Reasons FOLX Might Not Be Able to Prescribe Testosterone

There aren’t a lot of hard stops on trans, nonbinary, or intersex folx taking testosterone, but there are a few.

A torso with lines tattooed over top surgery scars.

While there aren’t many, there are some conditions and factors which means that FOLX is unable to safely recommend someone start testosterone.

For the most part, you will know if one of these conditions applies to you! If you’re not sure, or think they may, you can reach out to our member advocate team at support@folxhealth.com to better understand.

FOLX is currently unable to prescribe testosterone if someone:

1. Has end stage liver disease

Most often, chronic liver failure is the result of cirrhosis, a condition in which scar tissue replaces healthy liver tissue until the liver cannot function adequately. The body processes testosterone through the liver, so if a person has severe liver disease, taking T could put an additional, life-threatening burden on the liver.  

2. Has polycythemia

Polycythemia is an increase in the number of red blood cells in the body, as detected by the hemoglobin levels in the blood (or the amount of iron-containing protein found in red blood cells). It can be caused by a number of underlying conditions such as genetic disorders, heavy smoking, kidney problems, and sleep apnea. When a person has polycythemia, the extra red blood cells cause the blood to be thicker, and this, in turn, increases the risk of other health issues, such as blood clots. 

Testosterone can increase a person’s hemoglobin (which is why we have labs to measure this), which would compound the risk of blood clots in someone who already has polycythemia. Since blood clots can be fatal, we currently are unable to provide T to a person with polycythemia.

3. Is currently pregnant or trying to get pregnant

Testosterone is a teratogen (an agent or factor which causes malformation of an embryo), which means it can cause harm to a developing fetus.  

It’s important to understand that testosterone is not a form of birth control, even if a person is no longer having monthly bleeding. If a person gets pregnant while on T and wants to continue the pregnancy, they should discontinue T immediately. You can read more about T and fertility here, and members can talk to one of our clinicians if they want to discuss birth control or abortion options.

4. Is cisgender

Currently, FOLX is only prescribing testosterone for gender affirming therapy. Many cisgender men (assigned male at birth, with testosterone producing parts - i.e. testes) use testosterone as well, but this is not currently a service that FOLX offers.  

5. Is under 18

We honor transgender youth and fully support their right to all gender affirming care. Due to complicated regulatory and legal reasons, we are not able to offer care to anyone under the age of 18 years old.

Gratefully, this list is relatively short! Some people are able to safely receive treatment closer to home while having one of these conditions, but at present, FOLX is unable to (which isn’t to say we don’t want to!). Learn more about testosterone routes available here, and get started here.