#testopel

(Re: this ask!)

This is true, and I neglected to mention it, so thank you for that! If anon decides to look into this route, though, I’d probably recommend that they “test” if pellets are a viable option for them before travelling—a small but real percentage of people extrude the pellets (5-12%), and while there’s no 100% guaranteed predictor to figure out if this could happen in advance, it would really suck to extrude a pellet while travelling without consistent doctor access.

I figure you know that since you mentioned risks, but I’m putting the source here because whenever we mention pellets on this blog we tend to get people assuming that they extrude 100% of the time and are never safe. :) They do have higher rates of complication than something like injection, which is worth considering if you’re unsure how your body reacts to things in its skin that it wants gone—some people can’t get surface piercings, for example, such as the eyebrow or “vampire bites”, because something about their bodies rejects them. And things like collagen disorders can make this more likely, especially if the affected form of collagen is found in the interstitium or epidermis.

All that said, if the timeframe works and anon can establish pellets as a physically (and financially!) viable option in advance, that could totally work! I tried to hit a couple different bases with that answer, since I wasn’t sure if their question was about whether or not going off T for that length of time would revert them to someone who could “pass” for a cis woman.

I’m also gonna add @keshiik‘s replies to this ask:

tbh it'd be way better to bring testosterone (pill form ideally) and claim you have a cis man's endocrinological problem or just say it's for an illness and leave it at that. i've travelled overseas several times and they've never checked my meds, even when reentering the States (which is the most stringent customs i've been thru), so i wouldn't worry about airline agents, & like. almost everyone has a medication of some sort. if you just play it cool the ppl you're with won't think anything of it

I agree with the sentiment of this that it’s better to stay on T during travel if they’re concerned about being flagged as trans in a country with a very trans-unfriendly government. I don’t think I’d go for pill form, though; it’s extremely difficult to access in the US, because the original form of oral T (methyltestosterone) was very liver-toxic. (This is also why a lot of people believe that all forms of oral T are very liver-toxic.)

Oral undecanoate, the pill form sometimes prescribed in Canada and Europe, is easier on the liver but requires several doses a day to keep a consistent level in your body, which might also make it a pain for travelling.

There are also injectable forms of T that are done monthly instead of weekly or biweekly, such as Sustanon, but I believe that these aren’t prescribed in the States; they’re used in the UK, Australia, and possibly Canada. Anon should not take Sustanon if they have a peanut allergy, though, because it’s suspended in peanut oil.

North American customs are generally okay with prescription drugs if you can prove that you have a legal prescription for them, though you should absolutely look up specific crossing regulations before travelling (they’re different for air vs land vs sea etc). You generally need the meds to be in their original containers with prescriptions on the bottle, or have a paper prescription from your doctor; if you’re travelling with injection supplies, you’ll also need a note about the needles. And if you’re entering the States or Canada, you need to declare that you have a controlled substance for personal medication use to the customs officer.

I don’t know about Egyptian customs, though. And while I agree that you shouldn’t have to disclose what your medication is for, I don’t think I’d recommend claiming that you’re cis, or in any way inviting scrutiny into your medications and body. If you absolutely need to, I think “hormone disorder” or “endocrinological problem” is the safest thing to say, but any more than that and we’re getting into territory I don’t feel comfortable speaking authoritatively on. My experiences with border crossings have been all in North America, and I have a significant amount of privilege there for being white and typically travelling with my cis family through the NEXUS program.

With all this taken into account/TL;DR: I think that if anon chooses to stay on T while travelling to a country that isn’t very trans-friendly, then long-acting forms like pellets or Sustanon would be the best bet for them, so that they could avoid the additional complicator of taking meds through customs and safely administering while travelling. Both of these they should make sure they tolerate well in advance, especially pellets.

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.)

It is called Testopel. Typically 4-12 pellets are inserted into the gluteal muscle which remain active for 4-6 months. Its not a form that should be used for starting out on as you cant know what dose you will need yet, hence it should be for those who have an established maintenance dose to avoid having to have any removed or supplemented. This form isnt available everywhere so what you can get depends on what is available as well

you’re right it’s important to be an informed consumer. Every route of medication has its risks.  It’s important to understand that testosterone pellets in various formulations have been studied and considered safe for 40 years.  One of K-con’s major claims, that they were not studied by the FDA, is true-- the FDA does not study drugs, and it never has.  It is responsible for reviewing drug studies for new or substantially different drugs, and approving or denying the studies, or suggesting they undergo additional studies before approval.  The FDA did do that in this case.   The current formulation has been also been studied and proven safe and effective by multiple (non-USA) regulatory bodies, such as in Australia.The scary quotes that k-con links to (that it “lacks specific information and data...”) is found in the same study that concludes: “ The formulation approved by the FDA in 1972 was Testopel®. Despite a lack of information provided by the package insert, there is a wealth of information available through peer-reviewed studies on similar preparations and the product itself. Pellets provide sustained eugonadal (ideal cis-male) T levels for 3–6 months. Contemporary studies suggest that the FDA recommended 3–6 pellets are inadequate for most men and that 10 pellets (750 mg) produce the most reliable levels. Post implantation levels are affected by the volume of distribution, i.e., thin men require fewer, whereas morbidly obese men might require more. Extrusion and implantation infection rates (complications) at high-volume centers with Testopel® are less than 1 %, and patient acceptance of the procedure is very high.”

Yes. Basically the result of that is having like no hormones in your body (no T and no oestrogen being produced) which is not healthy. There would still be tiny amounts produced by the adrenal glands and adipose tissue but there would be no substantial benefit from those. Your body cannot remain in a healthy state without one or the other dominating as they are involved in far more than reproductive functions. They provide many other protective functions

Low oestrogen (and thereby also progesterone) can include:

fatigue

mood swings

memory loss (cognitive impairment)

irritability

concentration problems

stress

depression

increased risk of cardiovascular problems (as it is protective)

low bone density - osteopenia and osteoporosis

dry skin

increased risk of incontinence and UTIs

Low T can include:

fatigue

decreased muscle mass

depression

decreased energy

insomnia

memory loss

concentration problems

decreased bone mass

weight gain

increased risk of cardiovascular problems

All of those issues and increased risks also subsequetly affect mortality. You need to be on one or the other. It is not healthy for your body to have nothing, physically or emotionally. Yes some people go on hormone blockers but those are to block puberty, they are not a long term solution. Post menopause many women go on HRT to combat the effects of low oestrogen. It is fine to have it removed but post it you would need to remain on a form of HRT or you are at risk of many problems. If you are actually considering that then you need to talk with your doctor and/or endo about it but it will be highly unadvisable for your health

I cant really provide you with any pros to doing that (and coming off T) because the only pros would be the removed cancer risk. There are no other pros to doing it unless you were remaining on HRT after it. Having a hysto done but without an oophorectomywould be a better option if you didnt want to remain on T or use any HRT. You need to weigh up what you are wanting from it. Stopping T alone would reverse some of the changes, either oophorectomy not performed or using oestrogen instead as the form of HRT would also have the same result as well as feminisation. As would complete hysto with no HRT but not only that but all the detrimental effects of having extremely low hormone levels

Here is a post to look at as well

Testosterone pellets (Testopel) are inserted into the gluteal muscle not the arm. Here is a video about it

MRI numero dos (this time with Dotarem aka contrast) found what’s likely more Testopel residuum- 1.5 years after the last implant and 1 year after the 2nd surgery I had to deal the complications/ foriegn body response caused by the hormone implant (which I’d been on for 2.5 years up until the malfunction)!!! Feels never ending 🤯