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Who should avoid TRT?
The Endocrine SocietyTrusted Source recommends that people with the following conditions do not start taking TRT:

Obstructive sleep apnoea
Research recommends that clinicians need to exercise caution when prescribing TRT to people who have severe obstructive sleep apnoea.

TRT causesTrusted Source neuromuscular changes to the airways as well as chemical changes in the metabolism. It can also cause low levels of oxygen in the body tissues, known as hypoxia. This can cause symptoms such as confusion, restlessness, difficulty breathing, rapid heart rate, and bluish skin.

TRT may also cause hypercapnia. Hypercapnia is a condition where carbon dioxide levels get too high in the blood. This can lead to problems such as respiratory acidosis, with symptoms including fatigue and drowsiness or a strong desire to sleep.

Severe lower urinary tract symptoms
Severe lower urinary tract symptoms include urinary frequency and urgency. These symptoms may be a sign of an enlarged prostate or benign prostatic hyperplasia (BPH).

Past researchTrusted Source found a correlation between TRT and lower urinary tract symptoms (LUTS) due to testosterone’s growth-promoting effects on the prostate. This is common among aging men who developed hypogonadism late in their life. Recent clinical trials support this theory, concluding that although TRT may help in reducing prostate inflammation, it does not lower urinary tract symptoms and may even make these symptoms worse in the long term.

Elevated hematocrit levels and thrombophilia
People who have a high red blood cell count and thrombophilia should avoid taking TRT. TRT can increase red blood cell count which in turn increases blood viscosity. This may lead to blood clot formation, stroke, and ischemia.

A 2021 research study conducted on trans men using long-term TRT concluded that TRT caused an increase in red blood cell count. Red blood cell counts were taken from the individuals on a yearly basis and results showed an increase of 10% after the first year and 38% after 10 years.

Prostate cancer
Prostate cancer needs testosterone to grow, therefore taking TRT may make the cancer cells grow faster. The National Cancer Research Institute states that men with higher levels of testosterone in their blood are more likely to be diagnosed with prostate cancer.

High prostate-specific antigen levels
Research has shown a link between TRT raising antigen levels in men over the age of 65 years. Researchers performed a clinical trial on men aged over 65 who took TRT for a period of 12 months. At the end of the 12 months results showed an increase of 4.0 ng/mL in antigen levels in 5% of the men.

Ischemic stroke
Researchers carried out clinical trials on 15,401 men aged over 45 years who had low testosterone levels. Those who were given TRT showed a 21% greater risk of cardiovascular conditions such as cardiac arrest and cerebrovascular disease compared to the proportion of men who did not take TRT.