Hormone deficiencies are one of the leading causes of accelerating the aging process. This causes chronic diseases and makes you feel older than you are. Data supports that hormone replacement therapy with pellet implants is the most effective and the most bio-identical method to deliver hormones in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy.
Bio-identical hormones are plant-based hormones that are biologically identical to human hormones
For women, benefits may include:
For men, the benefits may include:
What are hormones and why are they needed?
Hormones regulate and influence your entire body, from your metabolism, brain, immune system, to your response to stress. All hormones influence multiple body systems. Estradiol, which is a female hormone, is known to have over 400 effects in the body. Aging causes our hormones to decline. Declining hormones levels are thought to be one of primary causes of aging. Dozens of studies show natural testosterone to be highly preventative against osteoporosis, Alzheimer’s dementia, breast cancer, and many other debilitating illnesses.
Lack of Estrogen causes an increased risk of osteoporosis, colon cancer, Alzheimer’s disease, Parkinson’s disease, diabetes, and heart disease. Replacement of the natural hormones that our bodies already manufacture, can lead to restoration of health and vitality. Through bio-identical hormone therapy, these hormones are returned to optimal levels, thus slowing the again process and improving our mood, strength, sexual function, memory, muscle tone, libido, and well as general health and wellness.
What are Bio-Identical Hormones?
Bio-identical hormones are plant-based proteins that have structurally engineered to replicate the body's normal hormone levels. Hormone replacement therapy is now tailored specifically for the individual for optimal results. The great appeal of bio-identical hormones is that they are natural, and our bodies can metabolize them as it was designed to do, minimizing side effects. Restoration and balance being the goals of hormone therapy.
Symptoms of Decreased Hormones
Are Bio-Identical Hormones Safe?
Bio-identical hormones are safe and effective. Several studies have shown that bio-identical testosterone therapy reduces the risk of prostate cancer. Even for patients with prostate cancer, studies show that bio-identical hormone therapy does not increase the risk of cancer progression. Recent studies indicate that men who have low testosterone levels are at higher risk for prostate cancer. Bio-identical progesterone has been shown to reduce the risk of breast cancer, while the synthetic hormone progestin increases the risk of breast cancer. The goal of hormone therapy is to restore the hormones to an optimal state based on science. Your individualized program is based upon your lab work and physical condition.
Why not use synthetic hormones?
Synthetic hormones are similar but not identical to the body’s hormones. Some synthetic hormones, such as Premarin, are made from pregnant horse urine. Horses produce over 35 different estrogen molecules, but not one of them is the same as estrone, estradiol, or estriol, the three human estrogens. The difference between synthetic hormones and the human body’s own hormone receptors lead to increased risks and side effects. The risks associated with synthetic hormone replacement (HRT) came to the forefront when The Women's Health Initiative study of 2002 showed a significant increase in the risk of heart disease and cancer with the use of HRT. Moreover, because synthetic hormones come in prepackaged dosages, they cannot be individualized to the needs of each patient. Bio-identical hormones, on the other hand, are individually compounded at specific doses for each patient, allowing for a more personalized hormone treatment. And, because bio-identical hormones are identical in structure to hormones already found in the body, the potential risks and side effects are minimized.
What are hormone pellets?
Pellets are made up of either estradiol or testosterone. The hormones are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice and smaller than a ‘tic tac’. In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials.
Pellets deliver consistent, healthy levels of hormones for 3-5 months in women and 4-6 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. Estrogen delivered by subcutaneous pellets, maintains the normal ratio of estradiol to estrone. This is important for optimal health and disease prevention. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy.
In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal and andropausal symptoms (male hormone decline or “male menopause”), maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance.
Testosterone delivered by a pellet implant, has been used to treat migraine and menstrual headaches. It also helps with vaginal dryness, incontinence, urinary urgency and frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase sense of well being, relieve anxiety and improve memory and concentration. Testosterone, delivered by pellet implant, increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of testosterone for optimal mental and physical health and for the prevention of chronic illnesses like Alzheimer’s and Parkinson’s disease and heart attacks, which are associated with low testosterone levels.
Even patients who have failed other types of hormone therapy have a very high success rate with pellets. There is no other ‘method of hormone delivery’ that is as convenient for the patient as the implants. Pellets have been used in both men and women since the late 1930’s. In fact, there is more data in support of pellets than any other method of delivery of hormones worldwide.
How and where are pellets inserted?
The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the lower abdominal wall or upper buttocks through a small incision, which is then taped, closed. The experience of the health care professional matters a great deal, not only in placing the pellets, but also in determining the correct dosage of hormones to be used.
Are there any side effects or complications from the insertion of the pellets?
Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection and the possible extrusion of the pellet. Other than slight bruising or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women. 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. If the hemoglobin and hematocrit (blood count) get too high, a unit of blood may be donated.
After the insertion of the implants, vigorous physical activity is avoided for 72 hours in women and 5-7 days in men. Early physical activity is a cause of ‘extrusion’, which is a pellet working its way out. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, this is a ‘clean procedure’ and antibiotics are most often not needed.
Why haven’t I heard about pellets?
You may wonder why you haven’t heard of pellets. Pellets are not patented and have not been marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia. Pellets were frequently used in the United States from about 1940 through the late 70’s prior to when oral patented estrogens began being marketed to the public.
Do men need hormone therapy?
Testosterone levels begin to decline in men beginning in their early 30’s and is routinely referred to as “andropause”. Most men maintain adequate levels of testosterone into their mid 40’s to mid 50’s, some into their late 70’s to early 80’s. Men should be tested when they begin to show signs of testosterone deficiency as mentioned. Even men in their 30’s can be testosterone deficient and show signs of bone loss, fatigue, depression, erectile dysfunction, difficulty sleeping and mental decline. Most men need to be tested around 50 years of age. It is never too late to benefit from hormone therapy.
What does the procedure entail?
The long-lasting pellets make this hormone therapy treatment option easy and convenient. Instead of dealing with a daily hormone pill schedule, bio-identical hormone creams or shots, you meet with an AllCare Medical provider every three to six months for an easy insertion. During the simple in-office procedure, the tiny pellets are inserted into the buttock area. The small incision site requires just a small bandage. The pellets, which contain estradiol and/or testosterone, react to the needs of your body by secreting additional hormones just as your body naturally would during periods of stress or exercise. In addition, the body does not experience extreme highs and lows because hormone delivery is constantly maintained.
Most patients notice a difference very quickly. However, it can take up to four weeks for the full affect to be felt. Results can last up to six months. Our provider will closely monitor your progress to ensure that you sustain proper hormone levels and to determine the timing for subsequent pellet insertions.
What if my primary care physician or my gynecologist says that there is ‘no data’ to support the use of pellet implants?
He or she is wrong. There is a big difference between ‘no data’ and the doctor not having read the data. It is much easier for busy practitioners to dismiss the patient, than it is to question their beliefs and do the research. It’s about a patient making an informed choice. After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve as well as overall physical and sexual health. These are obvious benefits that the patient experiences. There is also data that supports the “long term” safety of hormones delivered by pellet implants.
Do pellets have the same danger of breast cancer as other forms of hormone replacement therapy?
Pellets do not carry with them the same risk of breast cancer as high doses of oral estrogens. Oral prescriptive estrogens do not maintain the correct estrogen ratio or safe hormone metabolites. Pellets do not increase the risk of breast cancer like the synthetic, chemical progestins used in the Women’s Health Initiative Trial. Data supports that balanced, bio-identical hormones are breast protective.
Are there side effects to estrogen delivered by pellet implantation?
When a patient first starts on hormone therapy there may be mild, temporary breast tenderness, which resolves on its own. Hormone receptors may be very sensitive and take time to adjust. There may be a temporary water weight gain, which will also resolve on its own. Women, especially those who have not had a hysterectomy, may choose a different method of delivery of estrogen, as the risk of bleeding is significant. Balancing the progesterone to estrogen ration can effectively curtail vaginal bleeding.
Will hormone therapy with estradiol and testosterone pellets help with hair loss?
Hormone deficiency is a common cause of hair loss and treatment with estradiol and testosterone implants can help re-grow hair. Hair becomes thicker and less dry with pellet therapy.
How long until a patient feels better after pellets are inserted?
Most female patients begin to ‘feel better’ within 48-72 hours while others may take a week or two to notice a difference. Men usually take 2-4 weeks before they start to notice the benefits of the pellets. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalances and illness.
How long do pellets last?
The pellets usually last between 3-5 months in women and 4-6 months in men. The pellets do not need to be removed. They completely dissolve on their own.
Do patients need progesterone when they use the pellets?
Most of the time, when estradiol is prescribed, progesterone is also prescribed even if the patient has had a hysterectomy. Progesterone is prescribed in an alternate delivery system as it dissolves too quickly to include in the pellet. It usually is delivered in an oral troche or cream.
The main indication for the use of synthetic progestins, like Provera®, is to prevent the proliferation (stimulation) of the uterine lining caused by estrogen. However, there are progesterone (not progestin) receptors in the bone, brain, heart, bladder, breast and uterus where progesterone has been shown to have beneficial effects.
Progesterone can be used as a topical cream, vaginal cream, oral capsule (Prometrium®), sublingual troche or drops. Only oral progesterone (100-200mg) and vaginal progesterone (45-90mg) have been studied and shown to protect the uterine lining from estrogen stimulation.
Women at any age may experience hormone imbalance. Levels decline or fluctuate contributing to debilitating symptoms. Hormone therapy with pellets is not just used for menopause. If a patient is pre-menopausal, she uses the progesterone the last two weeks of the menstrual cycle (day 1, being the first day of bleeding). Pellets are useful in severe PMS, post partum depression, menstrual or migraine headaches, and sleeping disorders. Pellets may also be used to treat hormone deficiencies (testosterone) caused by the birth control pill.
How are hormones monitored during therapy?
Hormone levels will be tested and evaluated before therapy is started. This will include a complete blood count, complete metabolic profile, lipids, estradiol, SHBG, testosterone and free testosterone. Thyroid hormone levels will also be evaluated. Additionally, men need a PSA, women need a FSH and Progesterone. Levels will be reevaluated during hormone therapy, usually four weeks after insertion and prior to insertion of the next set of pellets. After the first year of therapy, hormone levels may be followed less frequently. Men must notify their primary care provider and obtain a digital rectal exam for prostate symptoms. Women are advised to continue their monthly self-breast exam and obtain a mammogram and a pap smear as advised by their gynecologist or primary care provider.
What are the Benefits and Cost? Will insurance cover the procedure?
AllCare does not take insurance assignment, but we will give our patients all the paperwork necessary to receive reimbursement from their insurance companies. Medical savings accounts generally pay for hormone pellet replacement.
For men, the chances are good that their hormone pellets will be covered by their insurance long before the next pellets are inserted; usually six months. However, women have more trouble getting reimbursement. This is not fair, but it’s up to patients to pester their insurance company to change this inequity. Our patients generally lose weight from hormone pellet replacement, and in that way can sometimes stop taking cholesterol medicine as well as high blood pressure medicine as their treatment continues after the first year.
Patients save time and money by replacing hormones in various ways:
Save time spent in other doctors offices waiting for treatment for multiple symptoms
Save money on copays for the medications patients no longer need: blood pressure medicine, cholesterol medicine, medication for dry eyes, medications for osteoporosis, and meds for anxiety and depression
Save your job by decreasing poor work performance
Save your marriage if health and sex are points of contention. Divorce is expensive!
Save money on weight loss programs as pellet testosterone causes fat to be traded for muscle
Delay plastic surgery to look younger as pellets immediately improve skin color, tone and elasticity
Prevent Alzheimer’s disease, and dementia—better than the expensive long term care insurance.
When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective. There is better, ‘unbiased’ data on pellets and bone density than any pharmaceutical drug on the market and it is beyond the scope of this handout to examine the cost of drugs used for insomnia, depression, sexual dysfunction, obesity, diabetes, hypertension and more conditions that are related to hormone imbalances
The cost for the 1st insertion of pellets (for normal dosing) is $500 for men/ women. Men need a much larger dose of testosterone than women and the cost is higher. Pellets need to be inserted 2-4 times a year depending on how rapidly a patient metabolizes hormones. Re-insertion costs the same (see chart below). There may be extra costs for progesterone creams or troches.
Cost and Fee schedule
Consultation – (45 minutes) no labs $100
Consultation (with labs) $300
Follow-up pellet consultation (at 4 weeks & 14 weeks) w/labs $150
Pellet Insertion – Female $400 (includes up to 3 pellets)
Per Pellet Fee – Female (over 3 pellets) estrogen $30 per pellet/Testosterone $40
Pellet Insertion-Male (includes up to 3 pellets) $500
Per Pellet Fee-100 mg-Male (if over 3 pellet) $40
Per Pellet Fee-200 mg-Male (if over 3 pellet) $60
Specialty lab work (individually priced) TBD
All fees are expected at the time of service.
We do not have billing or pre-certification staff. All contact with insurance companies is your responsibility.
Most insurance companies will reimburse men for pellet implantations, but not women.
This service is not covered by Medicare so you may not send in your bill for reimbursement.
Patients know that prevention is much more cost effective than disease. In conclusion, estrogen and testosterone therapy by implantation of pellets is a safe and effective method of hormone therapy for both men and women. Long, continuous administration of hormones by pellets is convenient and economical for the patient. Pellet implantation has consistently proven to be more effective than oral, intramuscular, and topical hormone therapy with regard to bone density, sexual function, mood and cognitive function, urinary and vaginal complaints, breast health, lipid profiles, hormone ratios and metabolites.
HOW TO GET STARTED:
1. Call or email our office and request the Bio-identical New Patient Medical History Questionnaire. Fill out these forms and fax or email it back to us. We will determine if you are a candidate for bio-identical hormone pellets or if we need more information.
2. After reviewing your medical history, we will contact you for a consultation appointment.
3. Lab work: You can also have your lab work completed during your consultation visit or we will give you the appropriate paperwork to have your blood drawn at the lab of your choice. Lab is generally a covered insurance benefit. However, if you have not met your annual insurance deductible, it will be MUCH cheaper to have it done at our office. We will give you the paperwork to file with your insurance company. It is recommended to contact your insurance company PRIOR to having the lab done at an outside facility, as it will more than likely be several hundred dollars if you have to pay for it yourself. We will give you the coded paperwork but WILL NOT have any dealings with ANY insurance company or insurance issues.
4. Lab results: About 2 weeks after your lab draw, you will be contacted by our office for pellet insertion.
5. Follow up assessment: 4 weeks later, you will return to the office for hormone lab work. This is important as we need to assess your response before your next pellet insertion.
6. Follow-up Lab: At around 14 weeks after the initial insertion, you will again have your labs drawn to assess your hormone levels in order to determine when your next pellet insertion will need to be performed.
7. Four to six months after initial pellet placement: We will meet with you again to assess your treatment and adjust your bio-identical hormone dosage, if necessary. Your next pellet insertion will occur at that time.