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

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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. To assess T and exercise effects, alone and in combination, on ABP in men aged 50-70years, waist circumference≥95cm and low-normal serum T (6-14nmol/L), without organic hypogonadism. A 2 × 2 factorial randomised, placebo-controlled study. Randomization to daily transdermal AndroForte5® (Testosterone 5.0%w/v, 100mg in 2ml) cream (T), or matching placebo (P) (double-blind), and to supervised exercise (Ex) or no additional exercise (NEx), for 12weeks. 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: -3.0mmHg, p=.026) driven by day-time changes (T+Ex:+3.5 vs. P+NEx: -3.0mmHg, 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: -0.5mmHg, p=.015). Night-time DBP was lower with exercise (P+Ex: -4.0 vs. P+NEx: +0.7mmHg, 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: +0.7mmHg, p>.05). Ex increased average 24-h pulse pressure (PP, exercise*time, p=.022), largely during daytime hours (exercise*time, p=.013). 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.