Testosterone and Blood Pressure Regulation

<i>Background:</i> There is substantial evidence that androgens may play a role in determining sex-specific blood pressure. Men are at higher risk for developing coronary heart disease or hypertension compared to premenopausal women. However, effects of androgens on the renal and cardiovascular system are complex. This review provides a critical overview of testosterone actions. <i>Methods:</i> We searched Pubmed library for experimental, animal and clinical studies, using the keywords ‘blood pressure’, ‘hypertension’, ‘testosterone’ and ‘androgens’. <i>Results:</i> While acute administration of testosterone seems to decrease vascular tone, the long-term net effect of androgens appears to be vasoconstriction via upregulation of thromboxane A₂ expression, norepinephrine synthesis, angiotensin II expression, and endothelin-1 action. Furthermore, androgens cause cardiac hypertrophy, promote atherosclerosis, vascular remodelling and stimulate renal prohypertensive processes involving the renin-angiotensin-aldosterone system. Androgens seem to promote oxidative stress in the kidney and may also play a role in the differentiation of brain areas involved in blood pressure regulation. <i>Conclusion:</i> The effects of sex steroids on different parts of the renal-vascular system are complex and often contradictory. In sum, net effects of androgen action seem to be vasoconstriction, atherosclerosis and stimulation of the renin-angiotensin-aldosterone system. Therefore, androgens may determine blood pressure and the prevalence of cardiovascular disease.