Testosterone

Implants, Benefits and Myths

Introduction [1][2]
-Testosterone is a hormone found in humans, as well as in other
animals.
-The testicles primarily make testosterone in men and most often
associated with sex drive, it also plays a vital role in sperm
production, Women's ovaries also make testosterone, though in much
smaller amounts.
-Testosterone production starts to increase significantly during
puberty, and begins to dip after age 30.
-It can boost libido, increase muscle mass, sharpen memory, and
bump up energy. Yet, most men lose testosterone with age.
"A reported 20 to 40 percent of older men have a medical
condition called hypogonadism and need testosterone replacement
therapy (TRT)."
-Successful hormone therapy involves getting just the right dose by
the right delivery method for your individual needs, there
are patches, creams, injections, and testosterone pellets.
-For delivering a consistent dose on the long term, pellets may be a
good option.

Low Testosterone levels

Low levels of testosterone can produce a variety of symptoms in men,
including:
 Decreased sex drive
 Less energy
 Weight gain
 Feelings of depression
 Moodiness
 Low self-esteem
 Less body hair
  Thinner bones

Testosterone pellets and procedure

-Testosterone pellets, such as Testopel, are small and measure 3
millimeters (mm) by 9 mm and contain crystalline testosterone.
-It is slowly release testosterone over the course of three to six
months.
-Implantation is a simple procedure that typically takes only 10
minutes.
-The skin of the upper hip or buttocks is thoroughly cleaned then
injected with a local anesthetic to reduce discomfort.
-A small incision is made. Tiny testosterone pellets are placed under
the skin with an instrument called a trocar.
-Typically, 10 to 12 pellets are implanted during the procedure.
-These pellets are a long-acting form of testosterone therapy.
-They should deliver a stable, steady dose of testosterone, typically
providing the needed level of hormone for four months.

Benefits of testosterone implants [3][4][5][6]

 For delivering a consistent dose over the long term, pellets are the
best option. Pellets deliver consistent, physiologic levels of
hormones and avoid the fluctuations of hormone levels seen with
other methods of delivery.
 Extrusion and implantation infection rates at high-volume centers
with Testopel® (approved by the FDA) are less than 1 %, and
patient acceptance of the procedure is very high.
 None of the patients who complied with post-implant procedure
instructions experienced infection or pellet extrusion.
 Patient satisfaction was high and serum hormone values were
improved.
 Absence of foreign material within the pellet packaging.
 Implanted testosterone pellets can normalize testosterone and LH
levels and improve symptoms for at least 3 months and up to 6
months in men with hypogonadism, and should be considered as a
therapeutic option for hypogonadal men.
 Increase muscle mass, bump up energy, relieve depression,
increase sense of well-being, relieve anxiety, improve memory
 Increase lean body mass (muscle strength, bone density) and
decrease fat mass.
 Hormone replacement therapy with testosterone implants is
superior to oral and topical (both the patch and gel) hormone
replacement therapy for bone density.

Relationship between Testosterone therapy and

prostate cancer?
There is no relationship.
Study (1)
"The relationship between testosterone and prostate cancer remains
complex. While most studies suggest no relationship between
testosterone supplementation and prostate cancer incidence and
progression, most published studies are reassuring, with most of
the discrepancy likely due to methodologic and patient heterogeneity.
Current professional society guidelines for testosterone
supplementation provide appropriate recommendations for proper
patient treatment and monitoring" [7]

Study (2)
"Among men with low testosterone levels and normal PSA,
testosterone treatment was not associated with an increased risk
of aggressive or any prostate cancer (CaP). The clinical risks and
benefits of testosterone treatment can only be fully addressed by
large, longer-term randomized controlled trials." [8]
Study (3)
"Despite the historical reluctance towards use of testosterone therapy
in men with a history of prostate cancer, modern evidence suggests
that testosterone replacement is a safe and effective treatment option
for hypogonadal men with non-high-risk prostate cancer." [9]

Study (4)
"The authors concluded that men with prostatic intraepithelial
neoplasia (PIN) do not have an increased risk of cancer development
when treated with testosterone replacement than men without PIN" [10]

Relationship between testosterone therapy and

mortality risk?
There is no relationship.
Study (1)
"There appears to be no change in mortality risk overall for men
utilizing long-term testosterone therapy." [11]

The relationship between testosterone therapy and

CV Risk
There is no relationship.
Study (1)
"There is no consistent evidence of increased cardiovascular risk with
testosterone products" [12]

Study (2)
"Similar conclusions were reached as a joint consensus between the
American Association of Clinical Endocrinologists and the American
College of Endocrinology in an official position paper that essentially
reports that no compelling evidence indicates that T therapy increases
CV risk" [13]
Reference: -
1) Medically reviewed by University of Illinois-Chicago, College
of Medicine on August 26, 2016 — Written by James Roland
https://www.healthline.com/health/what-is-testosterone
2) Medically reviewed by Daniel Murrell, MD on August 24, 2018
— Written by Christine Case-Lo
https://www.healthline.com/health/testosterone-pellets#talk-to-
your-doctor
3) A Review of Testosterone Pellets in the Treatment of
Hypogonadism Andrew McCullough 2014 Oct 3
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431706/
4) Cavender RK, Fairall M. Subcutaneous testosterone pellet
implant (Testopel) therapy for men with testosterone deficiency
syndrome: a single-site retrospective safety analysis. J Sex Med.
2009;6(11):3177-92.
https://www.ncbi.nlm.nih.gov/pubmed/19796052
5) Kaminetsky JC, Moclair B, Hemani M, Sand M. A phase IV
prospective evaluation of the safety and efficacy of extended
release testosterone pellets for the treatment of male
hypogonadism. J Sex Med. 2011;8(4):1186-96.
https://www.ncbi.nlm.nih.gov/pubmed/21269402
6) Testosterone Pellet Therapy for Men by Paul Savage, MD,
FAARM, ABAARM August 29, 2016
https://www.power2practice.com/article/male-testosterone-
pellet-therapy/
7) Testosterone Replacement Therapy and Prostate Cancer
Incidence Michael Louis Eisenberg World J Mens Health. 2015
Dec; 33
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709428/
8) Testosterone treatment and the risk of aggressive prostate cancer
in men with low testosterone levels PLoS One. 2018; 13
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014638/
 9) Testosterone Therapy Among Prostate Cancer Survivors Sex
Med Rev. Author manuscript; 2017 Oct 1.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026903/
10) Testosterone replacement therapy and the risk of prostate cancer
Asian J Androl 2015 Apr 10
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814970/
11) Testosterone Therapy and Mortality Risk Int J Impot Res 2014
Jul 31 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312542/
12) Hackett GI. Testosterone Replacement Therapy and Mortality in
Older Men. Drug Saf. 2016;39(2):117-30.
https://www.ncbi.nlm.nih.gov/pubmed/26482385
13) Testosterone Replacement Therapy and Cardiovascular Risk: A
Review World J Mens Health 2015 Dec 23
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709429/