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Yes, pellets are by far, in my opinion, the superior delivery system, especially for Testosterone. My clinic is one of the largest in Florida and my patients do exceptionally well on pellets. They have several advantages over other treatment modalities. First, they are "fire and forget", that is, once they are in you do not have to worry about daily or weekly administration. Pellets deliver a relatively continuous stream of hormone to the body keeping the serum levels relatively constant over time. Particularly in those individuals who need hormones for physiological balance in addition to overall feelings of wellness, the constant levels provide stronger physiological results (lower sugar and cholesterol levels). Another very overlooked advantage is that pellet patients are in the office 3-4 times a year as opposed to less frequently. For those who are really working on heath, physiologic optimization (sugar and cholesterol), weight and longevity, a personal visit more frequently allows a closer relationship and better long term results. So for may reasons, pellets are superior And isn't it true - you pay more for a Mercedes than you do for a Chevy? Better quality and outcomes often come with a greater cost. Further, the cost of acquisition of pellets is far higher than the costs of materials of any other modality (anything implantable has stricter manufacturing standards and that requires a greater cost of production. In our office, as we build our pricing schedule, we build in the same margin, for all intents and purposes, for all of our modalities. That is, we make the same professional fees, approximately, for a year's worth of pellet therapy and a year's worth of just about any other modality (creams, injection). After all, we are charging for our professional knowledge and decision making and we just add on the cost of the modality to that. Pellets are more expensive because the cost to buy the pellet is more expensive than a cream. I and many of my colleagues are highly trained experts, not only in hormones, but also in wellness and preventative medicine. It is sad that current Insurance standards do not recognize the superior value of this type of treatment. As highly trained experts, many of whom get exceptional results, it is only fitting that we get paid for the extent of our knowledge and the degree of our expertise.

@@Jcarrozzella yeah true, doesn’t mean I can afford a Mercedes. This country is a rip off when it comes to medications, or any medical service with or without insurance. The billing is purposely designed to mislead and the way procedures are estimated is always a low ball. Real bunch of vocational folks.

Well, transference is a real issue. I have had several male patients whose spouses ended up with Testosterone levels well in the 400’s due to inadvertent transference issues. There are multiple literature references to this issue such as: Busse, K. L., and H. I. Maibach. "Transdermal estradiol and testosterone transfer in man: existence, models, and strategies for prevention." Skin Pharmacology and Physiology 24.2 (2011): 57-66. Perhaps “in all the years you have been in this space” have not yet allowed you to have a sufficient experience to have seen all the things that actually happen.

Pellets already a tried and true, longstanding delivery modality. They have been available and used for over 80 years. They are governed by significant FDA restrictions. They are created in 503 be compounding facilities with very close FDA scrutiny. They are composed of FDA approved components: Testosterone, hysteric acid a very meticulously and carefully manufactured. They are but one of many delivery methods. All delivery methods have the pros and cons. In this office, preventative medicine is a very important aspect of the delivery of healthcare. One of the overlooked benefits of pellet-based therapy is that patients must come to the office 3 or 4 times a year for pellet insertion. This allows interaction between the provider and the patient. This interaction allows for closer scrutiny of metabolic parameters, development of a better doctor-patient relationship and clearly over the years that we have been doing pellets in this office, those who have received pellets get far superior preventative medicine outcomes. Not to mention the convenience of "fire and forget" pellet based therapy that allows the patient's not have to worry about daily application of the hormone therapy In terms of cost, the margins on pellets are no different than the margins on any other delivery method. Properly constructed business models will create the appropriate margin for delivery of the service. What makes pellets more expensive is they are more expensive modality because they require physical insertion within the body, and that is typical for anything that is required to be implanted in the body. The fact that it requires added scrutiny to ensure its safety and efficacy adds to the cost of development and liability, thus the base "products" are more expensive when compared to creams or injections, but the margins that the provider makes is basically the same across all delivery methods. In summary, pellets are an exceptional delivery method. Ensure high patient compliance. And the overall outcomes of treatment are superior with pellet based therapy compared to any other delivery modality

No, foam or gel dopes not have a First-pass through the liver. HOWEVER...please note that Biologically Denticle Testosterone, Estradiol and Progesterone have NO ADVERSE EFFECTS due to liver first pass. That is they are SAFE when taken by mouth when compared to the synthetic hormones. The first pass concern is only relevant to synthetic hormones of these types

You are welcome. We like to stay on top of everything Testosterone. And we try hard to make sure that all our patients know and understand exactly, everything we do.

@@Jcarrozzella Just viewed a post on the herb "LEZPODESA CUNEATA". It is showing promise better than TONGAT ALI ???

Is the cream working as good as the injections?

Tim, thank you for the note. Appreciate you stopping by and taking time to review the videos and alert a little bit about hormone therapy. Testosterone is such a wonderful hormone., Obviously everyone knows that it is the "male hormone". However, few people actually realize that testosterone is 1 of most prevalent hormones in women as well. The concentration of testosterone in women far outpaced is that of most of the other sex hormones. The number "looks smaller" because of the different units of measurement, testosterone is present in women in the literature is very strong that it is a very beneficial hormone properly restored in women that have insufficient levels. The good news is that testosterone in women is crucial for energy, focus, brain health, bone health, pelvic health leading to less incontinence with coughing and sneezing, muscle health leading to less falls after the age of 60, reduction of visceral and subcutaneous fat, improvement of sugar and cholesterol metabolism, breast cancer protection, improved sex drive and improve sexual responsiveness. There are many other benefits to testosterone as well. These are all well-documented medical literature. Sadly, the FDA fails to recognize testosterone as an essential hormone for women's health and vitality is the age. Conventional medicine also misses the point. The problem, however, with testosterone is that is indeed an "androgen". As such testosterone may be responsible for oily skin, facial and body hair, acne, change in the voice, change in the hair, and irritability and aggression. These are inherent excess effects of testosterone regardless of the motor administration (pellet, cream, injection, sublingual) the expression of excess effects is largely related to a woman's genetics, the amount of sex hormone binding globulin and other very individual factors. And in every single application of testosterone to a woman there is a balancing effective getting the best benefits noted above and balancing them against any potential excess effects. While it is commonly believed that pellets may provide a greater incidence of excess effects, this is more likely due to ineffective and inappropriate dosing by the provider and not by the modality of administration itself. I have been providing pellet based therapy for nearly 15 years. I have done almost 12,000 inserts, about 60% of those in women. It is always about properly balancing the dose to get an effect against those of excess effects. And the incidence of these problems really is unrelated to the mode of administration and more related to the ultimate dose combined with other genetic and physiological factors. Testosterone pellets happen to be the easiest mode of administration, give the smoothest course of action and provide very high patient's satisfaction. Administering and fine-tuning the other modes of administration can take a great deal of time longer and is subject to absorption across the gut or across the skin which can change from day-to-day.

@@Jcarrozzella Thank you for your well thought out response doctor. I wish you were practicing in my state.

That is a very interesting question. In older men, above the age of 25, we recommend Testosterone Cream on the scrotum. (not gel as it has alcohol in it and it will burn the scrotum - but we do not use gel as the dose is too small). However, I really cannot comment on a 3 year old. I would most definitely defer to the recommendation of an endocrinologist. We generally treat adults over the age of 25.

BigGoronSword- thank you for your input here. I appreciate your enthusiasm for creating a healthy lifestyle! You are right, being flexible and open to new food options is key when trying to create a healthy nutritional program that improves insulin resistance. And after you make those nutritional changes, follow-up with your provider. You want to make sure that those nutritional changes are in fact “moving the needle” toward continued metabolic improvement. Good luck with your health journey BigGoronSword- and thanks again for your comment 😊 - Erin

Hello Devon, thank you for your comment. Certainly, there can be a number of different explanations, however, well over 95% of the time, the cause of persistent uterine bleeding in insufficient Progesterone levels in the blood. As a rule of thumb (yet not 100% of the time), the Progesterone to Estradiol Ratio, should be well in excess of 150-200 to 1. Anything less than that may lead to persistent bleeding. Sometimes a withdrawal bleed is necessary to completely “shed” the uterine lining and then resume progesterone. Sometimes an agent called Lysteda or tranexamic acid can be used to “put a cork in it” and help stem the bleeding. Of course in more advanced and persistent cases a visit to the OB/GYN and a possible uterine biopsy will be necessary. I hope this is helpful for you, and I wish you the best of luck.

@@JohnCarrozzellaMD thank you... you're wonderful.

Steve, thank you for your interest in our UA-cam channel. Pellet-based therapy, a trusted method used in the US for over 80 years, has benefitted millions through its continual advancements. Today's patented Evexias pellet comprises testosterone and its biologically identical form, combined with safe and effective binders like hyaluric acid and methylcellulose for proper function and gradual testosterone absorption. It also contains a low dose of triamcinolone to manage inflammation and scarring. Our office successfully inserts over 200 pellets monthly, with a continuation rate surpassing 90% yearly. This method is particularly helpful for those who often forget to take their medications, providing consistent hormone levels. With over 10,000 pellets inserted personally, I've seen high patient satisfaction and minimal side effects. We are firm advocates of this tried and true method, which continues to deliver high patient satisfaction. We appreciate your engagement and look forward to further discussions.

When testosterone needs to be re-dosed really depends on the modality and the person. Injections can be done from daily up to twice a week for ideal results. Creams are applied daily, sometimes twice daily. And finally pellets are put into place every 10 - 20 weeks depending on the person and their metabolic rate.

@@Jcarrozzella So maybe the endocrinologist is giving me pellets going by the time scale of testosterone treatment methods you gave me. If so are the pellets good?

@@mangmiketeamtaiaha7256 Sorry, but there is no way that I can comment on the quality of an unknown brand of pellets

Not sure I understand, the whole 1 minute video discusses Zinc Glycinate. It is a short hit and not a full detailed lecture. Sorry for the confusion.

a good doctor doesn't treat numbers and he does treat people. so, if someone is "overdosed or under dosed" it might just be because the doctor is doing "his thing" instead of treating the patient. What level a particular patient does best at is the level that the patient does best at. Good hormone specialists search to fine the optimum hormone levels regardless of what the blood sj=lip say (that's because the good hormone docs know what the literature has to say and they apply the literature's principle to the day to day management of patients)

Jennifer, I have been doing BHRT for over 13 years now. Funny, because in the beginning, I thought that weight was the biggest issue post menopause...NOT!!! I now think that the biggest issue women deal with after menopause is hair loss. It is pervasive, many women deal with it, it is multi-multi-multi factorial and it is EXTREMELY hard to get a great result. All too often it is blamed on Testosterone and DHT, but IMO, it is not that simple. Yes, the SIMPLE cases of increased hair loss at the start of BHRT may be related to T and DHT and a T blocker such as spironolactone can be miraculous. However, far more often than not, the hair loss is a factor of telogen effluvium (rapid hair loss due to the reactivation of baseline metabolism) and can be related to issues of nutrition, micronutrients, thyroid, genetics, scalp health, the type of shampoo one uses and so many other factors. These underlying issue must be addressed. You know, as dramatic as hair loss in women can be, in all of this time and hundreds if not several thousand women patients, I think I have only seen less than 10 stop therapy because of hair loss. So, the bottom line is, you need a doctor who knows the complexity of hair health and you ultimately need to sit down and decide, what is more important, my hair or my long term health. Now I am not saying it is a one or the other decision, but the balance of which one is more important is certainly something that each patient with a hair issue may ultimately need to address.

@@Jcarrozzella thank you for responding, I appreciate all your expertise and I have learned a lot from your videos I definitely need my hormones that’s for sure, can’t imagine life without them

Michelle, that is great news!! Keep on the BHRT. As my mentor says, as long as it is working and doing good things for you, you only have to stop when you are 110!!

Chris, I am so sorry that you are have such medical issues. Goodness!! It looks like you have several issues here that need to be addressed. I want to be clear, that the issues you have may require the attention of a medical specialist. So, please make sure that your headaches and blood pressure issues are checked out. In this forum, I really cannot address any specific and personal medical needs. However, as it relates to some of the hormone specific questions you mentioned, I will endeavor to address those. First, continuous use of Testosterone may in fact lead to an elevation of the blood count. This is a benign condition known as “physiologic erythrocytosis”. It is very simply a normal healthy response of the body to an increased need for oxygen carrying capacity. No properly done prospective study has ever shown the harm in the increase of the blood count in response to Testosterone therapy. Far too often, physicians who are not experts in hormone therapy and who have not read the extensive body of literature on this topic will confuse this healthy response of the body (quite similar to the production of red blood cells when people live or work at high altitude elevations) with a dangerous medical condition known as Polycythemia Vera. In deed PV is a very dangerous blood cancer that leads to an increase of all of the elements of blood (Red Cells, White Cells and most importantly platelets). This increase, particularly in platelets is indeed responsible for an increase in blood clotting and stroke. Again, Physiologic Erythrocytosis in absolutely NOT a dangerous condition and has nor known connection to adverse outcomes. Physiologic Erythrocytosis does NOT require regular phlebotomy (drawing off excess blood) In addition, the proper prescription of Testosterone will lead to an improvement of cholesterol parameters. And this effect is linear, meaning that the higher the level of Testosterone, the more positive effect on the cholesterol/lipid profile. In fact the effect is so profound that testosterone will lower the risk of cardiovascular disease even in men with the most sever forms of heart disease. This is clearly demonstrated in one of my favorite studies of Testosterone on cardiac outcome in men with known severe cardiac disease: doi.org/10.1016/S0735-1097(16)32098-8 Finally, PCSK9 Inhibitors are exceedingly expensive medications that have questionable value. While there are some studies in the US that show MODEST improvement, emerging literature shows that the modest benefits of these medications may be far outweighed by the downside: (doi.org/10.1080/17512433.2020.1787832 ). Of all of the medications studied for the reduction of cardiovascular disease, Testosterone, by far shows the greatest benefit. Chris, so yes, there is REAL research out there, you just need to find a provider who knows, understand and has experience with the current medical literature.

While Zinc has so many positive properties in hormone balance and immunology, so far the results of Zinc n relation to the benefits for UC have been mixed,

Hi Danny! Thank you for your question. Is a testosterone level of 370 normal? Yes, 370 is "normal" for a 52-year-old male (meaning it falls in the normal range on a lab slip - are you a lab slip? Didn't think so...lol). And yes, it is normal for most 52-year-old men to feel decreased libido, erectile dysfunction, decreased muscle mass, irritability, fatigue and decreased sense in overall wellness. However, your second question is more important... what would make you optimal= meaning increased libido, improved sexual function, motivation, confidence, decreased visceral fat, and increased energy. Well, everyone is different and your optimal level is going to be unique to you. At our clinic, most men tend to feel great when their testosterone levels are between 1500-2000. With that being said, that may not be where you feel best. We have men that are below that range and we have men that are above that range. We treat the patient (and their symptoms), not just their lab values. When patients first come to our clinic, their questionnaire scores tend to be very high, meaning they have symptoms that would indicate the need for hormone optimization therapy. As we optimize your hormones, your self-assessment scores will improve, letting us know that we have found hormone levels that are exactly right for you. When your hormones are optimized, that will not only allow you to experience healthy aging and vitality, but also to do more with the time that you have.

To the extent that zinc optimization improves testosterone production, it may be. However, generally, zinc is not necessarily a supplement for sexual dysfunction. To my knowledge, the strongest direct influencers of sexual dysfunction (other than hormone optimization) are Nitric Oxide supplements. We recommend the NEO 40 (only available in doctor's offices) and Affirm. Each one of these supplements increases Nitric Oxide levels (each through a separate and distinct mechanism) and then improves sexual function in both men and women AND enhances the effectiveness of PDE5 inhibitors (like Viagra and Cialis)

@@Jcarrozzella Thanks for your response. What about beetroot extract? Does it provide NO? I heard somewhere that it does. Thanks in advance.

@@honestdudeguru the NEO 40 is a beet root extract. It is the best one that I have tasted (I hate beets!!). This one has a very pleasant raspberry flavor. Bottom line, Beet root has the nitrogen derivatives that will convert to NO.

@@Jcarrozzella But you said the NEO 40 is a prescribed medicine whereas I can get beetroot extract over the counter. Right?

@@Jcarrozzella NEO 40 is available on Amazon. Do you recommend a particular brand?

Yes there are!! And I think it is a tragedy that the good news about BHRT Hormone Therapy is not more widely known as safe and effective. I change lives dramatically on a daily basis and this treatment is literally life changing!! I wish you well. Please let us know if there is anything we can do to help you in your journey.