Why is the Type and Delivery Method of Testosterone Replacement so Important?
One of the questions I receive from friends and acquaintances who are considering starting testosterone pellets is, “Why do you treat men and women ONLY with testosterone pellets?”.
It launches a brief dissertation on the benefits of Testosterone long acting subcutaneous pellets, compared to Testosterone cyprionate for men, and testosterone compounded vaginal T, creams with T in it and sublingual T compounds.
I have used all of these other types of testosterone replacement and found all of them wanting. In general, these other types of testosterone never brought my patients back to youthful health, with the feeling of exuberant quality of life that T pellets do! And much more.
Specifically, they ask me….
1. What type of testosterone is the easiest to use with the least upkeep? In other words, which type must be dosed the fewest times per day, week, or year?
1-a. T pellets are dosed twice a year for men and three times for women. This is better for a lot of reasons…first you don’t have to think about your hormones more than a few times a year instead of daily, or several times a day.
1-b. Next you won’t forget your dose with pellets because we will remind you and make it easy, we make an appointment when you leave after a pellet insertion. When using pellets, you get the dose I want you to get, not the dose you manage to give yourself when you remember. Lastly you don’t have to lug along your temperature sensitive meds with you when you travel (most countries won’t let you bring T in for unknown reasons).
2. Which testosterone provides the best quality?
Non-micronized testosterone pellets from a reputable compounding pharmacy are pure testosterone without additives, these can be placed under the skin in the fat of the hip by an experienced medical inserter. The results are slow release for 3-6 months and mimics the secretion of the ovaries and testes in young women and men. We call that “physiologic dosing”, and it is much improved over other delivery systems whose dose increases from 0-maximum over 12 or 24 hours which is not what the body does with the hormones it secretes. Other forms of T convert into estrogens at up to 80% of the t dose as it goes through the stomach, or skin, vaginal or mucosa of the mouth. T pellets get to your blood stream as pure T and is not changed into estrogen until it is broken down after it is used by your body.
3. What kind of testosterone has the fewest problems (side effects)?
The side effects of testosterone shots are secondary to them not being biologically identical to the testosterone humans make in their ovaries and testes. The formulation in shots causes high cholesterol, weight gain, rapid hair loss and excessive hair on the back. They should never be used for women, and only if a man has low cholesterol, and no inflammation should they be used for men.
The gels and creams are used up rapidly by being converted to estrone and estradiol as the topical testosterone passes through the skin. Most men who use creams gels or patches stop using them within 3 months because they make so much estrogen, they develop man-boobs, belly fat, weight gain and generalized swelling.
Pellets do not convert into E2 and E1 in any large amount, and if they do, we add anastrazole to the pellets to block the conversion. T Pellets win the competition for the fewest side effects.
4. Which one will last the longest?
Drugs of all types have what is called a “half- life”, which means that it is the number of hours, days or months when a particular dose of a drug is gone, and the time when the dose should be re-dosed.
For example, an oral antibiotic that is dosed twice a day has a half -life of 12 hours. The half-life of T gels is between 6 and 8 hours, so must be dosed that often to keep a clinically active blood level. The half-life of Testosterone Cyprionate intramuscular shots is between 1-2 weeks dependent on the dose and the person. Shots must be dosed that often or they are not clinically effective in men.
5. If Pellets are so wonderful, why don’t more doctors use them for Testosterone replacement?
To dose and care for patients on T pellets takes training and not just a weekend course. It takes months and years to get good at it. Not only do you have to know all the physiology of all hormones that interact with testosterone and Estrogen, but you have to understand how genetic abnormalities such as COMT genetic enzyme defects change the metabolism of T and E2, and E1.
The medical learning needed to be good at prescribing pellets is different than any other drug treatment doctors learn about in med school, which means that you remember a name of a drug, what it does, a few side effects and one dose that works for everyone, of every race, sex and size.
For T pellets a doctor has to know the physiology of how T interacts with every other hormone and binding protein that is produced in the liver which can affect the free blood level of T. I actually “see” in my mind’s eye, the interactions of all the hormones involved in each patient as I decide on a dose. I have been able to do this since I took my first physiology course in college. It was an inborn talent for me rather than a learned ability.
To make it more of a challenge, Pellets have to be dosed based on height and weight, body fat mass, activity level, diet and stress level. This requires a long visit with the patient and an hour or more before the first visit and more than an hour after to determine the beginnings of the next treatment. Most physicians who don’t specialize in pellet hormone treatment don’t have the time or inclination to spend this much time figuring out the dose and other supplements and meds that the patient needs because they work for HMOs and I don’t and they treat other illnesses and I don’t. It takes immersion of a treating doctor in hormone replacement specialization to do this type of hormone therapy. That is what I do and have taught my Doctor-Daughter to do as well as my Nurse Practitioners and Nurse. Dr Sullivan and I actually have the inborn talent to “see” a patient’s hormones and determine dose to correct the symptoms of both men and women who are experiencing the loss of testosterone.
This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.
