Treatment of Males with Low Testosterone

Testosterone replacement is covered for symptomatic primary or secondary hypogonadism due to disorders of the testicles, pituitary, or brain, delayed male puberty, and gender dysphoria with informed consent, provided diagnostic labs and exams meet policy requirements. Coverage requires two fasting AM testosterone measurements from identical labs, LH/FSH assessment, PSA, hematocrit, and digital prostate exam within 12 months prior to initiation, and documents discussion of FDA-listed risks; testosterone is excluded for late-onset/idiopathic hypogonadism, active breast or prostate cancer (except disease-free ≥2 years post-prostatectomy), recent thrombotic or major cardiac events, PSA/hematocrit thresholds above limits, and for those desiring fertility.

"Testosterone therapy is covered for symptomatic hypogonadism (congenital or acquired) due to a disorder of the testicles, pituitary gland, or brain."