Bioidentical Hormone Therapy Solutions For Men

Bio Identical Hormone Pellet Implants:

Pellets have been used as a hormone delivery system in women and men since the late 1930’s. In Europe and Australia, many pharmaceutical companies produce pellets, but there is only one pharmaceutical company that commercially produces pellets in the US, Slate Pharmaceutical. Therefore, most of the pellets used in the United States are manufactured by special compounding pharmacies. The ingredients (estradiol or testosterone) are U.S.P. pharmaceutical grade and are prepared from soybean and yam and are purified to be exactly like pure estradiol and testosterone. The raw materials used at Pensacola Wellness Solutions come from PCCA (Professional Compounding Centers of America) which has been in operation since 1981. The actual pellets are prepared from a well established compounding pharmacy company in Missouri that specializes in pellet hormone therapy. This allows us to get the individual dosing and combinations that match the patient’s individual needs based on lab results.

The insertion of pellets is a quick, simple, and relatively painless procedure performed with a local anesthetic in the office setting. Taking less than 5 minutes, the area (upper outer buttock) is anesthetized, and a very small incision (5mm) is made to allow the insertion of the pellets through a small sterile medical instrument. The pellets are deposited in the fatty tissue below the skin. Then the skin is closed with tape. The pellets, which cannot be felt, are slowly absorbed over 4-6 months.

Pellet side effects will be the same as with any testosterone delivery system. They are noted under the risks/benefit section of the hormone replacement workup. The main areas of concern with males are the possible increase in red blood cell count (measured as hemoglobin/hematocrit), the decrease in sperm production (important for younger males), and the increase stimulation of the prostate gland. For this reason a baseline rectal exam to assess the prostate gland is important along with a PSA (prostate specific antigen) blood test. Although testosterone replacement does not cause prostate cancer, testosterone replacement can accelerate the growth of an undiagnosed cancer. Monitoring blood work is important in male hormone replacement.

Because testosterone is converted to estrogen naturally, too much testosterone can produce too much estrogen. Too much estrogen in the male is as much of a problem as too little testosterone. Too much estrogen can cause hot flashes, low energy, decreased libido, and even breast enlargement. This is why the monitoring of blood levels is important to avoid these negative side effects. In a small number of patients, the physician will need use an additional oral medication (aromatase inhibitor) to block the enzyme that converts testosterone to estrogen.

Testosterone and its derivatives are considered controlled substances and are classified as a Class III substance because of the potential for abuse. The history of anabolic steroid abuse centered on the careless use by body builders and professional athletes who were trying to enhance performance by increasing muscle mass. Congress enacted the Anabolic Steroid Control Act of 2004, Public Law 108-358 (118 Stat. 1661), which the President signed on October 22, 2004. The House Report (108-461) stated that the purpose of the Act is “to prevent the abuse of steroids by professional athletes. It will also address the widespread use of steroids and steroid precursors by college, high school, and even middle school students.” The House Report also noted that steroid precursors “are as dangerous to the body as those banned under the original Act. At Pensacola Wellness Solutions, the purpose of male hormone replacement is to restore testosterone to normal physiological levels.

Complications from the pellet insertion could include minor bleeding or bruising, infection rarely, and extrusion (working its way out) of the insertion site, even more rarely. After the insertion, vigorous physical activity should be avoided for 3-7 days. Early physical activity is a cause for the extrusion. Antibiotics may be prescribed for patients at risk for infection or those who have had a joint replacement.

There are many hormonal treatment options for men, including topical delivery systems for hormones that conveniently and generally provide steady hormone blood levels if applied regularly. There are two preparations (Androgel and Testim) that are produced by pharmaceutical companies. These are gels which are applied daily and the dosing is based on the volume applied. Some describe the application as a bit messy because of a sticky residue. Importantly, the patient should wash well before having contact with children or pregnant women as the drug can be transmitted with intimate physical contact.

Patches represent a topical delivery system but in a depo form. There are two preparations, Testoderm and Androderm, that are applied every 7 days. They eliminate the need for daily application while allowing a steady delivery of hormone through the skin. The possibility of skin reactions i.e. redness, rashes, and itching is one of the negative features of this system.

Intramuscular testosterone cypionate in depo form is one of the most widely prescribed preparations for hormone replacement. The half life is 8 days and the dose is calculated based on blood work and clinical effects. Because the drug is metabolized fairly rapidly, the effects may last only one or two weeks requiring administration twice monthly. Hence, with injections it is difficult to achieve steady blood levels and symptoms may fluctuate between injections. Because the drug is suspended in an oil base, deep injections can be uncomfortable particularly if the volume is large.