BHRT- Pellet Therapy For Men And Women

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BHRT and Pellet Therapy- Helping You Feel As Good As You Look!

Bio-identical Hormone Replacement for Improved Health and Quality of Life


What are Pellets?


Why pellets?

Even patients who have failed other types of hormone therapy have a very high success rate with pellets. There is no other ‘method of hormone delivery’ 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 method of delivery of hormones. Click here for a summary of the data supporting the use of hormone implants.

How and where are pellets inserted?



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.

Why haven’t I heard about Pellets?

You may wonder why you haven’t heard of pellets. Pellets are not patented and have not been marketed in the United States . They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia . Pellets were frequently used in the United States from about 1940 through the late 70’s when oral patented estrogens were marketed to the public. In fact, some of the most exciting data on hormone implants in breast cancer patients is out of the United States . Even in United States , there are clinics that specialize in the use of pellets for hormone therapy.

Do men need hormone therapy?



Pellets do not carry with them the same risk of breast cancer as high doses of oral estrogens that do not maintain the correct estrogen ratio or hormone metabolites. Nor, do they increase the risk of breast cancer like the synthetic, chemical progestins used in the Women’s Health Initiative Trial. Data supports that balanced, bio-identical hormones are breast protective.
Testosterone, delivered by pellet implantation, has been shown to decrease breast proliferation and lower the risk of breast cancer, even in patients on conventional hormone replacement therapy. Clinical studies show that bio-identical testosterone balances estrogen and is breast protective. This is not true of oral, synthetic methyl-testosterone found in Estratest® , which gets converted to a potent synthetic estrogen, which can stimulate breast tissue. In the past, testosterone implants have been used to treat patients with advanced breast cancer. In 1940, it was theorized that treating patients with testosterone implants earlier, at the time of diagnosis, would have an even greater benefit, preventing recurrence. Androgens have also been shown to enhance the effect of Tamoxifen® therapy in breast cancer patients. References supporting these statements can be found in the data section of the website in the ‘Breast Cancer Folder’. A power point presentation ‘Nov 07′, summarizing the full text references, may be viewed.
So, how can my doctor claim that bio-identical hormones are not safer that synthetic, chemical ‘hormones’?
Although some physicians and pharmaceutical companies claim that, ‘bio-identical hormones are not safer than synthetic, chemical hormones’, this is not true. Bio-identical progesterone (including FDA approved Prometrium®) does not increase the risk of breast cancer like the synthetic progestins. Progesterone, used vaginally, does not negate the beneficial effects of estrogen on the heart like the synthetic progestins. Estriol, an estrogen widely used in Europe is a bio-identical hormone, which has never been submitted for FDA approval in the United States . It does not bind strongly to estrogen receptors and does not stimulate breast tissue. Numerous studies have shown that vaginal estriol does not increase the risk of breast cancer (RR 0.7). It has safely been used in breast cancer survivors where it lowered the risk of recurrence and death. It is important to understand that balanced hormones are the key to health and disease prevention. There are FDA approved bio-identical hormones like Prometrium®, estradiol gels and patches, and the testosterone pellet. FDA approval is only required if a pharmaceutical company wants to market a drug to the public.
Are there side effects to estrogen delivered by pellet implantation?
Hormone deficiency is a common cause of hair loss and treatment with estradiol and testosterone implants can help to re-grow hair. Hair becomes thicker and less dry with pellet therapy. Click here for more information ‘Hair Health and Hormone Balance’
How long until a patient feels better after pellets are inserted?
How long do pellets last?
Do patients need progesterone when they use the pellets?
Most times when estradiol is prescribed, progesterone is also prescribed even if the patient has had a hysterectomy. The main indication for the use of synthetic progestins, like Provera®, is to prevent the proliferation (stimulation) of the uterine lining caused by estrogen. However, there are progesterone (not progestin) receptors in the bone, brain, heart, bladder, breast and uterus where progesterone has been shown to have beneficial effects. Progesterone can be used as a topical cream, a vaginal cream, an oral capsule (Prometrium®), or sublingual drops. Only oral progesterone (100-200 mg) and vaginal progesterone (45-90 mg) have been studied and shown to protect the uterine lining from estrogen stimulation.
If a patient is pre-menopausal, she uses the progesterone the last two weeks of the menstrual cycle (day 1, the first day of bleeding). Hormone therapy with pellets is not just used for menopause. Women at any age may experience hormone imbalance. Levels decline or fluctuate contributing to debilitating symptoms. Pellets are useful in severe PMS, post partum depression, menstrual or migraine headaches, and sleeping disorders. Pellets may also be used to treat hormone deficiencies (testosterone) caused by the birth control pill.
How are hormones monitored during therapy?
Hormone levels will be drawn and evaluated before therapy is started. This will include a FSH, estradiol, testosterone and free testosterone for women. Thyroid hormone levels may also be evaluated. Men need a PSA, sensitive estradiol, testosterone, liver profile and blood count prior to starting therapy. Levels will be reevaluated during hormone therapy, usually prior to insertion of the next set of pellets, 4-5 months. 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?
When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective. There is more good, ‘unbiased’ data on pellets and bone density than any pharmaceutical drug on the market. It is beyond the scope of this handout to examine the cost of drugs used for insomnia, depression, sexual dysfunction, obesity, diabetes, hypertension and more.
Will insurance cover the procedure?
Some insurance companies cover the cost of pellets, especially in men. Others do not. Most physicians require payment for their services. Patients may want to contact their insurance companies to see if their costs will be reimbursed. Prevention is much more cost effective than disease. Patients are able to ‘appeal’ a denied claim.
Is there a role for testosterone implants (pellets) in a pre-menopausal female?
Testosterone pellets may be used in pre-menopausal females (women who have not stopped menstruating). Testosterone has been shown to; relieve migraine or menstrual headaches, help with symptoms of PMS (pre menstrual syndrome), relieve anxiety and depression, and improve sex drive and libido. If a pre-menopausal female has a testosterone pellet inserted, she must use birth control. There is a theoretical risk of ‘masculinizing’ a female fetus (giving male traits to a female fetus).