Pellets….and Why We Don’t Believe in Them

Pellets….and Why We Don’t Believe in Them

Pellets! To Do or Not To Do? I think the first thing we need to understand is what they are and what they do. Pellets are small implantable fused hormones that are typically testosterone or estradiol, that are inserted underneath the skin of the hip with a local anesthesia. Usually pellets are reinserted, for women, every 3 months. Clinical studies were done on men to determine dosing and men are given dosing every 4-5 months. The dose for women was extrapolated from the dosage for men, and herein lies a problem: women tend to need more insertions (about every 3 months) and there is an unpredictable conversion to DHT (dihydrotestosterone) and/or estrogen-estradiol (E2) and estrone (E1). (Estrone is the breast cancer cell proliferator) Some women do fine with pellet implants, while others, if their pellet converts mostly to estrogen, will gain weight. If these women convert these pellet implants mainly to DHT, they will start showing masculinizing symptoms such as: male pattern baldness, facial and body hair, acne, and voice deepening, among other health issues. Once these issues develop, the damage has been done. Symptoms often materialize after the 3rd and 4th pellet insertion (about a year) but I get emails from women weekly who experience hair loss and male pattern baldness as soon as their first pellet implant. Another concern for pellet users is that these pellets often lead to extremely elevated levels of testosterone that is much higher than normal female physiology. We call this “supra-physiologic dosing” as opposed to “physiologic dosing”–exactly what each body needs.

For me, personally, pellets for women simply don’t make sense. All that testosterone being implanted continuously has to go somewhere. Women aren’t meant to metabolize all that testosterone. And when it converts to estrogen, it is problematic. Women over the age of 35 are already estrogen dominant. Why? Because we begin to lose our progesterone (that balances out our estrogen) around age 35. Remember these 5 words: Estrogen is a FAT STORER. So when all that testosterone in the pellet begins to convert to estrogen, this is the weight gain piece. So why would I want to put even more estrogen into my already estrogen dominant body? Even more importantly is the whole estrone piece. Why would I want to increase my risk of breast cancer with the testosterone pellet converting to estrone, which, again is the breast cancer cell proliferator? Estrogen dominant women already have a heightened risk for breast cancer. So for me, to put anything in my body on purpose, that could heighten this risk for breast cancer just doesn’t make sense.

It does seem like many women do ok with their first pellet insertion. Their hormone levels are typically lower than they used to be due to aging or having a hysterectomy, or changing due to childbirth, for example. So getting that first whopping supra-physiologic dose of testosterone gives women extra energy initially. Libido is also typically initially impacted. It is after the 2nd, 3rd, or 4th implant (about every 3 months) that significant health issues can arise. At my Happy Hormone Cottage, we spend a lot of our time fixing and rebalancing women who have had a negative experience with pellet implants. It does take time to rebalance these women, but it can be done. Optimal hormone balance in 3 areas: sex hormones, adrenal glands and thyroid is what we strive for.


Testosterone in pellets converts to estradiol (E2) and Estrone (E1), which is the breast cancer cell proliferator. Women over age 35 are already estrogen dominant. Why would I want to increase estrogen dominance? This promotes weight gain and adds a heightened risk for breast cancer.

Another huge area of concern with pellets is with hair loss and male pattern baldness. I have received literally hundreds of emails and continue to get several a week, from desperate women who are in various stages of hair loss from their pellet implants: from thinning hair, to bald spots to being practically bald. Hair is a big deal! Typically these women return to their healthcare practitioner who implanted the pellet to complain of their hair loss…..only to be chronically told that “your pellet has nothing to do with your hair loss. Check your thyroid, ” Or “our pellet is not responsible for your hair loss. It is what you have done the past few years with your erratic hormone replacement that is the culprit,” etc. The truth is that when testosterone metabolizes via the pathway known as the 5 alpha-reductase pathway, the testosterone is being converted to DHT, which is responsible for male pattern baldness and hair loss. So the fact is that YES, THE PELLET IS INDEED RESPONSIBLE FOR THE HAIR LOSS AFTER THE PELLET HAS BEEN IMPLANTED. This hair loss could be anywhere from mild (as in thinning hair) to male pattern baldness in the front and sides of the hair….to extreme cases where almost all the hair is gone. What to do? We suggest 4 things:

  1. Stop getting pellet insertions
  2. Purchase the supplement Saw Palmetto and take 2 capsules a day. This stops the conversion of testosterone to DHT (you can purchase this on my online store at http://www.shophappyhormonecottage.com
  3. Purchase, also, the supplement Biotin to promote new hair growth. You can take these 2 supplements together (also available on my online store)
  4. Find a viable functional medicine facility, like my Happy Hormone Cottage, that is well-versed in optimal hormone balance, and in my opinion, does not believe in or use pellets as part of their protocol for women.

I also want to say how unimpressed I am with blood labs being used to determine hormone levels. Blood labs simply provide a number. What we are more concerned with at my Happy Hormone Cottage is WHAT the hormones are DOING inside our bodies and how hormones are being metabolized.  I also want to get a read on cortisol levels, including diurnal cortisol, and if thyroid seems problematic (Thyroid expert and friend, Dr Daryl Turner, and inventor of our nifty Thyroflex machine, tells me that 8 out of every 10 women have a malfunctioning thyroid) we do use a 10-point blood panel to evaluate thyroid, in conjunction with our thyroflex machine. (Read more on my “Thyroid Health” web page) From every email I have ever received from a “pellet victim,” their doctor who implanted them always uses blood labs to determine frequency and dosage of pellet. There is just so much more information available in our bodies that blood labs simply can’t identify.


If the testosterone in the pellet converts to DHT, pellet users will start showing masculinizing symptoms such as: male pattern baldness, facial and body hair, acne, and voice deepening, among other things.

S0 WHAT TO DO?  AT OUR HAPPY HORMONE COTTAGE………

I founded my Happy Hormone Cottage in August 2009, in the heart of Centerville, Ohio, as a safe place for women to come to be heard, validated and educated in all things natural hormone balance. Why? Because following my own radical hysterectomy and being helped back to health by my compounding pharmacist husband, what I knew was that women were going to their doctors for help in this arena of erratic hormone levels causing:  sleep disruptions, anxiety, depression, mood swings, sugar cravings, irritability, fatigue, low libido, brain fog, hot flashes, weight gain……and were coming out with a prescription for an anti-depressant or a sleeping aid or even worse, with the comment, “Go home and walk your dog. This will pass.” (I am not making this up!) Doctors have told me they received about 4 hours of hormone education in medical school, so is it any wonder most are not well-versed in optimal hormone balance? Our motto at my little cottage – “Get Tested, Get Treated, Get Better.”  Women showed up; were listened to and accepted; educated and offered options for their hormone health and balance. As they say, the rest is history. Women showed up, began to feel better, told their friends and family….who told their friends and family and my little cottage grew! Today, I have 4 Happy Hormone Cottages in the Cincinnati-Dayton area and we have developed from an educational facility to a medical facility with our own nurse practitioner and medical director. We also own our Piqua Compounding Pharmacy, so our clients can come full circle with us from being educated in a step one consultation ($25 for the hour), to an easy take home testing kit, to meeting with our nurse practitioner who will analyze the test results and with the client, develop a customized hormone strategy, to having our compounding pharmacy ship their therapy directly to their home.

What sets us apart from the pellet facilities, and quite frankly, from other hormone facilities, is that we dose our compounded bio-identical hormone creams physiologically. This means that the dose is customized for each woman based on her body’s needs. We don’t believe in supra-physiologic dosing. It doesn’t make sense to us based on the biochemistry of our bodies.

When considering hormone balance, it is important to balance the 3 major sex hormones of estradiol, progesterone, and testosterone. In fact, our first line of defense in hormone balance is always progesterone cream (note: many pellet places don’t use progesterone and if they do, they use progesterone capsules. We prefer progesterone cream because the progesterone capsules convert to allapregnenolone for sleep, and very little converts to progesterone. Of course, one of the “studies” I read from a popular pellet manufacturer stated that “women without a uterus don’t need progesterone.” This is not valid information based on the biochemistry of our bodies and the latest research. Another reason, in my opinion, for the pellet buyer to beware.) What we know is that women who are having regular monthly cycles don’t need estrogen. So we never give women estrogen, who are still having regular periods. We check hormone levels first (using cutting edge dried urine strip testing from Precision Analytical Lab in Oregon) and then we customize the bio-identical hormone therapy creams for each individual client. It is this physiologic dosing that achieves hormone balance. We give each woman the hormone dose she needs with a strategy developed specifically for her; also addressing any adrenal issues that show up in the testing. We adjust this dosing over time by listening to our body’s biofeedback at an appointment 3 months following initiation of therapy. We recheck these hormone levels every year or every other year, based on the conversation between our nurse practitioner and our client at their annual visit.


Pellets use supra-physiologic dosing of testosterone. All that testosterone has to go somewhere. Pellets simply do not make sense based on the biochemistry of our bodies.

At my HHC, we understand that our focus is not only the eradication of hormone imbalance symptoms (listed above) but also the PREVENTION OF DISEASE. We know from the research that estrogen performs over 300 jobs in our body, with two of the most important dealing with protecting our brain from dementia, and protecting our heart from heart disease. Progesterone helps balance estrogen to help prevent beast cancer; while testosterone signals the osteoblasts to build strong, new bone; helps with memory recall, energy AND when also healing tired adrenal glands, can help libido.  Isn’t this the point of BHRT – Bioidentical hormone replacement therapy? To refill depleting hormone receptors that deplete with age, so we can focus on a higher quality of life, prevent disease and therefore ultimately restore and maintain our bodies to WELLNESS?

Finally, I often get asked, “How long should I use my hormone creams?” My response is always, “For life….or until we are dead!” Why wouldn’t we do this? As we age beyond 35, and our bodies lose their ability to make the hormones we need, in the quantities in which we need them, why would we not continue to use them for the rest of our lives? This just makes sense.  Once I have refilled my hormone receptors, I must keep them refilled to maintain a high quality of life.

For more information or to schedule a consultation, call us at 513-444-6343 or email us at Info@happyhormonecottage.com. To get started, Visit our Begin Your Journey page.

Note: if providers are interested in learning more about optimal hormone balance, you can visit my HHC Consulting page. Our passion is helping you help women achieve hormone balance the right way. There is a need!

    Visit My Blog Entries Below For More Information:

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    Note: I have made a special pellets page with lots more information. Please refer to that page as it will answer most questions. Back in January of 2012, I wrote a blog entitled, “I Get Asked This Question A Lot!” that has to date generated 59 responses, and counting. The... Read more »
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