Testosterone Pellets?

Bio-Identical Hormone Therapy Explained

I’m a big fan of bio-identical hormone therapy for women, which I’ve been prescribing for 25 years now.

Bio-identical hormones have the same molecular structure as those made by the body but are synthesized and derived from a plant precursor in a laboratory. This is because plants do not have a menstrual cycle and don’t make human hormones. This also includes testosterone for perimenopausal and menopausal women.

As estradiol and progesterone hormone production decline with age, the female body will convert testosterone made in the adrenals to make estrogen, in essence robbing Peter to pay Paul. Women don’t produce large quantities of testosterone, to begin with, and by converting what little testosterone they have into estrogen in the fat cell leaves women with less T for muscle mass, bone density and libido to name a few.

Testosterone Pellets Explained

I’m not a fan of testosterone pellets, which involves giving supraphysiologic-dosed pellets under the skin, typically lasting 3-6 months before they are used up. A supraphysiologic dose is one that provides a much higher dose than even a young healthy hormone-producing woman would ever generate. It delivers up to 8-10 times normal menstruating female blood levels within the first week of pellet placement. After the first 5 weeks, the levels are still 4-8 times greater than normal.

The first issue I have is that the pellets cannot be removed if you hate them. You just have to wait it out 3-6 months before your levels drop to the normal range again. This can increase irritability, aggression, acne, pelvic pain, flare PCOS, hair loss and create a lust-driven libido.

The second issue is the super high levels of testosterone achieved. A menstruating woman’s levels are typically between 20-70. A week after pellets, levels range between 250-350.

For example, we may give these and higher levels to a genetic female transgendering to become a physiologic male. These are not the levels where women reside but instead given to create a male in a woman’s body. As a matter of fact, for a genetic male transgendering to become a physiologic female, we suppress their testosterone to normal adult female levels under 50, as men’s testosterone levels average between 300-1100 depending on age. Thirdly, we don’t really understand the long-term effects of supraphysiologic testosterone on women’s bodies 20 years from now. I recommend against being part of this longitudinal data collecting experiment.

Why Do We Offer Pellets?

One reason may be to saturate the testosterone receptors with high doses of testosterone much like we give insulin in Type 2 Diabetes. In addition, high levels of testosterone will be converted into estrogen, which will increase a woman’s estradiol level to premenopausal levels. This could be a problem if a woman is suddenly diagnosed with breast cancer and wants to lower her estrogen level. Again she will just have to wait it out. Another reason is economics. Testosterone pellets are expensive, not covered by insurance, and it stands to reason that women don’t want to do injections more than every quarter which explains why the testosterone starts out so high.

So what is the best testosterone?

The best testosterone is the one you can control and is within a normal physiologic level for a healthy woman.

I recommend a cream that is applied to the inside wrists and may be alternated with the clitoris. Usually, application is one time daily 3-4 consecutive days per week. This helps to decrease the development of tolerance.

This form of testosterone has been used for decades, empowers the user to stop if the effects are undesirable and to titrate the dose quickly while enhancing libido, muscle mass, bone density and mood.