Women's Wellness Center

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 opportunity for hormonal support before, there is safety, and still much to gain by initiation of hormone therapy later in your journey. The hormones of interest: testosterone, estradiol, and progesterone.

Bioidentical Hormones: Molecularly Identical to the Body’s Own

Testosterone, far from being exclusively the male hormone, 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, bone/muscle development, and more. Thus, decline in testosterone activity during perimenopause can cause loss of vigor and well-being. Women often attribute these changes to a “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, the primary estrogen, affects the brain, heart, bones, joints, skin – and nearly all body systems. Decline in the 40’s, to undetectable in the 50’s, brings hot flashes, mood swings, insomnia, vaginal dryness, and brain fog. Estradiol replacement relieves these symptoms and lowers risk of breast/colon/lung cancer, heart disease, dementia, diabetes, and osteoporosis.

Progesterone balances estradiol’s effects, protecting the uterine lining from overgrowth, reducing uterine cancer risk. Oral capsules of progesterone are effective for uterine protection and also for sleep and calming effects.

What is Bioidentical Hormone Pellet Therapy?

With this method for estradiol and/or testosterone therapy, 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 of hormone levels.

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 a band aid, 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.

Why We Specialize in the Pellet System

Our practice has always evolved as new data emerges. With more than 30 years of clinical experience in women’s health, plus comprehensive knowledge and practice of all hormone therapy options, we’ve found the pellet implant system to offer the most consistent, convenient, and effective results. Since launching the pellet program in 2019, we’ve repeatedly observed superior outcomes with this method, our patients reporting exceptional symptom relief, and unmatched long-term experience. For these reasons and more described herein, we now focus our treatment exclusively on the pellet system for testosterone.

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.
Injections: Required weekly or biweekly, injections provide unsatisfactory results because hormone levels swing dramatically between shots, creating a “roller coaster” of extreme excess and deficiency, plus more risk and side effects.
Creams, Gels: These methods avoid the liver first-pass, but deliver low, unpredictable amounts through the skin’s barrier, leading to inconsistent results, ongoing symptoms, and frustration. Even perfect daily use of a cream doesn’t provide sustained therapeutic exposure throughout the day. And if you miss a day (which is very common), you fall back into a hormone-deficient state, essentially starting from scratch. With topical hormone therapy, serum hormone monitoring is almost useless, as hormone levels will vary throughout a 24-hour period, providing no real indication of therapeutic potential.

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

It seems common sense to assume topical creams are easier to “adjust” – but that belief overlooks how hormone therapy works in the body. Hormones don’t provide meaningful results when doses are altered frequently. 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 interrupt this process and prevent your body from ever reaching a therapeutic rhythm.

If starting with a low dose is desired, it can be accomplished with the pellet implant. In contrast to topical creams, whatever the dose with pellets, your serum hormone levels will be stable for many weeks creating a steady, ongoing treatment effect.

Some like the idea of control they believe they’d feel with a daily cream. However, this approach rarely leads to long term satisfaction. In practical and therapeutic terms, the feeling of control in using a cream is an illusion.

What if I Have a Bad Reaction with Testosterone Implant?

The majority report no significant side effects. Some report facial hair or acne, usually easy to manage with well-known effective treatments. Those with genetic predisposition have the option to start preventive treatment at initiation of therapy. Change in voice is uncommon, usually reversible with dose reduction, but the few who experience this often consider it subtle and inconsequential compared to the physical and emotional benefits gained with testosterone. Genital sensation is often improved, as testosterone enhances blood flow to vulvar tissues. For some this may appear as mild tissue prominence initially, certainly not to a pathologic level, and in time not a noticeable change.

Concerns for dramatic negative outcomes are largely unfounded, arising more from hearsay than fact. If something seems off, we are here to guide you through it.

Safety of Bioidentical Hormone Therapy

Clinical studies of bioidentical testosterone in women have not shown increased incidence of cancer or any significant health risk. On the contrary, numerous reports suggest testosterone to be breast protective, as well as protective of the heart, bones, and brain. Although past fears about estrogen therapy arose from the discredited 2002 WHI Study, modern comprehensive analysis confirms bioidentical estradiol is safe, protective, and life-enhancing.

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, symptoms, and current laboratory results
Address any side effects, concerns, and questions
Plan ahead for continued improvement

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

Economics of Hormone Pellet Therapy for Women

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

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References for Testosterone, Estrogen, and Pellet Implant Therapy

Levy B, Simon JA. A Contemporary View of Menopausal Hormone Therapy. Obstet Gynecol. 2024 Jul 1;144(1):12-23.
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.”
Glaser R, Dimitrakakis C. Testosterone Therapy in Women: Myths and Misconceptions. Maturitas, 2013 Mar;74(3):230-4. “Abandoning myths, misconceptions and unfounded concerns about T therapy in women enables 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. 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, et al. 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.”
Iellamo F,Volterrani M, Caminiti G, Karam R, Massaro R, Fini M, Collins P, Rosano GM.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 effective and safe 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 RL, Dimitrakakis C. Incidence of invasive breast cancer in women treated with testosterone implants: Dayton Prospective Cohort Study, 15-year update. AdvPrev MedHlthCare, 2025; 8:1070. 47% reduced incidence breast cancer w/long-term testosterone implant.
Glaser R, Dimitrakakis C, Trimble N, Martin V. Testosterone pellet implants and migraine headaches: a pilot study. Maturitas, 71 (2012) 385–388. “Continuous testosterone effective therapy in reducing severity of migraine headaches in pre- /post-menopausal women.”
Savvas M, Studd JW, Norman S, Leather AT, Garnett TJ, Fogelman I. 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.”
Traish AM, Gooren L. Safety of physiological testosterone therapy in women: lessons from female-to-male transsexuals (FMT) treated with pharmacological testosterone therapy. J Sex Med. 2010 Nov;7(11):3758-64. “Treatment of FMTs with supra-physiological doses of T had minimal adverse effects. No increase in mortality, breast cancer, vascular disease, or other health problems were reported.”
Mikkola T, Tuomikoski P, Lyytinen H, Korhonen P, Hoti F, Vattulainen P, Gissler, Mika M, Ylikorkala, O. 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.”
Ashley B. Petrone, James W. Simpkins, Taura L. Barr. 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, Rattinger G, Schwartz S, Buhusi M, Tschanz J. Lifetime estrogenexposure 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.”
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.”
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. “In comparison to synthetic estrogens and synthetic progestins, bioidentical progesterone + estradiol are associated with the least risk in breast cancer (no increase in risk).
Lobo RA, et al. Back to the future: Hormone replacement therapy as part of a prevention strategy for women at the onset of menopause, Atherosclerosis, 2016 Nov;254:282-290. “We propose that HRT should be considered as part of a general prevention strategy for women at the onset of menopause.“