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Frequently Asked Questions about Hormone Pellets

What are hormone pellets?
Hormone pellets are about the size of a grain of rice and are inserted under the skin in the buttock area and gradually release hormones.

Are hormone pellets painful?
Lidocaine is used to numb the skin and after that one should not feel any pain. Only a small cut is made in the skin and no stitch is needed.

Can one resume normal activities after pellet placement?
We recommend no swimming or tub baths for a week after having pellets placed. For two days it is recommended not to do any vigorous activities such as horse riding or long distance running that might open up the wound.

Are hormone pellets new?
Hormone pellets have been used in this country since 1938 and are a popular form of hormone delivery in Europe and Australia. There is a new FDA approved testosterone pellet called Testopel but the generic compounded versions have been available for a long time.

What is the advantages of hormone pellets?
Hormone pellets gradually release hormones so it provides a steady supply of hormones over four months. Pellets eliminate the need of having to take pills daily or rubbing on creams. Oral pills are chewed up by the stomach acid and liver so do not stay in the form we give them. Oral hormones are broken down by the liver into little pieces that are like clotting factors and that is why there is believed to be an increased risk of blood clots, strokes and blood clots with oral hormones. There are studies showing that oral hormones have a higher risk of these compared to other forms of delivery.

What are the most common side effects?
With estrogen and progesterone some women get breast tenderness and can get spotting. However this generally resolves with time and the dose can be adjusted so this does not happen.

Can hormone pellets be used with a history of breast cancer?
There are studies showing that testosterone given with arimidex that blocks the conversion of testosterone to estrogen is safe in breast cancer and helps with the symptoms of menopause.

Can progesterone be put in pellets?
Only a few pharamacies make progesterone pellets as heat sterilization cannot be used with progesterone. Unfortunately, most physicians are not aware of how to use progesterone pellets but we have found pharmacies that manufacture these pellets and we are one of the only practices that can use estrogen, testosterone and also progesterone pellets.

We have worked with bio-identical hormones for many years and are excited to be able to offer hormone pellets to our patients. Many people are not familiar with hormone pellets so here are answers to some common questions.

What are hormone pellets?
Hormone pellets are about the size of a grain of rice and these are inserted under the skin and slowly release the hormone over four to six months. The hormones they contain are bio-identical which means that they are identical to what the human body makes.

Is it painful?
A numbing medicine called lidocaine is injected in the area and after this is injected one cannot feel any pain. Only a small cut is made in the skin and this is so small that no sutures need to be placed to close the skin. Most often people cannot feel the pellets but for men several pellets have to be inserted and some people might be able to feel a slightly swollen area but that dissipates with time.

How do hormone pellets compare with oral hormones?
When hormones are given orally, the stomach acid chews them up and the liver breaks them up into small pieces. The liver produces clotting factors out of the oral hormones that increase the risks of heart attacks, strokes and blood clots. Studies have shown that giving the hormones either topically or under the skin have lower risks of heart attacks, strokes and blood clots because the hormones do not go through the liver. In addition, these are bio-identical hormones which is very different from premarin which is made from pregnant horse urine.

What are the risks of pellets?
Any time a cut is made in the skin, there is a risk of infection but this is rare. If the pellets are not inserted deep enough, there is a risk that the pellets can work their way out of the skin causing an infection in the process. There is some discomfort at the site of the insertion but this resolves in a few days.

Are pellets something new?
Hormone pellets have been used since the 1930s and are more commonly used in Europe where pharmaceutical companies manufacture them. In the United States, testosterone pellets have recently been marketed as “Testopel” but a pharmaceutical company. However, those are more expensive and similar testosterone pellets are made by compounding pharmacies. Compounding pharmacies also make pellets companies estrogen and progesterone for women. Women also need some testosterone and all of these hormones can be given as pellets.

Where should I go for pellets?
We have three providers and some of our providers have been doing pellets for many years. We accept insurance for the visit although the pellets are an out of pocket expense.

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