What’s the Difference?

What is Testosterone?

Testosterone is an important hormone that helps men develop male features. It helps build muscles, keeps bones strong, affects your mood, and plays a big role in sex drive. As men get older, their bodies make less testosterone. This can start happening around age 40.

When testosterone gets too low, doctors call it “testosterone deficiency” or “low T.” Some signs of low testosterone include:

• Feeling tired all the time
• Less interest in sex
• Trouble getting or keeping erections
• Losing muscle and gaining fat
• Feeling sad or grumpy
• Brain fog (trouble thinking clearly)

What is Testosterone Replacement Therapy?

When men have low testosterone, doctors might suggest testosterone replacement therapy (TRT). This adds testosterone to the body to bring levels back to normal. There are different ways to get testosterone therapy:

• Skin gels and patches
• Pills
• Injections
• Pellets placed under the skin

This article compares two popular methods: testosterone pellets and injections.

Testosterone Pellets: The Basics

What Are They?

Testosterone pellets are small, solid cylinders about the size of a grain of rice. They’re made of pure crystallized testosterone. Brand names include Testopel (75mg pellets) or compounded versions like E100 (100mg pellets).

How Are They Used?

1. A doctor numbs a small area of skin, usually on your hip or buttock
2. They make a tiny cut (about 1/4 inch)
3. They place 6-12 pellets under your skin
4. The cut is closed with a stitch or surgical glue
5. The whole process takes about 10-15 minutes

How Do They Work?

Once placed under your skin, the pellets slowly dissolve over 3-6 months, releasing a steady amount of testosterone each day. Most people need new pellets every 4 months.

Testosterone Injections: The Basics

What Are They?

Testosterone injections are liquid testosterone mixed with oil. Common types are testosterone cypionate and testosterone enanthate. They come in small vials with a specific concentration (like 200mg/mL).

How Are They Used?

1. The liquid is drawn into a syringe
2. It’s injected into a muscle (usually the thigh or buttock)
3. This is done every 1-2 weeks
4. Each injection takes just a few minutes
5. You can learn to do it yourself at home, or have a doctor do it

How Do They Work?

After injection, your body absorbs the testosterone over several days or weeks. Levels peak 2-3 days after the shot, then gradually decrease until your next injection.

Key Differences Between Pellets and Injections

1. How Testosterone Levels Change

Pellets: Provide steady, consistent testosterone levels without big ups and downs. This can mean more stable energy, mood, and sex drive.

Injections: Create a “peak and valley” pattern. Testosterone levels get very high a few days after the shot, then drop lower as you approach your next injection. Some men notice changes in how they feel throughout this cycle.

2. How Often You Need Treatment

Pellets: Require a doctor visit every 3-6 months for a minor procedure.

Injections: Need to be given every 1-2 weeks (either at a doctor’s office or at home).

3. Side Effects

Both methods can cause similar side effects, but some happen more with one method than the other:

Pellets:

• Possible infection or scarring at the insertion site
• Pellets sometimes work their way out of the skin (about 5-10% of the time)
• Lower chance of raising red blood cell count too high (35% of patients)
• Cannot be easily removed if problems occur

Injections:

• Soreness at the injection site
• Higher chance of raising red blood cell count too high (67% of patients)
• Can be stopped immediately if problems occur
• More peaks and valleys in mood and energy

4. Convenience Factors

Pellets:

• Only need treatment 2-4 times per year
• Don’t have to remember weekly or bi-weekly shots
• Cannot adjust dose once pellets are inserted
• Need a doctor to insert them

Injections:

• More frequent treatments (26-52 times per year)
• Can adjust dose easily if needed
• Can be done at home after training
• Need to be comfortable with needles

5. Cost Considerations

Pellets:

• Usually more expensive per treatment
• May or may not be covered by insurance
• Fewer doctor visits per year

Injections:

• Usually less expensive per dose
• More commonly covered by insurance
• More doctor visits (if you don’t self-inject)

Who Might Prefer Each Method?

Pellets Might Be Better If You:

• Hate needles or don’t want frequent injections
• Travel often and don’t want to pack testosterone
• Want stable hormone levels without ups and downs
• Don’t want to think about treatment every week
• Have trouble remembering to take medications

Injections Might Be Better If You:

• Want the lowest-cost option
• Want to be able to adjust your dose easily
• Are comfortable giving yourself shots
• Have concerns about a minor surgical procedure
• Are new to testosterone therapy and want to try it first

What the Research Shows

Studies comparing these methods have found:

1. Both methods effectively raise testosterone to normal levels
2. About 70% of men are satisfied with their treatment, regardless of which method they choose
3. Injections cause high red blood cell counts more often than pellets
4. Pellets provide more consistent hormone levels than injections
5. The choice of method is often influenced by doctor recommendation

Important Health Considerations

Regardless of which method you choose:

1. Regular Check-ups: You’ll need blood tests to check your testosterone levels, red blood cell count, and prostate health.
2. Possible Risks: All testosterone therapy carries some risks, including:
   • Increased red blood cell count
   • Acne
   • Sleep apnea
   • Possible effects on prostate health
   • Potential heart risks in some men
3. Not for Everyone: Testosterone therapy isn’t right for men who:
   • Want to father children soon (it can reduce fertility)
   • Have certain types of prostate cancer
   • Have severe heart disease
   • Have very high red blood cell counts

Making Your Decision

When choosing between pellets and injections, consider:

1. Talk to your doctor about the pros and cons of each method for your specific situation.
2. Consider your lifestyle and which method fits better with your daily routine.
3. Think about cost and check what your insurance covers.
4. Reflect on your preferences about needles, procedures, and how often you want to deal with treatment.
5. Ask about starting with injections before committing to pellets, especially if you’re new to testosterone therapy.

Frequently Asked Questions

General Questions About Testosterone Therapy

Q1: How do I know if I have low testosterone? A: Signs include constant tiredness, low sex drive, trouble with erections, losing muscle, gaining fat, mood changes, and brain fog. The only way to confirm it is with a blood test ordered by your doctor.

Q2: Is testosterone therapy safe? A: When properly prescribed and monitored by a doctor, testosterone therapy is generally safe for most men with low T. Regular check-ups and blood tests are important to prevent side effects.

Q3: Will testosterone therapy help me build muscle? A: Yes, testosterone therapy often helps increase muscle mass and strength when combined with exercise, especially in men who have low testosterone levels.

Q4: Does insurance cover testosterone therapy? A: Many insurance plans cover testosterone therapy when it’s medically necessary, but coverage varies. Injections are more commonly covered than pellets.

Questions About Testosterone Pellets

Q5: How long do testosterone pellets last? A: Testosterone pellets typically last 3-6 months, with most men needing replacement every 4 months.

Q6: Does the pellet insertion procedure hurt? A: Most men report minimal discomfort during pellet insertion because the area is numbed with local anesthetic. Some soreness for a few days after the procedure is normal.

Q7: Can pellets come out of the skin? A: Yes, pellet extrusion happens in about 5-10% of procedures. If this happens, contact your doctor.

Q8: What happens if I don’t like pellet therapy? Can the pellets be removed? A: Pellets are designed to dissolve over time and are difficult to remove once inserted. This is why doctors often recommend trying injections first.

Questions About Testosterone Injections

Q9: How often do I need testosterone injections? A: Most men receive testosterone injections every 1-2 weeks, depending on the type of testosterone and their individual needs.

Q10: Can I give myself testosterone injections? A: Yes, many men learn to self-administer testosterone injections at home after proper training from a healthcare provider.

Q11: Do testosterone injections hurt? A: Most men report mild discomfort similar to a flu shot. Using proper technique and rotating injection sites helps minimize pain.

Q12: Why do I feel great after my injection but worse before my next one? A: This “roller coaster” effect happens because injections cause testosterone levels to peak 2-3 days after injection, then gradually decline. Some men solve this with more frequent, smaller doses.

Comparing Pellets and Injections

Q13: Which method gives more stable testosterone levels? A: Pellets provide more stable, consistent testosterone levels without the peaks and valleys that can occur with injections.

Q14: Which method is better for athletes or men who exercise regularly? A: Both methods can support athletic performance. Pellets offer consistent levels, while some athletes time their injections around training schedules.

Q15: Which method has fewer doctor visits? A: Pellet therapy requires fewer doctor visits (2-4 per year) compared to injections (up to 52 visits if you don’t self-inject).

The Bottom Line

Both testosterone pellets and injections can effectively treat low testosterone. The “best” method depends on your personal preferences, lifestyle, and specific health needs. Many men try different methods before finding the one that works best for them.

References

1. Pastuszak AW, et al. (2015). Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen. Sexual Medicine, 3(3), 165-173.
2. McCullough A. (2018). A review of testosterone pellets in the treatment of hypogonadism. Current Sexual Health Reports, 10(1), 9-15.
3. Cavender RK & Fairall M. (2009). Subcutaneous testosterone pellet implant therapy for men with testosterone deficiency syndrome: a single-site retrospective safety analysis. Journal of Sexual Medicine, 6(11), 3177-3192.
4. McFarland J, et al. (2017). Serum Testosterone Concentrations Remain Stable Between Injections in Patients Receiving Subcutaneous Testosterone. Journal of the Endocrine Society, 1(8), 1095-1103.