Hormone Pellet Therapy

Hormone pellets are the most natural way to deliver hormones in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of bio-identical hormones providing optimal therapy. After pellets are inserted, patients notice that they have more energy, sleep better and feel happier. Muscle mass and bone density increases, while fatty tissue decreases. Patients notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory improves as well as overall physical and sexual health.

What are Pellets?

Pellets are made up of either estradiol or testosterone. The hormones, estradiol or testosterone, are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice and smaller than a Tic Tac. In the United States, pellets are made by a compounding pharmacist and delivered in sterile glass vials.

Why pellets?

Pellets deliver consistent, healthy levels of hormones for 4-6 months. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. It is the fluctuation in hormones that causes many of the unwanted side effects and symptoms a patient experiences. Estrogen delivered by subcutaneous pellets, maintains the normal ratio of estradiol to estrone. This is important for optimal health and disease prevention. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy. In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance. Even patients who have failed other types of hormone therapy have a very high success rate with pellets. In addition, there is no other method of hormone delivery that is as convenient for the patient as pellets.

How and where do you insert pellets?

The insertion of pellets is easy, quick, and relatively painless. A small area on the hip is sterilized and local anesthetic is injected just under the skin. A tiny nick is made in the skin and, using a trocar, the hormone pellets are inserted under the skin. The tiny incision is closed with adhesive strips and covered with a band-aid.

What are the complications of pellet insertion?

Complications from the insertion of pellets include minor bleeding, bruising, discoloration of the skin, infection, and possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin these complications are very rare. Vigorous physical activity is avoided for 48 hours in women and up to 5 to 7 days in men.

What are the side effects of hormone pellets?

Most women feel great on the pellets and have no side effects. Those women who do experience side effects most commonly report breast tenderness, which is a result of estrogen stimulation of the breast tissue. Testosterone may cause mild acne and rare facial hair growth. If these symptoms develop, we reduce the dose of the pellets. There may be a temporary water weight gain which will also resolve on its own. The body will tone up, as bone density and muscle mass increase and fatty tissue decreases.

I have heard that estrogen increases my risk of breast cancer. Is this true?

At this time, we have no evidence that estrogen increases a woman’s risk of developing breast cancer. If estrogen does stimulate breast cell growth, it appears that testosterone counteracts that process and may be protective against breast cancer development. We know that the combination of oral equine estrogen and synthetic progesterone (PremPro) does increase the risk of breast cancer. Our recommendation is to stick with non-oral bioidentical estrogen and testosterone and if progesterone is necessary, use bioidentical instead of synthetic.

How often do I need to have the pellets inserted?

The pellets usually last between 4 and 5 months. Timing of pellet insertions is individualized based on levels.

How fast will I feel the effects of the hormone pellets?

Some patients begin to feel better within 24-48 hours while others may take a week or two to notice a difference. The pellets do not need to be removed. They completely dissolve on their own.

Why do I have to take progesterone with the pellets?

Unopposed estrogen stimulation of the uterine lining causes overgrowth of the lining, or hyperplasia, and potentially uterine cancer. Progesterone prevents this overgrowth in most cases. Progesterone can cause fatigue so we suggest that progesterone be taken at night. In some women it can also cause weight gain and fluid retention. Progesterone can be used as a topical cream, a vaginal cream, oral capsule, or sublingual drops or capsules. If a patient is pre-menopausal she uses the progesterone the last two weeks of the menstrual cycle. If a woman has had a hysterectomy, progesterone is unnecessary.

Will testosterone pellet implant increase my sex drive?

Testosterone increases not only drive, but sexual enjoyment and orgasmic potential. Women who are receiving testosterone report more frequent sexual fantasies, desire to initiate sexual interaction, and pleasure associated with sexual activity.

How do you monitor hormone levels?

Hormone levels are drawn and evaluated before therapy is started. This includes a FSH, estradiol, testosterone and free testosterone for women. Men need a PSA, estradiol, free estradiol, testosterone and possibly estrone prior to starting therapy. Levels will be reevaluated during hormone therapy at 4-6 weeks and again in 4-5 months. After the first years of therapy hormones levels are followed less frequently. The PSA in men is followed every 6-12 months.

Hormone therapy with pellets is not just used for menopause. Women at any age may experience hormone imbalance. Levels decline or fluctuate contributing to debilitating symptoms. Pellets are useful in severe PMS, post-partum depression, menstrual or migraine headaches, and sleeping disorders. Pellets may also be used to treat hormone deficiencies caused by the birth control pill.

Testosterone levels begin to decline in men beginning in their 30’s. Most men maintain adequate levels of testosterone into their mid 40’s to mid 50’s, some into their late 70’s early 80’s. Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30’s can be testosterone deficient and show signs of bone loss. Most men need to be tested around 50 years of age. It is never too late to benefit from hormone therapy.