WHY DO I NEED TESTOSTERONE?
Testosterone is the third female hormone and is just as essential as estrogen and progesterone. Women need this hormone to keep their thought processes quick and their libido healthy. Testosterone also improves energy levels, bone density, muscle mass, strength, sleeping habits and may prevent some types of depression.
WHAT ARE PELLETS?
Pellets are made up of either estradiol or testosterone. The hormones, estradiol or testosterone, are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice and smaller than a ‘Tic Tac’. In the United States, pellets are made by a licensed compounding pharmacist and delivered in sterile glass vials.
WHY ARE PELLETS OPTIMAL FOR HORMONE REPLACEMENT?
Pellets deliver consistent, healthy levels of hormones for 3-6 months, depending on the dosage. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. It is the fluctuation in hormones that causes many of the unwanted side effects and symptoms a patient experiences. Pellets do not increase the risk of blood clots like conventional or synthetic hormone 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, improvement in sex drive, libido, sexual response and performance. Even patients who have failed other types of hormone therapy have a very high success rate with pellets. In addition, there is no other method of hormone delivery that is as convenient for the patient as pellets.
WHEN WERE PELLETS FIRST USED FOR HORMONAL REPLACEMENT?
Pellets have been used in both men and women since the late 1930’s. In fact, there is more data to support the use of pellets than any other method of delivery of hormones. Pellets are not patented and not 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 England and Australia with some from Germany and the Netherlands. Pellets were frequently used in the United States from about 1940 through the late 70’s, early 80’s when 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 Stated there are clinics that specialize in the use of pellets for hormone therapy.
HOW AND WHERE DO YOU INSERT PELLETS?
The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the lower abdominal wall or hip through a small incision which is taped closed. Experience of the health care professional counts; not only in placing the pellets, but in determining the correct dosage of hormones to be used.
WHAT ARE POTENTIAL COMPLICATIONS FROM INSERTING HORMONE PELLETS?
Side effects from the insertion of the pellets include minor bleeding or bruising, discoloration of the skin, infection (rare) and possible extrusion of the pellets (rare). Testosterone itself may cause an increase in the production of red blood cells so a complete blood count will be drawn periodically to monitor for these changes. If the level gets too high, a unit of blood may be donated. Some patients may also notice an increase in facial hair or acne.
WHAT CAN I EXPECT AFTER PELLET INSERTION?
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 decreases. 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.
DO PELLETS HAVE THE SAME DANGER OF BREAST CANCER AS OTHER FORMS OF HORMONE REPLACEMENT?
Traditional hormone replacement therapies, utilizing synthetic estrogens, have been determined to increase the risk of breast cancer by the Women’s Health Initiative Trial. Recent medical research suggests that bio-identical testosterone pellets may DECREASE the risk of breast cancer.
HOW LONG DO THE PELLETS LAST?
The pellets usually last between 3 and 4 months in women and 5 to 6 months in men. High levels of stress, physical activity, some medications and lack of sleep may increase the rate at which the pellet absorb and may require that pellets are inserted sooner in some patients.
The pellets do not need to be removed. They completely dissolve on their own.
DO I HAVE TO BE IN MENOPAUSE TO BENEFIT FROM PELLETS?
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 caused by the birth control pill.
DOES TESTOSTERONE IMPROVE DEPRESSION AND ANXIETY?
Yes. In fact, many patients who get testosterone implants are able to come off of their antidepressants.
DOES TESTOSTERONE THERAPY INCREASE THE RISK OF STROKE OR HEART ATTACK?
Some clinical studies have alluded to an increased risk of cardiovascular disease including strokes and heart attacks in some patients on testosterone, but an equal number of studies have shown a decreased risk of cardiovascular events in patients on this therapy.
I GET HORRIBLE HEADACHES – WILL THE PELLETS HELP ME?
In most cases, yes. Many patients with a history of migraine headaches and menstrual headaches have had great improvement of their headaches after pellet therapy.
DO I NEED TO TAKE ANY OTHER HORMONE MEDICATIONS?
Usually not, although some patients may benefit from a low-dose progesterone pellet for breakthrough symptoms, or progesterone tablets orally to address persistent insomnia.
DO WOMEN NEED TO TAKE PROGESTERONE ALONG WITH THE TESTOSTERONE PELLETS?
Any time estradiol is prescribed, progesterone is also prescribed. There are progesterone (not progestin) receptors in the bone, brain, heart, breast and uterus. Progesterone can be used as a topical cream, a vaginal cream, oral capsule, or sublingual drops or capsules. If a patient is pre-menopausal she uses the progesterone the last two weeks of the menstrual cycle.
HOW ARE THE HORMONES MONITORED DURING THERAPY?
Hormone levels will be drawn and evaluated before therapy is started. This will include a FSH, estradiol, CBC, progesterone and free testosterone for women. Men need a PSA, CBC, LH, zinc, total and free testosterone, and estradiol prior to starting therapy. Levels will be reevaluated during hormone therapy at 4-6 weeks and again in 3-5 months. After the first years of therapy hormones levels are followed less frequently. The PSA in men is followed every 6-12 months.
WHAT IS THE COST FOR PELLETS?
The cost for the insertion of pellets will vary depending on the dose of the hormones and the number of pellets needed. Men need a much larger dose of testosterone than women and the cost is higher. When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective.
WILL INSURANCE COVER THE PELLETS AND INSERTION?
Some insurance companies cover the cost of pellets, others do not. Each insurance and specific policy benefit coverage is different. Colorado Ageless Intitiute suggests that each patient check with their insurance company for coverage before scheduling an appointment. A letter that can be submitted to your insurance company can be downloaded from the FORMS section of our website.
MY DOCTOR SAYS THERE ISN’T ANY DATA TO SUPPORT THE USE OF BIO-IDENTICAL HORMONE PELLETS.
Though well intentioned, your doctor is wrong. In fact, bio-identical hormone pellets have been used in both men and women since the late 1930’s, and there is more data to support the use of bio-identical hormone pellets than any other form of hormone therapy. In other words, there is a difference between “no data” and “not having read the data.” See our RESOURCES page for more data.