The testosterone patch is barely an option anymore in the US. Androderm, the only FDA-approved transdermal testosterone patch, was discontinued in 2023. That leaves testosterone pellets as the main long-acting alternative to daily gels or weekly injections.
Low energy, fatigue, reduced muscle mass, and low libido are the usual reasons men look into testosterone replacement therapy at all. Exogenous testosterone, meaning testosterone that comes from outside your body rather than your own production, can be delivered several ways. This article breaks down how pellets actually work, what the research says about their risks, and where patches (and their estrogen counterparts, still used in women's hormone replacement therapy) fit into the bigger picture of testosterone therapy today.
How Testosterone Patches Used to Work
Applied Nightly, Dosed in Milligrams, Not Months
Testosterone patches like Androderm delivered a steady 2 to 6 mg of testosterone per day through the skin, usually applied once nightly to the back, abdomen, thighs, or upper arms. Peak levels showed up 6 to 8 hours after application, closely following the body's natural daily testosterone rhythm.
Dosing could be adjusted in days, not months. If labs came back too high or too low, a provider could bump the strength at the very next patch.
The One Real Advantage: It Reversed Fast
Patches had one clear edge over pellets: reversibility. According to PubMed, a pharmacokinetics review in Translational Andrology and Urology found testosterone levels dropped back to baseline within about 24 hours of removing the patch. Pellets offer no such off-switch. Once inserted, you're committed to whatever dose is under your skin until it dissolves months later.
That fast reversal made patches a reasonable option for men who wanted to stop or adjust therapy quickly, such as those managing side effects or planning a pregnancy.
Testosterone Patches Are Almost Impossible to Find in the US Now
Androderm, the Only FDA-Approved Patch, Is Gone
Androderm was the sole FDA-approved testosterone transdermal patch sold in the US. AbbVie, through its subsidiary Allergan, stopped making it in early 2023. No generic version was ever approved, and no other manufacturer has stepped in to fill the gap.
The American Society of Health-System Pharmacists listed the shortage as permanent, not temporary. So if a provider brings up "the patch" as an option, they're likely talking about compounded testosterone creams or gels applied to the skin, not an actual adhesive patch.
Even When Available, Patches Caused Skin Reactions in Nearly Half of Users
Skin irritation was always the patch's biggest weakness. According to PubMed, a pharmacokinetics review in Translational Andrology and Urology found that combined clinical trial data put application-site reactions at roughly 48%. Itching was the most common complaint.
That same review found gel formulations caused far fewer skin problems than patches did. This is part of why gels largely replaced patches even before Androderm disappeared. When Androderm was still on the market, it was applied to dry skin on the lower abdomen, back, or upper arm, with a new patch needed every single day to keep dosing steady in daily life.
You've probably felt an adhesive bandage get itchy after a day. Now imagine wearing one, in the same rotation of spots, every single day for months.
How Testosterone Pellets Actually Work in Hormone Replacement Therapy
A Trocar Places Pellets Under the Skin in a Minor Surgical Procedure
Pellets are small, rice-grain-sized cylinders of crystallized testosterone. A provider numbs the hip area or upper buttock with local anesthetic. Then a hollow needle called a trocar inserts several pellets under the skin through a tiny incision. This minor surgical procedure is done in-office, not in an operating room.
The whole visit typically takes 10 to 15 minutes. No stitches are usually needed. Most men have 6 to 12 pellets placed at once, depending on their dose. Unlike subcutaneous injections, which need to be repeated weekly, pellets sit in place and slowly release hormones into the bloodstream over several months through continuous release.
Pellets Spike High Early, Then Fade Toward the End of the Cycle
Pellets don't release hormones in a flat, even line. According to PubMed, a randomized trial in Sexual Medicine comparing a branded pellet (Testopel) to a compounded version found testosterone levels were similar between the two. But both climbed fast after insertion and then dropped over time.
In that same trial, 82% of men had fallen below 300 ng/dL, the low end of a typical treatment target, by the end of the six-month window. That's the tradeoff with pellets: fewer visits, but an uneven ride from peak to trough instead of a steady weekly dose.
Testosterone Patch vs Pellets: Side by Side
| Factor | Testosterone Patch | Testosterone Pellets |
| Current US availability | Effectively unavailable (Androderm discontinued 2023) | Available, FDA-approved (Testopel) or compounded |
| Dosing schedule | Daily application | One procedure every 3 to 6 months |
| Ability to adjust dose | Easy, next application | Difficult, must wait for pellet to dissolve |
| Hormone curve | Relatively steady day to day | High early peak, gradual decline |
| Main risks | Skin irritation, dermatitis | Elevated hematocrit, extrusion, infection |
| Procedure required | No | Yes, minor in-office insertion |
With both methods on the table, here's where the real tradeoffs come in, starting with the risks.
The Risks Come First: What Pellets Can Do to Your Blood and Skin
Elevated Red Blood Cells Raise Clot and Cardiovascular Risk
Testosterone therapy in general can raise hematocrit, the percentage of red blood cells in your blood. Pellets are more likely to push levels into a supraphysiologic range because of that early spike. According to PubMed, a study in the Journal of Urology found men who developed secondary polycythemia on testosterone therapy had a 35% higher risk of major cardiovascular events or blood clots in their first year of treatment.
This isn't a reason to avoid testosterone therapy altogether. But it is a reason your provider needs to check your hematocrit regularly, especially with a delivery method that spikes early and can't be turned down mid-cycle.
Extrusion, Infection, and Scarring Are Pellet-Specific Complications
Because pellets involve a small incision, they carry risks, patches and gels don't. According to PubMed, a study on testosterone pellet use in Transgender Health reported:
- Pellet extrusion (a pellet working its way back out of the skin): over 13% of patients
- Hematoma at the insertion site: nearly 7% of patients
- Cellulitis: over 3% of patients
Scar tissue can also build up at the insertion site over repeated cycles. None of these risks are unique to any one brand of pellet. They come with the procedure itself.
Compounded Pellets Add a Layer of Uncertainty
Many pellets used in bioidentical hormone replacement therapy clinics are compounded, meaning a pharmacy custom-mixes the hormone dose rather than using an FDA-approved product like Testopel. According to PubMed, a 2025 review in the Revista da Associação Médica Brasileira found that compounded hormonal pellets lack the dosage control and safety oversight that FDA-approved products go through.
That doesn't mean compounded pellets don't work. The Sexual Medicine trial above found compounded and branded pellets performed similarly. But it does mean the quality and consistency can vary more by pharmacy, which matters when you're trusting a single insertion to manage your hormones for months.
The same critical review flagged additional concerns tied to the supraphysiologic peaks pellets can produce:
- Weight gain
- Mood swings
There's a small risk with any hormone therapy, but a provider who knows your medical history can screen for factors, like a history of blood clots or high hematocrit, that would make pellets a poor fit before you ever get to the insertion.
Testosterone therapy is FDA-approved for diagnosed testosterone deficiency, not for mood management on its own. If mood changes are your main concern, that's worth raising directly with a provider rather than assuming a hormone adjustment alone will fix it.
