There are many methods to deliver testosterone in men. One of the oldest and most well studied methods is the ‘implantation of subcutaneous testosterone pellets’. This method of delivery is also the most convenient, most reliable, and possibly the most cost effective way to deliver testosterone.
Testosterone pellet implantation has been used for androgen (testosterone) replacement since 1940. Current implants are well standardized and release testosterone at a very consistent rate. Four to eight, 200 mg. pellets are implanted under the skin of the lower abdomen wall. This is performed by a physician as an out patient office procedure under local anesthesia. The procedure takes about 10 minutes and is virtually pain free. Antibiotics are given one hour before the procedure and for up to 24 hours following the procedure to prevent an infection. Complications are rare and include extrusion of the pellet, minor bleeding, and infection.
The bioavailability of testosterone from the pellets is virtually complete. There is no first pass hepatic inactivation and no swings in plasma testosterone levels as seen with injections. It is also suitable for patients who do not absorb the topical creams and gels and who do not like the frequent dosing and fluctuations of sublingual lozenges. Often the implants are placed after a patient has been treated with another form of testosterone for three months and a PSA has remained stable. Testosterone does not cause prostate cancer, but may stimulate an undiagnosed cancer.
The implanted pellets deliver testosterone for five to seven months depending on the patient. The first time pellets are implanted; testosterone, estradiol, and estrone levels are checked (at one month) to assess the absorption of testosterone and the conversion to estrogen. Also, the first timepellets are implanted testosterone levels are rechecked at month 4, 5, 6, and 7 to determine when additional pellets are needed. On average, testosterone pellets are implanted at 5-6 month intervals.
Any time testosterone therapy is initiated, PSA levels are checked at 3, 6, and 12 months, then every 6 months thereafter.
What you need prior to having testosterone implants placed.
- A 3 month trial of treatment with shorter acting testosterone preparations with a stable PSA level (< 2.5) or negative prostate biopsy.
- Keflex or Doxycycline will be given prior to the procedure. You are to take one dose of antibiotics prior to the procedure and a second dose the following morning.
- You may drive yourself to and from the procedure.
- You must notify the physician of any allergies or bleeding problems prior to the procedure (anti-coagulant or aspirin therapy).
- Your health care provider should be consulted and notified when you have the testosterone implants placed. You need follow up care including a routine digital rectal exam and the laboratory studies mentioned above.
- You should familiarize yourself with information on ‘Prostate Protection and Testosterone Therapy’.
- It is recommended that you view the ‘Andropause, Hormone Balance in Men’ presentation on this website.
- If you are interested in a consultation for testosterone implants or other hormone replacement therapy, you may contact Dr. Glaser through this website
‘Sub-dermal pellet implantation’ is also an excellent method to deliver estradiol and testosterone in women.