In Detail
Testosterone therapy, prescribed and monitored appropriately, has a well-established safety profile. The largest contemporary trials have not shown an increase in cardiovascular events or prostate cancer in properly selected men, and the historical concerns from older, lower-quality studies have been substantially revised.
Risks that do require monitoring include erythrocytosis (elevated red blood cell count), changes in PSA, fertility suppression, acne, and fluid retention. These are managed through lab monitoring at predictable intervals, dose adjustment, and occasionally adjunct medications.
Contraindications include untreated prostate or breast cancer, severe untreated sleep apnea, untreated polycythemia, and uncontrolled heart failure. Men actively trying to conceive should generally not be on standard testosterone therapy. A thorough pre-treatment evaluation identifies who is and is not an appropriate candidate.