By Dr. Jennifer Frangos, D.O. Updated November 2026.
Pellets or Injections: The Quick Version
Pellets and injections can both raise testosterone in women, but they behave very differently once treatment starts. A pellet is placed under the skin during an office procedure and releases hormone on its own timeline. An injection is prescribed in amounts a provider can change at the next prescription, based on your labs and how you feel.
Neither method has the backing of the main international guideline on testosterone for women. The 2019 Global Consensus Position Statement says its recommendations do not apply to injectables, pellets, compounded preparations, or any product that pushes blood levels above the normal female range. What the consensus does set is a goal: testosterone levels that approximate what is physiologic for a premenopausal woman. In our view, the better method is the one that makes it easiest to stay near that goal, check it with labs, and change course when needed.
Amazing Meds does not offer pellets. We prescribe testosterone for women as a cream or an injection, chosen by what each woman is comfortable with. That is our bias, and we would rather say it up front. The rest of this page lays out the differences as plainly as we can.
Pellets and Injections, Row by Row
This table compares the two methods on the questions women ask most, whether they are choosing for the first time or are unhappy with what they have now.
| Question | Testosterone pellets | Testosterone injections |
|---|---|---|
| How it is given | Small pellets are placed under the skin through a small incision during an office procedure. | A liquid medication prescribed by a provider, who sets the amount from your labs and symptoms. |
| Can it be adjusted? | Not after placement. In our view, a placed pellet cannot be turned down. You wait for it to wear off. | Yes. Your provider can raise or lower the amount at the next prescription. |
| Can it be removed? | Hard to do. The Menopause Society notes implanted pellets are difficult to remove if a complication arises. The FDA label for Testopel lists implant site infection and pellet extrusion as possible problems. | Nothing is implanted, so there is nothing to remove. Your provider can stop or change the prescription. |
| How levels are checked | A blood test shows where you are, but a high result cannot be lowered until the pellet fades. | A blood test shows where you are, and the result can change the next prescription. |
| How it is usually paid for | Coverage depends on the plan. Aetna’s pellet policy, for example, calls implanted testosterone pellets experimental for menopause symptoms. | At Amazing Meds, provider visits and labs can go through insurance when we are in network. The medication itself is self-pay for everyone. |
| What the 2019 consensus says | Its recommendations do not apply to pellets or compounded preparations. It also advises against any testosterone product, pellets included, that raises levels above the normal female range. | Its recommendations do not apply to injectables either. The same advice against levels above the normal female range names injections too. Its general aim is levels in the premenopausal physiologic range. |
For more on how this route works for women, see our guide to testosterone injections for women.
Why the adjustment row matters most to us
The consensus panel found that testosterone given in physiologic amounts was linked to mild increases in acne and body or facial hair in some women, but not to scalp hair loss, clitoral enlargement or voice change.
A Menopause Society practice review of compounded hormones described implanted pellets as producing marked and prolonged rises in estradiol and testosterone, often far above the normal range. If a lab result or a new symptom says an injectable amount is too high, the provider can lower it at the next prescription. A pellet keeps releasing until it runs out.
The consensus warning covers both methods
The consensus applies the same caution to injections. Besides saying its recommendations do not cover pellets or injections, the panel advised that any testosterone preparation that produces levels above the normal female range is not recommended, and it named pellets and injections in that same advice. An injection given in too large an amount can overshoot just as a pellet can.
That is why we check levels with labs before treatment starts and again during treatment. The goal is to keep each woman in a normal range, or a range suited to her needs, and to catch a level that is drifting too high before it causes problems. With an injection or a cream, a lab result that comes back high can change the next prescription, so the lab work and the ability to adjust go together.
Approval status of each method
Neither option is FDA-approved for women. The FDA-approved testosterone pellet, Testopel, is labeled for males with low testosterone from specific medical causes. Testosterone cypionate injection is also labeled for males. So both are off-label when a woman uses them.
Pellets made by compounding pharmacies are a separate case, because compounded products are not FDA-approved at all. A 2020 National Academies report asked prescribers to limit compounded bioidentical hormones to narrow situations and singled out pellets for safety concerns tied to how they deliver the drug. The consensus statement adds that where no approved female product is available, using a male product off-label can be reasonable as long as levels stay in the female physiologic range.
Already Have Pellets and Thinking About Switching?
A lot of women reach this question after a pellet is already in place. Maybe you felt good at first and less good as it wore off. Maybe side effects showed up and there was no way to dial them back. Here is what moving to a different method looks like with us, with no guessing about doses.
Why women start looking
In our providers’ experience, once a pellet is placed its dose cannot be turned down, and how fast it wears off varies from woman to woman. That can leave some women with a dip in how they feel as it fades.
Parts of that view are backed by published sources. A Menopause Society practice review notes that implanted pellets are difficult to remove if a complication arises, so in practice the pellet stays until it is used up. On how fast they wear off, a 2025 review of compounded hormone pellets pointed to problems with dose accuracy and release consistency, and called the possibility of very high hormone levels a major concern.
Pellets also have supporters. A 2025 chart review from a urology practice reported a minimal side effect profile in women who had pellets placed over several years. Our concern is narrower: once one is in, neither you nor your provider can change what it does.
Labs come before any prescription
We always need labs before prescribing testosterone, whether you are new to treatment or coming off pellets. The consensus statement also calls for a baseline total testosterone level before starting and ongoing checks to screen for overuse.
If you already had blood work done, we accept outside labs up to 180 days old when they include the markers we need. Tell us if you have a pellet in place now or had one recently, so the provider reads your results in context.
What the provider visit covers
The visit happens by telehealth. Expect your provider to ask about:
- When your last pellet was placed and how you felt as it wore off
- Any acne, hair changes, mood shifts or other side effects you noticed
- Your main reason for treatment, such as low sexual desire, and what has changed
- How you feel about needles
From there, the provider decides whether testosterone makes sense for you now, which form fits, and when to start, all based on your labs and symptoms. Your care manager goes over medication prices after that first visit, before anything is ordered. We do not publish starting amounts because they depend on your results.
Good questions to bring
- What did my labs show, and what range are we aiming for in my case?
- How will we know if my level is too high?
- How often will we recheck my labs?
- Can I move between cream and injection later if I want to?
The Third Option: Testosterone Cream
Some women want neither a pellet procedure nor a needle. A cream applied to the skin is the other form we prescribe. It is easy to use. In our providers’ experience it is usually less effective than an injection, which is why we usually suggest injections for women who are comfortable with them. Women who are needle-shy get cream.
Creams come with their own trade-offs. The consensus notes that women who use testosterone are generally using either a men’s product with the dose modified or a compounded therapy. On safety, the same statement says available data suggest short-term transdermal testosterone does not affect breast cancer risk. Cream still goes through the same lab checks as an injection, since any form can push levels too high.
Whichever form you use, it helps to know which changes are expected and which mean a call to your provider. Our guide to testosterone side effects in women walks through them.
Testosterone for Women at Amazing Meds
Amazing Meds is a telehealth hormone clinic treating women in all 50 states. You start with a free call with our care team, then labs, then a visit with a telehealth provider. For visit fees, insurance and medication costs, see the real cost of HRT in 2026. See how Amazing Meds works.
Questions About Switching
Do I have to wait until my pellet is completely gone before switching?
There is no single rule we can give here. The timing depends on your lab results and symptoms, and your provider makes that call at your visit. Please do not try to time a switch on your own.
Will a blood test tell me whether I need testosterone?
Not by itself. The consensus statement says a blood total testosterone level should not be used to diagnose low sexual desire, and that no cutoff level of any androgen can be used for that purpose. Labs are still needed before treatment, to know your starting point.
What is testosterone for women actually proven to help?
According to the consensus, the only evidence-based reason to prescribe testosterone to women is hypoactive sexual desire disorder, meaning low sexual desire that causes distress. Claims about other benefits have less support.
Is a testosterone pill an option?
The consensus panel does not recommend oral testosterone, because it is associated with adverse lipid profiles. At Amazing Meds, testosterone for women is prescribed as a cream or an injection.
How long has testosterone for women been studied for safety?
The consensus says long-term safety has not been established, and safety data for physiologic doses do not go beyond 24 months of treatment. That is one reason ongoing lab checks matter.
What should I do if I stop treatment and my symptoms come back?
Talk with your provider before restarting anything or booking a new pellet elsewhere. Symptoms such as low desire or fatigue can have more than one cause, so expect fresh labs and a conversation about your goals. The consensus also advises that testosterone be stopped if a woman sees no benefit, so whether it helped the first time is part of deciding whether to start again.
Sources
- Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666.
- Stuenkel CA. Compounded Bioidentical Hormone Therapy: New Recommendations From the 2020 National Academies of Sciences, Engineering, and Medicine. The North American Menopause Society Practice Pearl, 2020.
- National Academies of Sciences, Engineering, and Medicine. Prescribers Should Restrict the Use of Non-FDA Approved Compounded Bioidentical Hormones Except for Specific Medical Circumstances. July 2020.
- Wender MCO, Steiner ML, Fernandes CE, et al. Compounded hormonal pellets: a critical review of current evidence and risks. Rev Assoc Med Bras. 2025;71(7):e20250121.
- DailyMed. TESTOPEL (testosterone pellets) prescribing information. U.S. National Library of Medicine.
- DailyMed. DEPO-Testosterone (testosterone cypionate injection) prescribing information. U.S. National Library of Medicine.
- Hernandez BS, Saffati G, Lowrey KA, et al. Long-term testosterone pellet insertion in women with low libido shows no evidence of erythrocytosis and a minimal side effect profile. Transl Androl Urol. 2025;14(7):1842-1848.
- Aetna. Clinical Policy Bulletin 0345: Implantable Hormone Pellets.
This page is for education only. Talk with a licensed provider who knows your health history before starting or changing treatment. Testosterone is not FDA-approved for use in women, and any decision to start, stop or change hormone therapy should be made with your provider based on your labs and symptoms.