What are pellets?

Pellets are made up of either estradiol or testosterone. The hormones, estradiol or testosterone, are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice and smaller than a ‘Tic Tac’. In the United States, pellets are made by a licensed compounding pharmacist and delivered in sterile glass vials.

Why are pellets optimal for hormone replacement?

Pellets deliver consistent, healthy levels of hormones for 3-6 months, depending on the dosage. 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. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy.

In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, improvement in sex drive, libido, sexual response and performance. Even patients who have failed other types of hormone therapy have a very high success rate with pellets. In addition, there is no other method of hormone delivery that is as convenient for the patient as pellets.

When were pellets first used for hormonal replacement?

Pellets have been used in both men and women since the late 1930’s. In fact, there is more data to support the use of pellets than any other method of delivery of hormones. Pellets are not patented and not marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of England and Australia with some from Germany and the Netherlands. Pellets were frequently used in the United States from about 1940 through the late 70’s, early 80’s 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 United Stated there are clinics that specialize in the use of pellets for hormone therapy.

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. Experience of the health care professional counts; not only in placing the pellets, but in determining the correct dosage of hormones to be used.

What are potential complications from inserting pellets?

Complications from the insertion of pellets include minor bleeding, bruising, discoloration of the skin, infection, and possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin these complications are very rare. Extended exposure to moisture (swimming, hot tubs, bath tubs) is avoided for a few days, and vigorous physical activity is avoided for 24-48 hours in women and up to a few days in men. Please don’t think you will have to restrict your workout, but maybe just lay off the gluteal exercises for a day or so. Antibiotics may be given if a patient is diabetic or has recently had a joint replaced.

What can I expect after pellet insertion?

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, coordination 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.

What are the most common side effects when the pellets are first inserted?

When a patient first starts hormone therapy there may be mild, temporary breast tenderness; which gets better on its own. Hormone receptors may be very sensitive and take time to adjust. There may be a temporary water weight gain which will also resolve on its own. The body will tone up, as bone density and muscle mass increase and fatty tissue decreases. Patients may experience a mild form of “puberty” as their hormonal levels come up into normal ranges.

How soon will I feel the effects of the pellets?

Some patients begin to “feel better” within 24-48 hours while others may take a week or two to notice a difference.

How long do the pellets last?

The pellets usually last between 3 and 5 months in women and 4-6 months in men. High levels of stress, physical activity, some medications and lack of sleep may increase the rate at which the pellet absorb and may require that pellets are inserted sooner in some patients.

Do the pellets need to be removed every 3-6 months?

The pellets do not need to be removed. They completely dissolve on their own.

Do men need hormone replacement?

Testosterone levels begin to decline in men beginning in their 30′s. Most men maintain adequate levels of testosterone into their mid 40′s to mid 50′s, some into their late 70′s early 80′s. Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30′s can be testosterone deficient and show signs of bone loss. Most men need to be tested around 50 years of age. It is never too late to benefit from hormone therapy.

Do patients need progesterone when they use the pellets?

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.

Do I have to be in menopause to benefit from pellets?

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.

How are the hormones monitored during therapy?

Hormone levels will be drawn and evaluated before therapy is started. This will include a FSH, estradiol, testosterone and free testosterone for women. Men need a PSA, estradiol, SHBG, testosterone and CBC. Levels will be reevaluated during hormone therapy at 4-10 weeks and again after any changes in dose. After the first years of therapy hormones levels are followed less frequently. The PSA in men is followed every 6-12 months after the initial insertions.

What is the cost for pellets?

The cost for the insertion of pellets will vary depending on the dose of the hormones and the number of pellets needed. Men need a much larger dose of testosterone than women and the cost is higher. When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective. For most women, pellets will be less expensive than the compounded creams and patches. For men needing pellets twice a year, pellets usually cost about the same as monthly creams but with the physician visits included. Men needing pellets more than twice a year may end up spending a slightly more but will enjoy greater convenience.

Will insurance cover the pellets and insertion?

Some insurance companies cover the cost of pellets, others do not. Each insurance and specific policy benefit coverage is different. Charleston HealthSpan Institute suggests that each patient check with their insurance company for coverage before scheduling an appointment if insurance reimbursement is a worry.

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