Many patients ask us, “Does health insurance cover testosterone therapy for me?” because testosterone replacement therapy is sometimes deemed a “novel” medication.
As long as you can demonstrate a need, most health insurance carriers will cover the majority of the expense of testosterone replacement medication for males.
Of course, the amount your insurance pays differs from one provider to the next, as well as depending on your unique health plan and other factors such as your deductible.
Though we cannot guarantee that your insurance will cover the cost of testosterone replacement therapy, we can help you get started with a free consultation or a simple phone call to your insurance provider.
If you have specific medical conditions or a physician’s diagnosis, your health insurance company may have already approved testosterone replacement therapy for you. These conditions may include the following, depending on the insurance company:
Other situations, including as having had a prostatectomy, may also eliminate the necessity for testosterone tests.
Is testosterone free with insurance?
The good news is that TRT does not need to be costly. Most insurance companies will cover all forms of testosterone replacement medication, so you’ll only have to pay a co-pay. Depending on your region, treatment procedure, and insurance coverage, co-pays might range from $30 to $100 per month. Generic alternatives will also help to reduce out-of-pocket expenses.
Injections are the least expensive sort of testosterone replacement therapy if you don’t have insurance, and they can cost anywhere from $40 to $100 each month. Pellets, which are slow-release drugs implanted beneath the skin, cost around $500 each month on average, but this might vary depending on your dose. Monthly costs for gels, creams, and patches can range from $200 to $500.
TRT is a critical component of regaining your total health, wellness, and sense of well-being. It’s crucial to remember, though, that expenses might fluctuate from month to month or week to week as your doctor fine-tunes your treatment.
Is testosterone replacement therapy safe?
TRT can help those with low testosterone levels, but it also has a lot of short-term adverse effects. It may also increase the risk of liver and cardiac problems in persons who use TRT for a long time.
Are testosterone tests covered by insurance?
The hormone level in your system can be determined with a simple blood test, which is best done in the morning due to shifting testosterone levels during the day. A man’s testosterone level should be between 300 and 1,000 ng/dL. Most insurance companies will cover you if your blood sugar level is less than 350ng/dL.
Who qualifies for TRT?
To acquire a prescription for TRT, you must have low testosterone levelsless than 300 nanograms per deciliter (ng/dL)as well as certain symptoms (see page 7). “It’s conceivable to have low levels and not have symptoms,” Dr. Hayes explains. “However, given the existing uncertainty about long-term safety, it is not suggested that you begin on TRT if you do not experience any of the important symptoms, particularly fatigue and sexual dysfunction, which are the most common.”
Testosterone levels are measured via a simple blood test. Multiple tests are needed because levels might change on a daily basis and are influenced by medication and nutrition. According to Dr. Hayes, “in 30% of situations when the first testosterone test is low, the levels are normal when the test is repeated.”
TRT is not necessarily the primary course of therapy, even if your levels are low and you have multiple symptoms. “Often, if you can identify the source of dropping levels, you can address that problem and naturally increase low levels,” Dr. Hayes explains.
Weight increase, for example, is the leading cause of declining levels. “The impact of weight on testosterone levels is greater than that of age. Testosterone levels decrease as weight increases “she explains. In terms of testosterone levels, a five-point increase on the BMI scalefor example, from 30 to 35is akin to adding ten years to your age.
“Any additional factors that can alter levels, like as medication or medical issues, should be discussed with your doctor,” says Dr. Hayes. In these cases, your doctor may decide to address the underlying illness or switch your prescription or dosage to one that has no effect on testosterone levels.
TRT’s limitations must also be understood by men, as many regard it as a kind of youth fountain. “It has a smaller influence than many men would assume,” Dr. Hayes explains.
Sexual health and vigor, for example, are two frequently stated TRT advantages. The effects of TRT on 790 males aged 65 and older were examined in a double-blind study published in The New England Journal of Medicine on February 18, 2016. Those who got TRT for a year reported improvements in sexual function, including activity, desire, and erectile function, compared to those who received placebo. The group, on the other hand, only saw a minor improvement in mood and no changes in walking speed, which was used to assess TRT’s effect on vitality.
How much does peak TRT cost?
TRT expenses vary depending on whatever type you’re prescribed. If you have health insurance and require TRT to treat a medical problem, you will most likely not be responsible for the entire expense. The price may also vary depending on where you live and whether a generic version is available.
You should expect to pay anywhere from $20 to $1,000 per month in most cases. The final price is determined by a number of factors, including:
Keep in mind that TRT just raises your T levels, therefore it’s not cheap. It won’t treat the underlying reason of your low T, so you might need to take it for the rest of your life.
How much does testosterone shots cost?
When determining the monthly cost of testosterone therapy, there are numerous variables to consider, making it impossible to budget for a definite number.
As your therapist seeks to balance your dosages and concentrations, the cost can fluctuate on a monthly or weekly basis. Insurance plans may also have an impact on cost, lowering out-of-pocket costs for therapy that your clinician deems medically necessary. But we’ve here to talk about the cost of testosterone without insurance. Let’s get started.
Your therapist can design a personalized program to assist you in calculating overall expenditures for your specific needs, such as:
The following are the average price ranges for various testosterone delivery methods; these prices are based on a national North American average, which does not take into account local pricing:
Testosterone injections are frequently less expensive than alternative testosterone administration techniques, with prices ranging from $40 to $400 per month, depending on dosage and injection frequency.
Testosterone Pellets are little crystalline testosterone pellets that measure 3 mm by 9 mm. These pellets, which are implanted beneath the skin and slowly release testosterone over three to six months, are a long-acting form of testosterone therapy. The cost normally starts around $500 and can go up depending on the dosage.
Oral testosterone is available, however some specialists believe it can be harmful to the liver and recommend other options. Depending on the quantity and frequency, oral pills might cost anywhere from $100 to $300.
Topically administered testosterone gels and creams can cost anywhere from $200 to $500 each month, depending on dosage and concentration.
Dermal adhesive patches, like gels and lotions, deliver testosterone to the bloodstream through the skin. They’re also around the same price, ranging from $200 to $500 per month depending on dosage and frequency.
Patches that cling to the gums or inside the cheek are known as testosterone buccal systems. They normally cost between $200 and $500 per month and are applied twice daily, every 12 hours.
Testosterone therapy is a crucial part of a patient’s transition process. Although it appears to be costly, it is an important part of the procedure since it adds a hormone related with the patient’s gender.
How much does home TRT cost per month?
Testosterone replacement therapy is successful, and the costs are determined by a variety of factors:
Your dosage some of us may require more treatment than others, which means they’ll have to spend more for it.
The simplest method to break down the costs is to make a list of what each type of treatment includes.
Blood and Lab Work
It can be costly to have your hormones tested, especially since the treatment that follows is tailored to address specific hormonal deficiencies. Aside from the aforementioned financial considerations, there’s also the question of whether you’ll have the test done in a lab or doctor’s office, or if you’ll collect your own sample and submit it to a lab.
The costs involved can be substantial. A full 8-hormone panel can cost up to $800, and other laboratories charge up to $1,500 for a wide range of tests that aren’t covered by insurance.
At-home testing is a far more cost-effective alternative. It can, however, be costly, costing anywhere from $80 to $350.
Hone presently provides an at-home hormone assessment for $45, which includes all of the materials you’ll need to draw a blood sample. After that, you’ll package and submit your sample to a lab that works with Hone and is certified by the Clinical Laboratory Improvement Amendments (CLIA) and, where applicable, the College of American Pathologists (CAP). The accreditation of a lab signifies that it complies with or surpasses all federal testing standards set by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), and the United States Food and Drug Administration (FDA) (FDA).
Medical Services
Once the lab has returned your results, you’ll book an appointment with a Hone-affiliated physician for a video consultation. (The cost of this consultation is included in the $45 at-home hormone assessment, as previously stated.) Endocrinology, urology, internal medicine, and hormone replacement therapy are among the specialties of these experts. They’ll go through all of your results with you and see if you’re a good candidate for TRT.
If you meet the criteria, the doctor will create a pharmaceutical treatment plan that is unique to you. They’ll also go through everything you should know before you start, such as the benefits and hazards of TRT.
If you chose Hone for TRT, you’ll be enrolled in a $120/month membership plan, plus the cost of medication, which we’ll go through shortly. The subscription package offers the following features:
Every 90 days, check testosterone levels to see how they’ve progressed and whether medication/dosage has to be adjusted.
TRT drugs and tools for self-administering are delivered free to your home on a monthly basis.
It’s worth noting that the fees associated with these services, particularly those associated with blood and lab work, can vary greatly. A tailored treatment plan might cost as much as $1,000 per month, depending on criteria such as medicine and dose, location, and insurance eligibility. Do your homework before choosing on Hone for your hormone optimization needs, regardless of whether you choose Hone.
Medication costs (per month)
Assume your doctor has determined that your low testosterone levels necessitate TRT. What will the monthly cost of your prescription be?
Your out-of-pocket charges for medicine are determined by the same criteria that determine the costs of lab/blood testing and medical services. If your doctor administers the treatment, your expenditures are likely to rise as a result of the office visits. If you choose an at-home treatment plan, keep in mind that not all of them include the cost of supplies (such as syringes or needles), so make sure you inquire before you commit.
Injections: Injections are the most cost-effective TRT method. Without insurance, a single 200 mg/mL testosterone vial might cost anywhere from $40 to $100 every month. (Once again, this does not include delivery or the materials needed for self-injecting, and the price rises as the monthly dosage prescribed rises.)
A monthly testosterone dosage of 200 mg/mL costs $48 via Hone. If you require a higher monthly dosage, the price may alter. The cost of your medication covers delivery to your home as well as injectable materials.
Creams: A transdermal kind of TRT that you apply to particular areas of your body (typically the scrotal area), testosterone cream can cost anywhere from $30 to $500 per month, or even more if you use a brand name. A monthly subscription of testosterone cream starts at $48/month when added to Hone’s prescription plan, with the price modified to match your specified amount.
Troches: Hone offers this sublingual form of TRT for $48/month, which is a popular alternative to self-injection and creams. The cost is comparable to, if not better than, the majority of at-home testosterone companies that include troches in their subscription programs.
Oral Rx’s: Prescribed testosterone tablets can be rather costly, costing anywhere between $100 and $300 per month. Clomid (beginning at $34/month) and anastrozole (starting at $20/month) are two of Hone’s possibilities. It’s worth mentioning, though, that doctors rarely prescribe long-term oral testosterone use because there’s a risk of liver damage. Consult your doctor to determine whether this is the best treatment option for you.
Does insurance pay for hormone replacement therapy?
Menopausal symptoms such as hot flashes and nocturnal sweats affect approximately 90% of women. OB/GYN Elyse Erlich, M.D. discusses hormone replacement therapy and how it can assist women in their 40s, 50s, and beyond manage their symptoms.
What causes hot flashes and night sweats?
Our hormone levels estrogen and progesterone decrease as we approach menopause. When your ovaries stop producing eggs, you stop producing estrogen, which causes hot flashes, night sweats, sleeping issues, and vaginal dryness.
What are bioidentical hormones?
Bioidentical hormones are plant-based and lab-made hormones that are chemically identical to the hormones your body produces naturally. There are two types of bioidentical hormone products: those made by pharmaceutical corporations and those made by a compounding pharmacist specifically for you based on your hormone tests.
Are they covered by insurance?
The majority of hormones approved by the FDA are covered by insurance. The level of coverage for each product is determined by your plan. Most insurances do not cover compounded bioidentical hormones.
What are some other types of hormones?
Bioidentical hormones are available in a variety of forms. A patch is applied to the skin, a spray is applied to your arm, a gel is applied to your arm or inner thigh, and tablets are taken orally. Some products should be taken on a daily basis, while others should be applied once or twice a week. Oral estrogen is the least desirable estrogen type since it increases the risk of blood clots.
Progesterone should be used with hormone replacement treatment by all women who haven’t undergone a hysterectomy.
Because testosterone replacement is not FDA-approved, it must be done by a compounding pharmacy.
How do you know what hormones are lacking in a patient?
The ovaries stop generating estrogen and progesterone when a woman reaches menopause. These are the hormones that are missing from the body. A woman’s testosterone production is also reduced, and she typically quits producing testosterone by the age of 65.
Does a patient feel better right away?
Patients usually see an improvement in their symptoms after a few weeks of starting hormone therapy. The hormones may take up to three months to achieve a steady state. After that, we can adjust the dose by adding or decreasing hormones based on your symptoms to help you feel more balanced.
How does a patient know if she needs hormone replacement therapy?
If a patient’s mood swings, vaginal dryness, hot flashes, or nocturnal sweats are interfering with her lifestyle, she may benefit from these medications.
It is not always required to monitor hormone levels before beginning hormone replacement treatment. If a woman exhibits all of the symptoms listed above and her menses have stopped, she is clearly menopausal.
When utilizing compounded bioidentical hormones, however, salivary hormone testing is required to monitor hormone levels and modify the medicine appropriately.
How long have they been around?
Hormones have been manufactured by pharmaceutical businesses for more than 50 years. Bioidentical hormones have been compounded by pharmacists for at least 30 years.
Does hormone replacement therapy completely get rid of symptoms?
Yes, most of the time. Women who take hormone replacement treatment report that their hot flashes and night sweats go away, that they sleep better, that their mood improves, and that they feel better overall.
At what age should you start taking them?
If you decide to undergo hormone replacement treatment, you should begin it as soon as you reach menopause. This will help with menopausal symptoms as well as osteoporosis prevention. A woman should begin hormone therapy within 10 years of her previous period.
Is the older woman at risk if she stays on estrogen?
After five years on estrogen and progesterone, the risk of breast cancer increases. On hormones, there’s also a larger risk of stroke and blood clots, and the older you get, the higher the risk. Finally, long-term hormone use has been linked to an increased risk of Alzheimer’s disease. It’s a two-edged sword, to be sure.
How do you address these risks?
To help with symptoms, we use the smallest amount of hormones possible and advise patients to consider weaning off hormones in their 60s. Because they feel so amazing, some women choose to stay on hormones well into their 60s. This is a suitable alternative as long as a woman is in good health.
Are there any natural ways to alleviate the symptoms of menopause?
Hot flashes can be reduced in number and intensity if you exercise during menopause, especially if it makes you hot and sweaty. Acupuncture may aid in reducing the severity and frequency of hot flashes.
There are a variety of non-hormonal options to explore. They don’t entirely eradicate symptoms like hormones do, but they don’t come with the hazards that hormones do. They usually reduce the severity and frequency of symptoms by 40%.
Two FDA-approved products have been shown to be effective. Brisdelle, for example, is manufactured from paroxetine, the main element in antidepressants. This is given at a considerably lower dose than antidepressants. The second is Fosteum, a soy-based product. Fosteum has been found in studies to help enhance bone density.
Relizen, created from tree pollen, Estrovera, made from rhubarb, and Integrative Therapeutics’ AM/PM combination are all herbal treatments I frequently offer. When a patient begins these, I always advise giving them three months to be fully effective.
Are there any other products that can help?
Many herbal remedies are available over-the-counter, however studies have shown that many are ineffective.
New patients are welcome at Dr. Erlich’s office. She has an office in Arlington Heights at 1051 W. Rand Road, Suite 101. Beginning in mid-August, she will be seeing patients at Womancare, 355 Northwest Highway in Palatine. To make an appointment, call 847-221-4900.
Does TRT have side effects?
A tiny percentage of men have immediate negative effects with testosterone treatment, such as acne, sleep disturbances, breast swelling or discomfort, or ankle swelling. High red blood cell counts, which can raise the risk of clotting, are routinely monitored by doctors.
Long-term testosterone medication appears to increase the risk of cardiovascular disorders such as heart attacks, strokes, and death from heart disease in men. For example, the Testosterone in Older Men study was terminated in 2010 after preliminary findings revealed that men on testosterone replacement medication had much more heart problems. “Theoretical cardiac adverse effects become a little more immediate in older men,” adds Dr. Pallais.
Some doctors are also concerned that testosterone therapy may accelerate the growth of prostate cancer cells. The evidence is mixed, just like it is with the possible cardiac dangers. Doctors are wary of providing testosterone to men who may be at danger because prostate cancer is so common.
Hormone replacement therapy for males usually outweighs potential hazards for male patients with low blood testosterone levels. For most other men, though, it’s a joint decision with their doctor. It gives guys who are unhappy a chance to feel better, but the brief fix may divert focus away from long-term risks. “I can’t say for sure if this increases or decreases your personal risk of heart disease and prostate cancer,” Dr. Pallais explains.
When considering testosterone therapy or other medications, bear the dangers in mind. Dr. Pallais says, “I frequently discourage it, particularly if the man has borderline levels.”