#sottopelle

..cela un'estrema sensibilità sotto una scorza di indifferenza.

Baci nell’ombra

If you’ve looked into various forms of hormone replacement therapy for trans men, you’ve probably stumbled upon the option of subcutaneous pellets. A lot of people don’t know much about them, because not many people go this route due to lack of insurance coverage and availability. Still, it’s by far the most convenient method of taking testosterone, so it’s worth reading about.

What exactly is it? 

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. 

A physician’s assistant will cut a small incision on one of your buttcheeks (they’ll give you lidocaine first so you don’t feel it), shoot some rice-size pellets in, and close it up. You shouldn’t 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 won’t 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. They’ll 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. You’ll then get the next implant, this time on your other asscheek (they alternate).

What are the advantages?

Convenience. It’s 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? 

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 they’re fairly new, and a lot of insurance companies don’t cover them. If you don’t have insurance and are looking for an alternative to injections that you’re 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 you’re 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.

Where can you get them?

I’m 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.

Arizona:

Tutera Medical Inc (Paradise Valley)

Tutera Medical Inc (Scottsdale)

California:

Nurturing You Women's Health & Wellness, Inc. (Corona)

Connecticut:

Middlesex Hospital (Middletown)

Florida:

Advanced Individualized Medicine ( Dr Clint Potter ) (Naples)

YuNique Medical Services, LLC. (Ocala)

Sekine, Rasner & Brock, M.D. PA (Jacksonville)

Gentle Gynecology & Obstetrics (Weston)

Gentle Gynecology & Obstetrics (Pembroke Pines)

Kansas:

Mirabile, MD Beauty, Health & Wellness (Overland Park)

Massachusetts:

Fenway Health (Boston)

Berkshire Medical Center (Pittsfield)

Men's Health Boston (Chestnut Hill)

Minnesota:

Minneapolis Park Nicollet (Minneapolis)

Missouri:

Advanced Health Care LLC (Lee’s Summit)

North Carolina:

New Day Wellness Center (Charlotte)

Oklahoma:

Tulsa Women's Health Care (Tulsa)

Utah:

Rebirth OB/GYN Clinic (Salt Lake City)

(Last updated: 8/22/18. If you’re looking at this post a while after this date, click to look at the post on my blog to see if there are updates.)