Wait, there’s a long-term injectable testosterone? Yes, it’s called Testopel (short for testosterone pellet), and this blog is all about it! Maybe you’ve been taking T and weekly injections just don’t work for you. Or you have pets or partners or limited laundry opportunities, and gel isn’t ideal. Or you can’t get patches anymore, or insurance won’t cover oral T, or a long-term injectable would be safer, or even just more convenient for you.
Testopel has FDA approval as replacement therapy for “conditions associated with a deficiency or absence of endogenous testosterone.” That’s medspeak for when the body doesn’t produce enough testosterone. Insurance companies might not agree with us, but that sure sounds like gender affirming care!
How Big Is Testopel And How Much Testosterone Is It?
Testopel pellets are about 1/8″ in diameter and 3/8″ in length (3.2mm x 9 mm.)
Visualized, that’s about 1/6th of a dime by half of a dime. So here’s a totally not true-to-size depiction of how big a testosterone pellet is:
Each pellet contains 75 mg of testosterone, 0.97mg of stearic acid NF and 2 mg of polyvinylpyrrolidone USP.
How Is Testopel Dosed?
The prescribing information suggests:
- Implant two pellets for each 25mg of testosterone a week desired.
- Expect the amount of testosterone absorbed by the body to gradually decrease each month.
- Effectiveness usually lasts three to six months. Estimated absorption is
- 1/3 of the available testosterone is absorbed in the first month
- 1/4 in the second month
- 1/6 in the third month (which gets us to about 3/4th of the total testosterone absorbed.)
- Every body’s timing is different!
But How Many Pellets?
A typical dosing range of testosterone starts at 25mg of cypionate or enanthate a week, with a max dose of 100mg/week.
- 25 mg/week is 2 pellets implanted
- 37.5 mg/week is 3 pellets implanted
- 50 mg/week is 4 pellets implanted
A 50 mg/week dosage (4 pellets implanted) is roughly like doing an injection of 0.25mL of 200mg/mL solution. 100 mg/week would be 8 pellets implanted.
What’s Implantation Like?
Pellets need to be inserted by a trained provider, so expect to have a medical appointment. Your provider will:
- Sterilize and numb the area where the pellets will be inserted – usually the upper outer side of your butt. Pellets are placed in the layer of fat underneath your skin and on top of your muscles.
- Make a small incision in your skin.
- Implant the pellets using an instrument big enough to fit a pellet.
- Once done, close the incision – usually with steri strips – and place a bandage over it.
How Do You Take Care of Your Implantation Site While You Heal?
- You may experience some swelling and discomfort.
- You can apply ice packs over the bandage.
- Take pain reliever as advised by your provider.
- Don’t immerse your incision site in water until the incision is healed. No hot tubs or swimming!
- Your provider may ask you to refrain from showering for a few days.
- Take your bandage and steri strips off when advised.
- Your provider may advise you to avoid strenuous activity for a few days.
What To Watch Out For
Call your provider if:
- You experience prolonged tenderness, redness or swelling at the insertion site.
- You have discharge from at the insertion site or other signs of infection..
- You have a fever and/or chills above 101.5 F.
- You experience nausea or vomiting, or dizziness or lightheadedness.
- You feel the pellets moving under your skin or coming out of the wound.
What’s Great About Testopel?
- Only need injections every three to six months.
- Don’t need to keep a kit of syringes, needles, vials, alcohol wipes, and sharps containers!
- Steady release of hormones – you’re much less likely to experience the highs and lows of weekly dosing.
- Discreet!
What’s Not So Great About Testopel?
- Insertion is done at a medical office. You might have a copay or other expense each time.
- You can’t easily adjust the dosage.
- If it isn’t right for you, the pellets need to be surgically removed.
- May be expensive or not easily covered by insurance. Drugs.com estimates the cost without insurance to be about $115/pellet.
What Else Do I Need To Know?
All the standard informed consent information about the risks and benefits of testosterone apply to Testopel. Some of our resources about T include:
- All The T
- Testosterone And You: Gettin’ Square, The QueerDoc Way
- What You Need To Know Before Starting Testosterone
- Testosterone: A Quick Crash Course in Gender Affirming Care
- Testosterone and Cardiovascular Disease Risk
- Testosterone and the Singing Voice
You can also check out the Testopel brand site, but it’s pretty cis-oriented.
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