Dr. Charles Mok explains when insurance covers testosterone replacement therapy. Coverage requires testosterone below 280 ng/dL and a diagnosed medical condition like testicular disorder or chemotherapy damage, not just age-related decline. Qualifying symptoms include underdeveloped genitalia, gynecomastia, and night sweats.
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The FDA indication for testosterone replacement therapy is for men with low testosterone. That's defined by a level generally less than 280 nanograms per deciliter. That's a blood test that's actually severely low, but it's indicated for those men that have either disordered the testicles, brain, extra female chromosomes, and in some case, chemotherapy, but not for the indication of low testosterone due to aging. Aging is not considered a disease by the fda, and it's not considered a disease by insurance companies. They must have symptoms such as poor development of the genitalia, like underdeveloped penis or testicles gynecomastia, which is breast enlargement, night flashes and hot sweats, which men rarely get. They're saying, basically, we'll pay for it if they have severe low testosterone due to a medical condition that we recognize, but not for low testosterone associated with aging.