Hormone Pellet Therapy

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The individual testosterone pellets are slightly larger than of a grain of rice, and are inserted into the subcutaneous fatty tissue of the upper hip or flank, where they provide a slow release of hormone into the bloodstream. The simple procedure takes only a few minutes during an office visit, first with numbing of the skin, then one tiny incision that does not even require a stitch to close. Over a 4-6 month period, the pellets dissolve completely, and must be replaced if therapy is to continue.

The pellet delivery system for men is far superior to other methods of testosterone delivery because of the efficient, gradual, and consistent delivery of the hormone into the circulation. Thus, men are more likely to have symptom relief, and less likely to have side effects with pellet therapy compared to other delivery methods. For example, a significant drawback to intramuscular injection of testosterone (besides the inconvenience of receiving a shot every 1-2 weeks) is the inconsistent level of serum testosterone with this method, resulting in a roller coaster pattern of hormone excess and deficiency throughout the interval between injections. Testosterone topical gels often do not absorb well enough to provide optimal symptom relief. Additionally, they are associated with odor and risk of transference to a partner, child, or pet. The testosterone patch is often poorly tolerated due to skin irritation and itching, and can also be associated with poor systemic levels.

Note: Do not confuse testosterone pellet therapy discussed here with synthetic androgen used purely to enhance muscle mass or athletic performance. The latter are very potent, have been associated with cardiac and liver damage, are not bioidentical, and are not appropriate for use as hormone supplementation.

Testosterone pellet therapy is safe, well tolerated, and convenient, and pellet insertion is a low risk procedure. Procedure related risks include infection, bleeding, bruising, swelling, pain, extrusion of pellets, or scarring.

Scientific understanding of the side effects and risks related to testosterone therapy has evolved over the past two decades, as experience has been gained and medical research has been active. It was once assumed that high levels of testosterone might increase risk of prostate cancer. This was based on the observation that some advanced prostate cancers slowed with testosterone deprivation therapy. However, further study has shown the mechanism of cancer development to be more complicated than first thought. Many scientific articles have now documented not only that higher testosterone levels are not associated with increased prostate cancer risk, but also that lower testosterone levels are associated with increased prostate cancer risk. It is now well accepted by experts in the scientific community that testosterone supplementation is safe, and does not increase the risk of prostate cancer.

1. Morgenthaler A. Controversies and advances with testosterone therapy: a 40-year perspective. Urology, 2016, 89:27-32.
2. Y Cui, H Zong, H Yan and Y Zhang. The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis. Prostate Cancer and Prostatic Disease, (2014) 17, 132–143. “This meta-analysis shows that regardless of the administration method, Testosterone replacement therapy does not promote prostate cancer development or progression.”
3. Baillargeon J, et al. Long-term Exposure to Testosterone Therapy and the Risk of High Grade Prostate Cancer. The Journal of Urology, Dec 2015,194:6, 1612-1616. “Our finding that testosterone therapy was not associated with an increased risk of high grade prostate cancer may provide important information regarding the risk-benefit assessment for men with testosterone deficiency considering treatment.”