FAQs

Bio-identical hormone pellets, or implants, are made up of hormones (i.e. testosterone) that 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, the majority of pellets are made by compounding pharmacists and delivered in sterile packaging.

Testosterone is the most crucial hormone for overall health in both men and women. It plays a central role in regulating inflammation, immunity, muscle mass, bone density, brain function, and mood. A pivotal discovery even revealed that every molecule of estrogen within our cells is produced from testosterone, underscoring its essential role in maintaining hormone balance. Adequate testosterone levels are not only vital for optimal mental and physical health but also for preventing chronic conditions such as Alzheimer’s and Parkinson’s disease, which have been associated with low testosterone levels.

Testosterone delivered via pellet therapy offers several advantages over other methods. In fact, even patients who have failed other types of hormone therapy typically have a very high success rate with pellets, which have been used in both men and women since the late 1930s.

These pellets are designed to provide a consistent, steady release of testosterone, avoiding the fluctuations seen with oral, topical, or injection-based therapies. This steady release can help alleviate a range of symptoms, from migraine and menstrual headaches to vaginal dryness, incontinence, and urinary urgency. Moreover, clinical studies have shown that testosterone pellet therapy can increase energy, relieve depression, reduce anxiety, and improve memory and concentration in both men and women. Additionally, testosterone pellets can contribute to increased lean body mass and improve muscle strength and bone density, while also decreasing fat mass, thereby promoting a healthier body composition.

For the majority of patients, bio-identical hormone pellets avoid the fluctuations associated with every other method of delivery. Pellets do not increase the risk of blood clots or other side effects like conventional or synthetic hormone replacement therapy. Pellets also tend to provide superior relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response, and performance.

These pellets are not patented, which has limited their marketing in the United States for financial reasons. They are more commonly used in Europe and Australia, where pharmaceutical companies produce and research them extensively. In fact, much of the research on pellet implants originates from these regions. In the United States, pellets were widely used from about 1940 until the late 1970s, when oral patented estrogens became popular. Remarkably, some of the most compelling data on hormone implants, particularly in breast cancer patients, comes from U.S. studies. Today, there are still clinics in the United States that specialize in hormone therapy using pellet implants.

The insertion of bio-identical hormone pellets is typically a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the “love handle” or upper buttocks through a small incision, which is then closed with a skin tape (steri-strip). The experience of the health care professional matters a great deal, not only in placing the pellets, but also in determining the correct dosage of hormones to be used.

Hormone levels may be drawn and evaluated before therapy is started. This may include an FSH, estradiol, and testosterone (free and total) for women. Men need a PSA (prostate specific antigen), estradiol, testosterone, and blood count prior to starting therapy. Thyroid hormone levels (TSH) may also be evaluated. In men, follow up levels, including a PSA, blood count and estradiol, may be obtained prior to some of the subsequent testosterone implantation.

Furthermore, men are encouraged to notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care physician.

Some patients begin to notice improvements within 24 to 48 hours after insertion, while others may require one to two weeks to experience the full benefits. Maintaining a healthy diet and lifestyle is essential, as these factors work in concert with hormone balance to support optimal health. Additionally, stress and any side effects or adverse reactions from prescription medications can affect how quickly you benefit from the testosterone implant.

Bio-identical hormone pellets usually last approximately three months in women and four months in men. Please note that the pellets do not need to be removed; they should completely dissolve on their own.

Possible side effects from the insertion of pellets include bruising and discoloration of the skin. More rarely, patients may experience minor bleeding, infection, allergic reaction, or extrusion of the pellet (which is when the pellet works its way out). 

It is also important to be aware of the potential sex-specific complications of bio-identical pellet hormone treatment:

• Women: Contrary to rumors, women do NOT “grow a penis” even with a large dosage of testosterone! Voice lowering occurs only at extremely high levels and should return to normal as the levels decline. Testosterone may cause a slight increase in facial hair in some women; this issue generally resolves as the dosage is decreased. 
• Men: Testosterone stimulates the bone marrow and increases the production of red blood cells. Consequently, testosterone pellets can cause men to experience an elevation in red blood cells. If the hemoglobin and hematocrit (blood count) get too high, male patients may benefit from donating a unit of blood.

After the insertion of the implants, vigorous physical activity should be avoided for 48 hours in women and up to five to seven days in men. Prematurely resuming physical activity can lead to extrusion. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced; however, because this is a “clean procedure,” antibiotics are not usually needed.

Very rarely, a patient may develop a localized area of redness (typically 3–8 cm) accompanied by itching at the site of the testosterone implant. This reaction is most often due to sensitivity to the skin adhesive applied before the steri-strip or the tape adhesive itself. Tenderness is usually minimal or absent, and there should be no other signs of infection.

Testosterone pellets may be used in pre-menopausal females (women who have not stopped menstruating). Testosterone has been shown to relieve migraine or menstrual headaches, help with symptoms of PMS (premenstrual syndrome), relieve anxiety and depression, increase energy, help with sleep, and improve sex drive and libido. If a pre-menopausal female has a testosterone pellet inserted, she should use birth control. There is a theoretical risk of “masculinizing” (or giving male traits to) a female fetus.

Fortunately, it is never too late for men to benefit from hormone therapy. As testosterone levels fall with age, estrogen levels may increase, highlighting the need for careful hormone balance monitoring.

While many men maintain adequate levels of testosterone into their mid 40s (with some into their late 60s), others notice their testosterone levels begin to decline as early as their late teens. Testosterone deficiency can manifest in bone loss, fatigue, depression, erectile dysfunction, difficulty sleeping, and mental decline. If these signs are evident, men should be tested as soon as possible.

In Dr. Richards’ clinical experience, continuous testosterone therapy delivered via bio-identical hormone pellets more effectively relieves menopausal symptoms (e.g. hot flashes) than estrogen alone or a combination of testosterone and estrogen. More than half of the women treated with estrogen pellets experience uterine bleeding, a side effect that necessitates further evaluation (often including a vaginal ultrasound and endometrial biopsy). In addition, estrogen can stimulate breast tissue, leading to discomfort, breast pain, and cyst formation, while also increasing the risk of breast cancer. Given that elevated estrogen levels are physiologically needed only during the mid-cycle for pregnancy preparation, most women tend to feel better with lower, more naturally balanced estrogen levels.
A pivotal study by Sherwin compared the effects of four treatment regimens (testosterone alone, testosterone combined with estradiol, estradiol alone, and placebo) in surgically menopausal women. ¹ The study found that the group receiving testosterone alone demonstrated the greatest improvements in somatic, psychological, and overall function. In contrast, the estrogen-only and placebo groups showed poorer outcomes, and higher circulating testosterone levels were associated with a better response. These results are consistent with the understanding that testosterone serves as the primary substrate for estrogen production in various tissues, including the brain, bones, vascular system, breast, and adipose tissue.
Moreover, excess estrogen can lead to adverse effects such as anxiety, weight gain (particularly increased abdominal fat), tender breasts, emotional lability, and symptoms of PMS. Long-term exposure to high levels of potent estrogens – such as estradiol and synthetic forms like PREMARIN^® – has been linked to an increased risk of breast cancer. In some patients, an excessive conversion (aromatization) of testosterone to estradiol can further diminish testosterone’s beneficial effects. In these cases, an aromatase inhibitor (e.g., anastrozole) may be prescribed, and combination therapy using testosterone and an aromatase inhibitor can be considered for patients, including breast cancer survivors or those with elevated estrogen levels.
Overall, these findings support the use of testosterone pellet therapy as a safer and more effective option for managing menopausal symptoms compared to estrogen-based therapies alone.

No. Women who are treated with testosterone implants alone (no estrogen therapy) do not require progestin therapy. With this in mind, if estradiol or other estrogen therapy is prescribed, progestins are also needed. The main indication for the use of synthetic progestins, like PROVERA^® or progesterone, is to prevent the proliferation (stimulation) of the uterine lining caused by estrogen. Progestin therapy is NOT required if estrogen therapy is not prescribed.

Hormone deficiency is a common contributor to hair loss. As such, testosterone implants can help stimulate regrowth by restoring hormonal balance. Many patients report that, with pellet therapy, their hair becomes thicker and less dry over time.

The cost for the insertion of bio-identical hormone pellets is roughly $550 for women and $1,100 for men. Because males need a much larger dose of testosterone than women, the cost of their treatment is typically higher. 

Pellets need to be inserted three to four 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, bio-identical hormone pellets are very cost-effective.

Some insurance companies cover the cost of bio-identical hormone pellets, especially in men, whereas others do not. Patients may want to contact their insurance companies to see if their costs will be reimbursed. We urge patients to remember that prevention is much more cost-effective than disease!

He or she is wrong. There is a big difference between “no data” and not having read the data. It is much easier for busy practitioners to dismiss the patient than to question their beliefs and read the research. It becomes important for the patient to make an informed choice. There is also data to support the long-term safety of testosterone delivered by pellet implants.

Testosterone therapy, particularly through pellet implantation, has been explored for its potential protective effects against breast cancer. Some studies suggest that testosterone may counteract estrogen-induced breast tissue proliferation, thereby reducing cancer risk. ² Historically, testosterone implants were utilized in the treatment of advanced breast cancer, with early theories proposing that initiating such therapy at diagnosis could prevent disease recurrence. ³