Testosterone Pellet Use in Transgender Men

Purpose: We assessed the efficacy and short-term adverse effects of testosterone pellet use in transgender men to broaden therapeutic options.Methods: We conducted a retrospective study of 30 transgender men who started testosterone pellets between 2018 and 2020.Results: Testosterone pellets were started at dosages 675-825 mg per cycle and dose was adjusted according to testosterone levels obtained 1 to 6 months post-testosterone pellet insertion. Pharmacokinetics of testosterone pellet in transgender men was similar to those in cisgender men. Total testosterone levels reached a peak in 1 month and remained in the therapeutic range for similar to 4 months in the range of 300-800 ng/dL. After switching over to testosterone pellets, 100% of patients continued to achieve amenorrhea and deepening of their voice. Most of the patients noticed increased hair growth in androgen-dependent regions (96.3%) and improved libido (70%). Adverse events were notable for a rate of polycythemia that was unexpectedly high at 46.67%. Pellet extrusion was found in 13.33% of patients. There was a low rate of pellet site hematoma (6.67%) and cellulitis (3.33%). No thromboembolic or cardiovascular events occurred in any of the patients.Conclusion: This study reveals that testosterone pellets are a reasonable alternative to other testosterone modalities in transgender men but would use caution in patients with a history of polycythemia or higher risk for thromboembolic events.

Automated summary

This study evaluated the efficacy and adverse effects of testosterone pellets in transgender men and found that they are a reasonable alternative for hormone therapy. Testosterone pellets provided desired effects such as amenorrhea, voice deepening, increased hair growth, and improved libido. Adverse effects included polycythemia, pellet extrusion, hematoma, and cellulitis, but no thromboembolic or cardiovascular events were observed.