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Testosterone Pellet Insertion (Testopel®)

austin family medicine testosterone pellet insertion

What are hormone pellets?

Hormone pellets are one of the best ways to get your hormone levels replaced. Hormone pellets are slipped under the skin of either hip, and they are dissolved by your body. While dissolving, hormones are slowly infused into your bloodstream. This creates a smooth hormone replacement effect that lasts for 3-5 months. Your hormone levels rise within days after insertion, peak at one month, and slowly drift downwards over the next several months.

 

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 are extremely easy to apply and very cost effective, but creams have more variation for several reasons. First, it is applied to the skin which has different levels of thickness and can vary its rate of absorption. Second, the amount of blood flow to the skin changes how quickly hormones are absorbed. Third, the hormone clickers can have variations in the amount dispensed with each click.

Injections: For men who use testosterone injections, they are probably 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 buttocks. The area is anesthetized with local numbing medication. This process takes about 30 seconds, and the remainder of the procedure is painless. A small incision (about 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 months (trough).

Where do the pellets go? Do you have to take the pellets out?

The pellets are placed in either hip near your buttocks. The pellets are completely absorbed by your body over time, and they do not need to be removed. When it is time for another pellet insertion, new pellets are simply inserted as the previous ones have completely dissolved.

 

How do the pellets work?

The hormone pellets are crystallized hormones shaped into a pellet similar in size to a grain of rice. After insertion, your body erodes the pellets slowly releasing the hormones into the bloodstream. The pellets create very steady hormone levels across the 4 months between repeat pellet insertions, and 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 are the risks of the procedure? What are the side effects?

The risks of the procedure are minimal. The most common risk or complication is superficial infections of the skin from the incision that is easily treated with antibiotics. Another risk is bleeding 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. The achiness is limited by using an ice pack for 15 minutes immediately after the procedure, and you should continue to use ice packs to the area the remainder of the day for about 15 minutes every 1-2 hours. Side effects hormones should be discussed with your physician; however, the side effects of Bio-Identical Hormones should be minimal as we are using the exact hormones that your body already creates. Not enough or too much of the hormones can cause imbalances that create symptoms. Discuss with your doctor if you have questions about symptoms of low or high hormones.

 

What if my estrogen levels rise?

Many men experience rising estrogen levels with testosterone therapy. This happens because all males have the capability of converting testosterone to estrogen. The rate at which this happens is determined by several factors, including genetics and body weight. Fat cells are the main source of estrogen. They readily create estrogen from testosterone, so your estrogen production is based on your body fat composition. The conversion of testosterone to estrogen is easily blocked with medications like anastrazole and exemestane. These estrogen blockers can be placed in your testosterone pellets, so you do not have to take an additional pill every day. We check your estrogen levels every 6 months.

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 rise too high during testosterone replacement. Men with high blood counts need to donate blood every 6 months or more if advised by their physician. Blood counts that are too high cause viscous (thick) blood that can theoretically raise your risk for strokes and heart attacks.

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. You do not need to fast for hormone levels, and you do not need an appointment. You can simply show up at our office without calling. If you want to review these lab results, then you should make an appointment one week after your blood draw to discuss them with the physician. 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 months tell us your lowest levels (trough).   With these 2 hormone levels timed appropriately, we are better able to calculate how many pellets you will need for your next insertion.

If this is your follow-up hormone pellet insertion, you may still need to get your hormones checked at 1 month and 4 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.