Limited Use Note(s) |
|
TESTOSTERONE1% 2.5g Foil Packet
| Reason For Use Code | Clinical Criteria |
|---|---|
| 397 | For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients. Note: Older males with nonspecific symptoms of fatigue, malaise, depression who have a low normal random testosterone level do not satisfy these criteria. |
| LU Authorization Period: 1 year |