Between 2015 and 2023, total Medicare Part D testosterone claims more than doubled. That's the rebound. The dip that preceded it lasted exactly one year.

In 2015, following an FDA warning about cardiovascular risks, testosterone claims in Medicare Part D fell to 487,069. By 2023, that number stood at 1,003,470. The warning didn't reverse the trend. It paused it.

The FDA Warning Barely Left a Mark

The timeline is worth sitting with. Claims peaked at 611,962 in 2013, fell through 2015, then recovered steadily every single year afterward. By 2017, prescribing had already returned to 2013 levels. By 2023, it had grown 64% beyond them.

The beneficiary count tells a similar story. The number of Medicare patients receiving testosterone prescriptions nearly doubled over the decade, from 56,569 in 2013 to 107,063 in 2023. That's not a niche treatment pattern. That's a mainstream prescribing behavior in a population where cardiovascular risk is already elevated by age alone.

Total drug cost, meanwhile, fell from $220,993,319 in 2013 to $112,468,246 in 2023, even as claim volume grew by over 390,000. Cost per claim dropped from $361.12 to $112.08. Medicare is paying far less per prescription than it used to, but it's writing far more of them. The net result: taxpayers are spending roughly half what they spent a decade ago to cover twice as many patients.

Who's Prescribing It Now Looks Very Different

The specialty breakdown is where the story gets structurally interesting. Family Practice leads all specialties in 2023 with 232,348 claims, a 52.2% increase from 2013. Urology, the traditional home of testosterone prescribing, sits second at 205,608 claims. Internal Medicine, despite being the third-largest specialty by volume, grew only 4.4% over the decade.

The fastest growth came from providers who weren't in this space at all ten years ago.

Nurse Practitioners grew testosterone claims by 591.6%, from 16,697 to 115,479. Physician Assistants grew 446.6%. Together, those two groups now account for nearly 19% of all Medicare testosterone claims. In 2013, they accounted for roughly 5%.

This shift matters because scope-of-practice expansions over the past decade have given NPs and PAs independent prescribing authority in most states. The testosterone prescribing data reflects that structural change in real time. A treatment once concentrated in urology and internal medicine offices is now distributed across a much wider and less specialized prescriber base.

Florida Leads, New York Costs More

Geography adds another layer. Florida led all states in 2023 with 108,856 total testosterone claims, followed by California at 102,079 and Texas at 85,387. Florida's cost per claim was $90.96, among the lowest of any high-volume state.

New York, by contrast, had 38,319 claims but the highest cost per claim of any top-prescribing state at $212.20. A Medicare patient in New York receiving a testosterone prescription costs the program more than twice what a patient in Florida does for the same drug category. That gap, $212.20 versus $90.96, almost certainly reflects differences in formulation mix, with injectable generics concentrated in some markets and branded topical products in others.

The number of prescribers writing testosterone prescriptions grew from 23,275 in 2013 to 32,183 in 2023, a 38% increase. But claim volume grew 64% over the same period, meaning the average prescriber is writing more testosterone prescriptions per year than their 2013 counterpart. The prescriber base expanded. The intensity of prescribing expanded faster.

What the data can't resolve is whether the cost-per-claim collapse from $361.12 to $112.08 reflects a genuine shift to lower-cost generics and delivery methods, or whether it masks a bifurcated market where some patients receive cheap injectables and others receive expensive branded gels, with the average obscuring both. That question has direct implications for how much the program will spend if the current volume trajectory continues.