Hormone Pellet Therapy

For today's topic, I'd like to touch a little more on hormones because I will be introducing a new hormone treatment option.
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hormone pellet therapy

I will tell you the honest back story. I had been resisting getting into the topic of hormone pellet therapy for the first decade-plus of my practice. This was entirely due to negative experiences I had in my earlier years in practice.

Multiple times I ran hormone labs on patients who had gotten hormone pellets (from a very well-known pellet company who shall remain nameless). Every time, the sky-high levels completely freaked me out.

So I just put the whole topic out of my mind, leery that it could in fact be done well. I focused on developing and refining all the rest of my knowledge, experience, and optimization of hormone care, and not touching the topic of hormone pellets with a 10-foot pole.

Then a few years back, a colleague changed my mind on all this. I wasn't specifically looking into learning or providing hormone pellets, but I ended up learning a lot from her.

She is one of the most experienced hormone experts in the Seattle area. She has a very full practice of happy patients and is frequently sought by professional and educational organizations, on the topic of training healthcare providers how to best address hormone imbalances.

And it sure didn't seem that she was overdosing all her patients on hormones. In fact, it seemed like they were all responding well, and many were happy to have the option. It seemed like she was doing them right. And because she teaches other providers (and has now become a good friend of mine), this last June I finally put aside my reservations and learned from the pro.

what are they?

Hormone pellets are about the size of a grain of rice, and contain hormones (estrogen and testosterone) that slowly release for about 3 to 6 months. The pharmacy that I will be using compounds the estrogen and testosterone pellets for my patients. That way I can offer just the dose that each patient needs and fine-tune doses for each patient.

The pellet is inserted just below the skin, usually above the buttock area (think right above your back pocket) during an office visit. It does involve anesthesia (numbing up the area) and a small incision, though the incision is so small that it doesn't even require a stitch. Just some bandages and the patient is on their way.

"Hormones text with male and female sign" by wuestenigel is licensed under CC BY 2.0.

how do they fit into the hormone treatment option realm?

I view them as just another option. I have had quite a number of patients ask about them over the years. It is the preferred route for many people. In times past, I had to refer out, and hope that the provider my patient found could responsibly match them to the right hormone dosage.

Now I can offer this to any patient where it is a good fit, and monitor them myself.

​who should consider this option?

You may be a good candidate if you:

• Are currently taking estrogen and/or testosterone and want to skip having to take your dose every day (or week)
• Want your hormones dosed in a more even-keeled way (because pellets provide a sustained release so there is no up-and-down swing, the main example being testosterone injections)
• Often forget to take your dose (and then deficiency symptoms pop up)
• Find it a pain to deal with the pharmacy every month
• Travel and find it difficult to take your prescription with you (or have it mailed to different addresses)
• Or just generally are tired of your current format and want to try something different

It is important to first be dialed in on your current hormone prescription in some other route (such as creams, pills, or injections) so that I can calculate a pellet dosage from your current prescription.

If you have never taken these hormones (estrogen/ testosterone), have a bleeding disorder, or are taking a blood thinner, then you may not be a good candidate.

"Female and male hormonal balance concept image" by wuestenigel is licensed under CC BY 2.0.

how long do pellets last?

Generally women see maximal benefit for the first 3-4 months, then the pellet declines in potency. For men, the time frame is more around 4-6 months.

These are general expectations. Everyone is on a spectrum, so some may feel that the dose decline on the earlier end, and some will feel that it lasts much longer than what I wrote above.

the cost and other details

The exact cost of the hormone pellets (and their insertion) depends on the ingredients and dosage.

Initially, the costs of pellet procedures will range from $250-400 (with women being on the lower end and men on the upper end, as men tend to require larger doses thus more pellet supply costs).

This pricing may change after I have treated a handful of patients, if there are more unanticipated costs to providing pellets, but this is our starting plan.

Insurances do not cover this cost.

Your insurance should cover your office visit (and labs) like usual (if yours does), but insurances do not consider hormone pellets Standard of Care, and thus they are not Medically Necessary.

Lab monitoring is also an essential piece. Not only do we need (somewhat) current labs while you have been taking your current hormone prescription, but we will plan labs to occur at a specific time post-insertion to check your response.

This, and all other pertinent information, will be discussed during the initial visit.

​so what's the first step?

If you are interested in discussing and potentially pursuing this option, please take the first step and schedule a follow up visit (Portland: 503-232-3215; Salem: 503-990-8395).

Just a regular 30-minute visit is fine. It can be virtual or in-person.

There is a lot for us to talk about so that together we can make an exact game plan and then schedule the actual pellet insertion visit (I will be doing them at both offices).

I hope you have been able to get out there and enjoy our summer a little bit before we return to fall time.

Let me know when you need more support keeping it all moving and going, I am here for you!

Dr. Angela Cortal

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