Low testosterone (hypogonadism)
What the FAA's documents say about low testosterone (hypogonadism), in plain words, with the FAA's own words one press away.
FAA term: Low Testosterone (Low T) Hypogonadism
Hormone replacement therapy (female)
The FAA also publishes a disposition table for Hormone Replacement Therapy (HRT) - Female, whose examples of hormone replacement include testosterone. Crosscheck has a page on it.
Short version
The Low Testosterone (Low T) Hypogonadism disposition table sorts the condition by its treatment.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ATreated with topical testosterone only. | Examiner issues | Examiner can issue |
| Row BTreated with one or more of anastrozole, clomiphene citrate, human chorionic gonadotropin (HCG), testosterone (oral or injectable), Testopel or tamoxifen. | Worksheet | CACI |
| Row CAll others, or treatment that requires or is concurrent with phlebotomy, for which the table says to see the Blood Donation page. The row's note says use of enclomiphene citrate is not acceptable. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Low testosterone (hypogonadism)
- Row A · Examiner can issue
Treated with topical testosterone only. The table says ISSUE if the examiner can determine the condition is under control, current medications are acceptable, and there are no symptoms that would interfere with flight or safety related duties, and has the examiner annotate Block 60.
Treated with topical testosterone only … If the AME can determine the condition is under control, current medications are acceptable, and no symptoms that would interfere with flight or safety related duties: ISSUE Annotate Block 60.
- Row B · CACI
Treated with one or more of anastrozole, clomiphene citrate, human chorionic gonadotropin (HCG), testosterone (oral or injectable), Testopel or tamoxifen. The table sends the examiner to the CACI worksheet for hypogonadism, and says this requires a complete blood count (CBC) lab and a current, detailed clinical progress note from the treating physician or a completed Low Testosterone (Low T) Hypogonadism Status Summary. If the pilot meets all CACI worksheet criteria and is otherwise qualified, the table says ISSUE, and has the examiner annotate the elements or findings in Item 60, annotate the correct CACI statement in Block 60, and keep the required supporting information on file.
Treated with one or more of the following: • Anastrozole • Clomiphene citrate • Human Chorionic Gonadotropin (HCG) • Testosterone (Oral or Injectable) • Testopel • Tamoxifen … See the CACI - Hypogonadism Worksheet. This requires a complete blood count (CBC) lab AND a current, detailed Clinical Progress Note from the treating physician OR a completed Low Testosterone (Low T) Hypogonadism Status Summary … If the pilot meets all CACI worksheet criteria and is otherwise qualified: ISSUE … Annotate (elements or findings) in Item 60. … Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
All others, or treatment that requires or is concurrent with phlebotomy, for which the table says to see the Blood Donation page. The row's note says use of enclomiphene citrate is not acceptable. The examiner defers and submits the information the table lists to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
All others OR Requires or concurrent treatment with phlebotomy (See Blood Donation page.) Note: Use of enclomiphene citrate is NOT acceptable. … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
The FAA pathways for low testosterone (hypogonadism)
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: The progress note from the urologist, endocrinologist or treating doctor
The note the examiner reviews, and what it finds.Within 90 days before the examA current, detailed progress note from a clinic visit with your urologist, endocrinologist or treating physician, no more than 90 days before the exam. Your AME reviews it.
It finds
- The condition is stable on the current regimen, with no changes recommended
- No side effects which would interfere with flight duties
Or the Status Summary
The worksheet also takes these findings from a completed Low Testosterone (Low T) Hypogonadism Status Summary.
Show the FAA's words: The progress note from the urologist, endocrinologist or treating doctor
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the urologist, endocrinologist, or treating physician no more than 90 days prior to the AME exam.
FAA source: CACI – Low Testosterone (Low T) Hypogonadism Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
A current, detailed Clinical Progress Note from the treating physician or OR a completed Low Testosterone (Low T) Hypogonadism Status Summary finds: [ ] Condition is stable on current regimen, no changes recommended, and no side effects which would interfere with flight duties. Note: Mild skin irritation and acne are acceptable.
FAA source: CACI – Low Testosterone (Low T) Hypogonadism Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Step 2: A complete blood count (CBC)
Performed within the last 90 days, and what it verifies.Within 90 days before the examA complete blood count (CBC) performed within the last 90 days.
It verifies
- Hematocrit is 54% or less
Show the FAA's words: A complete blood count (CBC)
Complete blood count (CBC) performed within the last 90 days verifies: [ ] Hematocrit is 54% or less
Note: Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.
FAA source: CACI – Low Testosterone (Low T) Hypogonadism Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Step 3: The worksheet's criteria
Your medications, phlebotomy, and any venous thromboembolic event.One or more of the medications the worksheet lists.
The worksheet's list
- Anastrozole
- Clomiphene citrate
- Human chorionic gonadotropin (HCG)
- Testopel
- Testosterone (oral or injectable)
- Tamoxifen
Initial ground trials
- Clomiphene citrate: a 14-day initial ground trial, and your AME must confirm no visual side effects present
- HCG: a 7-day initial ground trial
Not acceptable
- Not: Enclomiphene citrate
The worksheet's other criteria
- No treatment with phlebotomy required
- No venous thromboembolic event (VTE), such as PE/DVT
Show the FAA's words: The worksheet's criteria
Medications for condition (one or more of the following):
Note: Enclomiphene citrate is NOT acceptable. [ ] Anastrozole [ ] Clomiphene citrate
Requires a 14-day initial ground trial, and
AME must confirm no visual side effects present [ ] Human Chorionic Gonadotropin (HCG)
Requires a 7-day initial ground trial [ ] Testopel [ ] Testosterone (Oral or Injectable) [ ] Tamoxifen
FAA source: CACI – Low Testosterone (Low T) Hypogonadism Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Does the individual require treatment with phlebotomy. [ ] No
FAA source: CACI – Low Testosterone (Low T) Hypogonadism Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
Any venous thromboembolic event (VTE) such as PE/DVT? [ ] No
FAA source: CACI – Low Testosterone (Low T) Hypogonadism Worksheet. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The table says ISSUE if the examiner can determine the condition is under control, current medications are acceptable, and there are no symptoms that would interfere with flight or safety related duties, and has the examiner annotate Block 60.
Row BWorksheetCACI
The table sends the examiner to the CACI worksheet for hypogonadism, and says this requires a complete blood count (CBC) lab and a current, detailed clinical progress note from the treating physician or a completed Low Testosterone (Low T) Hypogonadism Status Summary. If the pilot meets all CACI worksheet criteria and is otherwise qualified, the table says ISSUE, and has the examiner annotate the elements or findings in Item 60, annotate the correct CACI statement in Block 60, and keep the required supporting information on file.
Row CDefers to the FAASpecial Issuance
The examiner defers and submits the information the table lists to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Treated with topical testosterone only. The table says ISSUE if the examiner can determine the condition is under control, current medications are acceptable, and there are no symptoms that would interfere with flight or safety related duties, and has the examiner annotate Block 60.
Treated with topical testosterone only … If the AME can determine the condition is under control, current medications are acceptable, and no symptoms that would interfere with flight or safety related duties: ISSUE Annotate Block 60.
- Row B · CACI
Treated with one or more of anastrozole, clomiphene citrate, human chorionic gonadotropin (HCG), testosterone (oral or injectable), Testopel or tamoxifen. The table sends the examiner to the CACI worksheet for hypogonadism, and says this requires a complete blood count (CBC) lab and a current, detailed clinical progress note from the treating physician or a completed Low Testosterone (Low T) Hypogonadism Status Summary. If the pilot meets all CACI worksheet criteria and is otherwise qualified, the table says ISSUE, and has the examiner annotate the elements or findings in Item 60, annotate the correct CACI statement in Block 60, and keep the required supporting information on file.
Treated with one or more of the following: • Anastrozole • Clomiphene citrate • Human Chorionic Gonadotropin (HCG) • Testosterone (Oral or Injectable) • Testopel • Tamoxifen … See the CACI - Hypogonadism Worksheet. This requires a complete blood count (CBC) lab AND a current, detailed Clinical Progress Note from the treating physician OR a completed Low Testosterone (Low T) Hypogonadism Status Summary … If the pilot meets all CACI worksheet criteria and is otherwise qualified: ISSUE … Annotate (elements or findings) in Item 60. … Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
All others, or treatment that requires or is concurrent with phlebotomy, for which the table says to see the Blood Donation page. The row's note says use of enclomiphene citrate is not acceptable. The examiner defers and submits the information the table lists to the FAA for a possible Special Issuance, and annotates the elements or findings in Block 60.
All others OR Requires or concurrent treatment with phlebotomy (See Blood Donation page.) Note: Use of enclomiphene citrate is NOT acceptable. … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance Annotate (elements or findings) in Block 60.
The CACI worksheet's criteria
Progress note
It finds
- The condition is stable on the current regimen, with no changes recommended
- No side effects which would interfere with flight duties
Or the Status Summary
The worksheet also takes these findings from a completed Low Testosterone (Low T) Hypogonadism Status Summary.
Complete blood count (CBC)
- Hematocrit is 54% or less
Your medications for low testosterone
The worksheet's list
- Anastrozole
- Clomiphene citrate
- Human chorionic gonadotropin (HCG)
- Testopel
- Testosterone (oral or injectable)
- Tamoxifen
Initial ground trials
- Clomiphene citrate: a 14-day initial ground trial, and your AME must confirm no visual side effects present
- HCG: a 7-day initial ground trial
Not acceptable
- Not: Enclomiphene citrate
The worksheet's other criteria
- No treatment with phlebotomy required
- No venous thromboembolic event (VTE), such as PE/DVT
Show the FAA's words: the CACI worksheet's criteria for Low testosterone (hypogonadism)
- Stable on the current regimen, with no changes recommended and no side effects which would interfere with flight duties
FAA criterion: a current, detailed progress note from the treating physician, or a completed Low Testosterone (Low T) Hypogonadism Status Summary, finds the condition stable on the current regimen, no changes recommended, and no side effects which would interfere with flight duties. The worksheet notes that mild skin irritation and acne are acceptable.
A current, detailed Clinical Progress Note from the treating physician or OR a completed Low Testosterone (Low T) Hypogonadism Status Summary finds: [ ] Condition is stable on current regimen, no changes recommended, and no side effects which would interfere with flight duties. Note: Mild skin irritation and acne are acceptable.
- No treatment with phlebotomy required
FAA criterion: the worksheet asks whether the pilot requires treatment with phlebotomy, and the acceptable answer on it is no.
Does the individual require treatment with phlebotomy. [ ] No
- No venous thromboembolic event (VTE), such as PE/DVT
FAA criterion: the worksheet asks about any venous thromboembolic event (VTE) such as PE/DVT, and the acceptable answer on it is no.
Any venous thromboembolic event (VTE) such as PE/DVT? [ ] No
- A complete blood count (CBC) performed within the last 90 days
FAA criterion: a complete blood count (CBC) performed within the last 90 days verifies the hematocrit is 54% or less. Beside that line the worksheet cites Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.
Complete blood count (CBC) performed within the last 90 days verifies: [ ] Hematocrit is 54% or less … Note: Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline.
- Medications for the condition from the worksheet's list
FAA criterion: medications for the condition, one or more of the following -- anastrozole; clomiphene citrate, which requires a 14-day initial ground trial, and the examiner must confirm no visual side effects present; human chorionic gonadotropin (HCG), which requires a 7-day initial ground trial; Testopel; testosterone (oral or injectable); tamoxifen. The worksheet notes that enclomiphene citrate is not acceptable.
Medications for condition (one or more of the following): … Note: Enclomiphene citrate is NOT acceptable. [ ] Anastrozole [ ] Clomiphene citrate … Requires a 14-day initial ground trial, and … AME must confirm no visual side effects present [ ] Human Chorionic Gonadotropin (HCG) … Requires a 7-day initial ground trial [ ] Testopel [ ] Testosterone (Oral or Injectable) [ ] Tamoxifen
If the examiner defersSpecial Issuance
The table's last row is all others, or treatment that requires or is concurrent with phlebotomy. Its note says use of enclomiphene citrate is not acceptable, and the table marks the row DEFER.
What the FAA lists to send
- Item 1. The Low Testosterone (Low T) Hypogonadism Status Summary, or a current, detailed clinical progress note generated from a clinic visit with the treating urologist, endocrinologist (preferred), or treating physician no more than 90 days before the exam. The note must address all items listed on the Status Summary: a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan; prognosis; and follow-up.
- Item 2. Items the physician specifically addresses: the current medications, and if there is any history of cardiovascular disease, thromboembolic events, or prostate cancer. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
- Item 3. A lab CBC performed no more than 90 days before the exam.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's last row is all others, or treatment that requires or is concurrent with phlebotomy. Its note says use of enclomiphene citrate is not acceptable, and the table marks the row DEFER.
All others OR Requires or concurrent treatment with phlebotomy (See Blood Donation page.) Note: Use of enclomiphene citrate is NOT acceptable. … DEFER Submit the information to the FAA for a possible Special Issuance
What the FAA lists to send
- Item 1
The Low Testosterone (Low T) Hypogonadism Status Summary, or a current, detailed clinical progress note generated from a clinic visit with the treating urologist, endocrinologist (preferred), or treating physician no more than 90 days before the exam. The note must address all items listed on the Status Summary: a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan; prognosis; and follow-up.
Low Testosterone (Low T) Hypogonadism Status Summary. … OR … A current, detail ed Clinical Progress Note generated from a clinic visit with the treating urologist, endocrinologist (preferred), or treating physician no more than 90 days prior to the AME exam. It must address all items listed on the Status Summary: • A detailed summary of the history of the condition • Current medications, dosage, and side effects (if any); • Physical exam findings; • Results of any testing performed; • Diagnosis; • Assessment and plan; • Prognosis; and Follow-up.
- Item 2
Items the physician specifically addresses: the current medications, and if there is any history of cardiovascular disease, thromboembolic events, or prostate cancer. The FAA's progress-note sheet says that when a letter uses the words "it must specifically include", they highlight specific items (that may or may not be part of a standard current, detailed Clinical Progress Note) for the physician to address.
It must specifically include: … Current medications; and … If there is any history of cardiovascular disease, thromboembolic events, or prostate cancer.
“IT MUST SPECIFICALLY INCLUDE” If this language is in your letter, it is to highlight SPECIFIC items (that may or may not be part of a standard current, detailed Clinical Progress Note). Make sure your physician addresses these specific items important for medical certification or clearance.
- Item 3
A lab CBC performed no more than 90 days before the exam.
Lab - CBC performed no more than 90 days before the AME exam.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later exams
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
See “Pilot Information – Clinical Progress Note
Enclomiphene citrate is not acceptable
Both documents say enclomiphene citrate is not acceptable. On the table it is a note in the row the table marks DEFER.
Show the FAA's words: good to know, 2
Note: Use of enclomiphene citrate is NOT acceptable. … DEFER Submit the information to the FAA for a possible Special Issuance
Note: Enclomiphene citrate is NOT acceptable.
Two medications need a ground trial
On the worksheet, clomiphene citrate requires a 14-day initial ground trial, and the examiner must confirm no visual side effects present. Human chorionic gonadotropin (HCG) requires a 7-day initial ground trial.
Show the FAA's words: good to know, 3
[ ] Clomiphene citrate … Requires a 14-day initial ground trial, and … AME must confirm no visual side effects present [ ] Human Chorionic Gonadotropin (HCG) … Requires a 7-day initial ground trial
Treatment with phlebotomy is deferred
Treatment that requires or is concurrent with phlebotomy is in the table's last row, marked DEFER, and the table says to see the Blood Donation page.
Show the FAA's words: good to know, 4
All others OR Requires or concurrent treatment with phlebotomy (See Blood Donation page.) … DEFER Submit the information to the FAA for a possible Special Issuance
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- CACI – Low Testosterone (Low T) Hypogonadism WorksheetOpen to print: CACI – Low Testosterone (Low T) Hypogonadism Worksheet, a PDF at the FAA, in a new tab
The worksheet of criteria the examiner reviews.
CACI
- Low Testosterone (Low T) HypogonadismOpen to print: Low Testosterone (Low T) Hypogonadism, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Medication guidance
Medications Crosscheck lists as taken for low testosterone (hypogonadism), each with its own page on what published FAA guidance says about it.
- Listed in the FAA's low testosterone (hypogonadism) table
- Listed in the FAA's low testosterone (hypogonadism) table
- Listed in the FAA's low testosterone (hypogonadism) table
- Listed in the FAA's low testosterone (hypogonadism) table
- Listed in the FAA's low testosterone (hypogonadism) table
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.