mar 19, 2024
• Journal: The World Journal of Men's Health
• Print ISSN: 2287-4208
• Electronic ISSN: 2287-4690
• Peer Reviewed: Peer Reviewed
• Volume: 42
• DOI: https://doi.org/10.5534/wjmh.230239
• Keywords: Pharmacology (medical); Urology; Psychiatry and Mental health; Public Health, Environmental and Occupational Health; Health Policy; Aging; Reproductive Medicine
• Additional Information: Received: 2023-09-08; Revised: 2023-10-24; Accepted: 2023-11-05; Published online: 2024-02-14; Copyright: Copyright © 2024 Korean Society for Sexual Medicine and Andrology; License: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.