Testosterone Pellets

Dear Dr. Dean,

I have been getting a testosterone pellet inserted in my abdomen as part of my bio-identical hormone replacement therapy for about two years. Do you offer pellet insertion?

LEE, [Pensacola, FL area]

Dear Lee,


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You don't need to take testosterone! Women very efficiently convert dehydroepiandrosterone (DHEA) to testosterone. DHEA is the most abundant steroid hormone in the body, but it drops dramatically with age. Women can get all the testosterone they need by taking oral DHEA each morning.

Also, I do not do hormone pellet insertions. Inserted hormone pellets will certainly elevate your testosterone levels for several months. However, elevations of hormone levels are not the complete answer to someone with age-related gonadal dysfunction (i.e., low testosterone).


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Those who administer such treatments do not understand basic endocrine physiology. Hormones act on receptors located in the cell membrane of the target cells. When hormone levels are high, the number of receptors decreases, and receptor sensitivity also decreases. Similarly, when hormone levels decrease, receptor number and sensitivity increases. Thus, there is a reciprocal relationship between hormone levels and hormone receptor number and receptor sensitivity.

As you can see from the above figure, there is a daily diurnal rhythm of testosterone levels in young men. Testosterone is highest at night and early morning, and lowest during the day. The rhythm is lost in us older guys, resulting in a low “flat line.”

Un-illustrated, is the rise and fall of receptor number and receptor sensitivity, which is *opposite* to the level of the hormone.

With the pellets, the hormone level rises, and stays elevated for *months*—which results in low levels of receptors and reduced receptor sensitivity. I have found that pellets stop working in most men, after a while.

That’s why I favor testosterone injections, administered every two-three weeks. This results in a bi- to tri- weekly rhythm of testosterone highs and lows, which provides prolonged favorable results in most men. The injections are easy to self-administer, and are much less expensive than the pellets (usual cash price is about $75 in many pharmacies for 10 ml, lasting 20-30 weeks).

I hope this answers your questions,

Ward Dean, MD

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