Testosterone Replacement Therapy with Pellet Protocol
TRT pellet preparation
Once the decision to try testosterone replacement pellet therapy has been made, discussing details intrinsic to pellet implantation is essential. To begin, pellet implantation requires an incision with a small stab to introduce the pellets under your skin. This procedure can be performed using a local anesthetic or numbing solution to minimize discomfort. Regardless, pellet implantation is a minor procedure that does require some preparation and planning. First, it is important to take precautions to minimize swelling and the risk of infection. Both of these side effects associated with a procedure may increase your discomfort and compromise the efficacy of your pellets. As such, you must discontinue any medications and dietary food products that may increase your chance of blood thinning for at least one month before your procedure. Blood thinners can promote blood oozing into the surgical field where trocars are inserted to implant the pellets.
The most common medications that may cause blood thinning to include aspirin products, otherwise known as NSAIDs, and multivitamins, fish oil. Dietary restrictions should include avoiding almonds and restricting the eating of fish that naturally contain fish oil. Another essential precaution is to avoid any risk factors for getting an infection, including avoiding active infections that may present with symptoms of a cough, ear aches, or pain during urination. If you have an active infection during your procedure, the bacteria may enter your bloodstream and travel to the newly created surgical field. This means not partying and keeping your distance from others for at least two weeks before surgery. More critical is to avoid smoking for at least one month before your procedure since the nicotine found in cigarettes is the most recognized risk factor for getting an operative infection. In addition, you may have some discomfort, especially over the first few days after your procedure. As such, you must arrange to have your procedure done at the end of the day or week to have ample time to recover. Finally, although pellet implantation is a minor procedure, having a significant other give you a ride is prudent as you might get the jitters from the numbing medicine used to complete your procedure comfortably.
TRT pellet implantation procedure
Your testosterone pellets are commonly placed in your upper arms or upper buttock lower back region. It requires a small stab incision for pellet implantation, so it must be performed under sterile conditions. The procedure starts by prepping and draping the area, limited to a 3 x 3 inch squared area. 8 to 12 oval pellets are typically placed using a small caliber trocar. The pellets are limited to two in number through each trocar tunnel. Limiting the number of pellets per tunneled track avoids overlapping pellets that can bump and even damage each other. This mechanical damage to pellets in line is akin to a train accident resulting in train cars smashing each other! It is prudent to draw a map of the proposed tunnels that can be 4 to 6 in number and positioned radially and evenly dispersed like the spokes of a wheel. Limiting the number of pellets placed in each tract is also prudent so that the most proximal pellet is still positioned away from the stab incision, thus minimizing the risk of extrusion. After mapping your trocar tunnels and prepping and draping the surgical field, 20 to 40 cc of 1% lidocaine with epinephrine is infiltrated into the area to achieve complete anesthesia. The stab incision is then made through the skin into the deeper layer of the subcutaneous fat from which the pellets are delivered.
Aiming trocar along the mapped tunnels, the cannula is first delivered with the piston engaged and angled 15 to 30 degrees to the skin surface. This angulation ensures that the pellets are implanted into the deep fat. Once the trocar and piston have been fully inserted, the piston is removed, and the pellets are dropped into the trocar lumen. Next, the piston is re-engaged, and the pellets are deposited by simultaneously withdrawing the trocar and pressing the piston down. A similar procedure is performed for the proposed tunnel using the map of the markings. To minimize the risk of expulsion, the stab incision is closed with one or two absorbable stitches, and the repaired incision is covered with a surgical tape called a Steri-Strip.
Post Testosterone replacement pellet therapy
Immediately following the placement of your testosterone pellets, you will experience minimal discomfort since the numbing solution will provide you comfort for at least two to four hours. On the evening of your surgery, you may feel some discomfort from your procedure since there will have been some trauma to your tissues. This pain is tolerable and can be managed with Tylenol. Patients are also provided a limited 24-hour course of antibiotics to manage discomfort. Since you have had a small break in your skin, you must avoid sweating, which may result in unnecessary contamination of your wound. In addition, you may wish to limit your physical activity to minimize stretching of the tissues that may irritate your surgical field. You are typically asked to avoid a full shower to avoid wetting your incision for 48 hours following surgery. Remember that since you have not required general anesthesia and the pellet implantation process is minimally invasive, it is feasible to go to work the next day as long as you don’t have a physically demanding job. Patients may return to total physical activity, consider taking a significant vacation, and have no limitations as early as 72 hours following surgery.
Patients will typically feel the effects of testosterone augmentation as early as two weeks following surgery. Improvements will first include an increase in energy and better sleep. This will be followed by improvements in libido and strength typically observed within one month. Weight loss resulting from loss of fat mass and increase in strength from a gain in lean muscle mass will be observed after three months. Your testosterone levels will be typically reassessed at one month to verify enhanced levels and to ensure that testosterone levels are not too elevated. The next test of your testosterone levels will be completed approximately one month before your net pellet implantation, typically scheduled at 5 to 6 months.