Author: Dr. Gary Huber
Hormone pellets are an easy and convenient option for balancing hormones levels. Have a question? Gets answers here.
Pellets - Hormone Implants
Frequently Asked Questions
Hormone replacement with pellets offers one of the most natural ways 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.
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 3-6 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, like transdermal creams and patches, do not increase the risk of blood clots like conventional or synthetic drug (HRT) 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. Pellets have been used in both men and women since the late 1930’s. In fact, there is more data to support the use of pellets than any other method of delivery of hormones.
How and where do you insert pellets? The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are inserted in the upper buttocks through a small incision, which is taped closed. The experience of the health care professional matters a great deal, not only in placing the pellets but in determining the correct dosage of hormones to be used.
Complications from the insertion of pellets include minor bleeding, 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.
Vigorous physical activity is avoided for 2 to 3 days after placement. Antibiotics may be given if a patient is diabetic or has had a joint replaced.
Why haven’t I heard about Pellets? You may wonder why you haven’t heard of pellets. Pellets are not patented and not marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of England and Australia with some from Germany and the Netherlands. Pellets were frequently used in the United States from about 1940 through the late 70’s, early 80’s when patented estrogens were marketed to the public. In fact, some of the most exciting data on hormone implants in breast cancer patients is out of the United States.
What if my primary care physician or my gynecologist says that there is no data to support the use of pellets, is he or she is wrong? There is a big difference between ‘no data’ and not having read the data. Likewise, many patients have been told by their physicians, that there is ‘no data to support bio-identical hormone therapy’. It is much easier for busy practitioners to say this and dismiss the patient, than it is to question their beliefs and do the research. Remember, it’s your body, it’s your choice. It is about how you want to feel. 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 will overall physical and sexual health.
Do pellets have the same danger of breast cancer as other forms of hormone replacements? Pellets do not carry with them the same risk of breast cancer as high doses of oral estrogens, like Premarin. Premarin is a synthetic drug made from horse urine and does not maintain the correct estrogen ratio or hormone metabolites. Bio-Identical pellets do not increase the risk of breast cancer like the synthetic, chemical progestins used in the Women’s Health Initiative Trial. In fact, data supports that balanced hormones are breast protective. The American Cancer Society has clearly stated on their website that the use of estrogen therapy does not increase the risk of cancer and may ever reduce the risk.
When a patient first starts on hormone therapy there may be mild, temporary breast tenderness, which gets better on its own. 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. The body will tone up, as bone density and muscle mass increase and fatty tissue decreases. Some patients begin to ‘feel better’ within 24-48 hours while others may take a week or two to notice a difference.
How long do they last? The pellets usually last between 3 to 6 months depending on your activity level and body mass. The pellets do not need to be removed. They completely dissolve on their own. In women, anytime estradiol is prescribed, progesterone is also prescribed. There are progesterone (not progestin) receptors in the bone, brain, heart, breast and uterus. 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. 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. Estradiol pellets are only used in women who have had a hysterectomy. Estradiol pellets given to a women with a uterus may cause bleeding that is difficult to control. Other forms of estrogen replacement are more appropriate in those cases.
How are my hormones evaluated after they are inserted? Hormone levels will be drawn and evaluated before therapy is started. This will include a FSH, estradiol, estrone, testosterone and free testosterone, thyroid studies, and liver enzymes. Men need a PSA, estradiol, estrone, and testosterone prior to starting therapy. Levels will be reevaluated during hormone therapy at 4 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. 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.
How much does this cost? You will need to schedule a 30 minute office appointment plus a $95 procedure fee to cover the cost of sterile equipment. The cost of the pellets themselves is relatively inexpensive, around $15 per pellet. Women may need just one or two pellets while men may need up to 5 or 6 pellets. Men need a much larger dose of testosterone than women (generally between 3-5 pellets), so therefore the cost is higher. Pellets need to be inserted 2 to 3 times a year depending on how rapidly a patient metabolizes hormones. When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective.
Will my insurance cover this? Some insurance companies cover the cost of pellets, others do not. You may want to contact their insurance companies to see if their costs will be reimbursed. But remember, prevention is much more cost effective than disease.
In conclusion: estrogen and testosterone therapy by implantation of pellets 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 proven 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, hormone ratios and metabolites.