Can Pilots Take Testosterone?

The aviation industry maintains strict regulations where pharmaceutical drugs are concerned, but can pilots take testosterone? Let’s find out…

Pilots can take testosterone as a supplement or as part of hormone replacement therapy. However, you do need to inform your aviation medical examiner (AME) about it. The Federal Aviation Administration (FAA) allows the use of testosterone, but the approval is based on absence of any side effects. 

If you are taking testosterone therapy to treat an underlying health condition such as hypogonadism you will require special issuance before being cleared for flying an airplane.

What medications can pilots not take?

The FAA prohibits pilots from taking any medications that can cause drowsiness, intoxication or excess stimulation and interfere with their cognitive capabilities.

The medications fall under two categories:

1. Do not issue (DNI): The FAA advises AMEs to not issue or renew medical certificates for candidates who are using medications or substances under this class. AMEs need to check why the applicant is using the medication, the frequency of use and the medicine’s potential long-term impact.
2. Do not fly (DNF): The FAA recommends pilots to not fly for a pre-defined duration if they are using medicines with label warnings that it may cause drowsiness. 

The time is equivalent to five times the medicine’s half-life or dosage gap.

For example, if you take a medication every eight hours, you need to wait for at least 40 hours after your last dose before piloting an airplane.

The list of DNI medications include,

• Controlled substances such as medical marijuana
• Psychotropic medications such as antidepressants and tranquilizers
• Seizure relief medicines
• High doses of steroids
• Chemotherapy pills
• Medicines for heart ailments
• Drugs used to treat parasitic infections
• A new drug with less than 12 months of approval from the Food and Drug Administration

So if a drug received approval for safe use from the FDA last year, you should be wary of using it before the required time has elapsed.

The DNF medications comprise,

• Allergy medicines such as antihistamines
• All types of sedatives
• Muscle relaxants
• Pain relievers
• Sleep aids
• Dietary supplements like Valerian

Can pilots use steroids?

Pilots can take steroids within a prescribed range for certain health conditions. According to the Aircraft Owners and Pilots Association (AOPA), the FAA allows the use of medicinal corticosteroids such as prednisone orally up to a daily dose of 20 mg.

However, you will need to disclose any use of over the counter and prescription drugs to the AME before your physical checkup to avoid being grounded. 

You will need to specifically state the reason for taking the medication such as to treat arthritis or chronic conditions like asthma and irritable bowel syndrome.

If you experience any debility you may have to wait for up to three weeks for the adverse effects to subside before receiving approval to fly. Use of anabolic steroids or muscle strength enhancers is permitted for certain health conditions such as chronic fatigue, only if approved by an AME. 

The rules for transgender men aspiring to be pilots with regard to testosterone replacement therapy are not yet defined in most countries. 

For example, Adam Harry, a transgender man with a private pilot license from South Africa was denied a commercial pilot license by the aviation regulator in India on account of hormone therapy medication. 

According to FAA guidelines, transgender persons need to submit their medical records and an evaluation of mental health from a psychiatrist. 

Can you take testosterone in the air force?

Testosterone is a male sex hormone produced mainly in the testicles which regulates several bodily functions such as muscle mass, bone density and red blood cell production. 

Normal testosterone levels are vital for performing tasks involving physical endurance and muscular strength. Blood work would show if you are suffering from low testosterone levels. Low testosterone can affect performance levels, reduce muscle mass, cause sexual dysfunction and impact memory and ability to focus. 

However, the use of any performance enhancing substance is illegal in the armed services, including the air force, unless it’s prescribed by an authorized physician or flight surgeon. 

Air force personnel could take testosterone in cases where the person is born with a condition that causes testosterone deficiency. Other reasons include damage to a testicle due to an accident or pituitary gland disease requiring hormone therapy. 

Service personnel including fighter pilots who are caught taking steroids such as dehydroepiandrosterone or DHEA are in violation of the Uniform Code of Military Justice. 

The offense can lead to a downgrading in rank or even expulsion from the air force. Indiscriminate use of testosterone can elevate your blood pressure above standard limits for a considerable period. 

This could impact your heart and kidneys leading to medical emergency events like blood clots, cardiac arrest and strokes raising midair safety concerns. High levels of testosterone also speed up the growth of certain types of cancers especially those related to the prostate.

Treatment plans to boost testosterone levels naturally involving weight loss, exercise and stress management have shown significant increases in the hormone in a short period.

Can pilots take anti anxiety medication?

The FAA has approved the use of certain anxiety medications such as Lexapro, Prozac, Celaxa and Zoloft on a case-by-case basis. However, the FAA recommends pilots taking anxiety medicines to go for counseling along with a six monthly review of their medical certification. 

Pilots can take anxiety medicines if they are prescribed by their psychiatrist and validated by an FAA-authorized AME. 

The AME needs to check if the anxiety is due to an underlying physical condition and whether it could impair the pilot’s ability to function in a high-stress situation.

You will need to abide with the guidelines regarding how much time you need to wait after each dose before getting into the cockpit. However, the FAA has banned pilots from using mood stabilizers and drugs such as Xanax. 

This includes medications used to treat attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD).

FAA medicine restrictions

The FAA considers both the medical condition and the medication while advising AMEs to issue or deny medical certificates. The restrictions also depend on which class of certification you are applying for. A first-class certificate is issued for an airline pilot while commercial or professional pilots have to apply for a second-class certificate.

Most beginners including recreational and private pilots are eligible for a third-class medical certificate where you are may be eligible for special issuance for certain conditions.

The medicines prohibited by the FAA for pilots include,

• Angina or heart-related medicines which cause dilation of arteries
• Anticholinergics that cause blurred vision and a fast heartbeat
• Cancer treatments including chemo and radiation therapy
• Controlled substances (Schedule I-IV) that affect cognitive functions
• Bladder regulation medicines that may result in confusion
• Psychiatric meds that may cause hallucination
• Steroids in large doses which may elevate blood pressure
• Centrally acting hypertension medicines which could lead to dizziness

The FAA also advises pilots to not fly for a prescribed duration of time if they are using medicines that carry a generic warning. These medicines can cause drowsiness and affect the user’s ability to drive or operate machinery. It includes allergy medicines such as antihistamines, pain relievers, dietary supplements and aids to treat sleep disorders.

Pilot drugs

A study by the National Transportation Safety Board found that forty percent of pilots killed in airplane crashes involving noncommercial flights have restricted medicines in their system.

Federal Aviation Regulations prohibits the use of any substance or drug that would have an effect on the pilot’s faculties to take decisions in high stress situations.

However, each person’s reaction to a drug may not be the same often necessitating further evaluation. Also, changes in altitude and pressure have a concomitant effect on blood chemistry. 

Drugs that seem safe for use on the ground may cause serious adverse reactions at higher altitudes, hampering the pilot’s judgment and ability.

Often, a thorough checkup involving the pilot’s medical history covering health conditions, allergies and prescribed treatments is the only way to minimize the chances of a mishap.

Can pilots take Accutane?

Pilots cannot take the drug isotretinoin also known as Accutane. The FAA has prohibited its use for pilots and instituted a mandatory two-week waiting period for medical certificate applicants who are currently taking the drug. 

Accutane, prescribed for treating acne among other skin problems, is shown to affect the vision especially at night. Additionally, it can cause psychiatric side effects such as a propensity to depression and suicide. 

The night vision impediment is observed for a long period even after the user has stopped taking the medication. The FAA has advised AMEs to include a restriction on the medical certificate after the mandatory waiting period. This restriction states that the pilot is not authorized to fly any airplane at night.

FAQ relating to whether pilots can take testosterone

Can you take testosterone in the air force?

You can take testosterone in the air force but only in certain cases according to the guidelines of the American Urological Association.

The parameters include:

• Genetic conditions or testicular development issues
• Damage to testicles due to accident or disease
• Pituitary gland or autoimmune disease leading to hormone deficiency

Possible side effects of testosterone treatment are related to the heart and kidneys, especially in the long term.

The air force encourages service personnel to use natural means to boost their testosterone levels. 

These consist of:

• Weight training to maintain a healthy body mass index
• Lowering intake of alcohol
• Having a balanced diet with adequate proteins
• Managing stress with counseling or any other technique
• Ensuring you get sufficient sleep

Can pilots fly while taking steroids?

Pilots can take certain corticosteroids if the dose is below 20 mg for medications such as prednisone or 80 mg of hydrocortisone. However, you will need to wait for the recommended duration of time between each dose before flying. 

You will need to inform the AME if you are using any steroids before taking a medical test for certification. In most cases the FAA approves the use of steroids only if the reason for use is valid, such as to treat an underlying health condition. 

Use of performance enhancing steroids is banned though hormone replacement therapy may be allowed. This could be due to genetic disorders, accidents and diseases. Protein shakes and dietary supplements need to be taken with care as certain types often contain steroids that come under restricted substances.

The FAA allows pilots to receive medical certification who have undergone gender reassignment surgery or hormone therapy due to gender dysphoria. The pilots need to have undergone the treatment for at least five years or the surgery five years prior to applying for the certificate.  

What medications disqualify you from being a pilot?

The drugs that the FAA has either banned or restricted its use for pilots fall in the below categories,

• Anticoagulants 
• Antiviral 
• Anti-anxiety agents 
• Barbiturates
• Chemotherapy
• Experimental, mood altering and investigational 
• Hypoglycemic 
• Motion sickness
• Narcotics and sedatives 
• Antihistamines
• Steroids 
• Tranquilizers

Can commercial pilots take Viagra?

While commercial pilots can take Viagra, the FAA advises pilots to wait for a minimum period of six hours before flying. The drug used to treat erectile dysfunction or impotence could make it difficult for a pilot to distinguish between blue and green lights. 

This could hamper a pilot’s ability to land a plane by identifying runway lights and may impair his ability to navigate the aircraft in relation to instrument panels.