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Some men shouldn't be on testosterone.
Most clinics won't tell you that, because they make money when you start. Here are five reasons Peter will say no — and the reasoning behind each one, so you can judge for yourself.
My job is not to sell you testosterone. My job is to teach you about it, so we can do what's safe, ethical and medically right.
Peter O'Brien, NP1. Planning for children?
If you are trying to have a child now or may want to within the next year, let us know before starting testosterone therapy. Testosterone can significantly reduce sperm production and, in some men, temporarily stop sperm production altogether.
After testosterone is discontinued, sperm production often recovers over several months, but recovery can take a year or longer and varies from person to person. If maintaining fertility is important to you, we can discuss your goals before treatment and review other options that may be more appropriate.
2. You have active or untreated prostate cancer
Worth being precise here, because the internet is not. Testosterone does not cause prostate cancer. That myth has been around for decades and it isn't supported.
But if you already have prostate cancer and it's active or untreated, you shouldn't start testosterone while that's the case. It's one of the reasons PSA is on every lab panel we run — baseline and then ongoing.
3. You have sleep apnea that isn't under control
Low oxygen overnight is hard on your heart, your blood pressure and your general health before testosterone enters the picture. Testosterone also thickens the blood slightly, which doesn't help.
If any of this sounds like you, get screened before you start:
- You snore loudly
- You wake up gasping
- You're exhausted even after a full night's sleep
Treated apnea isn't a barrier. Untreated apnea is a reason to wait.
4. You have uncontrolled heart failure
Men with heart failure need clearance from their cardiologist before starting testosterone. Not from us — from the specialist who knows their heart.
The honest state of the evidence: there are a lot of studies on testosterone and heart failure, and when researchers pooled them together in a meta-analysis, the result came back inconclusive. That's the real answer, and it's why we defer to your cardiologist rather than guessing.
5. You're not doing proper labs
This is the one that turns a safe treatment into a dangerous one, and it's entirely avoidable.
No responsible clinic should ever give you testosterone without a proper set of labs. Baseline before you start. Follow-up labs after. Tracking how you're actually feeling. Proper dosing. Ongoing blood monitoring.
If a clinic will prescribe after a form and a credit card, that tells you what you need to know about how closely they'll be watching once you're a customer.
Testosterone therapy can be very safe when it's prescribed appropriately, monitored carefully, and tailored to the individual. Good outcomes come from careful evaluation, appropriate dosing, and consistent follow-up.
Peter O'Brien, NPWhat we watch, and why
- PSA — prostate
- Hemoglobin and hematocrit — blood thickness
- Estrogen — balance
- Total and free testosterone — are we actually there yet
- Liver enzymes
If none of this applies to you
Then testosterone may well be worth a conversation. It starts with bloodwork, not with a prescription, and if the numbers don't support treatment we'll tell you that too.
My job is to optimize your health safely, not rush you into something that isn't right.
Start with a conversation. If it isn't a fit, that's a useful answer too.