Avoid Pellet Hormone Therapy

An important part of Hormone Therapy is determining the right route of administration for You.

Your unique genetics, medical history, and timing of the start of hormone therapy, dictate how your hormone should be taken (route).

Orally? or Under the tongue?
As my patient, We will have discussed which is best for You.  You can read more about my “8 Rights of Hormone Therapy” HERE.

For example: It is best to take your hormones orally–orally offers the best protection against heart disease, diabetes, and atherosclerosis.

If you are:
*starting hormone therapy more than 10 years post-menopause, have a history of Factor V, Protein S or C,
*have a history of blood clots, Heart Attack or Stroke, *or have other factors determined by your provider,
then your hormone should be taken under the tongue (sublingually).

See how important “route” is?
And why understanding your unique blueprint provides not only optimal results, but a safe and effective experience for you?

And why working with a certified hormone provider is essential not only for your safety, but also for your optimal results?

It is just as important to maintain control of your hormones on a daily basis.

Your body adjusted your hormones daily for you when you were younger based on thousands of factors–continuous streams of information–
is she stressed?

is her blood sugar high or low?
is her blood pressure up or down?

is she sleeping, running, sweating, sitting, having sex (or wanting to have sex )?
Is she gaining weight? Losing weight?
Is her body fat high or low?

Are her adrenals taxed?
Is the thryoid taxed?
Is the gut leaking?

What medication is she taking?

What toxins is she exposed to?

Is the estrogen, progesterone, DHEA, testosterone balanced or imbalanced?

You get the picture–lots of information, every mili-second, analyzed, to determine your hormone balance.

So it makes sense that you would want to maintain the ability to do this, too,  in perimenopause, menopause, and (andropause for men).

This means that you want the ability to dose yourself on a daily basis — and avoid taking hormones in a “bulk” form.

It is for this reason that I am NOT A FAN of hormone pellets or testosterone injection therapy.

Hormone should be empowering and allow you the flexibility to adjust dosing based on stress and life change.
Pellets are very limiting: they dont offer daily adjustment,
the dosing is largely a “guess” by the provider; if you get too much,
you have to wait 6months for levels to drop; if you dont get enough,
providers wont offer support (they dont know how),
and blood levels are not followed, so it is uncertain if optimal levels for healthy aging, are met.
My professional experiences with patients who have had pellets placed, has been:
levels are never balanced
results have been poor
surgical insertion is pricey
too much or too little hormone is uncomfortable and a waste of money
I have had women come to me AFTER pellets have been placed, and they were not giving the right dose or followed up at all.
Many are very depressed, have gained alot of weight, and some (if on too much testosterone) were suicidal. Too much testosterone in women make them feel this way–Which is scarey not just for them, but for also their spouses and family members.
I have never seen a woman or man on hormone pellet therapy achieve optimal levels. Ever.
In Fact, I am working with several women right now who are regreting their pellet insertions–3 feel worse and one feels no better.
Which is what I have seen from pellet therapy as it has been in and out of vogue over the last 20 years.
This is why I will never offer this option to my patients.
I prefer that my patients learn to listen to their bodies, and adjust levels, particularly progesterone and testosterone, as needed based on stress.

I will just say it plain and clear:
Men and women should avoid using hormone pellets.
Men should avoid testosterone injection therapy.

Pellets are becoming more “popular” recently–suddenly they are “all the rage”, largely because doctors can charge a huge fee for the hormone pellet, and another huge fee for the surgical implantation (ie big money-makers).

Providers who are not specialized in hormone replacement see this is a great way to infuse cash into their businesses. They also dont have to “balance” your hormones.

If you are a candidate for oral therapy, and this is not offered as an option, and only pellets are offered, then you have been misguided by your provider getting pellets inserted, and will be missing out on the benefits of oral therapy.
The only women who should EVER consider pellet therapy are those who:
1. Are more than 5-10 year post menopause when starting hormone therapy (transdermal/sublingual routes should be considered) and are not candidates for oral therapy
2. Have a history of blood clots, heart attack, or stroke (transdermal/sublingual routes should be considered) and are not candidates for oral therapy
3. Dont care about daily balance, empowering themselves with dose adjustments with protesterone and testosterone, and arent looking for optimal blood levels or healthy aging
4. Dont care if they have to wait out 6 months for a bad result to “resolve” on pellet therapy (typically due too much hormone)
5. Dont care if they have no results, on pellet therapy (typically due to too little hormone)
6. Are military persons without access to pharmacy, particularly compounded medications if they are using sublingual forms such as RDTs, troches, triturates, or compounded capsules for their specific and bioidividualized needs as forms of medications on a daily basis, or a way to store hormones that must be refrigerated (ie troches)–usually those stationed in the field, with the understanding that they are trading the convenience of “bulk” hormone adminstration for the empowerment of daily balance. (Oral therapies can typically be gathered in larger quanties and refilled through the mail, and could be continued with relative ease).
7. Are traveling for 6 months or longer, without access to pharmacy, particularly compounded medications if they are using sublingual forms such as RDTs, troches, triturates, or compounded capsules for their specific and bioidividualized needs as forms of medications on a daily basis, or a way to store hormones that must be refrigerated (ie troches)–such as missionaries or charitable work in specific areas of world, with the understanding that they are trading the convenience of “bulk” hormone adminstration for the empowerment of daily balance. (Oral therapies can typically be gathered in larger quanties and refilled through the mail, and could be continued with relative ease).

My professional experience has been this:

I have worked with many patients who have had hormone pellets inserted and they are not happy with the results.
Levels are too high, too low–never “just right.”

I shared office space with a provider many years ago, who inserted pellets, and I observed patients struggling with sub-optimal results (too high, too low–never “just right”), and it was sad for me to observe, and dishearting to patients who had the expecation of hormone balance.

I had so much sorry for these patient who had spent a lot of $$ for sub-optimal, and often terrible/worse-than-pre-pellet, results. And who were often misinformed of their options for optimal hormone balance and for healthy aging.

Here are more reasons Why I am not a Fan of hormone therapy (bulk hormone administration):

1. The doses are not individualized--Not all women are the same. Every single woman is different, and requires different therapy. Pellets are a “one size fits all” scenario–you get whatever dose the doctor “guesses” is right for you from pre-made pellet dose options. There is no bioindivuality.

This goes against the whole premise for bioindividualized and bioidentical hormone therapy.

If the dose isn’t right for you–you feel no better:

If the dose isnt high enough and you wont get optimal levels, symptom relief, or the benefits of healthy aging and disease prevention.

If the dose is too high, you feel worse (PMS, acne, weight gain, bloating, mood imbalances, depresson, etc) and for which there is no solution.
Pellets last 6 months–you must endure.
You must suffer through.

2. Levels are not optimized— once a pellet is inserted, levels are typically not followed, and if your symptoms are not improved (not enought hormone), you might need to take additional hormone, IF you can get your provider to listen to you, check your levels, and then know how to optimize your levels (adding more pellets will not be an option).

Agan, If you are given too much, then you need to wait-out the imbalance 6 months until the pellet dissolves and “wears off”. Again, you have to wait it out.


The bioindividualized results are poor.
The cost is high.
Patient satisfaction is low.

And sadly this contributes to the “bad rap” hormone replacement ultmately gets from the media, and from patients who have had less than optimal experiences.

Also, cortisol is a thief–it steals hormones. It LOVES to steal progesterone. Think about it this way: when you were younger, and still menstruating regularly, and became stressed for whatever reason, sometimes periods would become irregular. Why? Because the stress you experienced, increased cortisol. And cortisol in turn steals your progesterone, and the lining of the uterus has less progesterone to support and stabilize it, so it sheds irregularly : either early, late, heavy , light, between cycles, etc.

Stress is real, it impacts hormones at every age. Pellets dont allow for women to adjust for stress and cortisol “steals.” Menopausally, or post-hysterectomy, you won’t experience the break-through bleeding with stress like you did when you were younger as a results of the “cortisol steal”, but you may begin to experience loss in sex drive, weight gain, or adrenal fatigue–which is tired, wired, restless, anxious, sad, hopeless EXHAUSTION.

3. The side effect are real. Women especially need to be careful with testosterone pellets–too much can cause acne, depression, fluid retention,  and suicidal feelings. I have seen this first hand in women who have been dosed way to high with testosterone, who have come to me for help, and it is a dangerous experience for the patient and frightening for their family members.

Too much estrogen can cause headaches, bloating and weight gain–PMS at 50?   NOT   FUN.

Progesterone, if offered (it is often neglected by providers) is a hormone which levels are rarely optimized on pellet therapy. Providers who dont understand the wonderment of progesterone view it only as a uterine protectant–as it prevents endometrial growth in menopausal women with an intact uterus. But progesterone does so much more at the cellular level, and for every cell of the body–not just the uterus.

Women without optimized progesterone are still left sleepless, restless, and without the “sense of calm” that progesteorne provides.

Progesterone supports our “stress cycles” (cortisol) and our adrenal systems. Lack of progesterone can cause adrenal fatigue.

4. Hormones are not taken with your circadiam rhythm: 
There is reason that I dont compound estrogen and progesterone together into one capsule:

Estrogen gives you energy. Take it in the morning for a rockstar day.
Progesterone calms you: Take it a bedtime for deep, restorative sleep. If you are not sleeping while on hormone replacement therapy you are either not taking progesterone or you are not taking enough progesterone. If you are on progestin, please stop right away. This is a dangerous synthetic hormone that offers nothing good for the female body.

Testosterone can be finicky for women:
take more when you are expending energy, want increased sex drive, or have a lot of stress.
Take less when the opposite is your experience, or when you get acne or when you feel grumpy. Some fall into a deep depression, and express feelings or thoughts of suicide.

So can see that You are not optimzing your experience by taking hormones together in one capsule, or continuously in a pellet form. And if your dose is not individualized to your needs, injections or pellet-inserted, you are “stuck” with that suboptimal experience until the dose “wears off.”

5.Under-the-skin hormone therapy does not offer the best disease protection. Oral (swallowing a pill) is the best route for estrogen and progesterone, for optimal protection, if you are a candidate to take them this way. Again, this comes down to your certified provider understanding the right route for you, and being vested in your long-term, optimal, disease-prevention benefits.

Oral estrogen keep the blood vessel clean, prevents plaque build-up, and thereby offers the BEST protections from heart disease, heart attack, stroke and alzheimers.

If you are working with a provider that ONLY offers pellets or injections, or tells you that that pellets or injections are the “BEST” way to balance hormons, then they do not truly offer healthy aging, functional medicine and disease prevention in their practice–and they likely are not certified in hormone replacement therapy.

6. Post Pellet care.  Most providers know how to insert pellets, but dont know how to manage hormones post-insertion very well.
They are trained to insert, but not follow-up.

So if you are struggling after pellet insertion, you could be on your own to either suffer through your new yucky symptoms (dose is too HIGH), or find a certified provider who can help you resolve the symptoms that are left untreated (dose is too LOW), or wait it out 6 months until the pellets dissolve.

6. Blood levels are not optimal for disease prevention. Beyond not being the right route for disease prevention, Levels are not followed, and rarely optimized. Optimal estrogen levels prevent alzhemiers and osteoporosis.
Wouldnt you want your hormone therapy to achieve optimal levels?

And remember: cortisol is a thief–it steals hormones. Pellets dont allow for women to adjust for stress and cortisol “steals.”

All of this can be discouraging for patients who are paying massive $$ out of pocket and not getting optimal results.

This is why, once your program is completed, I will meet with you every 6 months, to reveiw and optimize your treatment plan, hormone doses, and blood levels.

Here is Why I like daily hormone management:
I like my patients to have empowered control of their hormones, and have the ability, along with the flexibility, to adjust progesterone up, testosterone up or down, and DHEA up or down accordingly to their daily needs,  lifestyle stressors, and life experiences.

What your body is telling you is important, and you can listen to these cues and optimize your hormone therapy accordingly.

Having this type of communication with your body is wonderful.
Over time, I will teach you how to make simple hormone adjustments based on what your body is telling you.

For example:

I will teach you that If you have been sleeping well, and suddenly begin to wake-up during the night, then it is likely that stress is pushing your cortisol up, and cortisol is stealing your progesterone–leaving you sleepless.

So, I will teach you to increase your progesterone for a few nights, identify your stressor–and deal with it–increase your self-care, and then when you begin sleeping well again, lower your progesterone to previous.

See how empowering this is?
To not give up your empowerment, daily self-conversations, listening to your body and cues, and not give up  control to “bulk” hormone therapy?

Living your optimal life is your goal, and hormones when taken the right way, with the right does, to achieve the right levels, under the supervision of the right provider, to achieve the right results, can do just that for You.

Hormone are awesome when done Right 🙂

Live Life Optimally,


 ProTip: The only exception that I make to “bulk” hormone therapy administration is for my military persons.
Men and women, stationed overseas, for unknown amounts of time, without specialized medical care or access to compounding pharmacies, may need specialized “bulk” hormone therapy. This is still individualized for their specific needs and situation, and is a whole other story 🙂

Final thoughts: Hormone therapy should be bioindividualized for each womans needs–there is not ONE hormone replacement plan that will work for ALL women, and pellets and injections purpose that there is, which is a huge flaw in the concept of individualized, bioidentical hormone replacement therapy.

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Meet Kristie

Kristie RosserKristie is a wife and mother of 4 and an athlete. She has been working in healthcare for more than 25 years. Kristie’s goal is to assist her patients to achieve and maintain an exceptional level of health and life-balance. She successfully blends prevention, optimization, hormone therapy, and age management with balanced and healthy living into her progressive wellness and integrative medical practice. Read more

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