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Data supports that hormone replacement therapy with pellet implants is the most effective and the most bio-identical “biologically equivalent” method to deliver hormones in both men and women.  Implants, placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy.

What are Pellets?
Pellets are made up of either estradiol or testosterone. The hormones are pressed or fused into very small solid cylinders. Pellets are larger than a grain of rice and smaller than a  "Tic Tac". In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials.  There is an FDA approved 75 mg testosterone pellet (Testopel®).

Why pellets?
Pellets deliver consistent, healthy levels of hormones for 3-5 months in women and 4-6 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with other methods of delivery.  Estrogen delivered by subcutaneous pellets maintains the normal ratio of estradiol to estrone. This is important for optimal health and disease prevention.  Pellets do not increase the risk of blood clots like conventional (oral) or synthetic estrogen replacement therapy. 
In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance.
Testosterone delivered by pellet implant, has been used to treat migraine and menstrual
headaches.  It also helps with vaginal dryness, incontinence, urinary urgency and frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase sense of well being, relieve anxiety and improve memory and concentration.  Testosterone pellets increase lean body mass (muscle strength, bone density) and decrease fat mass.  Men and women need adequate levels of testosterone for optimal mental and physical health and for the prevention of chronic illnesses like Alzheimer?s and Parkinson?s disease, which are associated with low testosterone levels. 
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 pellet implants. Pellets have been used in both men and women since the late 1930?s.

How and where are pellets inserted?
The insertion of pellets is a simple, relatively painless procedure performed under local
anesthesia (which means a lidocaine injection is used to numb the area). Pellets are inserted in the lower abdominal wall or upper buttocks through a small incision that is taped closed. The experience of the health care professional matters a great deal, not only in placing the pellets, but also in determining the correct dosage of hormones to be used, as well as in treating other issues underlying hormone imbalance.

Why haven’t I heard about pellets? 
This is an excellent question. 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.

What if my primary care physician or my gynecologist says that there is ‘no data’ to support the use of pellet implants?  
He or she is wrong.  There is a difference between „no data? and not knowing about or having read the data. It is much easier for busy practitioners to dismiss the patient, than it is to question their beliefs and do the research. After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue can decrease. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve as will overall physical and sexual health.  There is data to support the "long term? safety of hormones delivered by pellet implants.
How long until a patient feels better after pellets are inserted? 
Some patients begin to feel better within 24-48 hours while others may take a few weeks to notice a difference.  Diet and lifestyle, along with hormone balance are critical for optimal health.  Stress is a major contributor to hormone imbalance and illness. 

How long do pellets last?
Pellets usually last between 3 and 5 months in women and 4-6 months in men. Pellets do not need to be removed since they completely dissolve on their own. 

How much does this cost? 
The cost for the initial insertion of pellets is  $200 depending plus the cost of pellets. Men need a much larger dose of testosterone than women and the cost is higher. Pellets need to be inserted 2 to 4 times a year depending on how rapidly a patient metabolizes hormones.  When compared to the cost of drugs to treat the individual symptoms of hormone decline, as well as the monthly costs of bio-identical hormone replacement, pellets are very cost effective. Pellets have been shown to be more effective at reversing bone loss 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? 
Yes, some insurances do pay for the procedure.  Patients may want to contact their insurance companies to see if the procedure will be covered.  Most insurance companies  will cover your lab testing.  Please ask the front desk for ICD10 (diagnosis)and CPT (procedure) codes to use when calling an insurance company.