Hormone pellets were designed in 1939 for women who underwent radical hysterectomy and needed hormone replacement. It has been widely used in Australia and Europe for more than 70 years. It is the best method for testosterone therapy since it achieves physiologic levels quickly and maintains adequate levels over the span of months.
What are hormone pellets?
Testosterone pellets are created using thousands of pounds of pressure. They are then autoclaved for sterility. Then, the hormones are shipped to your physician to be placed under your skin for testosterone therapy.
What are the advantages of hormone pellets?
Each hormone replacement therapy has its advantages and disadvantages. Hormone pellets create very steady levels of hormones with minimal fluctuation. Moreover, they work for everyone. Since the pellets are easily dissolved by the body, everyone who gets pellets inserted achieves optimized hormone levels quickly and effectively.
Hormone Creams: The hormone creams cause variable testosterone levels. You may forget one day. The next day, you may sweat after applying the cream or put on clothing that rubs it off. Testosterone replacement cream is the least effective testosterone therapy.
Injections: For men who use testosterone therapy injections, they are very familiar with the volatile testosterone levels. With injections, the testosterone levels peak within the first 24 hours, and they are very low by the end of the week.
How are the pellets inserted? Where are the pellets placed?
The pellets are placed in either hip near your upper buttocks. The area is anesthetized with numbing medication. This process takes about 30 seconds, and the remainder of the procedure is painless. A small incision (about 3-5mm) is made in the skin. After the incision, all of the pellets are slipped beneath the skin and Steri-strips are placed across the incision. Stitches are not required. Immediately after the insertion, your body begins to erode the pellets and hormones are released into the bloodstream. Your blood levels will hit their highest level by 30 days (peak) and lowest level by 4-6 months (trough).
Where do the pellets go? Do you have to take the pellets out?
The pellets are completely dissolved by the body over time. The pellets never need to be removed. When it is time for another pellet insertion, new pellets are inserted through the previous insertion site.
How do the pellets work?
After your pellets are inserted, your body erodes the pellets which slowly releases the hormones into the bloodstream. Testosterone pellets create very steady hormone levels across the 4-6 months between repeat pellet insertions. They require much less dose adjustments. After the first couple insertions, the right dose will be dialed in for your body. Once the right dose is determined, you will not need dose adjustments in the future unless your symptoms have changed.
What if I have high estrogen on testosterone therapy replacement?
If your estrogen levels rise on testosterone therapy, then we will encourage you to start an estrogen blocker like anastrozole or exemestane. At your follow-up pellet insertion, we can add anastrozole to your pellets, so you no longer have to take anastrozole or exemestane pills.
What if I still feel like I have low testosterone? Will I need to supplement with another form?
You should not need to supplement with another form of testosterone while on testosterone pellets. If you feel that your testosterone levels are low, then the levels need to be checked and more pellets need to be inserted next time. If your levels are in the optimal range, we can evaluate you for other causes of your symptoms (adrenal fatigue, dysfunctional thyroid, poor gut health).
What are the risks of the procedure? What are the side effects?
The risks of the procedure are minimal. The most common complication is superficial infections of the skin from the incision that is easily treated with antibiotics. This rarely happens as we use sterile technique. Another minimal risk is bleeding at the insertion site, which is easily stopped with pressure, stitches, or topical agents (Drysol). Most patients experience aching in the area of insertion for 1-2 days after the procedure.
What if my blood count rises?
Testosterone stimulates blood cells to multiply which is why men have higher blood counts than women. Some men’s blood counts tend to rise too high during testosterone replacement. Men with high blood counts need to donate blood regularly. Blood counts that are too high cause viscous (thick) blood that theoretically raise your risk for strokes and heart attacks although this has never been proven.
When do I get my hormone levels checked?
After your first hormone pellet insertion, we ask that you return in 1 month and 4 months to check your hormone levels. Remember that you do not need to fast for hormone levels. If you are having symptoms, sometimes we utilize supplemental hormone creams in order to limit symptoms until your next hormone pellet insertion appointment. The levels at 1 month tell us your highest levels (peak), and the levels at 4-6 months tell us your lowest levels (trough). With these two hormone levels timed appropriately, we are better able to calculate how many pellets you will need for your next insertion.
At your follow-up hormone pellet insertion, you may still need to get your hormones checked at 1 month and 4-6 months if your physician is still dialing in the correct dose for you. Once the right dose is determined, you will only need hormone levels drawn every 4-6 months.