Testosterone replacement therapy, more commonly known as TRT, can be one of the most effective treatments for men who suffer from low testosterone levels.
It’s often prescribed to those diagnosed with certain forms of hypogonadism, and its effects are nearly immediate—but does insurance cover it?
This article will take you through everything you need to know about whether or not your insurance company will cover your testosterone treatment.
Is TRT Covered By Insurance?
The best answer: Yes, but it depends on your plan and provider. While private health insurance in the United States typically covers TRT, they usually have limitations that can limit your coverage or force you to pay out-of-pocket.
To get an idea of what you might expect, we spoke with experts in various fields and combined their answers with online research and our own experiences with TRT coverage. There are three broad categories of insurers:
- Medicare, Medicaid, and other government programs
- Private insurance plans
- TRT costs without insurance plans for military personnel or veterans
Of course, not all plans fit neatly into these categories.
How Does TRT Work in men?
The testes produce small amounts of testosterone daily, but production slows in men as they age. The body makes about one-tenth of its testosterone after age 30.
Many older men begin experiencing symptoms associated with low T, including weight gain, decreased energy, depression, decreased sex drive, increased bone fragility (osteoporosis), and reduced muscle mass.
The good news is that TRT can help alleviate most of these symptoms. Without treatment, almost all men experience some symptoms as they age. One study found that 96 percent of men over 65 have at least one condition linked to low T—with erectile dysfunction being the most common side effect experienced by 85 percent of all patients studied.
How Do I Get Testosterone Replacement Therapy?
If you’re wondering, how do I get testosterone replacement therapy? It’s relatively simple.
There are three ways to get on TRT: you can go through your primary care physician (PCP), an endocrinologist, or a urologist. Whichever route you choose, you should have a consultation with your doctor beforehand. When considering getting started on TRT, it’s essential to remember that each method has its pros and cons.
For example, if you see your PCP for TRT, they will likely prescribe testosterone gel or patches—these require self-administration and blood work for monitoring.
On the other hand, if you see an endocrinologist or urologist for treatment, they may recommend injectable forms of T—these come with more rigorous testing requirements but less hassle in terms of administration and monitoring.
Who Can Prescribe It, And Where Can I Get it From?
If you’re on Medicare, you can only get testosterone if it’s been approved by your doctor. If you’re over 65 and have low testosterone levels, insurance companies must cover it—but some require you first to try other therapies.
In addition, if you have Type 2 diabetes or a history of prostate cancer, your doctor may prescribe it; though, they might recommend skipping it if blood work indicates an unhealthy PSA level or too much red blood cell production.
Most people can also get coverage from their insurance companies—but whether they will provide it depends on your specific plan and where you live. Some plans cover hormone therapy for low T, while others don’t (either explicitly or excluding certain medications).
Those that do often exclude coverage for women but not men.
Why Is There A Bigger Demand For BHRT Now?
The US Food and Drug Administration (FDA) recently approved testosterone replacement therapy (TRT) for men diagnosed with hypogonadism.
But what is hypogonadism, and how common is it among adult males?
To answer the question, it’s first essential to know that testosterone naturally declines in men after age 30. The good news is that hypogonadism—which affects over 6 million adult males in the US alone—is highly treatable using hormone replacement therapy (HRT).
Benefits of testosterone treatment include increased muscle mass, reduced body fat, decreased bone density loss due to osteoporosis, and improved sexual function.
What Are The Benefits Of BHRT Treatment?
The apparent benefit of BHRT treatment is that it will help you maintain a healthy and functional testosterone level. The testosterone levels in your body significantly affect your physical, emotional, and mental well-being.
The health risks associated with low testosterone levels include problems with libido, erectile dysfunction, lower sperm count, and mass muscle reduction, among other things. All these symptoms can have a severe negative impact on your everyday life.
How Long Will I Have To Take Testosterone Replacement Therapy Medication Before I See Results?
You can expect to see results after three months of regular use. Once you begin treatment, take a progress report and see how you feel compared to your original baseline before starting treatment.
Have your testosterone levels rechecked two months later and check how your symptoms have improved or gotten worse.
See if it’s time for a dosage adjustment. Many clinics suggest scheduling an appointment for about every three months during testosterone replacement therapy to continue treatments without interruption until you’ve seen enough improvement or reached a symptom-free state.
This will likely be when you are no longer dependent on testosterone replacement therapy. Many men are not sure when to stop taking their medication entirely once symptoms have subsided.
Are There Any Side Effects Of Taking BHRT Medication For Low T Levels Or Andropause Treatment?
The side effects of taking testosterone replacement therapy (TRT) are well-documented, but some may still be surprising. For example, low sprm count is a potential side effect for men undergoing TRT treatment for hypogonadism, so if you have a partner, you’ll want to ask your doctor about using a con.dom during sx.
Low sprm count isn’t just for hypogonadal men. However—it’s also possible due to anabolic steroid use or heavy alcohol consumption, both of which can deplete testosterone levels.
But in many cases, it will be reversible upon discontinuation of testosterone and hasn’t been reported with bioidentical hormone replacement therapy (BHRT).
How Much Does Testosterone Replacement Cost?
Most doctors prescribe 100mg of Testosterone Cypionate every one or two weeks. Many insurance companies will cover your treatment as hormone replacement therapy, and since testosterone is not an expensive drug, many people pay out-of-pocket. Does Blue Cross Blue Shield Cover Testosterone
Treatment? If you’re on Medicare and you have hypogonadism, then yes. How Much Is TRT Without Insurance? Testosterone Replacement Therapy ranges anywhere from $0-$200 per month, depending on your health coverage and needs.
Does My Health Insurance Cover Testosterone? It depends on what type of insurance you have; more often than not, it’s considered an anti-aging treatment so plans will cover it to some extent with a co-pay.
Is TRT worth the risk?
Of course, when you’re talking about insurance coverage for TRT, there are two sides. Are the risks worth the costs? Are the potential side effects worth what you’re getting out of the treatment?
Some studies have shown that TRT can be beneficial for many men, but it might be a risk some people aren’t willing to take. Your doctor is there to help advise you on your options and risks. They can also help you determine whether your insurance covers testosterone replacement therapy. So don’t assume anything; ask!
How many years can you stay on TRT?
Most doctors recommend that you remain on TRT for five years, but Dr. Pescovitz notes that you may need to stay on TRT indefinitely, depending on your particular situation.
When I started writing scripts for testosterone in 1994 and 1995, there were many more options available than there are now, he says. If a patient wants it, they can stay on TRT forever. That said, there are some downsides associated with continuing TRT treatment.
For one thing, it’s expensive—to purchase testosterone for self-administration from an online pharmacy (which is legal), you’re looking at $200–$400 per month on average and sometimes much more than that.
What age should you start TRT?
There is no consensus on whether age plays a role in initiating TRT. And it’s important to note that each case is different: Some men may need TRT as early as age 40, whereas others may not require treatment until they’re 60.
When deciding whether you should start TRT, you’ll have to look at your symptoms and overall health—are you experiencing issues like low energy or sex drive? If so, it might be time for a visit with your doctor. Discussing how you feel with your physician can help you determine if testosterone replacement therapy is right for you.
What happens if low testosterone goes untreated?
It can be a tough pill to swallow when you find out that your low testosterone is not being covered by insurance. It seems unfair, but there’s no reason to lose hope just yet.
If you’re willing to put in some time and effort, it may be possible for you to get testosterone replacement therapy (TRT) covered after all!
In conclusion
Unfortunately, testosterone replacement therapy is not covered by most insurance plans, making treatment expensive. However, it’s important to remember that your particular plan doesn’t cover TRT doesn’t mean you’re out of luck altogether.
In conclusion, there are many ways you can obtain TRT if your plan doesn’t protect it or if you have a co-pay or deductible too high for your budget.
Make sure you discuss these options with your physician to find what works best for you and fits within your budget. (Note: as mentioned previously, there are programs like getting Low T costs where patients pay $1 per day for their prescription.) Good luck!