can an arnp prescribe testosterone replacement therapy is a common question in clinics today. You want clear rules not guesswork. Your care depends on who can write the script and manage labs.

We answer can an arnp prescribe TRT with clear criteria. You’ll see how state laws and federal rules shape access. We review DEA needs protocols and collaboration limits. You’ll know when to book with an ARNP and when to see an MD. We cover insurance implications and referral tips. You get plain language and actionable steps. That way your treatment stays safe legal and streamlined.

What Is an ARNP and Their Prescriptive Authority

An ARNP (Advanced Registered Nurse Practitioner) holds graduate education and national certification. Practice follows state nurse practice acts and board rules. ARNPs diagnose, order labs, and prescribe, including controlled substances when authorized. Testosterone is a Schedule III drug under the DEA.

Prescriptive authority depends on state scope, DEA registration, and payer rules. Requirements include APRN licensure, national certification, and a DEA number for Schedules II–V. States may also require controlled substance registration, PDMP checks, and sometimes a physician collaboration agreement (AANP, NCSBN).

• Full practice, independent prescriptive authority, 27 states and DC, AANP 2024
• Reduced or restricted practice, collaborative or supervisory terms, remaining states, AANP 2024
• Schedule status, testosterone Schedule III, DEA

Item	Value	Source
Full practice authority states	27 + DC	AANP 2024
Testosterone schedule	III	DEA CSA
PDMP use	Required by most states	CDC, state boards

Can An ARNP Prescribe Testosterone Replacement Therapy

Can an ARNP prescribe testosterone replacement therapy is permitted, if federal and state requirements are met. Can an ARNP prescribe TRT includes Schedule III prescribing under DEA registration.

Federal Rules For Controlled Substances

Can an ARNP prescribe testosterone replacement therapy follows federal controlled substance rules. Testosterone carries Schedule III status under the Controlled Substances Act, which sets registration, recordkeeping, and prescription standards (21 U.S.C. §812, 21 C.F.R. §1308.13).

• Hold an active DEA registration for the practice state, if you prescribe testosterone (21 C.F.R. §1301.12).
• Use a valid NPI and state license, if you register with the DEA (21 C.F.R. §1301.13).
• Follow 21 C.F.R. Part 1306 for prescription content, if you issue Schedule III scripts, including date, patient, drug, quantity, directions, and your signature.
• Use Electronic Prescribing of Controlled Substances when required by state law, if you transmit prescriptions electronically (21 C.F.R. Part 1311).
• Maintain records for 2 years or longer per state law, if you prescribe or dispense controlled substances (21 C.F.R. §1304.04).
• Conduct legitimate medical purpose prescribing within usual professional practice, if you treat hypogonadism with testosterone (21 C.F.R. §1306.04).

Data and classifications

Item	Federal status	Source
Testosterone	Schedule III	21 C.F.R. §1308.13(e)
DEA registration	Required per state	21 C.F.R. §1301.12
EPCS	Permitted and regulated	21 C.F.R. Part 1311
PDMP programs	Operate in all 50 states and DC	PDMP TTAC 2024

Sources: DEA, Code of Federal Regulations; PDMP Training and Technical Assistance Center.

State Scope-Of-Practice Variations

Can an ARNP prescribe testosterone replacement therapy varies by state scope and collaboration rules. Full practice states grant independent evaluation, diagnosis, and prescribing, while reduced or restricted states impose collaboration or supervision.

• Confirm full practice authority in your state, if you want independent prescribing. 27 states and DC grant full practice authority to APRNs per AANP’s 2024 map.
• Check collaborative practice requirements, if your state lists reduced practice. Examples include Texas and Florida, which permit Schedule III prescribing with defined protocols and limits under state law.
• Verify supervisory rules, if your state lists restricted practice. Examples include North Carolina and California’s transition-to-practice pathways, which tie prescriptive authority to supervision or specific certification.

Practical steps

• Review your board of nursing scope statement, if you plan testosterone therapy for hypogonadism.
• Enroll and query your state PDMP before and during therapy, if state law mandates checks.
• Align dosing and monitoring with guideline-based care, if labs confirm androgen deficiency.

Sources: American Association of Nurse Practitioners State Practice Environment 2024; Texas BON; Florida BON; North Carolina BON; California BRN.

Supervision, Collaboration, And Protocols

can an arnp prescribe testosterone replacement therapy under a collaboration model depends on your state scope and written protocols. can an arnp prescribe TRT under supervision requires documented oversight that matches state board rules.

Standing Orders and DEA Registration

Can an ARNP prescribe testosterone replacement therapy? Yes, when state law, licensure, and DEA rules are met. Testosterone is a Schedule III drug (21 U.S.C. 812). Prescribing requires an active state license, NPI, and DEA registration for Schedule III. Orders must follow 21 CFR 1306.03, 1306.05 (content/DEA number), and 1311 (EPCS with two-factor authentication). Keep records per 21 CFR 1304, check PDMP per state law, and limit refills to 5 within 6 months (21 CFR 1306.22). Document a legitimate medical purpose (21 CFR 1306.04).

Standing protocols may define:
• Indications: Low morning total testosterone on 2 days (ICD-10 E29.1, Z79.890).
• Routes/dosing: IM cypionate, gels, or patches within guideline ranges.
• Monitoring: Hematocrit, PSA, lipids, LFTs, adverse effects.
• Stop rules: Hematocrit ≥54%, abnormal prostate findings.
• Safety: PDMP checks, diversion mitigation steps.

Guideline alignment: Endocrine Society 2018 and AUA 2018 support structured diagnosis, labs, and monitoring.

Requirements Table

Requirement	Rule/Number
Schedule	III (21 U.S.C. 812)
Refills	5 in 6 months (21 CFR 1306.22)
Prescription content	21 CFR 1306.05
EPCS authentication	21 CFR 1311
Record retention	21 CFR 1304

Telehealth and Cross-State Care

Can an ARNP prescribe testosterone replacement therapy via telehealth? Yes, if federal and state rules permit. An ARNP must hold an active license in the patient’s state.

Under DEA telemedicine flexibilities (88 FR 79836, through Dec 31, 2024), initial in-person exams were not required. Outside this, the Ryan Haight Act (21 U.S.C. 829e) mandates an in-person exam unless a narrow exception applies. Use synchronous audio-video when state law requires. Confirm patient location each visit. All e-prescriptions for controlled substances must use EPCS with two-factor authentication (21 CFR 1311).

Safeguards for telehealth TRT:
• Verify identity, state location, and licensure alignment each visit
• Obtain prior labs (two morning total testosterone levels)
• Order labs via CLIA-certified facilities
• Check PDMP for all new prescriptions/refills per state law
• Schedule follow-up at 3 months, then 6–12 months with labs and safety review

Cross-state prescribing: No APRN Compact is active (NCSBN). Cross-state care requires individual state licenses or telehealth clinics licensed in patient’s state.

Sources: DEA temporary rule 88 FR 79836, 21 U.S.C. 829e, 21 CFR 1311, NCSBN APRN Compact, state PDMP statutes.

Clinical Criteria And Safe Prescribing

Can an arnp prescribe testosterone replacement therapy hinges on verified hypogonadism and guideline-based safety steps. Can an arnp prescribe TRT also relies on your state scope, your DEA status, and documented monitoring.

Diagnosis And Baseline Testing

Can an arnp prescribe testosterone replacement therapy after you confirm biochemical low testosterone with symptoms. Confirm morning total testosterone on 2 separate days, use the same lab, and fast when feasible (Endocrine Society, 2018; AUA, 2018).

• Document symptoms, for example low libido, erectile dysfunction, low energy, loss of body hair, low bone density.
• Identify causes, for example opioids, glucocorticoids, pituitary disease, obesity, OSA, hemochromatosis, HIV.
• Order labs, for example total testosterone, LH, FSH, prolactin, SHBG or free testosterone if SHBG abnormal, CBC with hematocrit, CMP, lipid panel, A1c, TSH, estradiol if gynecomastia, PSA based on age and risk.

Use these thresholds and timing.

Measure	Threshold or Target	Timing	Sources
Total testosterone	Low if consistently < 300 ng/dL	2 separate mornings	AUA 2018
Free testosterone	Use when SHBG abnormal	With total T	Endocrine Society 2018
Hematocrit	Defer if > 50–54%	Baseline	Endocrine Society 2018
PSA	Baseline based on age, risk	Before start	AUA, USPSTF context
LH, FSH	Low or inappropriately normal in secondary	Baseline	Endocrine Society 2018

Confirm primary vs secondary hypogonadism, then image the pituitary if severe secondary signs, for example very low T, panhypopituitarism, visual symptoms (Endocrine Society, 2018).

Dosing Options And Monitoring

Can an arnp prescribe testosterone replacement therapy using FDA-labeled formulations and target mid-normal serum levels. Titrate to symptom relief and a trough total testosterone near 400–700 ng/dL, adjust for product timing (AUA, 2018).

• Choose injectables, for example cypionate or enanthate 50–100 mg weekly or 100–200 mg every 2 weeks IM or SC.
• Choose gels, for example 1% gel 50–100 mg daily, apply to shoulders or upper arms, avoid transfer risk.
• Choose patches, for example 4 mg nightly, rotate sites to reduce dermatitis.
• Choose pellets, for example 150–450 mg implanted every 3–6 months, plan for minor procedure risks.
• Choose oral undecanoate, for example 158–396 mg per day in divided doses with meals.
• Choose nasal gel, for example 11 mg per nostril three times daily.

Monitor methodically.

Parameter	Interval	Action Threshold	Sources
Total testosterone	2–3 months after start or change	Out of mid-normal	AUA 2018
Hematocrit	3–6 months, then annually	> 54% hold or reduce	Endocrine Society 2018
PSA	3–12 months per risk, then per guideline	Rise > 1.4 ng/mL in 12 months prompts urology	AUA 2018
LFTs, lipids, A1c	6–12 months as indicated	Abnormal results	FDA labels
Adverse effects	Each visit	Acne, edema, mood change, gynecomastia	FDA labels

Check your PDMP before each new controlled prescription where required by state law. Use product-specific timing for labs, for example gel 2–4 hours post application, injection midway between doses.

Contraindications and Risk Management

Can an ARNP prescribe testosterone replacement therapy? Only if no absolute contraindications exist (Endocrine Society 2018; FDA).

Contraindications:
• Prostate or male breast cancer
• Hematocrit >50–54%
• Desire for fertility (use gonadotropins or SERMs instead)
• Severe untreated OSA
• Uncontrolled heart failure
• Recent MI or stroke (within 3–6 months)

Risk management:
• Erythrocytosis: dose reduction, switch to gel, or phlebotomy
• Gel transfer: cover site, wash hands
• Acne/edema: adjust dose or formulation
• Gynecomastia: optimize dose, check estradiol if symptomatic
• BPH/LUTS: urology referral if PSA/symptoms rise
• CV risk: manage BP, lipids, diabetes, obesity, tobacco; note FDA warnings

Product safeguards: Long-acting testosterone undecanoate (Aveed) requires REMS setting due to POME/anaphylaxis risk. Document informed consent covering fertility suppression, CV uncertainty, and monitoring duties.

Sources: Endocrine Society 2018; AUA 2018; FDA safety communications and labels.

Practical Steps For Patients

Can an ARNP prescribe testosterone replacement therapy depends on state scope and DEA status. Use these steps to confirm safety, legality, and access.

Finding a Qualified ARNP

Can an ARNP prescribe testosterone replacement therapy? Yes—if properly licensed, certified, and DEA-registered. Verify before booking.

Checks:
• Confirm state authority for Schedule III prescribing (board of nursing, AANP map).
• Verify state license, NPI, and DEA status (license lookup, NPPES, DEA).
• Ask about collaborating physician agreements if required.
• Confirm board certification (ANCC, AANP) and specialty (family, adult, endocrine).
• Request TRT experience—panel size, monitoring, adverse event tracking.
• Ensure PDMP use for all controlled prescriptions.
• Review workflow: two morning testosterone tests + symptoms (Endocrine Society, AUA).
• Confirm baseline labs: testosterone, LH, prolactin, hematocrit, PSA, lipids.
• Ask about contraindication screening: prostate cancer, high hematocrit, untreated OSA.
• Verify in-person/telehealth process, including identity, location, and licensure alignment.

Insurance, Prior Authorization, And Costs

Can an ARNP prescribe testosterone replacement therapy under your plan when criteria match policy terms. Prepare documents to speed approval.

• Call your plan for coverage of testosterone cypionate, enanthate, gels, patches, and pellets.
• Request prior authorization criteria, including ICD 10 codes such as E29.1 and documentation of two low morning total testosterone values.
• Ask about step therapy, quantity limits, and site of care rules for injections.
• Gather records, including symptoms, two morning total testosterone levels, baseline hematocrit, and PSA if age 40 or older per AUA.
• Use in network labs to reduce costs, and ask for bundled lab orders on the same date.
• Compare pharmacy prices using GoodRx for cash options when plans exclude TRT.
• Confirm injection supply coverage, including syringes, needles, and alcohol pads.

Item	Typical requirement or range	Source
Low T confirmation	Two morning total testosterone values on different days	Endocrine Society 2018
Hematocrit threshold	Avoid start if hematocrit above 50 percent	AUA Guideline
Office injection fee	10 to 40 dollars per visit	Clinic fee schedules, examples
Testosterone cypionate 200 mg per mL 10 mL	40 to 150 dollars cash	GoodRx price ranges
Topical gels monthly	30 to 400 dollars cash	GoodRx price ranges
Patches monthly	100 to 500 dollars cash	GoodRx price ranges
Pellets procedure	500 to 1000 dollars per placement	Clinic cash lists, examples
Total testosterone lab	20 to 50 dollars cash	National lab cash lists
PSA lab	20 to 60 dollars cash	National lab cash lists

• Endocrine Society guideline on testosterone therapy 2018 https://academic.oup.com/jcem/article/103/5/1715/4939465
• American Urological Association testosterone deficiency guideline https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline
• DEA and PDMP resources https://www.deadiversion.usdoj.gov

When To Refer To Specialists

When to refer to specialists centers on guideline triggers, risk factors, and abnormal findings.

Trigger	Threshold	Specialist
Hematocrit	≥54%	Hematology
PSA rise	>1.4 ng/mL in 12 months	Urology
PSA absolute	>4.0 ng/mL	Urology
Testosterone	<150 ng/dL with low or normal LH/FSH	Endocrinology
Prolactin	Elevated above lab range	Endocrinology
Cardiovascular event	MI or stroke within 3–6 months	Cardiology
Sleep apnea	Moderate to severe, untreated	Sleep medicine

• Refer for suspected pituitary disease, if prolactin is high, testosterone is <150 ng/dL, or MRI is abnormal (Endocrine Society 2018).
• Refer for prostate concerns, if PSA is >4.0 ng/mL, PSA rises >1.4 ng/mL in 12 months, or DRE is abnormal (AUA 2018).
• Refer for erythrocytosis, if hematocrit is ≥54% or symptoms appear, despite dose changes (Endocrine Society 2018).
• Refer for fertility goals, if you want to preserve sperm, since hCG or SERMs fit better than testosterone (AUA 2018).
• Refer for high cardiac risk, if recent MI, stroke, or decompensated heart failure exists (FDA, AHA).

Conclusion

Your path to testosterone therapy works best when you pair clarity with diligence. Choose an ARNP who treats you like a partner. Expect transparent plans precise monitoring and fast answers to questions.

Protect yourself by keeping copies of labs scripts and visit notes. Track symptoms energy mood sleep and sexual health in one log. Bring that record to every visit. It speeds decisions and flags risks early.

If anything feels off ask for a second look or a specialist handoff. You deserve safe legal and effective care. Take the next step today. Verify credentials book a consult and prepare your questions so you walk in confident.

Frequently Asked Questions

Can an ARNP prescribe testosterone replacement therapy (TRT)?

Yes. ARNPs can prescribe testosterone if allowed by their state scope of practice and if they hold active state licensure and DEA registration. Testosterone is a Schedule III controlled substance, so ARNPs must follow federal and state rules, including proper documentation, PDMP use where required, and guideline-based care for conditions like hypogonadism.

Do state laws affect an ARNP’s ability to prescribe testosterone?

Absolutely. Prescriptive authority varies by state. Twenty-seven states and Washington, D.C. allow full practice and independent prescribing. Other states require collaboration or supervision by a physician and may limit controlled substance prescribing. Always confirm your state’s board of nursing rules and any collaborative agreement requirements.

What federal requirements must an ARNP meet to prescribe testosterone?

An ARNP needs an active DEA registration, a valid state license, and an NPI. Prescriptions must meet Controlled Substances Act standards, be for a legitimate medical purpose, and include all required elements. ARNPs should maintain appropriate records, check the PDMP as required, and follow evidence-based protocols for diagnosis, dosing, and monitoring.

Is testosterone a controlled substance?

Yes. Testosterone is a Schedule III controlled substance under the Controlled Substances Act. This means stricter prescribing requirements, DEA registration for prescribers, potential limits on refills, and enhanced recordkeeping and monitoring obligations.

What should patients verify about an ARNP before starting TRT?

Confirm the ARNP’s active state license, DEA registration, and NPI. Check state scope authority (full, reduced, or restricted), whether a collaborating physician agreement is required and in place, national certification, experience treating hypogonadism, and participation in the PDMP. Ask about their protocol for labs, follow-up, and referral thresholds.

Can ARNPs prescribe testosterone via telehealth?

Often, yes—if permitted by federal and state laws. The ARNP must verify patient identity and location, hold an active license in the patient’s state, review appropriate labs, check the PDMP, and document a legitimate medical purpose. Some payers require in-person exams first. Rules may change, so verify current telehealth regulations.