Bioidentical Hormone Pellet Therapy for Women

Being proactive by supplementing hormones in the early stages of hormonal decline is key to maintaining health and vigor as we age. Even if you were not given the opportunity to receive hormonal support until later in your journey, there is safety, and still much to gain by initiation of hormone therapy.

We use bioidentical hormones, which are molecularly identical to the body’s own. Though available in many forms of delivery, our preferred method is the subcutaneous hormone implant, or pellet, which we have found is consistently associated with the highest degree of patient satisfaction.

What is Bioidentical Hormone Pellet Implant Therapy?

With this method, 2-3 small pellets placed beneath the skin provide a steady reservoir of hormones that slowly diffuse into the bloodstream. This approach most closely mimics the body’s natural hormone production, providing consistent, reliable benefits with minimal fluctuation.

The procedure is simple and quick. After numbing the skin, hormone pellets are inserted into the fatty tissue of the upper hip area through a tiny incision, closed with only a steri-strip, heals in a couple of days, and provides 3-4 months of therapy.

Pellets are compounded by specialized pharmacies that comply with Current Good Manufacturing Practice (CGMP) regulations enforced by the FDA, ensuring strict quality and safety standards.

What Hormones Can Be Administered?

Testosterone

Far from being “the male hormone”, testosterone plays a vital role in female health, eliciting physiologic effects through androgen receptors in almost all female body tissues – impacting energy, mood, cognition, sexual function, metabolism, and more. Decline in testosterone activity during the early 40s (perimenopause) can cause low libido, irritability, depression, fatigue, brain fog, joint pain, bladder control problems, and general lack of well-being. Women often attribute these changes to the “natural” progression of aging. But, recognizing this as a signal of hormonal deficiency can trigger a proactive approach to improve health and vitality in the second half of life.

Estradiol

Estradiol, the primary estrogen, affects the brain, heart, bones, joints, skin, and more. As levels decline in a woman’s 40s and become undetectable in the 50s, this brings hot flashes, night sweats, mood swings, insomnia, vaginal dryness, and musculoskeletal pain. Replacement with estradiol relieves these symptoms and lowers risk of heart disease, dementia, diabetes, and osteoporosis.

Progesterone

Progesterone balances estradiol’s effects, protecting the uterine lining from overgrowth, reducing uterine cancer risk.
Oral capsules are effective for uterine protection and helpful for sleep and calming effects. Other delivery forms include the progestin IUD, buccal or vaginal formulations. Progesterone topical creams are not sufficient for uterine protection.

Why We Specialize in the Pellet Implant System

After more than 30 years of experience, with thorough knowledge of all forms of hormone therapy, we have observed since introducing our pellet program in 2019, this method provides the most dependable, convenient, and effective results.

Our patients receiving pellets have almost universally reported superior symptom relief, and their overall and long-term experience is unsurpassed. Pellet therapy involves office visits every 3-4 months, ensuring consistent monitoring and personalized time with your provider.

Because the majority of our patients continue with pellets long term, we dedicate our time and expertise to this program. Quite simply, pellets work best – and our current approach allows us to focus fully on continuously providing the best outcomes without wasting anyone’s time on methods that don’t deliver.

Why Not Pills, Injections, or Creams?

Pills: When swallowed, estrogen and testosterone travel first to the liver, stimulating clotting and inflammatory factors—raising the risk of blood clots, stroke, or pulmonary embolism. This is fully avoidable with pellets. (Progesterone is a unique exception, as the oral form does not cause toxicity via the liver, and poses no risk).
Injections: Required weekly or biweekly, injections provide sub optimal results because hormone levels swing dramatically between shots, creating a “roller coaster” of extreme excess and deficiency, more risk and side effects.
Creams, Gels, and Patches: These methods avoid the liver, but deliver only low amounts through the skin’s barrier, with highly variable and unpredictable absorption, leading to inconsistent results, ongoing symptoms, and frustration. This explains why topical hormone therapy has taken a back seat in our treatment approach.

What About Risks/Side Effects?

Clinical studies regarding bioidentical testosterone in women have not shown increased incidence of cancer, cardiovascular disease, or any medical condition. On the contrary, numerous reports suggest bioidentical testosterone to be breast protective, as well as protective of the heart, bones, and brain. With testosterone implant, the majority report no significant side effects. Some experience facial hair or acne, usually easy to manage with well-known effective treatments. Those with a genetic predisposition have the option to start preventive treatment at initiation of therapy.

Although past fears about estrogen therapy arose from the flawed and now discredited 2002 Women’s Health Initiative (WHI) study, modern comprehensive analysis confirms that bioidentical estrogen is safe, protective, and life-enhancing. Patients using estradiol therapy are typically pleased with the treatment. Upon initiation, some report transient breast tenderness, relieved with dose adjustment.

Bioidentical oral progesterone carries no known medical risk. Most enjoy the therapeutic side effect of sleepiness at night.

What if I Have a Bad Reaction with Testosterone Implant?

This is a common concern – fear of a major or uncontrollable reaction to the “male” hormone. We hope by now you have learned that testosterone is not the male hormone, but a crucial hormone for all humans. A serious undesired reaction is extremely rare.

Concern for improbable outcomes such as voice change or clitoral enlargement are largely unfounded, arising more from hearsay than fact. Voice change, very uncommon, is usually reversible with dose reduction. Of the few who’ve experienced voice change, most consider it subtle and inconsequential compared to the physical and emotional benefits gained. Clitoral sensation is often improved, as the blood flow and responsiveness of erectile tissues of the vulva are enhanced with testosterone. For some this may appear as slight clitoral prominence initially, but in time not a noticeable change.

Should I Start with Topical Creams – To Easily Adjust the Dose?

It seems common sense to assume that topical creams are more desirable because they seem easier to “adjust” – but that belief overlooks how hormone therapy truly works in the body.

Hormones don’t provide meaningful results when doses are altered frequently. Each change takes several weeks for your body to process. Beyond absorption of the product, time is required to create downstream effects in your body, such as protein synthesis, receptor activation, and brain-level adaptation. Daily or weekly dose changes, even with good intentions, interrupt this process and prevent your body from ever reaching a therapeutic rhythm.

Limitations of Topical Creams

Some like the idea of control they feel with a daily cream. But we have observed in years of clinical practice, this approach rarely leads to a high degree of satisfaction. Here’s why:

Hormone levels constantly fluctuate throughout the day with creams – rising after morning application but dropping back down by evening – leaving you underdosed for many hours. Your body has to play “catch up” every day.
Even perfect daily use doesn’t provide sustained therapeutic exposure. And if you miss a day (which is common), you essentially fall back into a hormone-deficient state, essentially starting from scratch.
Only a small number of patients continue with hormone creams, due to ineffectiveness and/or inconvenience. Even the ones who continue never receive the high level of satisfaction our pellet patients enjoy. Others experience little to no results for months, only to give up in discouragement. Such a large percentage of cream users have demonstrated suboptimal outcome, we have become reluctant to prescribe it. Now, we are pleased to offer a superior method.

When someone has taken the steps to research and prepare for their long-awaited hormone consultation, we want them to experience meaningful progress – not to waste the next year “experimenting” with a low-efficiency delivery system because of fear, or misguided belief that it’s easier.

Pellet Implant Therapy Offers Enhanced Patient Support

One of the greatest advantages of the pellet program is the level of care built into the process. You will be seen every 3–4 months for a thorough, face-to-face evaluation with your provider where we:

Review your progress and symptoms
Discuss lab results if applicable
Address any side effects, concerns, and questions
Plan ahead for continued improvement

No other treatment approach provides this level of consistent oversight and collaboration.

If your goal is long-term symptom relief, protection, and peace of mind — a treatment that works with your body rather than chasing daily fluctuations — pellets offer the most stable and successful path forward.

Economics of Hormone Pellet Therapy for Women

Health insurance will not cover any form of testosterone therapy for females, nor any compounded prescription. The cost of female pellet therapy is $365.00 per 3-4 months – about $3.50 per day – a modest investment considering the potential savings on medications for sleep, mood, metabolic and bone health, plus improved quality of life and performance.

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Laura Grant, MD, MSCP. Dr. Laura Grant is board-certified in Obstetrics and Gynecology, and is a Menopause Society Certified Practitioner, maintaining annual certification through The Menopause Society (formerly The North American Menopause Society, NAMS).

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Printable pdf’s to share with someone who needs to know

References Related to Testosterone, Estrogen, and Pellet Implant Therapy

Turner R, Kerber IJ. A theory of eu-estrogenemia: a unifying concept. Menopause, Vol. 24, No. 9, pp. 1086-1097. “Estrogen action through Estrogen Receptors is critical for homeostasis in women and men. Considering there are more than 3,600 ubiquitously distributed Estrogen Receptors and signaling pathways, it is biologically naive to conclude that estrogen, with its complex genomic and nongenomic actions, should be deficient from a menopausal woman’s body.”
Glaser R, Dimitrakakis C. Testosterone Therapy in Women: Myths and Misconceptions. Maturitas, 2013 Mar;74(3):230-4. Abstract: “Although testosterone therapy is being increasingly prescribed for men, there remain many questions and concerns about testosterone (T) and in particular, T therapy in women. A literature search was performed to elucidate the origin of, and scientific basis behind many of the concerns and assumptions about T and T therapy in women. This paper refutes 10 common myths and misconceptions, and provides evidence to support what is physiologically plausible and scientifically evident: T is the most abundant biologically active female hormone, T is essential for physical and mental health in women, T is not masculinizing, T does not cause hoarseness, T increases scalp hair growth, T is cardiac protective, parenteral [non oral] T does not adversely affect the liver or increase clotting factors, T is mood stabilizing and does not increase aggression, T is breast protective, and the safety of T therapy in women is under research and being established. Abandoning myths, misconceptions and unfounded concerns about T and T therapy in women will enable physicians to provide evidenced based recommendations and appropriate therapy.”
Bianchi VE. The Anti-Inflammatory Effects of Testosterone. The Journal of the Endocrine Society, 2018 Oct 22;3(1):91-107. “Low Testosterone level has implications for metabolic health in both males and females and should be considered a risk factor because of its correlation with metabolic syndrome and all-cause mortality.”
Samantha Worboys, et al. Evidence That Parenteral [pellet implant] Testosterone Therapy May Improve Vasodilation in Postmenopausal Women Already Receiving Estrogen, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 1, Jan 2001, 158–161. “This study provides evidence that testosterone implant therapy may improve [mechanisms of] arterial vasodilation in postmenopausal women already using HRT. This supports the concept that androgens have important physiological actions in women as well as in men, and provides additional safety data pertaining to postmenopausal testosterone use.”
Britto R, Araújo L, Barbosa I, Silva L. Improvement of the lipid profile in postmenopausal women who use estradiol and testosterone implants. Gynecological Endocrinology, 2012; 28(10):767-769. “The use of E and T implants showed statistically significant decrease in Total Cholesterol at the beginning of the Hormone Therapy and some decrease in LDL in the group using Hormone Therapy. In the group without HT there was no difference in lipid profile.”
Iellamo F, et al. Testosterone Therapy in Women With Chronic Heart Failure: A Pilot Double-Blind, Randomized, Placebo-Contolled Study. Journal of the American College of Cardiology, Volume 56, Issue 16, Oct 2010, 1310-1316. “Testosterone supplementation improves functional capacity, insulin resistance, and muscle strength in women with advanced Chronic Heart Failure. Testosterone seems to be an effective and safe therapy for elderly women with Chronic Heart Failure.” 
Glaser RL, Dimitrakakis C. Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole; a prospective, observational study. Maturitas, 2013; 76(4):342-9. “Testosterone and/or Testosterone+Anastrazole, delivered subcutaneously as a pellet implant, reduced the incidence of breast cancer in pre and postmenopausal women”
Glaser R, Dimitrakakis C, Trimble N, Martin V. Testosterone pellet implants and migraine headaches: a pilot study. Maturitas, 71 (2012) 385–388. “Continuous testosterone was effective therapy in reducing the severity of migraine headaches in both pre- and post-menopausal women.”
Savvas M, Studd JW, et al. Increase in bone mass after one year of percutaneous estradiol and testosterone implants in postmenopausal women who have previously received oral estrogens. Br J Obstet Gynaecol. 1992 Sep:99(9):757-60. “Subcutaneous estradiol and testosterone implants will result in an increase in bone mass even after many years of oral estrogen replacement therapy.”
Mikkola T, Tuomikoski P, et al. Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause, Sept 2015, Vol 22, Issue 9, 976-83. “In absolute terms, the risk reductions mean 19 fewer coronary heart disease deaths and 7 fewer stroke deaths per 1,000 women using any Hormone Therapy for at least 10 years.”
Petrone AB, et al. 17β-Estradiol and Inflammation: Implications for Ischemic Stroke. Aging and Disease, Volume 5, Number 5, October 2014; 340-345. “Estradiol has been shown to be a powerful immunomodulator and neuroprotective molecule in ischemic stroke.”
Matyi J, et al. Lifetime estrogen exposure and cognition in late life: the Cache County Study. Menopause, December 2019, Volume 26, Issue 12, p 1366-1374. “Our results suggest that longer endogenous estrogen exposure and Hormone Therapy use, especially in older women, are associated with higher cognitive status in late life.”
Glaser R, Kalantaridou S, Dimitrakakis C. Testosterone implants in women: Pharmacological dosing for a physiologic effect. Maturitas 74 (2013) 179–184. “Pharmacologic dosing of subcutaneous T, as evidenced by serum levels on therapy, is needed to produce a physiologic effect in female patients. Safety, tolerability and clinical response should guide therapy rather than a single T measurement, which is extremely variable and inherently unreliable.” This means that it is important to treat the patient for symptoms, rather than rely solely on lab reports as a guide for hormone dose adjustments.
Glaser R, York AE, Dimitrakakis C. Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS). Maturitas, 2011 Apr;68(4):355-61. “Continuous testosterone alone, delivered by subcutaneous implant, was effective for the relief of hormone deficiency symptoms in both pre- and post-menopausal patients.”
Shapiro S, Farmer RD, Mueck AO, et al. Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies: Part 2. The Women’s Health Initiative: estrogen plus progestogen. J Fam Plann Reprod Health Care 2011;37:165–172. See also a British Medical Journal Editorial Commentary: Does hormone replacement therapy cause breast cancer? Commentary on Shapiro et al papers Parts 1-5. The editorial author states “Breast cancer risks from the WHI study have been adjusted by investigators over the last decade, such that statistical significance has become borderline, with doubt cast over the association being causal.” Shapiro et al concluded that once the statistics of the WHI study were more carefully examined, estrogen therapy had not been conclusively shown to be the cause of breast cancers.
Fournier A, Berrino F, Clavel-Chapelon, F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat, 2008 Jan: 107(1): 103-111. Investigators found that, in comparison to synthetic estrogens and synthetic progestins, micronized [bioidentical] progesterone + bioidentical estradiol were associated with the least risk in breast cancer (no increase over baseline risk).
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