Potential Medical Discharge for Hormone Therapy?

[ConcernedHPSP]

Hi everyone,

I'm a medical student currently on HPSP scholarship. I was recently seen by a doc for fatigue and some performance issues. After bloodwork, I was given the option of testosterone replacement as an option due to having fairly low testosterone levels, esp for someone in their late 20s. I know TRT can be a fairly controversial topic, but I am considering this as I'm rather tired of feeling like crap everyday.

I know people successfully stay on AD on TRT but I also know HPSP is a bit of a murky area and I feel like people have definitely been medically DQ'd for less. If I do decide to pursue treatment, obviously I would inform my branch immediately. That said, my biggest fear is that this will result in me not only getting kicked out of service but also having to repay the scholarship. If anyone has been in a similar situation with a disqualifying condition popping up during medical school (such as ADHD, etc.) I would love any advice on your experience.

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[pgg]

Don't avoid treatment for a diagnosed medical condition, for fear of losing HPSP.

Disclose it to HPSP.

No one will care.

 

[orthoPA81]

I agree with disclosing it but it could be disqualifying.

I was an Air Force PA and had to complete many MEBs (medical evaluation boards). I can’t remember off the top of my head if testosterone therapy is disqualifying. I would say likely not but you may have limitations on your deployment status if you require an injectable medication.

 

[ValeRx]

I agree with disclosing it but it could be disqualifying.

I was an Air Force PA and had to complete many MEBs (medical evaluation boards). I can’t remember off the top of my head if testosterone therapy is disqualifying. I would say likely not but you may have limitations on your deployment status if you require an injectable medication.

Could use topical.

 

[TheEarDoc]

Do what is best for your health.

Disclose it to HPSP

I seriously doubt they would boot you out, but if they did it would be a medical discharge and most likely that would mean no loan repayment back to the government.

I know several people who are officers with similar issues (a couple with Graves Disease, one with Addisons, etc.) and they have been able to stay in with no med board.

 

[DeadCactus]

Look under DoDI 6130.03 5.24.q: "History of hypogonadism that is congenital, treated with hormonal supplementation, or of unexplained etiology."

It's a bit of a grey area because most people on TRT don't actually have abnormal testosterone levels, they just have nebulously "low" levels for their age. So you don't really have hypogonadism but then you and your provider are saying your symptomatic and clinically have hypogonadism and need treatment with hormonal therapy which then means you don't meet entry/retention standards and need to go through a medical board. Are they really going to boot out a physician over TRT? I really doubt it but you can never know. But it means jumping through some hoops and even more hoops if you ever want a special duty physical like flight.

I keep meaning to read up more on this. From the outside, it can seem like most of the TRT treatment is people who work hard jobs with terrible lifestyles, who feel appropriately tired, and then feel better on TRT because they are now taking a steroid and not because they are correct an abnormal defect in their physiology.

 

[ValeRx]

It's all about level of treatment needed, specialist care, etc. Lots of factors, including things that would make you non-deployable.

 

[DOswag]

Don't know what the other services will say about it. But according to Air Force Medical Standards Directory revised this year 7 Jun 2021 section M: Endocrinology and Metabolic: (M32 for those who have ever seen or are familar with the MSD)

Hypogonadism with medically required injectable hormone replacement does meet the threshold for retention and would require an iRILO
Topical androgens used for hormone supplementation/replacement do not require an iRILO but one may be submitted.

What this means is if requiring injectable treatment, it would require an iRILO which is the process in which AFPC would have to take a look and make a determination of return to duty or not. I'm a psychiatrist so I obviously don't work with the M section in MSD (mental health is section Q) but I do attend the AMRO meetings monthly. My suspicion is that for active duty, I highly doubt they'd spend all the money to train you then MEB you for this if it's easily treatable. Docs have been retained for much more challenging medical conditions than this. They typically try to hang on to us. I don't really know how this impacts HPSP since you're still in school though.

Definitely do not avoid disclosing for fear of losing the scholarship. Get treated and if it impacts the scholarship then oh well, you'll still be a doc and can easily pay back your loans when you're out (I doubt it will impact the HPSP though).

 

[Hewibr22]

Does anyone know if a ADHD diagnosis is disqualifying after already receiving army HPSP and being in school for a year? I've never taken any medication and have done some research on non stimulant medications like strattera and am curious if we are allowed to take them or even adderall?

 

[TheEarDoc]

Look under DoDI 6130.03 5.24.q: "History of hypogonadism that is congenital, treated with hormonal supplementation, or of unexplained etiology."

It's a bit of a grey area because most people on TRT don't actually have abnormal testosterone levels, they just have nebulously "low" levels for their age. So you don't really have hypogonadism but then you and your provider are saying your symptomatic and clinically have hypogonadism and need treatment with hormonal therapy which then means you don't meet entry/retention standards and need to go through a medical board. Are they really going to boot out a physician over TRT? I really doubt it but you can never know. But it means jumping through some hoops and even more hoops if you ever want a special duty physical like flight.

I keep meaning to read up more on this. From the outside, it can seem like most of the TRT treatment is people who work hard jobs with terrible lifestyles, who feel appropriately tired, and then feel better on TRT because they are now taking a steroid and not because they are correct an abnormal defect in their physiology.

It is frustrating though. A female has hormone issues and no one bats an eye giving them hormone therapy. A male has hormone issues and they talk about TRT and suddenly people are upset about it.

 

[DOswag]

Does anyone know if a ADHD diagnosis is disqualifying after already receiving army HPSP and being in school for a year? I've never taken any medication and have done some research on non stimulant medications like strattera and am curious if we are allowed to take them or even adderall?

Active duty psychiatrist here. Don't know if this is different for other branches but for Air Force, no. ADHD is not disqualifying. Technically by the AFIs, it has the 'potential' to be handled administratively but the condition has to be so severe to be impairing your ability to perform your duties despite you receiving treatment. The military ain't about to let you get away that easy after you've received HPSP and signed up. I've seen a physician returned to duty after going through iRILO with a bipolar diagnosis which for anyone else is an automatic full MEB... They want to keep physicians in.

 

[Aegis]

Active duty psychiatrist here. Don't know if this is different for other branches but for Air Force, no. ADHD is not disqualifying. Technically by the AFIs, it has the 'potential' to be handled administratively but the condition has to be so severe to be impairing your ability to perform your duties despite you receiving treatment. The military ain't about to let you get away that easy after you've received HPSP and signed up. I've seen a physician returned to duty after going through iRILO with a bipolar diagnosis which for anyone else is an automatic full MEB... They want to keep physicians in.

Currently ANG, formally Active Duty flight surgeon. I agree with your points, just a couple caveats. If the ADHD is impairing and duty limiting than it becomes more of a medical DQ condition, so these are definitely case by case. Also, ADHD that requires meds will be DQ from flying status unless specifically in a Go-Pill program.

 

[Aegis]

Hi everyone,

I'm a medical student currently on HPSP scholarship. I was recently seen by a doc for fatigue and some performance issues. After bloodwork, I was given the option of testosterone replacement as an option due to having fairly low testosterone levels, esp for someone in their late 20s. I know TRT can be a fairly controversial topic, but I am considering this as I'm rather tired of feeling like crap everyday.

I know people successfully stay on AD on TRT but I also know HPSP is a bit of a murky area and I feel like people have definitely been medically DQ'd for less. If I do decide to pursue treatment, obviously I would inform my branch immediately. That said, my biggest fear is that this will result in me not only getting kicked out of service but also having to repay the scholarship. If anyone has been in a similar situation with a disqualifying condition popping up during medical school (such as ADHD, etc.) I would love any advice on your experience.

TRT as previously mentioned is murky waters at the moment. Are you thinking of becoming a flight surgeon at any point? This might hinder passing a class I flight physical, but also might not as the ground is constantly shifting. Here is the advice I give to people as a flight doc. It's not a black and white machine and the culture has definitely shifted in the last decade or so to allow providers much more flexibility in determining what is a DQ condition. Flying status gets a bit more cut and dry ho. however. Do as you do, take care of yourself as you would and let the Air Force figure out how to best incorporate you into the fold. There might be limitations to where you can deploy for example if you need a refrigerator for your injections. Can you show that you have been stable on this and improving? Are you trying to be a flyer? All of these things matter and we take each case on an individual basis. Even with the worst case scenario that it is DQ from service you will hopefully have the opportunity to speak with someone about your options. For example, I advice members all the time that if they could get off XX med or change XX med to YY med it would be better for their retention. So don't fret, take care of yourself and let the Air Force flex around you, don't try to flex around them.

 

[DOswag]

Currently ANG, formally Active Duty flight surgeon. I agree with your points, just a couple caveats. If the ADHD is impairing and duty limiting than it becomes more of a medical DQ condition, so these are definitely case by case. Also, ADHD that requires meds will be DQ from flying status unless specifically in a Go-Pill prog

Do you mean medical DQ as in MEB? ADHD is not a boardable condition per the MSD, and AFI it is listed as an unsuiting condition which would lead to administrative separation.