Pellet Therapy

Is it a good option?

There are different methods of administration when using Compounded Bio-identical Hormone Replacement Therapy:

  1. Sublingual Lozenge or Troche (small medicated lozenge designed for optimal dissolution) – my favorite method for HRT as it promotes better absorption of the medication into the bloodstream and faster results.
  2. Cream – easy to use, but perhaps not the most optimal in terms of absorption. Most beneficial if increase in bone density is an important goal to achieve.
  3. Oral (capsules) – my least favorite method of administration, since the actual amount of medicine delivered cannot be regulated with unknown amounts metabolized and neutralized by the liver.
  4. Pellet Therapy: See below!

In general, I am open to prescribing any of the above means of HRT. My primary goal is to provide the education so as to allow the patient to choose the method she believes to be most effective for her.

Since I’ve received a few inquiries regarding what is known as Pellet Therapy, I feel compelled to give an explanation as to why I prefer not to be a provider of this particular method for HRT.

Pellet Therapy

In Pellet Therapy, Estrogen and Testosterone are pressed in to a very small solid cylinder, larger than a grain of rice. After the pellet is inserted under the skin, initially a high dosage of Estrogen/Testosterone is delivered to the body; in some instances, hormone concentration not completely leveling off over time.

The problems with this technique of delivery are multiple:

  1. The higher dosage of estrogen can affect the breast tissue in such a way as to increase potential of promoting cancerous events in the breast. A steady, low dosage of estrogen has a more stable impact on breast tissue and thus is far less likely to have undesirable effects.
    Read more: “Estrogen concentration in the blood and risk of breast cancer”
  2. The higher dosage of estrogen, can stimulate the lining of the uterus that can lead to heavy bleeding and hyperplasia which is a precancerous state of the uterus. Although a woman with a uterus will normally be given oral progesterone to offset the stimulatory effect of estrogen, based on my practice experience sometimes no amount of progesterone can offset the effect of estrogen on the uterine lining. These women sometimes will need a hysterectomy either because the bleeding won’t stop or there are some precancerous/cancerous changes in the uterus
  3. Estrogen effects the production of clotting factor(s) in the liver. Women with high levels of estrogen are prone to blood clot formation. Blood clotting is a well known factor in strokes and/or heart attacks
  4. Contrary to common claims made about Pellets, the human body doesn’t have the automatic tendency to regulate their effect by promoting the release of the Pellet hormones at steadily low rate. The plain fact is that the use of pellets for this type of hormone replacement therapy is still at an investigational stage with many facts as yet unknown.

Final Thought

The idea behind prescribing Hormone Replacement Therapy is to be able to achieve what needs to be achieved ( symptom relief, prevention of bone loss ) with the minimum dosage possible. Also the ability to increase the dosage if symptoms still present, and decrease the dosage in the presence of adverse event(s). Unfortunately, these cannot be achieved when Pellets are used: once they are inserted under the skin, they cannot be removed regardless of the severity of the adverse reactions.

To discover your path to wellness and schedule a health assessment, contact us today.