Bioidentical Hormone Replacement Using Pellets

What is Bioidentical Pellet Hormone Replacement Therapy?

Bioidentical hormones are derived from plants and can be used topically, orally, or via pellet insertion. Bioidentical hormones assist in correcting hormonal imbalances. Hormonal imbalances occur naturally as females get older.  Also known as perimenopause and menopause. 

Pellets are small, about the size of a grain of rice, that contain hormones. These pellets are inserted into your upper hip in a simple in-office procedure. 

These pellets slowly release hormones (estrogen or testosterone or both) into your system over three months. 

Bioidentical Hormone Replacement therapy is not a quick fix and immediate results type of treatment.  While you and I would love for that to be so it simply isn’t.  As with all things health-related it takes time to find your sweet spot and what works with your body.

You’re dealing with hormones in your body; this is a very complex and sophisticated machine. 

While I was initially excited to begin this process and thought relief was soon on its way.  I found out over time that this was not to be.  Here’s what happened.

Bioidentical Hormone Initial Appointment October 2021

I met with the doctor and had labs drawn per their request.  Then had to return weeks later for my actual consult about whether or not I was a candidate.  Upon review of my labs and symptoms, I was indeed a candidate for pellet therapy.  

The pellets which are the size or smaller than a grain of rice are inserted into your upper hip.  They numb the area and you’ll feel the slight burn of the numbing agent which goes away in seconds. 

Then the doctor makes a small incision and inserts the pellets.  You’ll have gauze placed over the area or liquid adhesive may be used to close the site.  

Either way, you’ll leave with minimal dressings, and you’re on your way.  You may experience some soreness from the site.  I removed the dressing 48 hours later per instructions. The site closed and all was good.

Follow Up Appointment

The follow-up appointment was about 4 weeks later and consisted of new labs to see how the pellets were affecting my hormones.  Or rather how my hormone levels had changed and if I would need a booster. Or an extra dose of the pellets. I did get a booster at that time.

Now I waited for the effects.  It took about 2 weeks before I noticed any difference.  Then I began to have energy, my mood improved and I was happier, my libido was back, and overall I started to feel good. This lasted for about 3 months then tapered off.

Drop Off

Also known as the drop-off.  The pellets will slowly release into your body over time. However, once they completely dissolve you are no longer receiving the testosterone or hormones and there is a noticeable difference.  I felt the crash almost like a hard sugar crash but with your hormones. 

All my symptoms came back before I could get in for the next treatment.  Talk about Dr. Jekyll and Mr. Hyde.  

There was no forewarning of what to expect.  That would have been nice to know beforehand how severe it was going to be. At least for me, it is. 

It’s recommended to schedule your next pellet insertion 2 weeks before noticing a drop-off.  This takes some time to figure out since you have to wait to see how long before your body starts to “drop off” around the 3-month mark.  And then make sure to schedule 2 weeks shy of that point.

Still Not Feeling 100%

By the time I came back to my doctor’s office, I still had lingering symptoms of fatigue and needed further improvement.  I did feel significantly better after the initial pellet insertion but it wasn’t optimal yet.  So then I was placed on thyroid medication which I did not want to be on since it was not bioidentical but synthetic.  Trying to feel better I gave it a try, ignoring my uneasiness with using synthetic drugs.  

I did need an additional pellet insertion. It was placed and the dosage increased slightly.  Again, the same thing happened I started to feel better upon insertion, but then I noticed the drop-off yet again.  I hadn’t noticed any difference with the thyroid medication either.  

This particular doctor’s office I had some issues with as far as staff, billing, and communication issues.  Having been in the medical field for so long, I can’t tolerate poor staffing and left the practice.  I was also switched without my knowledge from seeing the MD to the NP.  

Perhaps this may not be an issue for most but I like to stick with one provider.  Even if there are multiple providers in one practice every doctor, nurse practitioner, or physician assistant all practice and treat differently.  I chose to leave the practice and continued with finding the right fit for me.

Pellet Therapy with new Practice – January 2022

So I was on another mission to find another doctor who could do the BHRT specifically pellet therapy.  I wanted to continue with this route as I had already had 2 treatments prior and felt somewhat better.

I did find another provider who is very well-informed on BHRT. She is also female and can relate to all that I was feeling.  She too has the pellets placed and has experienced all the same symptoms more or less.  This makes all the difference to me.  

So I had another round of labs done and had pellet insertion done again.  This time with a different dosage according to what this doctor thinks I need.  The same procedure is followed for insertion and noted at the other doctor’s office.

I did react to the tape being used in the dressing but that is nonrelated to the pellets.  I had an allergic reaction topically to the adhesive being used. 

It took about 2-3 weeks for me to notice a difference.  

I did have side effects with this dosage as I had horrible headaches for a week.  Migraine-type headaches and I couldn’t function most of those days.  It took me a while to figure out that it was the pellets.  Once the headaches finally went away I started to notice an improvement in my symptoms. 

Finally, I felt so much better and had great improvements compared to the treatment before at the other office. I thought this is finally what I’m supposed to feel like.  Everything was so much better.  

I went to have labs drawn again weeks later to see what my hormone levels are and if I need more pellets.  After reviewing my labs I did go back in for a booster.  Again, I experienced headaches followed by noticeable improvements. 

I did experience the drop-off but knew this time it was coming and called the office to get in.  They made a note as to when to schedule the next insertion based on that timeline.

Side Effects

It wasn’t until my next insertion with a new dosage that I experienced side effects.  This time I received the full dosage of what I had from the original insertion plus the booster dosage.  I had it all at the same time. I will remind you that once these pellets are placed they cannot be removed. They are in there and you will have to essentially wait it out for the side effects to wear off.

I had a lot of side effects with this new dosage. 

I didn’t feel any of the benefits that I had felt before this treatment.  None. 

Instead, those headaches I mentioned, were even worse and I had to take OTC migraine medicine, seclude myself in my room and do the best I could to get through the day.  It was unbearable. 

All of my symptoms of fatigue, brain fog, memory loss, irritability, moodiness, loss of concentration, low libido, painful PMS or PMDD, and more it was back. And I was miserable.  Now I also noticed hair growth or hirsutism (hair growth face, chest, and back on females) triggered by excess androgens or testosterone. 

I was not happy, to say the least.  I called my doctor and they got me pretty quick to have my labs drawn again.  And of course, my testosterone levels are way over the mark.  

And there is nothing I can do about it except wait. Wait for three freaking months for it to wear off. I was told that it will start to taper off in a few months or less and I’ll feel better.  And have the benefits of it once it levels off.

Um no. Never happened.

It didn’t level off.  The one time I wanted to have a severe drop-off and it didn’t happen.  I never felt better and it didn’t seem to taper off. Those benefits they spoke of did not happen.

So basically, I paid to feel like crap for 3 months.  Again once they’re in they’re in.  So I say this I will never do pellet therapy again.  

You cannot adjust your dosage in real-time and based on present moment symptoms or side effects.  You have to endure the side effects until they dissolve.  It was equally irritating that I willingly paid to feel this way! Ugh, it still pisses me off.

Needless to say, I did not continue with the next insertion. It took about another month before I felt that the pellets had dropped off. That’s 4 months of feeling like crap.  That is how much excess testosterone I had placed, it took another month for it to drop off. 

Find what works for you

I’m now trying different avenues for BHRT treatment.  I’m currently trying Winona which is all telemedicine.  They use BHRT but do not use testosterone. They use DHEA. I’ll have my experience and review of that to come.  Hint, I’m already on to another treatment because it wasn’t a fit for me.

Hormones are Complex

I think it’s easy to gloss over the fact that we are having hormone treatment by saying pellets.  It loses its weight or complexity of what is being adjusted.  These are major hormones we are adjusting and fine-tuning. This must be taken seriously and you must be an advocate for yourself. Don’t settle for not feeling well.

As I always say no two people are the same therefore no two people will have the same experience or outcome.  This is even more true with bioidentical hormones.  Don’t take it lightly or think it’s not a big deal.  

My pellet therapy consisted of only testosterone.  You can also have estrogen placed via pellets but this is dependent on what your body needs.  

I questioned why I was not also being treated for progesterone, hell it wasn’t even being tested.  The answer was that most women only need testosterone. Being the person I am, I didn’t accept this answer and my intuition tells me I need something else.  I think a better approach and all other hormones (thyroid, estrogen, progesterone, testosterone) are to be tested for true personal treatment.  

I’d also like to mention that once I was given the synthetic thyroid medication, it never came up again about needing to increase my dosage or not.  It’s like it was given to you by another provider so you must continue with it.  Even though I’m still having symptoms of fatigue, thinning hair, etc.  

The struggle to find the right provider or more importantly a provider whose belief in not using synthetic hormones including thyroid meds is so real.

You can only do what works for you.  You may be okay with synthetic thyroid medication and that’s your choice.  For me, however, I finally found someone who will use bioidentical hormones including testosterone (not pellet form) and bioidentical T3 and T4.  More on that treatment and if it works to come. I’m also reading a very informative book about thyroid treatment. You can find it here, The Thyroid Debacle.

I hope my experience helps you in some way.  Pellets are on trend and seem to be a fit for some women. However, things do not always go well.  They didn’t for me.  I hope this helps you to look out for possible side effects and what to expect with pellets.  

Please check out my article on PMDD and Endocrine Disruptors to Avoid, if you’re starting your hormone journey.

I wish you peace and guidance on your journey. Take care and be well.