Frequently asked questions
Bio-Identical Hormone Replacement Therapy (BHRT) Pellet Implants For Women and Men
Significant data supports that hormone replacement therapy by pellet insertion is the most effective method to deliver hormones in both women and men. Pellets, which are placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy.
what are pellets?
Pellets are made up of either estradiol or testosterone. The hormones are pressed or fused into very small solid cylinders. In the United States, the majority of pellets are made by compounding pharmacists and are delivered in sterile glass vials. The pellets we use are compounded by an FDA-Registered 503B Outsourcing Facility.
WHy pellets?
Pellets deliver consistent, healthy levels of hormones for 3-4 months in women and 5-6 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. Estrogen is delivered by subcutaneous pellets. Medical data support the conclusion that pellets do not increase the risk of blood clots unlike conventional or synthetic hormone therapy. When compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal and andropausal symptoms (male hormone decline or male menopause), maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance. Estrogen delivered by pellet has been used to treat migraine and menstrual headaches. It also helps with vaginal dryness, incontinence, urinary urgency and frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase sense of well being, relieve anxiety and improve memory and concentration. Testosterone increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of hormones for optimal mental and physical health and to help reduce the risk of Alzheimer’s, osteoporosis and coronary artery disease (CAD).
How and where are pellets inserted?
The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the upper buttocks through a small incision, which is then steri-stripped closed. The experience of the health care professional matters a great deal, not only in placing the pellets, but also in determining the correct dosage of hormones to be used.
Are there any side effects or complicatons from the insertion of the pellets?
Complications from the insertion of pellets may include minor bleeding or bruising, discoloration of the skin, infection and the possible extrusion of the pellet. Other than slight bruising or discoloration of the skin, these complications are very rare. Testosterone may cause a very slight increase in facial hair in 7% to 10% of women, which can be easily treated. Testosterone stimulates the bone marrow and may increase the production of red blood cells in men. If so, low dose aspirin may be recommended. After the insertion of the pellets, vigorous physical activity is avoided for 72 hours in women and 5-7 days in men. Early vigorous physical activity may cause “pellet extrusion”. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, antibiotics are usually not needed.
Why haven't i heard about pellets?
You may wonder why you haven’t heard of pellets. Pellets cannot be patented since they are made from wild yams, and thus “Big Pharma” has little economic incentive in marketing BHRT. However, they have been used in Europe and Australia for over 30 years, and acceptance is rapidly expanding.
Do men need hormone therapy?
Testosterone levels begin to decline in men by age 45-50. Men should be tested when they begin to show signs of testosterone deficiency as mentioned. Even men in their 30’s can be testosterone deficient and show signs of bone loss, fatigue, depression, erectile dysfunction, difficulty sleeping and mental decline. It is never too late to benefit from hormone therapy, and to quote Neal Rouzier, M.D., (an expert in BHRT), “there is no age limit to receiving BHRT”.
What if my primary care physician or my gynecologist says that there is "no data" to support the use of pellets?
He or she is wrong. There is a big difference between “no data” and the doctor not having read the data. It is much easier for busy practitioners to dismiss the patient, than it is to question their beliefs and do the research. It’s about a patient making an informed choice. After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve as well as overall physical and sexual health. These are obvious benefits that the patient experiences. There is also data that supports the “long term” safety of hormones delivered by pellets. Please reference Abraham Morgentaler, M.D. (Harvard Professor and world expert) in his book “Testosterone For Life”. (https://www.amazon.com/Testosterone-Life-Recharge-Vitality-Overall/dp/0071494804)
Do pellets have the same danger of breast cancer as other forms of hormone replacement therapy?
Studies show that bio-identical pellets do not carry the risk of breast cancer that is otherwise associated with use of synthetic estrogens and progestins as demonstrated in the Women’s Health Initiative Trial. BHRT has been shown to be safe in women, even with a family history of breast cancer. Data supports that balanced, bio-identical hormones are breast protective.
are there side effects to estrogen delivered by pellet implantation?
When a patient first starts on hormone therapy there may be mild, temporary breast tenderness, which resolves on its own or with a regimen of over-the-counter Oil of Evening Primrose. Hormone receptors may be very sensitive and take time to adjust. There may be a temporary water weight gain, which will also resolve on its own or with a mild diuretic. Women with an intact uterus may experience spotting or bleeding. Balancing the progesterone to estrogen ratio can effectively curtail vaginal bleeding. Further diagnostic testing may be ordered to determine the cause of bleeding if it persists.
how long until a patient feels better after pellets are inserted?
Most female patients begin to feel better within a week or two. Men usually take 2-4 weeks before they start to notice the benefits of the pellets. Diet and lifestyle, together with hormone balance, are critical for optimal health. .
Do female patients need progesterone when they use the pellets?
When estradiol pellets are inserted, progesterone is prescribed in oral form (not yet available in effective pellet form), even if the patient has had a hysterectomy, since progesterone is also breast protective and serves as a positive influence in the bone, brain, heart, bladder, and uterus. Progesterone can be used as an oral capsule, sublingual troche or vaginal cream. Only oral progesterone (100-200mg) and vaginal progesterone (45-90mg) have been studied and shown to protect the uterine lining and breast tissue from estrogen stimulation.
how are hormones monitored during therapy?
Hormone levels will be tested and evaluated before therapy is started. This will include a complete metabolic panel, lipid panel, CBC and endocrine panel for both men and women. Thyroid hormone levels will also be evaluated. Men also need a PSA blood test. Levels will be re-evaluated 4 weeks post-insertion. Men are encouraged to obtain a digital rectal exam for routine prostate evaluation on a yearly basis. Women are advised to continue their monthly self-breast exam and obtain a mammogram and a pap smear as advised by their gynecologist or primary care physician.
how much does pellet therapy cost?
Our patient coordinator will go over the cost for initial and follow-up insertions. Women typically get insertions every 3-4 months while men every 5-6 months, depending on how rapidly a patient metabolizes hormones. There will be extra costs for progesterone and thyroid supplementation, if needed. When compared to using topical creams, gels, vaginal inserts and pills, pellets are very cost effective.
will insurance cover the procedure?
Our office requires payment at the time of service. Patients may want to contact their insurance companies to see if their costs will be reimbursed.
In conclusion, estrogen and testosterone therapy via pellet delivery is a safe and effective method of hormone therapy for both men and women. Long, continuous administration of hormones by pellets is convenient and economical for the patient. Pellet implantation has consistently proved to be more effective than oral, intramuscular and topical hormone therapy with regard to bone density, sexual function, mood and cognitive function, urinary and vaginal complaints, breast health, lipid profiles and hormone ratios.