Policy Number
Last Update
Youth Services

Aetna considers leuprolide (Lupron, Viadur, Eligard) medically necessary for the following indications subject to the specified limitations:

  • To suppress onset of puberty in transgender adolescents if they meet WPATH criteria (see Appendix).
  • For female to male transgender persons, to stop menses prior to testosterone treatment and to reduce estrogens to levels found in biological males.
  • To reduce testosterone levels in male to female transgender persons.

Aetna considers histrelin acetate implants experimental and investigational for all other indications (e.g., precocious puberty due to adrenal hyperplasia, and suppression of onset of puberty in transgender adolescents) because there is insufficient evidence in the peer-reviewed literature.