Anti Aging Med Spa
Watch Dr Capasso’s presentation on Hormone Pellets
One of the best ways for natural hormone replacement is with bio-identical testosterone pellets. The pellets are made up of natural testosterone and are pressed into very small, solid cylinders by a compounding pharmacist. They have been used in Europe and Australia for years. These pellets are about the size of a grain of rice. Testosterone pellets have been used in both men and women in the United States since the late 1930’s, and the 75 mg testosterone pellet was FDA approved in the 1970’s. Testosterone pellets are one of the best ways to replace testosterone naturally in your body. Testosterone pellets do require a prescription from a physician and are administered by a physician in a simple procedure. They are primarily used for testosterone deficiency in both men and women who are unable to make sufficient amounts of testosterone in their body due to menopause, andropause, chronic diseases, injury or other unspecified causes. Multiple studies support that hormone replacement therapy with pellet implants is the most effective and natural way for both men and women.
The pellets are made by a compounding pharmacist under sterile procedure and are placed in sterile vials or ampules. These can be sterilized by different methods. I suggest not using the pellets that are sterilized with “iodine” since this may cause a reaction or rejection in the body after it is inserted. For this reason, I prefer to use the pellets that are sterilized with radiation.
They can be easily inserted in a quick office procedure in your doctor’s office, taking 8 to 10 minutes with virtually no pain. The pellets are placed into the fat area of your upper buttock/hip region. Your physician will clean the skin with a topical antibacterial scrub, then numb the area on your hip with a local anesthetic like lidocaine. Then the pellets would be inserted through very small incision in your skin into the fatty layer, which is then taped closed. No stitches are needed. The pellets will completely dissolve over the next 3 to 6 months depending on the number of pellets placed and how quickly your body breaks it down. The testosterone pellets work by releasing a constant supply of testosterone into your body in a natural way. Your body will form blood vessels over the pellets to allow the hormone to get into your bloodstream at a slow, consistent rate. If you are more active, your body may require more testosterone and the pellets will get absorbed more quickly. The reservoir of testosterone pellets under your skin mimics what your ovaries or testes would do in your body, allowing your body to get testosterone at a consistent level. This is the most physiological and natural way to deliver testosterone to your body, avoiding the fluctuations that can make you feel unbalanced, commonly seen in other methods of delivery. In women, testosterone pellets deliver healthy levels of hormones for 3-4 months and 4-5 months for men. Studies have shown that testosterone hormone pellet therapy is superior to conventional hormone replacement for relief of menopausal symptoms; improving restorative sleep, maintaining bone density, and improving sex drive response and performance!
In studies, it has been shown to treat migraines, menstrual headaches, vaginal dryness and incontinence. Chronic brain illness like Parkinson’s or Alzheimer’s has been associated with low testosterone levels in both men and women. Optimal levels of testosterone throughout your life may help to prevent some of these chronic illnesses. Testosterone pellet therapy has worked even in patients who have failed other types of hormone replacement.
To see if you are deficient in testosterone, we will do a complete evaluation including a symptom questionnaire and baseline hormone labs prior to starting treatment. During your pellet hormone therapy, our physician will again recheck your labs to make sure that the dosing is proper and monitor you for any other potential complications.
There are numerous studies that support the safety and efficacy of testosterone pellets in both men and women; and it has the best convenience and safety profile for replacement. It is important to find an experienced health care provider to determine the proper dosing and placement of the pellets. Dr. Anthony Capasso has been doing hormone pellet replacement since 1998 and has trained over 40 physicians on his techniques.
There are many advantages to testosterone pellets therapy. Namely, it is delivered in a steady matter, which keeps your levels consistent in your blood and avoids erratic mood swings that may occur using other delivery forms of testosterone. Testosterone pellets do not increase the risk for blood clots like conventional or synthetic hormone replacement. Another advantage is you don’t have to worry about applying a topical gel, which may have a characteristic odor on a daily basis. In addition, the topical gels can be absorbed in other people within four hours of application; therefore, caution has to occur around spouses and children because they may absorb the testosterone with skin contact. In addition to the above, testosterone pellets therapy is a much more convenient method of delivery since it only needs to be done every 3 to 5 months. There are very few disadvantages to using testosterone pellets they include having to do a minor office procedure and most insurance companies don’t cover the cost.
Complications are rare from the insertion of pellets.
They can include:
The side effects of testosterone pellets are rare. In less than 5%, infection can develop at the injection site; most times it’s the body rejecting the pellet “thinking” the pellet is a foreign object. Most of the time the skin cultures don’t grow any bad bacteria and simply removing the pellets and taking a short course of antibiotics will heal it up quickly. In less than 2% of the cases, if the pellet is not implanted correctly, they may extrude out especially if physical activity is started too soon after pellet placement. Other minor side effects to testosterone therapy include: slight facial hair growth in women, enlargement of breast tissue in males, increased risk for acne, prostatic enlargement, increased anxiety, and an increase in the red blood cells or blood counts. If your blood counts increase too high, donating some blood to the blood bank will get it back to normal. All forms of testosterone replacement can give the above side effects. The only one specific to pellets is extrusion.
Some of the above side effects occur when the testosterone in your body converts into excess estrogen. There are natural substances and prescription medications that can decrease the conversion of testosterone to estrogen in your body. When indicated, your doctor may prescribe natural substances or medications called Aromatase Inhibitors to reduce these unwanted side effects. Your doctor will check the conversion of testosterone to estrogen in your blood work to determine whether or not you need to use aromatase inhibitors like the prescription medication anastrozole or natural substances like DIM. DIM (3,3′-Diindolylmethane) is a compound derived from the digestion of indole-3-carbinol, found in cruciferous vegetables such as broccoli, cabbage, kale, and Brussels sprouts. High concentrations of DIM can be found in prescription-grade vitamins that we carry.
Almost all symptoms associated with menopause, including hot flashes and night sweats, can be treated with testosterone-only pellet therapy without the bad side effects that estrogen can cause. Because of this, I don’t recommend estrogen pellet therapy in every female. In studies, greater than 50% of the women who had estrogen pellets had experienced uterine bleeding. Past clinical studies looking at estrogen pellets reveal higher side effects: including weight gain, edema, breast pain, and increased risk for breast cancer. Estrogen in females stimulates the endometrium and potentially could cause bleeding. In a postmenopausal woman, this would cause an unnecessary evaluation by a gynecologist which typically includes a vaginal ultrasound and/or endometrial biopsy to ensure that the bleeding was not related to cancer. Most women will feel better when their estrogen levels are lower and have an optimal estrogen-to-progesterone hormone ratio.
In addition, long-term exposure to synthetic estrogens (Premarin) or higher estrogen (estradiol) is likely to increase the risk for breast cancer.
A study published by Sherwin in 1985 revealed that 89% of the participant’s menopausal symptoms, including hot flashes and night sweats, were relieved with testosterone pellets only. Testosterone pellets therapy is extremely effective and it doesn’t have the unwanted side effects like weight gain, breast tenderness/cysts formation, swelling, or uterine bleeding associated with it. It is the preferred method for hormone replacement in perimenopausal and menopausal women.
Some women may need estrogen, especially if they’ve had a hysterectomy at a young age. In addition to the testosterone pellets, a lower dosage of natural estradiol pellets are preferred and tolerated better than the higher doses that were used in past studies.
Men and women both can convert too much testosterone into estrogen by the enzyme aromatase; this sometimes can interfere with the beneficial effects of testosterone and cause unwanted side effects. Aromatase inhibitors like the natural substance DIM or the prescription anastrozole may be prescribed to prevent unwanted symptoms. Recent clinical studies have used pellet combinations of testosterone with anastrozole in breast cancer survivors and in men with higher tendencies to convert their testosterone to estrogen.
Hormone deficiency can be a common cause of hair loss in both men and women. Hair loss or thinning can be caused from many things like thyroid problems, iron deficiency, hormone imbalances, infections, medications, chemicals and other causes. Hair thinning in untreated postmenopausal women is probably related to lower hormone levels including estrogen and testosterone. In men and women we have seen hair and scalps become healthier with proper balancing of hormones like thyroid, estrogen, and testosterone within several months of being on pellet hormone therapy. Estradiol and testosterone pellets can help regrow your hair if your hormones are deficient.
Male pattern baldness occurs in predominantly men and rarely in women who inherit hair follicles with a genetic sensitivity to the hormone dihydrotestosterone (DHT). Hair follicles sensitive to DHT causes the hairs to get thinner and die off earlier. The areas of the male scalp sensitive to DHT include the crown and hairline, which can progress to more apparent baldness leaving a small area or “horseshoe” pattern of hair in men if left untreated.
DHT is a byproduct of testosterone breakdown. Testosterone is converted to DHT in your body by the enzyme 5-alpha-reductase. Keeping DHT levels lower in your body allows the hair follicles to continue to thrive. Some males have a higher tendency to convert their testosterone to DHT causing hair to shrink and fall out. We usually suggest natural nutrients that decrease that conversion or block the 5-alpha-reductase enzyme, like the natural substance saw palmetto or prescription DHT blockers like Finastride or Avodart. Fortunately women rarely convert down this pathway and don’t experience hair loss with testosterone pellet therapy.
Hair loss in postmenopausal females is not associated with androgen excess because their levels of androgens are usually low. In fact, most of the thinnest, brittle hair we see in our clinics is in postmenopausal women with the lowest testosterone levels. Within 3-4 months of optimizing their hormones we see new hair growth and healthier scalps.
Most patients feel better in 7 days. However some will feel better in as soon as two days and as long as two weeks. There are other important factors that will affect how quickly you will feel after testosterone pellets are inserted. Poor sleep, diet or increased stress can make it feel like your hormones are not working and contribute to hormone imbalances. It is vital to balance your life with proper sleep, exercise, nutrition, and relaxation to obtain optimal health allowing your body to get back to awesome.
In women, testosterone pellets last 3-4 months and 4-5 months in men. Pellets may be needed 2-4 times per year.