Hormone replacement therapy pellets are made up of hormones, most commonly either Estradiol or Testosterone. The hormones 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 glass vials. There is an FDA approved 75 mg testosterone pellet.
Why pellets for hormone replacement therapy?
Pellets deliver consistent, healthy levels of hormones for 3-4 months in women and 4-5 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. Estrogen delivered by subcutaneous pellets, maintains the normal ratio of estradiol to estrone. This is important for optimal health and disease prevention. Hormone replacement 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, and improvement in sex drive, libido, sexual response and performance.
Testosterone and hormone replacement therapy delivered by a pellet implant has been used to treat migraine and menstrual headaches. It also helps with vaginal dryness, incontinence, urinary urgency and frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase sense of well being, relieve anxiety and improve memory and concentration. Testosterone, delivered by pellet implant, increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of testosterone for optimal mental and physical health and for the prevention of chronic illnesses like Alzheimer’s and Parkinson’s disease, which are associated with low testosterone(low T) levels. Even patients who have failed other types of hormone replacement therapy techniques have a very high success rate with pellets. There is no other ‘method of hormone replacement elivery’ that is as convenient for the patient as the implants. Pellets have been used in both men and women since the late 1930’s. There is more data to support the use of pellets than any other hormone replacement therapy method. In addition, there is significant data that supports the use of testosterone implants in both women and men.
How and where are hormone replacement pellets inserted?
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 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.
Are there any side effects or complications from the insertion of the pellets?
Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women. Testosterone stimulates the bone marrow and increases the production of red blood cells. A low testosterone level in older men is a cause of anemia. Testosterone, delivered by implants or other methods, can cause an elevation in the red blood cells. If the hemoglobin and hematocrit (blood count) get too high, a unit of blood may be donated.
After the insertion of the implants, vigorous physical activity is avoided for 48 hours in women and up to 5 to 7 days in men. Early physical activity is a cause of ‘extrusion’, which is a pellet working it’s way out. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, this is a ‘clean procedure’ and antibiotics may not be needed.
How long until a patient feels better after pellets are inserted?
Some patients begin to ‘feel better’ within 24-48 hours while others may take a week or two to notice a difference. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness. Side effects and adverse drug events from prescription medications can interfere with the beneficial effects of testosterone implants.
How long do pellets last?
Can a patient be allergic to the implants?
Very rarely, a patient will develop local zone of redness (3-8 cm) and itching at the site of the testosterone implant. There is minimal or no tenderness and no other sign of infection. Pellets are made of up testosterone, stearic acid and PVP (povidone). Patients may react to the PVP. Implants can be compounded or made without PVP. Many patients who develop a local reaction to the implant have low cortisol levels and upon further questioning, have symptoms of adrenal insufficiency. Cortisol testing may be recommended. If needed, 25-50 mg of benedryl works well for the itching.
How are hormones monitored during therapy?
Levels will be reevaluated during hormone therapy, usually prior to insertion of the next set of pellets. After the first year of therapy, hormones levels may be followed less frequently. Men must 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.
How much does this cost?
The cost for the insertion of pellets will vary depending on the dose of the hormone and the number of pellets needed. Men need a much larger dose of testosterone than women and the cost is higher. Pellets need to be inserted 2 to 4 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, pellets are very cost effective. Prevention is much more cost effective than disease. Long, continuous administration of hormones by pellets is convenient and economical for the patient. Pellet implantation has consistently proven more effective than oral, intramuscular, and topical hormone therapy with regard to bone density, sexual function, mood and cognitive function, urinary and vaginal complaints, breast health, lipid profiles, hormone ratios and metabolites.
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