Low Testosterone Treatment
Testosterone Pellet Implantation
For men who need testosterone replacement but don't want to think about it daily or weekly, pellets offer a different rhythm: a brief office procedure a few times a year, and steady hormone levels in between. No gels to apply, no transfer risk to family members, no peaks and troughs between injections. Texas Regional Urology offers testosterone pellet implantation at our offices in The Woodlands, Tomball, and Kingwood.
How Pellets Work
What Is Pellet Implantation?
Testosterone pellets are small cylinders of crystallized testosterone, roughly the size of a grain of rice, placed under the skin — usually in the fat of the upper buttock or hip through a tiny incision.
Once in place, they dissolve slowly, releasing testosterone into the bloodstream at a relatively steady rate over several months. The pellets are fully absorbed and don't need to be removed.
The advantage over other delivery methods is the steadiness. Injections produce a peak after each dose that falls off before the next, and some men feel that cycle in their energy and mood. Daily gels maintain steadier levels but require remembering, and they carry a genuine risk of transferring testosterone to a partner or child through skin contact. Pellets avoid both problems.
The trade-off is flexibility. Once pellets are in, the dose can't be adjusted until they wear off — so the initial dose and the monitoring that follows matter considerably. Learn more about low testosterone.
Once in place, they dissolve slowly, releasing testosterone into the bloodstream at a relatively steady rate over several months. The pellets are fully absorbed and don't need to be removed.
The advantage over other delivery methods is the steadiness. Injections produce a peak after each dose that falls off before the next, and some men feel that cycle in their energy and mood. Daily gels maintain steadier levels but require remembering, and they carry a genuine risk of transferring testosterone to a partner or child through skin contact. Pellets avoid both problems.
The trade-off is flexibility. Once pellets are in, the dose can't be adjusted until they wear off — so the initial dose and the monitoring that follows matter considerably. Learn more about low testosterone.
Why Men Choose It
Benefits of Testosterone Pellets
Steady Levels
Pellets avoid the peaks and troughs of injection schedules, which some men notice as a cycle in energy and mood.
Nothing to Remember
A few office visits a year replaces daily application or weekly injections.
No Transfer Risk
Unlike topical gels, there's no possibility of transferring testosterone to a partner or child through skin contact.
Months of Coverage
A single insertion typically lasts three to six months depending on dose and individual metabolism.
Brief Office Procedure
Insertion takes about 10 to 15 minutes under local anesthetic.
Who Qualifies
Am I A Candidate?
Pellets are appropriate for men with properly diagnosed low testosterone — meaning at least two morning blood tests confirming levels below the normal range, alongside symptoms consistent with deficiency. Testosterone shouldn't be started on symptoms alone, and it shouldn't be started on a single convenience blood draw taken in the afternoon.
Before starting, we evaluate PSA, hematocrit, and the conditions that commonly suppress testosterone — obesity, sleep apnea, poorly controlled diabetes, opioid use, certain medications. Treating those sometimes resolves the problem without hormone therapy at all.
Testosterone therapy suppresses sperm production, so pellets are not appropriate for men currently trying to conceive or who may want children in the near term. Fertility-sparing alternatives exist that raise your body's own production instead. Men with untreated prostate cancer, breast cancer, severe untreated sleep apnea, significant heart failure, or elevated red blood cell counts need those addressed first.
Before starting, we evaluate PSA, hematocrit, and the conditions that commonly suppress testosterone — obesity, sleep apnea, poorly controlled diabetes, opioid use, certain medications. Treating those sometimes resolves the problem without hormone therapy at all.
Testosterone therapy suppresses sperm production, so pellets are not appropriate for men currently trying to conceive or who may want children in the near term. Fertility-sparing alternatives exist that raise your body's own production instead. Men with untreated prostate cancer, breast cancer, severe untreated sleep apnea, significant heart failure, or elevated red blood cell counts need those addressed first.
Recovery Time
What to Expect
Before the Procedure
Diagnosis is confirmed with repeat morning testosterone testing, and baseline PSA, hematocrit, and other labs are obtained. We'll discuss fertility before you start, not after.
The Insertion
The area over the upper buttock or hip is cleaned and numbed with local anesthetic. A small incision is made, the pellets are placed through a trocar, and the site is closed with adhesive strips — usually no stitches. The whole procedure takes 10 to 15 minutes.
The First Few Days
Keep the site dry for a few days and avoid soaking baths, swimming, and hot tubs. Avoid strenuous lower-body exercise for about a week to reduce the risk of the pellets working their way out. Some bruising and tenderness is normal.
Weeks to Months
Levels rise over the first weeks and remain relatively stable. Sex drive and mood often improve within three to six weeks; changes in muscle mass and body composition take several months.
Monitoring
We check testosterone levels, PSA, and hematocrit at intervals throughout treatment. This isn't optional — testosterone therapy requires ongoing monitoring, and elevated red blood cell counts in particular need to be caught and managed.
Repeat Insertions
Most men need pellets replaced every three to six months, timed by how you feel and what your levels show.
Risks & Side Effects
Side Effects
Site Reactions
Bruising, tenderness, and swelling at the insertion site are common and settle within days.
Pellet Extrusion
Occasionally a pellet works its way back out through the incision, most often when activity is resumed too soon.
Infection
Uncommon, but possible at any insertion site, and treated with antibiotics.
Elevated Red Blood Cell Count
Testosterone stimulates red blood cell production, and levels that climb too high raise clotting risk. This is monitored with periodic bloodwork and is one of the main reasons follow-up matters.
Suppressed Fertility
Testosterone therapy reduces or stops sperm production, and that suppression can persist after stopping. Discuss this before starting.
Dose Can't Be Adjusted Mid-Cycle
Unlike gels or injections, pellets can't be dialed back once placed. This is the main structural trade-off of the method.
Other Effects
Acne, fluid retention, breast tenderness, worsening sleep apnea, and mood changes are possible and generally dose-related.
Answers to your Testosterone Pellet Questions
Frequently Asked Questions
Typically three to six months.
Duration varies with dose and individual metabolism, and we time replacement by your symptoms and lab levels. Most men settle into a predictable schedule.
Local anesthetic makes it well tolerated.
You'll feel the numbing injection and then pressure, but not sharp pain during placement. Tenderness at the site for a few days afterward is normal.
Testosterone varies by time of day.
Levels peak in the morning and fluctuate day to day, so a single afternoon sample frequently misleads. Guidelines call for two separate morning measurements before diagnosing.
Yes — it suppresses sperm production.
Testosterone therapy signals the body to stop producing its own testosterone and sperm, and recovery after stopping isn't guaranteed. Tell your urologist before starting if children are a possibility.
Current evidence does not support that.
Research hasn't shown that replacement therapy causes prostate cancer, though it can accelerate growth of an existing one. PSA is checked before starting and monitored throughout.
Steadier levels, less flexibility.
Pellets avoid the peaks and troughs between injections and require far less frequent attention. Injections cost less and allow dose adjustment at any point.
Tired all the time and not sure why?
Let's find out if testosterone is the cause.
Proper diagnosis comes first — we'll test correctly before treating, and tell you honestly if testosterone isn't your answer.
