Is Testosterone Treatment Covered by Insurance?

Key Takeaways

• Most health insurance companies cover TRT if a healthcare provider deems the treatment to be medically necessary. Insurance typically requires documentation.

• Medication costs vary by insurance plan and drug formulation. Generic injections are often the most affordable, while gels, patches, or pellets may cost more.

• If your insurance doesn’t cover TRT, you still have options. Patient assistance programs and alternative testosterone treatments are other ways to manage cost while maintaining hormone health.

Testosterone replacement therapy (TRT) is an FDA-approved treatment for clinically diagnosed low testosterone levels (male hypogonadism) caused by medical conditions (such as testicular, pituitary, or hypothalamic disorders). Though research supports TRT’s ability to restore hormone balance and relieve symptoms like low libido, erectile dysfunction, decreased muscle mass, and reduced bone density, insurance doesn’t always cover the treatment. This can pose an accessibility challenge for the drugs.

In this guide, we’ll cover everything you should know about health insurance coverage for testosterone therapy, the cost of the hormone therapy with and without insurance, and more.

Not always. Insurance may cover some or all of the cost of TRT, but that depends on your specific plan, the form of testosterone prescribed, and whether there is a medical necessity for treatment.

If your provider denies coverage, you may be able to appeal the decision, especially if you have lab work confirming a diagnosis of low testosterone.

If your insurance provider grants coverage, keep in mind that it may not extend to all related services, such as follow-up visits or lab monitoring. Your insurer will determine which parts of care are included.

There are four main factors that might affect whether or not an insurance provider will cover testosterone therapy:

• Type of insurance plan

• Medical necessity

• Testosterone levels

• Type of TRT treatment

Type of Insurance Plan

Different insurance companies have their own stipulations about coverage.

Some private health insurance plans might cover the full cost of treatment if a healthcare provider has diagnosed you with low testosterone and you have the documentation to prove it. But every policy is different, and there may be out-of-pocket costs and copays to consider.

Medicare and Medicaid may also cover TRT if a healthcare provider deems the treatment medically necessary. However, Medicaid coverage varies by state.

Medical Necessity

Most insurers require documentation confirming a diagnosis of hypogonadism, which usually means at least two separate morning readings of low testosterone plus consistent symptoms. Insurers may also grant coverage if you have certain medical conditions that cause low testosterone, such as Klinefelter syndrome or Kallmann syndrome.

Coverage for other uses, such as gender-affirming hormone therapy, has expanded under some plans, but approval can still vary widely and may involve additional paperwork or prior authorization.

Testosterone Levels

Your testosterone levels may be low, but are they low enough? Some insurance plans have a specific cutoff for hormone levels that qualify for testosterone treatment. The good news is, your provider can easily run the necessary blood test to document such results. Hims also offers at-home testosterone testing if you suspect your levels are low. A licensed clinician must review results and confirm the diagnosis.

Type of TRT Treatment

A formulary is the list of drugs your insurance covers, often divided into cost tiers. Even when insurance covers your testosterone treatment, your out-of-pocket expenses will vary based on where the medication falls on the formulary. 

While some plans may cover certain formulations of TRT — like injections — they might exclude or place higher costs on others, such as testosterone gels, patches, or pellets. This may also come into play if you choose a brand-name product like Depo-Testosterone^®, Delatestryl^®, AndroGel^®, or Testim^® instead of generic versions of these drugs. 

For all of these reasons, it’s important to check your insurance plan before starting treatment.

Here are some steps you can take to find out if your insurance carrier covers TRT:

• Devise an action plan with your healthcare provider. Since most health insurance companies require documentation of medical necessity before approving TRT, your provider can help by ordering the necessary lab tests and confirming your diagnosis.

• Contact your health insurance carrier. You might not like the music you hear while you’re on hold, but picking up the phone is the best way to confirm what your plan covers and to learn about any specific requirements, such as pre-authorization or lab testing.

• Review your plan’s formulary. Coverage often depends on whether the specific formulation of TRT (injections, gels, patches, or pellets) is listed on your insurer’s formulary, and, if so, at what tier.

• Check your out-of-pocket costs. Even if TRT is covered, the cost of deductibles, copays, and coinsurance may vary widely. Understanding these specifics upfront can help you avoid surprises later.

• Ask about ongoing requirements. Some insurers may require regular follow-up labs or visits to continue coverage. Make sure you understand any expectations of monitoring.

• Consider appealing if you’re denied. Try not to panic if you’re denied treatment. You may be able to appeal or provide additional medical evidence to support your claim, which may change the coverage decision. You may also be able to connect with a patient advocate for additional support.

The cost of TRT with insurance can vary widely depending on your plan, deductible, and formulary coverage. In many cases, if your healthcare provider deems treatment necessary and you’ve met your plan’s requirements, your insurance will cover at least part of the treatment. FDA labeling limits TRT, such as testosterone cypionate injections, and hypogonadism due to medical causes. Age-related low T may not be covered by many insurers.

And remember, “covered” doesn’t necessarily mean “free.” You may still be responsible for copays, coinsurance, or meeting your deductible before coverage kicks in. Costs can also differ depending on the TRT formulation. For example, generic injectable testosterone is usually the least expensive option and more likely to be covered than brand-name gels, patches, or pellets, which may fall on higher tiers of your insurer’s formulary.

In addition to the medication itself, keep in mind that follow-up labs, specialist visits, and monitoring appointments may not always be fully covered, leading to additional out-of-pocket expenses.

If you don’t have insurance — or if your plan doesn’t cover TRT — you’ll need to pay for treatment out of pocket.

TRT costs vary widely depending on the formulation, with generic injectable testosterone sometimes available for as little as $10 per month, depending on where you live, your dose, and other factors. 

Topical gels or patches may cost between $200 and $500 per month, and implantable pellets can run upward of $1,000 per insertion.

In addition to medication, you’ll also need to budget for initial bloodwork, follow-up lab tests, and office visits, which can add hundreds of dollars per year.

If TRT costs seem a bit too steep with or without insurance, you can explore cost-lowering options like:

Patient Assistance Programs 

Pharmaceutical companies sometimes offer patient assistance programs to help those who can’t afford their prescriptions. If you qualify based on income or insurance status, these programs may provide testosterone at a lower cost (or no cost). Ask your provider or pharmacist if assistance is available for the specific testosterone product your healthcare provider prescribed.

Payment Plans 

Some pharmacies and insurance plans may offer payment options that allow you to pay for your prescriptions in installments rather than paying all at once.

HSA and FSA 

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you may be able to use pre-tax dollars to cover the cost of testosterone therapy and related expenses like lab testing or office visits.

Alternative Treatments

You may also want to explore other options for treating low testosterone. Some clinicians prescribe compounded enclomiphene to raise natural testosterone levels while preserving fertility. These treatments are not FDA-approved and should be used only under medical supervision. For instance, Hims offers access to prescription alternatives to traditional testosterone therapy — no insurance required. Options include compounded enclomiphene and a combination of enclomiphene + tadalafil, starting at $99 per month for a 10-month plan.

While not approved by the Food and Drug Administration (FDA), some research suggests that enclomiphene is comparable to testosterone gel in raising testosterone levels, but without the fertility-suppressing side effect. This makes it an appealing choice for men who want to boost testosterone while maintaining reproductive health.

If the prospect of navigating insurance coverage for TRT feels overwhelming, know you don’t have to figure it out alone. Start by working with your healthcare provider to confirm medical necessity and get the right documentation in place. Then, contact your insurer to check on coverage for the specific formulation of TRT you’re considering, and ask about monitoring requirements.

If your plan doesn’t cover treatment — or if out-of-pocket costs are too steep — explore patient assistance programs, payment options, or alternative treatment options. Taking these steps can help you access the care you need while keeping costs manageable.

Does insurance cover testosterone treatment?

Insurance doesn’t always cover TRT. Coverage depends on your insurance plan, your documented testosterone levels, and whether there is a medical necessity for the treatment.

What documentation do insurance companies usually require?

Most insurance plans require two separate low testosterone test results taken in the morning, plus confirmation of related symptoms.

Which types of TRT is insurance most likely to cover?

Generic injectable testosterone is usually more affordable and more likely to be covered. Gels, patches, and pellets may be covered at higher formulary tiers, with higher copays.

How much does TRT cost without insurance?

Out-of-pocket costs for TRT vary. Injections may be as low as $20–$100 per month, gels or patches may cost around $200–$500 per month, and pellets can run upwards of $1,000+ per insertion. You’ll also need to budget for labs and office visits.

Are there alternatives if my insurance doesn’t cover TRT?

Yes. Alternative options to TRT include patient assistance programs, HSAs/FSAs, and TRT-specific alternatives like enclomiphene (not FDA-approved).