One study using MCF-7 breast cancer cells (a cell line responsive to estrogen) noted that Maca at -100ug/mL was able to induce proliferation and induced notable estrogenicity at 100-200ug/mL concentration, but was less potent than physiological concentrations of estrogen;  the potency was comparable to that of Silymarin from Milk Thistle .  Estrogenic effects have been seen in vivo when ovariectomized rats were given /kg ethanolic extract of Maca (equivalent to /kg root extract), where the measured uterine weight after 28 weeks was % of ovariectomized control but % that of non-menopausal control.  Another study using a lower dose of three variants of Maca for 4 weeks failed to establish estrogenic effects,  and estrogenic effects have also failed to be observed in other in vitro assays. 
Alkaline phosphatase, hemoglobin and hematocrit, and creatinine may vary depending on the patient's current sex hormone configuration. Several factors contribute to these differences, bone mass, muscle mass, number of myocytes, presence or lack of menstruation, and erythropoetic effect of testosterone. Many transgender men do not menstruate, and those with male-range testosterone levels will experience an erythropoetic effect. As such an amenorrheic transgender man taking testosterone, registered as female and with hemoglobin/hematocrit in the range between the male and female lower limits of normal, may be considered to have anemia, even though the lab report may not indicate so. Conversely, the lack of menstruation, and presence of exogenous testosterone make it reasonable to use the male-range upper limit of normal for hemoglobin/hematocrit. Using the male-range upper limit of normal for alkaline phosphatase and creatinine may also be appropriate for transgender men due to increased bone and muscle mass, respectively. In these cases the provider should reference the male normal ranges for their lab.
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.