Hormone replacement therapy (HRT) has been a godsend to many patients. Its anti-aging and general health benefits have improved their quality of life and well-being, not to mention sleep, mood, muscle strength, sex drive, and numerous other issues. The issue has always been which form of HRT is best. For many, it has been oral forms. This is fraught with a number of issues. Estrogen (of any form) given orally will increase inflammatory markers and clot risk. Testosterone cannot be given orally at doses that men require without causing liver issues. This has led to the development of subcutaneous hormone pellets. These are small cylindrical pellets that are implanted under the skin and slowly release the hormone contained in that pellet over the course of months.
Pellets are particularly well adapted for testosterone replacement in men. Topical testosterone typically does not generate optimum levels in the blood. Injections can generate those levels, but there is too much variation on a daily basis—from too much the day after an injection to too little as the injection is wearing off. Testosterone pellets can be placed every 4-6 months and offer steady and optimal levels the entire time. There is also far less effect on increases in the blood count that is seen with injectable testosterone.
Pellets are more complicated for women. Because we don’t know how an individual is going to respond to the initial dose, we have to proceed with caution with women that still have a uterus. Too high a dose of estrogen can cause uterine bleeding, and this might last the entire time the pellets are active (at least three months). We start low and go slow. For women that have had a hysterectomy, pellets are ideal—offering a steady level of estrogen (and testosterone if needed) for about three months.
The actual placement of pellets is straight forward. They are usually placed over the upper outer buttock area. Lidocaine with epinephrine is used to anesthetize the area. A small (1cm) incision is placed and a tract is created in the subcutaneous tissue using a specialized tool (a trocar). Pellets are then pushed through the trocar into the tissue, and the trocar is withdrawn. Pressure is applied to stop any bleeding and steri-stips are used to close the wound. We typically check levels of the hormones in one month to check on dosing and again at three months to see how the pellets are holding up.
Dr. Neuenschwander is currently doing pellet therapy at BEMC. Ask your practitioner if you quality for this convenient, life changing therapy.
