Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
Testosterone cypionate or enanthate or propionate injection

Criteria Approval Period

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

  1. Hypogonadism

    2. OR

  2. Orchiectomy

    3. OR

  3. Undescended testes

    4. OR

  4. Klinefelter's syndrome

    5. OR

  5. Female-to-male (gender) transformation

    6. OR

  6. Pituitary tumour

    7. OR

  7. Removal of pituitary gland

Indefinite

OR

For the indication of:

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

    2. OR

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

Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

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

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