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

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...


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

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 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

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. 


#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

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. 

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 include Ethinyl estradiol, esterified estrogens, conjugated equine estrogens and so on. 

Synthetic formulations of progesterone 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

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


#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, 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

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! 

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.

Click Here to Leave a Comment Below 24 comments
Stephanie - May 22, 2018

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.

Westin Childs - May 22, 2018

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.

Susan - May 23, 2018

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.

    Westin Childs - May 24, 2018

    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.

Judy - July 13, 2018

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?

    Westin Childs - July 13, 2018

    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.

Robin Woody - July 20, 2018

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.

Dr. Susan - July 26, 2018

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.

Denise - July 29, 2018

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?

    Westin Childs - July 30, 2018

    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.

Keri - July 31, 2018

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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.

    Westin Childs - July 31, 2018

    Hi Keri,

    Thanks for sharing! Keep us updated on your hair growth status after stopping the pellets.

Lee - August 8, 2018

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.

    Westin Childs - August 8, 2018

    Hi Lee,

    I personally don’t really see the utility in using testosterone pellets for men. It’s very easy to use subcutaneous injections which are almost painless and don’t damage the muscle tissue and which can be titrated quite easily.

Esabel Salazar - August 21, 2018

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.

    Westin Childs - August 22, 2018

    Hi Esabel,

    Thanks for sharing your story and please do keep us updated 🙂

Brenda - August 25, 2018

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??!

    Westin Childs - August 27, 2018

    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.

Leslie - September 10, 2018

I thought I had heard if you have bad reactions to the pellets you can go in and have them removed.

    Westin Childs - September 10, 2018

    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.

Diane - September 19, 2018

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?

    Westin Childs - September 19, 2018

    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!

Paulette - September 19, 2018

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?


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