Many patients are curious about the subcutaneously implanted pellet as a method of hormone replacement therapy (HRT), and how it compares to injectable hormones. Pellets are “new” to most patients, however, they have been used clinically in the United States since the 1940’s. While there are pros and cons to every dosage form, pellets are often a smart choice for patients who have low hormone levels.
Pellets are superior to other modalities because of their duration of action and release kinetics. A typical patient will apply a hormone cream or gel twice a day or inject themselves every one to two weeks with a slow-release hormone like testosterone cypionate. While it is obvious that the injection lasts longer, injectable hormones also come with the burden of a patient having to inject themselves, or travel to their doctor’s office every week or two to have the injection performed… not to mention the pain of the injection itself.
Creams and gels provide stable hormone levels but can take weeks for their effects to be noticed by the patient. Injectable hormones produce sharp “peaks and troughs” in drug concentration in the time between the patient’s injections. Peaks can be dangerous, as the drug concentration will be higher than what is physiological for the patient, and troughs will leave the patient feeling crummy in the days leading up to their next shot.
Pellets are inserted subcutaneously under local anesthesia, by a trained provider. The long duration of action (3 to 6 months)of the pellet is preferred by patients whose busy schedules cannot afford to travel to a clinic every week for an injection or are concerned about a cream transferring to their loved ones. Ultimately, the decision of which HRT dosage form is ideal for you and your lifestyle should be made with the input of your doctor and compounding pharmacist.