Frequently Asked Questions about Hormone Replace Therapy

Introduction

Data supports that hormone replacement therapy with pellet implants is an effective bio-identical method to deliver hormones in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of hormones.

BHRT Fused Pellet Implant History

Pellet implants were a very popular mode of hormone administration in the U.S. until the 1970’s, when many oral and topical commercial products were developed. While the demand for pellets diminished in the U.S., pellet implants continued to be a very popular mode of hormone administration throughout Europe and Australia. In the last 10 years, due to advances made in processes and a better understanding of the benefits of fused pellet implants for hormone replacement, this mode of hormone administration has grown in popularity in the U.S.

Over 70 years of research has illustrated the benefits of pellet implants in administering hormones in both women and men.

• Pellet implants deliver consistent, physiologic levels of hormones.
• The consistent and physiologic dosing has been shown to maintain and improve bone density.
• Pellet implants bypass the liver and don’t negatively impact clotting factors, blood pressure, lipid levels, glucose or liver function.

What is BHRT?

An individualized approach to hormone replacement therapy, using Biologically Identical Hormones (BHRT), pinpoints a person’s exact hormone levels, and what hormones are needed to balance their hormone deficiency. The differences between synthetic and biologically identical hormones are in their chemical structures and functionality. Biologically identical hormones have the same chemical structure as the hormones created naturally in the human body.

What are BHRT Fused Pellets Implants?

Fused pellet implants are compounded using biologically identical hormones (most often Estradiol or Testosterone). The hormones are pressed/fused into very small cylinders. College Pharmacy also compounds DHEA, Pregnenolone, Progesterone, Biest, and Testosterone with Anastrozole fused pellet implants.

Where Are BHRT Fused Pellet Implants Inserted?

Pellet insertion is a relatively simple in-office procedure done under local anesthesia. The pellets are inserted subcutaneously (under the fatty lining of skin), either in the lower abdomen or the upper buttocks through a very small incision. The incision is then closed with surgical glue or sterile-tape strips. If inserted correctly, patients cannot fell the implants under their skin. Implants placed under the skin consistently release small, physiologic doses of hormones, which have been shown to have many benefits.

How Long Do BHRT Fused Pellet Implants Last?

Fused Pellet Implants typically last between 3-5 months, depending on how rapidly the hormones are metabolized. After insertion of the pellets, vigorous physical activity should be avoided for 2-3 days, or as suggested by the healthcare practitioner. Some patients begin to feel symptom relief within 48 hours, while others may take up to two weeks to notice a marked difference. The pellets do not need to be removed. They are completely dissolved by the body.

Are There Any Side-Effects?

Generally, there are minimal side-effects associated with the pellet implant procedure. Complications include: minor bleeding, bruising, infection, and pellet extrusion. Other than slight bruising, the other complications are very rare. Hormone side-effects vary and should be discussed by your healthcare practitioner.

How Do I Know What Hormones I Need?

Before starting any hormone replacement therapy, patients should work directly with a knowledgeable healthcare practitioner to have hormone testing done to evaluate their personal hormone profile. Based on existing hormone levels and health history, the practitioner will make a hormone replacement recommendation. Once pellets have been inserted, hormone levels will be reevaluated prior to the insertion of the next round of pellets. After the first year of therapy, the practitioner may suggest testing less frequently based upon patient feedback and prior hormone levels.

How Are Hormones Monitored During Therapy?

Hormone levels will be drawn and evaluated before therapy is started. This may include a FSH, estradiol, testosterone, and free testosterone for women. Men need a PSA, sensitive estradiol, testosterone, liver profile and blood count prior to starting therapy. Thyroid hormone levels may also be evaluated. Levels will be reevaluated during hormone therapy, usually prior to insertion of the next set of pellets, 4-5 months. After the first year of therapy, hormone levels may be followed less frequently. Men must notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care practitioner.

Can A Patient Be Allergic to The Implants?

Very rarely, a patient will develop local zone of redness (3-8 cm) and itching at the site of the testosterone implant. There is minimal or no tenderness and no other sign of infection. Many pellet formulations include stearic acid and PVP (povidone). Patients may react to the PVP. Many patients who develop a local reaction to the implant have low cortisol levels and upon further questioning, have symptoms of adrenal insufficiency. Cortisol testing may be recommended. If needed, 25-50 mg of Benadryl works well for the itching.

Recommendations:

• Benadryl 25-50 mg every 6 hours as needed.
• Check am and pm salivary cortisol levels PRIOR to beginning hydrocortisone therapy.
• Check for other symptoms of cortisol deficiency.
• Begin therapy with hydrocortisone (10 mg BID) with or without Benadryl.
• If the itching and redness do not respond to hydrocortisone, prescribe a Medrol dose pack.
• Implants are not removed.
• If there is any question of infection, begin Keflex.

How Much Does This Cost?

The cost for the insertion of pellets will vary depending on the dose of the hormone and the number of pellets needed. Men need a much larger of testosterone than women and the cost is higher. Pellets need to be inserted 2 to 4 times a year depending on how rapidly a patient metabolizes hormones. When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective.

Will Insurance Cover the Procedure?

Some insurance companies cover the cost of pellets. Others do not. Most physicians require payment for their services. Patients may want to contact their insurance companies to see if their costs will be reimbursed. Prevention is much more cost effective than disease. Patients are able to “appeal” a denied claim.

How Can I Get BHRT Fused Pellet Implants?

BHRT Fused Pellet Implants require a prescription from a healthcare practitioner. It is very important to work with a practitioner that is well versed in BHRT as well as the actual pellet implant procedure. The placement of the pellet and the hormone dosing are extremely important in determining safety and efficacy. BHRT Fused Pellet Implants are most often made by special compounding pharmacies, such as College Pharmacy, using strict United States Pharmacopeia (USP) guidelines.