Limited coverage criteria – testosterone injection

Last updated on March 24, 2025

Special Authority requests can now be submitted online. It's simple and quick!

This drug is eligible for automatic approval when patient meets criteria and the request is submitted by eForms

Generic name	testosterone cypionate or enanthate or propionate
Strength & form	100 mg/ mL vial

Special Authority criteria	Approval period
For the treatment of testosterone deficiency in one of the following diagnoses: Hypogonadism OR Orchiectomy OR undescended testes OR Klinefelter's syndrome OR Female-to-male (gender) transformation OR Pituitary tumor OR Removal of pituitary gland	Indefinite
For the indication of: Surgery of pituitary gland AND where low testosterone levels have been documented OR AIDS-wasting syndrome AND where low testosterone levels have been documented	Indefinite

Special Authority criteria

Approval period

For the treatment of testosterone deficiency in one of the following diagnoses:

Hypogonadism

Orchiectomy

undescended testes

Klinefelter's syndrome

Female-to-male (gender) transformation

Pituitary tumor

Removal of pituitary gland

Indefinite

For the indication of:

Surgery of pituitary gland AND where low testosterone levels have been documented

AIDS-wasting syndrome AND where low testosterone levels have been documented

Indefinite

Practitioner exemptions

None

Special notes

For any cancer-related condition, please contact the British Columbia Cancer Agency at (604) 877-6098 ext. 4610

Special Authority request form(s)

Log in to eForms
HLTH 5328 – General Special Authority request (PDF, 656KB)

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