Is the dosage of 150 mg of testosterone pellets for every 25 mg of testosterone (testosterone) desired weekly accurate?

From the Guidelines

No, the dosage of 150 mg of testosterone pellets for every 25 mg of testosterone desired weekly is not accurate. The goal of testosterone therapy is to achieve a total testosterone level in the middle tertile of the normal reference range, with the minimal dosing necessary to drive testosterone levels to the normal physiologic range of 450-600 ng/dL 1. To determine the appropriate dosage, clinicians should adjust testosterone therapy dosing based on individual factors, including body weight, metabolism, previous hormone levels, and treatment goals. Key considerations for testosterone pellet dosing include:

• The typical conversion for testosterone pellets is approximately 75-100 mg of pellets to achieve 6-8 mg of testosterone release per day (equivalent to about 42-56 mg per week)
• For a target of 25 mg of testosterone weekly, you would need approximately 50-75 mg of pellets, not 150 mg
• Testosterone pellets are designed for slow, sustained release over 3-6 months, with the release rate decreasing over time
• Using 150 mg of pellets for a 25 mg weekly target would likely result in significantly higher testosterone levels than intended, potentially causing side effects such as acne, mood changes, increased red blood cell production, and other androgenic effects Regular blood testing is essential to monitor testosterone levels and adjust future pellet dosages accordingly, as recommended by the American Urological Association guideline 1. Important factors to consider when determining the appropriate pellet dosage include:
• Individual patient factors, such as body weight and metabolism
• Previous hormone levels and treatment goals
• The need for regular blood testing to monitor testosterone levels and adjust future pellet dosages accordingly By taking these factors into account and using the minimal dosing necessary to achieve the desired testosterone levels, clinicians can help ensure safe and effective testosterone therapy for their patients 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Testosterone cypionate injection is for intramuscular use only. The FDA drug label does not answer the question.

From the Research

Testosterone Pellet Dosage

• The claim that 150 mg of testosterone pellets are required for every 25 mg of testosterone desired weekly is not directly supported by the provided studies 2, 3, 4, 5, 6.
• However, a study on testosterone pellet implantation practices found that most specialists use at least 10 pellets at initial implantation, with limited need for subsequent dose adjustments 3.
• Another study found that implantation of 12 testosterone pellets (900 mg) was well tolerated and provided adequate and sustained serum testosterone concentrations 2.
• A study on the efficacy and safety outcomes of compounded testosterone pellets versus branded testosterone pellets found that both types of pellets were effective in treating testosterone deficiency, but the dosage used was 10 pellets of 75 mg for the branded pellets and 8 pellets of 100 mg for the compounded pellets 4.
• A review and case report on subcutaneous testosterone pellet therapy for reversal of male osteoporosis found that consistent levels of testosterone achieved through pellet therapy can reverse osteoporosis, but the dosage used was not specified 5.
• A multi-institutional observational study found that implantation of 6 to ≥10 testosterone pellets (450 to ≥750 mg) increased total testosterone into the therapeutic range at 1 month postimplantation and sustained therapeutic levels for 4-6 months 6.

Rule of Thumb for Testosterone Pellet Dosing

• A rule of thumb mentioned in the question states that 450 mg dosing increases testosterone by 100-200 ng/dL, but this is not directly supported by the provided studies.
• However, a study found that implantation of 12 testosterone pellets (900 mg) resulted in mean testosterone serum concentrations fluctuating during the first 2 weeks, but remaining higher than or equal to 300 ng/dL through day 113 2.
• Another study found that implantation of 6 to ≥10 testosterone pellets (450 to ≥750 mg) increased total testosterone into the therapeutic range at 1 month postimplantation and sustained therapeutic levels for 4-6 months 6.