What Does Bio-Identical Pellet Hormone Therapy for Women Involve?
If you are deemed a suitable candidate for bio-identical pellet hormone therapy, the process begins with baseline blood work and a consultation. Once cleared for treatment, a small area of skin just above your buttock will be numbed with a local anesthetic. A tiny two- to three-millimeter incision is then made, through which a thin metal tube with a plunger painlessly inserts the testosterone pellet into the deep fat layer, where it will remain undetectable. The small opening is covered with a steri-strip skin tape, which naturally falls off within four to five days as the skin heals.
Your post-pellet insertion progress will be monitored through symptom resolution and follow-up blood work over the next few months. Many women begin noticing improvements within the first month, and in most cases, Dr. Richards recommends follow-up insertions every three months to maintain optimal hormone levels.
Testosterone and Estrogen: The Body’s Natural Balance
The human body is designed with remarkable precision; there are no “mistakes.” It would be inefficient, even impractical, for the body to rely on a hormone critical to cellular health if its circulation fluctuates widely in females and remains at a consistently low level in males. Instead, the body has developed a more reliable system for ensuring estrogen is available where needed.
Research by Evan Simpson 1 has revealed that every tissue dependent on estrogen for proper function produces an enzyme called aromatase, which converts testosterone into estrogen inside the cells. Their findings showed that circulating estrogen levels in the bloodstream do not directly correlate with the estrogen levels within individual tissues. For example, bone cells may have significantly higher or lower estrogen levels than brain or breast tissue, depending on their specific needs. This variation occurs because each tissue regulates its own estrogen supply by adjusting aromatase activity based on available testosterone and local demand.
Estrogen is essential for the health of both men and women. It supports critical functions in the bones, brain, heart, vascular system, gastrointestinal tract, skin, and reproductive organs. Interestingly, due to their larger body mass, men likely have more total estrogen in their tissues than women do. Furthermore, a woman’s elevated blood estrogen levels occur for only a limited phase of her life (typically 25 to 30 years). Even during her reproductive years, her circulating estrogen may be lower than her husband’s for several days each month.
To assume that women need high circulating estrogen levels for optimal health is scientifically inaccurate. What truly matters is the estrogen inside the cells, not the amount floating in the bloodstream. The body’s ability to regulate estrogen at the cellular level (via testosterone conversion) is a built-in, natural mechanism essential to long-term health.
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Why Do Women Need Testosterone?
For decades, testosterone has been mistakenly labeled a “male hormone,” while estrogen has been considered the defining hormone for women. In reality, testosterone plays a critical role in women’s health – supporting energy levels, mental clarity, mood stability, libido, muscle tone, and bone strength. Despite its importance, testosterone deficiency in women has often been overlooked, leaving many struggling with symptoms like fatigue, brain fog, weight gain, anxiety, and reduced sexual function.
As a leading hormone treatment doctor in Bethesda, Mark Richards, MD has helped countless females enhance their overall quality of life with bio-identical pellet hormone therapy. Designed to restore balance using plant-derived hormones that closely mimic those naturally produced by the body, this treatment can provide a steady, consistent release of testosterone to help women regain vitality and improve cognitive function.
The same environmental factors that have significantly lowered testosterone (T) levels in men have likely also affected women. Although men and women have different reproductive organs, their physiological dependence on testosterone and estrogen for overall health is remarkably similar.
In women, most testosterone is produced by the ovaries, with a smaller amount coming from the adrenal glands. Women are naturally more sensitive to testosterone than men, meaning they require lower levels to maintain physical, emotional, and neurological health. Their testosterone receptors are highly responsive, but this sensitivity can diminish with age. As a result, even a small drop in testosterone levels can lead to significant health effects, as the body experiences a proportionally larger hormonal shift than men would at the same rate of decline.
A recent German study found that women with low testosterone levels had a significantly higher risk of mortality over the next four and a half years. The most striking finding was that women in the lowest 20% of testosterone levels faced a more than 50% increase in mortality risk compared to those in the top 80% combined. 2 These findings highlight the critical role of testosterone in women’s long-term health and longevity.
What Are the Symptoms of Low Testosterone in Women?
The average 40-year-old woman has less than half the testosterone she had at 21.3 So, what happens as testosterone levels decline?
In brief: menopausal symptoms.
When testosterone levels drop below what your body needs, you may experience:
- Changes in mood (e.g. depression, irritability)
- Anxiety
- Unexplained weight gain
- Fatigue
- Insomnia
- Cognitive and memory issues
- Decreased muscle strength
- Decreased libido
- Hot flashes
- Bone loss
As testosterone levels continue to decline, symptoms often worsen and align with those on the Menopausal Rating Scale (MRS), such as:
- Night sweats
- Heart discomfort (skipping, racing, tightness, etc.)
- Aggression
- Physical and/or mental exhaustion
- Decrease in concentration/forgetfulness
- Bladder problems (e.g. difficulty urinating, incontinence)
- Vaginal dryness, burning, or difficulty with intercourse
- Joint and muscular discomfort/rheumatoid complaints
How Can Women Benefit from Bio-Identical Pellet Hormone Therapy?
Testosterone plays a vital role in women’s overall health, but individual sensitivity to the hormone varies. While some women maintain adequate testosterone levels through their ovaries and adrenal glands (often due to genetics, exercise, or other factors), this group is the minority. Most women, especially those who have had their ovaries removed, begin to experience the effects of testosterone deficiency in their 30s, 40s, or 50s, leading to symptoms like fatigue, mood disturbances, weight gain, decreased libido, cognitive decline, and bone loss. Additionally, as women age, their sensitivity to testosterone decreases, meaning higher levels may be needed to achieve the same benefits they once experienced.
Bio-identical testosterone pellets – which have been used safely and effectively in the U.S. since 1939 – can offer a consistent, long-term solution by providing a steady release of testosterone into the body. Unlike creams, injections, or dissolvable tablets (which can lead to erratic absorption and fluctuating hormone levels), pellets are designed to deliver molecularly identical testosterone in a way that closely mimics the body’s natural production. This steady delivery can regulate intracellular estrogen production, maintain hormonal balance, and reduce common symptoms of deficiency.
For more information, or to schedule a consultation with Dr. Mark E. Richards, please contact us today.
Medical References*
1 Oxford Academic
2 National Library of Medicine
3 Healthline