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Frequently Asked Questions

What are pellets?

Estradiol and Testosterone pellets are bio-identical hormones derived from plant sources such as wild yams or soy. The hormones, estradiol and testosterone, after being formulated into the exact human molecular structure as the human hormones, are pressed or fused into very small solid cylinders. These pellets are about the size of a grain of rice. In the United States, pellets are made to order for each individual patient based on their needs by a licensed compounding pharmacist and delivered in sterile vials.

Why are pellets optimal for hormone replacement?

Pellets deliver consistent, healthy levels of hormones for 3-4 months in women and 4-5 months in men, depending on the dosage and how quickly the patient uses the medication. Pellet insertion avoids the fluctuations and absorption issues of hormone levels seen with many other hormone delivery methods by their ability to deliver more hormone when it is needed and less if not needed. Matching the dose to the needs of the individual helps relieve many of the unwanted side effects and symptoms a patient experiences. Pellets do not increase the risk of blood clots or liver damage like conventional oral 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, improvement in fatigue and sense of well-being as well as improvement in memory and concentration, anxiety, sex drive, libido, sexual response and performance. It also helps with vaginal dryness, incontinence, urinary urgency and frequency.

Testosterone delivered by pellet implant has been shown to be effective in treating migraine and menstrual headaches as well as increase lean body mass and decrease body fat mass. Studies have shown that men and women need adequate levels of testosterone for the prevention of chronic diseases like heart disease, diabetes, osteoporosis, Alzheimer’s disease, Parkinson’s disease, and even prostate cancer which are associated with low testosterone levels. Many patients who have failed other types of hormone therapy have a high success rate with pellets. No other hormone delivery method is as convenient as the pellets. Patients also do not have to worry about accidentally spreading or contaminating others as they do with topical applications. Hormone pellet implants have been used safely and effectively in both men and women since the late 1930s.

When were pellets first used for hormonal replacement?

Pellets have been used in both men and women since the late 1930s. In fact, there is more data to support the use of pellets than any other method of delivery of hormones. Pellets are not patented and not marketed in the United States by pharmaceutical companies. 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 to the early '80s when patented estrogens were marketed aggressively to the public and physicians.

How and where do you insert pellets?

The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the lower abdominal wall or hip through a small incision which is taped closed with a steri-strip. The experience of the health care professional counts not only in the placement of the pellets, but also in determining the proper dosage of hormones to be used.

What are potential complications from inserting pellets?

Complications from the insertion of pellets include minor bleeding, bruising, infection, and possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin these complications are very rare. Extended exposure to moisture (swimming, hot tubs, and bath tubs) is avoided for 4 to 5 days, and vigorous physical activity is avoided for 48 hours in women and up to 5 to 7 days in men. Antibiotics may be given if a patient is diabetic or has recently had a joint replaced.

Why do many providers say “there is no data to support the use of pellets”?

There is a big difference between “no data” and “not knowing” the data. Pharmaceutical companies significantly influence medical school education and many physicians are not taught about these options. It is much easier for busy physicians to dismiss the patient than it is to question conventional wisdom and go against their old beliefs. Searching and reading the research takes precious time out of physician’s busy lives that are already pushed to the limit. Pellets have been used effectively and safely in both men and women since the late 1930s. In fact, there is more data to support the use of pellets than any other method of delivery of hormones.

What can I expect after pellet insertion?

After hormonal pellets are inserted, most patients notice that they sleep better, have more energy, feel happier and have an improved sense of well-being. Muscle mass will increase while body fat decreases if patients take advantage of their new found energy and exercise. Patients may notice increased physical performance, improved memory and concentration, improved skin tone as well as improvement in overall physical and sexual health.

Will hormone therapy with testosterone help with hair loss?

Hormone therapy is a common cause of hair loss and treatment with hormone replacement therapy especially with Testosterone has been shown to help re-grow hair in women. Hair becomes thicker and less dry with pellet therapy.

Do pellets have the same danger of breast cancer as other forms of hormone replacement?

Pellets do not have the same risk of breast cancer as high doses of oral estrogens, like Premarin, that do not maintain the correct estrogen ratio or hormone metabolites. Nor, do they 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. Clinical studies have shown that testosterone balances estradiol and has been used to treat patients with breast cancer.

What are the most common side effects when the pellets are first inserted?

When a patient first starts 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. Patients may experience a renewal of youthfulness as their hormonal levels rise into their normal ranges.

How soon will I feel the effects of the pellets?

Some patients begin to "feel better" within 24-72 hours while others may take one to three weeks to notice a difference

How long do the pellets last?

The pellets usually last between 3 and 4 months in women and 4-6 months in men. High levels of stress, physical activity, some medications and lack of sleep may increase the rate at which the pellet absorb and may require that pellets are inserted sooner in some patients.

Do the pellets need to be removed every 3-6 months?

The pellets do not need to be removed. They completely dissolve on their own as the body needs them.

Do men need hormone replacement?

Testosterone levels begin to decline in men beginning in their 30s. Many men maintain adequate levels of testosterone into their mid-40s to mid-50s, some into their late 70s early 80s. Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30s 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.

Do patients need progesterone when they use the pellets?

Any time estradiol is prescribed, progesterone is usually prescribed especially if the patient still has her uterus. 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.

Do I have to be in menopause to benefit from pellets?

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, joint and back pain, and sleeping disorders. Pellets may also be used to treat hormone deficiencies caused by the birth control pill.

How are the hormones monitored during therapy?

Hormone levels will be drawn and evaluated before therapy is started. This will include a CBC, CMP, TSH, FSH, Estradiol, Testosterone and Free Testosterone for women. Men need a CBC, CMP, TSH, PSA, FSH, Estradiol, and Testosterone prior to starting therapy. Levels will be reevaluated during hormone therapy at 4-6 weeks and sometimes in 3-4 months. After the first years of therapy hormones levels are followed less frequently. The PSA in men is followed every 6-12 months.

What is the cost for pellets?

Given the relatively low cost, convenience and superior effectiveness of pellets, they are an extremely good value. Pellets last three to five months in women, so the monthly cost averages $70 to $115 for women.

Will insurance cover the pellets and insertion?

Testosterone Replacement Therapy is FDA approved for men in the United States. It is also approved for women in England and in Australia. However, it is not approved for women in the U.S. Many medications can be and are frequently used “Off Label”. Most insurance companies do not cover the cost of pellets for women even though some may claim to. In an effort to keep costs reasonable for everyone, we require patients to pay for their treatment at the time of insertion. Upon request, we will provide you with an insurance form with the proper insurance codes for you to submit to your insurance company or HSA plan. You will need to fill out the personal information on the form prior to mailing it. Any insurance reimbursement will come directly to you.

The cost of Testosterone treatment in men is covered by some insurance companies since it is FDA approved for men and we will file when appropriate. We ask that you call your insurance company and verify your coverage.

For both men and women, we recommend that you plan to have at least two insertions within a 6-8 month period so you will have a fair trial and be able to more fully experience the benefits of therapy. More than 95 percent of people have a positive experience and return for more treatments because of the multiple benefits that the treatments have made in their lives.