Which Testosterone Option Is Right For You? Dr. Mistry Explains Injections, Pills, Pellets, and Creams

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee talk about the many different options for testosterone supplements. Many patients come to us with bad experiences on testosterone and don't realize that there are several different types of hormone therapy available to them. The most commonly used method is testosterone injections, and these can be self-administered or given in the clinic either directly into the muscle or subcutaneously. This is a solid and affordable option for many people. For those wanting to avoid needles, there are pills, creams, and pellets! Testosterone pills are often used for younger patients who need to avoid the impact hormone therapy can have on their fertility. Testosterone creams can be a great alternative to shots or pills and can be applied directly to the skin. The nasal gel Natesto is applied in the nostrils to prevent messy transference, which can be a concern for cream users. Finally, there are testosterone pellets. At NAU Urology Specialists, we use high-quality BioTE branded pellets which are inserted into a small incision in the skin (usually the buttocks) and slowly absorbed by the body over several months. 

Hormone therapy can be incredibly helpful for so many men and women, and we want to ensure our patients have options that work for them. If you or someone you love is interested in or already on testosterone treatment and would like to learn more about these options, please give us a call today! 

This episode was previously aired on 8.21.21. Don’t forget to like, subscribe, and share us with a friend! As always, be well!

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Welcome to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: Hello, everyone. Welcome to the Armor Men's Health Hour. I'm Dr . Mistry, your host, with my co-host Donna Lee, professional comedian .

Donna Lee: That's right. I'm ready to get back to the comedy world. So let's do it.

Dr. Mistry: I'm doing a set. I'm, I'm making a set in my mind. I think I'm going to do a set on...

Donna Lee: Penises.

Dr. Mistry: No, no, no. I have, I have six children, so that should be enough. A lot of those comedians do that.

Donna Lee: Yeah . And four of them have penises.

Dr. Mistry: OK. Well today, I'm a board certified urologist. My last name is Mistry: M-I-S-T-R-Y. This show is brought to you by the urology group practice started in 2007, NAU Urology Specialists, based out of Austin, Texas.

Donna Lee: Mhmm. The most expensive city in the world to live in.

Dr. Mistry: Is it?

Donna Lee: It's like at the very top two , I think. New York and Austin.

Dr. Mistry: Man.

Donna Lee: But everybody's still moving here.

Dr. Mistry: We've beat California again.

Donna Lee: We're number two.

Dr. Mistry: ...in the worst reason. Our practice is the second biggest urology group in Austin, which means that we try a little harder.

Donna Lee: On the weekends .

Dr. Mistry: [Inaudible] style. If you are looking for a, a unique perspective on your men's health condition, whether it be an enlarged prostate, low testosterone, whether it be management of kidney stones, a diagnosis of prostate cancer, or bladder cancer, kidney cancer, we are here for you. The talents and techniques of our staff practitioners are amazing. We are here to take great care of you, and in a way that I think is kind of takes your whole body and whole mind into consideration.

Donna Lee: That's right. We take a look at the whole body because we care and we want you to start holistically. Then we're shooting you over to surgery. I'm just kidding.

Dr. Mistry: I am a surgeon.

Donna Lee: He does like surgery.

Dr. Mistry: As a urologist, we do train in surgery for six years. Interestingly enough, that was my training. So even though it may seem like a lot of the things we deal with are kind of simple, like vasectomies and kidney stones and enlarged prostates, where you treat a lot of, you know, things with medicines, most of our training in fact, is in the operating room , because it takes a long time to learn when to operate and when not to operate.

Donna Lee: Right? You're the most supplement, holistic dude though I've ever met who's a surgeon.

Dr. Mistry: Because I know that it's not, you know, knives don't solve all problems.

Donna Lee: Yeah. But most of you surgeons like to make sure knives solve problems. So I'm impressed that you'll tell a patient, "Hey, why don't we start with a supplement and some physical therapy. We're going to fix you right up."

Dr. Mistry: We can't fix everything with, with surgery.

Donna Lee: Correct.

Dr. Mistry: We are open to see you as a patient. And we'll get to a really interesting topic here in a moment. But Donna, how do people get ahold of us?

Donna Lee: You can call us during the week at (512) 238-0762. You can ask for me, my extension is 220. If you want to leave a voicemail or a question there. Our email address is armormenshealth @gmail.com , where you can send your incredible, insightful questions that will certainly help other people, just like you. And our website's armormenshealth.com. You can listen to our podcast, by the way. I bet I've been saying forever that we won awards and we finally won some awards: second best sexual health podcast...

Dr. Mistry: We are number two!

Donna Lee: ...for feedspot.com, and we're also the second best men's wellness podcast. And we're in the top 30 of prostate podcasts.

Dr. Mistry: Well, that's awesome.

Donna Lee: Yeah. Good job , Dr. Mistry.

Dr. Mistry: So this week I thought I'd talk about alternative forms that patients may not think about when it comes to getting their testosterone.

Donna Lee: Oh, okay.

Dr. Mistry: And this, what leads me to believe this is that I recently had a patient, he was pretty young, 36 years old, and he was giving himself testosterone every day, 0.1 or 20 milligrams, 0.1 CC's sub-q injection.

Donna Lee: Every day.

Dr. Mistry: And, he, when he made the comment was, was that...

Donna Lee: He's exhausted.

Dr. Mistry: ...that he's the only one that he knows that does that. And I was like, "We have a few hundred that give themselves daily sub-q injections."

Donna Lee: Oh, I thought it was more weekly, but people can do it daily.

Dr. Mistry: That's right. So , when, when people come to us for advice on how to administer testosterone, we've talked a lot on this show about when and how and where people decide that they want testosterone. But let's say that decision's already been made, or let's say you're already on testosterone. A lot of people take creams because they don't like needles. And so the creams are done daily. They're often covered by insurance. If they're not, we can usually get you a compounded cream for about $40 to $60 a month. The good things about creams is there's no injections and it can give you a little bit of testosterone every day, but the bad parts of creams are that they're not always absorbed and some people worry about transference, whether to a partner or to a child. We also have a really cool cream that's put in the nose called Natesto, although...

Donna Lee: It's like a gel?

Dr. Mistry: It's a gel that's put into the nose. And why do we put it in the nose? Well, it doesn't transfer unless somebody is picking your nose.

Donna Lee: Or you're sneezing on someone.

Dr. Mistry: You can pick your friends and you can pick your nose, but you can't pick your friend's nose...especially if they have Naesto in there. Another cool thing about Natesto is that in , in studies it's been shown to not affect sperm production, which is a common side effect of testosterone. And so in our younger guys who are trying to keep their fertility, Natesto becomes an option. So if you're out there and you've been given no options, then that may be an option for you.

Donna Lee: Why doesn't it affect sperm?

Dr. Mistry: Something about how it gets absorbed. When it gets absorbed through the nasal passages, it seems to be doing less of an impact on the brain function that leads to sperm function. So it's a more complicated answer, but the answer is it hasn't, has shown to have less of an impact.

Donna Lee: What a nice option for guys that are in their thirties trying to have babies.

Dr. Mistry: And sometimes the cream is put on the inner thighs or on the scrotum or under the armpits. These also reduce the likelihood of transference. By far and away though, the most common way that people get testosterone in our clinic is going to be through injections. We teach you how to inject yourself because we don't need you in our office every week getting injected. Although a good hundred people come into our office every week to get injected.

Donna Lee: They just can't do it themselves.

Dr. Mistry: We do that for about $15 an injection, so it's cheaper than most people get. We don't usually charge your insurance because insurances sometimes don't pay for it. So if you're interested in injection therapy in the office, we can offer that. It cost between $15 and $25, whether you bring them medicine yourself or you use ours. Then we have , have sub-q injections which I talked about earlier. This is right under the skin instead of the muscle. So if you've been injecting into your muscle and been having pain or swelling or discomfort or anything that you think is happening because you're injecting the muscle, the sub-q injection can be less traumatic for you. Benefits are that you get less of highs and lows with your amount. So if you only inject once a week, you can go real high and then real low. If you're injecting less often than once a week, then that I think that the, you're spending the last four or five days of your cycle completely without testosterone. It just doesn't, it just gets out of your system too quick. So daily sub-q injections, it doesn't cost very much. We think that testosterone injection therapy costs less than maybe $40 bucks a month, $30 bucks a month with the needles. So if you're interested in that kind of approach , we can do it. One of our most popular ways of doing it is through pellets. Pellets are inserted every six months and that insert it and forget it kind of option.

Donna Lee: Right. That's for men every six months. For women...

Dr. Mistry: Every six months. For women, it's every three months. And it costs $300 bucks for women and $600 bucks, $650 bucks...

Donna Lee: It sounds like a big nut, but it's only, what? About a hundred bucks a month.

Dr. Mistry: It's not that much, and for not having to worry about it...

Donna Lee: I said "nut."

Dr. Mistry: I don't know why. It also gives you a more stable level. There's less ups and downs. So if you suffer from high estrogen levels or high red blood cell counts from previous testosterone efforts, then the pellets may help reduce those, the likelihood of that happening. We then offer a couple of really new, cooler options that if you've never been offered, you should come and let us know. There's a pill called Jatenzo.

Donna Lee: Jatenzo.

Dr. Mistry: Jatenzo. And there's an injection called Xyosted. The Xyosted injection is nice because it's prefilled, so you don't have to like muck with like filling a syringe, like, like a mad scientist, if you don't wanna do that. And then Xyosted is a pill, and these are both FDA approved. Insurances pay for it varyingly. So, you know, when you come in and want to try one of these things, we can certainly try it. If we have other pill options too , that can increase your testosterone. We use those almost exclusively in fertility patients or in younger patients that are looking to not mess with their own, you know , inherent testosterone metabolism. So you should know out there that testosterone replacement therapy or hormone therapy is not just a one size fits all or limited choice option, especially if you've kind of approached this topic in the past. We have a lot of options. We can usually find one that works great for you, both within your budget, as well as your biologic needs, as well as kind of your own personality needs. I really think that's great. And BioTE is the type of pellet that we use. We have thousands of patients that have tried BioTE over the years. Our repelleting rate is generally very good, meaning that patients satisfaction can be over 85% to 90%. For select patients now, we're offering a pretty good deal. On your first set of pellets, instead of $600 bucks, it's a hundred bucks. So if you're interested in maybe trying the pellets , we're doing this in an effort to see if, you know, if you like them , then maybe you'll, you'll get them, you know, and pay for them . That's really our hope.

Donna Lee: Again, we don't make enough money because we don't charge people things.

Dr. Mistry: But , but the , the BioTE pellets are something that we've have seen a lot of people be very happy with. So if you've kind of thought about it, then let us know. If you're getting pellets elsewhere, but they don't have a name, you know, like a , like a branded name, then they could be just what we call compounded pellets , which we stopped using many years ago because of a lack of consistency in how they're made. We've been very pleased with the product that we get. And we would encourage you to , you know , always seek for a better standard of care, especially if it's a chronic care management issue.

Donna Lee: Mhmm. You know why I like my testosterone injection every two weeks.

Dr. Mistry: Why?

Donna Lee: Because I get the most amazing dreams. Like they're super bad-ass .

Dr. Mistry: We should really time when Michael does the laundry with your injection day , and then he'll get lucky every two weeks.

Donna Lee: We'll do a case study on me .

Dr. Mistry: How do people get ahold of us and learn about testosterone options?

Donna Lee: You can call us during the week at (512) 238-0762. You can send an email that comes directly to me, too, and I can, I will always respond to every email regardless of when we can answer it. But our email address is armormenshealth@gmail.com. Our website is armormenshealth.com, and let's do our podcast . They're free and they're everywhere. Thanks, Dr . Mistry!

Dr. Mistry: Thank you, Donna.

The Armor Men's Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.