Clinical guidelines established by the Endocrine Society and the American Urological Association identify clear absolute and relative contraindications to testosterone therapy.
Men with known or suspected prostate cancer, male breast cancer, or an uninvestigated elevated PSA are excluded because androgens can accelerate certain hormone-sensitive malignancies. Uncontrolled congestive heart failure and recent myocardial infarction or stroke also warrant avoiding or delaying treatment.
Men desiring active fertility in the near future should avoid exogenous testosterone because it suppresses luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and may reduce sperm production.
Patients with baseline erythrocytosis (hematocrit greater than 50% to 54%) or untreated severe obstructive sleep apnea require thorough evaluation and management before therapy can be considered.
Risks and limitations
- Candidacy can only be determined through comprehensive laboratory testing and an in-person clinical assessment.
- Some contraindications, such as untreated sleep apnea or mild polycythemia, may be manageable so that treatment can be safely reconsidered at a later date.