An extremely effective form of bio-identical hormone therapy is subdermal pellets made from estradiol or testosterone.  For women who are having difficult menopause transitions due to problems with absorption, marked fluctuations in hormone levels or who have lost their ovaries surgically at a young age (perhaps due to endometriosis or pelvic inflammatory disease), hormones in this form can restore a quality of life and function which has been lost.  Economically, this is more efficient than multiple medical visits, time lost from work, or the suffering of severe menopausal symptoms such as disturbed sleep, depression, anxiety, fatigue, muscle aches, hot flashes etc.  It cannot be overemphasized that patients who are inadequately replaced will have many more visits  for symptoms such as heart palpitations, migraines, urinary dysfunction, visits for sexual dysfunction, chronic aches and pains. These patients will probably have many unnecessary tests for arthritis, for chronic fatigue syndrome, for lupus, and many other complaints.

Pellets solve the problem of unpredictable absorption of a complex compounds through the skin or the bowel.  This is a major problem when bio-identical hormones are compounded and taken either orally or through the skin.  Each pellet consists of a hard crystal of 17 beta estradiol-- the natural estrogen produced by the human ovary, which releases into the blood stream, attains a steady state, and then will get used up as the estrogen is metabolized in the body. This will provide a very steady estrogen level of approximately 150 - 250 picograms per ml, which is a therapeutic level.  Each pellet lasts from 3-4 months.  The use of pellets has dramatically decreased the amount of physician visits by these patients for other related problems. We can show that, once the patients have been stabilized,  most patients requiring pellets two to three times a year and requiring very little in the way of other medical therapy in between times.  The requirements for use of estrogen pellets include a normal gynecological exam, a normal mammogram, no uterus, no previous history of breast or uterine cancer, and no history for clotting disorders.  This is no different than the contraindications for any other estrogen use.

The ovary also produces male hormones, which are similar  to testosterone.  Another sources of androgen (male hormone) in a woman is the adrenal gland, which produces a substance known as dehydroepiandrosterone sulfate. There is a dramatic fall in both of these products around the time of menopause.  The resulting loss of androgens causes a decrease of energy and decrease in sex drive and vaginal lubrication in a percentage of women. For women who have problems with low male hormones, we have been adding a testosterone pellet along with the estradiol.  This is particularly useful for women whose ovaries have been surgically removed.  This provides an androgen level which is compatible with that of the normal range of female patients.   Benefits include:

• The use of these pellets causes a feeling of well being, increased energy, increased sex drive. 
• Transdermal testosterone may also be safer to use because there is also less lowering of HDL-cholesterol (good cholesterol) because the testosterone in the pellets by-pass the liver. 
• Stability of hormones blood levels compared to the fluctuation experienced with injections, pills, or patches.
• Androgens, such as testosterone. also add to bone density.  Some studies have show as much as a 25% increase in bone density.
• Finally, testosterone is a very effective treatment for the breast tenderness associated with fibrocystic breast disease since it reduced ductal hyperplasia of the breast.

Estrogen and Testosterone hormone pellets should be used with caution in women who have their uterus because continuous exposure to estrogen on the uterus may increase the risk of uterine cancer unless the patient faithfully uses progesterone.

The implant procedure consists of injecting a small amount of local anesthesia in the skin of abdominal wall or the outer thigh. A tiny nick is made in the skin with a scalpel.  A large needle is placed through this incision and the pellets are inserted. The incision is then closed with a Steri-Strip, and pressure is applied until bleeding stops, and the area is then covered with a dressing. We have not had any major problems in terms of side effects from this procedure. Some expertise is required in terms of placing the pellets so that underlying structures are not traumatized. This has been acquired with a great deal of experience. Cost wise, the procedure currently costs approximately $450.00. Unfortunately, pellets are not covered by insurance for women-- only men.

These can be obtained from Cathy Crowley at the Pavilion Compounding Pharmacy, 3193 Howell Mill Road NW, Atlanta GA 30327.  404 352-5780.  Her E-Mail address is pcompound@bellsouth.net and her website is www.pavilioncompounding.com. A special needle and trocar are needed to insert these and it should be done only by a trained physician.  For more information about the use of estrogen and testosterone pellets for the treatment of menopause in women and andropause in men, please contact

Andrew B. Dott M.D,

Riverbend Ob-Gyn and Counseling PC

993 D Johnson Ferry Rd Ste 360

Atlanta GA 30342

tel:   404 250 1350           fax:   404 250 1359

drdott@midlife-passages.com