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 daily can be a challenge for some. Another worry for these treatments is that they can 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 healthcare provider or learn to inject yourself.
Some of the other negative side effects 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 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.
For delivering a consistent dose over the long term, pellets are the best option. Pellets deliver consistent, physiologic levels of hormones and avoid the fluctuations of hormone levels seen with other methods of delivery.
Hormone replacement therapy with testosterone implants is superior to oral and topical (both the patch and gel) hormone replacement therapy for bone density.
Pellet implantation is a short, simple and painless. The insertion is a simple in-office procedure and is less painful than drawing blood. It requires just 1 cc lidocaine and an incision in the upper hip area, where the pellet is placed inside. No stitches are necessary and the incision is so small it can be closed up with a piece of tape. Implantation may sound a bit scary, but it is actually a simple procedure that takes only a few minutes.
Testosterone pellets 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 four months. These pellets are a long-acting form of testosterone therapy. They deliver a stable, steady dose of testosterone. Pellets typically provide the needed level of hormone for four months.
Testosterone pellet implants release testosterone at a steady rate of 1.3 mg/200 mg implant/day. (Kelleher, S. Testosterone release rate and duration of action of testosterone pellet implant.) Testosterone pellets provide sustained levels of testosterone for at least 3 months and up to 4 months. Implantation of 800-1600 mgs of pellets achieved optimal results with respect to peak mean testosterone level and duration of effect.
Testosterone pellets were generally well tolerated and natural testosterone is viewed as the best androgen for substitution in hypogonadal men. Subcutaneous testosterone implants provide the patient, depending on the dose of implants, with normal plasma testosterone for 3-4 months. (Gooren LJ, Androgen replacement therapy: present and future.)