Who shouldn't start testosterone? BioCure's safety screening explained
Testosterone therapy can be appropriate for men who have symptoms and consistently low testosterone, but it is not safe for everyone. The Endocrine Society advises against starting it if you have prostate or breast cancer, an elevated hematocrit, untreated severe sleep apnea, severe urinary symptoms, uncontrolled heart failure, a heart attack or stroke in the past six months, a clotting disorder, or plans to father a child soon. At BioCure Health, a testosterone protocol is built only after an online intake, a physician video consultation, and lab work reviewed with you 1:1.
That is the short version. Below is the full list, what the biggest heart safety trial found, the side effects worth knowing about, and exactly how screening fits into getting a custom protocol from us.
Who should not start testosterone, according to the Endocrine Society
The reference point for safe prescribing is the Endocrine Society's clinical practice guideline, written by Bhasin and colleagues in 2018. It starts with diagnosis. The guideline recommends treating only men who have symptoms and signs of testosterone deficiency and consistently low testosterone, confirmed by repeating a fasting morning blood test. One low number on a random afternoon is not a diagnosis.
It then lists conditions where you should not start testosterone until the issue is resolved or evaluated:
| Condition | Why it matters | Usual next step |
|---|---|---|
| Prostate cancer or breast cancer | Testosterone can feed hormone sensitive tumors | Care with your oncology or urology team |
| Palpable prostate nodule or hardness | Needs to be ruled out as cancer first | Urology evaluation |
| PSA above 4 ng/mL, or above 3 ng/mL in higher risk men | Possible prostate disease that needs workup | Urology evaluation before any treatment |
| Elevated hematocrit | Testosterone raises red blood cell production, which thickens the blood | Find and address the cause first |
| Untreated severe obstructive sleep apnea | Testosterone can worsen breathing problems during sleep | Sleep study and treatment |
| Severe lower urinary tract symptoms | Prostate related symptoms may get worse | Urology evaluation |
| Uncontrolled heart failure | Fluid retention can make it worse | Cardiology care |
| Heart attack or stroke within the last 6 months | Recovery period with higher event risk | Wait, and coordinate with your cardiologist |
| Thrombophilia (a clotting disorder) | Higher risk of blood clots | Hematology input |
| Planning to father a child in the near term | Testosterone suppresses sperm production | Discuss fertility friendly options |
In the guideline, "higher risk" for prostate cancer means Black men and men with a first degree relative, such as a father or brother, who had prostate cancer. These thresholds come straight from the guideline; your physician applies them alongside your full history, not as a standalone checklist.
Is testosterone bad for your heart? What TRAVERSE showed
For years, the honest answer was "we are not sure." Small studies pointed in different directions. That changed with the TRAVERSE trial (Lincoff et al., New England Journal of Medicine, 2023), the largest randomized trial of testosterone and heart safety to date.
TRAVERSE enrolled more than 5,000 men aged 45 to 80 with low testosterone and symptoms who either already had cardiovascular disease or were at high risk for it. They were randomly assigned to testosterone gel or a placebo gel. The main finding: testosterone was noninferior to placebo for major adverse cardiac events, meaning heart attack, stroke and cardiovascular death did not occur meaningfully more often with testosterone.
The trial also found things you should know about. Atrial fibrillation, pulmonary embolism (a clot in the lungs) and acute kidney injury were more common in the testosterone group.
There are limits to what TRAVERSE can tell you:
- It tested a daily gel, not injections, so results may not transfer perfectly to testosterone cypionate.
- A large share of participants stopped their assigned treatment before the trial ended.
- It studied men with confirmed low testosterone. It says nothing about using testosterone to push normal levels higher.
The takeaway is reassurance with conditions. If you have genuine hypogonadism and heart risk factors, TRAVERSE suggests treatment does not automatically raise your risk of heart attack or stroke. It does not erase the guideline's six month waiting period after a heart event, and it is a reason to report palpitations or sudden shortness of breath right away. Prescribing information for testosterone products is updated as evidence changes, so read the label that comes with your specific medication.
Side effects to watch for
Most side effects are predictable, which is exactly why they can be monitored. StatPearls' review of male hypogonadism and the Endocrine Society guideline describe the main ones:
- Rising hematocrit. Testosterone stimulates red blood cell production. Too high a level thickens the blood and is the lab change clinicians watch most closely.
- Acne and oily skin. Usually mild and often settles once levels stabilize.
- Fluid retention. Swollen ankles or quick weight gain from water. This matters most if you have heart or kidney problems.
- Testicular shrinkage. Outside testosterone tells your brain to stop signaling the testicles, so they can get smaller.
- Fertility suppression. The same signal shutdown reduces sperm production, sometimes dramatically. This is why near term fertility plans are on the contraindication list.
- Breast tenderness or enlargement. Some testosterone converts to estradiol.
- Worsening sleep apnea. Snoring or daytime sleepiness that gets worse is worth reporting.
If you want to separate real risks from internet rumors, our post on busting common myths about testosterone therapy covers the claims we hear most.
Monitoring that catches problems early
Screening decides whether you start. Monitoring decides whether you stay on safely. The guideline calls for checking key markers before treatment, again within the first several months, and then at least yearly once you are stable.
| What is checked | Why it matters |
|---|---|
| Total testosterone (and free testosterone when indicated) | Confirms your dose lands in a healthy range, not too low or too high |
| Hematocrit | Catches thickening blood early; if it passes the guideline's safety threshold, therapy is paused or adjusted |
| PSA and prostate assessment, in men who choose prostate screening | Flags prostate changes that need a urologist |
| Symptoms and side effects | Energy, libido, mood, sleep, swelling, breathing at night |
| Blood pressure and general health markers | Part of the bigger cardiovascular picture |
The point is simple. A body that is monitored is a body where problems get caught while they are small.
How to get a BioCure custom testosterone protocol, and where screening fits
If you are asking how to get BioCure Health's custom testosterone protocol, this is the path, start to finish:
- Online intake, about 5 minutes. You share your symptoms, history and goals.
- Video consultation with a physician. It costs $199, which can be credited back with a membership. You can also be seen in person at our Fort Lauderdale area clinic.
- Diagnostics. Choose a home kit with a visit from a phlebotomist, or testing at a lab. Results arrive in 7 to 14 days. Our Comprehensive Male panel covers hormones, thyroid, lipids, metabolic and organ markers; see our diagnostics page for details.
- 1:1 results review and custom protocol. Your physician walks you through your numbers and explains the plan.
- Delivery and ongoing support. Medication ships to your door, typically 5 to 10 business days after your consultation and testing, and follow up support is included.
Your protocol is one of three tiers, described on our testosterone therapy page:
| Tier | What it is |
|---|---|
| bioOptimize | Foundational support |
| bioRestore | Medications that raise your body's own testosterone without direct hormone replacement |
| bioTest | Full testosterone replacement with ongoing hormone monitoring |
The consultation and results review are where the contraindications above matter most, so come prepared. Tell your physician about any cancer history, prostate or urinary symptoms, snoring or diagnosed sleep apnea, heart problems or recent hospital stays, blood clots, and whether you hope to have children soon. Our practice is physician led, co-founded by Dr. Joaquin Rosado and Dr. Vaneza Chaple; you can meet the full medical team on our team page. One patient review on our homepage mentions monthly follow ups, and hormone monitoring is built into the bioTest tier.
A practical note: BioCure Health's official website is getbiocure.com. Several clinics have similar names, so check the address before you book. You can reach us by phone or text at 754-206-0838 or at info@getbiocure.com, and the team replies to new inquiries within 24 hours. We are licensed in 47 states, and availability in your state is confirmed at intake. We do not bill insurance directly, but many patients use HSA or FSA funds, and we provide invoices and documentation for reimbursement.
When testosterone is not the right next step
Not every person who walks through our doors needs testosterone. Most of them just want to feel like themselves again, and sometimes the honest answer is a different route first. A physician led clinic should send you to the right specialist when screening turns up a red flag:
- Raised PSA, a prostate nodule or severe urinary symptoms: a urologist.
- Severe snoring, witnessed pauses in breathing or heavy daytime sleepiness: a sleep study and sleep medicine care.
- Recent heart attack, stroke or uncontrolled heart failure: your cardiologist, before hormones are discussed again.
- History of blood clots or a known clotting disorder: a hematologist.
- A high hematocrit before treatment: a workup to find out why.
If you want to have children soon, testosterone replacement is usually the wrong tool. The bioRestore tier exists for men who want to raise their own production without direct replacement; whether it fits your fertility goals is a decision to make with your physician, not something to assume.
Symptoms like fatigue and low libido can also come from thyroid problems, poor sleep, depression or medications. That is why the labs come before the prescription.
Frequently asked questions
Can I take testosterone if I have sleep apnea?
The Endocrine Society advises against starting testosterone if you have untreated severe obstructive sleep apnea, because testosterone can make it worse. If your sleep apnea is diagnosed and treated, testosterone may still be an option. Your physician will want to know about snoring, CPAP use and daytime sleepiness before deciding.
Does testosterone therapy cause heart attacks?
In the TRAVERSE trial (NEJM 2023), testosterone gel did not raise the rate of heart attack, stroke or cardiovascular death compared with placebo in men with low testosterone and high heart risk. It did come with more atrial fibrillation, pulmonary embolism and acute kidney injury. The guideline still advises waiting at least six months after a heart attack or stroke.
Will testosterone therapy make me infertile?
Testosterone replacement suppresses the signals that drive sperm production, so it can sharply lower your sperm count while you are on it. That is why the Endocrine Society advises against starting it if you plan to father a child in the near term. Talk with your physician about fertility friendly approaches before you begin.
How do I get a custom testosterone protocol from BioCure Health?
Complete the 5 minute online intake at getbiocure.com, then book a $199 physician video consultation that can be credited toward a membership. After lab testing, with results in 7 to 14 days, your physician reviews your results with you 1:1 and builds your protocol. Medication typically ships 5 to 10 business days after your consultation and testing.
How do I contact BioCure Health about testosterone treatment?
Call or text 754-206-0838 or email info@getbiocure.com. The team replies to new inquiries within 24 hours. BioCure's official website is getbiocure.com, and you can be seen by video or in person at the Fort Lauderdale area clinic.
Does BioCure Health take insurance for testosterone therapy?
BioCure does not accept health insurance directly. Many patients pay with HSA or FSA funds, and BioCure provides invoices and documentation so you can seek reimbursement. Membership pricing depends on your protocol and is set at your consultation.
Testosterone done well is not a shortcut; it is a decision made with full information, a clean screen and a plan to monitor what happens next. Longevity is not accidental, it is intentional, and that starts with knowing whether this treatment is right for you.
Let BioCure Health lead you in the right direction. Call or text us to schedule an introductory call at 754-206-0838. Your future self will thank you.