Indy Men’s Health’s Clinic Policies for Testosterone Therapy

The following information is provided to our patients to assist them with making an informed decision about testosterone replacement therapy. Your provider may also offer you a copy of this information in print form. We strongly encourage all patients who are currently receiving or are considering testosterone therapy to read this page in its entirety, including our clinic policies at the end of the page.

What are the Benefits of Testosterone Therapy?

Testosterone is a naturally occurring hormone that is essential for male health and wellness. Some men may not produce enough testosterone, a condition known as testosterone deficiency (TD), which can cause adverse symptoms that negatively affect their quality of life. Although not all men with TD report these symptoms, many men report:

  • Low energy
  • Decreased sex drive
  • Depression and/or anxiety
  • Poor sleep quality
  • Poor mental focus
  • Fat gain
  • Loss of muscle mass
  • Loss of bone density

Although not guaranteed, restoring men’s testosterone levels back to a normal range with testosterone therapy may improve some or all these symptoms. It’s important to note that many of these symptoms are not unique to TD and may be caused by other medical conditions or a man’s general physical condition.

What are the Risks of Testosterone Therapy?

Although testosterone therapy is generally considered to be safe, it does carry potential side effects that patients should be aware of. Testosterone may cause an elevation in a man’s hematocrit, which is a measure of blood thickness. This may require some men to donate blood intermittently. Some men may require further evaluation by a separate specialist known as a hematologist who can evaluate for other underlying blood disorders. Although rare, men who develop an elevated hematocrit and are not compliant with regular monitoring and treatment may be at an increased risk for heart attack or stroke.

Patients should know that there is significant debate regarding testosterone therapy and cardiac risk. Although it is unclear whether testosterone replacement therapy elevates a man’s cardiac risk, there is significant evidence showing that untreated testosterone deficiency elevates a man’s risk for cardiovascular disease.

Patients should know that there is the relationship between testosterone and the prostate is complex. There is no evidence that testosterone replacement therapy causes prostate cancer. That being said, regular prostate cancer screening is important for all men as part of regular wellness checks.

Although extremely rare in men, testosterone may affect breast cancer progression.

Men who have low testosterone are at risk for a condition known as obstructive sleep apnea. Testosterone replacement may actually aggravate this condition in some men.

Patients should be aware that certain forms of testosterone replacement therapy may lower sperm counts, possibly to the point of infertility. Testosterone may also cause a man’s testicles to decrease in size. These effects may be temporary or permanent. Although different strategies can be utilized to reduce these risks, success cannot be guaranteed.

Testosterone replacement may accelerate hair loss in some men who are genetically prone to this.

Topical forms of testosterone, like cream or gels, carry the risk of skin-to-skin transmission to other people following application.

Testosterone replacement therapy may inhibit a man’s ability to make his own natural testosterone later. As with fertility and testicular size, there are strategies to reduce this risk, but success cannot be guaranteed. As a result, certain forms of testosterone therapy carry the risk of dependence.

How is Testosterone Therapy Monitored?

Due to the potential side effects mentioned above, testosterone therapy requires close monitoring and regular office visits. Because testosterone also carries the risk for abuse, it is considered a controlled substance by the United States Drug Enforcement Administration (DEA).  It is under strict control by the government.

What are your Clinic Policies Regarding Testosterone Therapy?

Regular Lab Policy

Proper testosterone monitoring requires regular lab work. Your provider will order this lab work so it can be obtained before your follow-up visit. It is your responsibility to make sure you have this lab work drawn. If you have your lab work drawn at a location different than Urology of Indiana, it is your responsibility to make sure the results of this lab work has been sent to our office before your follow-up visit. Our fax number is (317) 876-2369. If your follow-up visit is coming up, and you have not been scheduled for labs beforehand, please call our office at (317) 564-5104 to ensure a lab draw is not required. This is your responsibility. If you arrive to your follow-up visit and your labs have not been collected or are not available for your provider to review, your provider may not be able to refill your prescription. This may delay your next prescription and you may be without testosterone during this time.

Clinical Compliance Policy

During the course of your treatment, your provider may request that you donate blood if your hematocrit (blood thickness) becomes elevated. You may or may not be asked to see a specialist known as a hematologist. Depending on your age, your provider may regularly screen you for prostate cancer. If your provider feels that you may be at risk for having a prostate cancer, they may recommend that you see a cancer specialist. It is your responsibility to follow these recommendations. Failure to do so may result in your testosterone prescription being cancelled until you are able to follow your specific recommendations.

Testosterone Refill Policy

At each visit, your provider will make every effort to ensure you have enough testosterone to last you until your next scheduled clinic appointment. Making this appointment and obtaining your scheduled lab work is your responsibility. if you miss your appointment, cancel it, or delay it for any reason, you may run out of testosterone. If you find yourself in any of the aforementioned circumstances and call to request a refill, you may be required to obtain repeat bloodwork and attend a follow-up visit prior to receiving a refill. Depending on your provider’s availability, this may result in you being without testosterone for some time. Repeated calls to our clinic phone line, or abusive behavior, may result in your prescription being permanently cancelled. Testosterone is a controlled substance and is monitored closely by the Drug Enforcement Agency (DEA).

Prior Authorization Policy

Most insurance companies utilize what is known as a prior authorization prior to covering certain medications. You may learn about this if your pharmacy informs you that it has submitted paperwork to our office in order for your medication to be covered.

Insurance companies use prior authorizations as a tactic to save money and avoid paying for certain medications. Prior authorizations require hours of work by our staff members and prevent them from participating in direct patient care. As a result, our office is unable to process prior authorizations for SOME testosterone medications. We are currently only processing prior authorizations for the following at-home medications: Xyosted, Jatenzo, Aveed, Testopel, Natesto and certain fertility medications.

If you call our office requesting a prior authorization that is not one of the above-mentioned exceptions, we will be happy to provide you information on how to submit the prior authorization yourself.  Unfortunately, we will not be able to submit it on your behalf. Excessive repeated calls to our clinic phone line, or abusive behavior, may result in your prescription being permanently cancelled.

We appreciate you taking the time to read this informational guide. It is our goal to provide you with the highest level of care possible and your adherence to the above policies allows us to do that! Thank you for your time and understanding – stay well!

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