Hormones can be compressed into very small pellets (the size of a “Tic Tac”), using specialized equipment.  Pellets should only be obtained from a 503B designated pharmacy.  Pellets are placed into the fatty layer underneath the skin, by a simple office procedure, performed under local anesthesia. Dosing is very accurate, customized and individualized.  The hormones dissolve from the pellets very gradually over a 4 to 6 month period of time.  In this way, hormones are constantly available to the bloodstream in physiologic amounts (amounts just right for optimal body functioning). Blood levels then remain in a steady state for 4 to 6 months.

Hormones taken by mouth go through the “First Pass Effect” and travel to the liver. Oral estrogens and testosterones can increase clotting factor production in the liver and then increase the risk of blood clot formation in the body, deep vein thrombosis, pulmonary embolism and stroke. These oral hormones are also converted into dangerous estrogens in the liver, that lead to an increase in the risk of breast cancer. Issues concerning transdermal creams/gels/lotions include problems in judging the right amount to apply and patients may apply too much. It is unknown how long transdermal hormones linger on the skin and they may transfer to children, pets, or clothing. Most of the compounded products have not been subjected to pharmacokinetic studies (studies that compare dosages with blood levels over time). Patients may think they’re receiving certain amounts of hormones, but the hormones may not even be absorbed through the skin! There are also problems with hormone patches as 40 to 60% of women don’t absorb estrogen in a consistent fashion from a patch. Injections of testosterone (always synthetic) are even more dangerous as the testosterone levels can reach superphysiologic levels (too high) in 2-3 days. Levels then fall abruptly leading patients to seek another injection before the next dose is due. Men receiving injections too frequently, especially if they have not had blood tests showing testosterone deficiency, can have an increased, rather than decreased, risk of heart disease secondary to stiffening of the heart muscle.

Hormone (always bioidentical) pellet therapy is one of the safest, most effective and studied methods of replacement. Pellets should only be administered by a trained professional after consultation and review of a hormonal profile. Hormonal imbalance/deficiency should also be confirmed by a baseline blood test. Given in a careful fashion, hormone pellet therapy can greatly improve the quality of life for both men and women.