What health condition would keep you from testosterone treatment? Testosterone replacement therapy (TRT) is prescribed for men with clinically confirmed hypogonadism, but certain medical conditions make treatment unsafe or require careful specialist assessment. Absolute contraindications include active prostate cancer and male breast cancer, where testosterone could accelerate disease progression. Relative contraindications—such as severe heart failure, polycythaemia, cardiovascular disease, and obstructive sleep apnoea—require individualised risk-benefit evaluation. Before commencing TRT, comprehensive medical assessment including blood tests, prostate examination, and cardiovascular screening is essential. This article examines which health conditions prevent or complicate testosterone treatment in the UK.

What Health Conditions Prevent Testosterone Treatment?

Testosterone replacement therapy (TRT) is a medical treatment prescribed for men with clinically confirmed hypogonadism—a condition where the body produces insufficient testosterone. Whilst TRT can effectively alleviate symptoms such as fatigue, reduced libido, and loss of muscle mass, it is not suitable for everyone. Certain pre-existing health conditions represent contraindications to testosterone treatment, meaning the therapy may be unsafe or require careful risk-benefit assessment.

Absolute contraindications are conditions where testosterone therapy should not be initiated due to significant safety concerns. These include active or suspected prostate cancer and male breast cancer. In these situations, testosterone could potentially worsen the underlying condition or accelerate disease progression.

Relative contraindications are conditions where testosterone may still be considered, but only after thorough evaluation and with enhanced monitoring. These include cardiovascular disease, severe heart failure (where treatment should be avoided or initiated only under specialist supervision), benign prostatic hyperplasia with moderate symptoms, polycythaemia (elevated red blood cell count), obstructive sleep apnoea, and severe lower urinary tract symptoms. Men planning to conceive should also avoid TRT as it suppresses sperm production. The decision to proceed with treatment in these cases requires individualised assessment by a specialist, typically an endocrinologist or urologist.

Before commencing testosterone therapy, clinicians must conduct a comprehensive medical history and physical examination, alongside baseline blood tests including full blood count, prostate-specific antigen (PSA), and a digital rectal examination (DRE). Additional tests such as lipid profiles and liver function may be appropriate for cardiovascular and metabolic assessment. The MHRA and NICE emphasise that testosterone should only be prescribed when there is biochemical evidence of hypogonadism (typically two early-morning testosterone measurements below the reference range) combined with relevant clinical symptoms. TRT is not appropriate for age-related decline in testosterone without confirmed hypogonadism. Patients with any contraindicated conditions should discuss alternative management strategies with their healthcare provider.

Prostate and Breast Cancer Contraindications

Prostate cancer represents an absolute contraindication to testosterone replacement therapy. Testosterone and its metabolite dihydrotestosterone (DHT) are androgens that can stimulate the growth of prostate tissue, including malignant cells. Whilst there is no conclusive evidence that testosterone therapy causes prostate cancer in men with normal prostates, administering testosterone to someone with existing prostate cancer could potentially accelerate tumour growth and disease progression.

Before initiating TRT, all men should undergo a baseline prostate evaluation, which includes a digital rectal examination (DRE) and measurement of serum prostate-specific antigen (PSA). Men with an elevated PSA level (above age-specific thresholds), abnormal DRE findings, or a history of prostate cancer should not receive testosterone therapy until prostate malignancy has been definitively excluded. If PSA rises significantly during treatment or DRE becomes abnormal, urgent referral to urology should be made following NICE NG12 guidance.

For men with a previous history of successfully treated prostate cancer, the decision to consider testosterone therapy is complex and requires specialist urological and oncological input. TRT may be considered in highly selected men after definitive treatment and a prolonged disease-free interval, though evidence remains limited and careful monitoring is essential.

Male breast cancer, though rare, is another absolute contraindication to testosterone treatment. Testosterone can be converted to oestradiol through the enzyme aromatase, and oestrogen can stimulate breast tissue growth. In men with breast cancer or a history of the condition, testosterone therapy could theoretically promote cancer recurrence or progression.

Men with benign prostatic hyperplasia (BPH) require careful assessment before starting testosterone. Whilst BPH is not an absolute contraindication, men with severe lower urinary tract symptoms (LUTS) should have their condition optimally managed before considering TRT. Regular monitoring of PSA levels and prostate symptoms is essential throughout treatment, as recommended in product SmPCs.

Heart Disease and Cardiovascular Risk Factors

Cardiovascular conditions represent important considerations when assessing suitability for testosterone replacement therapy. The relationship between testosterone and cardiovascular health is complex and has been the subject of considerable research and regulatory scrutiny. In 2014, the MHRA issued safety communications regarding potential cardiovascular risks associated with testosterone therapy.

Severe heart failure requires careful consideration before initiating testosterone treatment. Testosterone can cause fluid retention, which may exacerbate heart failure symptoms. UK SmPCs advise caution in men with severe cardiac, hepatic or renal insufficiency, and recommend stopping treatment if oedema develops. Men with severe heart failure should only be considered for TRT under specialist supervision.

Men with a recent cardiovascular event—including myocardial infarction, stroke, or transient ischaemic attack—should defer testosterone therapy until their condition has stabilised and they have been thoroughly evaluated by a cardiologist. The MHRA and European Medicines Agency (EMA) have concluded that evidence for increased cardiovascular risk with testosterone is inconclusive, but caution is still advised, particularly in older men and those with pre-existing cardiovascular disease.

Uncontrolled hypertension requires optimisation before considering testosterone therapy, as TRT may affect blood pressure in some individuals. Men with multiple cardiovascular risk factors—including diabetes, hyperlipidaemia, obesity, and smoking—require particularly careful assessment. The decision to proceed with testosterone in these cases should involve shared decision-making, with patients fully informed of potential risks and benefits.

Regular cardiovascular monitoring is essential for all men receiving testosterone therapy, including blood pressure measurement, lipid profile assessment, and evaluation for symptoms such as chest pain, breathlessness, or leg swelling. Any concerning cardiovascular symptoms should prompt immediate medical review and consideration of treatment discontinuation.

Blood Disorders and Clotting Conditions

Testosterone replacement therapy has significant effects on haematological parameters, making certain blood disorders important contraindications or conditions requiring enhanced monitoring. The most clinically relevant effect is testosterone's stimulation of erythropoiesis—the production of red blood cells in the bone marrow. This occurs through increased erythropoietin production and enhanced sensitivity of bone marrow progenitor cells to erythropoietin.

Polycythaemia (elevated red blood cell count) is a relative contraindication to testosterone therapy. Men with a haematocrit at or above 50% should not commence TRT until the underlying cause has been investigated and the haematocrit normalised. Testosterone-induced erythrocytosis is one of the most common adverse effects of TRT, with higher rates seen with intramuscular testosterone preparations compared to topical formulations. Elevated haematocrit increases blood viscosity, which theoretically raises the risk of thrombotic events including deep vein thrombosis, pulmonary embolism, stroke, and myocardial infarction.

Men with a history of venous thromboembolism (VTE), including deep vein thrombosis or pulmonary embolism, require careful evaluation before starting testosterone. Whilst there is no definitive evidence that testosterone directly increases VTE risk in men without polycythaemia, the potential for testosterone to elevate haematocrit means these patients require particularly vigilant monitoring. Those with inherited thrombophilias or recurrent VTE may not be suitable candidates for TRT.

Monitoring requirements for men on testosterone therapy include full blood count measurement at baseline, 3-6 months after initiation, and then annually. If haematocrit rises above 54%, testosterone dose reduction or temporary treatment cessation is recommended. Some men may require therapeutic venesection (blood removal) to manage persistent erythrocytosis. Men should be advised to maintain adequate hydration and report any symptoms suggestive of thrombosis, such as unilateral leg swelling, chest pain, or breathlessness, immediately to their GP or emergency services.

When to Discuss Your Medical History with Your GP

Open and comprehensive communication with your GP about your complete medical history is essential before considering testosterone replacement therapy. Many men may feel hesitant to discuss symptoms of low testosterone, such as reduced libido, erectile dysfunction, or fatigue, but these conversations are crucial for safe and appropriate treatment decisions.

You should specifically inform your GP if you have:

• Any history of prostate problems, including elevated PSA, abnormal prostate examinations, prostate cancer, or significant urinary symptoms

• Current or previous breast cancer, or any breast lumps or discharge

• Heart disease, including previous heart attacks, angina, heart failure, or stroke

• High blood pressure, particularly if poorly controlled

• Blood clots in your legs or lungs (deep vein thrombosis or pulmonary embolism)

• Sleep apnoea or significant snoring with daytime sleepiness

• Liver or kidney disease

• Epilepsy or migraine headaches

• Diabetes or metabolic syndrome

• Any blood disorders or abnormal blood test results

• Plans for conception or fertility, as testosterone therapy suppresses sperm production

Your GP will need to conduct a thorough assessment before referring you to a specialist for consideration of testosterone therapy. This includes discussing your symptoms in detail, performing a physical examination, and arranging baseline blood tests. Two early-morning (before 11 am) testosterone measurements are required to confirm biochemical hypogonadism, as testosterone levels fluctuate throughout the day and can be temporarily suppressed by acute illness, stress, or obesity.

When to seek urgent medical advice: If you are already receiving testosterone treatment, contact your GP promptly if you experience chest pain, breathlessness, leg swelling, sudden severe headache, visual changes, difficulty passing urine, or any other concerning symptoms. These may indicate serious complications requiring immediate assessment and potential treatment modification. Regular follow-up appointments are essential for monitoring treatment efficacy and safety, typically at 3 months, 6 months, and then annually, with more frequent review if you have any relative contraindications or develop complications.

If you experience any suspected side effects from testosterone treatment, you can report these through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

Frequently Asked Questions