Keywords: Pellets Dermal Transdermal Subdermal Implants testosterone Atlanta female male methyltestosterone estrogen estradiol oestradiol androgen menopause medication andropause drugs energy sex drive libido appetite cholesterol ovary hormone depression reproductive endocrinology

Sometimes, it is necessary to use an pellets or implants made of estrogen. This is a compounded substance where 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 pellets are under investigation by the FDA at the present time and have not been approved. However, they have been available for use in this country for over 40 years.   There have been no adverse effects demonstrated.

The use of pellets have dramatically decreased the amount of physician visits by these patients for other related problems. We can show that, once the patients have been stabilized, the number of physician visits and the number of tests for these patients declined dramatically, 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 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, such as delta 4 androstenedione, which has similar effects 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. The effect of androgen in women has been well documented in many papers, including papers by Barbara Sherwin, Ph.D., Nelson Watts, and Morris Notelowitz.

Oral androgens may be administrated in the form of methyl-testosterone.  This drug may have toxic effects on the liver, particularly in higher doses, and should be used cautiously.  Oral estrogen and testosterone also cause the liver to produce increased amounts of sex hormone binding globulin which actually reduce the amount of available hormone which is why increasing the dose of oral hormones may actually reduce libido and a sense of well being.  Oral androgens, by the "first-pass effect" through the liver also lowers HDL-Cholesterol which protect you from cardiovascular disease.

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 is approved by the FDA.  This provides an androgen level which is compatible with that of the normal range of female patients.  Because there is no problems with absorption, only 25% as much androgen is needed compared with an oral androgens.  Benefits include:

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 $350.00. Unfortunately, pellets are not covered by insurance for women-- only men.

Only 10% to 20% of women experience poorly controlled menopause since 80% to 90% of women do quite well on ordinary methods of hormone replacement. 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.

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

Dr. Andrew Dott  teaches advances hysteroscopic and laparoscopic surgical techniques, is on the speaker's panels for several American pharmaceutical companies and is a professional lecturer.  Among his lecture topics are female and male menopause, menopause, herbs and medications, endometriosis, and contraception.  He is available to travel and give seminars on the topics covered in this website both nationally and internationally.