Hormone Replacement Therapy

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FAQs: Hormone Implants - Pellets

Data supports that hormone replacement with pellet implants is the most effective and the most bio-identical method to deliver hormones in both men and women. The subcutaneous implant releases small, physiologic doses of hormones providing optimal therapy.

What are pellets?

These pellets are either estradiol or testosterone. They are small cylinders that are larger than a grain of rice, but smaller than a "Tic-Tac”. These pellets are made by compounding pharmacists and delivered in sterile glass vials. Our compounding pharmacist is local and all the materials are FDA approved. The compounder will provide a certificate of authenticity for all the compounds used.

Why pellets?

Pellets deliver consistent, healthy levels of hormones for 3-5 months in women and 4-6 months in men. The average patient will undergo an insertion every 3 months. These methods of application avoid the fluctuations, or ups and downs, of hormone levels seen with other methods of delivery. Estrogen delivered by pellets maintain the normal ratio of estradiol and estrone. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy.

Studies revealed that pellets were superior to conventional hormone therapy in:

• Relief of menopausal symptoms
• Maintenance in bone density
• Restoration of sleep patterns
• Improvement in sex drive, libido, sexual response and performance

Testosterone delivered by pellet implant has been used to:

• Treat migraine and menstrual headaches
• Treat vaginal dryness, incontinence, urinary urgency and frequency
• Increase energy
• Relieve depression
• Increase sense of well being
• Relieve anxiety
• Improve memory and concentration
• Increase lean body mass and decreases fat mass
• Adequate levels of testosterone are needed for optimal mental and physical health
• Alzheimer’s and Parkinson’s are associated with low testosterone levels

How are pellets inserted?

The pellets are easily inserted by a relatively painless procedure done under local anesthesia. These pellets are inserted in the lower abdominal wall and upper buttocks thru a small incision that is taped close. The most common area is the upper outer quadrant area of the buttocks commonly used for IM injections.

What are my limitations after insertion?

• Avoid vigorous activity for 48 hours in women and 5-7 days in men
• Early physical activity may cause extrusion of the pellet
• Antibiotics may be indicated in diabetics or in patients that have had joint replacement

Do men need hormone therapy?

Testosterone levels in men begin to decline in their early 30’s. These men should be tested when they show signs of testosterone deficiency which are:

• Bone loss
• Fatigue
• Depression
• Erectile dysfunction
• Difficult sleeping
• Mental decline

Most men need to be tested around the age of 50 and hormonal therapy can help at any age.

What can I expect after the pellets are inserted?

• More energy
• Sleep better
• Feel happier
• Increase in muscle mass and bone density
• Increase in strength, coordination and physical performance
• May see improvement in skin tone and hair texture
• Concentration and memory may improve
• Overall concentration and memory may improve

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

Pellets do not carry the same risk of breast cancer as high doses of oral estrogens that do not maintain the same estrogen ratio or hormone metabolites. Data supports that bio-identical are breast protective.

Testosterone implants have been shown to decrease breast proliferation and lower the risk of breast cancer.

Bio-identical testosterone balances estrogen and is breast protective. This is not true in oral synthetic methyl testosterone that is converted to a powerful estrogen and can stimulate breast tissue.

Studies have shown that testosterone enhances the effect of Tamoxifen and if used early in the treatment of breast cancer can decrease recurrences.

What are the side effects of estradiol pellets?

• Mild breast tenderness at the beginning of the treatment which resolves on its own.
• May be some temporary water retention
• Women that do not have a hysterectomy may have some spotting

The patient will usually start feeling better within 24 to 48 hours of insertion while others may take a week or two to notice a difference.

How long do the pellets last?

• 3-5 months in women
• 4-6 months in men

Do female patients need Progesterone when they use pellets?

Most of the time when estradiol is prescribed progesterone is also used even if the patient has had a hysterectomy.

There are progesterone receptors in the bone, brain, heart, bladder, breast and uterus and the use of progesterone has been shown to be beneficial. Progesterone can be used in the form of Prometrium or oral progesterone (100-200 mg and vaginal progesterone (45-90 mg) and these compounds have been shown to protect the lining of the uterus.

Premenopausal patients will use the progesterone the last 2 weeks of the menstrual cycle. Women can experience hormonal imbalances at any age.

How are hormones monitored during therapy?

Hormone levels will be drawn at the initial evaluation and before each reinsertion.

Women are advised to continue their monthly self breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or PCP

Men need to continue their yearly exams with their PCP.

Conclusion

In conclusion, estrogen and testosterone therapy by implantation is a safe and effective method of hormone therapy for both men and women. Pellet implantation has consistently proven more effective than oral, intramuscular and topical hormone therapy with regard to bone density, sexual function, mood, cognitive function, urinary and vaginal complaints, breast health, lipid profiles, hormone ratios and metabolites.

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