Bioidentical hormone therapy has become common today as both women and men are realizing its many benefits. They sleep better, have more energy and lose weight. Restoring and balancing hormones also improves mood and libido, and relieves PMS, hot flashes, depression and anxiety. It improves memory and helps get rid of brain fog.

Since more doctors are dabbling in bioidentical hormones and offering an array of options, we want to help give you the best information so that you can make an informed decision for your health. Many people ask “what’s the best dosage form for bioidentical hormones?” While pellet therapy has recently become popular with some doctors, is it really the best way to take bioidentical hormones?

Bioidentical Hormones
Bioidentical hormones have the exact molecular structure as hormones produced by your body, so when you restore them, your body knows what to do with them. Just as a key fits perfectly into the right keyhole, bioidentical hormones do the same in your cells. Research shows that hormonal decline is associated with loss of body function and increase in disease. Studies demonstrate that bioidentical hormone replacement therapy can improve sleep, fatigue, mood, cognitive function, bone mass, sexual function, muscle strength and body composition, and decrease inflammation. (1)

Methods of Bioidentical Hormone Delivery
While there are several methods of delivering bioidentical hormones to your body, today we will focus on three.

Capsules are able to deliver the exact dose that is prescribed by your doctor. You don’t have to rely on a “one size fits all” pill – you can take the dose that is needed for your particular health needs and symptoms. Capsules allow your doctor to individualize your dose and also make it easy to adjust your dose as you work with your doctor to find the right dose to alleviate your symptoms. With capsules, you can administer a higher dose than with creams.

Our doctors have experienced a lot of success with dispensing the bioidentical hormones in oral capsules. They have been pleased with the consistency of results and compliance that capsules allow, while our patients find them convenient and effective.

Creams, which deliver the hormones directly into your blood stream through your skin, may allow for lower absorption of hormones than capsules. Absorption depends upon time of year (humid or dry) and condition of your skin (hydrated, dry, irritated). All body sites are not as equally permeable. Application sites for the cream must be rotated, for instance, absorption could be different between the inner arm and inner thigh. The higher the dose you need, the more cream you have to apply to your body. So if you are needing a higher dose, then capsules may be the best fit for you.

Capsules vs. Creams
Choosing between capsules and creams depends on a few factors: a) the dose needed, b) the patient’s preference, and c) what works best. For those patients who have experience with bioidentical hormones in both capsules and creams, many have found better results by taking them orally. Conversely, some patients prefer creams.

With capsules and creams, if a woman still has symptoms of a hormone deficiency, then the doctor is able to increase the dose immediately so symptoms can be resolved in a matter of hours or days. If the dose is too high, then skipping a dose for a few days is usually all that is needed to eliminate symptoms.

Pellet Therapy
Pellet therapy involves implants that are placed under the skin that release hormones into your body. The pellets, which are a little larger than a grain of rice, contain hormones (either estradiol or testosterone) which are pressed or fused into very small cylinders. (Note that progesterone can’t be used in pellets because it dissolves too quickly.) Then pellets are inserted under the skin through a small incision (either lower abdomen or upper buttocks) with local anesthesia. The incision is then closed with sutures or sterile tape strips. The pellets are replaced approximately every 3 to 5 months. They do not need to be removed – they are dissolved by the body. Patients can begin to feel relief starting anywhere from 48 hours up to 2 weeks after the pellets are implanted.

Hormone Overdosing/Underdosing with Pellet Therapy
Pellet therapy has its limitations and is sub-optimal if the dose is delivered incorrectly. If too much is given, it cannot be removed. It requires frequent visits to the doctor and pellet placement.

These implants are supposed to release small doses of hormones consistently, however this is not always the result. If the dose is too high, then that person is stuck with the negative symptoms for several months until the pellets dissolve. For instance, doctors have witnessed a man who became so irritable from an overdose of testosterone pellets that he couldn’t interact with his clients. Some people need to take a leave of absence from pellets for this reason. If the dose is too low, then they could take supplemental hormones, however it would be challenging for a physician to know how much to add and the dosing would be guesswork. 

It is suggested to start with bioidentical cream first for two month then convert to pellets for a longer effect. 

Restrictions After Pellet Insertion
To avoid the pellets from working their way out of the body, there are post-op instructions one must follow. After the insertion of the pellets, vigorous physical activity, bathing and swimming should be avoided for approximately 5 days. A shower may be taken as long as the incision isn’t scrubbed until it is well healed, after about a week.

Side Effects of Pellet Therapy
Discomfort at the injection site for the first week
Minor bleeding
Discoloration of the skin
Pellet extrusion
Redness and itching at the implant site

Hormones can be tricky for a doctor to dose, so they must be knowledgeable and experienced with prescribing bioidentical hormone therapy. While it may sound more convenient to have pellets inserted once every few months rather than take pills or apply creams, doctors still need to know what they are doing. Pellet therapy seems to be a fad right now, “everyone is doing it,” but are they doing it right?