Pellet Therapy as HRT: What you should know

Hormone replacement through pellet therapy has been found to be an effective, convenient, and long-lasting treatment option for re-balancing hormones.

Hormone replacement with pellet therapy is considered the “gold standard” when it comes to estrogen or testosterone replacement. Advantages of pellet therapy include:

  • Pellets absorb slowly through the subcutaneous fat layer, leading to smooth even physiologic levels of hormone delivery. This reduces the risk of “supraphysiologic” levels (higher than normal ranges).
  • They are long-lasting, often up to 3-4 months in women and 4-5 months in men.
  • They eliminate the need to remember to take a daily or weekly prescription.
  • They lead to less side effects than some other hormone replacement modalities such as creams,  since they do not cause “peaks” or “valleys” of hormone level throughout the day.

As with all treatments, there are potential risks and benefits of both undergoing treatment and withholding treatment. Treatment carries the potential risk of unsuccessful results, complications and injury from both known and unforeseen causes. There is no warranty or guarantee made as to a result or cure. You have the right to be informed of such risks as well as the nature of the treatment, the expected benefits or effects of such therapy, the available alternative methods of treatment and their risks and benefits, and the controversies regarding the most appropriate diagnosis and treatment of low or suboptimal bio-identical hormone restoration and nutritional therapy.

  • Increased libido, energy, and sense of well-being.
  • Increased muscle mass, strength, and stamina.
  • Decreased frequency and severity of migraine headaches.
  • A decrease in mood swings, anxiety and irritability (secondary to hormonal decline).
  • Decreased weight, increased lean body mass}. A decrease in risk or severity of diabetes.
  • A decreased risk of Alzheimer’s and Dementia.
  •  A decreased risk of heart disease in men less than 75 years old with no pre-existing history of heart disease.

On January 31, 2014, the FDA issued a Drug Safety Communication indicating that the FDA is investigating risk of heart attack and death in some men taking FDA approved testosterone products.

The risks were found in men over the age of 65 years old with pre-existing heart disease and men over the age of 75 years old with or without pre-existing heart disease. These studies were performed with testosterone patches, testosterone creams and synthetic testosterone injections and did not include subcutaneous hormone pellet therapy.

A significant hormonal transition will occur in the first four weeks after you begin testosterone. Therefore, certain changes might develop that can be bothersome.

    • Fluid Retention: Testosterone stimulates the muscle to grow and retain water which may result in a weight change of two to five pounds. This is only temporary. This happens frequently with the first insertion, and especially during hot, humid weather conditions.
    • Swelling of the hands and Feet: This is common in hot and humid weather. It may be treated by drinking lots of water, reducing your salt intake, taking cider vinegar capsules daily, (found at most health and food stores) or by taking a mild diuretic, which the office can prescribe.
    • Mood swings/irritability: These may occur if you were quite deficient in hormones. They will disappear when enough hormones are in your system.
    • Facial breakout: Some pimples may arise if the body is very deficient in testosterone. This lasts a short period of time and can be handled with a good face cleansing routine, astringents and toner. If these solutions do not help, please call the office for suggestions and possibly prescriptions.
    • Hair loss: Is rare and usually occurs in patients who convert testosterone to DHT. Dosage adjustment generally reduces or eliminates the problem. Prescription medications may be necessary in rare cases.
    • Infection: Infection is indicated by excessive swelling, bleeding, or pus at the injection site. If this occurs please notify the office. Note: some tenderness at the insertion site can be expected and should not be cause for alarm.
    • Extrusion: After pellets are inserted into the subcutaneous layer of the skin, it is normal to notice a bump that may last until the pellets have completely dissolved (3-6 months). However, in rare cases, a pellet will attempt to come out. This is more likely if you do not follow the post pellet insertion instructions. A pellet attempting to extrude will often feel and look like a pimple. Please inform our office if this is occurring.

Bleeding, bruising, swelling, infection, and pain. Lack of effect (typically from lack of absorption). Thinning hair, male pattern baldness. Increased growth of prostate and prostate tumors. Extrusion of pellets. Hyper sexuality (overactive libido). Ten to fifteen percent shrinkage in testicle size. There can also be a significant reduction in sperm production.

There is some risk, even with natural testosterone therapy, of enhancing an existing current prostate cancer to grow more rapidly. For this reason, a prostate specific antigen blood test (PSA) is to be done before starting testosterone pellet therapy and will be conducted each year thereafter. If there is any question about possible prostate cancer, a follow-up with an ultrasound of the prostate gland may be required as well as a referral to a qualified specialist. While urinary symptoms typically improve with testosterone, rarely they may worsen, or worsen before improving.

Testosterone therapy may increase one’s hemoglobin and hematocrit or thicken one’s blood. This problem can be diagnosed with a blood test. Thus, a Hemoglobin and Hematocrit lab test will be ordered by your anti-aging specialist at regular intervals to monitor for this side effect.

  • Increased libido
  • Improvement of vaginal dryness
  • Increase in muscle mass
  • Improvement in balance
  • Improved dry eyes
  • Decrease in menopausal symptoms
  • Increased energy and sense of well-being
  • Decreased frequency and severity of hormonal migraine headaches
  • Decrease in mood swings
  • Decreased central obesity
  • Decreased anxiety and irritability
  • Decrease in subcutaneous fat (cellulite)
  • Possible improvement in arthritis in fibromyalgia

Bio-identical hormone pellets are made from plants and are FDA monitored, however they are not FDA-approved for female hormone replacement. The pellet method of hormone replacement has been used in Europe and Canada for many years and by select providers in the United States. The effects of estrogen and androgens will give you similar risks as you had prior to menopause, however they will be given now as pellets with specific dosing to return your hormones to physiological levels.

The WHI study on hormone replacement therapy that was reported first in 2002 had many flaws in the study. It only studied Premarin {horse estrogen} and Provera {a synthetic type of progestin} and had findings that were not consistent with the last 1,500 studies done on HRT. The WHI study is not applicable to treatment with bio-identical hormone replacement pellets.

  • Fluid Retention: Fluid entrapment may occur in the muscle due to testosterone’s stimulating effects on the muscle, causing it to grow. This may result in weight gain of 2-5 pounds. This is temporary and can last two to three weeks. This happens more frequently with the first insertion, and especially when done in hot and humid weather conditions.
  • Swelling of the hands and feet: More likely to occur in hot and humid weather conditions. This can be treated by drinking lots of water, reducing your salt intake, or taking apple cider vinegar capsules (available at most health food stores).
  • Breast tenderness and nipple sensitivity: May occur with the first pellet insertion. This is due to an increased blood supply to the breasts caused by the estrogen, which is desirable because the increased blood supply nourishes the tissue. If it is bothersome, an excellent remedy is evening primrose oil capsules (available at most health food stores).
  • Uterine spotting or bleeding: May occur in the first two months after an insertion, especially if you forget to take your progesterone or if the dose is not high enough. Our office must be notified of this. The bleeding is usually not an indication of a significant uterine problem. More than likely the uterus is simply releasing old tissue. If the bleeding continues for more than two months, it may be a sign that you have a benign polyp or fibroid of the uterus that needs to be removed.
  • Infection: Infection would be indicated by excessive swelling, bleeding, or pus at the insertion site. If this occurs please notify the office. Note: some tenderness at the insertion site can be expected and should not be cause for alarm.
  • Extrusion: After pellets are inserted into the subcutaneous layer of the skin, it is normal to notice a bump that may last until the pellets have completely dissolved (3-6 months). However, in rare cases, a pellet will attempt to come out. This is more likely if you do not follow the post-pellet insertion instructions. A pellet attempting to extrude will often feel and look like a pimple. Please inform our office if this is occurring.
  • Mood Swings and Irritability: Usually seen in patients who are very deficient in hormones. This will disappear when enough hormones are absorbed to achieve proper levels in your system.
  • Facial Pimples and Facial Hair: May occur if the body was extremely deficient in testosterone. This lasts a short time and can be handled with good face washing and use of astringents and skin toner. If you are troubled by these side effects, there are good natural and pharmacologic agents which can help. Please inquire about them.

Women who have had a hysterectomy may be candidates for HRT as they may become hormone deficient earlier in life:

  • If one ovary is removed along with the uterus– both estrogen and testosterone production may be reduced by 50%.
  • If both ovaries are left in place, but the uterus is removed – there is an increased risk of early estrogen/testosterone deficiency, due to a disrupted blood supply to the ovaries from surgery.

Perimenopause is the stage prior to menopause, where ovarian function slowly begins to decline. The ovaries produce lower and lower amounts of testosterone and estrogen from year to  year, which may result in symptoms of hormone deficiency.

Many women begin to experience symptoms 5 to 10 years prior to being diagnosed with “menopause”.  As many as 80% of women experience physical or psychological symptoms associated with perimenopause or menopause.

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Mood swings
  • Irritability
  • Insomnia
  • Depression, anxiety
  • Loss of sexual interest, low libido
  • Weight gain
  • Osteoporosis
  • Muscle or joint pain
  • Fatigue
  • Hair growth on face
  • Painful intercourse
  • Panic attacks, palpitations
  • Indigestion
  • Hair loss
  • Frequent urination, urinary leakage
  • Varicose veins
  • Memory lapses, forgetfulness

  • Hormone therapy  remains the most effective treatment for vasomotor symptoms (ie. hot flashes, night sweats) and the genitourinary syndrome of menopause (ie. vaginal dryness, urinary leakage). Hormone therapy has also been shown to prevent bone loss and fracture, reducing the risk of developing osteoporosis.
  • Other benefits may include:
    • Improvements in mood, sleep, and heart health.
    • Preservation of memory and cognitive function.
    • Promotion of growth and repair processes in the body, leading to improved wellness and longevity

Hormone therapy is approved by FDA for four indications:

  1. Bothersome vasomotor symptoms (ie. hot flashes, night sweats)
  2. Prevention of bone loss (ie. osteoporosis)
  3. Low estrogen caused by hypogonadism or primary ovarian insufficiency
  4. Genitourinary symptoms (ie. vaginal dryness, urinary leakage)

Why is hormonal health so important?

Hormonal health is prevention!  Hormone deficiencies lead to a decline in quality of life for both women and men, particularly contributing to the cascading effect of aging and accelerating chronic disease states.  Hormones play a vital role throughout the body – over 400 body functions are influenced by hormones.

What Are Bioidentical Hormones?

Bioidentical hormones are identical to the body’s own hormones. They are sourced from either soy or yam products and altered to have the same chemical structure as the natural hormones produced by the body. Since the chemical structure mirrors that of the body’s own hormones, bioidentical hormones also mimic the function of naturally produced hormones.

Many bioidenticals are FDA-approved and can be administered after a comprehensive review of the individual’s current health status and hormone levels to individualize a treatment plan for hormone restoration.

What Is Bioidentical Hormone Replacement Therapy (BHRT)?

BHRT uses bioidentical hormones to treat a variety of symptoms caused by hormonal imbalance in men and women. Bioidentical hormones can be delivered in many forms, one of which is known as “pellet therapy”-  where a tiny pellet is inserted under the skin to slowly release hormones over several months. Other methods of hormone replacement may include topical creams or oral capsules. Your provider will review available methods of treatment.

Hormones that can be corrected with BHRT include testosterone, estrogen, progesterone, and thyroid hormone.

BHRT with pellet therapy works quickly, producing steady levels of hormone over several months to reverse symptoms and return hormones to appropriate physiologic levels.

If you believe you may be experiencing symptoms of low or imbalanced hormones, consider treatment with bioidentical hormone replacement. Your individual symptoms, health history, and labs are used to direct a personalized treatment plan. Schedule an appointment with our anti-aging specialist to help you determine if hormone replacement therapy is a good treatment option for you.

For more information about our Hormone Replacement Program, our licensed practitioner would be happy to answer your questions about our approach to hormone balancing and its potential benefits. Please call 813-345-4044 or submit a consultation request to schedule a one-on-one appointment with our Wellness Specialist.