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January 19, 2019

Testosterone Pellets for Men and Women

Testosterone Pellets for Men and WomenThis FoxNews article and video discusses the benefits of testosterone pellets in both men and women with low testosterone symptoms. Dr. Landa makes some excellent points and highlights the importance of testosterone in women in her interview with Dr. Manny.  One being that women need and benefit from testosterone much in the same way as men.  But, she also discusses that the primary purpose of hormone replacement therapy is to improve the quality of life and increase the health span (the years of good quality of life), not just the life span. We could not agree more.

The FoxNews piece specifically discusses therapy with testosterone pellets, but the health benefits of testosterone are the same regardless of the mode of delivery.  As we have said in other posts there are advantages and disadvantages to the various forms of therapy whether they be creams, injections, or testosterone pellets.

In the end, it is more a matter of personal preference. In men we tend to recommend injections because of the ability to get predictably good blood levels of testosterone. Since women need about one-tenth the testosterone than men getting good blood levels with creams and pellets is easier to obtain.

However, pellet therapy has some advantages – the main being that they are the most bioidentical hormone replacement therapy option.

Pros and Cons of Testosterone Pellets Versus Creams and Injections

The advantages of pellets is very much in the eye of the beholder.  What may be an advantage or convenience to one patient may be a disadvantage or inconvenience to another, though there are some universal advantages and disadvantages.

Testosterone creams have the disadvantage of enabling some testosterone to be transferred to another person including children, and also to pets. This transference of testosterone does not occur with pellets or with testosterone injections.

Though weekly testosterone injections might seem painful and inconvenient, in reality there is very little discomfort and dosages can easily be adjusted. The fear of injections has typically been the main stumbling block for use of injectable testosterone. In our practice we typically recommend testosterone injections for men and typically a cream for women. We use 27 gauge 1/2 inch needles. When patients experience for the first time being injected with this size needle they lose their of injecting themselves.

Testosterone pellets need to be implanted every 3 to 6 months, and it does require an outpatient procedure and time away from work. Pellets typically last 4-6 months in males and 3-4 months in women.

The pellet insertion procedure is more invasive and more likely to be associated with discomfort than injections. Plus, there’s the added cost of having the procedure, plus the pellet therapy is more expensive than other forms of testosterone replacement. Rarely, is pellet implantation covered by insurance, though some insurances will cover the cost of testosterone pellets for men.

Getting the testosterone dose correct is critical.

If the dose is inadequate from pellet therapy, then either more pellets must be implanted or supplementation with testosterone creams or injections is needed until it’s time for the next implantation of pellets when the dosage can then be adjusted.

Conversely, if the dose is too high one must deal with side effects until the the testosterone level drops to a more therapeutic range as going in to remove pellets is very difficult.

Therefore, physicians tend to error on the side of not implanting enough pellets with the initial insertion. They will the adjust the dose accordingly with subsequent implantations.

There is more risk of infection with testosterone pellets (though still quite rare) than with testosterone injections even though injections are done more frequently. Also, testosterone pellet implantation involves cutting back on your physical activity for 3 to 4 days, which may or may not be an issue for some.

For the person who does extensive traveling pellet therapy makes more sense as there is no need to remember to take along testosterone cream or injection which can also lead to some questioning when going through airport security since testosterone is a controlled substance.

There is a trend towards testosterone pellets. It’s main advantage, quite honestly, is implanting pellets is a financial advantage for the doctor.

Testosterone Pellets for Women

Dr. Rebecca Glaser at Millennium Wellness Center is an expert on female hormone replacement therapy. She almost exclusively just uses testosterone therapy in treating postmenopausal women. She has found that testosterone alone is usually enough to alleviate women of postmenopausal symptoms. In addition, testosterone improves bone density better than estrogens and progesterones, and also improves muscle strength in women just like in men.

Here is an article Dr. Glaser authored that discusses Millennium Wellness Center

Pulsatile Hormone Release

Though Dr. Landa and others talk about testosterone pellets releasing testosterone in a pulsatile fashion similar to what the body does, most reports state that testosterone from pellets is released into the body in a steady fashion providing an even flow of it.  I’ve tried to find literature that discusses this pulsatile delivery of testosterone from pellets but have not found any.

Hormones in the body are naturally produced and released in pulses with levels of most hormones being elevated in the morning and declining throughout the day.  Strenuous exercise is a stimulant for testosterone release too.  This pulsatile release prevents tissues from developing tolerance or resistance to hormones over time.  So being able to mimic the body’s pattern of pulsatile release would be a big advantage in hormone replacement therapy.

Currently, there is not a testosterone treatment that readily achieves that, though testosterone creams come the closest to mimicking the body’s natural on-off production of testosterone.

Cost of Testosterone Pellet Therapy

There are two costs involved in testosterone pellet therapy.  The cost of the testosterone pellets and the cost of the insertion (implantation procedure). The average charge to insert the pellets hovers in the $300 to $500 range though can vary significantly by region of the country.

And, the cost of pellets vary. Many physicians use compounding pharmacies  to provide their pellets. Testopel is a commercial testosterone pellet that comes in a 75 mg testosterone dose. The pellets cost $90 to $100 each. A man may need 10 pellets whereas a women may need 2 or 3.

See related articles.

“Nonsexual Symptoms of Low T”

“Androgen Deficiency: Not Just for Men”

“How Declining Sex Hormone Levels Lead to Fat Gain”

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

  1. I have never used testo creams or pellets, only injections during HRT last year and it did wonders. My libido has never been so high.

  2. I’ve been experimenting with natural testosterone supplements with mixed results. Might be time to make the upgrade to pellets for more consistent results.

    1. Main side effect or risk is that of infection. Also, while you can add pellets if your levels don’t rise enough, it’s hard to remove them if they are too high.

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