WHAT IS TESTOSTERONE?
Men’s bodies produce the hormone testosterone mostly in their testes. In men, testosterone helps maintain:
• Bone density
• Fat distribution
• Muscle mass
• Muscle strength
• Red blood cell production
• Sex drive.
DO MEN NEED HORMONE REPLACEMENT?
Testosterone levels begin to decline in men beginning in their 30’s. Most men maintain adequate levels of testosterone into their mid 40’s to mid-’50s, some into their late 70’s early 80’s. Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30’s can be testosterone deficient and show signs of bone loss. Most men need to be tested around 50 years of age. It is never too late to benefit from hormone therapy.
Due to a number of societal changes impacting diet, exercise, and other lifestyle and environmental factors, more men today have low testosterone levels than previous generations (estimated currently to be 20-40% above age 45).
However, not all men have a testosterone deficiency or need to undergo replacement therapy. A testosterone deficiency state needs to be confirmed with lab tests and associated symptoms before treatment for this medical condition can begin. We do not use hormones for performance enhancement.
WHAT ARE THE SIGNS OF TESTOSTERONE DEFICIENCY?
Testosterone deficiency can have several effects on the body, including:
• Decreased sexual function
• Loss of bone density
• Loss of muscle mass
• Increase in fat mass
• Reduced muscle strength
• Memory loss
• Mood changes and depression.
WHAT ARE PELLETS?
Pellets are made up of either estradiol or testosterone. The hormones, estradiol or testosterone, are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice and smaller than a ‘Tic Tac’. In the United States, pellets are made by a licensed compounding pharmacist and delivered in sterile glass vials.
WHY ARE TESTOSTERONE PELLETS BETTER THAN PATCHES, SHOTS OR PILL FORMS OF TESTOSTERONE?
Testosterone pellets are pure bio-identical hormones, so they are not metabolized into byproducts like other supplemental forms of testosterone, and thus have fewer sideffects.
WHY ARE PELLETS OPTIMAL FOR HORMONE REPLACEMENT?
Pellets deliver consistent, healthy levels of hormones for 3-6 months, depending on the dosage. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. It is the fluctuation in hormones that causes many of the unwanted side effects and symptoms a patient experiences. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy.
In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, improvement in sex drive, libido, sexual response and performance. Even patients who have failed other types of hormone therapy have a very high success rate with pellets. In addition, there is no other method of hormone delivery that is as convenient for the patient as pellets.
WHY ARE TESTOSTERONE PELLETS BETTER THAN VIAGRA?
Testosterone fixes the real problem, which is a decreased libido and sexual response due to low hormone levels. Viagra, on the other hand, only treats the symptom of decreased erectile function, but does not fix the sexual desire issue. Furthermore, Viagra has many side effects and only works when you take it.
WHEN WERE PELLETS FIRST USED FOR HORMONAL REPLACEMENT?
Pellets have been used in both men and women since the late 1930’s. In fact, there is more data to support the use of pellets than any other method of delivery of hormones. Pellets are not patented and not marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of England and Australia with some from Germany and the Netherlands. Pellets were frequently used in the United States from about 1940 through the late 70’s, early 80’s when patented estrogens were marketed to the public. In fact, some of the most exciting data on hormone implants in breast cancer patients is out of the United States. Even in United Stated there are clinics that specialize in the use of pellets for hormone therapy.
HOW AND WHERE DO YOU INSERT PELLETS?
The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the lower abdominal wall or hip through a small incision which is taped closed. Experience of the health care professional counts; not only in placing the pellets, but in determining the correct dosage of hormones to be used.
WHAT ARE POTENTIAL COMPLICATIONS FROM INSERTING HORMONE PELLETS?
Complications from the insertion of pellets include minor bleeding, bruising, discoloration of the skin, infection, and possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin these complications are very rare. Extended exposure to moisture (swimming, hot tubs, bath tubs) is avoided for 4 to 5 days, and vigorous physical activity is avoided for 48 hours in women and up to 5 to 7 days in men. Antibiotics may be given if a patient is diabetic or has recently had a joint replaced.
IS THERE AN UPPER AGE LIMIT TO TESTOSTERONE THERAPY?
IF I HAVE DIABETES, WILL TESTOSTERONE PELLETS HELP WITH MY SEXUAL RESPONSE?
Testosterone typically improves libido and sexual desire. It may or may not improve erectile dysfunction, since most causes of erectile dysfunction are not caused by low testosterone.
WILL MY TESTICLES SHRINK WHILE I TAKE THE TESTOSTERONE PELLETS?
Yes, they will. Testicles are suppressed by taking any form of testosterone because they do not need to make testosterone while the pellets are working. When pellets wear off, it takes a few months for the testicles to recover. This can be reversed or prevented in addition to reversing reduction in sperm count if so desired by taking HCG injections along with the testosterone pellets.
DOES TESTOSTERONE THERAPY INCREASE THE RISK OF STROKE OR HEART ATTACK?
Some clinical studies have alluded to an increased risk of cardiovascular disease including strokes and heart attacks in some patients on testosterone, but an equal number of studies have shown a decreased risk of cardiovascular events in patients on this therapy. This possible increased risk is thought likely to be related to estradiol levels which can be elevated in some males even without testosterone therapy but levels can elevate with testosterone therapy. In these case, addition of a low dose of estrogen lowering medication (anastrozole) can easily control this complication.
DOES TESTOSTERONE CAUSE PROSTATE CANCER?
No. The byproducts of testosterone, dihydrotestosterone and estrone can cause prostate enlargement (benign prostatic hypertrophy). Because testosterone pellets contain pure hormone, they are not metabolized into byproducts. Studies have shown that the risk of prostate cancer in hypogonadal men actually decreases with testosterone therapy.
WHAT CAN I EXPECT AFTER PELLET INSERTION?
After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve, as will libido and sexual desire.
HOW LONG DO THE PELLETS LAST?
The pellets usually last between 3 and 4 months in women and 5 to 6 months in men. High levels of stress, physical activity, some medications and lack of sleep may increase the rate at which the pellet absorb and may require that pellets are inserted sooner in some patients. The pellets do not need to be removed. They completely dissolve on their own.
HOW ARE THE HORMONES MONITORED DURING THERAPY?
Hormone levels will be drawn and evaluated before therapy is started. This will include a FSH, estradiol, CBC, progesterone and free testosterone for women. Men need a PSA, estradiol, CBC, LH, zinc, and total and free testosterone prior to starting therapy. Levels will be reevaluated during hormone therapy at 4-6 weeks and again in 3-5 months. After the first years of therapy hormones levels are followed less frequently. The PSA in men is followed every 6-12 months.
WHAT IS THE COST FOR PELLETS?
The cost for the insertion of pellets will vary depending on the dose of the hormones and the number of pellets needed. Men need a much larger dose of testosterone than women and the cost is higher. When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective.
WILL INSURANCE COVER THE PELLETS AND INSERTION?
Some insurance companies cover the cost of pellets, others do not. Each insurance and specific policy benefit coverage is different. Colorado Ageless Institute suggests that each patient check with their insurance company for coverage before scheduling an appointment. A letter for your insurance company can be downloaded from the FORMS section on our website.
MY DOCTOR SAYS THERE ISN’T ANY DATA TO SUPPORT THE USE OF BIO-IDENTICAL HORMONE PELLETS.
Though well intentioned, your doctor is wrong. In fact, bio-identical hormone pellets have been used in both men and women since the late 1930’s, and there is more data to support the use of bio-identical hormone pellets than any other form of hormone therapy. In other words, there is a difference between “no data” and “not having read the data.” Explore our RESOURCES section for more data.