Contraindications to testosterone therapy

Contraindications to testosterone therapy

The main contraindications to testosterone therapy (T therapy) are:1

• Prostate cancer (locally advanced or metastatic)
• Male breast cancer
• An active desire to father children
• Haematocrit >54%
• Severe chronic heart failure (NYHA class IV)

An unevaluated prostate nodule or induration, or raised prostate specific antigen (PSA), should be fully investigated prior to starting T therapy.

Untreated sleep apnoea and severe LUTS have previously been considered contraindications to T Therapy, but more recent evidence suggests this may no longer be the case.2 These conditions should however, be fully investigated and optimally manged before starting treatment with testosterone.

References

• 1. Dohle GH, Arver S, Bettochi C et al. Guidelines on Male Hypogonadism. European Association of Urology 2017. Available at: http://uroweb.org/guideline/male-hypogonadism/ (Accessed May 2018).
• 2. Seftel AD, Kathrins M, Niederberger C. Critical update of the 2010 Endocrine Society clinical practice guidelines for male hypogonadism: a systematic analysis. Mayo Clin Proc 2015;90:1104-1115