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Will Insurance Cover Your Testosterone Therapy?

Insurance Cover Your Testosterone Therapy: Testosterone replacement therapy (TRT) is still relatively new. Insurance companies have always been slow to cover the cost of new treatments. So, will your insurance cover the cost of your therapy?

Many insurance providers are willing to cover costs if there is a valid need. Some medical conditions, such as a pituitary tumor or Klinefelter’s Syndrome, may be readily approved for treatment. Having had a prostatectomy may get you immediate approval. Get started by speaking with your physician and your insurance carrier.

How much does insurance cover testosterone?

A consultation with a physician is the first step. The office will work with your insurance. They will find out what is needed to get approval for treatment.

The main goal of your office visit is to find out if you need TRT. Your physician will discuss what symptoms you are having and run some tests. After consulting with your doctor, you will find out the testosterone therapy cost, what medical examinations and tests are needed, and how they affect the final cost.

Insurance companies usually require you to meet several of their standards to qualify for coverage. You will need to have lab work done to evaluate your testosterone levels. You will need to have these tests done on two different days in the early morning hours. 

If the results show a need for treatment, they are sent to your insurance provider. Insurance companies have their own standard for what is considered a low level of testosterone.

What if insurance won’t pay for your treatment?

The health insurance plan will usually cover at least part of the cost if a need is determined, but there are no guarantees. You may be denied coverage. 

There are many reasons for this. For example, your hormone levels may not quite meet the standards set by your insurance carrier even though you have symptoms. Other patients do not have health insurance at all.

Fortunately, testosterone therapy cost is reasonably priced. Many find this true even if they must pay entirely out-of-pocket.

How to know if you need testosterone therapy?

Around the age of 40, testosterone levels begin to fall and continue to decline about 2% every year. Many men tend to think about low levels being associated with Erectile Dysfunction or low libido. 

However, other symptoms may present themselves and can be serious. Symptoms such as weight gain, muscle loss, low energy, hot flashes, anxiety, depression and anemia. If you have symptoms, get tested.

You will need to have both low testosterone levels and several symptoms to be a candidate for testosterone therapy. If you have low levels, but no symptoms, testosterone is probably not right for you. But if you have symptoms, especially low libido or fatigue, TRT may be the right choice.

Levels of testosterone can fluctuate throughout the day or week. This means one test can show low levels and another appears perfectly normal. Therefore, at least two tests are needed. Blood will need to be drawn in the morning and on different days.

Even with symptoms and low T levels, TRT may not be the answer. Certain medical conditions can influence your T levels and some medications can suppress them. Your physician may be able to adjust a medication dosage or even switch prescriptions if that is affecting you. If you can identify a possible source of testosterone decline, you may be able to fix the problem without testosterone therapy.

Overweight men tend to have a greater decline in T levels than other aging men. Weight is a larger contributing factor than age. As weight increases, the testosterone level decreases. Diet and exercise could be the solution. It makes more sense to treat the underlying conditions and improve your T levels without TRT.

If your physician has ruled out underlying issues, you have low testosterone levels and symptoms, TRT may be your answer.

Treatment options

Testosterone treatment can be given via injection, gel or pellet. Injections should be every 1-12 weeks. Gels are rubbed into both arms, thighs or shoulders daily.

Each method has its own merits and issues. Gel tends to give you a more stable level over time since you are using it daily. However, you need to avoid close contact with other people for a few hours after application. Gels can cause women to get acne or facial hair.

Injections are not needed as often, but testosterone levels can fluctuate with this method. The first few days after the injection you may have high testosterone levels, but they decrease over time. Some patients report that mood and energy levels spike after the injection and then decrease steadily.

Testosterone therapy may not be a lifelong treatment. Life changes could eliminate the need for TRT in your future.

Many men feel improvements with treatment in only a few weeks. The full effect may take several months.

Patients have experienced increased health and a happier mood with therapy. The benefits of feeling happy and like yourself again are worth the cost.

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