Struggling with brain fog, low energy, or just not feeling like yourself lately? These could be signs of low testosterone. And for many, testosterone replacement therapy (TRT) offers a path to feeling better. But before starting treatment, it’s worth asking: Is testosterone replacement therapy covered by insurance?

While TRT can improve quality of life, the cost can be a deciding factor. If this is one of your ultimate worries, we’ve got the info you need.

In this blog, we’ll break down how insurance providers determine coverage for TRT, what factors influence out-of-pocket costs, and what you can expect to pay, with or without insurance.

What is Testosterone Replacement Therapy (TRT)?

​​If you’ve been diagnosed with low testosterone, you might be considering testosterone therapy. TRT can help bring your testosterone levels back to a healthy range so your body can function the way it’s supposed to.

Testosterone is a hormone that plays a major role in your energy levels, mood, sex drive, muscle mass, and overall well-being. When levels drop too low, it can affect everything from how you feel to how your body performs. TRT works by supplementing your natural testosterone through various methods, helping you regain balance and feel more like yourself again.

There are several common forms of TRT to choose from, depending on what fits your lifestyle and your doctor’s recommendations:

• Injections. Typically given weekly or every few weeks, injections are one of the most common and affordable options.
• Gels or Creams. Applied daily to your skin, these absorb into your bloodstream gradually.
• Patches. Worn on your body and replaced every 24 hours for a steady hormone dose.
• Pellets. Implanted under the skin by a doctor, these slowly release testosterone over several months.

You might benefit from testosterone therapy if you’ve been diagnosed with clinically low testosterone (also called hypogonadism). It’s also sometimes considered for aging men who are experiencing symptoms like fatigue, low libido, or brain fog due to declining hormone levels.

Is Testosterone Replacement Therapy Covered by Insurance?

So, is testosterone replacement therapy covered by insurance?

Yes, most insurance companies cover all forms of TRT. However, there may be out-of-pocket costs, and various factors can affect your total expenses.

Coverage for testosterone therapy generally depends on your insurance provider, diagnosis, and whether the treatment is considered medically necessary.

To qualify, most plans require clinical proof of low testosterone, typically confirmed through two early-morning blood tests. Your doctor may also need to submit documentation of your symptoms and a treatment plan. Without this, insurance providers are unlikely to approve TRT.

Medicare & TRT

Medicare offers limited coverage for TRT when it’s medically necessary. This usually applies only to diagnosed conditions like hypogonadism, not natural age-related hormone decline.

Coverage also depends on how the therapy is administered. If you receive treatment in a doctor’s office, it may be covered under Part B. Self-administered options like injections or gels may fall under Part D, depending on the plan. Always check your specific Medicare plan to confirm what’s included.

Private Insurance & TRT

Private insurers generally cover testosterone therapy when it's deemed medically necessary, but coverage details can vary.

Most require prior authorization, meaning your provider will need to submit your lab results and diagnosis before treatment begins. Some plans may only cover certain forms of TRT, like injections or gels, while others may also include patches or pellet implants.

Before starting treatment, contact your insurance company and ask:

• Do I need prior authorization for testosterone therapy?
• Are diagnostic lab tests covered?
• Which forms of TRT are included in my plan?
• What will my out-of-pocket costs be?

How Much is TRT Without Insurance?

As mentioned in the section above (Is testosterone replacement therapy covered by insurance), not all plans offer coverage, especially if your treatment isn’t considered medically necessary. If you're paying out of pocket, here's what you can expect.

• TRT injections are usually the most affordable option, typically costing between $40 and $150 per month, depending on dosage and pharmacy.
• Topical gels or creams tend to be pricier, ranging from $150 to $500 per month, especially for brand-name products.
• Transdermal patches fall in a similar price range, often costing $200 to $500 per month.
• Pellet implants, which last several months at a time, can cost $500 to $1,000 per insertion, making them one of the more expensive options annually.

In addition to the medication itself, you’ll also need to cover doctor visits, lab tests, and follow-ups, which can add a few hundred dollars per year if you’re paying out of pocket.

If you’ve been searching how much is TRT, there are a few ways to save. One option is using an HSA (Health Savings Account) or FSA (Flexible Spending Account). These are special accounts that let you use pre-tax money to pay for eligible healthcare expenses, including TRT. 

You can also ask your doctor or pharmacy about compounded testosterone, which is often more affordable than brand-name options. 

Lastly, comparing costs between TRT clinics and traditional healthcare providers can help you find a setup that works best for your needs and budget.

TRT Side Effects and Risks

Like any medical treatment, TRT comes with potential downsides. It’s important to be aware of TRT side effects before starting.

Common side effects may include:

• Acne or oily skin
• Fluid retention or swelling
• Mood swings or irritability
• Increased red blood cell count
• Breast tenderness or enlargement (gynecomastia)
• Sleep disturbances, including worsening sleep apnea
• Increased body hair or changes in skin texture

These are usually manageable but can become bothersome without proper monitoring.

There are also potential risks to consider, such as cardiovascular issues, reduced fertility, and the possibility of developing a dependency on external testosterone, which can suppress your body’s natural production.

That’s why medical supervision matters. Your provider will monitor your hormone levels, adjust your dosage as needed, and watch for complications. Regular check-ins help keep your treatment safe and effective over time.

Finding Testosterone Therapy Near You

When exploring TRT benefits, it’s just as important to find the right provider as it is to get the right treatment. You have a few options, each with their own pros and cons:

• Primary care doctors can often prescribe testosterone and monitor your levels, especially if you already have an established relationship.
• Endocrinologists specialize in hormone-related conditions and may offer more in-depth testing and long-term management.
• TRT clinics or men’s health centers focus specifically on testosterone therapy and often provide bundled services like labs, prescriptions, and follow-ups. 

To find a reputable provider, try searching “testosterone therapy near me” and check for licensed clinics or doctors with experience in hormone replacement. Look for reviews, credentials, and whether they offer personalized treatment plans based on your lab results.

Choosing the right provider can make a big difference in your experience and in the long-term success of your treatment.

Conclusion

So, is testosterone replacement therapy covered by insurance? In many cases, yes, but it depends on your provider, diagnosis, and proof of medical necessity. 

If you’re paying out of pocket, TRT can cost anywhere from $40 to $500+ per month, depending on the form you choose, with added expenses for labs and doctor visits.

While TRT offers real benefits (like improved energy, mood, and libido), it also comes with potential side effects and risks, making medical supervision essential. Whether you go through a primary care doctor, specialist, or TRT clinic, choosing the right provider is key to a safe, effective experience.

At RR Wellness Clinic, we’re committed to helping you feel your best, offering expert care and support every step of the way. Ready to explore if TRT is right for you? Contact us today to get started.