Testosterone Replacement Therapy With Pellets Versus Injections


I'm Dr. Anne Truong, MD

Dr. Anne Truong is a highly respected physician, best-selling author and internationally sought-after speaker on the topics of regenerative cell medicine, pain management, and applications for aesthetics and sexuality.

Testosterone is the man's hormone. As he ages, his body produces less testosterone – typically, about 20% less by his mid-forties. On top of natural aging, other low testosterone causes can include: excessive stress, weight gain, nutrient deficiency, toxin overload, and lack of exercise. Low testosterone can disrupt stamina, sex drive, virility, and bone strength. It can potentially lead to chronic fatigue, erectile dysfunction, and even cardiovascular disease. In this episode we will learn about testosterone replacement therapy and discuss:

  • Signs of low testosterone
  • What are bioidentical hormones
  • Hormone testing
  • How is bioidentical testosterone delivered

Testosterone Replacement Therapy Episode Contents

Testosterone Replacement Therapy Episode Video

Personal Experience Before Testosterone Replacement Therapy

Anne: Today we're going to talk about something that my husband knows very well about and something that he’s very passionate about is hormone replacement therapy, particularly testosterone bioidentical testosterone, hormone replacement therapy and it is something that is important, I think for men and for women, and I want to tell you our story and our journey.

Bao: I can tell you that when it comes to hormone replacement therapy, what started me on my journey with my darling wife, Dr. Anne here is that the kids, including her, were saying that I'm always in a bad mood and you don't realize that you're in a bad mood until someone actually tells you, especially your loved ones and that's important where you really need to change that.

and most importantly at that time I was not sleeping well. I had muscle losses in the mass. My libido, which is very important. I was not able to keep up with my darling wife here, Dr. Anne, and she pointed it out. And then I had no energy, I had a lack of concentration, some hair loss. So she said, "Well, darling, you need some help. And that's when she told me about the BHRT and I highly recommended, it's something that you all out there need to explore.

BHRT (Bioidentical Hormone Replacement Therapy)

Anne: BHRT stands for a bioidentical hormone replacement therapy and one thing that is of note is that a lot of men don't realize that your testosterone levels start to drop after the age of 35, 1% every year, actually, including women. Women testosterone level is one-one hundredth of a man level and particularly in a man and Bao used to be… he still is now, but when he was younger, a very viral man and very active.

So when he said he's not in the mood, he has a headache, he's tired, that's definitely not him at all.

And then compounded by the fact that stress, not able to not get enough sleep, not eating well, not exercising and running your own business, all of that, actually accelerate the loss of testosterone because you normally every man and every woman actually will lose testosterone after the age of 35 and some man, even faster than that, even before the age of 35 and with aging alone is 1%, but with other factors such as stress, toxin, toxic lifestyle factor, it could be more accelerated.

Signs Of Low Testosterone

Signs of low testosterone
Photographer: Nick Fewings

Anne: And what I did with Bao, sensing that, at that time he was about 45 or so, he's right now, 55, so we did blood work. Actually, his testosterone level was not super low, but it was lower than what it usually is, but apparently he was symptomatic, meaning he was showing symptoms of low testosterone and for men it usually appears as low libido.

Bao: Yeah, but let me interrupt for a second there. My main motivation also was that I started developing man boobs and a gut, which is something that I've been active all my life as an athlete, but I guess when you reach a certain age, you start to show that. So I was becoming, not necessarily a woman, but I was showing some of the physicality of becoming a woman, and I didn't want that, I knew that I had to do something about it.

Anne: Well, another thing too, when a man starts developing man boobs and a belly in the gut, is that the fat that he has in his body actually will pull away the testosterone in his system. So it steals the way your overall testosterone, you end up getting less testosterone. The more belly fat is actually a sign that you will have less testosterone, so the way to actually increase your own innate testosterone is to lose some of that belly fat and believe it or not, testosterone come from cholesterol. Cholesterol make testosterone, and I have to admit, testosterone is the father of estrogen. Testosterone is up here, cholesterol is up here, testosterone here and estrogen is the metabolite, is one of the product of testosterone.

So that's why for a man it becomes estrogen and through an enzyme called aromatase and aromatase is the enzyme that lives in the fat, and the fat convert the testosterone to estrogen.

And that's why women have more estrogen because women have more body fat, so that way allows them to have babies at that point.

Anne: So for women, actually, they lose their testosterone too and one of the signs of testosterone loss in women that they will see right away is hair loss and then libido and weight gain and hot flashes and night sweat. So not only just estrogen, it's testosterone that can cause that too.

Effects Of Testosterone Replacement Therapy

Effects Of Testosterone Replacement Therapy
Photographer: Isaac Smith

Bao: Now wouldn't you say that I'm a different person now being on this floor, how many years now?
Anne: Since like about 10 years now.
Bao: I love it. It works really well.
Anne: So what do you notice since you've been on the testosterone pellet?
Bao: I sleep better and most only the libido. Oh my God, that helps, to me that's life.
Anne: Too much.

Bao: Well, you created a monster, all right? So it's all her fault, but the libido, I sleep better, better concentration. Again, just the benefit of being on the testosterone really helps a lot in all facet of my life, really.

Anne: But what is it about it that you notice right away?

Bao: Well, I sleep better. I don't wake up in middle of the night, like three or four times, and again, the libido is definitely something that occurred very quickly. And most importantly, the family life, I'm not being a total butt head to the family. I'm actually a nice person now to deal with, I'm happier. So family for me was the most important thing.

How is Bioidentical Testosterone Delivered

Anne: Well, it's almost like andropause. Like women with menopause is andropause and men do undergo that as well, and the reason why I ask about the replacement is that both he and I have testosterone pellets, and you can get testosterone as an injection or as a cream, topical or as the pellet.

The most widely used is injection. You cannot take testosterone orally because it doesn't become bioavailable, or it just doesn't work, so you have to get it as an injection or on the skin, but on the skin, the absorption too variable, you don't know how much you're getting, and then it can also be transferred to your partner as well or onto your clothes.

The injection, usually it should be done really twice a week for injection of testosterone and instead of once a week, I see some of my patients used get it for once every two weeks, that's not enough because testosterone half life or duration of treatment is about 72 hours, so it goes away after three days. So you can feel good within the first 24 to 48 hours, and then you're going to feel bad after 72 hours, and then, you get it only once a week, you spend three days not feeling good at all and then when you get your injection, you feel good again. So I recommend if you're going to do injection, do it twice a week and make sure that you follow your levels by blood work accordingly.

Anne: Now injection tend to have more side effects, a conversion to testosterone, to estrogen, and also conversion of testosterone to another hormone called dihydrotestosterone or DHT, which can cause further hair loss as well. However, you can actually control all that conversion through a diet and exercise that will actually minimize that as well. However, the best form of getting testosterone that is in the most bioidentical or the most natural way that your body recognizes as testosterone is through pellet, which is like a size of a Tic Tac and I insert that under the skin, on the buttock area.

Bao: I wish I could show it to you guys where she implants it in my butt, but that would be another show, maybe not be appropriate to show you my butt.

Anne: Yeah, well, I insert on, on him. So you insert that on every four months and I have it to myself and my good friend, Shelly, the one that puts it on for me and for women is every three months. So you insert the little pallets about the size of a Tic Tac. For men, usually they get about 800 to about 1800 milligram at a time and for a woman, it's about 80 milligram to about 130 milligram.

The Process Of Administering Pellets

The Process Of Administering Pellets
Photographer: Faris Mohammed

Bao: Tell them the process because it's not surgical. It's a little hole that you make and you insert the pellets. I can't see because I'm laying on my stomach and essentially you put a bandaid over and you walk out.

Anne: Right. I cut a little hole, and in fact I don't even cut it, I use a little needle to make a little hole and I insert in the little Tic Tac, the pellets, and it stays underneath the skin and your fat in the butt, and what it does is that it releases hormones every day in a physiological or a concentration that your body needs every day for four months.

Bao: For men.

Anne: Yeah, for men and for three months for women and then after four months, you get a refill, or I put in more pellets on the other side of the butt. So that way I refill the tank again, so that way you don't go down to zero.

Think of it as filling up the gas tank. Before it gets too empty because after four months the pellet's concentration is about 50% of the way it was when we first placed it in and I follow up with blood work to see if the man has appropriate levels.

What I find is that the leaner the man is or less body fat with more muscle mass, he actually uses less testosterone and less side effect than a man that is less lean, but has more body fat because when a man has more body fat he do tend to convert through estrogen. What I find that if I tell my a patient, "Hey, just decrease the carb, decrease the red meat and exercise, have good sleep," Lord and behold, they utilize their testosterone level better. I don't have to increase the pellet concentration at all.

Feedback From Other Clients

Bao: Now I'm just curious. What's been the feedback from the spouses, the wives or the husbands?

Anne: Well, the first thing that a man notices after getting a testosterone replacement therapy is that on the fifth day after the first initial placement, is that he'll wake up with a morning erection.

Bao: Yeah, that's true.
Anne: Or night time erection.
Bao: Yep, I can attest to that.

Anne: Yeah, and when he wakes up with an erection, then his libido is going to be off the wall. He's going to feel like he's back in his early 30s again and going to be active again and often time when I see a man would mild ED that's in his 50s and he oftentimes I do blood work and it's really low testosterone and stress that is contributing to his under performance in the bedroom and this can be easily corrected.

Recommended Age To Start Testosterone Replacement Therapy

Anne: Now, some people say, "Well, if the doctor give you a testosterone, you're not making any of your own." Well, you're not making any of your own. Mother Nature doesn't want you to make anymore after 35 and your level is decreasing every year, so how can you make more? Even if you put more muscle mass on and have less fat, you're not going to make as much as you were when you are in your 20's.

So either way, getting additional testosterone it's also helpful, but it's good that you continue with maintaining your weight with good diet and exercise and stress management, so that way you have less conversion of that.

Bao: So by being on BHRT, what's been the age that you recommend or you've seen in your patients from… because some start young too, right?

Anne: Yeah, some start young because testosterone is made in the testicles and also a little bit in the adrenals, the gland on top of the kidney. So depending on somebody's lifestyle and the functioning of their glands, it could start as young as in the 30s, but it can go all the way up to a man in his 70s as well, because if you're starting to have these symptoms, and mainly what you're going to notice is low libido, fatigue, loss of muscle mass, more body fat and lack of sleep, then those are some of the symptoms there and of course that describe a lot of men that are stressed, that are busy working that are taking care of their family.

Anne: If you are over 35, think about getting your testosterone measured. it can be easily done with blood work. It's getting blood work, ask primary care doctor to get a blood work for a total testosterone and a free testosterone and get a blood work for SHBG, which is sex hormone binding globulin, because that's what binds the testosterone in the blood, so that way can take away the active testosterone as well and you want to make sure that you look at the estrogen level and look at your total red blood cells level as well.

Advantages Of Pellets

Bao: You really have to find a provider that knows all this, right? That's important.

Anne: Right. Absolutely find a provider that knows how to do hormone replacement therapy and is able to measure your blood work accordingly and be able to monitor and interpret the lab results. And if you are getting pellets, you should get it every four months since the out of six months because I've seen some patient getting it six months, and by six months, you got nothing left in the tank.

I'd rather you refill up your tank when you're 50% less full than you are at empty, so that way you don't have the peaks and the trough of having no testosterone at all.

Bao: I love the pellets because when you did it on me, I don't have to worry about injection twice a week or cream, et cetera and the pellets just slowly releases what I need for four months. I don't have to worry about it. I can travel, go on vacation.

Well, you implant it and you forget about it.

Bao: You don't have to worry about it, so it works really well.

Anne: You implanted it and you don't have to worry about bringing needles with you, bringing the bottle with you because the bottle is glass, you can break it, and then now with TSA check-in and all that, all that hassle. With the pellet, you place it in, four months later, you get a another reinsert and you don't have to worry about it at all.

Anne: I love it. As for a woman, I get it every three months. You insert and you forget about it, and for woman, interestingly, the testosterone will become estrogen. So when you get the testosterone, you don't need the estrogen patches.

Now some women need additional estrogen patch, but for myself, I don't need it as much, and I do have a uterus, so I sometimes will take a progesterone that will help me with sleep. But in some of my female patient, I don't need to give them estrogen or progesterone, they do just fine with just testosterone alone. I have a patient that is 65 and she and her husband have a terrific relationship, and she said that the testosterone help her be in the game with her husband and she wants to be frisky with him because he's frisky with her and the both of them are my patient on testosterone pellet at this time.

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