In Alabama, a video visit cannot start testosterone for a new patient. Ala. Code § 34-24-704(b) allows a controlled substance prescription by telehealth only when the visit is synchronous, the prescriber has had at least one in-person encounter with the patient within the preceding 12 months, and a legitimate medical purpose was established in that same window. Testosterone is Schedule III (21 C.F.R. § 1308.13(f)), so all three conditions apply.
The federal rule does not change that. The DEA flexibilities in 21 C.F.R. § 1307.41 run through December 31, 2026, as of September 2026, and they waive a federal in-person requirement. Alabama’s requirement is its own. For the other 50 jurisdictions, see telehealth testosterone by state.
Three conditions, all in the same subsection
As the Board of Medical Examiners quotes the statute, a controlled substance prescription may issue via telehealth only if:
- The visit includes synchronous audio or audio-visual communication with the prescriber, on HIPAA-compliant equipment.
- The prescriber has had at least one in-person encounter with the patient within the preceding 12 months.
- The prescriber has established a legitimate medical purpose within the preceding 12 months.
A questionnaire fails the first. A home video visit with a patient you have never met fails the second, and the second recurs: it lapses 12 months after the last in-person encounter.
A licensed person in the room counts as in person
The Board’s telemedicine page says the requirement “may be satisfied by the in-person assistance of personnel licensed by the Board of Medical Examiners or Board of Nursing at the originating site when the prescriber is evaluating the patient from a distant site using video communication.” A June 22, 2023 declaratory ruling says the same. A licensed professional counselor or social worker in the room does not count.
That opens a hybrid model: an Alabama RN, LPN, CRNP or PA sits with the patient at your site while the prescriber examines by live video. Document who was present and their license.
In an August 2024 guidance letter, the Board added that a later prescriber in the same practice, of the same or similar specialty, may keep prescribing on the strength of an earlier prescriber’s in-person exam, provided each prescriber has full access to the record and coverage protocols exist. The Board called this a “temporary accommodation,” so confirm it still stands before relying on it.
A second clock under § 34-24-703
Section 34-24-703 adds a separate trigger. If a physician or practice group provides telehealth services more than four times in 12 months to the same patient for the same condition without resolution, the physician must see the patient in person within 12 months or refer the patient to someone who will. The same hybrid visit counts. Most testosterone programs exceed four visits a year, so one annual in-person or hybrid encounter should be planned to satisfy both sections.
The certificate the DEA flexibility does not replace
To prescribe any controlled substance in Alabama, a physician must hold an Alabama Controlled Substances Certificate (ACSC), renewed every year. Renewal requires a current, Alabama-specific DEA registration, registration with the state prescription drug monitoring databank, and controlled substance CME. CRNPs and PAs need a Qualified ACSC and prescribe by telehealth under the same § 34-24-704 conditions. The Board’s FAQ #10 says the federal DEA waiver does not let an out-of-state physician prescribe controlled substances to an Alabama patient without an Alabama controlled substance certificate or permit.
If a CRNP prescribes, Alabama also requires physician presence for part of a newer CRNP’s hours, covered in Alabama puts a percentage on your physician’s time.
Keep testosterone out of weight-loss marketing
The Board’s FAQ #9 asks “Can I prescribe testosterone via telemedicine?” and answers “Should you?” beside Ala. Admin. Code r. 540-X-17-.03. That rule limits Schedule III to V weight-loss prescribing to physicians and requires the prescribing physician to be present at the facility. If your funnel sells testosterone for weight or body composition, ask counsel whether the rule reaches it.
The path that works in Alabama
For an operator with a physical site in the state:
- Open with an in-person or hybrid encounter at your Alabama site. Either the prescriber sees the patient in the room, or an Alabama BME or BON licensee is physically present while the prescriber examines by video.
- Document the legitimate medical purpose at that visit: history, exam, labs, diagnosis and plan.
- Confirm the prescriber’s Alabama license and ACSC or QACSC.
- Move follow-ups to synchronous video. The patient can join from home once the in-person encounter is on file.
- Calendar the next in-person or hybrid encounter before month 12. The same visit resets the § 34-24-703 count.
- Keep the exam in the shared chart so a covering prescriber can rely on the August 2024 guidance.
The aesthetics exam question is separate: see good faith exams in Alabama.
How MDside handles Alabama
MDside is LegitScript certified. Its testosterone visits are synchronous, live video with the prescriber, and offered only in states whose rules allow them. Alabama requires an in-person encounter first, so MDside does not start Alabama patients by video. See hormone therapy for the program and medical director in Alabama for supervision in the state.
What this means for you
Do not send Alabama testosterone traffic to a home-video intake. Build the first visit around your Alabama site, with the prescriber present or a Board-licensed staff member in the room during a video exam. Book the 12-month renewal at enrollment, and verify every prescriber’s ACSC or QACSC before launch. Then watch the federal date: after December 31, 2026, the DEA side may tighten too.
Related reading
Frequently asked questions
Can you get testosterone through telehealth in Alabama?
Yes, after an in-person encounter. Ala. Code § 34-24-704(b) allows a controlled substance by synchronous telehealth only if the prescriber had at least one in-person encounter with the patient in the preceding 12 months. A new patient cannot start by home video. Follow-ups can run by live video.
Does a video visit with a nurse in the room count as in person in Alabama?
Yes, according to the Alabama Board of Medical Examiners. The in-person requirement can be met when a person licensed by the Board of Medical Examiners or Board of Nursing is physically with the patient while the prescriber evaluates by video. A counselor or social worker does not satisfy it.
Do the DEA telehealth flexibilities override Alabama’s in-person rule?
No. The DEA flexibilities under 21 C.F.R. § 1307.41 run through December 31, 2026 and waive only the federal in-person requirement. Alabama’s § 34-24-704 applies on its own terms. The Board also says the federal waiver does not let an out-of-state physician prescribe to an Alabama patient without an Alabama controlled substance certificate.
How often does an Alabama testosterone patient need an in-person visit?
At least once every 12 months. Section 34-24-704 requires an in-person encounter within the preceding 12 months for each telehealth controlled substance prescription. Section 34-24-703 separately requires in-person care within 12 months after more than four telehealth visits for the same unresolved condition. A hybrid visit with a Board-licensed staff member present counts for both.
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This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.