The use of oral testosterone is usually avoided because it is directly metabolized by the liver and it can increase triglycerides and LDL cholesterol (the bad cholesterol) and decrease HDL (the healthy cholesterol). TESTOPEL® (pellet) and testosterone cypionate (injection) are FDA approved for men. In lower doses it is used as an “off label” treatment for women. Testosterone can increase energy, lean muscle mass, and bone density; it can also improve mood, sexual functioning, and overall quality of life.
Testosterone pellets and injections should not affect cholesterol levels because they are not directly metabolized by the liver. However, elevated hemoglobin or hematocrit levels can occur with testosterone therapy, especially in smokers; this can increase your risk for a clot or cardiac event. If there are any concerns, you will be referred to a hematologist. For men, it is important to know that testosterone replacement does not cause prostate cancer. But, if you unknowingly have prostate cancer, testosterone can promote the growth of metastatic prostate cancer – this can alert us sooner and allow for earlier intervention with a urologist. To monitor this, a PSA (prostate specific antigen) level will be drawn every 6 months (the PSA level is expected to rise 0.4-0.6 ng/dL while using testosterone).
- Overall sexual functioning
- Lean muscle mass
- Bone health
- Joint pain
- Cardiovascular health
- Menopausal symptoms in women
- Hot flashes/night sweats
TESTOPEL is FDA approved for testosterone deficiency in men and in lower doses it is used as an off-label treatment for women. Testopel is a bioidentical testosterone pellet (about the size of a tic tac) that is inserted underneath the skin just below the belt line. The pellet(s) provide a slow, steady release of testosterone and they dissolve over 3-5 months. Once the pellet is inserted it cannot be removed. Women usually need 1-3 pellets and the dose will depend on your weight. Most men need 10-12 pellets. If you do not have the expected response you likely need a higher dose next time.
The procedure is simple and patients report minimal to no discomfort. You will lay on your side and an ice pack will be applied to the site prior to the procedure to reduce bleeding and prevent bruising after the procedure. Next, an anesthetic is injected under the skin. A scalpel is used to make a small incision (about 3 mm) and an instrument is used to place the pellet(s) under the skin. Steri strips are placed over the incision to keep it closed followed by a clear tegaderm dressing.
After the Procedure
- Apply an ice pack to the area for 15 minutes when you get home and at bedtime. Repeat 1-2 times the following day. This will reduce bruising and discomfort.
- You can resume normal activity immediately after the procedure, but avoid vigorous activity such as squatting to avoid pellet expulsion (the area will feel tender and look red; the pellet may look like a pimple and push its way out or we may need to make a small incision to release the pressure and pellet).
- You can shower, but do not soak the dressing in water. Remove the dressing in 2-3 days and re apply a steri-strip or Band-Aid if needed.
- Remember – it is not uncommon to have bruising or tenderness. Don’t forget to use an ice pack at home!
- You can continue other methods of testosterone for one week because it takes about 5-7 days to notice the effects of TESTOPEL.
- Women with genitourinary syndrome of menopause (GSM) or vulvovaginal atrophy (VVA) may also need local vaginal estrogen or intravaginal DHEA.
- You will follow up in 6 weeks to have labs drawn and discuss your response to therapy. Do not eat or drink 8 hours before (except water or black coffee) and do not use other forms of testosterone for at least 48 hours prior to lab draw.