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Do NOT Start TRT (or proceed only with specialist clearance) If You Have Per Endocrine Society guidance, TRT is contraindicated or requires caution in men with: Prostate cancer, breast cancer, or a suspicious prostate exam / improved PSA (PSA above ~4 ng/mL, or above ~3 ng/mL if at higher risk, without urology evaluation) High hematocrit / polycythemia (blood that is too thick, raises clot risk) Untreated severe obstructive sleep apnea Uncontrolled heart failure , or a heart attack or stroke in the past 6 months A known clotting disorder (thrombophilia) or history of blood clots Severe urinary symptoms from an enlarged prostate Men actively trying to conceive in the near term , TRT suppresses sperm production Peptides Are Not Appropriate If You Have Active cancer or a recent cancer history , raising GH/IGF-1 is a theoretical concern where cell growth is involved Diabetes or insulin resistance , GH secretagogues can raise blood sugar Any situation where unverified sourcing cannot be ruled out Side Effects and Red Flags TRT Side Effects Common and manageable with dose adjustment and monitoring: Polycythemia (thicker blood from a rising red-cell count), the most important reason for regular blood tests Acne / oily skin Gynecomastia (breast-tissue enlargement, from testosterone converting to estrogen) Testicular shrinkage and reduced fertility Fluid retention , mood changes, sleep-apnea worsening Regulators have updated testosterone product labels to warn of venous blood clots (DVT/PE) and increased blood pressure , independent of polycythemia