Testosterone Replacement Therapy With Pellets Versus Injections

This podcast is for you. The modern man. I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthformenpodcast.com for more information and resources from the show. See you on the inside.

Foreign hello, it's Dr. Ann.

Hi. This is Bow, her husband. And welcome back to our is the third episode.

This must be our third recording here and we're glad to be here again. We're getting better and better every time. It only took us about 10 minutes to prepare. This time we know all where all the knobs are. So we're getting better. I'm so proud of this time. And today we're going to talk about something that my husband knows very well about and something that'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 Ben and for, for women. And I want to tell you our story and our journey.

I can tell you that when it comes to hormone replacement therapy, what started me on my journey with, with My darling wife, Dr. Ann 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 you know, most importantly at that time I was not sleeping well. I had, you know, muscle loss in the mast, my libido which is very important. I was not able to, to keep up with, with, with my darling wife here, Dr. Ann. And she pointed that out. And then, you know, I had no energy, I had a lack of concentration, some hair loss. And so you know, she said, well, you know darling, you, you need some help. And that's when she told me about the BHRT and I highly recommend it. Something that you all out there need to explore.

BHRT stands for bioidentical hormone replacement therapy. And one thing that is of note is that a lot of men don't realize that your testosterone level start to drop after the age of 35. 1% every year actually, including women. Women actually have more higher testosterone than any other hormones in their body. Women testosterone level is 1, 100 of a man level and particularly in a man and bao Used to be not. He still is now, but he, he, when he was younger, a very virile man, you know, and very active. So when he said he's not in the mood, he has a headache, he's tired, that 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 normally every man and every woman actually will lose testosterone after the age of 35. And some men 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. And what I did was with bow sensing that, you know, at that time he was about 45 or so. He's right now 55. And so we did blood work and his actually his testosterone level was not super low, but it was lower than what it usually is. And, but apparently he was symptomatic, meaning he was showing symptoms of low testosterone. For a man, it usually appears as low libido.

Yeah, but let me, let me interrupt for a second there. My main motivation also was that I started, 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. Right. But I was showing some of the physicality of, you know, being, becoming a woman. And I didn't want that. I knew that I had to do something about it.

Well, another thing too, when, when a man started developing man boob 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 away that 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. So testosterone is up here, cholesterol is up here, testosterone here. And estrogen is the metabolite is one of the, one of the product of testosterone. So that's why for a man, well, for a man that the, it becomes estrogen 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? That's why women have more estrogen, because women have more body fat. So that way allow them to have babies at that point. So for women, actually they have, 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 is testosterone that can cause that too.

Now wouldn't you say that I'm a different person now being on this for how many years now?

Since like about 10 years now, you know, and I love it.

It works really well.

So what, what, what do you notice since you've been on the testosterone?

You know, I sleep better. And then most importantly, the libido. Oh my God, that, that helps to me, that's life too much when you created a monster. All right, so it's all, 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 of my life, really.

But like, what is it about it that you notice right away?

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, that occurred very quickly. And most importantly, the family life. I'm not being a total butthead to the family. I'm actually, you know, a nice person now to deal with. I'm happier. So family for me was most important thing.

Well, it's almost like andropause, right? You know, like, like women with menopause is andropause and men do undergo that as well. And, and the reason why I asked about the replacement is that both he and I have testosterone pellet. And you can get testosterone as an injection or as a cream, topical or as the pellet. And the most widely used is actually 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 to get it for like once every two weeks. That's not enough because testosterone half life or duration of of treatment is about 72 hours. So it goes away after three days. So you're gonna feel good within the first 24 to 48 hours, and then you're gonna 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. You feel good again. I recommend if you're gonna do injection, do it twice a week and make sure that you follow your levels by blood work accordingly. Now, injection tend to have more side effects of 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 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 the size of a tic Tac. And I insert that under the skin, under buttocks area.

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

Yeah, well, I. 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 as well, every three months. So. So you insert the little pellets about the size of a tic tac. For men, usually they get about 800 to about 1800 milligrams at a time. And for a woman, it about 80 milligrams to about 130 milligrams.

Tell them the process, because it's not surgical. It's a little hole that you make and you insert the pellets. Right. I mean, I can't see because I'm laying on my. My stomach.

Yeah.

And essentially, you put a band aid over it and you walk out.

Right, right. It's. It's. It's inside you. I cut a little hole, and then, in fact, I don't even cut it. I use a little needle to make a little hole, and I insert in the. The. The little tic tac, the pellets, and it stays underneath the skin and the. In the. The fat of your. Your fat in the butt. And what it does is that it releases a hormone every day in a physiological or a concentration that your body needs every day for four months. And for men. And. 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 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 pellets concentration is about 50% of what 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 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.

I'm just curious, what's been the feedback from the spouses? You know, the wives.

Yeah.

Well, the husbands.

Well, the first thing, 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.

Yeah.

Or nighttime erection.

I can attest to that.

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 oftentimes when I see a man with mild ED that is in his 50s and he oftentimes I do blood work and it's really low testosterone and stress that is contributing to his underperformance in the bedroom. And this can be easily corrected. Now some people said, well, if you take extra, if the doctor give you testosterone, you're not making any of your own. Well, you're not making any of your own anyway. 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 20s. 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.

So by being on bhrt, I mean, what's been the age that you recommend or you've seen in your patients from. Because some start young too, right?

Yeah, yeah. Some start young because testosterone is made in the testicle 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 and 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 of mainly what you're going to notice is low libido, fatigue, loss of muscle mass, more body fat and loss and lack of sleep, then those are some of the symptoms there. And of course that describe, you know, a lot of men that are stressed, that are busy working, that are, you know, taking care of their family. And if you're over 35, you know, think about getting your testosterone measured. It can be easily done with blood work. Getting a blood work. Ask your 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 bind the testosterone in the blood. So that way it 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.

So you really have to find a provider that knows all this.

Right, right. That's important. 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, interpret the lab result. And you, if you are getting pellets, you should get it every four months instead of six months because I've seen some patient getting at six months, but by you got nothing left in the tank, I 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.

I mean, I love the pellets because when you did it on me, I don't have to worry about injection, you know, twice a week or cream etc, and the pellets just slowly releases what I need for four months. I don't have to worry about it. You forget about it, go on vacation, you have to worry about it.

So yeah, and you don't have to worry about bringing needles with you, bringing the, the bottle with you, because the bottle, the bottle is glass, you can break it. And then now with TSA checking and all that get all that hassle with the pellet, you place it in four months, later you get a, you know, another reinsert and you don't have to worry about it at all. I love it. As for a woman, I get it every three months, you insert it and you forget about it. For women, interestingly, the testosterone will become estrogen. So when you get the testosterone, you don't need the estrogen patch as well. Now, some women need additional estrogen patch. For myself, I don't need it as much and I do have a uterus, so I sometimes will take progesterone that will help me with sleep. But in some of my female patients, they I don't need to give them estrogen or progesterone. They do just fine with just testosterone alone. And I have a patient that is 60, 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 are on testosterone pellet at this time.

It's relationship.

Right.

I mean, for us. Right. I mean, it worked really well. So.

Right, right. It really do bring two people to together. Not not only have that emotional connection, but also the physical connection and now the hormonal connection as well. Well, I hope you find that helpful. And we'll see you at the next episode. See you next time. Goodbye now.

Goodbye. Thank you for joining us.

Sam.