To get an FAA medical certificate while being treated for low testosterone, your Aviation Medical Examiner works through the FAA Low Testosterone Hypogonadism CACI worksheet during the exam, and if every criterion is met the AME can issue on the spot. The worksheet requires four things: a stable condition on an approved medication, no need for therapeutic phlebotomy, no history of pulmonary embolism or deep vein thrombosis, and a hematocrit at or below 54 percent on a complete blood count drawn within 90 days of the exam.1Federal Aviation Administration. CACI – Low Testosterone (Low T) Hypogonadism Worksheet One important exception: pilots using topical testosterone only (gels, creams, patches) skip the worksheet entirely and follow a simpler route.
Does the CACI Worksheet Apply to You
The FAA’s disposition table sorts pilots into three groups based on their treatment.2Federal Aviation Administration. Low Testosterone (Low T) Hypogonadism Disposition Table
- If you use only topical testosterone and have no symptoms that would interfere with flight duties, the AME can issue without the CACI worksheet, without a CBC, and without a clinical progress note.
- If you use oral or injectable testosterone, anastrozole, clomiphene citrate, HCG, Testopel, or tamoxifen, the AME must complete the CACI worksheet using a current clinical progress note and a CBC drawn within 90 days.
- If you require therapeutic phlebotomy or use any medication not on the approved list, the AME cannot issue under CACI and must defer to the FAA’s Aerospace Medical Certification Division.
Knowing which group you fall into tells you what to gather before the appointment.
The Four CACI Criteria
Every box on the worksheet must be checked. If one fails, the AME cannot issue.1Federal Aviation Administration. CACI – Low Testosterone (Low T) Hypogonadism Worksheet
Stable on Current Treatment
Your treating physician’s clinical progress note must confirm the condition is stable on your current regimen, that no medication changes are recommended, and that no side effects interfere with flight duties. Mild skin irritation and acne are treated as acceptable side effects. As an alternative to a plain progress note, your doctor can complete the FAA’s “Low Testosterone (Low T) Hypogonadism Status Summary” form.
No Therapeutic Phlebotomy
You cannot currently require phlebotomy (blood removal to reduce red blood cell counts). Pilots who do fall outside CACI and require FAA review.
No Venous Thromboembolic Events
No history of pulmonary embolism or deep vein thrombosis.
Hematocrit at or Below 54 Percent
A CBC drawn within 90 days of the exam must show hematocrit no higher than 54 percent. Testosterone therapy can raise red blood cell production, and higher levels increase clotting and stroke risk.
Approved Medications and Ground Trials
The worksheet accepts a specific list of medications. Anything outside it forces a deferral. As of the April 2026 worksheet update, the approved medications and their pre-exam ground-trial requirements are:1Federal Aviation Administration. CACI – Low Testosterone (Low T) Hypogonadism Worksheet
- Anastrozole: no ground trial.
- Clomiphene citrate: 14-day initial ground trial, and the AME must confirm no visual side effects.
- Human chorionic gonadotropin (HCG): 7-day initial ground trial.
- Testopel (implantable pellets): no ground trial.
- Testosterone, oral or injectable: no ground trial.
- Tamoxifen: no ground trial.
A ground trial means no pilot-in-command duties and no acting as a required crewmember for the stated number of days after starting the medication. Finish the trial before you sit for the AME exam so the examiner can confirm it passed without incident.
One trap catches pilots: en clomiphene citrate is not acceptable, even though standard clomiphene citrate is. These are different compounds. If your prescription is for en clomiphene (previously marketed as Androxal), speak with your treating physician about switching before you apply.
What to Bring to the AME Appointment
Beyond your MedXPress confirmation number, bring three things:
- A clinical progress note (or the FAA’s Status Summary form) from your urologist, endocrinologist, or treating physician, from a visit within 90 days of the exam, confirming diagnosis, stability, and absence of flight-impairing side effects.
- CBC results from within 90 days, showing hematocrit.
- If you take clomiphene citrate or HCG, proof of the ground-trial start date. A pharmacy fill date, a prescription start date, or a physician note all work.
Pilots on topical testosterone alone are not required by the disposition table to bring the progress note or CBC, but a recent note on hand can prevent friction if the examiner wants extra reassurance.
Filling Out Form 8500-8 for Hypogonadism
You complete Form 8500-8 online through MedXPress before the appointment and bring the confirmation number to the AME.3Federal Aviation Administration. Medical Certification The confirmation expires if you don’t complete the AME exam within 60 days of submitting the application.4Federal Aviation Administration. How Do I Get a Medical Certificate
Two entries need careful attention:
- Item 17.a asks about current medications. List your testosterone therapy or other hypogonadism medication by name, dosage, and frequency. Write “clomiphene citrate” rather than “Clomid” so there’s no confusion with the prohibited en clomiphene citrate.
- Item 18 lists specific conditions, but hypogonadism has no dedicated checkbox. Report it under 18.x, which covers conditions not listed elsewhere. Include your original diagnosis date and the names of treating physicians.5Federal Aviation Administration. Guide for Aviation Medical Examiners – Item 18
Vague entries like “hormone therapy” without the drug, dose, and prescribing physician cause delays because the AME has to chase down clarifications before the review can proceed.
At the Exam
The AME imports your Form 8500-8 from MedXPress, performs the physical, and works through the CACI worksheet against your progress note and CBC.4Federal Aviation Administration. How Do I Get a Medical Certificate If every criterion checks out, the examiner annotates the findings in Block 60 and issues the certificate at the visit. Your supporting documents stay on file with the AME.2Federal Aviation Administration. Low Testosterone (Low T) Hypogonadism Disposition Table
Testosterone therapy can also worsen obstructive sleep apnea, and AMEs are required to evaluate OSA risk at every exam.6Federal Aviation Administration. Guide for Aviation Medical Examiners: Disease Protocols – Obstructive Sleep Apnea If you already have a diagnosed and treated sleep apnea condition, expect to provide documentation of CPAP or other therapy compliance alongside your hypogonadism paperwork. If OSA symptoms present an immediate safety concern, the AME must defer that issue separately.
If the AME Defers
When a criterion fails (hematocrit above 54 percent, a recent clot, missing documentation, a medication not on the approved list, or a phlebotomy requirement) the AME notes concerns in Block 60, withholds the certificate, and transmits the package to the FAA’s Aerospace Medical Certification Division within 14 days.7Federal Aviation Administration. Guide for Aviation Medical Examiners – AME Deferral Initial FAA review can take a month or more, and the AMCD may request additional specialist evaluations or updated labs.8Federal Aviation Administration. Special Issuances, AASI for All Classes Slow responses to those requests are the most common reason timelines stretch from weeks into months.
Once the AMCD grants authorization, your AME can reissue at future renewals under the specialized criteria without another full AMCD review.
Don’t Skip the Disclosure
Federal regulations prohibit fraudulent or intentionally false statements on any medical certificate application, and the FAA can revoke all of your airman certificates, not just the medical, on that basis.9GovInfo. 14 CFR 67.403 – Applications, Certificates, Logbooks, Reports, and Records: Falsification, Reproduction, or Alteration; Incorrect Statements Falsifying a federal form can also trigger criminal prosecution under 18 U.S.C. § 1001, which carries a fine and imprisonment of up to five years.10Office of the Law Revision Counsel. 18 USC 1001 – Statements or Entries Generally The FAA cross-references pharmacy databases and medical records, so undisclosed prescriptions surface. The CACI pathway exists specifically to certify pilots being treated for this condition; disclosing it is how you use that pathway.