15 Myths (Misunderstandings) About Testosterone Replacement Therapy with PelletsHormone pellets are the best, most natural way to deliver hormones in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of bio-identical hormones dbol test deca results pics optimal therapy. Pellets are made up tesyosterone either estradiol or testosterone. The hormones, estradiol or testosterone, are pressed or fused into very small solid cylinders. In the United States, pellets are made side effects testosterone pellets a licensed compounding pharmacist and delivered in sterile glass vials. Pellets deliver consistent, healthy levels of hormones for months, side effects testosterone pellets on the dosage. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery.
15 Myths About Testosterone Replacement Therapy | Natural Bio Health
A subcutaneous testosterone pellet is a long-acting, slow-release delivery system that can be utilized as androgen replacement therapy.
A year-old man who was treated with testosterone pellets developed dermatitis consisting of erythematous plaques and patches on both buttocks and thighs within 28 days following the subcutaneous insertion of testosterone pellets. The skin lesions rapidly resolved with high-potency topical corticosteroid application. The same cutaneous eruption occurred with each subsequent insertion of testosterone pellets. Other cutaneous adverse events associated with testosterone pellet insertion include acne, hirsutism, and male pattern alopecia.
Bleeding, bruising, fibrosis, infections, pellet extrusion, scarring, and subcutaneous nodules may also occur at the injection site. In summary, testosterone pellet-induced dermatitis is a rare adverse cutaneous event, which should be added to the list of potential testosterone pellet associated skin side effects.
We also review other cutaneous adverse events associated with this medication. A year-old man presented for evaluation of a pruritic rash on both buttocks and thighs in October He has a history of hypogonadism and receives insertion of testosterone pellets Testopel, Endo Pharmaceuticals Inc. His first insertion was 18 months earlier in April ; he did not develop any skin lesions after the initial insertion.
However, within 28 days after each subsequent insertion October , April , October , and April he developed a pruritic rash on his buttocks and thighs. Skin lesions appeared within four weeks after the second treatment of 12 testosterone pellets; each pellet was 75 mg for a total dose of mg. He received an intramuscular injection of triamcinolone corticosteroid from his primary care physician to treat the initial and subsequent episodes, which promptly treated the first and second reactions.
He then presented four weeks after his fourth injection. A cutaneous examination showed erythematous plaques and patches on the buttocks. Cutaneous plaques and patches on buttocks and lateral thighs arrows show representative lesions. A microscopic examination of the skin biopsy showed orthokeratosis and mild acanthosis of the epidermis.
Neither spongiosis nor elongation of the rete ridges were prominent. There was vacuolar alteration of the epidermal basal layer. An inflammatory infiltrate of lymphocytes was present not only around the blood vessels in the upper dermis, but also at the junctions between the epidermis and the dermis. There is lymphocytic inflammation in the papillary dermis.
Correlation of history, clinical morphology, and pathology established the diagnosis of testosterone pellet associated dermatitis. Topical treatment with a high potency corticosteroid cream clobetasol propionate 0. The likelihood of re-occurrence of the dermatitis with subsequent testosterone pellet therapy was discussed with the patient. However, he insisted on continuing treatment of his hypogonadism with the same medication.
A decreased dose of mg ten 75 mg testosterone pellets was inserted six months later in April The plaque was biopsied. The biopsy of the new skin lesion showed the same pathologic changes as his previous skin biopsy. The skin lesions completely resolved within a week after initiating treatment with clobetasol propionate 0. Male hypogonadism occurs when the body is not able to produce or keep testosterone at physiological level [ 2 - 3 ].
It can adversely affect many tissues and organs. Some of the symptoms of male hypogonadism include decreased lean body mass and strength, increased adipose tissue mass, mood disorders, and sexual dysfunction, especially diminished libido [ 1 - 3 ]. Male hypogonadism is frequently associated with aging [ 2 , 4 ]. It typically affects middle-aged and older-aged men [ 4 ]. The diagnosis of male hypogonadism is established by observing persistent signs and symptoms of low testosterone accompanied with a low total serum testosterone level [ 2 - 3 ].
However, there is an increased prevalence of low testosterone and hypogonadism in men with chronic obstructive pulmonary disease, end-stage renal disease, human immunodeficiency virus HIV infection, and type 2 diabetes mellitus [ 2 ]. Testosterone is the main treatment for male hypogonadism.
It is available in several forms: In addition, male hypogonadism can also be treated by periodically administrating subcutaneous testosterone pellets. Testosterone pellets are usually well tolerated. While acne, alopecia male pattern , and hirsutism are common skin side effects, other cutaneous adverse events like bleeding, bruising, fibrosis, infections, pellet extrusion, scarring, and subcutaneous nodules can occur at the implantation site. To the best of our knowledge, our patient is the first man described with testosterone pellet induced dermatitis.
The occurrence of testosterone pellet associated dermatitis is not a drug-limiting side effect; the severity and extent of dermatitis was significantly diminished by decreasing the dose of testosterone implanted.
Subcutaneous testosterone pellets are a form of androgen replacement therapy that is used to treat male hypogonadism. Several cutaneous side effects have been described in patients receiving this medication, including acne, male pattern alopecia, hirsutism, and implantation site events. Recurrent dermatitis can be added to this list of potential adverse skin events in men receiving testosterone pellet insertions.
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The authors have declared that no competing interests exist. Consent was obtained by all participants in this study. National Center for Biotechnology Information , U.
Journal List Cureus v. Published online Aug Alexander Muacevic and John R Adler. Received Jul 13; Accepted Aug This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Case presentation A year-old man presented for evaluation of a pruritic rash on both buttocks and thighs in October Open in a separate window. Testopel-associated dermatitis on buttocks and lateral thighs Cutaneous plaques and patches on buttocks and lateral thighs arrows show representative lesions. Closer view of the microscopic examination of testosterone pellet associated vacuolar interface dermatitis There is lymphocytic inflammation in the papillary dermis.
Discussion Male hypogonadism occurs when the body is not able to produce or keep testosterone at physiological level [ 2 - 3 ]. Table 1 Adverse cutaneous events and other testosterone drug associated side effects. Location Side Effects Cardiovascular Myocardial infarction, stroke Endocrine and urogenital Gynecomastia, excessive frequency and duration of penile erections Fluid and electrolytes disturbances Retention of calcium, chloride, inorganic phosphates, potassium, sodium and water Gastrointestinal Alteration in liver function tests, cholestatic jaundice, nausea, rarely hepatocellular neoplasms and peliosis hepatis Hematologic Bleeding in patients on concomitant anticoagulant therapy, suppression of clotting factors II, V, VII, and X Implantation site events Bleeding, bruising, fibrosis, infection, pellet extrusion, scarring, subcutaneous nodules Metabolic Increased serum cholesterol Miscellaneous Rarely anaphylactoid reactions Nervous system Anxiety, depression, generalized paresthesia, headaches, increased or decreased libido Skin and appendages Acne, alopecia male pattern , hirsutism Vascular disorders Venous thromboembolism.
Conclusions Subcutaneous testosterone pellets are a form of androgen replacement therapy that is used to treat male hypogonadism. Human Ethics Consent was obtained by all participants in this study. Testosterone replacement therapy for male hypogonadism: Pharmacologic and clinical profiles, monitoring, safety issues, and potential future agents. Int J Impot Res. A practical guide to male hypogonadism in the primary care setting. Dandona P, Rosenberg M. Int J Clin Pract. Testosterone therapy in men with androgen deficiency syndromes: J Clin Endocrinol Metab.
Age trends in the level of serum testosterone and other hormones in middle-aged men: An analysis of testosterone implants for androgen replacement therapy.
Pharmacokinetics and pharmacodynamics of testosterone pellets in man. Extrusion of testosterone pellets: Articles from Cureus are provided here courtesy of Cureus Inc. Support Center Support Center.
Alteration in liver function tests, cholestatic jaundice, nausea, rarely hepatocellular neoplasms and peliosis hepatis. Bleeding, bruising, fibrosis, infection, pellet extrusion, scarring, subcutaneous nodules. Anxiety, depression, generalized paresthesia, headaches, increased or decreased libido.