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Testosterone Therapy: What You Need To Know About Hypogonadism and Testosterone Pellet Therapy

June 10, 2017

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What is Testosterone Pellet Therapy?

Testosterone Pellet therapy is a method of delivering bio-identical hormones by using implanted pellets placed below the skin.  These pellets filled with testosterone or other hormones continuously release small quantities of bio-identical hormones in physiological doses to provide optimal therapy.  "Bio-identical" means that the hormones delivered are chemically identical to the hormones produced by your own body.  These pellets dissolve over time and are replaced by your health care provider every 3-4 months on average.

What is "Hypogonadism"?

Hypogonadism basically means reduced functional activity of sex glands (testicles and ovaries) causing declined biosynthesis functionalities of sex hormones.  In men, this means that the man with hypogonadism has lower levels of testosterone than he needs for optimal function.

 

What is the normal testosterone level?

Testosterone levels in normal healthy males range between 280-1100 ng/dL according to reports from the University of Rochester Medical Center.

Is it Bad to Have Low Testosterone?


It depends on the age at which the testosterone deficiency is detected. Low testosterone at puberty age males is highly undesirable. The role of testosterone in males is bringing forth both primary and secondary sexual characteristics. Low testosterone levels in young males, therefore, impair normal puberty developments such as deepening of the voice, mature sexual organs, growth of body hair, increased muscle mass, and other secondary male sexual characteristics. Testosterone deficiency, therefore, prevents the young affected young males from growing into men with the adult characteristics typical of adult males.

Low testosterone in men beyond the age of puberty is very common.  Typically, after the age of 30, testosterone levels start declining at a rate of 1% - 3% per year.  This is a normal part of human aging.  However, the effects of declining testosterone are often undesirable.  This decline of testosterone and the associated symptoms has often been referred to as "Andropause" or the male version of menopause.

 

What are the Symptoms of Low Testosterone?


The most undesirable side effect for most men is the decrease in sex drive as well aserectile dysfunction (ED) that often accompanies declining levels testosterone. Other undesirable effects of having low testosterone include:

  • Decreased ability to get and sustain an erection
  • Decreasing muscle mass
  • Decreasing bone density
  • Decreased Energy
  • Slower healing
  • Lower level of an overall sense of well-being
  • More difficulty losing fat
  • Lack of mental focus

Testosterone levels in older individuals tends to drop due to advanced age.  The effects aren't as marked as in young males and can be mitigated easily or ignored entirely depending on the severity and symptoms.

What causes low testosterone levels in men?

Low testosterone is caused by two types of hypogonadism (underproduction of testosterone); primary hypogonadism and secondary hypogonadism. Underactive testes are responsible for primary hypogonadism and can be acquired by an accident, illness or inherited. Inherited conditions causing primary hypogonadism include Klinefelter's syndrome (possession of three sex chromosomes), hemochromatosis (pituitary glands and testicular failure due to excess iron in the blood) and undescended testicles. Accidental injury can be brought by physical injury, mumps, orchitis or cancer treatment.

Secondary hypogonadism is a result of damage to hypothalamus or pituitary glands due to inflammatory diseases, normal aging, obesity, medications or pituitary disorders.

 

How do you test for hypogonadism?

The doctor begins by conducting physical examination during which s/he notes down the patient's sexual development such as muscle mass, the size of testes, pubic hair which should be consistent with the individual's age.

The second part of diagnosis involves blood testing to reveal the testosterone level present in circulation. This is a necessary step if the patient is found to be displaying symptoms of hypogonadism. Even a person with testosterone in the "low normal" levels on a blood test can have "clinically significant" hypogonadism.  These individuals may benefit from testosterone supplementation to bring there blood levels up into the upper third of the normal range.  Supplementation of testosterone to bring blood levels above the upper limits of normal range is rarely indicated and poses significant risks.

Further testing may follow if the patient is confirmed to have testosterone deficiency. Tests such as genetic studies, pituitary imaging, hormone testing, testicular biopsy and semen analysis may be done based on particular signs and symptoms.

Is Hormone Therapy Safe?

There are risks associated with hormone therapy.Men who have a history of prostate cancer, breast cancer, and possibly heart attack or heart disease, generally should not receive testosterone replacement therapy.   For the remainder of the adult male population, the evidence is mixed.  Some of these risks can be limited by an appropriate monitoring. A condition called polycythemia can occur with the production of too many blood cells. This can be determined in a blood test. The treatment is usually to adjust the dose of testosterone and have an occasional drawing off of excess blood.  Some studies have associated testosterone supplementation therapy with increased risk of heart attack, hypertension, heart disease, and stroke.  Other studies have associated testosterone supplementation with increased risk of prostate cancer. Other studies, however have concluded there is a lower risk for cardiac disease and no effect on prostate cancer. It seems, at this point, we just don't have all the answers regarding risks of testosterone therapy.

 

What are the side effects of hormone pellets?

Side effects often manifest immediately after the first dose of the hormone is administered. This is because the body isn't used to the sudden influx of new levels of hormones. Most commonly reported side effects include;

  • Sleep Apnea
  • Low Sperm Count
  • Testicle Shrinkage
  • Gynecomastia (increase in breast tissue)
  • Bloating
  • Acne
  • Blurred vision
  • Weight again
  • Headache
  • Cramping
  • Indigestion
  • Mood swings
  • Fatigue
  • Itching or reddening of implantation region
  • Minor bleeding
  • Infection
  • Bruising
  • Pellet extrusion

How Long Do Hormone Replacement Pellets Last?

Typically, fused pellet implants last between 3 and 5 months. The duration can at times be lower depending on the rate of metabolization in the individual. The suggestions of the doctor also effects the duration of the pellets.

How much does it cost for hormone replacement therapy?

Just like other forms of therapy, hormone replacement therapy can involve a range of procedures; assessment, prescription and so on. The average prescription cost averages about $145 per month. For patients who opt for other techniques of the therapy such as the use of gel, pills, and patches, testosterone therapy cost can be between $100 and $200 per month plus the necessary office visits and lab work for monitoring. The cost for pellet insertion and the extent of this bill largely depends on the number of yearly insertions whose frequency depends on how your body metabolizes the pellets.

How Expensive is Bio-identical Hormone Pellet Therapy?

Bio-identical hormone therapy can be less expensive in some aspects.  It can however be more expensive than some of the generic prescription transdermal formulations.  The overall cost of testosterone therapy, regardless of the route of administration share some expenses such as lab tests, identification, prescription costs, and follow-up appointments.

Is Bio-identical Hormone Pellet Replacement Therapy Covered by Insurance?

Testosterone replacement is often not covered by insurance in men who are having decreases in hormone levels due to normal aging.   In other cases, testosterone replacement may be covered by insurance.  Coverage can vary from company to company and even vary between different policies underwritten by a single company.  The best way to find out is to check your individual policy or speak directly with your insurance company representative.  On request, your doctor can give you an insurance form inscribed with appropriate codes which you will be advised to submit to your insurance company. In summary, there is considerable variation in coverage so it is best to check your policy.

How Common is Hypogonadism?

Over 60% of men aged above 65 years worldwide have testosterone deficiency. It is estimated that between 4 and 5 million of men and women aged 20 and 40 years have hypogonadism in the United States alone. Statistically, hypogonadism is prevalent in old age folks than their younger counterparts. It is however thought that the hypogonadism is underreported in both sexes since only 5% of hypogonadal women and men are receiving hormone therapy. Another reason for the underreporting is lack of knowledge by patients and many physicians viewing the condition as clinically insignificant.

Testosterone Pellets vs Injection. Which is better?

Therapeutically, implantation of testosterone pellets is considered by many physicians to be more effective than injections. The strongest argument for testosterone replacement therapy using implanted pellets is the consistency of release with sustained benefit combined with the convenience of not having to apply a gel, patch, or get injections every week for two weeks.

 

 

Resources:
16 Effects of Testosterone on the Body
Male hypogonadism Overview - Mayo Clinic
Testosterone Pellets: Side Effects, Effectiveness, Benefits
Is Low Testosterone Dangerous to Your Health? - Healthline
Low Testosterone - WebMD: Symptoms, Health Effects, and Testosterone Replacement
Fundamental Aspects of Hypogonadism in the Aging Male - NCBI - NIH
Testosterone Levels by Age - Healthline
Common Side Effects of Low Testosterone in Men - Healthline
What's Causing My Low Testosterone? - Healthline
Male hypogonadism Diagnosis - Mayo Clinic
Hormone therapy: Is it right for you? - Mayo Clinic
Bioidentical Hormones: Side Effects, Uses & More | Cleveland Clinic
Pellet Implant FAQ - College Pharmacy
Bioidentical Hormone Replacement Therapy Costs | BodyLogicMD
]BHRT Fused Pellet Implant FAQ - College Pharmacy
Male hypogonadism Symptoms and causes - Mayo Clinic
Is Testosterone Replacement Therapy Right for You?

About the Author
Dr. John B. Adams is board certified in Pain Management by the American Board of Medical Specialties and the American Board of Interventional Pain Physicians. With almost 2 decades of experience, he offers patients access to state-of-the-art pain management, emphasizing a multidisciplinary approach to pain management utilizing precision injections, neuromodulation technology, physical therapy, behavioral medicine and judicious use of medications including help with patients titrating off opiates (narcotic pain medications).

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