Does Blue Cross Blue Shield of Texas cover testosterone treatment

A perfect example of the encumbrances levied by insurance companies would be with a Testosterone company whose name we’ll withhold, which has approximately 50 locations in Texas. So, this company bills insurance for testosterone treatment. The detriment here to their patients is that insurance guidelines dictate that a male patient may only be prescribed testosterone if he falls below the insurance company’s diagnostic parameters for normal testosterone levels, regardless of age or symptoms. This normal range is generally around 250 – 800. Therefore, if the patient is not below that 250, they will generally not allow testosterone to be prescribed, or if they do, the dosage will be so low, that any tangible benefits will be tough to identify. And, the patient has already paid the initial startup cost of $500 to this clinic, but they can’t be prescribed – so, then they’re out $500, and still must search for a doctor who does not use insurance. Additionally, insurance guidelines typically dictate that the patient only receive a Testosterone injection once every 10 days to 2 weeks (in some cases only once every 3 weeks), meaning around day 6 the patient starts to feel like the energy has been sucked out of them due to the 6 to 7-day half-life of testosterone cypionate.

Furthermore, the insurance company generally requires the patient to physically see the doctor for each injection, as opposed to self-injecting at home. Surprisingly, it doesn’t even end there. The insurance companies DO NOT ALLOW for the prescription of the absolutely necessary ancillary medications, HCG (Human Chorionic Gonadotropin) and an aromatase inhibitor, such as Arimidex or Anastrozole. Again…it’s a bottom line issue for insurance companies. The patient is NEVER the #1 priority for these high-profit insurance companies.

The Effects of Testosterone Injections in a Man’s Body

The important thing to understand about testosterone is that when one injects testosterone into the body, the testes’ production of testosterone almost immediately shuts down, as the mechanism in the brain that releases the hormone which signals the testes to release testosterone,
Luteinizing Hormone (LH), switches off as a sort of safety switch since the body is tricked into thinking that the testosterone that is beinginjected, has actually been produced by the body, when in fact, it was merely injected. So, the pituitary gland says, okay we’re producing enough…no more luteinizing hormone for the testes. However, the detrimental effect of no LH production, means no signal to the testes to release testosterone. So, when the testes cease functioning, they inevitably atrophy. The HCG that our doctors prescribe our patients allows the testes to continue producing testosterone naturally so the patient doesn’t wind up with testes that shrivel up like raisins (pardon the graphic and slightly embellished nature of the description lol).

There’s More to Testosterone Therapy than Testosterone Injections

The other ancillary medication for which insurance companies do not allow during testosterone therapy is the aromatase inhibitor, typically in the form of Arimidex or the generic form, Anastrozole. When a man takes testosterone, inevitably he will create more estrogen, a hormone that is more dominant in females and known for its production of female characteristics. If one produces too much estrogen, which is a likely possibility anytime testosterone is taken, the effects can be devastating for a man. Excess breast tissue can develop, free testosterone can decrease, mood changes can occur, among a host of other negative consequences. These effects, however, can very easily be suppressed with the aromatase inhibitor (Arimidex or Anastrozole), which insurance will not allow.

So, if these are the effects of testosterone therapy without the ancillary medications HCG and Anastrozole, why is it that insurance companies will not allow the doctor to prescribe them? Again, the short answer is MONEY. Always remember, the less the insurance company must pay, the more profit they make. The insurance companies never look out for the best interest of the patient. The #1 priority of insurance is PROFIT.

F. Secondary Sexual Characteristic (Masculinizing or Feminizing) Gender Reassignment Surgeries and Related Services:

Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY. These procedures may include the following:

• Liposuction/lipofilling or body contouring or modeling of waist, buttocks, hips, and thighs reduction;

Facial Reconstruction:

F. Secondary Sexual Characteristic (Masculinizing or Feminizing) Gender Reassignment Surgeries and Related Services:

Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY. These procedures may include the following:

• Abdominoplasty;
• Blepharoplasty;
• Brow lift;
• Calf implants;
• Cheek implants;
• Chin or nose implants;
• External penile prosthesis (vacuum erection devices);
• Face lift (rhytidectomy);
• Facial bone reconstruction/sculpturing/reduction, includes jaw shortening;
• Forehead lift or contouring;
• Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty);
• Laryngoplasty;
• Lip reduction or lip enhancement;
• Liposuction/lipofilling or body contouring or modeling of waist, buttocks, hips, and thighs reduction;
• Neck tightening;
• Pectoral implants;
• Reduction thyroid chondroplasty or trachea shaving (reduction of Adam’s apple);
• Redundant/excessive skin removal;
• Rhinoplasty (nose correction);
• Skin resurfacing;
• Testicular expanders;
• Voice modification surgery; and/or
• Voice (speech) therapy or voice lessons.

NOTE 4: Preparatory or ancillary procedures (such as anesthesia, tissue harvesting for skin, fat, nerve or muscle grafting, etc.) and supplies or equipment (such as stents, prosthesis, implants, etc.) that are required for the procedures listed above are considered an integral part of the MtF or FtM transition process.

NOTE 5: Surgical repairs or revisions related to MtF or FtM procedures may be required, such as removal and replacement of prostheses.

Fertility Preservation:

H. Gender Reassignment Reproductive Services:

Procurement, cryopreservation/freezing, storage/banking, and thawing of reproductive tissues, such as oocytes, ovaries, embryos, spermatozoa, and testicular tissue may be considered medically necessary for individuals with gender dysphoria because gender reassignment services, such as long-term cross-sex hormone therapy or surgical procedures, may render an individual infertile whether or not the individual has reproduced in the past.