What testosterone pellets are and how they compare with injections

Testosterone pellets are small implants placed under the skin. They last about three to six months, with levels that rise early and then fall.

They are one way to give testosterone. Release lasts months, so they do not follow the daily rise and fall of natural testosterone.

What are testosterone pellets?

The U.S. pellet product (TESTOPEL) is a cylinder about 3.2 mm across and 9 mm long, roughly the size of a grain of rice, containing 75 mg of crystalline testosterone (TESTOPEL label). A clinician places the pellets under the skin. The AUA lists the usual sites as the buttock or flank (AUA Table 2).

Once implanted, the pellets release testosterone over several months. The label's replacement interval is every 3 to 6 months, with an adequate effect that ordinarily lasts 3 to 4 months and sometimes as long as 6 (TESTOPEL label).

How do pellets release testosterone?

The pellets dissolve slowly in the subcutaneous tissue. About one-third of the implant is absorbed in the first month, one-fourth in the second, and one-sixth in the third (TESTOPEL label).

In a 1990 crossover study of 43 men with hypogonadism, total and free testosterone peaked at the first month and stayed in the physiologic range for 4 to 6 months, depending on the implant dose (Handelsman 1990). The pattern is an early peak, then a decline.

Convenience and dose flexibility

After insertion, you do not take a daily gel or give yourself regular shots.

The first-month absorption is higher than later months, so levels rise and then fall over the implant's life. Injections and gels also rise and fall; pellets do that on a months-long scale.

If testosterone needs to be stopped, the pellets have to be removed. Pellet implantation is less flexible for dose adjustment than intramuscular injections (TESTOPEL label).

How do pellets compare with injections?

Testosterone injections let the clinician change the dose and the interval without another implant procedure. Intramuscular testosterone cypionate has a half-life of about 8 days, so levels fall gradually between shots (DEPO-Testosterone label). Gels and injections are the other common routes.

AlphaMD prescribes testosterone injections.

Who uses testosterone pellets?

In men, testosterone therapy is for testosterone deficiency: symptoms or signs plus two early-morning total testosterone results below 300 ng/dL (AUA 2018, statements 1 to 3). The TESTOPEL label also requires two morning levels below the normal range before starting (TESTOPEL label). Safety and efficacy have not been established for age-related hypogonadism.

Exogenous testosterone should not be prescribed to men who are currently trying to conceive (AUA 2018, statement 23, Strong, Grade A).

Androgens are contraindicated in men with breast cancer or known or suspected prostate cancer (TESTOPEL label).

In women, the only evidence-based indication for testosterone is hypoactive sexual desire disorder (HSDD). There are not enough data to support testosterone for other symptoms or for disease prevention (Global Consensus 2019). AlphaMD offers testosterone therapy for women as cream, gel, and injectables.

What are the main risks?

Pellets share the class effects of testosterone and add implant-site problems. Post-marketing reports include implant-site infection (cellulitis and abscess) and pellet extrusion (TESTOPEL label). The label does not give a reliable rate for those events.

Testosterone can raise blood pressure. In 2025 the FDA added an increased-blood-pressure warning to every testosterone product (FDA 2025; TESTOPEL label).

Hematocrit (the share of your blood made of red cells) should be checked before starting and on treatment. A hematocrit of 54% or higher on treatment warrants intervention, with a dose review first (AUA 2018, statement 11 and Table 8).

Bottom line

Pellets are small testosterone implants that last about three to six months. Levels typically peak in the first month and then decline. They avoid daily dosing. The tradeoff is an office procedure and less room to change the dose later. Injections can be changed more often. For women, AlphaMD offers cream, gel, and injectables. A licensed clinician decides whether testosterone is appropriate.

AlphaMD provides testosterone replacement therapy with injections, prescribed by a licensed clinician.