The VA can prescribe human growth hormone (HGH), but it is not on the VA National Formulary. That means getting it requires extra steps: a non-formulary drug request, prior authorization, and a confirmed diagnosis of adult growth hormone deficiency. The VA will not prescribe HGH for anti-aging or athletic performance, which are prohibited by federal law.
HGH Is Non-Formulary at the VA
Somatropin, the injectable form of human growth hormone, carries a “Non-Formulary” designation in the VA system. The VA National Formulary is the list of medications that VA providers can prescribe without additional approval. Drugs on the formulary are readily available at any VA pharmacy. Somatropin is not on that list.
Being non-formulary does not mean the drug is banned. It means your provider must submit a non-formulary drug request, essentially a formal justification explaining why you need this specific medication. That request goes through a review process before the prescription can be filled. In practice, this adds time and paperwork compared to a standard prescription, and approval is not guaranteed.
Who Qualifies for HGH Through the VA
The VA prescribes HGH only for medically documented growth hormone deficiency. The most common reasons veterans develop this condition include traumatic brain injury, pituitary tumors, radiation therapy to the head, or other damage to the pituitary gland. Symptoms can include increased body fat (especially around the midsection), reduced muscle mass, fatigue, poor bone density, and changes in mood or cognitive function.
To get a prescription, you need a confirmed diagnosis. That typically requires a stimulation test, where a substance is given to trigger your pituitary gland, and blood draws measure how much growth hormone your body produces in response. The traditional gold standard is the insulin tolerance test, which deliberately lowers your blood sugar to provoke a hormonal response. It requires monitoring by a trained endocrinologist, a nurse, a technician, and access to a lab for glucose analysis. The whole process takes up to three hours and involves multiple blood draws.
A newer option, an oral drug called Macrilen (macimorelin), was approved by the FDA based on a clinical trial led by a VA researcher at the VA Puget Sound Health Care System in Seattle. It showed comparable accuracy to the insulin tolerance test but is simpler to administer, doesn’t cause low blood sugar, and is generally better tolerated. This makes it a practical alternative for veterans who have heart disease or a history of seizures, since the insulin tolerance test is unsafe for those patients.
What Federal Law Prohibits
HGH is unique among prescription drugs. Under federal law (21 U.S.C. ยง333(e)), it is the only medication where off-label prescribing is explicitly illegal in two specific circumstances: for anti-aging purposes and for boosting athletic performance. Every other prescription drug in the U.S. can legally be prescribed off-label at a provider’s discretion. HGH cannot, in these two cases.
This means a VA provider cannot prescribe HGH simply because you feel fatigued, want to build muscle, or are looking to counteract normal aging. The prescription requires a legitimate medical diagnosis of growth hormone deficiency confirmed through testing. Veterans who approach their VA provider hoping for HGH as a wellness or performance supplement will be turned down, and this is a legal restriction, not just a VA policy choice.
The Approval Process Step by Step
If your VA provider suspects growth hormone deficiency, the process generally looks like this. First, your provider orders blood work to check your levels of a hormone called IGF-1, which reflects overall growth hormone activity. Low IGF-1 levels combined with symptoms and a relevant medical history (such as a past brain injury or pituitary problem) prompt the next step: a formal stimulation test, either the insulin tolerance test or the Macrilen test.
If the stimulation test confirms deficiency, your provider submits a non-formulary drug request for somatropin. This request goes to a VA pharmacist or review committee, who evaluates whether the clinical criteria are met. If approved, you receive the prescription. Because somatropin is an injectable medication, you will likely need instruction on how to give yourself daily injections at home, along with follow-up appointments to monitor your response and adjust dosing.
What It Costs
Somatropin falls under Copay Tier 3 in the VA pharmacy system, which is the brand-name medication tier. For a 30-day supply, the copay is $11. A 60-day supply costs $22, and a 90-day supply costs $33. On the open market, HGH can run hundreds or even thousands of dollars per month, so the VA copay represents significant savings for veterans who qualify.
Some veterans pay nothing at all. If you’re in Priority Group 1 or have a service-connected disability rating of 10% or higher, you’re exempt from medication copays entirely. Veterans with lower incomes or certain special eligibility factors may also qualify for copay exemptions. You can check your specific copay status through your VA enrollment records.
What to Expect If You’re Prescribed HGH
Growth hormone replacement is a long-term treatment, not a short course. Most people on HGH therapy take daily injections indefinitely, though your provider will reassess periodically. Benefits typically develop gradually over months. Body composition changes, like reduced abdominal fat and increased lean muscle, often become noticeable within three to six months. Improvements in energy, mood, and bone density can take longer.
Side effects can include joint pain, swelling, carpal tunnel symptoms, and fluid retention. These are often dose-related and may improve with adjustments. Your VA provider will schedule regular follow-up labs to monitor IGF-1 levels and watch for any complications. The goal is to bring your growth hormone levels into a normal range without overshooting into excess.