Bioidentical Hormone Replacement Therapy (BHRT) via pellets manages hormone imbalance symptoms by providing a steady, extended supply of hormones. This method involves the subcutaneous placement of small, solid implants containing bioidentical hormones. This consistent delivery system avoids the daily fluctuations common with pills, patches, or creams. Inserting the hormone source beneath the skin aims to mimic the body’s natural release patterns and maintain stable hormone levels.
The Physical Characteristics of Hormone Pellets
Hormone pellets are small, solid implants placed in the fatty layer just beneath the skin. They are typically cylindrical or slightly oblong, resembling a cooked grain of rice or a small Tic Tac candy. While size varies by dosage and hormone, they are generally three millimeters by nine millimeters.
The pellets are composed of bioidentical hormones, most commonly testosterone or estradiol, derived from plant sources. These hormones are compressed under high pressure into a sterile, solid compound. While some pellets may include a binding agent like stearic acid, many are pure crystalline hormones. They are typically white or off-white, have a smooth, hard texture, and are custom-made for the patient by compounding pharmacies.
The Process of Pellet Insertion
Pellet insertion involves a minor surgical procedure performed in the healthcare provider’s office. The process begins with sterilizing the placement site, typically the upper hip, upper outer buttock, or lower abdominal area. A local anesthetic, such as buffered lidocaine, is injected to numb the area, minimizing discomfort during the procedure.
Once the area is numb, a small incision, often less than five millimeters, is made in the skin. A specialized instrument called a trocar, a hollow, blunt-tipped device, is then used to create a small pocket in the subcutaneous fat layer. The hormone pellet, or multiple pellets depending on the required dose, is loaded into the trocar and gently deposited into this pocket beneath the skin.
Placement is targeted to the fatty tissue because it is highly vascular, which facilitates gradual and consistent hormone absorption. After placement, the trocar is withdrawn, and the incision is closed. Closure is usually accomplished using sterile adhesive strips (Steri-Strips) or a single suture, followed by a sterile dressing. The entire process is quick, often taking less than 15 minutes.
How Hormone Pellets Deliver Medication
Once inserted into the subcutaneous fat, the pellet functions as a consistent, long-term hormone delivery system. The release mechanism depends on the blood flow around the pellet site. Hormones slowly diffuse from the solid pellet into the surrounding tissue and then into the bloodstream, bypassing the digestive system and liver.
This process, which is driven by cardiac output, allows for a steady state of hormone delivery that avoids the peaks and troughs associated with daily oral or topical hormone applications. Maintaining consistent hormone levels helps minimize side effects and maintain symptom relief. The pellet gradually dissolves completely over time, leaving no residual material behind.
The duration of hormone release varies based on the patient’s metabolism, activity level, and the specific hormone and dose. For women, effects typically last between three to five months, while men often experience sustained release for four to six months. Patients are scheduled for re-insertion when symptoms of hormone imbalance return, signaling that the pellet has been fully absorbed.
Immediate Care Following Insertion
Proper care of the insertion site immediately after the procedure is important to ensure optimal healing and prevent complications. Patients are instructed to keep the insertion site completely dry for the first 24 to 48 hours. This means avoiding long showers, baths, swimming, or hot tubs for several days to prevent water from entering the small incision and introducing infection.
Specific activity restrictions must be followed to allow the pellet to settle securely in the tissue pocket. Strenuous exercise, heavy lifting, or activities that put excessive pressure on the insertion area (such as deep squatting or vigorous lower body workouts) should be avoided for three to seven days. This precaution helps prevent the pellet from being expelled, a rare complication known as extrusion.
It is normal to experience minor bruising, tenderness, or slight swelling at the site for the first few days to a couple of weeks. Patients must monitor the area for signs of complications, such as increasing redness, warmth, excessive swelling, or discharge. If these signs of potential infection or severe swelling occur, the healthcare provider should be contacted immediately.