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Saw palmetto extract may decrease the effectiveness of estrogen products by reducing estrogen levels in the body via its antiestrogenic effects.  It can interfere with the use of birth control pills that contain estrogen as an active ingredient. As a result, it is recommended that an additional form of birth control, such as a condom, be used to prevent pregnancy in patients taking birth control pills with saw palmetto extract. In addition, saw palmetto extract can also interfere with hormone replacement therapy by reducing the effectiveness of estrogen pills. The combination of saw palmetto extract with estrogen products should be used with caution. 
Other significant adverse effects of testosterone supplementation include acceleration of pre-existing prostate cancer growth in individuals who have undergone androgen deprivation; increased hematocrit , which can require venipuncture in order to treat; and, exacerbation of sleep apnea .  Adverse effects may also include minor side-effects such as acne and oily skin, as well as, significant hair loss and/or thinning of the hair, which may be prevented with 5-alpha reductase inhibitors ordinarily used for the treatment of benign prostatic hyperplasia , such as finasteride .  Exogenous testosterone may also cause suppression of spermatogenesis , leading to, in some cases, infertility.  It is recommended that physicians screen for prostate cancer with a digital rectal exam and prostate-specific antigen (PSA) level before starting therapy, and monitor PSA and hematocrit levels closely during therapy.