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November 17, 2015

The Ins and Outs of Hormone Pellet Therapy

The Dissent in Anti Aging MedicineHormone Pellet Therapy for Men and Women

Have you heard of pellet hormone treatment? It’s getting more attention as if it were something new. But in fact, subcutaneous hormone pellet therapy was first performed in 1939. Hormone pellet therapy is slowly becoming more popular for a few reasons which we will get to. Pellets are used for delivering testosterone, estrogen, or progesterone in hormonally deficient men and women helping both live higher quality lives. How is pellet therapy performed?

Office Procedure

Hormone pellets are inserted under the skin into the subcutaneous fat usually in the upper buttock but can be implanted elsewhere. It is an office procedure using sterile technique that takes 5 to 10 minutes. The skin area of implantation is prepped. Then the skin  is anesthetized with an injection of Lidocaine or numbing medicine.

A small 3 millimeter long incision is made in the skin. A trochar is then inserted into the subcutaneous fat creating a tunnel. Then pellets that are between the size of a Tic Tac and a grain of rice are inserted into the trochar and pushed into the tunnel created in the subcutaneous fat. The small incision is then close with Steri-strips though some doctors might use a single stitch. An ice pack is then place over for 10-15 minutes to minimize swelling, though the doctor in video below instructs his patients to apply ice for three hours.

And, the procedure is done and you go on with your day. Patients are instructed to avoid strenuously exercising the area of pellet implantation for 2-3 days. Also patients are advised against swimming, bathing, or using hot tubs for 3 days. Showers are fine.

The video below shows implantation of testosterone pellets.

What are the Complications of Hormone Pellet Therapy?

There are two types of complications with hormone pellet therapy: those related to the procedure and those related to the hormones. Every procedure including the most benign can have complications. Anytime the skin is penetrated there can be an infection of the skin and underlying tissues. This is reduced by using sterile technique. Pellets can extrude – that is come out of the body through the tunnel created underneath the of skin. This is usually the result of a technique error of leaving a pellet too close to the skin incision making it easier to work its way out.

The combined rate of infections and pellet extrusions is six to eight percent. This far more than seen with injections of hormones namely testosterone. In fact, in seven years of prescribing testosterone injections I have not had a patient get an infection from the injection – and they are self-injecting.

Complications related to hormones depend on which hormone is involved and are largely related to improper dosing – in other words too high a dose of a hormone. Such side effects are more of a nuisance and the dose can be adjusted down the next time pellets are implanted. Absorption rates of hormone pellets and the need to re-implant pellets can vary if a patient’s activity level changes dramatically. Such dosing related complications range from two to ten percent.

Advantages of Pellets

Pellets are wholly bioidentical and completely absorbed by the body. Hormone gels and creams can be bioidentical but are mixed in a base absorbed by the skin. the long-term effects on skin health is not known. Testosterone injections are suspended in oils like sesame or cottonseed and need to be metabolized in the liver.

Hormone pellets deliver a relatively stable dose of hormones for several months (four to six months) and large fluctuations in hormone levels are avoided that can occur with topical gels and creams and injections. In addition, more hormone is delivered during exercise as more blood flow passing by the pellets absorb more hormone. So pellets provide a bit of an on-demand system of hormone delivery.

Why Hormone Pellet Therapy?

Hormone pellet therapy is being marketed and more and more by manufacturers and suppliers of pellets. The fact that they are wholly bioidentical is an advantage though testosterone injections have been available since the 1930s  and have been the most studied form of testosterone over 70 plus years with fewer side effects than other FDA approved drugs.  More stable hormone levels are a benefit of pellet therapy but large fluctuations in hormone levels especially with testosterone injections can be minimized by more frequent injections of smaller doses of testosterone and topical gels and creams can be applied more than once a day to maintain more stable levels though that is more inconvenient.

Pellets are touted as being more convenient only requiring 2 or 3 implant procedures a year but that advantage is in the eye of the holder. One can self-administered two testosterone injections a week for 52 weeks in less time than it takes for most to drive to their doctor’s office for single pellet implantation procedure without any limits on physical activity following the procedure. Of course once the pellets are implanted you don’t have to think about injecting yourself or applying daily creams or gels.

Hormone pellet therapy is more expensive than other forms of hormone therapy. Depending on the part of the country the procedure itself can cost $300 to $500 plus the cost of the pellets. Insurance may or may not cover the costs for pellet therapy, but fewer insurance companies are covering the cost of any hormone replacement in general.

The annual costs for the pellets and the procedures can begin at $1,500 and go upward. For comparison a 10 milliliter vial of injectable testosterone typically runs less than $140 and will generally last 20 weeks. That makes the annual cost of testosterone injections $350. Commercial testosterone gels like AndroGel can range $25 a month if covered by insurance to $400 or more a month if not.

Now you know the ins and outs of hormone pellet therapy.

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

  1. I recently, 1 month ago, had bio-identical pellets (6) placed subcut. in my upper buttocks area. had immediate
    raised area and subsequent staph infection over the next 7-10 days? Clinician was able to retrieve 1 pellet, but not others. Have been on Clindamycin with no improvements. Any suggestions on tx. to resolve this problem?

    1. There isn’t much more to do than treat the infection at this point. Have they tried you on another antibiotic?

  2. Hi there just wanted to give you a brief heads up and let you know a few of the pictures aren’t loading properly. I’m not sure why but I think its a linking issue. I’ve tried it in two different web browsers and both show the same results.

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