Who Should NOT Receive Testosterone Replacement Therapy (TRT)?

Testosterone therapy is not appropriate for everyone. Certain conditions can make TRT unsafe or increase health risks, especially related to the prostate and cardiovascular system.
Absolute or Strong Contraindications

Men should not start TRT if they have:
• Prostate cancer (known or suspected)
• Breast cancer
• Unexplained prostate abnormalities (e.g., a lump not yet evaluated)
• Elevated PSA (Greater than 4 ng/mL) without proper assessment
• Elevated hematocrit (risk of blood thickening/clots)
• Severe congestive heart failure
• Untreated obstructive sleep apnea
Conditions Requiring Caution or Evaluation
• Enlarged prostate (BPH) with significant symptoms
• Any high-risk factors for prostate cancer

➡️ These patients need careful evaluation before considering therapy.
Required Monitoring Before & During TRT

To ensure safety, men should undergo:
• Prostate screening before starting therapy
• PSA testing at 3, 6, and 12 months in the first year, then annually
• Digital rectal exam (DRE) at 3–6 months, 1 year, then yearly
• Hematocrit monitoring before and during treatment
Important Note

Routine prostate screening (including DRE) is recommended for men around age 50 and older, even if they are not on TRT.
Bottom Line

TRT can be beneficial—but only when used safely.
Proper screening and monitoring are essential to avoid serious complications.

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