Current as of September 28, 2026. General information, not medical advice.
Short answer: Yes. Testosterone injections and gel are on the VA national formulary, with facility-level prior authorization, and there is a published national Criteria for Use your provider has to document against. The bar is two unequivocally low fasting morning levels at least a week apart, plus a real workup. Oral capsules, pellets and nasal testosterone are non-formulary.
The criteria your provider is working from
VA Pharmacy Benefits Management publishes a document called Criteria for Use for testosterone replacement in males, last updated March 2025. It is public, and knowing what is in it will make your appointment go better.
You need one qualifying condition. Hypogonadism with at least one clinical sign or symptom of androgen deficiency is the usual one. The list also covers HIV with low testosterone and weight loss, long-term high-dose glucocorticoids, bilateral orchiectomy, and Klinefelter or Kallmann syndrome.
Then you need all of the following: two unequivocally low baseline fasting total testosterone levels, at least a week apart, drawn between 8am and 10am. A documented workup of other treatable causes. A documented risk and benefit discussion. Baseline hemoglobin and hematocrit, LH, FSH and prolactin. And a PSA discussion.
There is no single national cutoff number. The criteria note that most trials used below 275 ng/dL for enrollment and that 264 is the lower 2.5th percentile in young non-obese men.
Absolute exclusions are active prostate cancer, active breast cancer, and untreated erythrocytosis with hematocrit above 48 percent. Things that need justification rather than a flat no include wanting children, severe untreated sleep apnea, PSA above 4, and recent cardiovascular events.
Why the bar is where it is
In 2018 the VA Inspector General found the diagnostic workup was incomplete in the majority of veterans receiving testosterone prescriptions. In fiscal 2014, 111,455 male VA patients were on testosterone, about 2.2 percent of male patients.
The criteria exist because of that report. It is worth knowing that the scrutiny is not aimed at you personally.
If you are already on testosterone from a civilian clinic
This is the paragraph most veterans need and almost nobody publishes.
The criteria address it directly. For patients on long-standing therapy, meaning more than about a year, without documentation, the requirement for two low baseline levels can be waived case by case. For patients recently started without documentation, the recommendation is to hold therapy for three to six months and then reassess.
Three to six months off. That is the cost of arriving without paperwork.
So if you are being treated privately and you expect to move onto VA care, get your pre-treatment labs into your own hands now, in writing, with dates. Two morning fasting draws, LH and FSH. That file is the difference between continuing and starting over.
What VA will and will not stock
Injectable testosterone in oil and testosterone gel are formulary with facility prior authorization. Prior authorization here means the drug is covered but needs approval at your facility before it is dispensed.
Oral capsules, pellets and nasal testosterone are non-formulary, which means a separate request with a clinical justification. Non-urgent non-formulary requests are decided within 96 hours, and there is an appeal to the facility pharmacy committee.
Copay depends on your enrollment and whether the condition is service connected. Care and medication for a service-connected condition is generally exempt from copays. Ask your facility rather than assuming.
How VA monitors you
The January 2026 companion guidance sets the schedule: testosterone, hemoglobin, hematocrit and PSA at three to six months and at twelve months. Dose adjustment if total testosterone goes above 900 or hematocrit above 51 percent. Stop if hematocrit exceeds 54 percent.
It also says an abnormal level should always be confirmed by mass spectrometry, and that levels below 150 need evaluation for secondary hypogonadism, meaning a pituitary problem rather than a testicular one.
And it is blunt about the market you are probably shopping in. Its words: social media and direct-to-consumer marketing of testosterone products may lead men to believe these products are the panacea for their ailments.
That is a fair warning and we will not argue with it.
Where this leaves you
If you are enrolled and your symptoms are real, start at the VA. It is covered, the criteria are reasonable medicine, and the monitoring is appropriate.
The honest reasons veterans end up paying privately are narrower than the ads suggest: a long wait for endocrinology, a provider who will not order the workup, a formulation VA does not stock, or a transition period where you are between coverage.
If that is you, the thing that protects you is documentation you can carry back.
Questions people actually ask
Will the VA prescribe testosterone? Yes, if you meet the published Criteria for Use. Injections and gel are formulary with facility prior authorization.
What labs does the VA require? Two unequivocally low fasting total testosterone levels at least a week apart, drawn 8am to 10am, plus hemoglobin, hematocrit, LH, FSH and prolactin, plus a workup of other causes.
I am already on TRT from a private clinic. What happens? With more than a year of documented therapy the two-level requirement can be waived case by case. Recently started without documentation, the guidance is to hold treatment three to six months and reassess.
Does the VA cover pellets or oral testosterone? Those are non-formulary. They require a separate request with justification, decided within 96 hours for non-urgent cases.
What hematocrit will make them stop my therapy? Above 54 percent. Dose adjustments start above 51.
Where we fit
We are not a replacement for VA care and we will say so. Where we help is the part VA is slowest at: getting a complete, properly timed workup into your record, and not losing continuity while your enrollment or your coverage changes.
Two morning fasting draws a week apart, LH and FSH, prolactin, hematocrit, read with you. Records in your hands, so nothing has to be repeated later.
Discounted pricing for military, law enforcement and first responders. Request a consultation at hewhealth.com or call (850) 820-8850.
Hew Health, LLC is a private medical practice. We are not affiliated with, endorsed by, or connected to the Department of Veterans Affairs. General information as of September 28, 2026, not medical or benefits advice. Confirm your own coverage with your VA facility. Testosterone is a Schedule III controlled substance. FDA-approved testosterone products are indicated for men with low testosterone caused by an associated medical condition, and none are approved for men with low testosterone who lack an associated medical condition.
Sources: "Testosterone Replacement Therapy (TRT) in Males — Criteria for Use," VA Pharmacy Benefits Management Services and National Formulary Committee, updated March 2025. "Evaluation for and Management of Males with Low Testosterone — Recommendations for Use," VA PBM with the National Endocrinology Field Advisory Board, January 2026. VA National Formulary, August 1, 2026, and VA Formulary Advisor. VHA Directive 1108.08, July 29, 2022. VA Office of Inspector General report 15-03215-154, April 11, 2018.