Testosterone Replacement Therapy
 

Hi,
Does anyone know what the CAA’s view is on Testosterone Replacement Therapy? Are there any restrictions for a class one medical taking this treatment?

thanks

For pilots undergoing TRT, whether they can obtain or maintain a Class 1 medical certificate largely depends on the individual circumstances, the specific regulations of the aviation authority overseeing the medical certification, and the advice of medical professionals specializing in aviation medicine.

Hi Quasar2548. Did you ever get any further guidance on this issue?

I've just had a cheeky look through the CAA medical regs. Given that they don't mention HRT, I suspect that the CAA couldn't care less about TRT.

TRT is not a problem, here is the HRT Guidance Material

Menopause and Hormone Replacement Therapy (Appropriate to all certificate classes)

Applicants suffering symptoms of the menopause should consult their own GP or gynaecological specialist in the first instance, who should give consideration to whether treatment is appropriate or not. A potential side effect and cardiovascular risk review should be addressed as part of treatment option considerations.

Once a treatment and/or follow-up plan is instigated, the applicant should consult with their AME as to whether there are any current or predictable symptoms, particularly mental health and well-being, together with any common side effects of treatment experienced, that might affect the safe exercise of licence privileges. If such symptoms are experienced, and/or while treatment is commenced, a temporary period of grounding may be considered if necessary.

I looked into this for a friend who’s on TRT. The CAA generally needs a full medical report to make sure your treatment’s under control and doesn’t affect your flying ability. It's best to chat directly with them for the specifics. If you're in this situation, just make sure all your docs are up-to-date and be ready to discuss how TRT might impact your health.

The CAA take a dim view on it.
I tried to go on it earlier this year. Went through my AME who pushed it up to the CAA. They wanted full independent endocrinology reports - extra to the prescribing doctor, a full report from the prescribing doctor and wanted to ground me whilst I trial the treatment. They then required endocrinology reviews annually.
It seems they didn't understand it or have a process for it.
However for females that wish to take HRT there is a process and only have to be grounded 2 days I believe...I stand corrected on this.
In my opinion they viewed it as steroids and I just wanted to get ripped. They discounted the improvement in cognitive thinking, sleep, energy, mood, other health benefits...all quite important for a pilot I would say 🤷‍♂️

Unfortunately Coffee and Cream the facts dont support your enthusiasm. If you have proven low levels of testrosterone as you age AND clear symptoms correlating to hypogonadism, monitored testosterone supplementation may be beneficial and that was what the CAA wanted. It may be harsh to ground someone for more than a couple of weeks, but the annual reviews would surely be what anyone taking the supplement would have anyway. However the risks include benign and malignant prostate issues, obstructive sleep apnoea, and deep venin thrombosis and pulmonary emboli. All are disqualifying or limiting for commercial pilots. Personally I wouldnt touch it with a bargepole unless medically indicated as above.

Basically what Radgirl highlights above - urologists/endos can't agree on this so what chance does the CAA have and for us pilots who wish to increase the quality of our lifes with normalising our hormones have to go through the process... Alot of UK specialists who operate in the NHS use their guidelines which basically means you have to be really clinically unwell to be diagnosed with hypogonadism, its much lower limit than the BSSA for example and our american friends. For the CAA purposes, If your on treatment, then it needs to be reviewed and under the care of someone that knows what their doing - this is probably the case for the vast majority of medical issues, but for us it typically means it will cost more. Theres a couple of great clinics in the UK that know what their doing and will give the medical oversight that CAA require, but its not as straight forward as it ought to be sadly, with the CAA.

Your first hurdle with the CAA is a diagnosis letter which follows the BSSA guidelines on testing etc. When you commence treatment, I was told 4 weeks minimum of medical suspension. It was basically "4 weeks on stable dose". Trouble with any TRT protocol is you start on given dose and after 6 weeks or so your bloods are taken, then its adjusted and the refinement begins to zero in on your optimised dose. So your dosing will change unless your very lucky. So plan for a longer downtime, i.e. 12 weeks+. I also agree and wish male HRT was viewed as the same as female HRT but I guess normalising your hormones is seen differently between the two sexes and I suspect its down to the anabolic abuse with the CAA wanting your numbers monitored (i.e. high numbers do lead to cardio risk, so it sort of makes sense in a way) but it could be easier to get onto it but with the required oversight.

I wouldn't recommend anyone try TRT unless its under the care of someone who knows what they're doing (i say this as theres many online providers popping up left/right and centre who would diagnose and treat your dog). It should be viewed as a potential life long treatment plan if it helps you and once your stable on any dose then bloods/paperwork confirming your all ok is academic.