@DrMariano 3311 wrote:

Pellet hormone delivery does not necessarily give “balanced” hormone delivery. Nor does it “flow straight into the blood stream whenever your body needs it” as if the body can decide whether or not to turn off the flow from the pellet. However, it does give a person pretty stable blood levels of the hormone. This helps avoid peaks of testosterone to estrogen conversion, which may give some men problems. And it bypasses the skin, so that DHT production is minimized. My primary objection is that pellets make the patient very dependent on the physician. The patient has to schedule their implantations (which occur about once every 3 months) around their physician’s schedule. They have to schedule their vacations so they don’t conflict with the days of implantation. The physician also can’t just take a vacation at any time since he/she has to schedule around the patients schedules for implants.

Other than high DHT levels, transdermal testosterone also provides very very stable blood levels of testosterone. One can minimize estrogen by avoiding placement on the abdomen. Some men prefer to not give themselves injections. However, many men feel transdermal testosterone is less convenient than once a week injections of depot testosterone. Thyroid function needs to be optimized since low thyroid hormone signaling will impair absorption of transdermal testosterone.

Injection of depot testosterone can cause a person to have significant peaks and valleys in testosterone levels, with the peaks becoming a problem since estrogen production is also increased during the peak. However, nearly flat levels can be obtained by doing more frequent injections. For example, if the half-life of testosterone cypionate in a man is about 7 days, then dosing every 3 days gives a much flatter testosterone curve than with once a week or less frequent injections. The flatness of the testosterone curve is very acceptable to many men, however, even when dosing once a week to even once a month (as one practitioner I know does her injections for her patients). The reduced frequency of injections compared to daily use of transdermal testosterone makes injections attractive to many men compared to transdermal testosterone.

Either one of these delivery systems has specific benefits and is completely acceptable.

In general, nearly all men tend to gravitate toward testosterone injections. Dosing is convenient. And it allows them, as with transdermal testosterone, to be fairly independent of the physician (unless the physician insists on giving the injections him or herself.).

Thank you for your detailed response. I actually was asking because I have tried both transdermal and injections. With injections, I felt very good, however, my libido was very poor, which was a major reason I sought out TRT. Injections did not increase my estogen. It stayed between 20-30 range (Quest Labs). In fact that was what my baseline estrogen was when I started TRT, just my testosterone levels were very low. With transdermal, initially, I felt great, and libido was excellent, then within a couple of weeks, my estrogen shot up to 70-100, and my libido disappeared, along with proper erectile function. When the doctor reduced the level of transdermal that brought my estogen levels into proper range, but then my testosterone levels were too low and I felt weak and tired with no libido. Very frustrating. BTW, my thyroid and adrenal was optimal during this period.

The doctor I was seeing at that point kept me on transdermal, and added a very low dose of arimidex and 25mg of danazol/day to control SHBG. At this point, I was perfect, great sense of well-being, excellent libido, all numbers in a optimal range, including SHBG dropping from about 53 to 28. Unfortuneately, I relocated, and my doctor only treats local patients. Therefore, I am now with a new provider who prescribed transdermal cream, but does not believe in arimidex for men and, like many doctors I have talked to, is not familair with low dose danazol treatment and its success as well documented by Dr. Malcolm Carruthers in his book.

He suggested pellet implants becuase he believes it is the best method of testosterone therapy for men and he feels it will give me the steady levels of testosterone, with positive libido effects and no spike in estrogen.