Hormone Pellet Therapy

Pellets: Best Form of Delivering Bioidentical Hormone Therapy


The use of hormone pellets is superior to injections. After placing pellets in clients for over 8 years the comparison to injections are superior.


The procedure is safe and performed in the office under local anesthesia.


The chief complaints of BHRT administration with creams and gels are daily administration and a high likelihood of transferring hormones to spouses, children, pets, goldfish and other assorted lovers.  Creams and gels take up to eight weeks to become effective.


Injectables are painful, must be performed once or twice a week, inconvenient for travelers, and subject at times temperature swings.  Injectable, on average, take four weeks to become effective.


Enter BHRT pellet administration.  Modern BHRT pellets release physiologic doses of plant-based, chemically the same as we produce ourselves, hormones, providing optimal therapy.  Pellet therapy is quick, easy, nearly painless following our protocol, cost-effective, and is the quickest onset set of action, four to seven days, of any method of BHRT treatment.


What are Pellets?


BHRT pellets, estrogen or testosterone, are pressed cylinders, smaller than a grain of rice, made specifically for the Regen Medical Center by a PCCA certified compounding pharmacy.  The FDA approved a 75-mg testosterone pellet in 1972.(1)


Pellets provide consistent, healthy hormone level for 3-5 months in women and 4-6 months in men.  In our experience, after two or three cycles, the effects of the pellets may last up to 6 months in both men and women.


Pellets avoid fluctuations in hormone levels, maintain normal ratios of one hormone to another, important for optimal health and disease prevention, and do not increase the risk of blood clots as conventional synthetic hormone replacement therapy does.


Pellets are superior in relieving menopause symptoms, maintaining bone density, restoring sleep patterns, and improving sex drive, libido, sexual energy, response and performance. (2)


Testosterone pellets in women treat migraine and menstrual headaches, vaginal dryness, urinary incontinence, urgency and frequency. In both men and women, testosterone increases energy, lean body mass, strength, bone density, a sense of well-being, improves memory and concentration.  Testosterone is an anti-depressant and anti-anxiety agent and decreases fat mass. Adequate levels of testosterone are necessary for optimal mental and physical health.  Associated with Alzheimer’s and Parkinson’s disease, multiple sclerosis and diabetes mellitus, type 2, low testosterone levels are problematic at any age.


Bioidentical pellet therapy is the most popular form of treatment at Regen Medical Center.  We perform four to five pellet procedures daily. First described in 1938, no other form of hormone delivery is as convenient or effective as implant therapy.


How Can They Not Hurt


The procedure does not hurt and takes about 15 minutes to perform. After local anesthesia a small incision is made and the pellets are placed with a trocar beneath  the skin into the fat. Steri-strips applied and cover dressing placed over the surgery site.



Insertion complications parallel any incision based procedure: Minor bleeding or bruising, skin discoloration, infection, and possible pellet extrusion. These are rare. As we use one time only disposable kits, inadequate sterilization of instruments is not an issue.


Excess testosterone metabolism can cause oily skin and hair, “acne,” typically a skin breakout on the neck and shoulders and, in women, a slight increase in facial hair.  If your beginning testosterone is low, you may experience a temporary “surge.” 


Supplements to lower testosterone for women include reishi mushrooms, red clover, black cohosh, chasteberry, maca root, and saw palmetto. Lowering total saturated fats, decreasing high-glycemic index foods, adding fiber and consuming phytoestrogenic foods such as tofu, soya milk, and flaxseed are remedies on the dietary end.


Spironolactone is a potassium-sparing diuretic that blocks the side effects of testosterone excess.


In our experience, these symptoms resolve in 10-20 days at which point we discontinue the supplements and medications.


We treat men with testosterone excess with saw palmetto, metformin spironolactone.


Estrogen excess results in breast tenderness, gynecomastia, vaginal bleeding, water weight gain and emotional lability.  For women we double our progesterone dose until the symptoms resolve.  In men we may add Progesterone Cream, Chrysin, DHEA and pregnenolone, and, if extreme, anastrozole 1 mg 1-2x/wk.


Testosterone stimulates bone marrow production of red blood cells. Testosterone therapy administered by any method, may cause an elevation in the red blood cells. Though testosterone does not cause a change in clotting factors, if the hemoglobin and hematocrit (blood count) reach a level of 18.5 and 55 respectively, we recommend a blood donation.


Post op concerns are surprisingly few. Theoretically vigorous activity within 48 hours of insertion may cause pellet expulsion. If the patient is immunocompromised or has had a joint replacement we add in a low dose antibiotic.


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


The great hormone cancer scare of 2002 courtesy of the Women’s Health Initiative studied oral synthetic hormones derived from horse urine. It is no surprise that the body would protect itself against these foreign invaders by forming cells around the affected tissues, in this case the breast, ovaries and uterus. Excess cells, by definition, are cancer. The hullabaloo does not include pellets as they are bioequivalent in composition. In fact, using bioidentical hormones decreases breast and uterine cancer by ten percent over using no hormone replacement at all.


Testosterone, decreased breast proliferation and lowered the risk of breast cancer, by 50% over those who use no hormonal therapy. In 1268 pre-and postmenopausal women, 142/100,000 in the testosterone group and 390/100,000 in the control group developed breast cancer.  The testosterone-treated group exhibited half the breast cancer risk of the not treated group. Put another way, the no testosterone group had more than double the risk of breast cancer than the treated group.(3)


Breast cancer treatment often includes anti-estrogen therapy. Menopausal symptoms, including hot flashes, sleep disturbance, depressed mood, irritability, and fatigue, often severe, are common due to treatment-induced hormone deficits.


43 breast cancer survivors were implanted with two 60 mg of bioidentical testosterone along with 4 mg. of anastrozole pellets every 90 days. The 43 patients have undergone a total of 75 subcutaneous insertion procedures.93% of the patient’s reached therapeutic goals of serum estradiol levels were ≤30 pg./mL and testosterone (range 120 to 518 ng/dL). (4)


No significant adverse effects occurred in any breast cancer survivors treated. No breast cancer has had disease recurrence after three years of therapy.


Three patients with metastatic breast cancer exhibited no disease progression since the onset of treatment. Testosterone implant therapy for advanced breast cancer dates back to the 1940’s.




Bio-identical progesterone, including FDA approved Prometrium  does not increase the risk of breast cancer as does synthetic progestins.  Progesterone, used vaginally, does not negate the beneficial effects of estrogen on the heart like the synthetic progestins. Estriol, an estrogen widely used in Europe is a bio-identical hormone does not bind strongly to estrogen receptors and does not stimulate breast tissue. Numerous studies indicate that vaginal estriol does not increase the risk of breast cancer (RR 0.7). Estriol lowers the risk of recurrence and death in breast cancer survivors.


Balanced hormones are the key to health and disease prevention.


Hair Loss


Imbalances in estrogen, testosterone, and thyroid hormones are common causes of hair loss. Pellet implants thicken hair and moisten scalp hair.


What is the onset of action in pellet therapy? 


Most patients notice a significant difference with 4-7 days of the implant. Rarely ten days go by without improved symptomatology. Of course, diet, lifestyle, stress reduction, blood sugar balance and total hormone balance are critical for optimal health.


How long do pellets last?


In women, pellets last between three and five months and in men, four to six months.



What about Progesterone?


Progesterone and synthetic progestins are not one in the same.


Progesterone (not progestin) receptors reside in bone tissue, the brain, heart, bladder, breast and uterus.


FDA approved in 1998, Prometriumâ, is a commercially available bioidentical hormone.  Also available as a compound, topicallyoras a vaginal cream, or asan oral capsule, progesterone delivery is versatile. Unfortunately, due to its nature the progesterone pellets are not yet ready for prime time.


Only oral progesterone (100-200 mg) and vaginal progesterone (45-90 mg) protect the uterine lining from estrogen stimulation.


Pre-menopausal patients’ progesterone therapy is cycled, i.e. administered on nights 14-25.  Doses range 6.25 mg up to 250 mg orally, and 3 to 30 mg transdermal, depending on symptoms and lab values.


Other Pellet Indications

Pellets address every indication for oral and transdermal hormone therapy. Severe PMS, post-partum depression, menstrual or migraine headaches, sleeping disorders, sexual dysfunction, and hormone deficiencies (testosterone) created by any form of contraception are rife for pellet therapy.

Hormone Monitoring

Every patient undergoes a laboratory evaluation before beginning any hormone therapy.

 We repeat labs before each insertion for the first year, then once or twice a year after that.

The Final Word

Bioidentical hormone pellets are a safe and effective alternative for both men and women. Pellets are convenient, economical, and provide a stable, predictable, hormonal environment. Pellet results are as or more effective than oral, intramuscular or topical hormone administration in regards to bone density, sexual function, mood, cognitive function, urinary incontinence, vaginal dryness, breast health, lipid profiles, hormone ratios and metabolites.