TRT for hypogonadism is now a CACI condition — most pilots on TRT can be certified by their AME on exam day. Specific ground trials, lab requirements, and hard disqualifiers apply.
Informational Use Only. The information on this page reflects our understanding of current FAA medical certification requirements and is provided for general educational purposes only. FAA policies, the AME Guide, and CACI worksheets are updated frequently and without notice. The FAA AME Guide and FAA Civil Aerospace Medical Institute (CAMI) are the authoritative sources in all cases. Nothing on this page constitutes legal or medical advice. Always verify current requirements directly with your Aviation Medical Examiner and the official FAA AME Guide at faa.gov/ame_guide before making any certification decisions.
TRT Is Now a CACI Condition — AME Can Issue on Exam Day
As of the updated FAA CACI worksheet (04/29/2026), low testosterone / hypogonadism treated with approved medications is a CACI condition. Your AME can issue your certificate on exam day without sending the case to the FAA regional office, provided all criteria are met. Key requirements: stable regimen with no side effects affecting flight duties, hematocrit ≤54% on a CBC within 90 days, no history of venous thromboembolic events, and no phlebotomy treatment. Enclomiphene citrate is not acceptable.
Your medication type and medical history determine which certification pathway applies.
Topical testosterone only (gel, cream, patch)
Oral or injectable testosterone, Testopel, Anastrozole, or HCG
Clomiphene citrate
Hematocrit >54% or treatment requires phlebotomy
History of venous thromboembolic event (PE or DVT)
Enclomiphene citrate use
Each medication class has specific issuance requirements. Some require ground trials before flying is permitted.
The CACI checklist focuses on flight-safety-relevant outcomes of TRT — particularly hematocrit, thrombotic risk, and stability of the current regimen.
Your treating physician must confirm the condition is stable on the current regimen, no changes are recommended, and no side effects that would interfere with flight duties are present. Mild skin irritation and acne are specifically listed as acceptable and do not disqualify.
A complete blood count (CBC) performed within 90 days of your exam is required. Hematocrit must be 54% or less. If elevated, you must be deferred to the FAA. Testosterone therapy commonly raises hematocrit — regular monitoring with your treating physician is essential.
If your condition requires phlebotomy to manage elevated hematocrit, you do not qualify for the CACI pathway and must be deferred to the FAA for Special Issuance. This is a hard disqualifier for the AME-can-issue pathway.
Any prior venous thromboembolic event (VTE) — pulmonary embolism (PE) or deep vein thrombosis (DVT) — disqualifies you from the CACI pathway. This requires full FAA Special Issuance review, which includes cardiovascular documentation separate from the TRT evaluation.
Your clinical progress note should address the diagnosis of hypogonadism, including the etiology if known (primary vs. secondary), and document that the condition is being managed appropriately with the current medications.
A detailed Clinical Progress Note from a urologist, endocrinologist (preferred), or treating physician within 90 days of your exam is required. It must address: diagnosis, assessment, plan, prognosis, current medications, and history of cardiovascular disease, thromboembolic events, or prostate cancer.
Using enclomiphene citrate — explicitly not acceptable; using it means you cannot be certified on this medication under any CACI pathway
Hematocrit above 54% — the most common reason TRT pilots are deferred; must be monitored regularly
Not completing the required ground trial (7 days HCG, 14 days clomiphene) before the exam
Undisclosed history of pulmonary embolism or DVT — this disqualifies from CACI and requires FAA Special Issuance
Currently undergoing phlebotomy to manage hematocrit — automatic deferral; CACI not available
Clinical progress note older than 90 days — must be current to the exam
Self-prescribed or unmonitored TRT — the physician note must come from an actual clinic visit with documented oversight
For clomiphene: not confirming absence of visual side effects — required before the AME can issue
What sets our practice apart for testosterone replacement certification cases.
HIMS Senior AME
FAA-designated HIMS Senior AME experienced in evaluating TRT cases across all CACI and Special Issuance pathways.
Pilot, Not Just a Physician
Active corporate jet pilot (ATP, CFI, CFII, MEI) — understands the operational implications of hormonal therapies and medication timing.
Direct Physician Access
You work directly with the doctor. No case managers, no handoffs — one point of contact from consultation through certification.
Remote Consultations
Pre-exam consultations available remotely so you know whether your current regimen is CACI-eligible and what documentation you need before your exam day.
Modern Patient Portal
A digital patient portal for document management and case progress tracking.
Two Arizona Locations
Flagstaff and Lake Havasu City offices — serving pilots across the Southwest and beyond.