BHRT Frequently Asked Questions

1. 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.


2. 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 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.


3. 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.

4. 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.

5. What are potential complications from inserting hormone pellets?

Complications from the insertion of pellets include minor bleeding, bruising, discoloration of the skin, infection, and possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin these complications are very rare. Extended exposure to moisture (swimming, hot tubs, bath tubs) is avoided for 4 to 5 days, and vigorous physical activity is avoided for 48 hours in women and up to 5 to 7 days in men. Antibiotics may be given if a patient is diabetic or has recently had a joint replaced.

6. Why do many providers say “there is no data to support the use of hormonal pellets”?

If your health care practitioner says that there is no data to support the use of pellets, he or she is wrong. There is a big difference between “no data” and not having read the data. Likewise, many patients have been told by their physicians, that there is “no data to support bio-identical hormone therapy”. It is much easier for busy practitioners to say this and dismiss the patient, than it is to question their beliefs and do the research.