Bioidentical Hormone Replacement Therapy, or BHRT, can be administered in many forms. The ones that most people are familiar with are pills, creams, gels and injections, but recently another option has been gaining popularity because it frees men and women from the hassle of remembering to take something daily, and also minimizes side effects. Hormone pellet therapy may seem like new technology, but actually dates back to the 1930s, and has been around long as bioidentical hormone therapy itself.
Just as with other forms of BHRT, hormone pellets are derived from plants, and are structurally identical to the hormones produced by the human body. Currently, pellets are only available for testosterone and estradiol therapy. Each pellet, which is about the size of a grain of rice, is inserted into a small incision in the upper hip area during a simple, in-office procedure. After it is inserted, the body will slowly begin to metabolize the pellet, which releases a steady, natural dose of hormones over the course of three to six months, depending on how quickly the body metabolizes the pellet.
In recent years, on-the-go, busy lifestyles have increased the demand for the convenience of pellet therapy. Pellet therapy offers the same general benefits as other BHRT delivery methods, but there are some distinct features and advantages that set it apart, including:
Testosterone pellet therapy is a great option for men who want to avoid the pain that can sometimes be associated with testosterone injections, or who are worried about the possible transference of creams to their loved ones or pets. Pellet therapy can last from 3-6 months once it is inserted, and delivers a slow release of testosterone that provides numerous benefits including:
Women can also choose hormone pellet therapy as an option for testosterone replacement, and get the same benefits of the natural-release formulation. Women suffering from menopausal symptoms see great improvements from estradiol and testosterone therapy, however, some women who are not going through menopause may also pursue testosterone therapy for:
As women age, their estrogen levels become lower. These hormone levels drop the most dramatically immediately before menopause (perimenopause), and then during menopause. In fact, many men have higher estrogen levels than some women after they have gone through menopause. Because the organ primarily responsible for estrogen production is the ovaries, a woman who has had a hysterectomy removing both ovaries will struggle with her estrogen levels as well. Estrogen pellets are typically prescribed to treat the symptoms of menopause, but may also be used for treating poor bone density, chronically low mood and to improve cardiovascular health.
RevitalizeMaui uses the latest advances in age management and total wellness to offer a new approach for men and women looking to revitalize their minds, rejuvenate their bodies and reclaim their confidence. With our treatments and process, we can help you look, feel and be your very best.
If you are interested in hormone pellet therapy, here is what you can expect:
1. Initial Consultation and Evaluation – After filling out paperwork detailing your history and any symptoms you are experiencing, you will meet with Dr. Okwuje for your initial consultation and evaluation. During this time you will discuss these things and your goals for BHRT, and he will recommend any testing that needs to be done before starting with your treatment plan.
2. Optimize your prescription – In most cases, if you have not already been on BHRT for a while you may need to use topical medications for a few months before having any pellets inserted. This is because pellets last for 3-6 months once inserted, so you want to be sure you have the correct prescription before having them put in. Your prescription may need to continue to be adjusted until you are free of any symptoms, and then you can switch to hormone pellets. While we are optimizing your prescription, you may need to have further testing and follow up appointments.
3. Pellet Insertion – Once your topical hormone prescription has been optimized, your pellet prescription will be determined. The procedure for insertion only takes a few minutes in our office. The insertion site is numbed, which is usually the upper buttocks or hip area. A small incision is made for the pellet, and once it is inserted the site is covered with a small bandage. You will want to avoid any extraneous lower body exercise immediately following your pellet insertion (this does not include walking). Swimming, hot tubs, and bathtubs should also be avoided (not including showers). After you remove the bandage, you can resume all normal activities.
4. Living with Pellets – Your pellets will begin to work 7-10 days after your pellet insertion. Once a pellet is inserted, it delivers a consistent dose of bio-identical (naturally derived) hormones into the bloodstream. These pellets are derived from plants, which closely mimic the hormones that are naturally within your body, and with each patients’ unique physiology in mind. Additional testing and follow ups will be required to ensure that your pellets are the correct prescription and your hormone levels remain optimized.
Pellets contain the hormones estradiol or testosterone, which are pressed/fused into very small, solid cylinders. The size of these pellets is larger than a grain of rice and smaller than a ‘Tic Tac’. The pellets used at our Center are made by a licensed compounding pharmacy and delivered in sterile containers.
Because pellets deliver consistent, healthy levels of hormones, they avoid the fluctuating hormone levels that are seen with every other delivery method. These fluctuations in hormones are what cause many of the unwanted side effects and symptoms a patient experiences.
When compared to conventional hormone replacement therapy in studies, pellets have been shown to be superior for relieving menopausal symptoms, the maintenance of bone density, restoration of sleep patterns, and the improvement of libido, sexual response and performance. Many patients who have been unsuccessful with other types of hormone therapy can have a very high success rate with pellets. There is also no other method of hormone delivery that is as convenient for the patient as pellets are, and they do not increase the risk of blood clots like synthetic hormone replacement therapy does.
Both men and women have been using pellet therapy since the late 1930’s. Pellets were frequently used in the United States from about 1940 through the late 70’s, the early 80’s. There is actually more data that supports the use of pellets than any other hormone delivery method. Most of the research available on pellets come from England and Australia.
Complications can include minor bruising, bleeding, infection, discoloration of the skin and possible extrusion of the pellet. Most of these complications are rare, other than slight bruising or discoloration of the skin. You should avoid extended exposure to moisture (swimming, hot tubs, bathtubs) for 4 to 5 days, as well as a vigorous physical activity for 48 hours in women and up to 7 days in men. If a patient is diabetic or has recently had a joint replaced, antibiotics may be given.
Many patients notice that they have more energy, sleep better and feel happier. You can see an increase in muscle mass and bone density, while fatty tissue decreases. You may also notice increased strength, coordination and physical performance. Improvement in skin tone and hair texture, concentration and memory and overall physical and sexual health can be seen as well.
No, pellets do not have the same risk of breast cancer like with high doses of oral estrogens, such as Premarin, that do not maintain the correct estrogen ratio or hormone metabolites. They also do not increase the risk of breast cancer like the synthetic, chemical progestins that were used in the Women’s Health Initiative Trial. Data, in fact, support that balanced hormones protect the breasts.
Some patients report that they start to “feel better” within 24-48 hours, while for others it may take a week or two to start to notice a difference.
For women, pellets usually last between 3 and 5 months, and 5-6 months for men. For some patients, some factors such as high levels of stress, physical activity, some medications and lack of sleep may increase the rate at which the pellets absorb and may require new pellets be inserted sooner.
The pellets completely dissolve on their own and do not need to be removed.
Testosterone levels in men begin to decline in their 30’s. When they begin to show signs of testosterone deficiency men should get tested. Men in their 30’s can be testosterone deficient and show signs of bone loss, and most men need to be tested by around 50 years of age.
Anytime you are prescribed estradiol, progesterone is also prescribed. Women have progesterone (not progestin) receptors in the bones, brain, heart, breasts, and uterus. Progesterone can be delivered as a topical cream, a vaginal cream, oral capsule, or sublingual drops or capsules.
Hormone therapy with or without pellets is not just used for menopausal women. You can experience hormone imbalance at any age, as levels decline or fluctuate. This is what contributes to debilitating symptoms such as severe PMS, menstrual or migraine headaches postpartum depression, and sleeping disorders. Pellets can also be used to treat hormone deficiencies that are caused by taking oral contraceptives.
Hormone levels evaluated before therapy is started. They will be reevaluated during hormone therapy at 4-6 weeks and again in 3-5 months. After the first years of therapy hormones levels are tested less frequently.
The cost for pellets varies depending on the dose of the hormones, as well as the number of pellets needed. Because men need a larger dose of testosterone than women, typically their cost is higher. The cost of insertion usually includes the cost of the pellets, and when you compare it to the cost of monthly medication, pellets are very cost effective.
The benefits of a successful and comprehensive treatment plan for hormone replacement and balancing go far beyond simply addressing symptoms. At RevitalizeMaui, we deliver medically-based solutions for low testosterone and provide other anti-aging solutions for men and women who live on or are visiting the island of Maui, and beyond through telemedicine.