Info on Subcutaneous Pellets for FTM HRT
If youâve looked into various forms of hormone replacement therapy for trans men, youâve probably stumbled upon the option of subcutaneous pellets. A lot of people donât know much about them, because not many people go this route due to lack of insurance coverage and availability. Still, itâs by far the most convenient method of taking testosterone, so itâs worth reading about.
There are two brands for this, Testopel and Sottopelle. Although you hear more about Testopel than Sottopelle, Sottopelle is technically the one that is explicitly recommended for transgender people.Â
A physicianâs assistant will cut a small incision on one of your buttcheeks (theyâll give you lidocaine first so you donât feel it), shoot some rice-size pellets in, and close it up. You shouldnât play sports or exert yourself too much for about a week following the implant. The wound will heal completely, leaving no scars. Your butt will be a little sore for about a week, but around 2-3 weeks after the implant it wonât feel any different from before. For the next 3-4 months (for Testopel) or 4-6 months (for Sottopelle), the pellets will slow release testosterone into your system. Theyâll do a blood test at 1 month and then again at 3 months, to see if they need to adjust the number of pellets or the exact timing of the implants. Youâll then get the next implant, this time on your other asscheek (they alternate).
Convenience. Itâs just one visit to the doctor every 3-6 months, followed by a fairly mild healing process.
No peaks and troughs. With injections, you have a peak in blood testosterone levels a few days after the injection, and a trough before your next shot. Here are some data on what that looks like (source in image):
As you can see, 3 days after an injection, the person is essentially overdosing on testosterone. They are then in a more typical range around 4-21 days after. Some people have issues with these peaks and troughs, experiencing mood swings throughout the week(s) between their shots.
The patches or gels also achieve this effect, but neither are particularly convenient to use compared to pellets.
Here is another graph that gives a good idea of what this will look like for a few shots done over 90 days (source):
What are the disadvantages?Â
Insurance coverage / price. When you do the math, pellets actually cost less per month than gels and patches, costing around $80-$150 per month without insurance. The problem is that theyâre fairly new, and a lot of insurance companies donât cover them. If you donât have insurance and are looking for an alternative to injections that youâre going to pay out of pocket for anyway, this might be a decent alternative.
Healing after implant. For most people a week of no sports might not be an issue, but if youâre a very competitive athlete, that can make a huge difference, making this not your best method for TRT.
Availability. A lot of urologists can do Testopel implants, but most of them have never worked with transgender patients, and many of them are afraid to begin doing that without some sort of training. You might have some difficulty finding a doctor willing to work with you on this without doing some traveling.
Iâm going to compile a list of places in the US that can help trans men get Testopel and Sottopelle in each state, as best I can. If you know of any places not listed that do this, please tell me so I can add them to this list.
Tutera Medical Inc (Paradise Valley)
Tutera Medical Inc (Scottsdale)
Middlesex Hospital (Middletown)
YuNique Medical Services, LLC. (Ocala)
Sekine, Rasner & Brock, M.D. PA (Jacksonville)
Gentle Gynecology & Obstetricsï»ż (Weston)
Gentle Gynecology & Obstetricsï»ż (Pembroke Pines)
Mirabile, MD Beauty, Health & Wellness (Overland Park)
Berkshire Medical Center (Pittsfield)
Menâs Health Boston (Chestnut Hill)
Minneapolis Park Nicollet (Minneapolis)
Advanced Health Care LLC (Leeâs Summit)
New Day Wellness Center (Charlotte)
Tulsa Womenâs Health Care (Tulsa)
Rebirth OB/GYN Clinic (Salt Lake City)
(Last updated: 7/18/17. If youâre looking at this post a while after this date, click to look at the post on my blog to see if there are updates.)
If nothing nearby you is listed, the desperate method to find a place would be to: 1. Call nearby endocrinologists who treat trans patients, and ask if they can do pellet implants and if not, ask if they any info on a clinic that does, 2. Call nearby urologists who do Testopel or Sottopelle implants, ask if they can treat transgender patients. 3. Go to a further away specialist to understand dosages, and check on the Sottopelle website for someone closer who perhaps will treat you as long as another doctor has already determined dosage (https://sottopelletherapy.com/find-a-doctor/)