Skin Deep: Testosterone Pellets 101
Highs and Lows of T
Testosterone is an important hormone. It can boost libido, increase muscle mass, sharpen memory, and bump up energy. Most men lose testosterone with age. A reported 20 to 40 percent of older men have a medical condition called hypogonadism and need testosterone replacement therapy (TRT).
But there are drawbacks to TRT, including the potential for heart disease, high red blood cell count, prostate growth, sleep apnea, acne, low sperm count, enlarged breasts, and testicle shrinkage.
Successful TRT involves getting just the right dose, by the right delivery method, for your individual needs. There are patches, creams, injections, and testosterone pellets—your doctor can discuss these options with you. For delivering a consistent dose over the long term, pellets may be a good option.
Finding the Right Dose
It can take time to find the right dosage for improving the symptoms of low T. Too much testosterone can trigger dangerous side effects, including a rise in your red blood cell count. You’ll have to work with your doctor to find the right dosage.
Creams, gels, buccal tablets (applied inside the cheek), and patches are all easy to self-administer, but they have to be done daily. Another potential danger is that these treatments can rather easily expose women and children to contact with excess testosterone.
Injections, meanwhile, can last longer and don’t present the contact problems that these other methods do. However, irritation can occur at the injection site. You have to go to a doctor or learn to inject yourself.
Peaks and Valleys of Testosterone Dosing
Some of the negative side effects of TRT are due to the highs and lows of testosterone dosage with conventional administration methods.
With testosterone injections in particular, testosterone levels can start off very high, and then become very low before the next injection occurs. This can result in a rollercoaster-like series of changes in mood, sexual activity, and energy levels.
These high peaks of testosterone exposure can lead to problems like increased red blood cell count. Dosage peaks can also lead to testosterone being broken down by enzymes in the body (usually in fat tissue) and being converted into estradiol, an estrogen. This excess estrogen can potentially lead to breast growth and tenderness.
Testosterone pellets, like Testopel, are small, 3 mm by 9 mm pellets that contain crystalline testosterone. Implanted under the skin, they slowly release testosterone over the course of three to six months. A short, simple procedure is done in your doctor’s office to implant the pellets under the skin, usually near your hip.
These pellets are a long-acting form of testosterone therapy. They should deliver a stable, steady dose of testosterone. Pellets typically provide the needed level of hormone for four months.
Implantation of Pellets
Implantation may sound a bit scary, but it is actually a simple procedure that typically takes only 10 minutes. The skin of the upper hip or buttocks is thoroughly cleaned, then injected with a local anesthetic. A small incision is made. Tiny testosterone pellets are placed under the skin with an instrument called a trocar. Typically 10 to 12 pellets are implanted during the procedure.
Occasional infection can occur, or the pellets can be “extruded” and come out of the skin. This is rare: 0.6 percent of cases result in infection, while 8.3 percent of cases result in extrusion.
Potential Drawbacks of T Pellets
Pellets do provide a long-term dosing solution for those with low T, but there are drawbacks. Infection and extrusion are possible outcomes. Also, it is difficult to change the dose easily, because another surgical procedure is required to add or remove pellets.
If you choose to use testosterone pellets, it may be a good idea to first use other forms of daily testosterone application, such as creams or patches, to establish the correct dose of testosterone that your body needs. Your doctor can help you with this.
Once you have an established dose that allows you to see the benefits without a rise in red blood cell count or other negative effects, you are a candidate for testosterone pellets.
Testosterone Pellets for Women
Although it is controversial, women are also receiving testosterone therapy. Postmenopausal women have been receiving TRT, with or without additional estrogen, for treatment of hypoactive sexual desire disorder. Improvements in sexual desire, orgasm, and satisfaction have been shown, and there may be evidence for improvement in muscle mass, bone density, cognitive performance, and heart health.
However, it is currently difficult to provide the low-dose therapy that women need. Testosterone pellets have been used in women; however there have yet to be consistent studies done to evaluate the risks, especially for the development of certain cancers.
Women are currently being treated with testosterone pellets, but it is “off-label” use, not yet approved by the FDA.
Talk with your doctor about whether you need testosterone therapy. Once you’ve established a dose that works with your body, you can consider the best method to administer that dose over the long haul.
Testosterone replacement therapy is a long-term commitment. Testosterone pellets mean more doctor visits and potentially more expense. But there may be less worrying about daily administration and dosage highs and lows.
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