Important notes before you read:
- Testosterone is a controlled substance. Federal and state laws restrict how it can be prescribed and refilled.
- Legalized THC (medical marijuana/cannabis) also has strict regulations.
- Both require an in-person appointment prior to refill. No exceptions. No grace period. You were given refills — when they elapse, you come in.
Why I Follow This Rule
I practice integrative medicine. I don’t follow most rules. But I follow this one.
The 1990s Controlled Substance Law: Congress passed the Anabolic Steroids Control Act of 1990, which classified testosterone and other anabolic steroids as Schedule III controlled substances. This was a response to abuse in professional sports and bodybuilding. The law was later expanded by the Anabolic Steroid Control Act of 2004 and the Designer Anabolic Steroid Control Act of 2014. The result? Testosterone is now treated much like narcotics — heavy regulation, strict refill limits, serious penalties for violations.
The morphine analogy: If I tried to give you a year’s supply of morphine, I couldn’t. The law does not allow it. Testosterone is treated the same way. Federal law limits controlled substances to a six-month supply under most circumstances. The pharmacy and I are both bound by this.
I don’t prescribe narcotics in my current practice (midlife and functional medicine). But testosterone got caught up in these regulations because lawmakers wanted to penalize people for “playing with” it. If you are a female taking testosterone, it is off-label — even more regulatory scrutiny.
I don’t follow most rules. But I follow this one — to avoid hefty fines and penalties.
The 13 Steps (Why You Get Charged)
Every refill request requires all 13 steps below. It takes time — my time and staff time. That time has value. That is why the $25 fee exists for non-controlled refills requested outside of appointments.
The Bottom Line (Each Rule Once)
| Issue | Policy |
|---|---|
| Testosterone (controlled substance) | No refills between appointments. In-person visit required. No exceptions. Off-label for females = more scrutiny. |
| THC (medical marijuana/cannabis) | No refills between appointments. In-person visit required. No exceptions. |
| Non-controlled prescription refill outside appointment | $25 fee. You probably missed your appointment. |
| Lab order re-issue | $25 fee. |
Standard Policies
Request refills at your appointment. Review your medications before your visit. We do not call in refills between appointments — especially for controlled substances.
Bring your medication bottles (or photos) to every appointment so we can verify doses and update your record.
How we send prescriptions: Almost all are e-prescribed directly to your pharmacy. Turnaround for approved non-controlled requests is 2 business days.
If you are overdue for a visit or labs:
- Non-controlled: Limited refill possible until you schedule. $25 fee applies.
- Controlled substances & THC: No refill. Schedule an in-person appointment.
You are responsible for scheduling before you run out.
The 13-Step Refill Process
- Message received (phone or portal)
- Attached to electronic chart
- Chart accessed and verified
- Flagged for nurse review
- Nurse reviews: Is it controlled? Labs done? Last visit date?
- Routed to doctor electronically
- Doctor reviews: labs, history, risks, dependency potential, drug interactions, FDA guidelines, benefit vs. risk
- Doctor decides whether to fill
- Doctor determines if follow-up appointment is needed
- Doctor documents decision in chart
- Doctor e-prescribes (if approved)
- Nurse documents prescription and pharmacy in chart
- Chart closed
For controlled substances & THC: The process stops at step 5. No refill. You must schedule an in-person appointment.
For non-controlled refills between visits: All 13 steps happen. That takes time. $25 fee.
Summary
- Testosterone & THC: No refills without an in-person visit. Federal and state law. No exceptions.
- Non-controlled refills outside appointment: $25 fee (covers the 13-step process).
- Lab order re-issue: $25 fee.
- All prescriptions: Almost all e-prescribed. Electronic records only.
I don’t follow most rules. But I follow this one — to avoid fines and penalties. Thank you for understanding.
Tamyra Comeaux, MD 