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

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.