Hormone pellet therapy is a method of replacing hormones. Hormone pellets are implants under the skin that release bioidentical hormones from plants.

Hormone pellet therapy is a treatment for replacing or regulating hormones in males and females, either with forms of estrogen or testosterone or with a combination of hormones. Compounded hormones are a mixture of hormones that a pharmacy or laboratory creates specifically for an individual.

Females may use hormone pellet therapy as a treatment for menopause symptoms. Transgender people may use the treatment to suppress or enhance certain sex characteristics.

This article looks at the potential risks and benefits of hormone pellet therapy.

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Hormone pellets are implants that a healthcare professional inserts under the skin. They release hormones called bioidentical hormones. Bioidentical hormones come from plants and are similar to the hormones that the human body produces.

Hormone pellets often contain a mix of hormones. These are known as compounded bioidentical hormone pellets, and the Food and Drug Administration (FDA) has not approved them as a treatment.

The reason behind this is that the National Academies of Science, Engineering, and Medicine (NASEM) informed the FDA that there is a lack of evidence supporting the safety and effectiveness of compounded hormone therapy.

However, there are claims that this kind of hormone therapy is safer and more effective than FDA-approved drugs.

Bioidentical compounded hormones may include estradiol, estrone, dehydroepiandrosterone, and testosterone.

A laboratory or pharmacy can make the hormone pellets using a prescription from a doctor. The pellets are about the size of a grain of rice.

A healthcare professional will consider factors such as hormone levels and body mass index (BMI) when working out an appropriate dose of hormones to insert.

To insert hormone pellets, a healthcare professional will numb the skin and make a small incision, usually into the hip area. They will then insert one or more hormone pellets underneath the skin.

They will close the incision with Steri-Strips, a stitch, or both. A person will need to follow the healthcare professional’s instructions after the procedure. Those with Steri-Strips may be able to remove them after 5–7 days.

The pellets provide a constant supply of hormones for about 3 months.

People wishing to use compounded bioidentical hormones may need to undergo a salivary test first to check their hormone levels. However, according to The American College of Obstetricians and Gynecologists (ACOG), “salivary testing does not currently offer an accurate or precise method of hormone testing.”

There is little scientific evidence to support the benefits of hormone pellet therapy. The FDA does not regulate compounded pellet therapy and has not approved it.

Providers of hormone pellet therapy suggest that the treatment will provide various benefits. These include:

There may also be advantages of a pellet delivery system, including:

  • direct absorption of hormones into the bloodstream, avoiding the liver and gastrointestinal system
  • control over the release of hormones so the body can absorb more or less as and when it needs them
  • continuous availability of hormones
  • no need to apply topical creams or gels each day, use patches, or take oral medication

According to a 2019 article, bioidentical hormones have a molecular structure identical to that of the hormones that naturally occur inside the body. Anecdotal claims suggest that compounded hormones can provide individualized treatments specific to a person’s symptoms and hormone levels. However, there is no scientific evidence to support the effectiveness or safety of this treatment.

The ACOG recommends FDA-approved hormone therapy, which includes:

  • Systemic estrogen therapy: This therapy, either with or without progestin, may be the best treatment for night sweats and hot flashes.
  • Systemic and local estrogen: This therapy may help relieve vaginal dryness.
  • Systemic estrogen: Systemic estrogen helps protect against bone loss that can occur in early menopause, and it may help prevent osteoporosis.
  • Combined hormone therapy: This type may help lower the risk of colon cancer

Learn more about hormone replacement therapy.

The side effects of hormone pellets may vary depending on the levels and types of hormones that the pellets contain.

The most common reports of side effects come from people who have had long-term, high dosages of testosterone. In females, high levels of testosterone can cause:

The drug label for one type of pellet containing the hormone estradiol lists the following potential adverse effects:

  • bleeding or spotting from the vagina
  • changes in menstruation
  • period-like pains
  • yeast infection
  • secretion from the nipples or breast tenderness or enlargement
  • nausea
  • vomiting
  • abdominal cramps
  • bloating
  • cholestatic jaundice
  • skin discoloration
  • eye changes
  • headaches
  • migraine
  • dizziness
  • chorea
  • weight changes
  • changes in libido

Some people believe that bioidentical hormone therapy is more effective and safe than other forms of hormone therapy. However, there is little evidence from randomized controlled trials to support this claim.

According to the ACOG, some bioidentical hormones have FDA approval, but the FDA does not regulate compounded hormones.

Compounded hormone therapy is a customized mix of hormones for an individual, which a pharmacy makes according to a doctor’s prescription. The individual’s blood or salivary hormone levels may determine the mix of hormones.

The FDA does not approve these medications because it is not possible to test individual mixes of hormones to see how the body responds.

There may be risks with compounded hormones because the strength and purity of the drugs can vary. This means that people may be unaware of the levels of hormones they are receiving.

The ACOG recommends FDA-approved hormone therapy rather than compounded hormone therapy.

Below, we answer some common questions about hormone pellet therapy.

What do hormone pellets for menopause cost?

The cost of hormone pellet therapy can vary depending on the provider, but an average cost may be close to $1,536 each year.

Healthcare insurance may cover FDA-approved hormone therapy, but the extent of the coverage may vary among plans. Most insurance companies are unlikely to cover compounded bioidentical hormone therapy because it is not FDA-approved.

Who is a candidate for hormone pellet therapy?

People who might consider hormone therapy are most commonly those going through menopause. These individuals may experience symptoms such as:

If the symptoms are interfering with everyday life, people may find symptom relief with hormone replacement therapy. The ACOG recommends using FDA-regulated hormone therapy.

Pellets containing testosterone are suitable for transgender men who wish to suppress female secondary sex characteristics.

Learn how to cope with menopausal hot flashes and night sweats.

Hormone pellet therapy is a type of hormone replacement therapy. People of any gender can choose hormone pellet therapy, but people going through menopause are typical candidates.

Hormone pellets contain one or more hormones. Once implanted under the skin, they steadily release bioidentical hormones. Bioidentical hormones originate from plants and are similar to human hormones.

Many hormone pellets contain a mix of hormones that a pharmacy or lab can make according to a doctor’s prescription. The FDA has not approved these compounded hormones, and it does not regulate them. As a result, they may pose safety risks.

There is little evidence supporting bioidentical hormones, particularly compounded hormones.

However, the current evidence supports the use of FDA-regulated hormone therapy to help relieve the symptoms of menopause.