Testosterone Pellets vs Injections
Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.
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Hormone replacement therapy may be beneficial if you have been diagnosed with low testosterone.
Injection therapy is the preferred method of our medical staff to replace testosterone, compared with pellets, creams, gels or patches.
Each of the treatment methods listed below has its own advantages and disadvantages.
Why would you need testosterone?
Hypogonadism, or testosterone deficiency in medical terms, is simply a term that means a low level of testosterone.
When the testes are not functioning normally, this can happen. It can be caused by a malfunction in the testes where testosterone is produced, or in the pituitary under the brain which controls the function.
Men of all ages can have low testosterone. As men age, testosterone levels tend to decline.
You may be able to benefit from supplemental testosterone if your body is not producing enough. Your endocrinologist will initiate testosterone replacement therapy if indicated.
Injections of testosterone undecanoate are commonly administered three times a month. However, alternative forms of testosterone can be used at different intervals.
You may be recommended to begin testosterone replacement therapy if you are experiencing symptoms of low testosterone or if blood tests have shown that you are low in testosterone. Low testosterone symptoms include:
- Fatigue
- Lethargy
- Depression
- Irritability
- Low libido
- Erectile dysfunction
- Reduced strength and endurance
- Excessive sweating and Night Sweats
- Poor concentration or memory
- Shaving less frequently
It is important to note that some of these symptoms may not be resolved by testosterone replacement therapy.
The impact of low testosterone
Testosterone, commonly referred to as "low-t," is the male sexual hormone responsible for growing body hair, deepening voice quality and creating muscularity in men.
Furthermore, it encourages red blood cell production, boosts mood and maintains strong bones; but low levels may have negative repercussions for multiple parts of the body resulting in unwanted symptoms.
Hypogonadism affects men of all ages; its most prevalent causes include age-related decline and certain medical conditions like heart disease or diabetes.
Low testosterone levels may result in changes to sexual drive and erections, fatigue, weight loss, low energy, loss of muscle mass, infertility and other physical symptoms for men.
Some may also experience emotional changes like depression or irritability as a result.
Doctors typically can diagnose low testosterone by testing a sample of blood early in the morning when levels are at their highest.
The test measures levels of both testosterone and the protein sex hormone-binding globulin; lower SHBG indicates decreased testicular function while higher SHBG indicates normal testicular functioning.
Furthermore, genetic disorders like Klinefelter syndrome may reduce testosterone levels.
At times, treating low testosterone may not be necessary; but for those who do, treatment options can help improve sexual performance and mood.
Erectile dysfunction medications, for example, can increase the amount of available testosterone. If you also suffer from insomnia symptoms, however, then your physician might suggest sleeping pills as well.
Low-T diagnosis
Men may self-diagnose low T.
Self-diagnosis can be problematic because many symptoms are part of normal aging. Therefore, using these symptoms for diagnosis is not reliable.
Only a doctor's test can tell you if your levels of testosterone are too low.
Your doctor will ask you about your health history, and perform a physical examination.
You'll likely also have a red blood cell test in addition to the testosterone test.
This test checks to ensure that you're not at risk of an increase in red blood cells.
Your doctor may recommend testosterone injections if your tests and exam reveal you to have a low T level.
Testosterone injections
This medicine is for injection in a muscle. This medication is typically administered in a clinic or hospital.
The pharmacist will give you a special guide with every prescription or refill. Please read the information each time.
Consult your healthcare team about the use of this medicine in children. This medication can be prescribed to children as young 12 years old for certain conditions. However, there are precautions.
Overdosage - If you believe you have taken this medicine in excess, contact an emergency room or poison control center immediately.
What could interact with this drug?
- Diabetes medications
- Warfarin is a blood-clotting medication that treats or prevents blood clots.
- Oxyphenbutazone
- Propranolol
- Steroids like prednisone and cortisone
This list does not cover all possible interactions.
List all your medications, herbal products, non-prescription medicines or dietary supplements.
Tell them if your use drugs, alcohol or smoke. Certain items can interact with your medication.
Ongoing checks
Regularly visit your team to check on your progress. The level of testosterone in the blood will be checked.
The only men with low testosterone levels that are approved to use this medication have certain medical conditions.
This medication has been linked to heart attacks and strokes.
If you experience breathing problems, changes in vision, confusion, chest pain, or tightness, sudden arm pain, severe headache, difficulty speaking or understanding, sudden numbness, or weakness, of your face, arm, or leg, or a loss of coordination or balance, notify your healthcare team immediately and seek emergency care.
Speak to your healthcare team about the benefits and risks of this medication.
This medication can affect blood sugar levels.
Consult your healthcare team before changing your diabetic medication or diet if you have diabetes.
Women rarely use testosterone injections.
Women should tell their healthcare team if you are planning to get pregnant or if you think that might be the case.
Unborn children can suffer serious side effects.
For more information, speak to your pharmacist or care team.
Consult your healthcare team to discuss your options for birth control while taking this medication.
Most athletic organizations prohibit the use of this medication by athletes.
What are the possible side effects of this medication?
Report any side effects to your healthcare team as soon you can:
- Allergic reactions: skin rash, itching and swelling of the lips, face or throat
- Shortness of breath and chest pain are symptoms of a blood clot.
- Heart attack symptoms include pain or tightness around the chest, shoulders or arms, nausea, shortness or breath, clammy or cold skin, feeling lightheaded or faint, and feeling faint.
- Blood pressure increases
- Liver Injury: Right upper abdomen pain, nausea, light colored stool, dark yellow or Brown urine, yellowing skin or eyes.
- Feelings of irritability or anger, mood swings
- Erections that are painful or prolonged
- Sleep apnea--loud snoring, gasping during sleep, daytime sleepiness
- Stroke - sudden numbness of face, arm, or leg; difficulty speaking; confusion; trouble walking or standing up straight, loss of coordination or balance, dizziness and severe headaches.
- Swelling in the hands, feet, ankles or other parts
- Feelings of depression, thoughts of self-harm or suicide, and worsening mood
Report any side effects that are persistent or bothersome to your healthcare team.
- Acne
- Changes in sexual drive or performance
- Pain, irritation, or redness at the application site
- Breast tissue growth that is not expected
This list does not include all possible side effects.
Testosterone pellets
Subcutaneous pellets are small, measuring 3 millimeters by 9 millimeters. They contain crystalline testosterone. They are implanted under your skin and slowly release testosterone for 3 to 6 month.
The procedure is simple and takes about 10 minutes.
After cleaning the skin on the buttocks or upper hip, a local anesthetic is injected to relieve discomfort. A small incision will be made.
These pellets provide a form of long-acting testosterone therapy. These pellets should provide a steady, stable dose of testosterone.
The procedure involves the implantation of 10-12 pellets. The effects last approximately 4 months. After that, the procedure must be repeated.
What could interact with this drug?
- Diabetes medications
- Warfarin is a blood-clot prevention or treatment medication.
- Oxyphenbutazone
- Propranolol
- Steroids like prednisone and cortisone
This list does not include all possible interactions.
It is important to provide a list of all your medicines, herbal remedies, non-prescription medications, and dietary supplements that you take to the medical professional who would prescribe and administer this therapy.
Tell them if your use drugs, alcohol or illegal substances. Certain items can interact with your medication.
Ongoing checks
The pellets are a good long-term solution for men with low testosterone levels, but they have some drawbacks.
It is possible that the pellets will "extrude" from the skin. Although it is very rare.
Furthermore, research shows that 0.3% up to 0.40% result in infection.
Another surgical procedure is needed to add pellets if the dose needs adjustment.
It may be best to try other testosterone applications, like creams and patches, before using testosterone pellets.
This will help you determine the right dose for your body. You can get help from your doctor.
You can use testosterone pellets once you have a dose that you are comfortable with.
What are the possible side effects of this medication?
High peaks in testosterone exposure can cause testosterone to be broken down and transformed into estradiol (an estrogen).
Breast growth and tenderness can be caused by excess estrogen.
TRT can also cause:
- Sleep Apnea
- Acne
- Low sperm count
- Breasts enlarged
- Testicle shrinkage
- Risk of blood clot increased
Overall risks of testosterone replacement therapy (TRT)
The use of testosterone replacement therapy can cause an increase in haemoglobin and haematocrit, which indicates a thickening or thinning of the blood.
This can be linked to an increased risk of stroke, heart attack and blood clots.
You will have your blood tested before treatment and regularly during treatment in order to monitor the haemoglobin level and haematocrit.
The treatment of testosterone can also lead to an enlarged or other prostate problems.
Your prostate specific antigen will be monitored to detect any changes.
It is especially important for men older than 45. Some other side effects include:
- Weight gain
- Increased appetite
- Hot flushes
- Acne
- Depression
- Restlessness
- Irritability
- Aggression
- Tiredness
- General weakness
- Excessive sweating
Your natural testosterone production may be affected by testosterone replacement.
Your fertility may be affected if you start testosterone replacement therapy. This can also result in a decrease in sperm.
You should talk to your endocrinologist if you plan on having children in future.
Pellets vs Injections
Pellets are a great treatment option because the patient can only visit the doctor four times a year. The pellets last about 90 days, before they are absorbed into the body.
Pellets are used to provide low dose of testosterone. A small incision in the hip is usually made, and several pellets will be placed under the skin under local anesthetic.
Pellets can be dangerous because, as with any surgical procedure the site of insertion could become infected and/or the pellets may be rejected.
The medical team is limited in their ability to adjust the dosage until the next set of pellets have been inserted.
It can take up to three months for the medical team to try a lower or higher dose.
Injections, on the other hand, are relatively quick and painless.
The medical team can adjust the dosage every seven days to treat symptoms and side-effects.
Are injections a better choice?
It could be argued that the best way to get bioidentical hormones is through testosterone replacement therapy injections.
The hormones that are injected into your body work in the same way as testosterone produced by your body.
Crucially, injections are the most effective way to control your dosage and monitor the effects.
What are the long term effects of different types of TRT?
This 2015 study looked at different types of TRT over the long term, and assessed its impact on different serum parameters.
The body of research confirms previous findings that different testosterone (T) formulations have variable adverse effects rates.
In particular, pellets and gels have lower rates of erythrocytosis and estradiol compared to injectable testosterone formulations. This may be due to the fact that their mean and peak T levels are higher.
Prostate-specific antigen (PSA) levels do not seem to be affected by the T formulation. Similarly, inconsistent variations in lipid concentrations occur. HDL levels in all groups showed no significant change.
Alternative and natural ways to increase testosterone
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It is a multi-action testosterone booster that works to promote healthy hormone levels, enhance energy and sex drive, build more muscle mass and decrease estrogens levels while at the same time improving prostate health.
The supplement includes doses of zinc, ashwagandha and fenugreek to increase testosterone production; additionally it also helps lower estrogens levels, inflammation levels and prostate health while being reviewed positively by military personnel who have seen positive results with it.
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Conclusion
There are many ways to administer testosterone today, including patches, creams, gels and nasal sprays.
These are temporary and can make it difficult to maintain a constant level of hormones.
Subcutaneous pellets and intramuscular injections are long-acting treatments which don't need daily dosage and can help achieve consistent hormonal balance.
The peak of short-acting injections is reached within a few days, and the fall occurs within 1-3 weeks.
The effects of long-acting injections are less dramatic, but they can still cause mood swings and unpredictable changes in sexual drive.
As the pellets dissolve, testosterone is released gradually, leading to predictable and steady hormone levels.
