Testosterone Pellets vs Injections for Men: Which Fits You?

There's not agreement in the medical community on what is a normal testosterone level in men. 300, you know, if you have symptoms of low testosterone at 300, you're still low testosterone, even though not by definition by the insurance company. So we go back to testosterone, the indication for testosterone in men in the first place. What is the optimal range? We don't really know based on lab, we know based on how you're feeling. For example, if you have high blood pressure and we put you on lisinopril, we don't measure a lisinopril level, we remeasure your blood pressure. If it's normal, then you're normal. So that's kind of changed our, our thinking about how we treat men with low testosterone. If you have symptoms of low testosterone regardless, regardless of the level, and you take testosterone replacement and you feel more normal and those symptoms are gone, that's the proper level and that's proper dosage. So from the FDA standpoint, it might be below a certain amount, or insurance companies might be below a certain amount. In the medical community, it is varied. Traditional doctors might say, well, I'm going to follow the FDA and the insurance guidelines because I take insurance and that's what we do. And there's other companies that are more focused on men's health and they'll say, well, I'm going to follow the international consensus guidelines, which is that there's no testosterone level that predicts which men will respond to testosterone. It should be based on symptoms and assessing somebody's response after they take testosterone replacement. So those are the two schools of thought. And this has led to how we deciding on cream versus injectables versus say a pellet. So testosterone pellets were one of the first options. And this is a small little, like it's a pellet, like a piece of rice. And in the case of men, you put a few of them in there, you put them into your skin, using the skin and the buttock and the fat, and it slowly gives testosterone levels over about a five month period and then you replace it and do it again. Then there's a shot which can be done twice a week, once a week, once a month, once every two months, depending on again, the traditional approach from medicine or the more contemporaneous approach. The contemporaneous approach would be generally weekly and their traditional approach would be once every two months. Just get the level barely up. And then there's the creams that really kind of came out as an opportunity to get rid of the shots and the pellets and also created new patents, intellectual property protection for companies to make a non generic testosterone. Because the shots and the pellets can be generic. Well, so let's talk about why we would choose one over the other. So step one is that a cream will never give you the therapeutic level that a shot or a pellet will give you. In general, I might say there might be some exceptions of this, but it's really hard to get that much testosterone through the skin. Additionally, studies have shown that creams have a neutral effect on cardiovascular disease, so a neutral effect in heart attack or strokes, whereas injectables and pellets are cardiac protective. So in our practice, we do not prescribe creams. So if you want creams, you would have to go see someone else. Notice between pellets and shots, clinically, really nothing. We do a lot of pellets in our practice because we offer them. And men seek us out because they want to get a pellet over a shot. And typically some man doesn't want to give himself shots. And that being said, some men don't tolerate the pellets super well because we're putting a few men there, they might hurt a little bit or they might cause irritation to the tissue. So I'd say about 80% of men can tolerate the pellets. And they really love that because they're coming into office basically twice a year. And there's other men that really like the fact that the shots are a little cheaper and they're not afraid to give themselves a shot or have some of your family give them a shot. And they're doing that once a week, maybe even twice a week. In some cases, the shots and pellets are about the same. And it's really a matter of preference between you and your healthcare provider. Typically, you know, you're making that decision based on your healthcare provider's information. But clinically the same. Most men do fine with one shot a week. Some men, because of whatever reason, they're maybe getting something called polycythemia, where they're growing too much red blood cells or they're feeling a little surge of the testosterone, they just cut the dose in half and give it twice a week. But 95% of the time, it's once a week. Pellets 95% of the time is every five.