Data supports that hormone replacement therapy with pellet implants is the most effective and most bio-identical method to deliver hormones in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy.
Pellets are made up of either estradiol or testosterone. The hormones 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, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials.
Pellets deliver consistent, healthy levels of hormones for 4-5 months in women and 3-4 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. Estrogen delivered by subcutaneous pellets maintains the normal ratio of estradiol to estrone. Several studies have suggested that 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.
Testosterone delivered by a pellet implant has been used to treat a migraine and menstrual headaches. It also can help with vaginal dryness, incontinence, urinary urgency, and frequency. In both men and women, testosterone has been shown to help increase energy, relieve depression, increase a sense of well being, relieve anxiety and improve memory and concentration. Testosterone, delivered by pellet implant, can increase lean body mass (muscle strength, bone density) and decreases fat mass.
The insertion of pellets is a simple, relatively painless procedure done with a small injection of a local anesthetic. The pellets are usually inserted in the upper buttocks through a small incision (the length of 2 grains of rice), which is then taped closed with a bandage over the site.
Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. This procedure is performed in a sterile manner, thus greatly reducing the likelihood of infection. Other than slight bruising, or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in hair growth in some women. After the insertion of the implants, vigorous physical activity is avoided for 72 hours in women and up to 5 to 7 days in men. Early physical activity is a cause of ‘extrusion’, which is a pellet working it’s way out.
Testosterone levels begin to decline in men beginning in their early 30’s. Most men maintain adequate levels of testosterone into their mid 40’s to mid 50’s, some into their late 70’s to 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, fatigue, depression, erectile dysfunction, difficulty sleeping and mental decline. Most men need to be tested around 50 years of age. It is never too late to benefit from hormone therapy.
Some patients begin to feel better within 24-48 hours while others may take a week or two to notice a difference. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness.
The pellets usually last between 4-5 months in women and 3-4 months in men. The pellets do not need to be removed. They completely dissolve on their own.
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 (testosterone) caused by the birth control pill.
Hormone levels will be drawn and evaluated before therapy is started. This will include estradiol, total testosterone, free testosterone for women, as well as a complete blood panel to monitor for overall health and possible contributing causes of symptoms. Levels will be reevaluated during hormone therapy, usually 6 weeks after the initial pellet to ensure the right dosage has been given. Men must notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care physician.