Adverse Effects of Bioidentical Hormones

Testosterone Adverse Effects

The American Urological Association recommends that testosterone therapy should not be initiated for 3-6 months after cardiovascular events, and commercially manufactured FDA-approved products should be prescribed rather than compounded testosterone whenever possible due to quality and potency concerns with compounded products 1, 2
Topical testosterone preparations carry a significant risk of secondary exposure to women and children, potentially causing virilization, precocious puberty, and hyperandrogenism 1, 2
Transdermal patches cause skin reactions in up to 66% of users, while gel preparations cause similar reactions in about 5% of users 3, 4
Erythrocytosis is a common adverse effect, with higher risk from injections than topical preparations, and risk increases with higher testosterone doses 4, 6
Testosterone therapy significantly impairs fertility by interrupting normal spermatogenesis, potentially causing severe oligospermia or azoospermia 1, 2
The Endocrine Society recommends baseline and follow-up measurements of PSA and hematocrit/hemoglobin levels, digital rectal examination, assessment of voiding symptoms and sleep apnea, and initial follow-up at 1-2 months, then every 3-6 months for the first year, and yearly thereafter 3, 5

Breast examinations should be performed regularly in women on estrogen therapy 7

The FDA has not approved any "bioidentical hormone therapy" for prevention of chronic diseases in postmenopausal women, and alkylated oral testosterone should not be prescribed due to risk of liver toxicity 1, 2, 8

Testosterone therapy should be used with extreme caution in men with existing cardiovascular disease, and should not be used in men trying to conceive 1, 2
Careful monitoring is needed when using testosterone in men with sleep apnea risk factors 3