How pellets work
A pellet is about the size of a grain of rice. It’s placed just under the skin, usually at the upper hip, in a quick office procedure with local numbing. Over the following months it releases hormone, highest in the first weeks and tapering after that, so there’s no daily cream, patch or pill to remember.
The pellets used for women in the U.S. are compounded, which means a pharmacy makes them. They are bioidentical, and they are not FDA-approved for women. Bioidentical and FDA-approved are two different things, and you should know which one you’re getting.
Why some women choose them
Some women love not having to think about a daily dose. Some have had creams rub off, patches irritate their skin, or worried about a gel transferring to a partner or grandchild. For a woman who has done well on a steady dose and wants the convenience, a pellet can make sense.
The trade-offs, straight
Choosing a pellet is a little like signing a lease instead of renting month to month. If you love the place, it’s easy. If something’s wrong, you can’t just move out tomorrow. Once a pellet is in, the dose can’t be turned down, and removing it isn’t simple. If you have side effects, you may be living with them until it wears off.
Levels can also run higher than with other forms, especially in the first weeks. With testosterone, that can mean acne, extra hair growth and, if levels run too high, voice changes that can be permanent. The insertion site can bruise, get infected, or occasionally push a pellet out. And if you still have your uterus, estrogen from a pellet still needs a progestogen to protect the lining.
That’s why, for most women, I want to know how your body handles a hormone and a dose before a pellet is on the table.
Who is and isn’t a good candidate
A pellet may fit you if your symptoms are stable, you’ve shown you tolerate the hormone, you want the convenience, you understand the trade-offs, and you’ll come back for monitoring.
A pellet is usually not the right choice if you’ve had a hormone-sensitive cancer, blood clots, liver disease or unexplained bleeding, if pregnancy is possible, or if your dose still needs fine-tuning. We’ll talk through your history before anything is placed.
How I treat it
Through the 4D Method, and Defend matters most here. I check your levels and your symptoms before any repeat pellet, not on a calendar. If a pellet isn’t working for you, we change course.
What the research says
ACOG advises against compounded hormone pellets, citing hormone levels that can run above the normal range, limited safety evidence and the difficulty of removing a pellet once it’s placed. The 2019 Global Consensus Position Statement on testosterone therapy for women says compounded testosterone can’t be recommended, and it supports testosterone for one use: low desire that bothers a postmenopausal woman, after a full assessment. I want you to hear those positions from me, not find them later on your own.
Questions to ask about any pellet
Ask me these, or ask anyone who offers you a pellet.
- Which hormone and what dose would I get, and why?
- Is this product FDA-approved for this use?
- What evidence supports it for my symptom?
- What happens if I have side effects?
- What will follow-up, testing and repeat pellets cost?
Serving Henderson and Las Vegas
I see women from Seven Hills, Anthem, MacDonald Highlands, Green Valley, Summerlin and Lake Las Vegas at my Henderson office. Pellets are placed in the office. Follow-up visits can often be done by telehealth for patients located in Nevada.
Hormone Therapy Institute · 2850 W Horizon Ridge Parkway, Suite 200, Henderson, NV 89052 · (702) 568-6108
Common questions
Are pellets safer because they’re bioidentical?
No. Bioidentical describes the molecule, not the safety. FDA-approved bioidentical options exist in other forms, and compounded versions haven’t been shown to be safer or more effective.
How long does a pellet last?
It varies from woman to woman, and it’s usually a matter of months. We decide on the next one based on your symptoms and your labs, not a date on the calendar.
What if I have side effects?
Call the office right away. Because a pellet can’t simply be turned off, we manage side effects while it wears off, and we change the dose or the form next time.
Does a low testosterone level mean I need a pellet?
No. A blood level alone doesn’t diagnose a desire problem or prove you need testosterone. Your symptoms, how much they bother you, your medications, your relationship and your overall health all belong in that decision.
I already have pellets from another provider. Can you help?
Yes. Bring the product, the dose, the insertion date, your recent labs and any changes you’ve noticed. We’ll go from there.
Where this comes from
I name my sources because you deserve to check them. This page is education. It is not a diagnosis or a treatment plan for you, and it doesn’t make you my patient. What’s right for you depends on your history, and that conversation happens with a clinician who knows it.
