Contraindications to testosterone treatment

Effects and side-effects of testosterone therapy have been described in detail above. Here the major reasons for not initiating or for interrupting testosterone therapy are briefly summarized.

The major contraindication to testosterone therapy is a prostate carcinoma. A patient with an existing prostate carcinoma should not receive testosterone. A carcinoma has to be excluded before starting therapy and the patient on testosterone should be checked regularly for prostate cancer (digital exploration, PSA, transrectal sonography and biopsy, if necessary) (see 13.1.3.2).

Breast cancer cells often are hormone-sensitive, especially estrogen-sensitive, and therefore, for reasons of safety, breast cancer is considered a contraindication to testosterone treatment. However, breast cancer is a relatively rare cancer in men and no cases of testosterone substitution and occurrence of breast cancer have been published, as an extended literature search revealed. Thus, this warning cannot be substantiated.

In some countries sexual offenders maybe treated by castration or antiandrogenic therapy. It would be a serious mistake to administer testosterone to such patients. Relapses and renewed crimes could be the consequence and the responsibility of the prescribing physician.

Testosterone suppresses spermatogenesis, a phenomenon exploited for hormonal male contraception (see Chapter 23). In hypogonadal patients with reduced sper-matogenetic function testosterone administration will also decrease sperm production. Such patients who wish to father children e.g. by techniques of artificial fertilization, should not receive full testosterone substitution therapy, at least not for the time their sperm are necessary for fertilization of eggs. This is of increasing importance as not only residual sperm in patients with secondary hypogonadism but also with Klinefelter syndrome may be able to fertilize eggs via intracyto-plasmatic sperm injection (ICSI) and induce pregnancies (e.g. Friedler et al. 2001).

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