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In this article
Hormone pellet treatment has gained popularity as one of several types of hormone replacement therapy (HRT) offered in recent years. In this article, we explore the advantages and disadvantages of this approach, providing a detailed examination of its benefits, risks, and considerations for those of you who are contemplating this form of treatment. We also look at the potential implications for people with Hashimoto’s thyroiditis and hypothyroidism, thyroid conditions that are more common in men and women over 50.
Hormone pellets are tiny implants about the size of a grain of rice. The pellets are inserted under the skin, usually in the buttocks or hip area, through a small incision. Once implanted, the pellets slowly release hormones into your body over an extended period, typically 3 to 6 months. They are commonly used as a form of hormone replacement therapy to alleviate perimenopausal and menopausal symptoms, andropause (the male equivalent of menopause), and other hormonal imbalances.
Hormone pellet therapy is considered a form of bioidentical hormone replacement therapy (BHRT) because it usually contains bioidentical hormones, which are chemically identical to those produced by the human body. For women, these pellets include estradiol, estrone, and dehydroepiandrosterone (DHEA), while testosterone pellets may be used for both men and women.
Convenience
One of the most significant advantages of hormone pellets is their convenience. Once inserted, the pellets provide a steady release of hormones for several months – typically between three and six months – eliminating the need for daily pills, frequent patch changes, or application of creams. This consistent delivery can produce more stable hormone levels, resulting in fewer symptom fluctuations.
This hands-off approach also allows you to avoid the inconvenience of remembering daily or weekly doses, which can be especially beneficial if you have a busy schedule.
Consistency
One of the most significant advantages of hormone pellet therapy is the steady release of hormones into the bloodstream. Unlike oral medications or creams, which may result in peaks and valleys of your hormone levels, pellets provide a more consistent and sustained release. This can be particularly beneficial if you experience significant hormone fluctuations with other methods of hormone therapy.
Improved symptom relief
Many patients on hormone pellet therapy report significant relief from symptoms of hormonal imbalance, including:
- Energy levels: Hormone imbalances can lead to fatigue and low energy. By restoring hormone levels, pellet therapy can boost overall energy.
- Mood and mental clarity: Hormones like estrogen and testosterone play a role in brain health and emotional well-being. Balanced hormone levels can alleviate mood swings, anxiety, depression, and “brain fog.”
- Sexual function: Testosterone therapy in both men and women can improve libido, sexual performance, and overall satisfaction.
- Sleep quality: Many patients report better sleep and reduced insomnia with hormone therapy.
In women, estradiol pellets may also alleviate common symptoms of perimenopause and menopause, such as hot flashes, night sweats, vaginal dryness, and bone density loss. For men, testosterone pellets can help combat symptoms of andropause, such as low libido, muscle loss, and cognitive decline.
Hormone pellets are bioidentical
Hormone pellets often contain bioidentical hormones derived from natural plant sources and chemically identical to the hormones produced by the human body. Many patients and healthcare providers believe that bioidentical hormones are preferable to synthetic hormones because they are recognized and metabolized by the body in the same way as naturally occurring hormones.
Bioidentical hormone therapy is also thought to reduce the risk of side effects associated with synthetic hormone treatments, such as an increased risk of blood clots, stroke, and cancer. While research is ongoing, some patients report feeling more “natural” or “balanced” when using bioidentical hormones compared to synthetic hormone treatments.
Treatment can be customized
Hormone pellet therapy can be tailored to your specific needs. Before the pellets are implanted, you’ll usually undergo blood tests to determine their baseline hormone levels. Based on these results, a healthcare provider can customize the type and dosage of hormones in the pellet to address the patient’s specific symptoms and needs. The dosage and combination of hormones can be adjusted based on your symptoms, hormone levels, and overall health. This personalized approach may lead to better outcomes and fewer side effects.
In addition, the steady release of hormones over time allows healthcare providers to monitor and adjust your therapy as needed. If your hormone levels are too high or too low, adjustments can be made during subsequent pellet insertions to fine-tune the treatment.
This personalized approach ensures that you receive the right amount of hormone for optimal results.
Low complication rates
Hormone pellet therapy has demonstrated remarkably low complication rates. A large retrospective study involving over 1.2 million pellet implants found an overall complication rate of less than 1%. This low incidence of adverse events compares favorably to other hormone delivery methods, such as creams, gels, injections, and patches, which have reported complication rates ranging from 10% to 30%. The safety profile of subcutaneous hormone pellet implants appears to be superior to other routes of administration for bioidentical hormone replacement therapy, with fewer side effects and better long-term continuation rates.
Potential health benefits
Some studies suggest hormone pellet therapy may offer additional health benefits beyond symptom relief. These potential benefits include:
- Reduced risk of heart disease
- Improved bone density
- Enhanced cognitive function
- Better mood and energy levels
However, more research is needed to fully establish these long-term benefits.
Fewer application-related issues
Unlike topical hormone treatments, pellets don’t carry the risk of transferring hormones to others through skin contact. They also eliminate concerns about the proper application or inconsistent absorption that can occur with creams or gels.
We’ve looked at the pros of hormone pellet treatment. Let’s review some of the downsides to consider.
Pellets require surgical insertion
Unlike oral or topical hormone therapies, hormone pellet therapy involves a minor surgical procedure to insert the pellets under your skin. Although the procedure is typically quick and performed under local anesthesia, some patients may experience discomfort, bruising, bleeding, swelling, scarring, or infection at the insertion site. The area can remain tender for a few days, and you’ll need to avoid certain activities like vigorous exercise until the insertion site heals.
It can be hard to picture what it’s like to get hormone pellets implanted under your skin. Here, one doctor walks you through her process:
Limited flexibility in dosage adjustment or reversal
One of the biggest challenges of hormone pellet therapy is adjusting the dosage once the pellets have been implanted. Unlike oral medications or topical treatments, where the dosage can be adjusted daily or weekly based on symptoms, hormone pellets release a steady amount of hormone over time.
If you experience side effects, have an adverse reaction, or if the dosage is too high or too low – or you need to change treatment for some reason – it can be difficult to make immediate adjustments. The pellets cannot be easily removed once implanted. Instead, you’ll need to wait for the pellets to dissolve, which can take several months. This lack of reversibility can be problematic, as you must wait for the pellets to dissolve naturally over time.
For this reason, hormone pellet therapy may not be ideal if you require frequent adjustments to your hormone levels or you’re just beginning hormone therapy and may need to experiment with different dosages to find the right balance.
Potential side effects
Like all forms of hormone replacement therapy, pellets can cause side effects. Common side effects include:
- Acne: Especially with testosterone pellets, you may experience an increase in acne, as testosterone can stimulate oil production in the skin.
- Weight gain: Some patients report weight gain and fluid retention on hormone pellets. However, this is not always directly related to the pellets and may instead be due to changes in muscle mass and metabolism.
- Mood changes: While hormone therapy can improve mood for many patients, it may cause irritability, depression, anxiety, or mood swings in others, particularly if hormone levels become too high or imbalanced.
- Hair growth or loss: Testosterone therapy can lead to increased hair growth in some areas, such as the face or body, while causing hair thinning or loss in others, such as the scalp. Women may develop increased facial hair, and men may have worsening male pattern baldness.
- Breast tenderness: Some women experience breast tenderness on hormone pellet therapy.
In rare cases, more severe side effects may occur, including blood clots, stroke, heart attack, or breast cancer. The risk of these side effects is thought to be lower with hormone pellets – which typically use bioidentical hormones – compared to synthetic hormones via other delivery methods. However, more research is needed to fully understand the long-term risks of hormone pellet therapy.
Higher initial hormone levels
Hormone pellets often result in higher initial hormone levels immediately after insertion. This surge can lead to temporary side effects or worsening of symptoms in some patients.
Not suitable for everyone
While hormone pellet therapy may be effective for many people, it is not suitable for everyone. Certain medical conditions may increase the risks associated with hormone replacement therapy. For example, if you have a history of hormone-sensitive cancers like breast cancer or prostate cancer, blood clots, or cardiovascular disease, your doctor may advise against any hormone therapy – including hormone pellet treatment – as it could worsen these conditions.
If you have any risk factors for or predisposition to hormone-sensitive cancers, or you’re at a higher risk for heart disease, you should approach hormone pellet therapy with caution. A thorough medical evaluation and discussion with a healthcare provider are essential to determine whether hormone pellet therapy is a safe and appropriate option for you.
Lack of long-term research
Although hormone pellet therapy has been used for decades, there is still a relative lack of long-term research on its safety and efficacy compared to other forms of hormone replacement therapy. Most studies on hormone therapy focus on oral or transdermal methods, leaving a gap in the scientific literature on pellet-based treatments.
As a result, while many patients report significant benefits from hormone pellet therapy, the long-term risks remain somewhat unclear. For example, there are some concerns about the risk of certain cancers, including endometrial and uterine cancer.
This lack of extensive research may be a concern if you are considering long-term use of the therapy, for example, you’re a younger person who may need hormone replacement for many years.
Lack of FDA approval
Hormone pellet insertion is a procedure that is not currently approved by the Food and Drug Administration (FDA). The hormones used in the pellets are FDA-approved, but the pellet delivery method has not undergone the testing required for FDA approval. This lack of regulation can lead to variations in quality and consistency between different providers.
Cost considerations
Hormone pellet therapy can be more expensive than other forms of hormone replacement therapy. The implant procedure is often not covered by insurance, leaving you to pay out-of-pocket for the pellets and the insertion procedure. The total cost can vary depending on the healthcare provider, the number of pellets required, and the frequency of pellet insertion, usually several times per year.
While some patients feel that the convenience and effectiveness of hormone pellet therapy justify the cost, others may find it prohibitive, especially if insurance does not cover the treatment. If you’re on a tight budget, the cost of hormone pellet therapy may be a significant barrier.
To better understand the pros and cons of hormone pellets, it’s helpful to compare them to other common HRT methods:
If you’re considering hormone pellet therapy, keep these factors in mind:
Your symptoms and health needs
Hormone pellet therapy can be highly effective for people experiencing significant symptoms of hormonal imbalance, such as severe menopausal symptoms or low testosterone. However, if your symptoms are mild, you may be able to achieve relief with less invasive methods such as topical or oral hormone therapy.
Your healthcare provider
It’s crucial to work with a healthcare provider who has specific training and experience in hormone pellet therapy.
Your medical history
If you have certain medical conditions, such as a history of hormone-sensitive cancers or cardiovascular disease, as noted earlier, you may need to avoid hormone therapy altogether. Always discuss your medical history with a healthcare provider before starting any form of hormone therapy.
Comprehensive hormone testing
Before starting treatment, your provider should conduct thorough hormone level testing to determine the appropriate dosage and combination of hormones.
Time and financial commitment
Hormone pellet therapy is not a one-time treatment; it requires regular pellet insertions every 3 to 6 months to maintain hormone levels, as well as ongoing monitoring. Hormone pellet therapy can also be more expensive than other forms of hormone replacement therapy. If you are not prepared for the time and cost involved, other forms of hormone therapy may be more suitable.
Potential risks
Discuss the potential short-term and long-term risks with your healthcare provider.
If you have Hashimoto’s thyroiditis or hypothyroidism and are considering hormone pellet therapy, there are several important factors you should take into account.
Thyroid function monitoring
You’ll need regular thyroid testing to monitor your thyroid function during hormone pellet treatment, as hormonal changes can affect your thyroid hormone levels and treatment requirements.
Specifically, it’s crucial to regularly test and closely monitor your thyroid-stimulating hormone (TSH), free thyroxine (free T4), and free triiodothyronine (free T3) levels.
Dosage adjustments
You’ll want to be aware that introducing hormone pellets may necessitate adjustments to your thyroid hormone replacement dosage. It’s relatively common, for example, to need a slightly increased dose of thyroid hormone medication when your hormone therapy includes estrogen.
Symptom management
Some symptoms of hypothyroidism overlap with those of sex hormone imbalances, making it vital that you and your healthcare provider work together to distinguish between the two as best as possible. This careful evaluation is needed to ensure your symptoms are appropriately attributed and treated.
Autoimmune considerations
If you have Hashimoto’s thyroiditis, be aware that it’s an autoimmune condition, and hormonal changes that result from hormone pellet therapy may influence your immune function. That’s why experts recommend that you periodically monitor your thyroid peroxidase (TPO) antibody levels for any changes.
Personalized approach
Given the complex interplay between thyroid function and sex hormones, a personalized approach is essential. This includes:
- A comprehensive initial assessment of your thyroid function and overall health status.
- Regular follow-up appointments to monitor your response and adjust treatment as needed.
- Consideration of combination T4-T3 therapy if standard levothyroxine treatment is insufficient.
Patient education
It’s also important that you learn about and understand:
- The importance of adherence to both thyroid hormone replacement and hormone pellet therapy.
- Potential symptoms that may indicate a need for dosage adjustment.
- The need for regular monitoring and follow-up appointments.
Hormone pellet therapy offers a unique approach to hormone replacement with several potential benefits, including convenience, consistent hormone delivery, and effective symptom relief for many patients in perimenopause, menopause, or andropause. However, it also comes with significant drawbacks, such as the need for a surgical insertion procedure, limited dosage flexibility, and potential long-term health risks.
The decision to use hormone pellets should be made carefully, considering your health needs, preferences, and risk factors. It’s essential to have a thorough discussion with a qualified healthcare provider to determine if hormone pellet therapy is the right choice for you.
As with any medical treatment, the key is to weigh the potential benefits against the risks and to choose the option that best aligns with your health goals and lifestyle. Remember that hormone therapy is not a one-size-fits-all solution, and what works well for one person may not be the best choice for another.
Ultimately, the goal of any hormone replacement therapy should be to improve your quality of life while minimizing potential risks. By staying informed and working closely with your healthcare provider, you can make the best decision for your needs and circumstances.
If hormone pellet therapy to treat perimenopause and menopause is not for you, consider working with Paloma’s hormonal healthcare providers. They’ll explore other options for hormonal treatment with you and work with you to develop a safe and appropriate treatment for your hormonal imbalances.
understand the connection
Perimenopause, Menopause, and Hypothyroidism
Gain insights into how these conditions are linked and how to manage your health effectively.
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