Pros and Cons of Hormone Pellets: Side Effects, Alternatives & More

Want to know if you should use hormone pellets?

Ever wonder if they actually work or if they are safe?

This guide will teach you everything you need to know about hormone pellets and should be used before you get them done. 

It will include basic information, side effects, the differences between other hormone routes and more...

More...

What are Hormone Pellets?

Hormone pellets are simply a way to put a specific amount of hormone into the body through a small procedure. 

These pellets are usually created and filled with bio-identical hormones such as progesterone, estradiol, and testosterone

For men, they typically include testosterone but for women, they may include all 3 or any combination. 

These pellets have gained significant traction over the last 10-15 years, but is it all hype or is there something to them?

In general, and for the record, I'm not a huge fan of hormone pellet therapy, but I will walk you through everything you need to know if you are considering this treatment

There are definitely some people who love their hormone pellets, and who do very well on them, but just because some people do well on them does not mean that everyone should use them

Hormone Pellets vs Other Hormone Administration Methods

Hormone therapy differs not in the hormone you use (although it can) but primarily in how you put it into your body. 

How you take your hormones dramatically impacts the serum levels of your hormones, other sex hormones in your body, your symptoms and much more. 

Because of this, it's worth exploring all of the options before you jump into hormone pellet therapy. 

Hormone pellets require a procedure to be placed, which is unique among all other forms of hormone replacement therapy. 

These pellets are usually inserted into the subcutaneous tissue in your hip or stomach area with a small incision (1).

The pellet then dissolves slowly over a period of months, all the while slowly releasing a stable amount of hormone into your bloodstream. 

The exact amount of hormone which is placed into each pellet can be adjusted based on the needs of the individual. 

In addition, these pellets can also come formulated with multiple hormones. 

Taking hormones through the skin, or via injection/pellet therapy, is preferred over oral administration. 

Oral administrations have been shown to cause highs and lows in hormone levels in your serum (2) and may dramatically increase other hormones such as SHBG

benefits of oral estrogen vs transdermal estrogen therapy

So, pellets are favored in that way. 

But how do they compare to creams/gels/shots?

In terms of efficacy, pellets are no more effective than a gel/cream or injection in theory. 

Basically, as long as you don't take your hormones by mouth you should be good to go. 

Creams/gels/shots/pellets tend to differ in other ways such as patient compliance (how likely you are to take them), potential negative side effects, ease of altering your dose and so on (3).

The choice of which type of hormone method you decide to use largely depends on your preferences. 

With this in mind, it's helpful to have a full understanding of the pros and cons of pellet therapy so you can help make the decision for yourself. 

Pros & Cons of Hormone Pellets

Every procedure, therapy or medication comes with a list of potential benefits and potential side effects. 

You must weigh this pros and cons to determine if the procedure is right for you!

In some instances, your Doctor may have an incentive to push you in one direction (usually due to reimbursement) even though there are other options available to you. 

Make sure you understand these pros and cons before you get hormone pellet therapy. 

Pros

#1. Set it and forget it approach

Perhaps the most important benefit of using hormone pellet is what I refer to as the "set it and forget it approach". 

This approach stems from the fact that hormone pellets are relatively hands-off in terms of patient compliance. 

You get the procedure done in a short visit and then the pellet dumps hormone into your body over the next 3-4 months. 

There's usually a peak hormone rise around the first 1 month and a drop from thereafter (4).

Most people tend to start feeling their symptoms return around 3-4 months (some shorter or longer) which drives them back into the office to get another pellet. 

This is great for some patients, especially if you find it difficult to apply gels/creams on a daily basis due to a heavy travel schedule or other conflicts. 

This is also another option if you can't stand to be injected on a weekly/biweekly basis (for hormones like testosterone). 

But, if you don't mind applying your hormones to your skin on a daily basis, then this benefit may not apply to you. 

#2. Contains bio-identical hormones (superior when compared to pharmaceutical and synthetic hormones)

Hormone pellets also have the benefit of containing bio-identical hormones. 

These are hormones which are exact replicas of your existing hormones and are superior to synthetic or pharmaceutical formulations (5).

Whenever you look for hormone replacement therapy, of any kind, make sure you are using bio-identical hormones. 

You'll know you are receiving these hormones because the name of the hormone your body creates is the same as the hormone you should be taking. 

For instance:

If you want to take estrogen then look for a medication which contains estradiol. 

If you want to take progesterone then look for a medication which contains progesterone USP. 

Synthetic formulations of estrogen (6) include Ethinyl estradiol, esterified estrogens, conjugated equine estrogens and so on. 

Synthetic formulations of progesterone (7) include medroxyprogesterone acetate, norethindrone acetate, norethindrone, norgestrel, norgestimate, levonorgestrel, desogestrel and megestrol. 

Whenever possible, stick to hormones which are identical to what your body produces naturally! 

#3. A stable stream of hormone delivery

The pellet delivery system is designed to provide a steady stream of hormone directly into your body. 

It is deposited into the subcutaneous tissue, which is relatively avascular compared to other tissues (meaning it has fewer blood vessels) which reduce the rate at which it is absorbed. 

This allows for your body to break down the pellet based on the surface area which supplies a relatively even hormone dose directly into your body and tissues over several months. 

This delivery peaks at around 1 month (based on some studies) and begins to fall from that point on at a steady rate (8).

You can compare this type of delivery to oral (which is much more erratic) and transdermal (creams and gels) which tend to have more peaks and troughs in terms of hormone delivery (9).

Cons

#1. Requires a small surgical procedure for each visit

The fact that hormone pellet therapy requires a small incision is something that should be considered by all patients. 

This procedure will require an office visit with a doctor and time on your part. 

You can compare this to simply calling in for a refill of your prescriptions which can easily be done over the phone or through an assistant. 

#2. More expensive when compared to other methods

Hormone pellets also tend to be more expensive when compared to other forms of hormone replacement therapy. 

Anytime your doctor has to do a procedure, spends extra time with a patient or has to mitigate an increased risk of infection, there will always be higher costs involved. 

The actual hormones themselves are quite cheap. 

The price that you pay for the pellet tends to come from the formulation of the pellet, the time it takes to implant it and so on. 

If you are trying to save money, then sticking to the basic hormones in gels/creams may be a cheaper alternative. 

Some hormone locations tend to shuttle people into hormone pellet insertion because it is a big money maker for the clinic. 

Do your best to avoid clinics like these, especially if you feel that you are being pushed into something you don't want to do. 

#3. Increased risk of pain/infection at the insertion site

Anytime the skin is entered, either through injection or otherwise, there is a small risk for infection or bleeding after the procedure. 

With infection rates around less than 1% of all procedures (10), there's probably around a 1 in 150-200 chance that your hormone pellet therapy may become infected or have complications. 

This risk is low but can be real if you plan to get the pellet 3-4x per year. 

#4. Inability to alter or adjust dosing after implantation

One of the biggest problems with hormone pellet therapy, from my perspective, is the fact that you can't alter dosing after you implant it. 

Once the pellet is implanted you will be getting the hormone that you were prescribed for several months whether it's the right dose for you or not. 

This can be a problem because it's quite rare that doctors get hormone dosing right on the first try. 

Adjusting hormone dosing is a regular part of treating patients with hormone imbalances and it can take months to get everything just right

If you put in a pellet which contains too much hormone then you will experience the side effects associated with hormone excess for several months. 

On the other hand, it's also possible to put in an insufficient dose and have the pellet be ineffective. 

It's far easier to simply add to your dosing or take away on your dosing when using gels and creams. 

Side Effects

Side effects from hormone pellets tend to stem from the DOSE and WHICH hormones they contain. 

So, it's not as if all hormone pellets will give you the same symptoms (or benefit) because that largely depends on your prescribing physician. 

There are some potential negative side effects which are unique to hormone pellets and these are included below: 

These side effects largely depend on the hormones you are using, the dose they are formulated with and various other factors such as how you tolerate them. 

Limitations & Who Should use Hormone Pellets

Hormone pellets certainly aren't for everyone, but I've combined a list of patients who tend to do well on this type of hormone therapy below: 

  • Those who desire the "set it and forget it approach"
  • Those who travel frequently or who frequently forget to use gels/creams
  • Those who have trouble remembering to apply their hormones on a daily basis
  • Those who already know what their "dose" is and just want a more convenient approach
  • Those who have better symptomatic control with pellets over gels/creams
  • Those who would rather not take the risk of exposing family members to hormone through close touch, etc.

If you do not fit within these parameters then it may be wise to seek out (at least initially) other ways to take your bio-identical hormones such as the transdermal route. 

Do Hormone Pellets Cause Weight Gain or Weight Loss?

Many patients get hormone therapy to fix a specific problem and one of the problems they are looking to fix is often their weight. 

There is no easy answer to this question because it really depends on if your doctor is able to dose your hormones accurately through the pellet therapy. 

If the dose is correct then you may expect to see an improvement in your symptoms and you may see some weight loss. 

If your dosing is incorrect, either too much or too low, then you may see the opposite effect and you may actually see weight gain (11).

This is why you see conflicting stories about people who state they either gained weight on hormone pellets or lost it. 

It's not the pellet therapy itself but rather the dose of the hormones. 

But remember:

The dose can be achieved through other means, such as gels or creams. 

The bottom line?

Don't count on hormone pellets as a primary weight loss tool, instead just be happy if they happen to help you with weight loss along the way. 

There are much better, and more targeted ways, to lose weight which you can read about here

Final Thoughts

Hormone pellets are one of many ways to provide your body with a steady supply of specific bio-identical hormones. 

Like other therapies in medicine, there are specific pros and cons to using this type of delivery system. 

While pellets may provide you decreased maintenance (in terms of how often you have to "apply" hormone), they come with an increased risk of other overdosing hormones and other side effects such as infection

Before you get a hormone pellet implanted into your body make sure you fully and completely understand the potential risks and benefits involved. 

Now I want to hear from you:

Have you had hormone pellet therapy?

Are you thinking about this type of therapy over other options?

Did it work for you? Why or why not?

Leave your comments below! 

References (Click to Expand)

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

96 thoughts on “Pros and Cons of Hormone Pellets: Side Effects, Alternatives & More”

  1. I have estradiol and testosterone pellets and did great. Well, I did great after I left my big ego know it all doctor who dosed me too low and found an amazing, compassionate doctor who answered all my questions and humored me when I needed it. There’s definitely a high level of trust because like you said if dosing is too high or too low you have to wait it out. Ultimately I’m happy with my choice. If I could do it again I might have figured out dosing with another delivery method snd then changed to pellets. I don’t know if a doctor would go for that. But my body, I’m in charge. I love the pellets because it’s so easy and a very reliable delivery method. As always I appreciate your articles and insight.

  2. Hi Stephanie,

    In a perfect world, figuring out your dosing first and then moving to pellets would probably be the best approach. Unfortunately, most people don’t even know that they have options which is why I like to write these posts! Glad you find them helpful.

  3. I had estradiol and testosterone pellets and swear I will NEVER do again! The estradiol dose too high and experienced spotting, heavy bleeding, severe cramping tender breasts and raging moods until it wore off! I was 5 years post menopausal. I switched to another physician and to troches. I am super sensitive to Estradiol and even at low dose of troches the bleeding continued hence he stopped them. I continue my T and Progesterone (compounded) and am missing my estrogen. I am now on Estrovera to see if this will help with my symptoms. All bleeding stopped with the discontinued use of estradiol troches. In the past I have used creams with no results. I was compliant in the use.

    • Hi Susan,

      Your story definitely highlights the fact that there is an element of trial and error when it comes to HRT. It’s a bummer that you’ve had to go through so many therapies, but hopefully, you can find the one that works well for you. It’s also worth pointing out that not all women may need estrogen after menopause due to body weight, aromatase, and other factors so it’s possible that you may fall into this group.

  4. I’m considering bioTe therapy. I’m 2 yrs post menopausal. Painful sex started about 1 yr ago. My gyne dr prescribed Premarin cream. I used it for a few months and it relieved some discomfort but not enough that I wanted to continue using it and I was too fearful of the side effects. My mom is a breast cancer survivor (she’s 82) and my dad passed away 8 mos. ago from bile duct/pancreatic cancer. He was 84 y/o and had a whipple procedure. Complications from sepsis ultimately lead to his death. I’m just very fearful of going through any type of treatment. As we all know, there are side effects from so many types of treatments whether it be by oral med, injection, of this type of treatment. My breasts are tender, I’ve gained weight, I feel fatigued a lot and have suffered from my hair thinning but that could simply be from stress. As cancer now runs on both sides of my family, would you suggest this treatment for me?

    • Hi Judy,

      If your mother had breast cancer at a late age that’s not necessarily considered a massive risk factor for breast cancer compared to getting it at a young age. The cancer from your dad is unrelated to hormone balance so it shouldn’t be a factor when you consider using hormones or not. If you are worried you can get a genetic test which can help give you a better idea as to your personal and individual risk.

      Premarin, however, is associated with an increased risk of breast cancer and should not be used regardless of personal risk factors especially when bio-identical hormones are available.

  5. Hi, I’ve been on pellets for about 3 years. My sisters Doc does not do blood screening. Got the testosterone pellets for the first year did great. Wanted to get them closer to home so I went to the local doc. He freaked cause the first doc does not do a blood test for hormone count. Says taking only the testosterone pellets causes bone and joint problems. He gave me estrogen and testosterone pellets along with progesterone by mouth. I didn’t like his bedside manners so I went to another doc after these wore off and really didn’t care for the 3rd doc either. So this time I go back to the first doc and he only gave me the testosterone pellets. I still have progesterone refills I’m taking. But I have noticed in the past 3 weeks my knee pops loudly when I step downstairs. Could the second doc be right about the taking only testosterone can damage bone health? I don’t run to the doctor when something is wrong. I’m not one of those. I do go to a chiropractor and he’s kinda baffled about my knee. Thanks.

  6. Knee popping sound is either from inflammatory changes on the articular surface of your patella or merely synovial fluid bubbles popping. Try to adjust your exercise routine to develop tone your quadriceps (thigh muscles) to help the patella track in proper alignment. Consult a functional medicine doc Nutriceuticals that can help. If sudden knee swelling or pain definitely get into see your Primary Care doc or your chiropractor or Orthopedic doctor.

  7. I am considering the BioTe implant because I have not been able to feel regulated with tx such as Prempro. Because of Turner’s Syndrome I have had premature ovarian failure and have never been able to produce hormones on my own. Have you known of any Turner’s patients that have used this as a way to better blend a hormone dosing closest to replace what their body can’t produce?

    • Hi Denise,

      I don’t personally know anyone with Turner’s syndrome who have used BioTe but I can’t imagine it would be that much different from those in menopause.

  8. [email protected]
    I used pellets for several years and recently stopped after suffering from severe hair loss and increased anxiety. I talked to the physicians I saw at the clinic repeatedly and they just said my thyroid levels were fine and kept prescribing increasing doses of T and a small dose of estradiol with oral progesterone prescribed. I now believe the pellets are what caused my hair loss and possibly weight gain and have decided to quit. Yes, they gave my libido a huge boost but I’ve decided having hair is more important. I’m frustrated that the clinic did not take my hair loss seriously. I’ve had to start wearing a hair topper (a type of wig) to cover my hair loss. I am hoping my hair will grow back now that I’ve stopped the pellets.

    • I had the same problem with hair loss, but appreciated the other benefits of Bio Te. I discovered products, both capsule and shampoo, that have DHT blocker, and they have made a huge difference in my hair. Apparently DHT is an element of Testosterone that causes hair loss. I strongly recommend this treatment.

      • Hi Dru,

        Yes, the DHT metabolite of testosterone is implicated in the development of male pattern baldness (but certainly not the only cause). DHT blockers can work if your main problem is DHT, but it can differ from individual to individual.

  9. Dr. Childs,
    Can you please comment on hormone pellets for men? I’m 67, and although I’ve had some of the symptoms low testosterone most of my life (mainly depression and fatigue), I don’t know if I want to go through the experimenting of trying to get the correct dose, as well as any side effects if there are any. Thanks.

  10. Hello Dr. Childs,

    I just started BioTÉ hormone therapy on 8/17/18.
    I like what you are doing on this blog. I will let you know my progress and experience.
    So far so good. I did feel an influx of energy and my joints — especially in my hands– feel less swollen and painful. My libido at barely 4 days is waking up too.

    My dx include diabetes, hypertension, hypothyroidism, arthritis. Due to my USO/BSO five months ago, my life has been impacted tremendously. But my arthritis seriously kicked in and knocked me off my feet. My thyroid was destroyed after the birth of my first daughter. I suffered a “thyroid storm” while pregnant. It was a high pregnancy and my endocrinologist dismissed me from his services as I refused to terminate my pregnancy when he prescribed strong meds to save my life. Fears of baby being affected. My daughter finished college in 2015 going for her masters soon. She is totally healthy. Normal 26 yr old.

    I have an unwavering faith in God. I’m very active and love life.

    I decided on the pellets therapy due to fear of cancer. We’ve had cancer in both of my parents’ families. My work consists of a lot of traveling. Driving consists of at least 50% of my day.

    I have felt so much better these last few days. Post op on March landed me in full menopause and really knocked me out. I am 48 yrs old in love with life. We have an 8yr old little girl after 17 yrs of not conceiving. I’m hanging on to life Dr. Childs. I will keep you posted.

  11. Hello
    I am a 45 year old woman who was experiencing extreme fatigue. The provider who manages my depression recommended a testosterone pellet implant. I jumped at the idea as it sounded like it would help with all of the issues I was having, low libido, etc.
    Boy was I wrong! I had the pellet implanted 3 months ago and I have been sick every day since. Increased fatigue, nausea, severe headaches, dizzy, light headed, migraine auras. My depression provider told me to see my PCP for these symptoms, which I did, all of my blood work and tests were normal. She said they were being caused by the testosterone pellet. And that there was nothing I could do about it but wait until it wears off. I have been searching online and I cannot find anyone else who has had the same side effects. The only thing I can come up with is that my body is converting the testosterone and it is making me sick. It’s been three months and I am starting to feel better but I am no where near 100%. Is it possible I am having this side effects from the pellet??!
    Thanks
    Brenda

    • Hi Brenda,

      Absolutely, hormones, if not properly balanced, will definitely result in negative symptoms. One of the reasons I recommend against pellets is because, if they aren’t dosed correctly, you’re stuck with those symptoms until your body absorbs all of the hormones.

    • Hi Leslie,

      The pellets begin to dissolve once they are implanted. It would be theoretically possible to try and go in to remove them but it would be difficult to find and usually not worth the risks of digging around to find it versus just letting it dissolve. It would be like trying to take a pill out of your stomach after a few hours of your stomach digesting it.

      • I have had an infection where my BHRT incision was. I received the pellet 3 months ago. When I showed my doctor the area, he said “yeah it looks like it’s on it’s way out”
        and gave me a rx for ciprofloxin. 3 days later I called to say the rx wasn’t helping, and I had pain in my butt and hip under the insertion area. I could not stand or walk for more than 5 minutes, without having to sit down. The incision area was pink, tender to the touch. I asked if I should go to Urgent Care, or have a refill. The doctors assistant said they don’t remove the pellet, and not to go to Urgent Care, but just wait to let the antibiotic work. I explained I was almost out and she said they would refill it.

        I waited another day, and ended up at Urgent Care where the doctors said I had cellulitis, from the pellet infection.

        How does a pellet put in three months ago, become infected? Are most cases of infection compounding contamination?

        • Hi Lori,

          It’s probably not the pellet which was infected because if it were then you would HAVE to have it removed in order for the infection to clear. If it was cellulitis then it will completely resolve with antibiotics.

  12. Considering hormone pellet therapy. I’ve been on the E-patch, T-cream, and oral progesterone for 6 months….and done well. But, with an insurance change this summer it is actually cheaper out of pocket to get the pellets. My provider said the dosing is based on the patient’s weight which doesn’t make sense to me. I’m on low dosages now and don’t want to take more than I’ve been taking for fear of the negative side effects. Why is dosing based on weight? Seems like I should be able to get a pellet with similar doses as to what I’ve been taking. Thoughts?

    • Hi Diane,

      I don’t recommend hormone pellets for all of the reasons stated here and I can confirm that hormone levels are not based on weight alone. Also, converting from topicals to pellets isn’t quite as easy as a 1:1 conversion because several factors can influence the rate of absorption. Some people do well on pellets, but I just don’t think the risks outweigh the benefits but that’s just my opinion!

  13. I am a 40 year old woman, who had a hysterectomy 3 years ago. Since then my hair has greatly thinned. And my thyroid levels go up and down but nothing that an endocrinologist will see me for. I also have 5 lumps on my thyroid. In my last round of blood work my testosterone levels were low but everything was mostly normal. My PCP has mentioned maybe I should do hormone pellet therapy. I am not sure. I want my hair back and energy but don’t want my symptoms to get worse or cause more problems. If you were my doctor what would you recommend?

  14. Dear Dr. Childs,

    Thank you for your information on this site. I am 2.5 weeks into estrogen/testosterone pellets and MISERABLE. This is my first experience and the dosage is way to strong for me. Libido taking over my life, depressed, highly irritable and the worst weight gain. I’ve easily packed on 7-10 lbs. I go for bloodwork on 10/10. This is an expensive exercise to go through to have buy new clothes for. I’m stuck in this mess until it wears off. Thoroughly disappointed. What I do have is more focus and my sleep has improved. Not worth the sore behind at insertion, the side effects and the cost. Aggressively looking into alternative methods.

    • Hi Marie,

      Thanks for sharing your story and I’m sorry to hear about your struggles. The most cost-effective alternatives include gels/creams.

  15. I am in my second cycle of pellets. During the first one, everything was perfect. After almost six months I think that all the pellets are gone, so I stopped the progesterone pills. Two weeks after I started to spot.

    I decided to have a second pellet treatment and to take my progesterone again. It has been almost ten days and I am still spotting and it is a little more after intercourse.

    • Hi Vaness,

      Spotting (if you are menopausal) may be an indication that your dose is too high. You’ll want to get that checked out as it’s never normal to spot after menopause.

  16. I’m 53, been suffering for nearly 2 years trying to find the right treatment for peri menopause/menopause. Got the bio-hormone pellet testosterone and estrogen on first time on June 18,2018. Today is Oct 5, 2018. It’13 days shy of 4 months. The insertion was no big deal. A little painful after like a sore spot but went away. I noticed it a couple more times two weeks later. I could feel the lump in my butt cheek. I was taking progesterone by mouth nightly. The first week I slept the best. Noticed a lot of self control in my emotions. Things didn’t irritate me as much. I was so thankful to have relief those first 3 weeks. After that was downhill. Into the 5th week I was feeling fatigue again, and could sense the depression coming back…I know all my symptoms were better but not enough to spend 400$ for 3 weeks of relief. I don’t want to over exaggerate…the worst part has been the last 3 weeks. I had to travel out of state for a wedding, 5 days out of my normal routine (and I’m not ocd) but felt very discombobulated, like I had had a mini stroke…brain fog, hard to communicate. I am a tall blond type A, strong confident person, always been active, but finding the right treatment is hardest thing I’ve ever done. I’ve had colonoscopy, endoscopy, ultra sound, cat scan. Trying to figure out what’s wrong and all blood test everything comes up normal. I don’t drink or smoke. It’s all related to stress and hormones. I can’t take serotonin drugs. God help me. And I know He will. He is my strength in weakness. Ladies reading this…I pray you are encouraged to know you not alone. I’m going to a new gyno next week to figure out next steps. I got a lot of great info from reading your blog. Thank you!

    • Hi Kim,

      Thanks for sharing and I’m glad you found it helpful. You might want to consider the creams and gels which are much less expensive compared to the pellets.

  17. I have been using pellets for estradiol and testosterone for years and have had a wonderful experience. However, I did start on estrogen cream first which stopped working for me after a time. Then I moved to pellet and we added testosterone. My amazing doctor started me on a low dose of testosterone based on bloodwork and we moved up from there. He orders bloodwork annually as well as when I voice a concern. His philosophy is to err on the lower dose side and then administer a low cost booster if needed. In all the years I’ve received pellets, I’ve only needed a booster once. I take oral progesterone and this works for me.

    • Hi Amanda,

      Thanks for sharing! Pellets do work for some people, I’m just pointing out here that the risk is often not worth it for many people (even though they work great for some, like yourself).

  18. I am a 50 year old women who just started Biot’e Hormone pellets October 4,2018.My medical doctor did a full bloodwork on me to figure out what I needed. She inserted 2 testorone pellets in me and gave me a prescription for progesterone (troche) to take at night before I go to bed. I don’t need estrogen because my body still produces it. After a week I Can feel a change in my body for the better. The only issue I’m having is one day I’m 3 pounds lighter on the scale and the next day I’m 3 pounds heavier. I eat very healthy and exercise. This is my 2nd week and I feel great. My only concern is why Is my weight fluctuating like that? Is it possible that my body is trying to adjust with the pellets and my body is shocked by what is happening? In 6 weeks I go back to my doctor to have my bloodwork done again to see if my levels improved.

    • Hi Michelle,

      Usually changes to estrogen and progesterone cause shifts in body weight such as that by influencing water retention and fluid status.

  19. Hi, I am 55 years old, I am menopausal, and have been taking creams for about a year (prescribed by bio identical hormone therapy doctor) to help with all the symptoms from this condition: fatigue, no libido, vaginal dryness, hot flashes, insomnia, joint/muscle pain, weight gain…well, you get the picture!! My blood/urine we’re both tested before the initial visit. My testosterone level- as of September 2018- is still less than 1, so I opted for a pellet implant. Since receiving it on September 20, 2018, I have had little/no relief from all the above symptoms…after being ‘assured’ it would help. (Insert sad face) I am reading every blog & website I can find to give me some idea if I should continue this treatment- I am scheduled for January for the next round of testosterone. I also take Progesterone capsules each night. I have had urine testing done before each visit, just not seeing an increase in testosterone yet. Please advise?

  20. I have been getting the biote hormone replacement for 1 1/2 years. I had a complete hysterectomy 21 years ago because of endometriosis. I used estrogen patches for years but had problems with them adhereing. After this last insertion, I developed vomiting, chills , sweats and left abdominal pain. Could this be related to dosing.

  21. Hi! I started testosterone pellet therapy 4 months ago. I’m 42. First 6-8 weeks was great for energy and exercise intolerance and then I started with horrible night sweats and insomnia. Labs indicated that my FSH went from 11 to 100. He retested to make sure. The same. Have you ever heard of testosterone pellets causing this situation or is it more likely that it is a coincidence? Doc added estradiol and it helped but FSH was up still at 50 and just recently added more. Thanks in advance!!

  22. [email protected]
    I was on pellets for 13 months. Estradiol and testosterone and supplements of promethium. My levels reached to 108 estradiol, 295 testosterone and 12 progesterone. Had ultrasound after 9 months to reveal fibroid. Continued on pellets but with lower dose estradiol. 6 months later new ultrasound shows fibroid growing. Stopped all pellets but no one could tell me how long remain in system. Last dose in April this year. New blood test end September showed estradiol at 73 and testosterone at 79. They told me to stop progesterone pills end of July. Had endometrial biopsy that showed negative for cancer. However started bleeding heavily with clots now for 3 weeks. Also had new tvus end September showed fibroid smaller but endometrium stripe at 10 mm when last 2 tuvs were 7 mm. Can the HRT withdrawal cause this bleeding and/or could I develop endometrial hyperplasia or worse in this short time on pellets.

    Thank you!

    • Hi Christine,

      The short answer is that yes, excessive estrogen (from any source) can cause both endometrial hyperplasia and endometrial cancer.

  23. Had the pellet implanted 2 weeks ago. Increased fatigue, headaches, breast tenderness, mood swings. Ugh …. I was so excited, now disappointed

  24. I am currently 58 years old, and experienced menopause 8 years ago. That same year, 2010, I had a total Throidectomy due to Stage 4 thyroid cancer. I take 120mg of Armour Thyroid daily, and have been on Sollo Pellets since May of 2017. I started having break through bleeding in February, 2018 (every other week). I have gained about 20 pounds with continual exercise and healthy diet activity.

    I am concerned about my weight gain as it impacts my lifestyle and self image. No matter how disciplined I am, the weight just keeps adding up.

    It is time for another insertion of the pellets – it’s been almost 5 months, the longest I’ve gone as I usually go every 3 months. But I intuitively feel I need to ‘get back to zero’ and start again with another doctor to figure this hormonce cocktail mix out! Thoughts?

  25. Hi, I am 59 years old. I had a total hysterectomy at the age of 26 and suffered many problems after that. So for 33 years I took Ogen. I have been diagnosed with fibromyalgia, severe hot flashes, headaches, fatigue, irritable bowel syndrome, Etc. two months ago I received the pellets and have seen very small difference in my symptoms. Two weeks ago I went for a little more estrogen. My only concern is the 6 pounds weight gain. I am considering stopping the pallets just because of the weight gain. I am interested in the bio identical hormone gel/cranes but where do I go for the prescriptions? Thanks for your help

    • Hi Beth,

      You’ll need to go to a doctor who specializes in bio-identical hormone management such as an anti-aging doctor. Generally, endocrinologists and primary care physicians are not trained to use these types of hormones.

  26. Hi! Im 43 years old and I’m just starting my 3 round of testosterone pellets. The first one was ok. I didn’t notice more energy and better sex drive. The second round I feel like I had too much! I’m not sure if the dose was bigger the second round but I’m assuming it was. With the second round my sex drive was off the charts. But with all the sex drive came HUGE waves of emotions and RAGE. The rage is the scariest thing to me. It made me feel like a lose cannon that could explode at any minute. I would go off on huge rounds of pure rage and hatred (which is not like me AT ALL). After a few months of pure hell emotionally my husband begged me to go back on 50mg of Zoloft which I had used previously in my life. I took the Zoloft for less that a week and it completely flatlined my sex drive. Yes I wasn’t full of rage, but I felt like a zombie and had ZERO sex drive. I stopped taking the Zoloft and went in for my 3rd round of pellets hoping to bring back what I had lost by taking Zoloft for 5 days. I was hesitant to lower the dosage as I wanted to feel like I did before and thought I would be ok with the same amount as long I was taking the Dim supplement and the progesterone. (I wasn’t taking Dim or progesterone on the last round.) Well here I am only 2 weeks into my new pellet and I can feel the rage starting to come back. I want to cry my eyes out thinking of being the crazy rage lady again for 3 months. I too was under the impression I could have it taken out but after reading your blog and comments I see that’s not a good option. Do you have any suggestions of anything I can take or do to help curb the rage feelings while I’m ridding this out? Any information would be greatly appreciated! Thank you so much

    • Hi Laurie,

      Unfortunately, there isn’t much you can do but let your body metabolize the testosterone. Your experience is one of the primary reasons why I recommend against hormone pellets.

  27. Dr Childs,

    Thank you for the impartial information here. It has been difficult to find neutral pellet info. I am 60 yrs old and have been on Bio HRT creams for 10 years, which were prescribed by my gyno doc and were working fine. I have recently switched to a functional dr for non hormone related issues as well as newly diagnosed osteoporosis. She saw that my hormone #s weren’t perfect, and we were surprised that my gyno never did follow up blood work in the 10 years that I was using the creams. Anyway, after a hormone blood lab the new dr felt that pellets would be a better match for me, and more convienent since I travel often. I have just had my #2 pellet insertion last week – after waiting 5 months from the 1st one. I did fine on the first round, but didn’t notice any change at all except for sensitive breasts.My new dr said she lowered my estrogen on the 2nd dose. She also prescribes 150mg of progesterone capsule at night and requires that I take 150mg of DIM (dindolymethane) daily.

    I saw my gyno for my annual this week and she scared me so much saying that the pellets are dangerous, cause breast and ovarian cancer, permanent hair loss, bleeding all long term. She said if I wanted to be her patient I have to stop using them. She said the problems become more of in issue the second year that you use the pellets.

    Honestly, she scared the XXX out of me.

    I am wondering if she knows what she is talking about. Like most women, I live in fear of cancer and am now so afraid that I am exposing myself to risk.

    We patients often get stuck between doctors who strongly disagree, and it is confusing to say the least.
    Can you do anything to help put my fears at ease?

    Donna

    • Hi Donna,

      All I can tell you is that it’s not uncommon for doctors to disagree on treatments and therapies, even doctors in the hospital do this all the time. I would recommend that look into the research and come to your own conclusion about safety. My own personal experience and research suggest that hormones (if used correctly) are incredibly safe and effective. But if you use too much (as suggested by your breast tenderness) then you may be doing more harm than good.

  28. Dr Childs, Thank you for taking the time to respond to my post.

    12 years ago I began researching the benefits of bio identical hormone replacement, and have used compounding creams until 6 months ago when I began pellets. It was my gyno dr who first prescribed the creams. I am baffled that she can endorse the compounding creams but be so adamant about the pellets.

    My conclusion from my research is that if it is BHRT it is a good thing as long as the dosage you are taking results in your hormone levels being where they should be.

    However, from my research there doesn’t seem to be a consensus on which tests (or types of tests) are accurate for which hormones and which labs provide credible test results. So how do you know with any confidence that you are not inadvertently “overdosing”?

    And that leads to my next question, if I may.

    What tests do you recommend for each of the hormones that need to be monitored? What test ranges are you looking for to achieve optimal results? How frequently should a person on pellets have their hormone levels tested?

    Thank you again, Donna

  29. Hi there! I started pellets about 3-4 months ago looking for a way to be healthy and also help with my libido. After blood work it was determined I needed only testosterone. I had the pellets put in in Sept. I noticed a slight increase in energy and some increase in sex drive. I was eager to do them again and not let’s the levels drop. At the 6 week mark we did blood work and the levels were good so dosing was correct. I just had my second round. After 24 hours I started feeling achy and sick. Diarrhea, body aches, pain, etc. I remembered that I get like this last time too…but just figured it was a virus and a coincidence.
    Now I’m thinking it’s a reaction to the pellets. This time seem worse and now it’s been 2 days feeling like this!! Starting to worry and wonder how long this will last!!!
    Is this something that could be a reaction to testosterone?

    • My pellets were done on Thurs. My left hip (which had littl pain before) is hurting more than the right hip (injection spot). I started feeling nauseous & weak yesterday. I didn’t know if it was due to taking Naproxen without having a full stomach. Today, I felt I pressure in my pelvic area.

  30. Hi: I was having all the symptoms of Menopause, ugh. My regular OBGYN prescribed me Permarin, works sorta but not even close to what pellets do. I was so tired, worn down, never sleeping full night, 4 or 5 hours at the most, very dry, moody, depression, cry easy—rarely cried before, bladder infections, weight gain, dreaded sex and I love sex. I went to a Hormone\OBGYN Dr., He checked my blood work and I had some negative numbers. He inserted 125 mg of Testosterone and 50 mg of Estrogen. I also take 205 mg of Progesterone capsules, 1 every night. Have to have mine made from compounding pharmacy because I am allergic to tree nuts and the Progesterone that is filled at local chain pharmacies contain tree nuts. Well, the hormone pellets absolutely brought me back to being in my 20’s again. Sex went from a meh 6 back to a 100 within 5 days. I was and still am amazed. I had weight gain in the beginning but after the bloating goes down I actually lose weight. I love the pellets and I swear by them. I still get bladder infections SOMETIMES, NOT AS BAD, and sometimes a little break through bleeding. But all in all it has been the best thing I can say that I have done for myself in the past 5 years. I have been on them since 2013. And I get them done every 4 to 5 months, sometimes before then and sometimes a little after those time frames, but close. I feel like a SEXY WOMAN AGAIN.
    P.S. I will say this, I have lost some hair. Not major. But it does kinda freak me out because my hair has always been super thick, shiny and long. But it could be the age thing also. 52. But a young 52 now. Lol.

  31. Hello, I am a 45-year-old woman, who is now premenopausal. I need some relief and I need some relief fast. My Dr. has recommended Biote Pellets. You name the symptom I have it right now. I feel like I have been hit by a freight train. However, I still have some concerns. What is the risk of it causing cancer? This is one of my main concerns. It’s also more costly. Are there any other alternatives that I can discuss with my Dr. Or would you recommend this to be it? If I have to, Cost is no option when it comes to my health.

    • Hi Evelyn,

      I generally do not recommend that pre-menopausal women use hormone pellets as they often provide way too much hormone. Biote pellets are better for women who are menopausal. If you are still cycling then you should be treated differently than a woman who has already gone through menopause.

  32. I have been doing the pellets for 3 years different doctors because nobody can get my hormones right.
    Now I’m having dry skin brittle hair depressed blah no energy what so ever. I had a complete hysterectomy no uterus no cervix. Different docs tell me I do not need progesterone. Some say I do. I’m confused.

  33. I am a male who has been on TRT intramuscular dosing 2ml every 2 weeks for some time now. I also take Levothyroxine 50mcg per day. I have subsequently developed secondary polycythemia due to this treatment and need phlebotomies every 4-6 weeks to bring my hematocrit levels down. Do pellets have the same cardiovascular side effects as injections?
    I am looking for an alternative to the bi-weekly injections and also to alleviate secondary side effects and the additional medical treatments then necessitate.
    Thanks

  34. Hello Dr.Childs,

    I am a 47 year old perimenopausal woman. I’m about to start my 4 round of Biote hormone pellet therapy. After my first round, I had to get a booster. I started with normal estrogen levels and very low testosterone. My level was a 12 and now it’s in the 200’s. My estrogen levels became high also. I’m also taking progesterone orally and DIM. Also after my first round, my libido was off the charts. I started my therapy in May of 2018 and I’ve gained close to 10 to 15 pounds. I’m not happy with my weight gain and it seems to be increasing. Can you please tell me what the normal range is for estrogen and testosterone levels for a woman my age? My menstrual cycles have also stopped. I haven’t had a full one since August of 2018. Spotting in September and October and nothing since. Please let me know what my next step should be. My next insertion is in a couple of weeks.

  35. I began Biote pellets at age 57 and am now 58. I always had a great sex drive but hitting menopause age 54 my testosterone went down to 9. I couldn’t get any interest in sex, and it became a weird foreign concept. Like, why are those people even doing that strange activity! The pellets gave me back my sex drive and more. First time, testosterone went up to 305 which is kind of high but I didn’t care, it was great! Second pellet T up in the 200s. My husband is very happy with my sex drive back and so am I. I couldn’t tolerate Prometrium so I take 2.5 mg Provera. I also get the estrogen pellet. I feel more energized, less anxious, sleep better, life seems less stressful, things don’t bother me as much. A little hair growth on chin and my pubic and underarm hair began growing again, lol. It is a HUGE problem when perimenopausal and menopausal women lose their testosterone and libido, and also feel depressed and anxious for no reason. You cannot have libido when your T is at level 9. I fully support these pellets. I tried testosterone orally and also gel and it was a failure with ups and downs and nausea. The pellet is the way to go if you want your libido, energy and joy of life back. What else is there? Women HAVE to replace testosterone. My husband is doing the pellet now too and our sex life is like teenagers again.

    • Hi Michelle,

      Many women do quite well on gels and creams as long as they are dosed correctly and they can obtain the same results that you are experiencing without the potentially negative side effects associated with pellet (cost, surgery risks, etc.).

  36. Hi, I just turned 60 and my new GYN doctor wants me to use BoiTe. I had my ovaries removed in 2007 and had my cervix and uterus removed in 1999. I never took any HRT and my levels are normal. I have severe vaginal dryness, high cholesterol, and low sex drive. I also have osteopenia and some arthritis issues. My doc wants to administer testosterone and estradiol.
    Although intrigued to start the pellets very afraid because I have felt fine with my mood swings and depression in the years past the my surgeries.
    Any suggestions what be great.

    Thank you for your site.

    • Hi Emily,

      I’m not a fan of hormone pellets for the reasons listed in this article. I believe other options such as creams/gels are superior because they allow you to individually titrate your dose.

  37. Hello! I’m 37 and have had 2 rounds of the Biote pellets. My testosterone was super low when my blood work was done, so that was the main focus..boosting my testosterone. I loved the idea of the pellets and couldn’t wait to try them out. My biggest complaints prior to getting them was my non existent sex drive and lack of energy. The first insertion I felt no difference. I was hesitant about a second round but my dr assured me that it sometimes takes a couple insertions before you feel the benefits. So in December I had my 2nd pellet insertion. I know she boosted my testosterone even more on that 2nd one. The first month was horrible. I was moody and irritable constantly. That has subsided but I have not felt any different. Still no sex drive. I am disappointed and will not get another pellet. However, I still have a fairly large lump at the insertion site. Its starting to worry me because it’s been over 3 months since the insertion and I would’ve thought the lump would go away as it did the first time. It has not reduced in size at all. Has anyone else had this issue?

  38. Hello Dr. Childs,
    I just love your background and wish you were my Doctor! I have Hypothyroidism. Can I go on Hormone therapy? I was told, if you are taking one type of hormone you can not take another?
    Well, Sir, this is going to be about my oldest sissy, she’d 66. Tiny petite active sweetheart! She did her research, made her decision and was implanted with the pellets on Tuesday! I said, why? I had never heard of the procedure. She said she just doesn’t feel right, she feels blah, nothing, she doesn’t feel like her! And she has felt this way for a long time! She did not want to go into too much detail, I think perhaps because Mom was there?
    Anyway, I am a bit nervous and excited. She has a few friends that have had the procedure and they are very happy! Hopefully, they will be too. I would probably do a cream or a gel first! Her levels were extremely low! Testosterone a 7, and Estrogen 4?
    Let’s hope for the best!
    Jenny Lys

    • Hi Jenny,

      It kind of depends on why you want to go on hormone therapy. There’s a general idea that hormone therapy (designed to bring the body back to youthful levels) is beneficial for everyone. Another group of people feels that hormone therapy is ideal for those people who are not feeling just right. My own opinion is that you probably shouldn’t start hormone therapy unless you are trying to achieve some goal such as improving your quality of life.

  39. I am currently perimenopausal and have an extremely hard time losing any weight at all despite starting a new exercise regimen 4 months ago and eating healthy. In fact, I’ve noticed a 20 lb weight gain the past 2 years. I truly believe I have a hormonal imbalance and I have ben thinking about the biote pellets. Would this be an option for someone who is not yet in menopause? I am at a lose at controlling my weight.

    • Hi Lisa,

      The only hormones you would want to consider using prior to menopause would be progesterone and/or testosterone. Using estrogen would likely exacerbate your weight issue.

  40. I have been doing the BioTE pellets for about 3 1/2 years., 16 rounds total. Before the pellets I was suffering from almost every menopausal symptom possible. I was exhausted and miserable. Doing the pellets gave me my life back! Pretty much all of the symptoms disappeared rather quickly. I still have thinner hair than before this all began but it doesn’t fall out in chunks anymore. I also am still working on losing the extra 3-4 pounds that I gained after turning 50 but some of that may have to do with being retired and having a few more glasses of wine during the week.

  41. Hello Dr. Childs, last March I received two rounds of pellet therapy with testosterone, estrogen and capsule form progesterone, after 2 months I decided it was not for me had side effects, gained 12 pounds even though it has been out of my system and I work out and try to watch what I eat. I believe this has messed up my thyroid and now I am using compounding hormones and desiccated thyroid to balance me out it has only been 3 months with a new doctor. Do you see this with other patients having this problem and is there success with getting the weight down? Thank you for your opinion. I’m down in Yuma Az.

    • Hi Barbara,

      Somewhat frequently I do see patients who are taking all sorts of hormones incorrectly (probably due to bad advice from other providers) who need to be straightened out. It is also a possibility that taking abnormal or incorrect amounts of hormones can cause other hormone imbalances but it’s impossible to say whether you fit into this category without a lot more information.

  42. Hello Dr. Childs, I am 5 days into my first BioTe Pellet and a nervous wreck. I didn’t do enough research on this at all, rushed into it by the PA who administered it as he was in and out of the room in 15 minutes. I’m 52 was feeling fatigued, loss of libido, can’t seem to lose weight around my middle, always tired. My Testosterone, Total MS was 16. My Testosterone, Free 1.5, TSH 1.08, T4 7.2, T3 free 2.4 and T4 Free 0.9. My FSH 17.7 and my estradiol is 47. I was given 175 mg Testosterone pellet and 100 mg progesterone pills to take daily by mouth. Is that a high dose for me? I woke up the morning after the pellets were inserted on my right upper butt area and my leg has a shooting pain going down it from my hip down when I move the wrong way or lean on that side. I have wicked cramps and incredible breast soreness which I haven’t experienced in about a year. I went back to the Dr. office and he said my symptoms were normal. So now I have to just wait and see until this wears off as it could not be taken out. I am grateful for your blog and hope that every woman reads this before making the decision to implant anything in their body. I’m terrified of weight gain as my goal was weight loss and it is promoted as a weight loss program in the Dr. office I got it in. Now I am reading most women have weight gain from it!

  43. Wish I had read this article before having the pellet put in. The doctor assured me it would increase my energy and metabolism. It has done the opposite. I have less energy. I have gained weight. When it finally wears off I will go back to oral medication or creams.

  44. I am on my second round of pellets. The first round went well. I noticed an increase in my energy level and mood. At the end of the first round, I found that I really crashed. I just got the second round. My doc increased the amount and a three days after getting the second pellet..I’m experiencing significant dizziness. My doc said that it wasn’t from the pellet but I have no other issues and no explanation for the dizziness. Could it be the pellet?? Help!

  45. Hello,

    I began with hormone pellets in August 2018. I’m not sure if they are right for me… it seems they wear off at about 2 1/2 months. I have an increase in facial hair and oily skin… could it be the testosterone? My doc hasn’t retested my hormones since Oct. My thyroid went totally out of whack for a short while, I was put on medicine only to have it go into hyper mode… went off and now it’s low normal… I have an appointment this Friday for another round… should I switch back to oral (I had a complete hysterectomy no ovaries) it’s complicated had some intense pain in my lady parts and urethral spasms… long story short a botched hysterectomy that cut my ureter and had multiple procedures and a total rebuild a year after with mesh involved… help please.

  46. I have used BioTe testosterone and progesterone cream for one year and after a UTI & bacterial overgrowth issues which I have never had and did not even really know anything about, I ended up with ultrasound showing 2 ovarian cysts and a fundal fibroid of the uterus. Also have white blood cells and platelets showing slightly abnormal and been very thirsty and dry since infection 3 months ago. Will have retest to see if labs return to normal. I have made decision to stop pellet, feeling this is the root of my issues. I am praying there is no cancer involved but it certainly is in back of my mind. What happens when stopping therapy like this? Is there a way to ease it? I see no other option but to stop immediately. Wondering if I should keep on using Progesterone cream even though stopping pellet. Last pellet was mid February and I have been metabolizing in 3 months according to past blood work. I was supposed to have one this week but I declined. Also, I have not had period in 6 months. FSH has been close to 100 last 2 checks where is was only 27 when I began. I was told this would even things out and I feel like I am completely a mess now. Praying it will all go back to the normal pace of entering menopause. Even though that is tough, these issues are much more stressful. I have friends that love the pellet therapy and have done well but I have not. I wish I had seen this site before I ever started them. It is hard to find info where others have experienced same things. Dr said my issues were most likely unrelated and only a part of aging but I suspect that is not the case.

  47. Hello,

    I am a 76 year old woman in good physical condition. I have been on Bioidentical Hormone Creams for 30 years. My energy is good, but I live in a remote area so it’s inconvenient to get to a doctor. I decided to try pellets in March, 2019. I had an injection in my left buttocks. A large welt followed along with excruciating pain down my left leg. Hot and burning. I thought I had a blood clot. Went to ER and then 2 doctors. Finally diagnosis was a shingles outbreak down my left foot and ankle. I had the shingles shot 20 years ago, so the outbreak was considered mild, although painful for a month and I still have numbness in my foot. I am now due for another pellet, but am nervous about having it. the BioTe provider assures me that it was not related to the pellet and is pushing pellets not creams. I ‘m considering starting over with another doctor and going back to the creams. I feel good, sleeping great, but have facial hair and unable to drop a few pounds Do you think there is any connection between the pellet insertion and the shingles outbreak?

  48. Aloha!

    I just turned 40 and have been under some unbelievable stress for a number of years. I decided to try pellets because I just didn’t want to be sooooo tired all the time. Dr did my labs and I was low in testosterone and thyroid. After 5 days of pellets, I was sleeping better and didn’t need a nap everyday. I waited a few weeks in integrate the thyroid treatment. Which, I decided to deal with nutritionally, including addressing the adrenals. I went back for my 6 week labs and everything looks really good. I started on armor thyroid and I feel so good. I’m stoked.

    • Hi Dan,

      Yes, I believe there is definitely truth to that statement. Hormones such as testosterone in men and estrogen/progesterone in women do seem to play a cardioprotective role and their decline seems to be closely associated with an increase in heart disease. It’s not the pellet therapy that is doing this, however, it’s the hormones and those can be taken via any route.

  49. What are the symptoms after stopping my bhrt with pellets? I am spotting and want it to stop hysteroscopy shows everything normal. Why I’m I still spotting? My 3rd insert that won’t happen is July 28, 2019. What should I expect after stopping?

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