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Do Testosterone Pellets Work?
Updated on August 24, 2023
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Do Testosterone Pellets Work?
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Yes, testosterone pellets work.

Testosterone pellets are a long-lasting treatment option for low testosterone levels. 

Low testosterone can cause several health issues, including low libido, low energy levels, and fatigue.

Testosterone pellets provide a steady dose of testosterone to the body, which can help to improve these symptoms.

What Are Testosterone Pellets?

Testosterone pellets are a form of hormone replacement therapy. Each pellet is cylindrical and about the size of a grain of rice. They contain a solidified form of testosterone.

Doctors place them under your skin because it is a safer and more effective way to deliver testosterone to your body compared to pills taken orally.1

Testosterone pellets help treat hormonal imbalances. They give your body a steady, low amount of testosterone for up to six months at a time.

How Do Testosterone Pellets Work?

Testosterone pellets effectively act as testosterone replacements. They work by elevating the levels of natural sex hormones to a healthy range, which is:

  • 300 to 1,000 nanograms per deciliter (ng/dL) in male adults
  • 15 to 70 ng/dL in female adults

Most men who undergo this treatment feel the effects, such as improved moods and energy levels. They experience the difference within four to six weeks after the pellets are implanted.

Doctors typically place the pellets under your skin or subcutaneously, close to the hip or on the buttocks. They’ll clean the site where they plan to insert the subcutaneous testosterone pellets.

Then, they’ll give you a local anesthetic and make a small cut in your skin. They’ll implant about ten pellets into the incision using a trocar tool.

As the pellets release testosterone, they will dissolve, leaving no residue. It means they must be reinserted, typically every three to six months.

Testosterone Pellets vs. Injections and Other Methods

Besides hormone pellets, the other forms of testosterone replacement therapy are injections and oral capsules.

Testosterone injections can be administered intramuscularly (IM) or subcutaneously (sub-q). Doctors give IM shots into a muscle while administering sub-q injections into the fatty tissue beneath the skin.

Common Testosterone Replacement Therapy Methods

1. Testosterone pellet

Testosterone pellets are placed under your skin and slowly let out testosterone into your body. 

Typical dosages: Every three to six months

  • Pros:
    • No transmissibility
    • Lasts longer and is given less frequently than other options
  • Cons:
    • The procedure is invasive
    • May cause skin allergies or infection

2. IM injection

An intramuscular (IM) injection releases a sterile liquid form of testosterone straight into your muscles.

Typical dosages: Once every one to two weeks

  • Pros:
    • No transmissibility
  • Cons:
    • Has peak and trough levels, which can cause mood and libido to change
    • The needle insertion may cause skin irritation
    • Need adjustments in dosage

3. Sub-q injection

A subcutaneous (sub-q) injection is a type of injection inserted into your subcutaneous fat, which is just underneath the skin.

Typical dosages: Once weekly

  • Pros:
    • Less painful than IM
    • No transmissibility
    • Fewer changes to your mood and libido compared with IM
  • Cons:
    • Can be expensive
    • May cause elevated blood pressure

4. Oral capsule

Oral capsules contain testosterone that can be taken by mouth. The testosterone are released into the bloodstream through the digestive system.

Typical dosages: Twice daily

  • Pros:
    • Convenient and easy to take
    • No transmissibility
    • The effects can be easily reversed if you decide to discontinue use or if an adverse reaction happens
  • Cons:
    • Can be costly
    • Effectiveness might vary based on whether or not you take it with a meal or the specific types of food you eat
    • May cause gastrointestinal symptoms like nausea or diarrhea
    • May raise your blood pressure

What Does No Transmissibility Mean and Why Is It Important? 

No transmissibility means there’s no risk of the testosterone in the medication being passed on to another person accidentally, such as through skin-to-skin contact.

This is important to consider because exposure to testosterone can potentially cause changes women and children may not want.2

Secondary exposure to testosterone in children may cause the following.

  • Early signs of puberty, like pubic hair and a bigger penis or clitoris
  • More erections
  • A higher sex drive
  • Faster bone growth
  • Aggressive behavior

These signs usually go away when the source of testosterone is taken away. But sometimes, the changes to the genitalia and bones don't completely go back to normal.

On the other hand, when women are exposed to testosterone, it may cause them to experience virilization. Virilization is the development of male physical traits in a female or prematurely in a boy. 

It is typically a result of excess androgen production. Secondary testosterone exposure in women may result in the following.

  • Changes in the menstrual cycle
  • Acne breakouts
  • Changes in body hair growth
  • Muscle bulk
  • Deepened voice

Testosterone can also cause virilization in a developing baby, so pregnant women may need to avoid secondary exposure. 

Hormone Replacement Therapy vs. Bioidentical Hormone Replacement Therapy

Hormone replacement therapy (HRT) and bioidentical HRT are two forms of treatment for symptoms caused by menopause and perimenopause. 

The traditional HRT uses hormones made from non-bioidentical hormones, like from pregnant horses’ urine and other sources of synthetic hormones.

On the other hand, bioidentical HRT uses hormones chemically matching the hormones your body naturally produces. They are commonly derived from plants, such as yams and soy.

Health experts still debate which approach is safer and more effective. Some studies show that bioidentical hormones carry a lower risk of breast cancer in women and cardiovascular disease.3

However, other studies show that there isn’t enough conclusive evidence for this claim.

Currently, both methods are found helpful in relieving some of the symptoms of menopause in women, such as:4

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Mood swings

Understanding Testosterone Replacement Therapies

Testosterone replacement therapies (TRTs) are treatments used for low testosterone levels commonly caused by hypogonadism, aging, and certain medical conditions, like diabetes.

They help increase testosterone levels to normal by helping the body produce the missing amount of testosterone.

Testosterone is the hormone produced by testicles in biological males or people assigned male at birth. It is responsible for many of the physical and psychological changes that happen during puberty.

Testosterone levels decrease with age but can also decline due to factors like stress, illness, and some medications.

The signs of a low testosterone level can be both obvious and subtle. Symptoms may include:

  • Decreased libido or sex drive
  • Low sperm count
  • Erectile dysfunction
  • Low energy level
  • Fatigue
  • Lowered lean muscle mass
  • Loss of body and facial hair
  • Difficulty concentrating
  • Depression
  • Irritability
  • Low sense of well-being
  • Increased body fat

Testosterone Pellets as an HRT Option for Gender Transition

As a form of hormone replacement treatment (HRT), testosterone pellets may be a good option for some people undergoing gender transition.5 

Testosterone pellets have more advantages than other forms of testosterone therapy, such as injections or gels. Testosterone pellets are:

  • Long-acting: They release testosterone over a period of months. This may lower your chances of experiencing unwanted side effects like mood swings and acne. 
  • Discreet: You can't see or feel the pellets under your skin since they are small. 
  • Convenient: You only need to have the pellets re-inserted every three to six months. 

If you’re interested in testosterone pellets for gender transition, it’s best to talk to your doctor about the risks and benefits of this therapy plan.

How Do You Know if Testosterone Pellets Are Working?

Health experts can assess if testosterone pellets are working by checking for signs of improvement and monitoring the testosterone levels through blood tests.

Signs of Improvement

Testosterone pellets help the body make up for its lack of testosterone production. It helps improve your testosterone levels by replacing the needed hormone.

Your body is likely responding to the pellets if you see improvements in the common signs of low testosterone. For instance, after receiving treatments, you may experience positive energy levels, libido, or mood changes.

Monitoring Testosterone Levels

Doctors should monitor your testosterone level to assess that the pellets are working. They can start monitoring three to six months after receiving your treatment.

A testosterone test is commonly used to evaluate the amount of testosterone in your blood sample. Testosterone testing can help your doctors follow up on the status of your hormone therapy.

Testosterone levels can vary throughout the day. So, it is important to have your blood taken in the morning when the levels are at peak.6

Your doctor should check your hormone levels with blood tests to ensure you receive sufficient amounts.

Generally, it’s best to check if you need new testosterone pellets when you feel their effects are wearing off.

What Are the Benefits of Testosterone Pellets for Men?

Testosterone pellets are a long-lasting choice for testosterone replacement therapy that offers significant benefits, especially for men.

Let's discuss these benefits in more detail.

Improving Sexual Function

As men grow older, their testosterone levels decline. It can lead to problems in sexual function, like lowered libido and erectile dysfunction.

Erectile dysfunction is the inability to get or keep an erection to perform sexual activity.

Testosterone pellets deliver a stream of testosterone into the body. These testosterone supplies can help enhance your overall sexual function by improving erectile function and reinstating your libido back to normal.

One study shows a significant improvement in the sex drive and other sexual activity measurements of older men (at least 65 years old) after receiving testosterone therapy.7 

Increasing Muscle Mass and Bone Density

Testosterone is essential in maintaining bone mineral density in men. It’s instrumental in helping build muscle mass and strength.

If your body isn’t producing sufficient amounts of testosterone, you may have a condition called male hypogonadism or testosterone deficiency syndrome.

A testosterone deficiency can hinder the development of muscle during puberty. Moreover, men with hypogonadism may also experience a decrease in bone density over time.

Testosterone pellets are a treatment option for hypogonadism. They work to balance your testosterone levels, which can increase muscle mass and bone density.8

How does it work? The testosterone boost from the pellet implantation enhances muscle protein synthesis, leading to muscle mass improvements.

Additionally, testosterone boosts the production of the neurotransmitter dopamine, encouraging tissue growth.

Restoring Energy Levels

Testosterone influences many aspects of a man's health, including energy levels.

When a man's testosterone levels fall below the normal range, he may experience fatigue, a lowered sex drive, mood changes, and difficulty concentrating.

Testosterone pellets can help improve these issues by elevating the body’s amount of testosterone. These pellets contain testosterone which helps stimulate the production of red blood cells.

Red blood cells carry oxygen to the tissues throughout the body. They help achieve good blood circulation, improving moods and energy levels.

Are Testosterone Pellets Safe?

Healthcare experts consider testosterone pellets a safe treatment for low testosterone or testosterone deficiency. However, like other medical treatments, they can have side effects and risks. 

Side Effects of Testosterone Pellets

You may experience mild side effects, such as acne, changes in sex drive, or sudden breast tissue growth. If these persistent symptoms bother you, you should let your doctor know. 

But some adverse reactions may need immediate medical attention, including the following

  • Allergic reactions
  • Signs and symptoms of a blood clot in your leg, including leg pain, swelling, warmth, or redness
  • Signs of a blood clot in your lungs, including difficulty breathing or chest pain
  • Signs of heart attack, including pain or tightness in the chest, shoulders, arms, or jaw, nausea, cold or clammy skin, feeling faint or lightheaded
  • Increase in blood pressure
  • Indications of liver injury, like right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes
  • Mood swings or irritability
  • Prolonged or painful erection
  • Sleep apnea or loud snoring, gasping during sleep
  • Daytime sleepiness
  • Stroke
  • Thoughts of suicide or self-harm
  • Worsening mood
  • Feelings of depression

Potential Risks and Adverse Health Effects

Testosterone pellets are a form of TRT. They may share some potential risks and adverse health effects linked with using testosterone therapy, such as: 

  • Increase the risk of stroke – A study shows that TRTs can increase the risk of stroke, especially in men with high cholesterol or other heart disease risk factors.
  • Increase the risk of a blood clot — Testosterone therapy can lead to too many red blood cells, increasing your risk of blood clots.10
  • Worsen sleep apnea — Studies show that testosterone therapy can make you breathe faster and respond more to low oxygen and high carbon dioxide levels in your body. It can lead to periods where you stop breathing while you're asleep.11

Concerns Regarding Cancer and Heart Health

Testosterone plays a role in the growth of prostate cells. Because of this, there are concerns that testosterone therapy can potentially increase your risk of prostate cancer.

However, studies didn’t find any conclusive evidence of the connection between higher prostate cancer risk and testosterone therapy in men with no family history of cancer.12

Another concern is that testosterone therapy may increase the risk of heart disease because testosterone causes a rise in your blood pressure.

But a study found no evidence that short to medium-term use of testosterone replacement increases cardiovascular risks in men with hypogonadism.13

Testosterone Pellets and Fertility

A possible side effect of testosterone treatment is infertility. Testosterone decreases follicle-stimulating hormone (FSH) levels, which is essential for sperm production.

Testosterone treatment affects your sperm count, contributing to infertility problems. Most of the time, impotence caused by TRT is reversible, especially for men who receive short-term treatment.

Any testosterone supplement can affect the normal balance of hormones needed for sperm production. But in general, testosterone administered through shots and pellets is more likely to cause infertility.

Talk to your doctor if you are already on TRT and are worried about your fertility. They can help you monitor your sperm count and ensure that TRT isn't hurting your ability to have children.

How to Safely Discontinue Testosterone Pellets

You can safely discontinue testosterone pellets, but only gradually and with the guidance of your doctor.

While on testosterone treatment, your body stops making its testosterone supply. Quitting testosterone therapy cold turkey may negatively affect you, so it’s best to do it slowly.

Your doctor may give you doses that decrease over time so your body doesn’t experience a big shock from the change.

Weaning off testosterone can take a few weeks or even longer, but it is the best way to get off TRT.

Potential Effects of Stopping Testosterone Pellets

When you end your testosterone pellet therapy, your body will start to produce testosterone at its own natural pace.

During your transition period, you may observe withdrawal symptoms, such as:

  • Weight gain
  • Drop in energy levels
  • Lowered libido
  • Irritability
  • Mood swings
  • Higher recovery time after exercising

These symptoms should go away on their own after a few weeks of stopping TRT. Generally, the longer you’ve been on TRT, the longer your body may get back to its normal testosterone levels.

Are Testosterone Pellets Right for You?

If you are considering testosterone pellet therapy, talking to your doctor about the risks and benefits is essential.

Determining Your Need for Testosterone Therapy

You can be a candidate for testosterone therapy if you both have several signs of low testosterone and testosterone level test with abnormally low results.

However, testosterone therapy may not be advisable for testosterone decline due to aging. 

Suppose you don't have a medical condition that causes your testosterone levels to drop. Your doctor might suggest boosting testosterone naturally by losing weight and building muscle mass through resistance exercise.

Discussing Options with Your Healthcare Provider

If you’re considering testosterone therapy, you should discuss your options with your healthcare provider. They’ll first order blood tests to determine the amount of testosterone in your body.

They’ll also want to know about your symptoms, medical history, family history, and lifestyle. 

From there, they’d recommend the form and dosage of testosterone suitable to your condition.

Updated on August 24, 2023
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13 sources cited
Updated on August 24, 2023
  1. FAQ: Testosterone Hormone Implants for Women and Men.” Health Additions, PLLC.
  2. Secondary Exposure To Testosterone From Patients Receiving Replacement Therapy With Transdermal Testosterone Gels.” Current Medical Research and Opinion.
  3. The Bioidentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, And Progesterone) Safer Or More Efficacious Than Commonly Used Synthetic Versions In Hormone Replacement Therapy?” National Center for Biotechnology Information.
  4. Bioidentical Hormone Replacement Therapy vs. Traditional HRT.” Center for Women’s Health.
  5. Hormone Therapy For Transgender Patients.” Translational Andrology and Urology.  
  6. Measurement Of Testosterone: How Important Is A Morning Blood Draw?” National Center for Biotechnology Information.
  7. Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels.” The Journal of Clinical Endocrinology & Metabolism.
  8. Effect Of Testosterone On Muscle Mass And Muscle Protein Synthesis.” National Center for Biotechnology Information.
  9. Cardiovascular and Cerebrovascular Safety of Testosterone Replacement Therapy Among Aging Men with Low Testosterone Levels: A Cohort Study.” The Americal Journal of Medicine.
  10. FDA Warns About Blood Clot Risk With Testosterone Products.” Harvard Health Publishing.
  11. The Short-Term Effects of High-Dose Testosterone on Sleep, Breathing, and Function in Older Men.” The Journal of Clinical Endocrinology and Metabolism.
  12. Testosterone Replacement And Prostate Cancer.” Indian Journal of Urology.
  13. Adverse Cardiovascular Events And Mortality In Men During Testosterone Treatment: An Individual Patient And Aggregate Data Meta-Analysis.” The Lancet.
Cristine Santander
Cristine Santander
Content Contributor
Cristine Santander is a content writer for KnowYourDNA. She has a B.S. in Psychology and enjoys writing about health and wellness.
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