Pellet implants are compounded using biologically identical hormones derived from the yam. The hormones are pressed into very small solid cylinders. Pellets are made up of either estradiol or testosterone. These pellets are larger than a grain of rice and smaller than a ‘Tic Tac’. In the United States, most pellets are made by compounding pharmacists and delivered in sterile glass vials. There is a ‘FDA approved’ 75 mg testosterone pellet (often used in urology offices.) Currently Stanford Urology center uses testosterone implants.

Pellet insertion is a relatively simple in-office procedure done with local anesthesia. The pellets are inserted subcutaneously (into the fatty lining under the skin), in the upper buttocks through a very small incision (the size of an eraser head). The incision is then closed with sterile-tape strips. Typically, patients cannot feel the implants below their skin. Implants placed under the skin consistently release small, physiologic doses of hormones, which have been shown to have many benefits.

For women, pellets can last between 3 and 5 months, and 5-6 months for men. For some patients, some factors such as high levels of stress, physical activity, some medications and lack of sleep may increase the rate at which the pellets absorb and may require new pellets be inserted sooner.

The pellets completely dissolve on their own and do not need to be removed.

Complications from the insertion of pellets may include minor bleeding, bruising, or infection at the insertion site (infection is extremely rare). Testosterone stimulates the bone marrow and increases the production of red blood cells. A low testosterone level in older men is a cause of anemia. Testosterone, delivered by implants or other methods, can cause an elevation in the red blood cells. After the insertion of the implants, vigorous physical activity is avoided for 5 days in both men and women so the tiny incision can fully heal.

Anytime you are prescribed estradiol, progesterone is also prescribed. Women have progesterone (not progestin) receptors in the bones, brain, heart, breasts, and uterus. Progesterone can be delivered as an oral capsule, tablet, or sublingual troche or fast burst tablet.

No, pellets do not have the same risk of breast cancer like with high doses of oral estrogen (Premarin), that do not maintain the correct estrogen ratio or hormone metabolites. They also do not increase the risk of breast cancer like the synthetic, chemical progestins that were used in the Women’s Health Initiative Trial. Data, in fact, support that balanced hormones protect the breasts.