Data supports that hormone replacement therapy with pellet implants is the most effective and the most bioidentical method of delivering hormones in both men and women. These implants, 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. These pellets are larger than a grain of rice and smaller than a ‘Tic Tac’. In the United States, most pellets are made by compounding pharmacists and delivered in sterile glass vials. There is also an ‘FDA approved’ 75 mg testosterone pellet.
Pellets deliver consistent, healthy levels of hormones for 3-5 months in women and 4-6 months in men. In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal symptoms, including hot flashes, night sweats, mood swings, anxiety, memory loss, vaginal dryness, depression, inability to hold urine, osteoporosis, joint pain, vaginal shrinkage, low libido, general fatigue, insomnia, headaches, and more.
Testosterone, delivered by a pellet implant, has been used to treat migraine and menstrual headaches. It also helps with vaginal dryness, incontinence, urinary urgency, and urinary frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase sense of well-being, relieve anxiety, and improve both memory and concentration. Testosterone, delivered by pellet implant, increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of testosterone for optimal mental and physical health, as well as for the prevention of chronic illnesses such as Alzheimer’s and Parkinson’s disease, which are both associated with low testosterone levels.
Even patients who have failed other types of hormone therapy have a very high success rate with pellets. Studies have shown that there is no other method of hormone delivery that is as convenient for the patient as pellet implants. Pellets have been used in both men and women since the late 1930’s, and there is more data to support the use of pellets than any other method of delivery of hormones.
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 lower abdominal wall or upper buttocks through a small incision, which is then taped 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 complications from the insertion of the pellets?
Complications from the insertion of pellets 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 considered rare. Testosterone may cause a slight increase in facial hair in some women. Testosterone stimulates the bone marrow and increases the production of red blood cells, which can reduce anemia in older men. Due to the possibility of elevated red blood cell levels, if the hemoglobin and hematocrit (blood count) get too high, a unit of blood may be donated.
After the insertion of the implants, vigorous physical activity should be avoided for 48 hours in women and up to 5-7 days in men. Early physical activity is a cause of ‘extrusion,’ which is a pellet working its way out. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, this is a “clean procedure,” and antibiotics may not be needed.
Why haven’t I heard about Pellets?
Pellets are not patented and have not been marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce and research pellet. In the United States, pellets were frequently used from about 1940 through the late 70’s, when patented oral 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. Even in the United States, there are clinics that specialize in the use of pellets for hormone therapy.
Do men need hormone therapy?
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 or too early to benefit from hormone therapy.
Based on the number of television and magazine ads for Viagra and Cialis, millions of men are looking for help with their ED. Although these drugs can provide help in this area, bioidentical hormone pellet therapy treats the root cause (low testosterone) and is a much safer solution than the commonly prescribed prescription drugs. Re-establishing your testosterone to an optimal level not only improves ED, but also provides the following benefits to improve your vitality and quality of life:
- Enhancement of libido and/or increased sexual drive
- An increase in lean body mass and a decrease in body fat
- Preventing muscle loss due to aging
- Reduction in fatigue and increased energy levels
- Consistency in moods and a reduction in feelings of anger and irritability
- Greater capacity for getting in shape
- Increased mental clarity, focus, and concentration
- Works in partnership with your body 24/7
- Completely natural with no side effects
- No pills, creams, and hassle-free
- Lasts up to six months
What if my primary care physician says that there is ‘no data’ to support the use of pellet implants?
There is a big difference between ‘no data’ and not having read the data. It is much easier for busy practitioners to dismiss the patient than it is to question their personal beliefs and do the research on pellet implants. 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, coordination, 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. There is also data to support the ‘long term’ safety of hormones delivered by pellet implants.
How long until a patient feels better after pellets are inserted?
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 also a major contributor to hormone imbalance and illness.
How long do pellets last?
The pellets usually last between 3-5 months in women and 4-6 months in men. The pellets do not need to be removed. They completely dissolve on their own.
How are hormones monitored during therapy?
Hormone levels will be drawn and evaluated before therapy is started. For women, this will include a FSH, estradiol, testosterone, and free testosterone. Thyroid hormone levels may also be evaluated. Men need a PSA, sensitive estradiol, testosterone, liver profile, and blood count prior to starting therapy. Levels will be reevaluated during hormone therapy, usually prior to insertion of the next set of pellets after 4-5 months. After the first year of therapy, hormones levels may be followed less frequently. 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.