Patient Portal

Testosterone

Important Safety Information

  • Administration caution: Use the formulation and route that match the specific treatment plan (e.g., injection, transdermal, buccal, etc.).
  • Monitoring: Ongoing monitoring is recommended, including serum testosterone levels, hemoglobin/hematocrit, liver enzymes, lipid profile, and PSA (prostate-specific antigen) in men.
  • Risk of abuse/misuse: Testosterone products may be misused for performance or physique enhancement, which can lead to serious cardiovascular or psychological effects.
  • Pediatric use: Testosterone can prematurely close growth plates in children; use in pediatric patients must be carefully evaluated.
  • Transference risk: With topical testosterone, unintended skin-to-skin exposure to others (partners, children) may result in virilization.


Indications/Use

  • Primary hypogonadism (congenital or acquired) in men.
  • Hypogonadotropic hypogonadism (congenital or acquired) in men.
  • Selected cases of delayed puberty in adolescent males (typically short-term).
  • Palliative therapy for certain breast cancers in postmenopausal women (infrequently used today).


Contraindications

  • Men with known or suspected prostate or breast cancer.
  • Pregnancy or breastfeeding.
  • Allergic reaction to testosterone or ingredients in the formulation.
  • Severe cardiac, hepatic, or renal conditions (testosterone can worsen fluid retention).
  • Elevated hematocrit (>54%).
  • Untreated or uncontrolled sleep apnea.


Side Effects

Common side effects may include:

  • Common: Acne, oily skin, increased body or facial hair, gynecomastia (from aromatization), mood fluctuations, and hot flashes/night sweats.
  • Cardiovascular: Elevated blood pressure.
  • Hematologic: Increased hematocrit/polycythemia.
  • Hepatic: Liver abnormalities or toxicity (greater risk with oral 17-alpha alkylated forms).
  • Reproductive: Reduced sperm count (infertility), testicular shrinking, erection changes or priapism.
  • Other: Sleep disturbances, worsening sleep apnea, swelling, nipple sensitivity.


Why is it important to move injection sites?

Rotating injection sites prevents irritation, tissue damage, and scar formation. Repeated injections in the same location can cause lumps, infections, and reduced absorption of testosterone.

What are the side effects of testosterone?

Potential effects include acne, oily skin, hair changes, mood shifts, increases in estradiol, and testicular atrophy. More serious risks involve elevated red blood cell count, worsening sleep apnea, changes in prostate size, and increased blood pressure. Regular check-ins with your provider help detect and manage these issues.

What are the benefits of testosterone?

Therapy can improve energy, muscle mass, strength, sexual desire, mood, cognitive clarity, and overall quality of life for people with clinically low testosterone and related symptoms.


What is the negative feedback loop?

This refers to how the body regulates hormones. When external testosterone is introduced, the brain reduces its signaling (LH and FSH), which in turn lowers natural testosterone production. This can lead to dependency on therapy for normal hormone levels and may affect fertility.


How does testosterone affect fertility?

Testosterone therapy can suppress sperm production because the brain decreases LH and FSH once it senses higher testosterone levels. Without these signals, sperm production drops, which may reduce fertility.


What is meant by transference when someone applies topical testosterone?

Transference is the accidental spread of testosterone to another person through skin-to-skin contact. This may cause hormonal effects in the exposed person. Hands should be washed after applying the cream, and treated skin should not touch others. Some formulations may also release hormone vapor for several hours, so avoid close contact with children during that time.


What increases PSA levels?

PSA (prostate-specific antigen) can rise for various reasons, such as:

  • Benign prostatic hyperplasia (BPH): Age-related enlargement of the prostate.
  • Prostatitis: Inflammation or infection of the prostate.
  • Recent ejaculation: May temporarily elevate PSA for 24–48 hours.
  • Prostate manipulation: Exams (e.g., DRE) or catheterization.
  • Age: PSA often increases naturally over time.
  • Testosterone therapy: May cause a modest PSA increase. A rapid or significant rise requires evaluation.
  • Prostate cancer: Can elevate PSA, though PSA alone cannot confirm cancer.