Dr Ray Andrew Family Doctore & Urgent Care

Ray Andrew Moab Utah Family Doctor
Ray Andrew Moab Utah Family Doctor

Grand Country Wellness Center, Moab & Provo Utah

Grand County Wellness Center, Moab Utah

Frequently Asked Questions About Testosterone Replacement


Q: What happens when the testes no longer produce sufficient testosterone?

A: Testosterone deficiency leads to both immediate manifestations (symptoms) and increased risks of chronic degenerative diseases.

Due to a number of factors, the average male testosterone level has decreased by 200mg/dl in the last 20 years! Increasingly we are finding men experiencing significant testosterone deficiency, some even in their 30s. We also treat men in their 90s. Men with testosterone deficiency (aka andropause) often notice an inability to maintain their muscle tone, poor sexual performance (including erectile dysfunction), malaise, and a loss of their zest for life. For some, the decline they experience is so insidious that they don’t recognize it. Instead, they gradually reduce their physical activity level and expectations for themselves, chalking it up to getting older, or assuming that their interests have simply “matured” over time. But there is much more to testosterone than physical strength, energy, and keeping the sexual juices flowing. Testosterone plays important roles in mood, physical strength, energy, sense of wellbeing, and avoidance of prostate cancer, dementia, osteoporosis, diabetes, and heart disease.

Q: Isn’t hormone replacement unnatural?

A: Sure, just like taking vitamin C is unnatural. It’s your choice—let nature run its course, or acknowledge the fact that you are no longer producing sufficient testosterone for your health and wellbeing.

Q: Are there any side effects to testosterone replacement?

A: Many men experience greater desire for intimacy. In fact, most men who present to our offices do so because they suddenly have a hard time keeping up with their wives, who now have their hormones back! Men may also notice a darkening of their gray chest hairs. Some men produce extra red blood cells and need to donate blood periodically. This is most common in men with unrecognized and untreated sleep apnea.

Q: At what age should I stop taking testosterone?

A: When do you want to stop living? The concept that one must take the lowest possible dose of hormones for the shortest possible time period comes from studies of drugs, not human hormones. You can stop taking hormones any time you like. However, if you were to take a look at graphs of every major killer in America (prescription drugs, heart disease, cancer, diabetes, osteoporosis, Alzheimer’s, etc.) across the lifespan, you will notice t
hat there is a strong correlation between disease and the loss of hormones. How often do you hear of young men developing heart disease or prostate cancer? We have yet to meet a man who developed prostate cancer with an optimal testosterone level. It’s not a coincidence.

Q: I want to try hormone replacement. Can I take a shot?

A: Excellent question. Doctors who do not specialize in hormone replacement often prescribe testosterone shots. Aside from increasing risk of liver disease, shots are notorious for causing the yo-yo effect of widely fluctuating hormone levels: you feel great for the first few days and fizzle out thereafter while waiting for your next injection. Moreover, the doses are not individualized based on testing. It’s a “one-size-fits all” approach using synthetic testosterone made by drug companies.

Q: So, what form of hormone replacement do you recommend?

A: The overwhelming majority of our patients prefer subcutaneous pellet therapy, often called “The Ultimate Hormone Therapy.” Hormone pellets are the best, most natural way to deliver tesosterone in men who no longer produce enough on their own. Implants, placed under the skin, consistently release small, physiologic doses of bioidentical hormones. Pellets are made up of pure testosterone, with no additives or side chains to make it patentable. The hormones are pressed or fused into very small solid cylinders. In the United States, pellets are made by a compounding pharmacist and delivered in sterile glass vials.

Q: What are the benefits of Pellet Therapy?

A: Pellets deliver consistent, healthy levels of hormones for 4-6 months. They avoid the ups and downs of hormone levels seen with every other method of delivery. It is the fluctuation in hormones that causes many of the unwanted side effects and symptoms of other hormone replacement methods. Testosterone pellets often improve cholesterol, whereas creams and gels make it worse.

Q: If pellets are so good, why haven’t I heard of them?

A: Another excellent question. Pellet therapy was pioneered in the United States in 1939, but is much more common in Europe and Australia today. There is more data to support the use of pellets than any other method of delivery of hormones. Unfortunately, medical education in North America is controlled by drug companies. Most physicians decry bioidentical hormone replacement because they know nothing about it, except perhaps the propaganda they have received from the drug companies and the specialty journals. Medical schools and residency training programs only teach us how to use patented drugs. A small percentage of us spend the additional time and money obtaining specialized training in human hormone replacement. Fewer still learn how to use pellets because there is a lot more to it than merely writing a prescription or even performing a surgical procedure.

For these reasons, many of our patients have approached their physicians about pellets and been disappointed. Don’t lose faith in your physician merely because he (or she) has not taken the time to search out and read the studies about pellets. Unless he specializes in it, he is not going to have the time (and be willing to spend the money) to learn about it, practice it under the guidance of a pioneer in the field, and perfect it in his own practice.

Q: Where do the pellets go?

A: Pellet insertion is a relatively painless procedure done under local anesthesia. The pellets are usually inserted in the hip through a small incision which is taped closed. Experience of the health care professional is important, both in determining the correct dosage of hormones to be used and in their placement.

Q: What are the risks of pellets?

A: Complications from the insertion of pellets include minor bleeding, bruising, discoloration of the skin, infection, and possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin these complications are uncommon. Even though you can shower the next day, you need to avoid tub baths, hot tubs, and swimming for 3 days while your wound heals. Vigorous physical activity is avoided for 7 days. You want to minimize blood flow to the hip and buttock while the implant site is healing. The more blood flow, the quicker the testosterone will be absorbed into the bloodstream (and therefore used up). Once the site has healed, you can exercise all you want. If this sounds like a lot of hassle, it’s only because you’ve never experienced pellets. Our patients who have used creams or shots before discovering pellets never go back.

Q: What can I expect after pellet implantation?

A: Everyone is different. Some patients begin to feel better within 24-48 hours, while others may take a few weeks. You may notice that you have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. You may notice increased strength, coordination, and physical performance. Your skin tone and hair texture may improve. Concentration and memory may improve, as will overall physical and sexual health. The bottom line is that hormone replacement improves health and wellbeing to the extent that the deficiencies are responsible for the problems in the first place. In other words, if you are still tired once your hormone levels have been optimized, we need to look for other causes of fatigue.

Q: How do you know when to take the pellets out?

A: We don’t take them out. They dissolve and get used up. They consist of pure hormone, so there is nothing to remove. Pellets usually last between 4 and 6 months. If you are pleased with the results, then you undergo repeat insertion.

Q: How do you know how much testosterone to give me?

A: Unlike the standard approach utilized with drug company substitutes for hormones, bioidentical hormone replacement is customized for your needs and circumstances. Your doses are determined based on your blood levels, symptoms, health conditions, and response to previous implants. Blood levels are checked before and one month after the first implants. Levels are rechecked a few months later, in anticipation of the next implants. After 12-18 months, levels are checked less often. Blood counts and PSA are monitored every 6-12 months.

Q: How does the cost of this therapy compare to the mainstream approach?

A: When compared to the cost of drugs to treat the individual symptoms and complications of testosterone deficiency, pellets are very cost-effective. They are also less expensive than all the commercially-available testosterone-like products. In fact, patients who come to us having previously used the patent drug formulations tell us that pellets are a bargain. Consider also the staggering cost and number of drugs used to treat insomnia, depression, sexual dysfunction, obesity, diabetes, high blood pressure, heart disease, Alzheimer’s dementia, and many other conditions. Cost aside, why take anything but pure testosterone? Your body doesn’t need the side chains, preservatives, or anything else that would make testosterone patentable.

Q: I want pellets. When can I start?

A: We want to ensure that your consult and implantation visit go smoothly, especially if you are traveling from out-of-town or out-of-state. To facilitate this, Dr. Andrew reviews all of your paperwork in advance. Call the office to schedule your appointment, after which you will be sent the necessary forms and instructions. Returning the forms and having your blood drawn as soon as possible will ensure you the best results and experience.

*Although the statements in this document have been substantiated by numerous studies worldwide, they have not been evaluated by the U.S. FDA. Because drug companies can’t patent what is found in nature, there is no incentive for them to pay hundreds of millions of dollars for approval of pure testosterone, which any sterile compounding pharmacy can make. This product is not intended to diagnose, treat, cure, or prevent any disease.


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Moab Family Health & Grand County Wellness Center  and the   The Hormone Centers of Utah