Pellets, Pills OR Creams? Bio-identical Hormone Replacement

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     Pellets, Pills OR Creams?

         Bioidentical Hormone                      


Bioidentical hormone therapy has become increasingly common today as both women and men are realizing the many benefits. Patients have found that they have more energy, sleep better with less anxiety and have a better body composition with the loss of abdominal fat. Restoring and balancing hormones in women improves mood and libido, and relieves PMS, hot flashes, depression and anxiety. In Men and Women it improves memory and helps get rid of brain fog.

We want to give you the best information so that you can make an informed decision for your health. We believe that you should see an expert in hormone management who will evaluate you with a professional plan and provide close follow up. Also we believe that you should have options for the best individual plan.

Bioidentical Hormones
Bioidentical hormones have the exact molecular structure as hormones produced by your body. Just as a key fit perfectly into the right keyhole, bioidentical hormones do the same in your cells. Research shows that hormonal decline with aging is associated with loss of body function and increase in disease. This is likely due to stress in its many forms. Studies demonstrate that bioidentical hormone replacement therapy can improve sleep, fatigue, mood, cognitive function, bone mass, sexual function, muscle strength and body composition. Also the right balance can decrease inflammation.

Treatment Plans
There are currently three main ways to deliver replacement hormones to your body. Pills can be swallowed or taken under the tongue. Creams can be delivered by patches applied with metered dose applicators, and pellets are delivered or placed under the skin for low long-lasting absorption.


Pills or Capsules are able to deliver an exact dose that is prescribed by your doctor.  Capsules allow your doctor to individualize your dose and also make it easy to adjust your dose as you work to find the right dose to alleviate your symptoms. With capsules, you can administer a higher dose than with creams.

The downside is that you have to metabolize the medication via the liver through direct blood flow from the gut system.  This has been shown in many studies to have untoward side effects. Further you have to remember to take them daily or twice daily and the cost can get expensive.

Creams deliver the hormones directly into your blood stream through your skin. Absorption amount of the hormone depends upon time of year and condition of your skin i.e. hydrated, dry, or irritated.  This can and does affect the amount of medication that is absorbed. Also, all body sites are not as equally permeable. Application sites for the cream must be rotated, for instance, absorption could be different between the inner arm and inner thigh.

Again the downside is that you have to apply daily or twice daily and many people don’t care for this option. There are patches however that bypass that problem but once again this mechanism depends on the condition of the skin and changes in environment which affect the absorption rate. Another issue is transference to others in the family which often occurs.

The advantage to creams is that the absorption of the cream bypasses the liver metabolism and avoids some of the side effects I mentioned earlier.


Pellets contain Estradiol and Testosterone and are compressed into the size of a grain of rice that are the implanted under the skin. The pellets then release hormones into your body over time. The pellets are inserted under the skin through a small incision (either lower abdomen or upper buttocks) with local anesthesia. The incision is then closed with sterile tape strips or butterfly closure. The pellets are replaced approximately every 4 to 6 months. They do not need to be removed and are dissolved by the body because they are a natural agent found in the body. Patients can begin to feel relief starting anywhere from hours up to 2 days or more after the pellets are implanted.



To avoid the pellets from working their way out of the body, there are post-op instructions one must follow. After the insertion of the pellets, vigorous physical activity, bathing and swimming should be avoided for approximately 3-5 days. A shower may be taken as long as the incision isn’t scrubbed until it is well healed.

The benefits of pellets are that you have a sustained dose of hormones in your body maintaining your youthful and natural functions. A steady state is maintained and that is much better for treating menopausal symptoms. For Men of course the benefit is that you do not have to take a pill or cream daily or twice daily. Women may still need to take Progesterone however because it is more difficult to absorb in a controlled fashion.

Often times we will combine these treatments until we have tested a patient over a period of months and evaluate and recalculate the exact and perfect individual dose. Hormone levels need to be followed over time to keep a balance especially when the patient is first being treated. We believe that all of our patients are unique and should be treated as individuals. We you’re your symptoms seriously. Therefore, we monitor these levels after treatment to endure a more rapid and complete resolution of your symptoms.

Your physician must be knowledgeable and experienced with prescribing bioidentical hormone therapy. Your hormone management should be addressed with knowledge of all the available tools to treat hormone imbalances, and treated with care by a full time expert in this field.

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