Contraindications and Precautions for Testosterone Therapy

Absolute Contraindications

The European Association of Urology recommends that testosterone therapy is contraindicated in men with carcinomas of the prostate, as well as in men seeking fertility due to its suppressive effect on spermatogenesis 1, 2
The American College of Physicians suggests that oral testosterone formulations are contraindicated in men with hypogonadal conditions not associated with structural or genetic etiologies, such as age-related hypogonadism 3
The European Urology guidelines state that active or treated male breast cancer remains an absolute contraindication for testosterone therapy due to limited safety data 1

The American Academy of Sleep Medicine recommends that testosterone therapy may exacerbate or lead to development of sleep apnea in patients with severe untreated obstructive sleep apnea 4
The European Urology guidelines suggest that testosterone therapy should be used with caution in men with severe lower urinary tract symptoms, though studies show it generally doesn't worsen symptoms in those with mild-moderate LUTS 1
The National Kidney Foundation recommends that testosterone should be used cautiously in patients with renal insufficiency due to fluid retention risk 4
The American Association for the Study of Liver Diseases suggests that while intramuscular and transdermal preparations don't appear to cause hepatic dysfunction, oral preparations have been associated with hepatotoxicity 4
The European Urology guidelines state that testosterone testing and therapy should be avoided during acute illness 1
The American Heart Association recommends that PDE5 inhibitors, often used with testosterone for erectile dysfunction, are contraindicated with nitrates due to dangerous blood pressure decreases 2

The National Comprehensive Cancer Network recommends that testosterone therapy should not be used in men with prostate cancer on active surveillance 2
The National Comprehensive Cancer Network suggests that testosterone therapy is contraindicated in men with prostate cancer on androgen deprivation therapy 2
The American College of Cardiology recommends that patients with recent cardiovascular events were typically excluded from testosterone trials, limiting data on safety in this population 3

The American Urological Association recommends that before starting therapy, patients should undergo digital rectal examination and PSA testing 4
The American Urological Association suggests that follow-up evaluations should be performed every 3-6 months for the first year and annually thereafter 4
The National Comprehensive Cancer Network recommends that PSA monitoring should be performed, with biopsy indicated for PSA increase of 1.0 ng/ml in any year or if PSA rises by 0.7–0.9 ng/ml with further increase in 3–6 months 4

The European Urology guidelines state that recent evidence, such as the TRAVERSE trial, confirmed no difference in prostate cancer incidence between testosterone and placebo groups at a mean follow-up of 33 months 1