How long have pellets been around?

Pellets were originally developed in 1939 for women who underwent radical hysterectomies. Widely used in Europe and Australia, they are the longest studied form of hormone replacement therapy to date.

What are pellets made of?

• Pellets are made by utilizing the steroid ring of the soy or yam plant to create estradiol and testosterone molecules.

• There is no cross allergy between pellets and soy allergic patients because it is a completely different molecule.

• Stearic acid is used as the binding agent in pellets.

• The likelihood of anyone being allergic to stearic acid is very rare. In fact, if you have ever taken aspirin, then you have ingested stearic acid.

Are pellets FDA approved?

• The ingredients in pellets are FDA approved, but the actual pellets are not.

• Rest assured, pellets are manufactured in a 503B facility which are under strict regulations by the FDA and pharmacy boards.

Are pellets covered by insurance?

• The pellets insertion procedure is beginning to be covered by a few insurance companies. Please consult your insurance company for a complete explanation of your covered procedures.

• A health savings account can be used to pay for the pellet procedure.

• Pellets are included in the price of the procedure.

Are pellets better than patches, shots or creams?

• Pellets are bioidentical and are readily absorbed by the body.

• Pellets are metabolized through the kidneys, not the liver, so byproducts are minimal.

• Pellets bypass the stomach, so you absorb more of the hormone rather than losing some of the hormone through the “first pass effect” that occurs with orally administered hormones.

• Blood flows around the pellets and the body absorbs a small amount of hormones over an extended period of time.

• Pellets mimic the way the body naturally produces hormones.

• Unlike other delivery systems, such creams, patches, gels, oral pills, or injectables, you will not experience a “rollercoaster” effect.

Is there any pain experienced during the pellet insertion procedure?

• You will feel the initial stick of the needle hitting your skin and a slight burning sensation when the lidocaine (numbing medication) is injected.

• You may feel some pressure but no pain during the procedure.

• Insertions take 3-5 minutes for women and 5-10 minutes for men.

What happens to the pellets after they are inserted and how often do they need replaced?

• Over time, the pellets are dissolved by blood flowing through capillaries and they are absorbed into the bloodstream.

• Cardiac output determines the absorption rate of pellets. The more active you are, the better the hormones are absorbed.

• On average, women need pellets replaced 3-4 times per year. Men will need pellets replaced 2 times per year.

• Most men and women can tell when it is time to replace their pellets because their symptoms begin returning.

• The more active you are, the better the pellets are absorbed. This may require very activity individuals to need their pellets replaced more frequently.

How long does it take for the pellets to get into the bloodstream?

• 24-72 hours. Symptom relief can occur anywhere from 24 hours to up to 3 weeks for first time pellet insertions.

• Estrogen begins to get into the bloodstream within 2 days while testosterone may take up to 7 days.

• If your hormone levels are extremely low, therapeutic lab values might not be achieved until your second round of pellets.

Pellet side effects

• Less than 2% of patients experience side effects from pellets.

• Side effects are more noticeable in the first two rounds of pellets during the initial hormone rebalancing phase.

• For those prone to acne, there is a risk of an initial flare up of acne. Talk to your provider if you have a history of acne prior to your first pellet round. Dosing can be adjusted to prevent acne outbreaks.

• Hair may appear to grow faster. If facial hair develops and becomes concerning, there are medications that can be prescribed that help.

• In women, the following may be observed:

  • Temporary fluid retention or swelling. This is typically associated with the first round of pellets. It will resolve on its own as the body regenerates.

  • Approximately 1% of women have hair thinning. This could be due to a genetic tendency to convert testosterone to DHT or a thyroid imbalance.

  • Post menopausal bleeding may occur. If you have a uterus, progesterone must be taken to balance out estradiol and prevent stimulation of the uterine lining. If bleeding does occur with pellet therapy, it is often due to an imbalance in progesterone. Labs will be ordered and assessed to determine estradiol, progesterone, and testosterone levels. A full work up may be necessary to rule out an underlying issue.

• In men, the following may be observed:

  • Mild fluid retention, acne, or increased hair growth.

  • Minimal testicular shrinkage.

Do I need to stop taking any medications before getting preliminary labs drawn?

• No. However, if you are currently on hormone replacement such as cream, patch, oral pill, or injection, do not apply or take your hormones directly before getting blood drawn.

• Once labs are drawn, you may resume taking your hormone therapy.

• For injectable hormones, such as testosterone cypionate, schedule your lab draw the day you are due for your shot (BEFORE the shot is given).

• Once pellets are inserted, women should continue their existing estrogen therapy for 3 days and discontinue on day 4.

• For men receiving testosterone pellets, they should discontinue their testosterone injections therapy 7 day after pellets are inserted.

What if I have a history of breast cancer?

• For women with a history of breast cancer, testosterone plus anastrozole pellets are a treatment option.

• Testosterone is an effective treatment for hot flashes, night sweats, insomnia, vaginal dryness, low libido, incontinence, bladder problems, bone health, fatigue, memory loss, mood changes (depression, anxiety, irritability), and joint/muscle pain.

• Dr. Rebecca Glaser is a pioneer in testosterone therapy among breast cancer survivors. If you have a history of breast cancer and would like more information about the safety and effectiveness of testosterone therapy, I suggest you read the associated research on her website. See the below link.