Testopel
Testopel (testosterone pellets) is an implantable pellet medication used as long-acting testosterone replacement therapy. It treats certain males with low testosterone and delayed puberty. The pellets are implanted, or placed under your skin, by a healthcare professional (HCP) typically every 3 to 6 months. Side effects include pain and swelling at the implantation site, as well as sexual side effects like more frequent erections and changes in sex drive.
What is Testopel (testosterone pellets)?
What is Testopel (testosterone pellets) used for?
How Testopel (testosterone pellets) works
Testopel (testosterone pellets) is a testosterone replacement therapy that acts like the natural sex hormone, testosterone. Testosterone is responsible for the development and maintenance of many male features and functions, such as muscle and bone strength and growth and regulating sex drive and sperm production. Testopel (testosterone pellets) works by raising testosterone to normal and healthy levels in males with low testosterone.
Drug facts
Risks and warnings for Testopel (testosterone pellets)
Testopel (testosterone pellets) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Infection and extrusion at the implantation site
Infections can occur where Testopel (testosterone pellets) is implanted. In addition, there's a chance the pellets can come out of your skin, a condition also known as extrusion. Both of these can happen together or separately at any time, but it's more likely to occur during the first month after implantation. Let your prescriber know if you have a fever, hardening of the skin at the implantation site, swelling, bleeding, bruising, pain, itching, or pellets coming out of the skin, because this might require further treatment.
Risk of blood clots, including heart attack or stroke
- Risk factors: History of heart conditions
Taking testosterone replacement therapy, like Testopel (testosterone pellets), can raise your risk of blood clots. This can lead to problems such as strokes and heart attacks. Your healthcare team will have you perform regular blood tests, called the complete blood count (CBC), to check that your blood cell counts are in the safe range. Get emergency help right away if you have chest pain, cold sweats, left arm pain, difficulty breathing, trouble walking, trouble speaking, or weakness on one side of the body, since you might have to stop taking the medication.
Potential for misuse, dependency, and addiction
- Risk factors: Taking more Testopel (testosterone pellets) than prescribed | Taking Testopel (testosterone pellets) with other testosterones
Testopel (testosterone pellets) is a controlled substance because it has a risk of misuse and dependency, especially if you use higher doses than prescribed or use it with other testosterones.
Continued misuse of Testopel (testosterone pellets) can lead to addiction. The FDA has only approved this medication for the treatment of low testosterone in males. Taking Testopel (testosterone pellets) for other reasons can lead to serious side effects, such as heart attack, heart failure, stroke, depression, hallucinations, and delusions. Only take this medication as prescribed by your healthcare professional.
Prostate problems
- Risk factors: Older adults
Taking Testopel (testosterone pellets) can raise the risk of developing an enlarged prostate, or benign prostatic hyperplasia (BPH), especially in older adults. Let your prescriber know if you experience any changes in your urinary routine, such as more urination at night, feeling like you need to urinate more often or immediately, trouble urinating, accidentally urinating, or urinating slowly.
Testopel (testosterone pellets) can also raise your risk of prostate cancer. Your prescriber might have you perform occasional blood tests and physical check-ups before and during treatment with this medication.
Liver problems
- Risk factors: Using high doses of Testopel (testosterone pellets) for a long time
Testopel (testosterone pellets) might cause serious liver problems that can lead to cancer or death. This is more likely to happen if you take high doses of Testopel (testosterone pellets) for a long period of time. Let your prescriber know if you are experiencing stomach pain, light-colored stools, dark urine, or if your skin or the whites of your eyes turn yellow, because you might need to stop the medication.
Swelling in the legs or arms (edema)
- Risk factors: History of heart, liver, or kidney conditions | Taking other medications that cause swelling
Testopel (testosterone pellets) can cause swelling in your legs or arms and sudden weight gain. It can be more serious in people with heart, liver, or kidney conditions. Talk to your prescriber if you have any of these symptoms, because you might need to stop the medication.
High calcium in the blood
- Risk factors: History of cancer | Taking other medications that cause high calcium in the blood
Testopel (testosterone pellets) can cause high calcium in the blood (hypercalcemia), especially in people with cancer. For people with cancer, high calcium levels might be a sign that the cancer has spread to the bones. During treatment with Testopel (testosterone pellets), your prescriber might have you perform regular blood tests to make sure your calcium levels are within a safe range.
Sexual side effects
Testopel (testosterone pellets) can cause changes in sex drive, either increasing it or decreasing it. The medication might also cause more frequent or prolonged erections. Prolonged erections lasting more than 4 hours, known as priapism, can become serious. If this happens, seek medical help immediately.
Fast bone maturation in children
- Risk factors: Children | Using Testopel (testosterone pellets) long term
Testopel (testosterone pellets) should only be used short term for delayed puberty in children. The medication causes the bones to mature faster than normal, before they're able to grow to their full length. This can result in children being shorter in height, especially if Testopel (testosterone pellets) is taken at a young age. Taking Testopel (testosterone pellets) for long periods of time might also stop bone growth altogether. The risk of this happening is higher in younger children. Your child's pediatrician might take regular X-rays of your child's hand and wrist during treatment to make sure the bones are developing normally.
Side effects of Testopel (testosterone pellets)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Enlargement of male breasts
- Pain or swelling at the implantation site
Less Common Side Effects
- Frequent erections
- Prolonged erections
- Changes in sex drive
- Male pattern baldness
- Acne
- Nausea
- Vomiting
- Bleeding
- Headache
- Anxiety
- Depression
Testopel (testosterone pellets) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain, cold sweats, left arm pain, difficulty breathing
- Stroke: face drooping, trouble seeing, walking, speaking, weakness on one side of the body
- Blood clot in the legs: pain, swelling, warm to touch, redness
- Blood clot in the lungs: trouble breathing, chest pain, cough
- Liver damage: stomach pain, nausea, vomiting, yellowing of the skin, yellowing of the whites of the eyes, light-colored stools, dark urine, weight loss
- Withdrawal: depression, fatigue, craving, restlessness, irritability, lack of appetite, trouble sleeping (insomnia), lower sex drive, low testosterone
More on Testopel (testosterone pellets) side effects
The following Testopel (testosterone pellets) side effects have also been reported
Discuss these possible effects with your doctor:
Tumors of the liver, liver cancer, or peliosis hepatis (a form of liver disease) have occurred during long-term, high-dose therapy with androgens. Although these effects are rare, they can be very serious and may cause death.
Androgens can stimulate existing prostate cancer in men who already have it but have not yet been diagnosed. Also, the prostate (a male gland) may become enlarged. Enlargement of the prostate does not mean that cancer will develop. If enlargement occurs and you have difficulty in urinating, it is a good idea to be checked by your doctor.
When androgens are used in women, especially in high doses, male-like changes may occur, such as hoarseness or deepening of the voice, unnatural hair growth, or unusual hair loss. Most of these changes will go away if the medicine is stopped as soon as the changes are noticed. However, some changes, such as voice changes or enlarged clitoris, may not go away.
When androgens are used in high doses in males, they interfere with the production of sperm. This effect is usually temporary and only happens during the time you are taking the medicine. However, discuss this possible effect with your doctor if you are planning on having children.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
For females only
Acne or oily skin
decreased breast size
irregular menstrual cycles
hoarseness or deepening of voice
increase in size of female genitals
increase in unnatural hair growth or male pattern baldness
These symptoms may occur in females whose male sexual partner uses a scrotal patch.
For males only
Blistering of skin under patch (especially when the nonscrotal patch is applied to bony areas of the skin)
breast soreness or enlargement
frequent or continuing erection of penis lasting up to 4 hours or painful penile erections lasting longer than 4 hours
frequent urge to urinate
itching or redness of skin under patch (less likely with nonscrotal patch) or at site of implants, mild to severe
For prepubertal boys only
early growth of pubic hair
enlargement of penis
frequent or continuing erections
Less common
For males or females
Dizziness
frequent or continuing headache
lack or loss of strength
overall body flushing, redness, or itching of skin
rapidly changing moods, such as depersonalization, dysphoria, euphoria, depression, paranoia, and quick to react or overreact emotionally
swelling of feet or lower legs
unusual bleeding
unusual tiredness
yellow skin or eyes (occurring with fluoxymesterone or methyltestosterone more often than with testosterone)
For females with breast cancer or bedridden males or females—in addition to the side effects listed above
Confusion or mental depression
increased thirst
increased urge to urinate or increased amount of urine
For males only
Black, tarry stools
burning sensation or hardening or thickening of skin under patch
chills
continuing pain at site of implants
difficulty in urinating
itching, skin redness, or rash under patch, severe (less likely with nonscrotal patch)
pain in scrotum or groin
vomiting of blood or material that looks like coffee grounds
Rare
For males or females—more likely with oral androgens or long-term or high doses of androgens
Abdominal or stomach pain, continuing
bad breath odor, continuing
black, tarry or light-colored stools or dark urine
loss of appetite, continuing
mood or mental changes
purple or red spots on body or inside the mouth or nose
swelling, pain, or tenderness of abdomen
vomiting of blood
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
For males and females
Acne, mild
decrease or increase in sexual desire or drive
hair loss or thinning of hair
increase in pubic hair growth
infection, pain, redness, or other irritation at site of injection
nervousness
stomach pain
trouble in sleeping
For males only
Decrease in testicle size
infection, pain, redness, swelling, sores, or other skin irritation underneath patch
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Testopel (testosterone pellets)
Pros
- A long-acting testosterone replacement medication
- Implanted every 3 to 6 months
- Can be used in children and adults
- Unlike testosterone gel, there’s no risk of accidentally exposing others to testosterone
Cons
- Can cause pain and swelling at the implantation site
- Risk of infections or extrusions at the implantation site
- Is a surgical procedure that must be done at the prescriber's office
- Dose adjustments are difficult since they require surgical removal or addition of pellets
Pharmacist tips for Testopel (testosterone pellets)
- The procedure to implant Testopel (testosterone pellets) can be quick, lasting about 15 minutes.
- Testopel (testosterone pellets) can cause some pain and swelling at the site of implantation, especially after the first few days. Ice the area for 20 to 30 minutes every hour as needed. If it doesn't get better, let your prescriber know - you might need to take something for the pain.
- Testopel (testosterone pellets) can often cause the breast area in males to become bigger, painful, or tender. This might continue throughout treatment with this medication. Let your prescriber know if this becomes bothersome.
- Testopel (testosterone pellets) can lower your blood sugar. If you have diabetes, you might need to check your blood sugar levels more frequently. Know how to manage low blood sugar.
- Testopel (testosterone pellets) can lower sperm count. This might affect your ability to have a baby and raise the risk for infertility. Let your healthcare team know if you're thinking of having a baby before you start this medication so they can talk with you about family planning options.
- Taking Testopel (testosterone pellets) together with blood thinners like warfarin (Coumadin) might cause you to bleed more easily, so you might need to get your blood clotting time (INR) checked more often. Let your prescriber know if you experience bleeding that takes longer to stop, bruising, blood in your urine, or dark stools, as your dose might need to be adjusted.
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Testopel (testosterone pellets) dosage
Typical dosage for Testopel (testosterone pellets)
The dose of Testopel (testosterone pellets) depends on your age and condition being treated. Your prescriber might change the dose based on your response to the medication and how well you tolerate it.
- Low testosterone: The typical dose is 150 mg to 450 mg implanted under the skin every 3 to 6 months.
- Delayed puberty: The typical dose varies. Generally, the dose is lower than the dosing range for low testosterone and should be given for a shorter duration, about 4 to 6 months.
Interactions between Testopel (testosterone pellets) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acenocoumarol
- Anisindione
- Atorvastatin
- Bupropion
- Dicumarol
- Fluvastatin
- Lovastatin
- Paclitaxel
- Paclitaxel Protein-Bound
- Pexidartinib
- Phenindione
- Phenprocoumon
- Warfarin
Testopel (testosterone pellets) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Testopel (testosterone pellets) will not be safe for you to take.
- Males with breast cancer or prostate cancer
- Currently pregnant
What are alternatives to Testopel (testosterone pellets)?
