by Sheila G. Seyster MSN CNM APRN

Introduction

Data supports that hormone replacement therapy with pellet implants are 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.

What are 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. At SeaMist MedSpa, we only purchase our pellets from a 503B compounding pharmacy, which is regulated and subject to inspection by the FDA.

Why pellets?

Pellets deliver consistent, healthy levels of hormones for 3 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. Low levels of testosterone are associated with Alzheimer’s, Parkinson’s and cardiovascular disease. 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. There is more data in support of pellet therapy than any other method of delivery of hormones worldwide.

How and where are pellets inserted?

The insertion of pellets is a quick, minimally invasive, relatively painless procedure using a local anesthetic. The pellets are usually inserted in the upper buttocks through a small incision, which is then taped and bandaged (no sutures required). 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. In less than 10% of women testosterone may cause a slight increase in facial hair. 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 sterile 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 have been used in the United States since the late 1930s. The biological structure of bio-identical hormones is an exact match (identical) of the hormones that already exist in your body. A natural substance cannot be patented and sold for a profit by pharmaceutical companies. Big pharma has never liked any natural substances, as their number one goal is to make as much profit as possible.

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 provider not having researched or read the data. Much of what providers know about drugs comes directly from pharmaceutical companies promoting big pharma products. Because pharmaceutical companies don’t manufacture natural hormones, most physicians do not learn about them unless they do their own personal research. Fortunately there is a growing change in how we practice medicine. This new evolution is a culmination of research efforts over years from some of the most distinguished medical and scientific research centers in the country.

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. Testosterone, delivered by pellet implantation, has been shown to decrease breast proliferation and lower the risk of breast cancer, even in patients on conventional hormone replacement therapy. Clinical studies show that bio-identical testosterone balances estrogen and is breast protective. There are currently some doctors using testosterone implants to treat patients with advanced breast cancer. References supporting these statements can be found in the data section of www.hormonebalance.org in the ‘Breast Cancer Folder’.

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 or can be treated short term using a mild diuretic.

How long until a patient feels better after pellets are inserted?

Some patients begin to feel better within 48-72 hours while others may take a week or two to notice a difference. Patients may begin to notice that they have more energy, are sleeping better and have an overall improved sense of well-being. Muscle mass and bone density will increase while visceral fat decreases. Patients will benefit from increased strength, coordination and improved physical performance. They may notice an improvement in their skin tone and hair texture. Concentration and memory may improve as well as overall physical and sexual health. There is long-term safety data of hormones delivered by pellet implants.

Diet and Lifestyle

Diet and lifestyle, along with hormone balance are critical for optimal health. At SeaMist MedSpa, we focus on treating the whole person.

How long do pellets last?

The pellets usually last approximately 3 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?

Yes, progesterone is prescribed for women even if she has had a hysterectomy. Progesterone is prescribed as an oral capsule. There are progesterone (not progestin) receptors in the bone, brain, heart, bladder, breast and uterus where progesterone has been shown to have beneficial effects. Natural progesterone protects against breast cancer, promotes feelings of well being, enhances the beneficial actions of estrogen, relieves menopausal symptoms, and stimulates new bone formation as well as protects against osteoporosis and cardiovascular disease. The most important use of progesterone is to prevent proliferation (stimulation) of the uterine lining caused by using estrogen alone.

How are hormones monitored during therapy?

Hormone levels will be tested and evaluated before therapy is started. This will include an in depth lab panel most often covered by your health insurance. Levels will be reevaluated 6 weeks after your first pellet insertion and on a routine basis thereafter. Women must agree to routine mammograms and a pap smear as advised by their gynecologist or primary care physician.

Will Insurance cover this procedure?

Your labs may or may not be covered depending on your individual insurance carrier. We are a concierge practice at SeaMist MedSpa. You may try using your Flexible Spending Account (FSA), which allows payment for certain medical expenses. However, if not accepted you will be responsible for payment in full at time of service.

At SeaMist MedSpa our belief is a well informed, educated patient realizes prevention is much more cost effective than disease. In conclusion, estrogen and testosterone therapy by implantation of pellets is a superior, safe and effective method of hormone therapy.  Administration of hormones by pellet is convenient and economical. This method 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.

Call Sheila and arrange for your personal consultation today at: 401-773-2740