There are 4 major issues that should be considered when deciding whether or not to take testosterone. These include sleep apnea, polycythemia (an increase in red blood cells in the blood), liver toxicity, and effects on the prostate. In addition, there has been concern that testosterone might increase the risk of heart disease in men, based on the fact that men often develop heart disease earlier in life than women, and that perhaps testosterone, the major male hormone, was somehow to blame, although studies have shown conflicting evidence.

Sleep apnea is a condition in which a person holds their breath for prolonged periods while they sleep. Bedmates of individuals with sleep apnea often notice that they snore loudly and have frequent breath-holding or "apnea" episodes. Testosterone therapy can potentially make sleep apnea worse, and should be considered before starting testosterone therapy.

Polycythemia: Some men who are given testosterone will have an increase in their hemoglobin, or hematocrit levels. Hemoglobin is a substance that carries oxygen in the blood. While a mild increase may be desirable and, in fact, increases energy and exercise tolerance, an excessive increase can be dangerous, and is called polycythemia. Polycythemia can be detected with a blood test. If this develops during testosterone therapy, it usually disappears with a change in dose or type of testosterone supplement.

Liver toxicity is an exceedingly rare side effect that tends to occur only with some of the oral testosterone preparations. Supplementation with testosterone up to a normal blood level is quite safe. However, men with liver disease such as hepatitis, or who are taking other medications with potential side effects to the liver should consult with their physicians.

Prostate disease is a common problem in aging men. The prostate gland is located at the bottom of the bladder, and normally tends to enlarge as men age. Sometimes the prostate gets so large that it begins to block urine draining from the bladder. This condition is called prostatism. Although testosterone therapy can make the prostate larger and therefore potentially worsen prostatism, this concern has not been a major problem in studies done to date.

Prostate cancer is the most common cancer in men, and occurs more frequently in older men. No study to date has shown that testosterone therapy increases the frequency of prostate cancer. It is extremely important, however, to ensure that prostate cancer is not present before initiating testosterone therapy. It is also important to monitor the prostate for as long as a man is taking testosterone therapy.

2 common methods of ensuring a healthy prostate include a digital rectal exam (DRE) which is done as part of a physical exam by your physician, and a prostate specific antigen (PSA) test. The PSA test is a blood test in which the measurement number increases when the prostate has become enlarged, inflamed, or a prostate cancer exists. Both a DRE and a PSA should be done before beginning testosterone therapy, and at regular intervals during therapy.

Richard A. Bebb, MD 
in association with the MediResource Clinical Team