Male testosterone levels in this country have been decreasing for decades, in addition to the usual age-related decline that begins after age 30. Consequently, many men are suffering not only from the symptoms of low testosterone, but adverse health effects as well. Low testosterone not only causes fatigue, insomnia, moodiness, anxiety, depression, and sexual dysfunction, but it also increases cardiovascular risk and osteoporosis in men. Testosterone supplementation therapy for men is available in topical gels and patches, injections, and subcutaneously implanted pellets. Most of these are available by prescription from family physicians or urologists.
“Why do I feel this way?”
“I have no energy! I’m exhausted all the time! I’m moody, anxious, depressed, I don’t sleep well, and I have night sweats. I can’t lose weight. I have absolutely no interest in sex. What’s wrong with me?” Do any of these symptoms of hormone deficiency sound familiar? Fatigue, night sweats, moodiness, anxiety, decreased motivation, decreased libido, decreased mental clarity, depressed mood, muscle aches and joint pain, and headaches are all symptoms of hormone imbalance. It’s common for testosterone-deficient men and women to sleep fitfully, often waking during the night and unable to go back to sleep. Cloudy thinking and impaired memory (“brain fog”) is commonly experienced as well. Patients who are administered therapeutic levels of testosterone generally report improvement in sleep patterns, increased mental sharpness, and overall improved well-being, along with relief of most or all of the symptoms listed above.
At the Center For Balance And Wellness, we specialize in compounded testosterone pellet therapy. In use in this country for over 30 years, this method of testosterone administration includes the subcutaneous implantation of sterile compressed bio identical testosterone pellets. It is a systematic approach, involving computer calculated dosing and post-dose monitoring of specific laboratory parameters in order to minimize risk and maximize benefit to the patient. Pellet therapy provides a more constant level of hormone than other therapies. Our testosterone pellets are prepared in a federally inspected and certified regional compounding pharmacy.
At the Center for Balance and Wellness, men who suffer from low testosterone may receive either testosterone pellet therapy or Clomiphene. Clomiphene is a tablet, taken by mouth, that stimulates the natural production of testosterone in a man’s body in appropriate patients.
Q. “Why pellets?”
Pellet therapy is one of many alternative ways to supplement testosterone in men. It has been used in Europe for over 70 years, and in the United States for over three decades. Pellet therapy is considerably less expensive than patches. Some men have allergic reactions to gels, and the odor may be objectionable. And even with perfect compliance, patients on intermittent injections may experience recurrence of symptoms days prior to their next injection. Pellet therapy offers an opportunity to obtain a smooth, consistently effective treatment that is cost-effective and minimizes the problem of compliance.
Q. What are testosterone pellets and how large are they?
Testosterone pellets are small, compressed cylinders of pure testosterone, 4mm diameter. None is larger than a Tic-Tac®. The pellets are prepared and sterilized in a certified regional compounding pharmacy. They are subject to a quality testing process, insuring potency, sterility, and dose consistency.
Q. How are the pellets administered?
The pellets are injected into subcutaneous fat (fat beneath the skin) of the upper outer buttock just below the waistline. It is an office procedure. With the patient lying on their side, the skin is prepped then anesthetized with an injection of Xylocaine anesthetic. Then a small 5 mm incision is made with a sterile scalpel. A stainless steel trocar, which looks like a metal syringe, is then inserted through this incision. Once in place in the subcutaneous fat a plunger pushes the pellets into place. Then the trocar is removed and the wound is covered with a steri-strip and a bandage. The whole procedure lasts 10 to 15 minutes.
Q. How do you decide what dose to use?
The pellet method involves a computer-calculated dose which is individualized to your needs based on your age, weight, and your pre-treatment levels of testosterone. Subsequent dosing is based on your clinical response and lab values obtained at four weeks after dosing. As many as 5 to 12 pellets are used to achieve the calculated dose level.
Q. How long does it take to work and how often will I require pellet insertions?
It may be a week after the first dose before patients notice an improvement in their symptoms. Hormone levels and a blood count are obtained at four weeks after the first dose in order to determine individual dose response. Repeat dosing is performed about every six months and sometimes more frequently depending upon the individual patient’s response. Your individual activity level and metabolism will determine the hormone level achieved after a dose, and the duration of its clinical effect.
Q. If I am currently on another form of TRT, will I experience a recurrence of
symptoms after starting pellet therapy while I am waiting for my levels to build
For patients being switched from another form of TRT, it is possible that they might experience a brief increase in symptoms during the first one or two weeks of pellet therapy. Generally, however, the transition is relatively seamless.
Q. How often will I require other office visits and blood work?
Hormone levels will be checked at four weeks after the first pellet administration. Additional lab work may be needed according to a patient’s individual response to therapy. The pellet method involves careful attention to several laboratory and clinical parameters. Testosterone therapy can stimulate production of red blood cells, thickening the blood, thus requiring blood donation intermittently. Some men aromatize testosterone to estrogen, and might require an additional prescription medication (aromatase inhibitor). The blood tests we order watch for these issues, as well as monitor your response to therapy. A lab profile will be rechecked yearly, including testosterone and estrogen levels, CBC, and PSA. Patients must continue to see their regular physician for yearly exams. Our physician only administers pellet therapy and will not do this exam for you.
Q. Are there any special preparations required prior to my insertion?
When medically appropriate we ask that patients stop aspirin a few days prior to insertions. In all patients taking any form of blood thinner, although the risk of bleeding and bruising from the pellet procedure might be increased, it rarely causes problems.
Q. Are there any special instructions or down time after insertion?
You will be given instructions that explain clearly how to handle the bandage that covers the incision. Though you may shower, we request that you not soak in a bath tub until 3-4 days after the procedure. We also request that there be no vigorous exercise or rough activities for seven days following an insertion, especially running, leg presses, squats, driving a tractor or 4wheeler, etc, though routine activities of daily life can be maintained. There will be local soreness for one to two weeks.
Q. Are there any complications particular to the insertion procedure?
As with all surgical procedures involving the skin and subcutaneous fat, wound infection is a rare but real possibility. If it occurs, such an infection generally responds to oral antibiotics. Further, the procedure will occasionally injure a minor blood vessel resulting in some bleeding and a larger bruise at the site. Very rarely, a hematoma, which is a collection of blood under the skin, may form at the wound site. Again, this is very rare and usually happens in patients on some form of blood thinner. Finally, on rare occasion, pellets may rarely extrude (come out of the incision) and be lost.
Q. What are some of the possible complications of testosterone therapy?
Testosterone therapy can stimulate production of red blood cells, thickening the blood, and potentially increasing the risk of stroke or heart attack . Intermittent blood donation will keep this under control. Also, estrogen overproduction through conversion of testosterone might require a prescription (aromatase inhibitor) in order to reduce risks associated with excess estrogen. Excess production of estradiol (yes, men make estrogen, too!) will increase body fat production and possibly decrease the effect of testosterone. The blood tests we do are surveillance for these issues, as well as monitoring your response to therapy.
At age 65 and above, testosterone therapy might increase the risk of heart attack, according to one study.
Finally, there can be increased hair loss, enlargement of the prostate, reversible testicular shrinkage, and a minor increase in the serum PSA level.
Q. How do I get started and how much does it cost?
- An initial office consultation at the Center for Balance and Wellness is $150. As we do not file insurance or Medicare, this may be paid in cash, or with a check or credit card. The purpose of this visit is to review your history, discuss lifestyle factors, and determine if pellet therapy is appropriate for you.
- A panel of lab tests (including hormone levels and other indicators of health status) will be ordered prior to your visit. A consultation appointment will then be scheduled to review your symptoms, history, lab results, lifestyle, and discuss options for treatment if indicated. Pellet therapy is only one of several options available to men.
- If pellet therapy is indicated, an appointment will be scheduled for administration. Testosterone pellet therapy for men is $680 (lasting approximately six months). Payment is required in advance.
- Please note that this therapy utilizes high quality compounded pellets prepared, sterilized, and quality tested in a certified compounding pharmacy. Although testosterone itself is an FDA approved drug, its use in this fashion is “off-label” (not FDA approved), and therefore not covered by insurance. You will be given a receipt for your payment that you may file with your insurance company if you choose to do so. Some patients pay for their pellet therapy from their Health Savings Account (HSA). We will not file insurance for you, and cannot file with Medicare.
Please note that the use of testosterone in compounded pellet form is considered “investigational“ by insurance companies and therefore is not a covered service. All patients will continue to see their regular physician for check ups and routine care, seeing Dr. Mauldin for hormone management only.