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Hormone Pellet Therapy

Information & FAQ’s
TrueMD Wellness
Introduction

When your natural hormones become deficient, symptoms can decrease your quality of life. Both men and women can suffer from these. Hormone therapy, using bioidentical hormones can help replenish and restore these low hormone levels to optimal levels. The result is many of the symptoms that are caused from lack of hormones resolve, they help bring vitality and that zest for life back into your life, and they can also improve your health. An added benefit is that any studies have demonstrated a reduction in your risks of developing many chronic medical illnesses when started early. This equates to helping you live a more active life with better quality of life.

Bioidentical Hormone Therapy

Hormone pellet therapy is our preferred method since it gives you the best results for symptom relief. This method of administering bioidentical hormones uses small pellets inserted under your skin. They are time-released and replenish your empty hormone tank to more youthful levels of hormones over a few months. Many people state they feel younger, have more energy and better sexual enhancement with the pellets versus other forms of hormone therapy.

With hormone pellet therapy, the length of time they last is variable for each gender. Women generally need pellets every three months and men need them every four months for adequate sustained relief. You just come back for these reinsertions during these intervals and you continue to feel and get the benefits of hormone therapy. You’ll love the improved feelings of a boost of energy, improved sexual libido, relief of the symptoms listed below, and many other benefits you’ll get from the pellets. In addition, you’ll also be embracing the improved health benefits that hormones can provide.

Both women and men may suffer from hormone deficiencies as they get older. When the ovaries in a woman stop functioning, they no longer produce hormones and this is menopause. When testicles in a man produce little testosterone, this is considered andropause. To know if you have these deficiencies, TrueMD does blood tests on you and discusses your problems during your evaluation. If we find you are a candidate for hormone therapy, we will get you started and you’ll love the way you feel.

Symptoms of Hormone Deficiencies

Usually symptoms of these two conditions cause problems when men and women go through their “pauses”, and this generally starts around age 45 to 55. Some symptoms may include the following:

Female Symptoms
  • Hot Flashes
  • Night Sweats
  • Bloating
  • Weight Gain
  • Decreased Libido
  • Insomnia
  • Irritability
  • Vaginal Dryness
  • Facial Wrinkles/Loose Skin
  • Mood Swings
  • Foggy brain
  • Fatigue
  • Anxiety
  • Depression
  • Hair Loss
  • Brain Fog
  • Breast Tenderness
  • PMS
  • Vaginal dryness
  • Dry Skin
Male Symptoms
  • Decreased Libido
  • Fatigue
  • Low Libido
  • Erectile Dysfunction
  • Muscle Loss
  • Weight Gain
  • Inability to reach orgasm
  • Insomnia
  • Irritability
  • Foggy brain
  • Depression
  • Hair Loss
  • Anxiety
  • Mood Swings
  • Facial Wrinkles/Loose Skin
  • Loss of Motivation
Hormone pellet therapy can relieve these symptoms and help men and women live the last half of their life with better quality of life, including maintaining a sexual life and their zest for life. We all want to live older, but we want to do this with good quality of life. Hormone pellet therapy helps you achieve that goal.
Research and Hormone Therapy
There is a plethora of evidence from well-respected studies that have proven the health-improving benefits of hormone therapy. If one starts early, e.g. in one’s ’50s, one can benefit the most from these preventive effects if hormones are administered continuously and for a long time, even for the life of the patient. These benefits may include a significant reduction in the risk of developing heart disease, osteoporosis, Alzheimer’s disease, and dementia.

In addition, for a woman, hormone therapy maintains the youthful integrity of the vagina allowing her to enjoy a better sex life longer. One’s skin is also better with hormones: estrogen stimulates receptors within the skin to produce more collagen while testosterone improves vascularity to bring more nutrients to the skin. All these effects and more are essential for maintaining more youthful-looking skin.

For men, erectile dysfunction may be treated with hormone therapy. In fact, some studies suggest that ED can be effectively treated in almost half the cases of ED. This is good news for men who suffer from this condition; they may not really need that “blue pill.”

Both men and women may develop a problem of frailty as they grow older, especially if they don’t embrace adequate hormone replenishment. This and many other problems may be treated and reversed with TrueMD hormone pellet therapy. Not only can replenishment of hormones improve your health, but it can also improve your quality of life during the remainder of your years.

From the many comments from thousands of patients, hormone pellet therapy is possibly the most effective and bio-identical method to deliver hormones in both men and women. Pellets placed under the skin consistently release small biologically active doses of hormones providing optimal hormone levels. Optimal levels are more like what fit young men and women have. You can’t begin to feel young again without youthful levels of hormones. Thus, you get relief of symptoms and feel the vitality of the pellets over several months due to their sustained release.

Call TrueMD today to get started on feeling good with hormone pellet therapy.

Hormone Pellet Therapy and the FDA
Hormone pellets are compounded by compounding pharmacies and are not FDA approved. The methodology and the concepts of bioidentical therapy aspects for use of the pellets, such as titration of the dosages for each individual person, are also not FDA approved. Thus use of hormone pellet therapy is considered off-label use of hormones.
FAQ’s about Hormone Pellet Therapy

Pellets are most commonly made up of either estradiol or testosterone. The hormones are pressed or fused into very small solid cylinders called pellets. These pellets can be as small as a BB or as large as large grains of rice. In the United States, pellets are made by compounding pharmacists and delivered in sterile glass vials. Pellet dosing is individualized according to your metabolism and clinical symptoms. Thus lab testing is done regularly during the initial evaluation of the dosage per patient. We have found that this individualization is imperative for proper dosing of each patient and to achieve optimal symptom relief and adequate blood levels for the best protection for your organs.

Bioidentical hormone therapy (BHT) is not just the type of hormones used, but also the method of administration of them. BHT only uses hormone whose molecular structure is exactly the same as hormones that flow naturally in a man or woman. They are considered safer than other hormones for two major reasons. In fact, many people have been afraid of using hormone for these reasons. But now, they can be confident that hormone pellet therapy does not increase these risks; thus they are considered safer.

As noted below, there is no increased risk of cancer using the bioidentical hormones, nor is there an increased risk of stroke. The risk is the same whether one takes the hormones or doesn’t. Since the risks are the same and since BHT relieves many symptoms of low hormones plus can provide protection for your health, why not use them?

BHT dosing varies for each individual person and is titrated according to the metabolism of each individual. All patients at TrueMD have found a tremendous difference in effect of different doses of pellets, and we titrate the dose according to each patient’s needs. We have our own proprietary system to titrate the dose for the best effects. The FDA doesn’t think this is necessary and is one of the reasons they believe pellets are off-label. However, we disagree from our experience with our patients.

As mentioned above, use of pellets does not carry any more risk of breast cancer as without hormone use. They may even provide a reduction in risk that other forms of hormone therapy don’t exhibit. Perhaps this is due to their maintenance of a more correct estrogen ratio, the addition of testosterone therapy, or safer hormone metabolites. Data supports that balanced bio-identical hormones are breast protective.

Estradiol, one of the hormones in our pellets. Nor is there any evidence that testosterone or BHT progesterone (the other main sex hormones) increases her risk of breast cancer. Some studies have even suggested a preventive effect of breast cancer on the breasts. Other studies using other estrogens and synthetic progestins showed increased risks of breast cancers. BHT actually may decrease risks, as has been demonstrated in several studies.

Testosterone, delivered by pellet implantation, has been shown to decrease breast proliferation and lower the risk of breast cancer, even in patients on conventional hormone replacement therapy. Clinical studies show that bio-identical testosterone, given transdermally as with pellets, balances estrogen and may be breast protective.

Of interest, in the past, testosterone pellets had been used to treat patients with advanced breast cancer.  Back in 1940 it was theorized that treating patients with testosterone implants earlier at the time of diagnosis would have prevented recurrence.  Androgens have also been shown to enhance the effect of Tamoxifenâ therapy in breast cancer patients.

Testosterone therapy as provided with hormone pellet therapy does not increase the risk of a man developing prostate cancer. At one time, it was thought that higher levels of testosterone in men caused this higher risk. However, recent studies have totally reversed this thought and it is now known that high levels of testosterone in older men are not associated with higher risks of prostate cancer. Multiple studies have confirmed this conclusion.

Pellets deliver consistent, healthy levels of hormones for 3 months in women and 4 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery.  The most important estrogenic hormone is estradiol. When estradiol is delivered by subcutaneous pellets, a steadier smooth level of hormones is maintained. This is important for optimal symptom relief and for better health and disease prevention.  Testosterone is also given with pellets and this confers even more healthy benefits in a continuous state.

More importantly, Pellets do not increase the risk of blood clots nor cancers, problems that we see with oral conventional or synthetic hormone replacement therapy. Thus, they are safer than conventional therapy and for this reason and many others, we prefer using them. In addition, symptoms of lack of hormones are relieved and patients feel better with pellets than with other hormone therapies. Thus, quality of life is better. And isn’t this what we want: better health while we live with more happiness due to a better quality of life.

Compared with conventional hormone replacement therapy, bioidentical hormone pellet therapy in many women and men is superior for treatment of:

  • Relief of menopausal symptoms in women, andropausal symptoms in men
    • These symptoms can include hot flashes, sweats, insomnia, sleep disturbances, emotional changes, moodiness, grumpiness, decreased libido, and fatigue.
    • These also include dryness of the vagina in women due to lack of estrogen resulting in thinning of the lining of the vaginal walls, making it difficult to have sex.
  • Restoration of sleep patterns – with less hot flashes, there is better sleep.

Improvement in sex drive, libido, sexual response and performance – the combination of estradiol and testosterone, when balanced appropriately, seem to provide the best effect.

Men and women need adequate levels of testosterone for optimal mental and physical health. Some testosterone is converted in the body to estradiol, and this has been associated with prevention of many chronic illnesses, such as heart disease, Alzheimer’s disease and osteoporosis. Studies have shown an association with these chronic medical illnesses and low testosterone and estrogen levels.

Even patients who have failed other types of hormone therapy have a very high success rate with pellets. There is no other ‘method of hormone delivery’ that is as convenient for the patient as the implants. Pellets have been used in both men and women since the late 1930’s. There is much data to support the use of pellets rather than any other method of delivery of hormones.

Testosterone delivered by a pellet implants has been shown to be helpful for treatment of the following:

  • Treat migraine and menstrual headaches
  • Treat and prevent vaginal dryness and atrophy
  • Treat incontinence, urinary urgency and frequency.
  • Increase energy levels
  • Improve sexual dysfunction
  • Relieve depression
  • Increase sense of well being
  • Relieve anxiety
  • Improve memory and concentration
  • Increase lean body mass (muscle strength, bone density)
  • Decreases fat mass

The insertion of pellets is a simple procedure that takes around 10 to 15 minutes. A small amount of anesthetic is injected in the upper outer buttocks, flanks or abdomen. A small poke hole is made in the skin and the pellets are inserted. The whole process is usually painless. The small poke hole is then closed with tape and that is all that is necessary

The dose of the pellets varies greatly from person to person. This is another aspect of bioidentical hormone therapy: the dose is titrated to each individual person. You have a metabolism that is different than anyone else, and individually everybody else does too. We want you to feel best on the hormones according to your metabolism and we want the blood level of the hormones to reach a certain level of efficacy to best help you with improved health.

Thus, we at TrueMD do regular blood tests to make sure you’re getting enough yet not getting too much that could cause some unwanted side effects. Generally, we start at a low dose and increase the dose as needed according to how you feel on the pellets. After all, one of our goals is to improve your individual quality of life.

Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. Soreness of the area can also occur for a few days after the pellets have been inserted. Other than slight bruising, or discoloration of the skin, these complications are very rare.

After the insertion of the implants, vigorous physical activity should be avoided for 2 to 3 days, but modest activity is okay. Early physical activity can be a cause of ‘extrusion’, which is a pellet working its way out.  Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced.  However, this is a ‘clean procedure’ and antibiotics are usually not needed.

One important concept of the pellet insertion site is that it should stay covered with some type of protective tape for several weeks. Clothing can rub on it and introduce bacteria into the area which can result in an infection and possible extrusion of the pellets. Thus, make sure you keep the tape on that was administered during the insertion as long as you can.

The response of each individual to hormone pellet therapy varies. Most patients’ responses are:

  • More energy – fatigue is markedly reduced
  • Improved libido – sex drive is enhanced as well as performance and enjoyment
  • Better sleep patterns – less insomnia and improved sleep
  • Feel happier – quality of life is much better
  • Increase in muscle mass and bone density – testosterone builds muscles
  • Increase in strength, coordination and physical performance
  • Improvement in skin tone and hair texture – estrogen stimulates collagen production in skin
  • Improvement in concentration and memory – hormones improve brain health

Both estradiol and testosterone are good for the heart and these are the main hormones used with hormone pellet therapy. Studies have suggested a 30% to 50% decreased risk of developing heart disease when hormone therapy is started early in menopause for women and possibly similar benefits for men. The earlier they are used, the better the protection from heart disease.

It has been said that “hormone therapy given postmenopausally is the only primary prevention therapy of coronary heart disease that reduces total mortality and extends life in women.” Along with eating right and exercising, hormone therapy is probably the best action you could do to preserve the health of your heart. But you must start as early as possib”le in menopause or andropause to receive the best benefits for this prevention.

Estrogen has been shown to do multiple actions which help the health of your heart. It improves the health of the inside linings of your arteries (endothelium) to allow the blood to flow better to feed your organs, including your heart. It improves your lipid profile, so less deposition of bad cholesterol occurs in your arteries. It decreases inflammation which is the rood cause of hardening of the arteries. It relaxes the muscles linings of the arterial vessels of the heart by increasing the production of a natural arterial dilator called nitrous oxide resulting in vasodilation. These and other actions result in improved heart health.

Testosterone has been associated with a decreased risk of heart disease, especially in men. As men grow older, if they maintain their testosterone levels to higher levels, they can reduce the risk of heart disease and dying from heart disease. Similar to estrogen, testosterone improves endothelial health and men’s lipid profile to heart healthier profiles. It also can improve blood pressure and helps prevent internal blood clotting. Men who have higher testosterone levels have been shown to have better survival; i.e. they live longer.

When started early in menopause, and possibly andropause, hormones generally help prevent the degradation of the bones that may ultimately result in a condition called osteoporosis. The consequence of osteoporosis is thinning of the bones that can predispose the bones to breaking easily. You have seen the little old ladies (and men) who have developed a severe hunched back or fall and break their hip. Much of this may be prevented with the use of hormones, especially when started early.

 

Multiple studies have confirmed the effectiveness of hormones in maintaining bone integrity and strength. One method we use to determine this is called a bone density test. If the density of the bone is low, this could increase your risk for developing osteoporosis and place you at a higher risk of fractures of the bone. Hormone pellet therapy has been shown to improve bone density. Thus, if you want to have stronger bones as you grow older, you may want to consider starting hormone therapy as early as you can in menopause and andropause.

We at TrueMD feel the best way to preserve your bones and to build your bones is to use hormone pellet therapy because such therapy employs both estrogen and testosterone to provide total balanced hormone therapy. Since we titrate the dose of pellets according to your blood levels, we believe you need an adequate blood level to result in the best benefit for your bones.

The two main hormones used for hormone pellet therapy are estradiol and testosterone. Estradiol has been shown to slow down the natural process of dissolution of the bones and thus helps prevent degradation of the bones. Testosterone has been shown to help build bone. The combination of the two hormones is very effective in preventing and treating the thinning of bones that would otherwise occur naturally as you age. But you must start early when your hormones are just starting to decrease, say around age 45 to 55. This offers you the best benefits

Many studies have demonstrated the protective effect of estrogen on the brain, but this protection is seen when hormone therapy is started early. Hormone pellets contain both estrogen and testosterone, and both may help in brain health. This therapy must also be continued for greater than ten years to see a significant difference. The longer you take them the better. In fact, once you get off the hormone therapy these protective actions fade away after two years and you’re back with normal risks of developing chronic neurodegenerative diseases.

The best way to receive this beneficial action of hormone therapy is to start early in menopause (and potentially early in andropause) and continue taking the hormones as long as you can. If you wait for years later, changes may occur in your brain that may lead to neurodegenerative disorders of the brain, such as Alzheimer’s disease and Parkinson’s disease. Studies have documented a remarkable decrease in the risk of developing Alzheimer’s disease when this early and continued use of hormones are done.

Patients ask when they can stop the pellet therapy. The answer is that they can stop whenever they want to not receive the benefits of hormone therapy any longer. Hormones, once started early, continue to provide some prevention from development of chronic medical illnesses. If they want to revert to having average normal risks of developing these degenerative disease risks, then stop. However, most would prefer to stay on them as long as they can.

You may wonder why you haven’t heard of pellets. Pellets are not patented and have not been marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia. Pellets were frequently used in the United States from about 1940 through the late 70’s when oral patented estrogens were marketed to the public. In fact, some of the most exciting data on hormone implants in breast cancer patients is out of the United States.

Testosterone levels begin to decline in men beginning in their early 30’s. Most men maintain adequate levels of testosterone into their mid 40’s to mid 50’s, some into their late 70’s to early 80’s. Men should be tested when they begin to show signs of testosterone deficiency. Even men in their 30’s can be testosterone deficient and show signs of deficiency.

Testosterone pellets in men have been shown to help:

  • Bone loss – less osteoporosis
  • Fatigue – renewed energy
  • Depression – relief from depression
  • Erectile dysfunction – improved in over half of men with ED
  • Difficulty sleeping – Improved rest
  • Mental decline – Better clarity of the mind, in men and women

Most men need to be tested around 40 to 50 years of age. Potentially it is never too late to benefit from hormone therapy

He or she is wrong.  There is a big difference between ‘no data’ and not having read the data. It is much easier for busy practitioners to dismiss the patient than it is to read and evaluate the latest research. It’s about a patient making an informed choice. There is a plethora of data that demonstrates the use of hormone therapy for relief of symptoms from lack of hormones, and for prevention of many health-related conditions. At the end of this FAQ are references of just a few great studies which you can show to your physician if he/she is interested in learning about recent studies that refute old myths.

Moreover, your physician may want to consider your concerns and how he/she may help you improve your quality of life. We at TrueMD embrace hormone pellet therapy because of the way we see our patients respond to them: they love them. After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve as will overall physical and sexual health. Overall, they feel great. In addition, they’re safe. There is data to support the ‘long term’ safety of hormones delivered by pellet therapy.

At one time there was an oral form of testosterone therapy that was used in women. It was indeed found to improve libido. However, this oral synthetic hormone, called methyl-testosterone (in Estratestâ), was found to cause liver problems and may not have been protective for breast tissue such as the bioidentical testosterone forms as used in pellets, possibly due to its conversion to a potent synthetic estrogen.  Estratestâ or any other oral testosterone pills are no longer commercially available in the United States.

When a patient first starts on hormone therapy there may be mild, temporary breast tenderness, which resolves on its own. Hormone receptors in the breasts may be very sensitive to hormones and take time to adjust. There may be a temporary water weight gain or swelling which will also resolve on its own.  Women who still have a uterus have an increased risk of starting their menses again, and vaginal bleeding can be significant. However, if excess bleeding is seen, further evaluation is recommended to make sure other potential causes of postmenopausal bleeding are not present.

There are two main ways that hormones can be given to you. One is via the oral route and one is through the skin. When estrogen is swallowed in the form of oral tablets, it goes through your GI tract and absorbed into your body. The first thing it goes through is your liver, and this is called the first-pass effect. In the liver, estrogen stimulates the extra formation of clotting factors. With extra clotting factors, you could form blood clots easier resulting in an increased risk of strokes and other clots in your blood vessels that can be detrimental to your health.

You may be familiar with the increased risk of clotting and strokes from the birth control pill. Even some young women have experienced this from these oral therapies. They increase the risk of clots in a similar fashion as oral estrogen therapy used in menopause, through this first-pass effect.

Pellets are administered through the skin, also called transdermal administration. This bypasses the liver and no first-pass effect. Without the first-pass effect, there is NO increased risk of clots, and therefore no increased risk of stroke or other clotting problems. Your risk is the same whether you use hormones or don’t. Studies have confirmed this.

BHT pellet therapy thus differs from conventional hormone therapy in that the oral latter types of hormone therapy are mostly administered via tablets and taken orally, which have been shown to increase the risks of stroke per the first-pass effect discussed above. This is especially pertinent after age 60, but we at TrueMD feel we don’t want to increase anyone’s risks. Thus, since bioidentical hormone pellet therapy does not carry these increased risks, they are considered a safer way to go.

Many people have a misunderstanding regarding the safety hormone therapy and cancer risks. This concern started with a study called the WHI that showed an increased risk of breast cancer in one group of women that took some synthetic hormones. However, in that same study, there was no increased risk of breast cancer when more natural hormones are used. In fact, this may be one of the main reasons why bioidentical hormone therapy has become so popular because they are safer than the synthetic types of hormones. Pellets are more natural bioidentical hormones and thus do not increase the risk of developing breast cancer, which has been confirmed and demonstrated in many studies.

Another misunderstanding is that higher levels of testosterone may increase a man’s risk of developing prostate cancer. This myth has been dispelled through multiple studies showing this to be false: there is no increased risk of prostate cancer when testosterone levels are higher. Thus, giving both bioidentical hormones of estradiol and testosterone, as we do with hormone pellet therapy, it’s safer. When BHT are administered appropriately, there is no increased risk of developing breast cancer in a women and prostate cancer in a man; the risk is the same with or without the hormones.

Unfortunately, this misunderstanding his continually perpetuated by the FDA for they continue to use the former synthetic studies data and fail to consider adequately the new data on BHT hormones. This is unfortunate, for it has made millions of women suffer from the harmful effects that the lack of hormones can cause to their bodies.

Many studies have demonstrated a significant decrease in the risk of developing colon cancer when estrogen therapy had been given over time. This reduction can be anywhere from a 19% to a 63% reduced risk of developing this type of cancer. Even the study that vilified hormone replacement therapy, the WHI study, showed a 37% reduced risk of colon cancer and a 24% reduction in risk of developing all cancers.

Testosterone may cause a slight increase in facial hair and acne in some people, but this can be dose related and a balance of testosterone and estrogen is necessary to help prevent this. Some people complain of hair loss while other hair growth on the scalp.

Testosterone stimulates the bone marrow and may increase the production of red blood cells from the bone marrow. This may cause an elevation in the amount of red blood cells in your blood. This is usually not harmful.  If the hemoglobin and hematocrit (blood count) get too high, high blood pressure may be a result. This can be treated easily: blood may be donated to the blood bank to reduce red blood cell mass and thin the blood.

Testosterone therapy may also shrink the testicles mildly in younger men. This can be an aesthetic problem and may be prevented with meds (HCG). However, in older men, this does not appear to be a major problem, but these preventive meds may be used by them too if desired. In younger men, it may also decrease the sperm count making it more difficult to conceive a baby. Thus, many times young men will elect to do HCG as an alternative therapy.

Hormone deficiency is a common cause of hair loss and treatment with estradiol and testosterone pellet therapy can help to re-grow hair.   Hair becomes thicker and less dry with pellet therapy. However, some people do experience hair loss and medications may need to be used to counteract this. Hair loss is a common symptom in women if testosterone is given in too high a dose, especially when starting hormone pellet therapy. That’s why TrueMD has developed its own proprietary method to titrating the dose of pellet therapy for women to avoid some of these unwanted side effects.

Some patients begin to ‘feel better’ within 24-48 hours while others may take a week or two to notice a difference. Hot flashes and sweats go away within 24 hours usually. Most people start feeling increased energy and libido within a few weeks. Diet and lifestyle, along with hormone balance are critical for optimal health.  Stress must also be reduced, since stress is a major contributor to hormone imbalance and illness

The pellets usually last around 3 months in women and 4 months in men. TrueMD titrates the dose so you get this sustained effect without excessive side effects. Most patients feel the hormones going away at the ends of these periods and are happy to revisit TrueMD for reinsertion of more pellets to give them that boost that they feel and that lasts during these periods of time.

Hormone pellets are absorbed very slowly when inserted into the fatty layer under your skin. They are essentially completely dissolved by the end of the 3- or 4-month interval. Pellets therefore are gone by that time and do not need to be removed. They completely dissolve on their own.

Hormone levels may be drawn and evaluated before hormone pellet therapy is started to evaluate hormone levels. Other tests may also be done to evaluate overall health. All these values are then discussed, and appropriate therapy begun. After pellets are inserted, levels are reevaluated during hormone therapy, usually at around 6 weeks after insertion of the pellets and dosages are titrated according to patient’s clinical symptoms and hormone levels at 6 weeks.

Once stable and adequate hormone levels are achieved, repetitive blood tests may not be necessary and are simply checked once a year. Men are advised to notify their primary care physician or urologist and obtain a digital rectal exam each year. PSA’s (a test for prostate cancer) are necessary yearly. Women are advised to continue their monthly self-breast exam and must obtain a mammogram and physical exam/pap smear yearly as advised by their gynecologist or primary care physician.

Many times, when estradiol is prescribed continuously as with pellets, progesterone is also prescribed, especially if the woman still has her uterus. It may even be used if the patient has had a hysterectomy. Progesterone can help improve sleep for some women, but not all women like the way they feel on progesterone. TrueMD only uses bioidentical progesterone therapy to avoid risks from synthetic progestins that are mostly used during conventional hormone therapy.

The main indication for the use of synthetic progestins, such as Proveraâ, is to prevent excess proliferation (stimulation) of the uterine lining caused by estrogen.  Progesterone can be used as a topical cream, a vaginal cream, an oral capsule (Prometriumâ), or sublingual drops. Only oral progesterone (100-200 mg) and vaginal progesterone (45-90 mg) have been studied and shown to protect the uterine lining from estrogen stimulation.

If a woman is pre-menopausal, at any age she may experience hormone imbalance. Levels decline usually starting in her 30’s to 40’s or fluctuate contributing to debilitating symptoms. Pellets are useful in severe PMS, post partum depression, menstrual or migraine headaches, decreased sexual libido, sexual dysfunction and sleeping disorders. Pellets may also be used to treat decreased libido caused by the birth control pill.

The cost for hormone pellet therapy for women is around $350 every three months; for men it is around $695 every four months depending on the dose of the hormone and the number of pellets needed. These costs may vary depending on the location. Men need a much larger dose of testosterone than women and the cost is much higher. Pellet insertions are four times a year for women (every three months) and three times a year for men (every four months). This interval may vary depending on how rapidly a patient metabolizes hormones.

When compared to the cost of drugs to treat the individual symptoms of hormone decline, including some conventional hormone therapies, pellets are very cost effective. There are many other very expensive treatments for bone loss, heart problems, and Alzheimer’s disease. If you can decrease your risk of developing these problems, you actually save a lot of money and headaches over the long run.

Plus, nobody wants these chronic debilitating diseases, so why not do everything you can to prevent them. These can decrease your ability to continue to have an active life, physically and sexually. In addition, when you consider the cost of drugs used for insomnia, depression, sexual dysfunction, obesity, diabetes, hypertension and more, the costs for pellet therapy is very low and much more cost effective. In addition, they usually work better than those other meds.

Most insurance companies cover the cost of physical exams and office visits for complaints associated with medical problems, such as symptoms of menopause for women and andropause for men. However, insurance companies do not cover the cost of hormone pellets for women nor for men because they are considered off-label, i.e. not approved by the FDA for most people. Most pellet therapies are cash pay and do not involve medical insurance.

There are rare situations where medical insurance will cover men’s pellets where the brand name Testopelâ must be used. However strict diagnostic criteria are needed before these are approved by insurance and the cost of the copay and deductibles for this brand name testosterone therapy may end up being much higher than the cost of using the compounded hormone pellets as used by TrueMD.  Testopel is very expensive as are the gels available. Overall, most patients find the pellets to ne more affordable.

Overall bioidentical estradiol and testosterone therapy by implantation of pellets is a safe and effective method of hormone therapy for both men and women. Long, continuous administration of hormones by pellets is convenient and economical for the patient. Hormone therapy at adequate levels as is delivered by hormone pellets has consistently proven very effective and safer than more conventional oral hormone therapy, especially compared to the more synthetic forms of the progestins.

Since there’s no increased severe risks with BHT hormone pellet therapy, such as no increase breast cancer, prostate cancer or stroke, they are safer. They provide excellent relief of symptoms from low hormones such as seen in menopause and andropause. They improve fatigue, sexual function, mood and cognitive function.

For women they offer welcome relief of urinary and vaginal complaints due to lack of hormones. For men they may improve erectile dysfunction. When given correctly, they also improve heart health, breast health, bone health, and brain health to potentially decrease risks of developing chronic medical diseases of these organs. All these make hormone pellet therapy a very excellent therapy to improve your life as you get older.

Improved heart health with hormone therapy

Lobo RA, Postmenopausal hormones and coronary artery disease: potential benefits and risks. Climacteric 2007; 10 Suppl 2: 21-26.

Clarkson TB, Anthony MS, Morgan TM. Inhibition of postmenopausal atherosclerosis progression: a comparison of the effects of conjugated equine estrogens and soy phytoestrogens. J Clin Endocrinol Metab. 2001 Jan; 86(1):41-7.

Grodstein F et al. Hormone Therapy and Coronary heart Disease: The Role of Time since menopause and Age at Hormone Initiation. Womens Health (Larchmt). 2006 Jan/feb; 15(1)

Tan RS, Cook K, Reilly WR. Testosterone therapy is not associated with MI or strokes. Abstract 1353. Presented at American Association Clinical Endocrinology 23rd Annual Scientific Meeting May 16th, 2014.

Tan Robert S., Cook Kelly R., and Reilly William G. Journal of Men’s Health. September 2014, 11(3): 139-139.https://doi.org/10.1089/jomh.2014.0042

“Low testosterone levels are associated with CVD risk.” Nat Rev Endocrinol. 2011 Oct 21;7(11):632.

Morris PD, Channer KS. Testosterone and cardiovascular disease in men. Asian J Androl. 2012 May; 14(3): 428–435.  doi:  10.1038/aja.2012.21

Alexander GC. Et al. Cardiovascular Risks of Exogenous Testosterone Use Among Men: A Systematic Review and Meta-Analysis. The American J of Medicine. 130(3). March 2017: 293-305. https://doi.org/10.1016/j.amjmed.2016.09.017

Alexandersen, P., Haarbo, J., Byrjalsen, I., Lawaetz, H., Christiansen, C. “Natural Androgens Inhibit Male Atherosclerosis.” Circulation Research. 1999; 84: 813-819. http://circres.ahajournals.org/content/circresaha/84/7/813.full.pdf

Torgerson DJ, Bell-Syer SEM. Hormone replacement therapy and prevention of nonvertebral fractures: a meta-analysis of randomized trials. JAMA 2001; 285:2891–7. https://www.ncbi.nlm.nih.gov/pubmed/11401611

Karim R, Dell RM, Greene DF, et al. Hip fracture in postmenopausal women after cessation of hormone therapy: results from a prospective study in a large health management organization. Menopause. 2011; 18:1172–1177. doi: 10.1097/gme.0b013e31821b01c7

Improved brain health with hormone therapy

Waring SC et al. Postmenopausal Estrogen Replacement Therapy and Risk of AD: A Population-Based Study. Neurology 52(5);965-970. 1999 Mar 23.

Baldereschi M. et al. Estrogen-Replacement Therapy and Alzheimer’s Disease in the Italian Longitudinal Study on Aging. Neurology, 1998; 50(4);996-1002

Kawas C, et al. A Prospective Study of Estrogen Replacement Therapy and the Risk of Developing Alzheimer’s Disease: The Baltimore Longitudinal Study of Aging. Neurology. 1997; 48(6):1517-1521

Tang M-X, Jacobs D, Stern Y, et al. Effect of oestrogen during menopause on risk and age at onset of Alzheimer s disease. Lancet 1996; 348:429–32. https://www.ncbi.nlm.nih.gov/pubmed/8709781

Zandi PP, et al. Hormone Replacement Therapy and Incidence of Alzheimer Disease in Older Women. The Cache County Study. JAMA. 2002;288(17):2123-2129.

No increase risk of breast cancer with estrogen and hormone pellet therapy.

Anderson, et al. “Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomized placebo-controlled trial” The Lancet Oncology, Vol. 13, No. 5, p476–486, March 7, 2012. http://doi.org/10.1016/S1470-2045(12)70075-X

Glaser RL, Dimitrakakis C. Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole: a prospective, observational study. Maturitas. 2013 Dec;76(4):342-9. doi: 10.1016/j.maturitas.2013.08.002.

US PREVENTIVE SERVICES TASK FORCE Hormone therapy for the prevention of chronic conditions in postmenopausal women: recommendations from the US Preventive Services Task Force. Ann. Intern. Med. 2005;142(10):855–860. https://www.ncbi.nlm.nih.gov/pubmed/15897536

No increased risk of prostate cancer with testosterone therapy.

Morgentaler A, Testosterone and prostate cancer: An historical perspective on a modern myth.  Eur Urology, 50:935-9, 2006

Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004 Jan 29;350(5):482-92.

Roddam AW, et al. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. 2008 Feb 6;100(3):170-83.

Shore MN, Op cit., Metab 2012.

No increased risk of stroke with transdermal estrogen

Modena MG, Sismondi P, Mueck A, et al. New evidence regarding hormone replacement therapies is urgently required. Transdermal postmenopausal hormone therapy differs from oral hormone therapy in risks and benefits. Maturitas 2005; 52:1–10.

Vinagradova Y, Coupland C, Jippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2019; 364.  doi: https://doi.org/10.1136/bmj.k4810 (Published 09 January 2019

Decreased risk of colon and other cancers with hormone therapy

Lin KJ, et al. The effect of estrogen vs. combined estrogen‐progestogen therapy on the risk of colorectal cancer. International Journal of Cancer.130(2). Mar 2011. https://doi.org/10.1002/ijc.26026

Rennert, et al. Use of Hormone Replacement Therapy and the Risk of Colorectal Cancer. J Clin Oncol. 2009 Sep 20; 27(27):4542-4547.  Doi: 10.1200/JCO.2009.22. 0764..

Am. Cancer Society. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html

Lower chance of dying early with hormone therapy; i.e. you live longer

Am. Cancer Society. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html

Salpeter SR, Cheng J, Thabane L, et al. Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women. Am J Med 2009; 122:1016–1022.

Massachusetts Male Aging Study. Proceedings of the Endocrine Society’s 87th Annual Meeting; June 4-7, 2005; San Diego, Calif.Abstract P1-561. 44

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