Understanding testosterone

Testosterone is an important hormone. It can boost libido, increase muscle mass, sharpen memory, and bump up energy. Yet, 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, and other conditions.

Successful hormone therapy involves getting just the right dose by the right delivery method for your individual needs. There are patches, creams, injections, and testosterone pellets.

For delivering a consistent dose long term, pellets may be a good option. Your doctor can discuss these options to find the right method for you.

Testosterone pellets, such as Testopel, are small. They measure 3 millimeters (mm) by 9 mm and contain crystalline testosterone. Implanted under the skin, they slowly release testosterone over the course of three to six months.

A short, simple procedure is performed 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, typically providing the needed level of hormone for four months.

It can take time to find the right dose for improving your symptoms of low testosterone. Too much testosterone can trigger dangerous side effects, including a rise in your red blood cell count (RBC). Research shows there are other risks for too much testosterone, too.

Finding the right dose may be a challenge for some people. You can work with your doctor to find the right dose for your body, which may also help you find the right method as well.

Creams, gels, buccal tablets for the inside of the cheek, and patches are all easy to self-administer, but they have to be done daily. Remembering to administer every day can be a challenge for some. Another worry for these treatments is that they can expose women and children to contact with excess testosterone.

Meanwhile, injections can last longer and don’t present the contact problems these other methods do. However, irritation can occur at the injection site. You have to go to a healthcare provider or learn to inject yourself.

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 testosterone being broken and converted by enzymes in the body — usually in fat tissue — into estradiol, an estrogen. This excess estrogen can potentially lead to breast growth and tenderness.

Other side effects of TRT may include:

Implantation is 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 to reduce discomfort. 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.

Pellets do provide a long-term dosing solution for those with low testosterone, but there are drawbacks.

Occasional infections can occur, or the pellets can be “extruded” and come out of the skin. This is rare: Research reports 1.4 to 6.8 percent of cases result in infection, while approximately 5 to 12 percent of cases result in extrusion.

It’s also difficult to change the dose easily, because another surgical procedure is required to add 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 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 RBC or other negative effects, you’re a candidate for testosterone pellets.

Although it’s controversial, women are also receiving testosterone therapy. Postmenopausal women have been receiving TRT, with or without additional estrogen, for the treatment of hypoactive sexual desire disorder. Improvements in sexual desire, orgasm frequency, and satisfaction have been shown.

There may also be evidence for improvement in:

  • muscle mass
  • bone density
  • cognitive performance
  • heart health

However, it’s currently difficult to provide the low-dose therapy women need. While testosterone pellets have been used in women, there have yet to be consistent studies done to evaluate the risks, especially for the development of certain cancers.

The use of testosterone pellets in women is also “off-label” use. Off-label drug use means a drug that’s been approved by the U.S. Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

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 that works for you to administer it.

TRT 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 other people coming into contact with testosterone.