Testosterone is a Schedule III controlled substance. Every telehealth TRT clinic in the country currently prescribes it under a temporary arrangement — and that arrangement has an expiry date: December 31, 2026.
If your model depends on prescribing without an in-person visit, that date is a business risk, not a compliance footnote.
The rule underneath everything
The Ryan Haight Act generally requires a practitioner to conduct an in-person medical evaluation before prescribing a controlled substance by means of the internet, subject to limited exceptions.
That requirement never went away. What happened is that pandemic-era telemedicine flexibilities suspended the in-person requirement, and the DEA has extended those flexibilities repeatedly — most recently through the end of 2026.
An entire industry was built inside a temporary exception. That is worth saying plainly, because a lot of operators believe the in-person rule was repealed. It was not.
What is supposed to replace it
The Ryan Haight Act directs the DEA to create a special registration for telemedicine prescribing. The DEA published a proposed rule in 2023 contemplating a framework of special registrations — including pathways for telehealth practitioners and for platforms dispensing controlled substances — and has continued working on updated regulations.
Until a final rule exists, nobody can register under it, and nobody can tell you exactly what it will require. Planning around a rule that has not been finalised is guesswork; planning for its arrival is not.
Why TRT specifically is exposed
- Schedule III. Testosterone sits squarely inside the Ryan Haight framework.
- The model is remote by design. Most telehealth TRT was built assuming no in-person visit ever happens.
- It is ongoing therapy. Unlike a single course of treatment, TRT patients need continuing prescriptions — so a change in the rules affects your entire panel at once, not just new patients.
- Volume attracts attention. High-volume remote prescribing of a controlled substance is a visible pattern.
What a defensible TRT operation looks like now
| Element | What it means |
|---|---|
| Real evaluation | A licensed provider assesses candidacy; some patients are declined |
| Confirmed diagnosis | Documented laboratory basis, not a symptom questionnaire alone |
| Provider licensed where the patient is | Licensure follows the patient’s location |
| Valid DEA registration | In the state where the prescription is issued, as applicable |
| Monitoring | Follow-up labs and documented dose adjustment over time |
| PDMP checks | Where the state requires them, performed and documented |
| Records that show reasoning | A reviewer should be able to reconstruct why this patient, this dose |
Most of this is simply good practice. It is also what distinguishes a clinic from a subscription that ships testosterone.
Contingency planning
Three scenarios are worth costing out now:
- Flexibilities extend again. Likeliest near-term outcome, and the least disruptive. It also lulls operators into never planning.
- A special registration framework lands. You will need to qualify, register, and probably meet requirements around records, data, and possibly physical presence somewhere in the chain.
- Flexibilities lapse without a replacement. The in-person requirement reasserts itself, and a purely remote model cannot start new patients.
The practices that will handle scenario three are the ones that already have a physical footprint, an in-person referral path, or a relationship with locations that can perform an evaluation. Building that after the deadline is not a plan.
The uncomfortable question about lab-light models
Some TRT operations run on a single low reading and a symptom score. If the rules tighten, that is the first thing that will not survive review — and it is already thin clinically.
Baseline labs, a documented diagnosis, and follow-up monitoring are the difference between prescribing and dispensing.
How MDside approaches this
We provide the professional entity, licensed providers, and prescribing workflow for hormone programs, with the evaluation and monitoring documented in a clinical record rather than an order form — and we track the DEA rulemaking so protocols change before the deadline rather than after it.
See what is included, or read about bringing lab draws on site.
Frequently asked questions
When do the DEA telemedicine flexibilities expire?
They have been extended through December 31, 2026. Extensions have happened repeatedly, but each one is temporary and none changes the underlying statute.
Can I prescribe testosterone without an in-person visit?
Currently yes, under the telemedicine flexibilities and subject to all other requirements. That permission is temporary.
What is the special registration?
A framework the Ryan Haight Act directs the DEA to create for telemedicine prescribing of controlled substances. A proposed rule exists; until a final rule is issued nobody can register under it.
Does a telehealth platform need its own DEA registration?
The proposed framework contemplated registrations reaching platforms as well as practitioners. Watch the final rule rather than assuming your current structure carries over.
What should I do before the deadline?
Tighten evaluation and monitoring documentation now, and build an in-person evaluation option — your own location or a referral relationship — so a lapse does not stop new patient starts.
General information about telemedicine controlled substance rules, not legal advice. This area is governed by temporary extensions and pending rulemaking and can change quickly — verify current DEA status and confirm with healthcare counsel.