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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. Hormone replacement with pellets is one of the most viable options available to women and men as the best, most natural way to deliver hormones to the body. Implants, placed under the skin, consistently release small, physiologic doses of bioidentical hormones providing optimal therapy. Even patients who have failed other types of hormone therapy have a very high success rate with pellets.

What are Pellets? 

Pellets are made up of either estradiol or testosterone. These hormones are pressed or fused into very small solid cylinders, resulting in pellets that 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, do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy.

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.
The pellets usually last between 3 and 4 months in women and 5-6 months in men. The pellets do not need to be removed. They completely dissolve on their own.

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. 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.

Why haven’t I heard about Pellets?  Because bioidentical hormones are derived from plants, pellets cannot be patented or marketed in the U.S. as opposed to synthetic hormones that are patented and marketed by drug companies. In contrast, pellets are frequently used in Europe and Australia where pharmaceutical companies do produce pellets. Most of the research on pellets is out of England, Australia, Germany and the Netherlands. Pellets were frequently used in the U.S from about 1940 through the late ‘70s to early ‘80s 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. Even in U.S. there are clinics that specialize in the use of pellets for hormone therapy.

What if my primary care physician or my gynecologist says that there is no data to support the use of pellets?  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 bioidentical hormone therapy’. It is much easier for busy practitioners to ignore this research and to dismiss patients’ interest in healthier, alternative treatments. Remember, it’s your body, it’s your choice. It is about how you want to feel.

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, 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.

Hormone receptors take time to adjust, and short-term incidences of breast tenderness or weight gain may occur. However, 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.

Hormone therapy for women: Hormone levels will be drawn and evaluated before therapy is started. This will include a FSH, estradiol, testosterone and free testosterone (and, if necessary, thyroid and liver enzymes check). In women, any time 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.

Hormone therapy for men: Men need a PSA, estradiol, free estradiol, testosterone and possibly estrone testing prior to starting therapy. Levels will be reevaluated during hormone therapy at 4-6 weeks and again in 4-5 months. After the first years of therapy hormone 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 ‘30s. Most men maintain adequate levels of testosterone into their mid ‘40s to mid ‘50s, even up to the early ‘80s. Most men need to be tested around 50 years of age.

How much does this cost?  The cost for the insertion of pellets is $250 and the cost of the number of pellets needed ($27-$50 per pellet). Men need a much larger dose of testosterone than women (generally between 3-6 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. Patients 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.
Courtesy Dr. R. Glaser.  www.hormonebalance.org