Data supports that testosterone implants effectively treat symptoms in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy without adverse effects.
Pellets, or implants are made up of hormones (i.e. testosterone) that 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, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials.
Bio-identical progesterone has not been shown to increase the risk of breast cancer like the synthetic progestins. In addition, progesterone, used vaginally, does not negate the beneficial effects of estrogen on the heart like the synthetic progestins.Estriol is a bio-identical estrogen widely used in Europe that does not bind strongly to estrogen receptor and does not stimulate breast tissue. Numerous studies have shown that vaginal estriol does not increase the risk of breast cancer (RR 0.7). It has safely been used in breast cancer survivors.
Over half of women treated with estrogen (especially the pellet implant) will experience uterine bleeding. If a menopausal patient has bleeding, she must notify her physician and have an evaluation, which may include a vaginal ultrasound and endometrial biopsy. Estrogen also stimulates the breast tissue can cause breast pain and cysts. It also increases the risk of breast cancer. Higher levels of estrogen (in the second half of the menstrual cycle) are needed for pregnancy. Most women feel better with lower levels of estrogen.
- Almost all symptoms, including hot flashes, are relieved with testosterone pellets alone. A study by Sherwin in 1985 looked at testosterone, testosterone with estradiol, estradiol alone and placebo. The group of women who responded best (somatic, psychological and total score)…testosterone alone! The groups that did the worst…estrogen alone and placebo. Higher levels of testosterone were associated with a better response. These results are expected.Testosterone is the major ‘substrate’ for estrogen production in the brain, bones, vascular system, breast and adipose tissue. Some physicians do not understand this and may insist that estrogen therapy is needed.
- Excess estrogen can cause anxiety, weight gain, belly fat, tender breasts, emotional lability, symptoms of PMS, and mood swings. Long-term exposure to stronger estrogens like estradiol and Premarin can increase the risk of breast cancer. In addition, there is exposure to many estrogen-like chemicals.
- Some women (and men) ‘aromatize’ or convert too much testosterone to estradiol, which can interfere with the beneficial effects of testosterone. An ‘aromatase inhibitor’ (i.e. anastrozole) may be prescribed to prevent this. Patients, including breast cancer survivors and men with elevated estrogens, may be treated with the combination testosterone-anastrozole implants.
Hormone deficiency is a common cause of hair loss and treatment with testosterone implants can help to re-grow hair. Hair becomes thicker and less dry with pellet therapy.
Some patients begin to ‘feel better’ within 24-48 hours while others may take a week or two to notice a difference. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness. Side effects and adverse drug events from prescription medications can interfere with the beneficial effects of the testosterone implant.
The pellets usually last between 3-4 months in women and 4-5 months in men. The pellets do not need to be removed. They completely dissolve on their own.
Testosterone pellets may be used in pre-menopausal females (women who have not stopped menstruating). Testosterone has been shown to relieve migraine or menstrual headaches, help with symptoms of PMS (pre menstrual syndrome), relieve anxiety and depression, increase energy, help with sleep and improve sex drive and libido. If a pre-menopausal female has a testosterone pellet inserted, she must use birth control. There is a theoretical risk of ‘masculinizing’ a female fetus (giving male traits to a female fetus).
Very rarely, a patient will develop local zone of redness (3-8 cm) and itching at the site of the testosterone implant. There is minimal or no tenderness and no other sign of infection. Pellets are made of up testosterone, stearic acid and PVP (povidone). Patients may react to the PVP. Implants can be compounded or made without PVP. Many patients who develop a local reaction to the implant have low cortisol levels and upon further questioning, have symptoms of adrenal insufficiency. Cortisol testing may be recommended. If needed, 25-50 mg of benedryl works well for the itching. See handout ‘Local allergic reaction’ for further recommendations.