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.