Bio-similar hormone therapy, (sometimes referred to as Bio-identical hormone therapy), can be administered in several different ways. I prefer the pellet method.  This method has a smoother delivery of hormone.  The SottoPelle ® technique, developed by Dr. Gino Tutera, is the method and protocol I use. These very small heat fused pellets are placed under the skin in the fatty tissue. Men typically need pellets inserted every six months.  Women need pellets every 4-6 months. Hormone level testing is done before therapy to determine necessity, and every 6 weeks for the first 6 months, then every 6 months thereafter if levels remain therapeutic. 

For those that don't wish to have hormone pellets inserted hormones can be administered through creams, gels, patches, injections, and capsules. 

Oral Routes

Oral hormone administration should be avoided except in the case of progesterone supplementation.  Oral estrogens experience metabolic first pass effect and are broken down by the liver soon after ingestion.  Oral testosterone, whether given alone, or in combination, undergoes similar first pass metabolism.  Furthermore, methyl testosterone has been linked to hepatic carcinomas. 

Topical Routes

Topical administration avoids first pass metabolism by the liver, however other issues arise.  Besides having to apply to the skin on a daily basis, topical administration can be messy and problematic.  In the instance of topical testosterone application, an enzyme exists in the skin that can metabolize it into 5-DHT.  This can lead to undesirable side effects.  In women, it can lead to undesirable hair growth.  

Injectable Routes 

Injections of testosterone can be given.  The recommendation is to give deep intramuscularly.  The injection is given every 7-14 days.  For those faint of heart, the injection route may not be palatable. Typical form is Testosterone Cypionate, which is either in cottonseed oil or sesame seed oil.  The injection technique may also give a "peak-and-valley" of testosterone levels, with the peak coming immediately 24 hrs after the injection with a slow progression towards the "valley" over the course of the week.  This method doesn't keep a static level and may result in symptoms returning towards the end of the week. 

Pellet Insertion Route

Inserted under the skin in the buttocks. The area is numbed, a small incision is placed and a special customized trocar is used to insert the pellets.  Both estradiol and testosterone pellets can be placed in this manner.  However, not all pellets are  created equal.  SottoPelle pellets are processed utilizing a "heat-fusion" method that makes them more uniform and more predictable in their hormone release pattern.  The favorable thing about pellet therapy is the smooth stable release of hormone, and the need to only place them 2-3 times a year. No messy creams or gels, and no irregular hormone levels from oral or injectable administration. 

Note:  Testosterone replacement is not for those seeking to become parents, male or female.  Testosterone decreases sperm count in men.  It also is ill advised for women who may be pregnant as it can affect the sexual differentiation of the developing fetus. 

Schedule an consultation  to discuss your options and what therapy may pertain to you.