FAQs: Bioidentical Hormone Replacement Therapy (BHRT)

What is Bioidentical Hormone Replacement Therapy (BHRT)?  

Hormone levels for both men and women will naturally decline with age - starting in your late 30s. [To learn more about the importance of hormone levels, read here.] This includes your testosterone, estrogen (men and women have both of these), thyroid, cortisol, and many more. As a result, you start to experience symptoms, such as constant tiredness, lack of energy, weight gain, brain fog, irritability, trouble sleeping, decreased sex drive, and other effects of aging.

Hormone Replacement Therapy (HRT) treats one’s hormone levels to improve associated symptoms. Traditional HRT often uses synthetic/artificial hormones or hormones derived from the urine of pregnant mares (to create conjugated estrogen, for example). In contrast, Bioidentical Hormone Replacement Therapy (BHRT) uses ingredients that are molecularly identical to those produced by the human body and are plant-based, made out of natural products such as soy or yam. 

What are hormone pellets? How are they administered? Is it a painful and/or invasive procedure?

The pellets are usually the size of a few rice grains. The ones our practice administers are made out of yams and implanted in the fatty tissue underneath the skin. Basically, they’re injected under your skin, usually in the buttocks or the lower abdomen. The procedure is done under local anesthesia (numbing the skin where you’ll be injected) and typically takes a few minutes. Thousands of our patients who have been pelleted have said that the procedure is quick and painless.

What conditions or symptoms do BHRT pellets treat?

It’s prescribed to alleviate symptoms associated with a hormonal imbalance (e.g. deficiency), most commonly as a result of aging, starting from your late 30’s for both men and women. For those experiencing constant tiredness, lack of energy, brain fog, weight gain, irritability, trouble sleeping, loss of sex drive or difficulty attaining lean muscle after exercising - this treatment enables you to optimize your hormones and continue feeling like your best self even as you go through perimenopause, menopause or andropause (male).

Significantly improved/impacted areas include mood, sleep, depression, anxiety, mental clarity, muscle mass, libido/sex drive, skin, hair, and bone density to name a few. Newer studies demonstrate protective effects on the heart and against Alzheimer’s dementia.

What are the benefits of bioidentical pellet therapy over other forms of HRT/BHRT (creams, pills, patches, gels)?

Since the pellet is implanted under the skin, there is a more stable release of customized hormones with consistent improvement in symptoms, eliminating the fluctuations seen with other methods that require frequent patient intervention. It’s also plant-based, making it natural, while some other HRT treatments can be synthetic. Hormone creams require daily application on the skin and the body may not fully absorb it, which may result in minimal improvement in symptoms. 

How quickly will I see results?

Many patients report feeling a difference within 7 - 10 days after pellet insertion, but it can take up to a month for some to notice the full effects. Approximately 4-5 weeks after getting pelleted, you’ll get bloodwork done again to compare with your baseline results prior to the pellet. Thousands of our patients have seen a significant difference in their physical body, emotional/mental wellbeing as well as in their measurable hormone levels from the pellet. Based on the results of the follow-up bloodwork, the second pellet may be adjusted to meet the ongoing needs of the patient. 

How long do they last? How often will I need to be pelleted?

The pellets last for months so you don’t have to get treated frequently–only a few times a year. Typically, the pellets can last between 3-4 months for women and 5-6 months for men. The duration depends on factors like metabolism, weight, and activity level.  

How long will I need to be on BHRT?

The duration varies among individuals. Some patients may need it for a short period, while others benefit from longer treatment. Regular check-ups with your BHRT physician are crucial to assess ongoing needs and adjust dosages if applicable. An overwhelming majority of our patients come back regularly to be pelleted. We have performed over 1500 pellet procedures over the last 7 years.

What are the side effects or risks associated with pellet therapy?

As with any form of medication, therapy, or supplement, there can be side effects, but they are generally uncommon and fairly mild: tenderness around the upper buttocks where the pellet is administered, the potential for infection, fluid retention, or acne. Usually these side effects occur only within the first few weeks and not with very many patients. Also, there are many options to treat these symptoms. For female patients who have asked if BHRT causes excessive facial hair or dramatically deepening of the voice–these are extreme scenarios that very rarely occur. For male patients who are worried they’ll develop breasts like women as a result of pellet therapy, this is also a very unlikely, rare scenario. As long as the BHRT dose is done correctly, and paired with the appropriate supplements, these symptoms do not generally occur. That’s why it’s important to get bloodwork done throughout the process and to be closely monitored and treated by an experienced BHRT physician to avoid incorrect dosing of hormones as well as to address any issues.

Can pellets be removed if there's a problem or an adverse reaction?

The pellets cannot easily be removed once implanted. However, because they’re plant-based/natural, they gradually dissolve after a few months and do not stay in the body. If there are side effects (such as the ones mentioned above), your healthcare provider could help treat these symptoms, which are not very common and do not last long. Although most of our patients continue with the pellet therapy, there is no obligation or medical need to get pelleted after the first time. 

Are hormone pellets safe for long-term use? Can you get dependent or build tolerance/resistance if you use it for a while?

Many people have used hormone pellet therapy safely for years. Although hormone replacement does not cause dependency, patients have shared that they have become accustomed to a new baseline in which they have more energy, sleep better, in a better overall mood, and possess increased focus and concentration. Patients can stop hormone replacement at any time, take breaks, and even get back on BHRT even after a few years later. 

However, as with any medical treatment, it's essential to have regular check-ups and monitoring with a healthcare professional to ensure the therapy remains appropriate for your needs.

BHRT: The Step-By-Step Pellet Process

What to Expect 

Step 1: Initial Consultation (Option: in-person or remotely via telehealth)

1. Establish a physician-patient relationship and discuss symptoms, health history, lifestyle, health goals/concerns and medications
2. Create a customized panel of bloodwork including hormone, vitamin, and inflammatory marker levels (you’ll receive a lab order at the end of this visit to get bloodwork done)
3. Review age-related health screenings (mammogram, prostate screening antigen/PSA)
4. Set up goals for treatment in the short term (1 month) and long term (1 year)

Step 2: Follow-Up Consultation (Must be in person to get pelleted on the same day if eligible)

1. Thoroughly review and discuss baseline bloodwork levels 
2. Identify any contraindications to treatment 
3. Create customized pellet doses based on bloodwork, weight, and symptoms
4. Place the pellet in the subcutaneous (fatty tissue) area of the upper outer buttock, which is then closed with a small waterproof bandage
5. Choose supplements that will optimize pellet therapy and maximize the current protocol (e.g. peptide injections can be added for targeted symptom treatments) 

Step 3 Post-Pellet Follow-Up Consultation (Option: in-person or remotely via telehealth)

1. Thoroughly review and discuss post-pellet labs 4-5 weeks after initial pellet placement (you’ll receive a lab order in advance to get bloodwork done at week 4 after being pelleted and prior to this visit)
2. Review the degree of symptom relief based on initial levels 
3. Schedule the next pellet insertion date (optional)
4. 3 - 4 months for women
5. 5 - 6 months for men