Hormone Optimization

Hormone replacement therapy or supplementation has a long history, and hormone replacement has been demonstrated to have many benefits. For women, hormone replacement therapy, when given at the proper time, using the proper hormones and dosing levels, and when monitored properly, can reduce risk of dementia, osteoporosis, heart disease, and even some cancers.

Because hormone replacement has become controversial since the publication of the Women’s Health Initiative study (WHI), many women have been afraid of hormone replacement and many doctors reluctant to prescribe it. However, with new information and worldwide data supporting the safety and efficacy of hormone replacement when given properly and monitored properly.

What is pellet hormone therapy?

Pelleted hormone therapy has a long history of use in men, and has become increasingly popular for women. Pellet hormone therapy involves inserting a tiny hormone containing pellet (about the size of a grain of rice) under the skin, usually in the buttocks region, every few months. The pellet releases the hormone slowly throughout that time providing continuous blood levels of the hormone. 

The most common hormones found in pellets are testosterone and estradiol, the “male” and “female” hormones, respectively. Monitoring of blood levels and hormone metabolites is an important part of therapy, and additional supplements or prescriptions may be needed to provide the proper hormonal support.

What is the procedure like?

After baseline evaluation including laboratory hormone levels and a full history and physical exam and evaluation of previous hormone replacement dosages (when appropriate), a starting dose is calculated. Ideally, this dosage should be at or just below the calculated dose so that normal levels are not exceeded.

Once the evaluation is complete, the pellets are available, and dosing is confirmed, an office visit for sterile pellet placement is scheduled. Typically, the pellets are inserted under the fat in the buttocks near the hip bones. This process is performed by first cleansing the skin, then numbing the skin and tissue under the skin and making a very small nick in the skin. A sterile hollow needle (trocar), large enough to fit the pellet through, is then placed through the skin and into the underlying fat pad, and the pellets inserted through the needle. The device is then withdrawn leaving the pellets about an inch under the skin.

The skin is closed with a steri-strip surgical tape and covered with sterile gauze which remains in place for 1-2 days.  Heavy exercise should be avoided for 72 hours following pellet placement, but normal activity is fine.  

Are there any downsides to pellet hormone therapy?

While pelleted hormone therapy can be very satisfying for many women, it is not for everyone. It is absolutely necessary to have a full evaluation and understanding of an individual’s response to hormone therapy.

We begin with a carefully planned and monitored regimen in order to achieve optimal results. Often, the unsatisfying results occur because the dosage was started at an excessively high level and not tailored to the individual. Our philosophy of “start low, go slow” with close monitoring of symptoms and hormone levels tends to create greater patient satisfaction and emphasize safety and tolerability.

Most women do well with placement every 3 months, although some are able to go longer as they metabolize the hormones more slowly. Creating a regimen that is specific to each patient is the primary objective in offering successful pellet hormone therapy.

Dr. Wulff is accepting appointments for new and ongoing hormone replacement therapy consultations including pelleted hormone therapy. This therapy can be helpful when traditional hormone replacement therapy fails to provide satisfactory relief or creates difficulties with consistent use due to inconvenience.