Safety Information

‍Last updated: May 14, 2026

This page provides safety, side effect, and risk disclosure information for Testosterone Cypionate, Enclomiphene, tadalafil, sildenafil, NAD+, and Sermorelin. It is intended to help prospective and current clients make informed decisions and to serve as a reference for clinicians, support staff, and anyone evaluating Feel30.

This page is not a substitute for medical advice from your prescribing clinician. It does not replace the Medication Guide provided with your prescription, nor does it cover every possible risk or drug interaction. Always discuss your full medical history with your provider before starting or changing a protocol.

If you are experiencing a medical emergency, call 911 immediately. If you suspect a serious or life-threatening reaction to a medication, call 911 or your local emergency number. Do not delay emergency care.

To contact your care team: message your prescriber through your patient portal, or support@feel30.com.

How to Use This Page

This page is organized by protocol category. Each section covers the products within that category, including who should not use them (contraindications), required warnings, common and serious side effects, drug interactions, and monitoring requirements. If you are looking for information about a specific product, scroll to the relevant category or use your browser's search function (Ctrl+F or Cmd+F) to find it by name.

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General Risks: Telehealth and Compounded Medications

Telehealth limitations

Feel30 delivers care through a telehealth platform. Telehealth has inherent limitations compared to in-person care: your clinician cannot perform a physical examination, diagnostic accuracy depends on the completeness and accuracy of the information you provide, and telehealth is limited to conditions that can be appropriately evaluated and treated remotely. If your clinician determines that in-person evaluation is needed, they will refer you accordingly.

Compounded medications

Several Feel30 products are dispensed as compounded medications prepared by FDA-registered 503A or 503B compounding pharmacies. Compounded medications are not FDA-approved for safety, efficacy, or quality. Compounding pharmacies are licensed and regulated at the state and federal level, but compounded drugs do not undergo the same pre-market review process as FDA-approved drugs. Feel30 partners exclusively with LegitScript-certified US pharmacies. Where a product is compounded vs. FDA-approved, this is disclosed in the relevant protocol section below.

State availability

Not all Feel30 products are available in every state. Availability varies by product and state regulation. For current availability discuss with your Feel30 provider, or contact support at support@feel30.com.

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Testosterone Optimization — Safety Information

Products in this section: Enclomiphene (standalone), Enclomiphene + Tadalafil, Enclomiphene + Sildenaphil, Testosterone Cream, Injectable Testosterone. For Tadalafil- and Sildenafil-specific safety details, also see the Blood Flow / Sexual Health section.

Protocol overview

These are prescription medications used under provider supervision to address clinically diagnosed low testosterone. Feel30 offers topical and injectable forms of testosterone, and also offers enclomiphene, a selective estrogen receptor modulator (SERM) that stimulates the body's own testosterone production through the hypothalamic-pituitary-gonadal (HPG) axis rather than supplying exogenous (coming from outside the body) hormone directly.

Who should not use these products (contraindications)

Do not use testosterone products if you have:

Known or suspected prostate cancer [FDA class labeling, 2/28/2025]
Known or suspected breast cancer [FDA class labeling]
A hypersensitivity to testosterone, sesame oil (injectable), castor oil (cream base), or other product components [product-specific PI]
You are a woman who is or may become pregnant, or breastfeeding — testosterone is Pregnancy Category X [FDA class labeling]

Enclomiphene is not FDA-approved as a standalone drug. The closest FDA-labeled analog (clomiphene citrate) is contraindicated in liver disease, abnormal uterine bleeding, and in any individual with a hypersensitivity to the compound. [Clomid PI]

For products containing Tadalafil or Sildenafil (Enclomiphene+ combinations): do not use if you take nitrate medications for chest pain or heart conditions. Combining PDE5 inhibitors with nitrates can cause a severe, potentially fatal drop in blood pressure. [FDA labeling for PDE5 inhibitors]

Boxed warnings

TOPICAL TESTOSTERONE (CREAM) — SECONDARY EXPOSURE WARNING: Secondary exposure to testosterone has occurred in children and women who have come into skin-to-skin contact with application sites on male users. Cases in children have resulted in inappropriate virilization, including enlargement of the genitalia and advanced bone age. Wash hands thoroughly after application, cover application sites with clothing, and avoid skin-to-skin contact with women and children until the site is washed or covered. [FDA class labeling for topical testosterone products]

No other boxed warning currently applies to testosterone products following the February 28, 2025, FDA class-wide labeling action that removed the prior cardiovascular boxed warning based on TRAVERSE trial data.

Warnings and precautions

Blood pressure increase — class-wide warning added February 28, 2025. Monitor blood pressure before and during treatment. [FDA class labeling]
Polycythemia (elevated red blood cell count) — hematocrit must be monitored; treatment may need to be paused or stopped if hematocrit exceeds safe thresholds. [FDA class labeling]
Worsening BPH and possible increased risk of prostate cancer — monitor PSA and prostate symptoms. [FDA class labeling]
Sleep apnea — may be initiated or worsened by testosterone therapy.
Fertility effects — exogenous testosterone (injectable, cream, oral) suppresses the HPG axis and can reduce sperm production and fertility. Enclomiphene is included in certain combination protocols in part to preserve fertility markers, but fertility preservation is not guaranteed.
Edema — especially in individuals with cardiac, renal, or hepatic disease.
Hypercalcemia — possible in immobilized patients.
Gynecomastia — breast enlargement or tenderness may occur with exogenous testosterone.

Adverse reactions

Common (reported in clinical trials and post-marketing surveillance):

Enclomiphene: Headache (~3.3%), nausea (~2.1%), hot flashes (~1.7%), dizziness, mild GI symptoms, mood changes, mild acne, blurred or abnormal vision (uncommon).
Enclomiphene + Tadalafil: All enclomiphene effects above, plus nasal congestion and light-headedness (PDE5 effect), headache (~6%), dyspepsia (~5%), back pain, flushing, myalgia (~2–3% each).
Testosterone Cream: Application site irritation, dryness, or redness, skin discoloration at application site, acne, libido changes, mood fluctuations, fluid retention, possible hair loss in genetically predisposed men.
Injectable Testosterone: Acne, injection site pain/swelling/bruising, libido changes, mood fluctuations, fluid retention, elevated blood pressure, elevated hematocrit/hemoglobin/PSA, testicular shrinkage, gynecomastia, night sweats.

Serious (seek immediate medical attention):

Chest pain, shortness of breath, sudden severe headache, slurred speech, or weakness/numbness on one side of the body (signs of cardiovascular event or stroke)
Signs of blood clot: leg swelling, leg pain, redness (DVT/PE — rare)
Allergic reaction: rash, swelling of face/lips/tongue, difficulty breathing
Priapism — erection lasting longer than 4 hours (applies to combinations containing Tadalafil or Sildenafil; requires immediate medical attention to prevent permanent damage)
Sudden vision loss/ Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) or sudden hearing loss (PDE5 class effect)
Severe hypotension (PDE5 + nitrate interaction — contraindicated)
Visual disturbances from enclomiphene (warrants discontinuation and provider evaluation)
Polycythemia / dangerously elevated hematocrit
Hypersensitivity or anaphylactoid reactions (rare; oil vehicle in injectables)

Hair loss note: Testosterone can convert to DHT, which may accelerate male-pattern hair loss in genetically predisposed men. This applies to all exogenous testosterone products and to enclomiphene (which increases endogenous testosterone). Clinicians can discuss protective options if hair loss is a concern.

Drug interactions and monitoring

Anticoagulants (warfarin and others) — testosterone may increase anticoagulant effect; INR monitoring required.
Insulin and oral antidiabetics — testosterone may reduce blood glucose and change insulin requirements.
Corticosteroids, ACTH — increased risk of edema.
Nitrates (all forms) — contraindicated with Tadalafil and Sildenafil. Combination can cause severe, potentially fatal hypotension.
Alpha-blockers — risk of hypotension when combined with PDE5 inhibitors.

Required monitoring while a patient on Feel30 testosterone protocols:

Baseline labs: Total Testosterone, SHBG or Free T, LH, FSH, PSA, Hematocrit
Follow-up labs at 4 weeks after dose change
Annual labs at minimum thereafter
Blood pressure monitoring consistent with February 2025 class labeling

Use in specific populations

Pregnancy: Contraindicated. Testosterone is Category X. Women who are or may become pregnant must not use testosterone products or come into contact with application sites (cream).
Lactation: Contraindicated.
Pediatric: Not indicated. Risk of advanced bone age and virilization.
Geriatric: Increased risk of prostate-related effects; clinical judgment required.
Hepatic impairment: Use with caution.
Renal impairment: Edema risk.

Compounded vs. FDA-approved status

Injectable testosterone at Feel30 doses is dispensed from FDA-registered 503A or 503B compounding pharmacies depending on the prescription. Enclomiphene is not FDA-approved as a standalone drug in the United States; compounded enclomiphene is dispensed from 503A pharmacies based on individual prescriptions. Compounded drugs are not reviewed by FDA for safety, efficacy, or quality prior to dispensing.

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Blood Flow / Sexual Health — Safety Information

Products in this section: Tadalafil and Sildenafil.

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Protocol overview

PDE5 inhibitors are prescription medications that improve blood flow by relaxing smooth muscle in blood vessel walls. Feel30 offers three PDE5 inhibitors with different duration, onset, and specificity profiles: Tadalafil (as needed or long-acting daily support) and Sildenafil (as needed with a moderate onset and duration).

Who should not use these products (contraindications)

Do not use PDE5 inhibitors if you:

Take nitrate medications in any form (nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, amyl nitrite/poppers) — combination can cause severe, potentially fatal hypotension [FDA labeling]
Have a hypersensitivity to Tadalafil, Sildenafil, or any product component
Take alpha-blockers and have not been stabilized on the alpha-blocker dose (risk of severe hypotension)
Have been advised by your clinician to avoid sexual activity due to cardiovascular risk

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Warnings and precautions

Cardiovascular risk — sexual activity itself carries cardiac risk. Patients with pre-existing cardiovascular disease should discuss risks with their prescriber before using PDE5 inhibitors.
Hypotension — PDE5 inhibitors lower blood pressure. Use caution if already taking antihypertensives.
Priapism — erection lasting more than 4 hours requires immediate medical attention to prevent permanent damage. Risk is elevated in patients with sickle cell disease, multiple myeloma, or leukemia.
Vision and hearing — rare reports of sudden vision loss (NAION) and sudden hearing loss or tinnitus have been associated with PDE5 inhibitor use. Seek immediate medical attention if these occur.

Adverse reactions

Common:

Tadalafil: Headache (~6%), dyspepsia (~5%), nasopharyngitis (~3%), back pain (~3%), flushing (~3%), myalgia (~2%), nasal congestion, light-headedness.
Sildenafil: Headache, flushing, nasal congestion, dyspepsia, dizziness, blue-tinted or color-altered vision (more common with Sildenafil than other PDE5 inhibitors due to cross-reactivity with PDE6 in the retina), transient blurred vision.

Serious (seek immediate medical attention):

Sudden vision loss or changes (NAION)
Sudden hearing loss or tinnitus
Priapism (erection lasting more than 4 hours)
Severe hypotension — especially if combined with nitrates or alpha-blockers
Allergic or hypersensitivity reactions

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Drug interactions

Nitrates (all forms) — contraindicated. Potentially fatal hypotension.
Alpha-blockers — risk of additive hypotension. Stabilize on alpha-blocker dose before starting PDE5 inhibitor.
CYP3A4 inhibitors (ketoconazole, ritonavir, erythromycin, grapefruit juice) — may increase PDE5 inhibitor levels. Dose adjustment may be needed.
Other antihypertensives — additive blood pressure lowering. Monitor.

Compounded vs. FDA-approved status

PDE5 inhibitors dispensed by Feel30 may be compounded formulations. Compounded drugs are not reviewed by FDA for safety, efficacy, or quality prior to dispensing. Tadalafil and Sildenafil are well-established FDA-approved drug classes.

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Growth Hormone Secretagogues — Safety Information

Products in this section: Sermorelin. Both are administered as subcutaneous injections.

Protocol overview

Growth hormone secretagogues are prescription medications that stimulate the body's own growth hormone (GH) production rather than introducing exogenous growth hormone. GH triggers the liver to produce IGF-1, which delivers downstream benefits including fat mobilization, tissue repair, and metabolic improvement. The body's natural negative feedback mechanisms help prevent overproduction. This is not a exogenous growth hormone.

Who should not use these products (contraindications)

Do not use growth hormone secretagogues if you have:

Active malignancy (cancer) — GH/IGF-1 axis stimulation may theoretically promote tumor growth
A family history of two or more first degree relatives with similar or identical types of cancer.
A known hypersensitivity to Sermorelin or any product component

Warnings and precautions

Glucose intolerance / elevated blood sugar — stimulation of the growth hormone (GH) axis may modestly reduce insulin sensitivity because GH counteracts some of insulin’s effects on glucose metabolism. Patients with prediabetes, diabetes, obesity, visceral adiposity, or underlying insulin resistance may be more susceptible and may require monitoring of blood sugar markers during treatment.
Fluid retention and edema — mild fluid retention, puffiness, or swelling can occur due to growth hormone–mediated sodium and water retention. This is typically less pronounced with sermorelin than with stronger GH secretagogues, but patients with pre-existing edema, uncontrolled hypertension, kidney disease, or heart failure should use caution and be monitored appropriately.
Theoretical tumor growth stimulation — GH and IGF-1 are growth-promoting hormones. Contraindicated with active malignancy.
Fasting matters for effectiveness — insulin and growth hormone are antagonistic. Inject fasted (2+ hours after eating) for optimal response.

Adverse reactions

Sermorelin — Common:

Injection site reactions (~25–33% initially; nearly always resolves within 2–3 weeks)
Injection site itchiness (normal; resolves with repeated exposure)
Minimal water retention
Headaches, dizziness, flushing
Mild nausea (typically during initial adjustment)
Mild joint stiffness or puffiness in hands/wrists (GH effect; often resolves with dose adjustment)
Mild fatigue (early weeks)

Serious (contact your provider immediately):

Glucose intolerance or significantly elevated blood sugar
Clinically significant peripheral edema
Allergic or hypersensitivity reactions (rash, itching, swelling)
Chest pain or tightness (rare; stop medication and seek evaluation)
Difficulty breathing (rare)
Blurred vision (rare)
Sleep disturbances

Drug interactions

Insulin and oral antidiabetics — GH axis activation may impair glucose metabolism, potentially requiring dose adjustments of diabetes medications.
Glucocorticoids — may reduce the GH response to secretagogues.
Other hormone therapies — discuss all current hormonal medications with your prescriber.

Compounded vs. FDA-approved status

Sermorelin was previously FDA-approved (as Geref) but has been discontinued as an FDA product; all current Sermorelin is compounded. Compounded drugs are not reviewed by FDA for safety, efficacy, or quality prior to dispensing.

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NAD+ Therapy — Safety Information

Products in this section: NAD+ (nicotinamide adenine dinucleotide)
Products may be administered as subcutaneous injections, oral formulations, or intravenous (IV) therapy depending on the prescribed protocol.

Protocol overview

NAD+ is a naturally occurring coenzyme involved in cellular energy production, mitochondrial function, DNA repair, and metabolic processes. NAD+ levels naturally decline with age and physiologic stress. NAD+ therapies are intended to support cellular metabolism and energy pathways by increasing availability of NAD+ precursors or NAD+ itself. This is not a hormone therapy.

Who should not use these products (contraindications)

Do not use NAD+ therapy if you have:

A known hypersensitivity to NAD+, niacin-related compounds, or any product component
Uncontrolled severe liver disease unless specifically cleared by your provider
Active severe illness requiring immediate medical evaluation

Warnings and precautions

Flushing and vasodilation — NAD+ products may cause warmth, flushing, chest tightness, or temporary light-headedness due to vasodilatory effects, particularly during IV administration.
Gastrointestinal symptoms — nausea, abdominal discomfort, cramping, or diarrhea may occur, especially with rapid infusion rates or higher doses.
Blood sugar effects — NAD+ participates in cellular metabolic pathways and may influence glucose metabolism. Patients with diabetes or insulin resistance should discuss monitoring with their provider.
Liver considerations — certain NAD+ precursor compounds are metabolized hepatically. Patients with underlying liver disease should use caution and may require monitoring.

Adverse reactions

Common

Nausea
Flushing or warmth
Chest tightness during infusion
Headache
Fatigue
Light-headedness
Abdominal cramping
Injection site irritation or redness
Temporary anxiety or jitteriness

Serious (contact your provider immediately)

Allergic or hypersensitivity reactions (rash, swelling, difficulty breathing)
Severe chest pain
Severe shortness of breath
Persistent vomiting
Severe dizziness or fainting

Drug interactions

Diabetes medications — glucose metabolism may be affected; monitoring may be appropriate in some patients.
Other IV therapies or supplements — discuss all injectable therapies, supplements, and medications with your provider prior to treatment.
Hepatically metabolized medications — caution may be appropriate in patients taking multiple liver-metabolized medications.

Compounded vs. dietary supplement / FDA status

Injectable NAD+ products dispensed by Feel30 may be compounded medications. Compounded drugs are not reviewed by the FDA for safety, efficacy, or quality prior to dispensing. Oral NAD+ formulations may be classified as dietary supplements and are not subject to the same FDA pre-market approval process as prescription drugs. These products are not intended to diagnose, treat, cure, or prevent any disease.