Replacing testosterone is now mainstream, and this is good news for men and women looking to slow the ageing process. As a consumer and a patient, you have options for hormone balancing, including testosterone pellets, how, why, and where to complete replacement therapy. Great questions, lets dig in and discuss pellet therapy.
Before you have pellets placed your provider should complete an extensive set of labs. This ensures that you only require testosterone replacement and you do not have another hormone issue, that requires attention. To create pellets you need a sterile compounding pharmacy. Mobile Care uses a nationally recognized pharmacy located right here in Golden, Colorado ensuring high quality and efficacious replacement. Compressing pellets using cholesterol or steric acid as a binder, prevents complications. Dr Jacob Weinstein recommends using cholesterol pellets as they are less likely to come out after insertion and have minimal effect on cholesterol levels. These pellets come in various formulations, including testosterone/anastrozole. Anastrozole is useful to prevent the conversion of testosterone to estrogen. This means patients do not need to take a pill once or twice a week, to keep estradiol levels in check. Always check with your provider what type of pellets you will receive.
Now that you know about pellets, we can discuss the procedure itself. Prior to having pellets placed you will need to refrain from drinking alcohol or using any blood thinners. Pellets are placed just under the skin and into the subcutaneous tissue or fat. A local anaesthetic, lidocaine, numb the area. Once you are sufficiently numb, the pellets are inserted through a small incision, usually near your love handles or buttocks. After the pellets, a suture may be required and several days of antibiotics. These antibiotics aim to prevent infection and speed up the healing process. You will need to avoid hot tubs, pools, and working out for one week while you heal. The great news is you can return to your day immediately after pellets. Why choose pellets?
The advantage of testosterone pellets is they bring up your testosterone level slowly over two to six weeks. Your testosterone doesn’t drop overnight, so we shouldn’t be ramping it back up overnight. The pellets slowly dissolve over 6 months for men and 4 months for women. Most patients start to “feel” the pellets working after 2 weeks and have significant improvement by 8 weeks. At this point, you should be seeing your provider for another set of labs. Now we can compare labs and how your symptoms are resolving. From here, your provider should work with you to find the balance that works best for you! Your body will change (increased lean muscle mass) and you will need to be rebalanced every 4-6 months.
What is rebalancing? When you take testosterone or estradiol, or any hormone for that matter it affects other hormones in your body. However, adding extra testosterone can cause an increase in estradiol as some testosterone converts to estradiol after replacement therapy. We “rebalance” by checking labs and adding supplements or placing patients on other medications. One advantage to pellets is the use of testosterone/anastrozole pellets. These limit the conversion of testosterone to estradiol.
The two common supplements used are DHEA and DIM. Your body converts DHEA, a steroid hormone made from cholesterol into testosterone. Supplementing with DHEA can improve overall testosterone levels in men and women. DIM, or Diindolylmethane, is a compound that is commonly useful in conjunction with DHEA to maintain a healthy balance of testosterone in the body. DIM is a natural aromatase inhibitor preventing the conversion of testosterone to estrogen. It increases the production of good estrogen metabolites, which compete with testosterone for protein binding on sex hormone-binding globulin. This increases the levels of free testosterone which is the form most useful to the body
Patients can often experience a change in their thyroid function after being on testosterone replacement for a period of time. Thyroid hormone signals the hypothalamus, resulting in the production of GnRH (gonadotropin-releasing hormone). Next, GnRH then instructs the pituitary gland to produce LH (luteinizing hormone). Finally, LH signals the testes to produce testosterone. Your provider should check thyroid function before starting any replacement therapy. Patients who are taking thyroid replacement and start testosterone, often experience a decrease in the amount of thyroid replacement required.
Finding A Provider
Now that we have the basics down, we need to find an experienced provider in your area. Testosterone replacement has become an industry over the past ten years. Patients have choices, from online providers to primary care and everyone in between. One service in Denver is Mobile Care. Dr Weinstein, or Dr Jake as he is known to patients, provides concierge hormone balancing from the comfort of your home or office. He relates, “Mobile Care is able to bring expert hormone balancing to your home on your schedule. We often see patients at work or in the evening or at weekends. Taking a half-day off work to drive across town for a lab draw or testosterone pellets is ridiculous.” He added, “Our patients enjoy the ease of follow up, being able to text their provider and service at home.” Interview your provider, ask about referrals from other patients, and providers before starting therapy.
Dr. Jacob Weinstein DNP ACNP is a dual boarded Acute Care Nurse Practitioner with experience in hormone replacement, functional medicine, peptide therapy, sexual health, performance coaching and workout/recovery medicine. Book a free consult here with Dr Jake today!