How to use an androgen pellet (testosterone replacement therapy)?

From the Guidelines

To use an androgen pallet, specifically testosterone replacement therapy, the most effective and recommended formulation is the transdermal gel, such as AndroGel 1%, applied at a dose of 50-100 mg/d to the skin of the back, abdomen, upper thighs, and upper arms, as it provides easy application and good skin tolerability, with minimal risk of transference 1. When considering testosterone replacement therapy, it is essential to consult with a healthcare provider to determine the best course of treatment based on individual hormone levels and medical history. The advantages and disadvantages of different formulations should be taken into account, including:

• Long-acting injections, such as testosterone enanthate, which offer relatively inexpensive and flexible dosing but require intramuscular injection and may result in fluctuating serum testosterone levels 1.
• Extra-long-acting injections, such as testosterone undecanoate, which provide fewer yearly injections and less fluctuation in testosterone levels but may be associated with injection-associated pulmonary oil microembolism 1.
• Transdermal patches, such as Androderm, which offer easy application and no risk of transference but may cause skin rash or irritation at the site of application 1.
• Subcutaneous implants, such as Testopel, which provide long-lasting therapy and less fluctuation in testosterone levels but require an incision for insertion and may be associated with pellet extrusion or infection at the site of insertion 1. It is crucial to weigh the benefits and drawbacks of each formulation and consider individual patient needs and preferences when selecting a treatment option. Key factors to consider include:
• Dosage and application site
• Potential for transference or skin irritation
• Convenience and ease of use
• Risk of adverse effects, such as injection-associated pulmonary oil microembolism or pellet extrusion By carefully evaluating these factors and consulting with a healthcare provider, patients can make informed decisions about their testosterone replacement therapy and achieve optimal outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Using Androgen Pellets

To use androgen pellets, also known as testosterone pellets, it is essential to follow the guidance of a healthcare professional. The pellets are typically implanted subcutaneously and release testosterone over time to treat hypogonadism 2.

Key Considerations

• The number of pellets implanted can affect testosterone levels, with 10-12 pellets resulting in higher estradiol levels compared to 6-9 pellets 2.
• Body mass index (BMI) can also impact testosterone levels, with men having a BMI ≥ 25 kg/m² attaining lower testosterone peaks with slower decay 2.
• Reimplantation is usually necessary every 100-120 days to maintain optimal testosterone levels 2.

Monitoring and Safety

• Patients receiving testosterone therapy should be monitored to ensure testosterone levels rise appropriately, clinical improvement occurs, and no complications develop 3.
• Potential risks of testosterone therapy include cardiovascular complications, rising prostate-specific antigen levels, worsening lower urinary tract symptoms, polycythemia, and increased risk of venous thromboembolism 3.
• Clinicians must consider the unique characteristics of each patient and make necessary adjustments in the management of hypogonadism to provide the safest and most beneficial results 4, 5.

Comparison with Other Treatments

• Subcutaneous testosterone enanthate autoinjector (SCTE-AI) has been compared to intramuscular testosterone cypionate (IM-TC) and found to have a potentially preferable safety profile, with lower levels of post-therapy estradiol and hematocrit 6.
• The choice of treatment modality should be based on individual patient needs and characteristics, and guided by healthcare professionals 5.

Important Points to Note

• Testosterone replacement therapy (TRT) is associated with multiple benefits, but recommendations are based on limited data from randomized controlled trials 4.
• Clinicians should be cautious when prescribing TRT, especially in older men with a history of heart failure, due to the lack of evidence on long-term safety 4.