FOLX generally offers two main routes for testosterone: injectable and gel. Other routes are out there, but they come with a lot of red tape around them largely by way of insurance/pricing or how they’re administered that keeps us from prescribing them. But we still want you to be informed of the options.
Individual, peel-open packets of the same type of gel that we typically prescribe as a pump bottle. The packets are a great option for convenience, but we lean toward the pump bottle in large part because individual packets can be exceptionally expensive (think $900/mo).
An adhesive patch that allows testosterone to be absorbed through the skin and into the bloodstream. While a great option for folx who want to avoid needles, these are still technically under patent and because of that can be very expensive (think $1000/mo). Our supplier has also communicated with us that these patches have been discontinued from production for now, making them an inconsistent and expensive option.
We are still able to prescribe these, but generally try to find less-expensive alternatives first.
If any FOLX members are insured and want to pursue either of these options, we recommend members contact their insurance providers to ask about whether they cover either of these routes and how to get coverage approved if so. Some insurance companies will require prior authorization to cover the cost of the prescription. The prior authorization process is initiated once a member goes to the pharmacy to pick up the medication, and the pharmacy contacts the insurance provider to authorize the prior authorization (we know), which can take days if not longer.
We absolutely don’t want to deter folx who want to pursue gel packets or patches, but rather inform you that coverage isn’t always a smooth, guaranteed process! For those interested in these routes, a FOLX clinician can talk through the pros and cons further in an appointment.
These next two routes for testosterone are not currently provided or prescribed by FOLX both for their price and for the fact that they require in-person appointments:
Injectable testosterone undecanoate
A sterile liquid form of Testosterone (testosterone suspended in oil) that is injected into the muscle every 10-12 weeks by a medical provider. As part of the prescribing requirements in the U.S., folx who receive testosterone undecanoate have to remain in their provider’s office for observation for 30 minutes after each injection.
While on the positive side this injection only needs to happen 4-5 times a year and doesn’t require learning self-injection or storing supplies, the barriers remain high to this method: providers need to be enrolled in a specific risk evaluation and mitigation strategy program called Aveed REMS, and it comes with a risk of serious pulmonary oil microembolism (POME) reactions (which is when some of the injection liquid travels to and blocks the blood vessels in the lungs, and is why folx on this route have to wait in their provider’s office for 30 minutes after each injection).
These are pellets that are implanted under the skin (subcutaneously) of the buttocks or belly through a small incision by a medical provider. The pellets gradually dissolve and release testosterone over time. Pellets need to be inserted every 3-4 months, and there is no need to remove the old pellets since they dissolve.
Pellets are the longest lasting type of testosterone available and offer less fluctuation in testosterone levels, but they do require provider visits and minor invasive procedures to be implanted.
Above all, both testosterone undecanoate and testosterone pellets can generally be quite expensive for those who are uninsured.
According to drugs.com, costs can run around $1,420 for one dose of injectable testosterone undecanoate, and Testopel pellets subcutaneous implants can be around $1,107 (with a coupon) for one dose. For those who are insured and interested in these routes, FOLX can only recommend contacting insurance to inquire about coverage, and seeking out a local LGBTQ+ provider who may be able to administer them.
With the different routes and dosages of testosterone, there are a lot of ways to find the one that fits best for each individual body. For those ready to get started with FOLX for Testosterone, the process begins here. For existing FOLX members with questions about dosage, don't hesitate to schedule time with a clinician or to reach out to your clinician on your portal. And for those who’ve just got some more questions, read up on Testosterone here, and feel free to reach out to us at firstname.lastname@example.org.