Testosterone Pellets: A Treatment I Rarely Saw Until the United States

最后更新： 2026年8月29日

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One of the quiet privileges of training abroad is seeing treatments performed routinely that you have rarely, if ever, encountered at home. During my time as a Research Scholar and Clinical Observer at Baylor College of Medicine, one of those was the testosterone pellet — a form of hormone therapy implanted under the skin that is common in American men’s health clinics, yet something we almost never do in Thailand.

I was curious about it, so I asked Basil Z. Kaaki, DMSc, PA-C — Assistant Professor in the Scott Department of Urology at Baylor, and a generous teacher I was lucky to learn from — to explain it to me the way he would to a patient. What follows is our conversation, lightly edited for clarity, along with my own reflection at the end on why I think this treatment has never really taken hold back home.

One thing to say before we begin: pellets are a delivery method for testosterone, and everything that is true of testosterone therapy in general is true of them. The safety section further down applies whichever form a man is given, and it is the part that matters most.

Let’s start with the basics — what is a testosterone pellet?

Dr. Kaaki: A testosterone pellet is a tiny cylinder of crystallised testosterone, a little smaller than a grain of rice. During a short in-office procedure, we place a number of these pellets into the fatty layer just under the skin, usually in the upper part of the buttock. Once they are in, they slowly dissolve and release testosterone steadily into the bloodstream over the following months.

The appeal is convenience. Instead of a gel every single day, or an injection every week or two, a man comes in just three or four times a year, has the pellets placed, and then essentially forgets about his testosterone therapy until the next visit.

Dr. Pom: When you put it in terms of frequency, the difference is quite striking.

Dr. Kaaki: It really is. Think about it over a year: a daily gel is around three hundred and sixty-five applications. Injections might be fifty to a hundred needle-sticks. Capsules can be well over a thousand doses. Pellets? Three or four visits. For the right man, that is a completely different relationship with his treatment.

Dr. Pom: Though “forgets about his testosterone therapy” is worth qualifying — the appointments become less frequent, but the blood monitoring does not go away.

Dr. Kaaki: No, and that is an important distinction. The convenience is in the dosing, not in the follow-up.

This is an old idea, isn’t it — not some new trend?

Dr. Kaaki: Much older than people assume. The story really begins with the same colourful figure who opens every testosterone lecture — Brown-Séquard, the nineteenth-century physiologist who injected himself with testicular extracts and claimed he felt decades younger. The science was shaky, but the underlying instinct proved correct.

The pellet itself came a bit later. In the late 1930s, a pioneering hormone researcher named Robert Greenblatt began implanting testosterone pellets, and he became one of the founding figures of modern endocrinology. The branded pellet most widely used in America today received its approval back in 1972. So when a patient worries this is some untested fad, I reassure them: we have more than half a century of experience with this exact product.

Who is the ideal candidate?

Dr. Kaaki: First and foremost, the same rules apply as for any testosterone therapy — the man must have a genuine diagnosis of testosterone deficiency, meaning a low level confirmed on two early-morning blood tests, together with real symptoms. Pellets are a delivery method, not a shortcut around a proper diagnosis.

Given that, pellets shine for a particular kind of patient. The man who travels constantly and cannot keep to a daily routine. The man who simply hates needles and dreads self-injection. And importantly, the man for whom self-injection is genuinely difficult or unsafe — someone with poor eyesight, or reduced hand coordination and fine motor control, where handling a needle every week carries a real risk of injury. For those men, coming in a few times a year to have this handled by a professional is not just convenient — it is safer.

Dr. Pom: That last group stood out to me. It is easy to forget that for some patients, the daily or weekly self-administration is itself the obstacle.

Dr. Kaaki: Exactly. And there is a consistency benefit too. Because the pellets release hormone gradually, men tend to avoid the peaks and dips that some experience with injections — the rollercoaster of feeling great a few days after a shot and flat before the next one. Many men describe the pellet as giving them a more even, level feeling throughout the months.

And the downsides? What should a man weigh against that?

Dr. Kaaki: The honest headline is that pellets require a minor surgical procedure, and that is the central trade-off. Every other method — gel, injection, capsule — you can do yourself at home. A pellet has to be implanted through a small incision by a trained clinician. That means a little local anaesthetic, a small cut, and a short recovery.

With that come a few small risks. The most talked-about is extrusion — occasionally a pellet works its way back out through the incision, usually when a man is too active in the first few days before things have healed. It is uncommon, and it is largely preventable by taking it easy for those first few days. There is also a small chance of bruising, minor bleeding, or infection at the site, as with any procedure that breaks the skin.

Dr. Pom: And unlike a gel, you cannot simply stop it once it is in.

Dr. Kaaki: That is a fair point and worth telling patients plainly. Once the pellets are placed, the testosterone is going to release over the coming months. If a man develops a reason to stop — a change in his blood count, say — you cannot just wash it off the way you can a gel. It is not easily reversible. That is another reason the upfront diagnosis and counselling matter so much.

What does the procedure and aftercare actually involve?

Dr. Kaaki: It is quick — usually ten to fifteen minutes. The man lies on his side or front, we clean and numb a small area over the upper buttock, make a tiny incision, and use a special applicator to place the pellets into the fatty layer. The incision is so small it usually needs only adhesive strips rather than stitches.

The aftercare is really about protecting that little wound while it heals. We ask men to avoid strenuous activity, swimming, and baths for about three days, keep the dressing on and dry, and it is fine to shower the same day. Some bruising is normal. And we give clear instructions to come back or seek help if there is significant bleeding, increasing pain, fever, or spreading redness — the usual signs that something needs attention. A few weeks later we check a blood level to make sure the dose is right.

What Every Man on Testosterone Should Know — Whatever the Form

This part is mine rather than Dr. Kaaki’s, and it is the section I would least like a reader to skip. The pellet is only a container. What goes into the body is testosterone, and testosterone therapy carries the same considerations regardless of how it is delivered.

• It suppresses sperm production, and it can do so profoundly. Testosterone given from outside switches off the brain’s signal to the testes. Any man who might want children — now or later — must have this conversation before starting, not afterwards. There are alternative treatments that raise a man’s own testosterone while preserving fertility, and that is the right route for him. Recovery of sperm production after stopping is usual but can take many months, and is not guaranteed.
• It thickens the blood. Testosterone raises the red cell count, and if the haematocrit climbs too high the dose has to be reduced, the treatment paused, or blood removed. This is the single most common reason therapy has to be adjusted, and in the large TRAVERSE safety trial it was the clearest adverse effect of treatment — one of the few findings that reached statistical significance rather than being a numerical signal. It is exactly the situation Dr. Kaaki referred to when he said you cannot wash a pellet off. It is why blood counts are checked before starting and at intervals thereafter, and why the follow-up is not optional.
• Bone is the other finding that held up statistically. In the fracture analysis of that same trial, men on testosterone had roughly 43% more clinical fractures than men on placebo. That was not the result anyone expected, since testosterone is generally thought of as good for bone, and the reason is not settled — but it is a real finding rather than a signal, and it is worth knowing about if you are older, have fallen before, or already have thin bones. It is a reason to discuss fracture risk at the start rather than assume treatment protects you.
• The prostate needs monitoring. PSA is checked before starting and during treatment. Testosterone therapy is not given to a man with untreated prostate cancer, and any man with a rising PSA needs that investigated rather than assumed to be the treatment.
• It is not a tonic for ageing. Testosterone therapy treats confirmed testosterone deficiency — low levels on two early-morning tests plus symptoms. It is not a performance product, and a man with normal levels will not benefit from it. If symptoms are present but levels are normal, the answer lies somewhere else, and looking for it is more useful than treating a number that is not low.
• Gels transfer by skin contact. Men using a gel must cover the area and wash their hands, because transfer to a partner or a child causes real harm. This is one respect in which pellets and injections have a genuine advantage.
• Sleep apnoea can worsen. If you snore heavily, stop breathing in your sleep, or wake unrefreshed, mention it — it changes how treatment is monitored.

Seek medical attention promptly for a wound that becomes increasingly painful, red, swollen or discharging, or for fever after any implantation. And seek urgent care for chest pain, sudden breathlessness, or swelling and pain in one calf, which need assessment regardless of the cause. In Thailand the emergency number is 1669.

Dr. Pom’s reflection: why we rarely do this in Thailand

I want to close with an honest reflection, because the most interesting thing about pellets for me was not the procedure itself — it was the question of why they are so common in the United States and so rare at home.

The biggest single reason, I came to understand, is not medical at all. It is insurance. In the American system, the branded testosterone pellet is a product that private insurance will often reimburse. Meanwhile the long-acting testosterone injection — a treatment many would consider simpler — frequently is 不 covered in the same way. So the economics quietly push both doctors and patients toward the pellet. When a treatment is the one that gets paid for, it becomes the one that gets used. That is a powerful force shaping day-to-day practice, and it is easy to miss until you see a different health system up close.

In Thailand, that particular incentive simply does not exist, and I think that explains much of the difference. But there is a second reason that is my own clinical judgement: compared with the alternatives, the pellet is more invasive. Every other option we have — gels, and especially modern long-acting injections that a patient receives only a handful of times a year — achieves the same goal without a scalpel, an incision, or the small risks of a minor procedure. When I can offer a man effective testosterone therapy without cutting his skin, that is usually where I would rather start.

None of this means pellets are a bad treatment — they are clearly a good one for the right patient, and I am glad I learned to appreciate where they fit. It is a genuinely valuable option, particularly for the man who cannot manage injections himself. But for most men in the Thai context, where the insurance incentive is absent and excellent less-invasive options are readily available, I do not see it becoming a first choice. This article is therefore an account of how pellets are used in the United States rather than a description of treatment offered here; the testosterone therapy I provide in Thailand uses gels and injections. Seeing pellets practised so routinely abroad taught me something not only about the treatment, but about how the systems around medicine shape the care patients actually receive.

If you are exploring testosterone therapy, the good news is that there are several effective options, and the right one depends on your diagnosis, your lifestyle, and your preferences. I explored the full range in my recent conversation on low testosterone with Dr. Kaaki, and how testosterone therapy relates to heart health in my piece on the landmark TRAVERSE trial.

My sincere thanks to Dr. Kaaki, both for this conversation and for his generosity throughout my time as a Research Scholar and Clinical Observer at Baylor.

See how 睾酮替代疗法 is structured in practice, including the different delivery options and the monitoring that should accompany treatment. If you have symptoms of low testosterone — reduced libido, erectile difficulty, persistent fatigue, low mood, or loss of muscle — please have it assessed properly rather than self-treating. Dr. Soarawee Weerasopone sees men’s health and testosterone patients at 曼谷医院总部 和 春武里是拉查三美泰医院 — 088-022-1445.

曼谷医院远程医疗服务适用于无法亲自就诊的患者，包括国际患者——请通过电子邮件提前向泌尿科预约： bhquro@bdms.co.th. Samitivej Sriracha is in-person only. For any enquiry about the cost of consultation, testing or treatment, please contact the hospital directly at the same address, or Samitivej Sriracha on 088-022-1445.

Frequently Asked Questions About Testosterone Pellets

What are testosterone pellets and how do they work?

Testosterone pellets are small cylinders of crystallised testosterone, each a little smaller than a grain of rice, implanted into the fatty layer under the skin during a short in-office procedure, usually in the upper buttock. Once in place, they dissolve slowly and release testosterone steadily into the bloodstream over three to four months. Their main advantage is convenience: instead of a daily gel or frequent injections, a man needs only three or four visits a year. The convenience is in the dosing, not in the follow-up — blood monitoring continues either way.

Who is the best candidate for testosterone pellets?

Pellets suit men who have a confirmed diagnosis of testosterone deficiency and who value convenience or struggle with other methods. They are especially useful for men who travel frequently, men who strongly dislike needles, and men for whom self-injection is difficult or unsafe, such as those with poor eyesight or reduced hand coordination. Because pellets release hormone gradually, they also help men who experience the peaks and dips of injections feel more even throughout treatment.

睾酮治疗会影响生育能力吗？

Yes, and this is the single most important thing for a younger man to understand before starting. Testosterone given from outside switches off the brain’s signal to the testes and suppresses sperm production, sometimes profoundly. Any man who may want children, now or in the future, should have this conversation before treatment begins rather than afterwards. Alternative medicines can raise a man’s own testosterone while preserving fertility and are the appropriate route in that situation. Sperm production usually recovers after stopping, but it can take many months and is not guaranteed.

What monitoring is needed on testosterone therapy?

Testosterone raises the red cell count, so the haematocrit is checked before starting and at intervals afterwards; if it climbs too high the dose must be reduced, treatment paused, or blood removed. PSA and prostate assessment are also part of monitoring, and testosterone is not given to a man with untreated prostate cancer. Testosterone levels themselves are checked to confirm the dose is right. This monitoring applies to every delivery method, and it is one reason a pellet, which cannot be quickly stopped, requires careful counselling first.

What are the risks of testosterone pellet implantation?

Because pellets require a minor surgical procedure, they carry small risks the other methods do not. The most discussed is extrusion, where a pellet works its way back out through the incision, usually caused by too much physical activity in the first few days and largely preventable by resting. There is also a small chance of bruising, minor bleeding, or infection at the site. Importantly, once pellets are implanted the testosterone cannot be quickly stopped, unlike a gel, so careful diagnosis and counselling beforehand are essential. Seek medical attention for a wound that becomes increasingly painful, red, swollen or discharging, or for fever afterwards.

Why are testosterone pellets common in the United States but rare in Thailand?

The main reason is insurance reimbursement. In the United States, the branded testosterone pellet is often covered by private insurance, while long-acting testosterone injections frequently are not, which encourages wider use of pellets. This financial incentive does not exist in Thailand. In addition, pellets are more invasive than the alternatives, since gels and modern long-acting injections achieve similar results without an incision, so many clinicians in the Thai context prefer to start with less-invasive options. This article describes how pellets are used in the United States; the testosterone therapy Dr. Soarawee provides in Thailand uses gels and injections.

How long do testosterone pellets last?

Testosterone pellets typically release hormone over three to four months, after which the procedure is repeated. Levels tend to peak roughly a month after implantation and gradually decline thereafter. A follow-up blood test a few weeks after the first implantation helps confirm the dose is appropriate, and timing of subsequent implantations is guided by both symptoms and blood levels.

Can I discuss testosterone therapy by video consultation?

Yes. Bangkok Hospital Headquarters offers a Telemedicine service, arranged in advance by email to the Urology department at bhquro@bdms.co.th. It is a useful way to review your symptoms and any previous hormone results, and to plan which blood tests are needed — particularly for patients travelling from abroad. Testosterone deficiency must be confirmed on two early-morning blood tests, so laboratory testing and examination still require an in-person visit. Samitivej Sriracha is in-person only, booked through the Urology department line 088-022-1445.

Featuring: Dr. Basil Kaaki, DMSc, PA-C — Assistant Professor, Scott Department of Urology, Baylor College of Medicine, Houston, Texas. Quoted with his permission.

免责声明 This article summarises an educational conversation for general information only and does not constitute medical advice. It reflects general principles and personal clinical opinion regarding testosterone therapy and may not apply to your individual situation. Testosterone pellets are not offered at this practice. Treatment availability, product approvals, insurance coverage, and regulations vary by country, and describing a treatment here is not an offer of that treatment. No diagnosis, prescription or individual medical advice is given through personal messaging channels or social media. Always consult a qualified healthcare professional before starting, stopping, or changing any treatment. In an emergency, attend the nearest emergency department — in Thailand the emergency number is 1669.