Although there are only a handful of hormones that we focus on for Bio-identical Hormone Replacement therapy (BHRT), there are many ways to apply these hormones. There are pills, patches, creams, gels, nasal sprays, sublinguals, suppositories, injections and pellets. There is a place for many of these applications and it is very patient specific, however some applications provide optimal response in the body more than others.
It is important to remember that the ovaries and testicles are NOT in the digestive system. This is the premise which guides my advice to patients on how to take their BHRT. What happens naturally is that the brain communicates with the ovaries or testicles that the body needs hormones. These glands then make and secrete their product hormones (Estrogen, Testosterone primarily) which then circulate around the body doing their jobs. Once these steroid hormones have done their jobs, they are then circulated through the livers’ second level of filtration (methylation, glucuronidation, etc) and excreted out of the body by way of the kidneys.
In contrast, Oral hormones go down the hatch and are metabolized by the liver first in what we call, first pass, through the P450 system. This enzyme system alters the hormones into intermediate metabolites that then circulate throughout the body and begin stimulating cells and doing their work. These intermediate metabolites have been shown to be problematic in studies on hormone replacement therapy and in particular the synthetic versions, pharmaceutical products because they are not exactly like the pure parent steroid hormone and can stimulate the receptors in varying intensities and durations. When using BHRT there are a few exceptions to using oral hormones that I won’t go into detail here as I want to talk about pellets.
History of Pellets:
Hormone therapy using pellets is not new. Pellet hormone replacement therapy has been available and researched for more than 70 years. Pellets were initially developed in France in the 1930’s for menopausal females. They were used in the United States from the late 1930s to the early 1970s. Time has proven to provide safer options as pellet hormone therapy utilizes bio-identical hormones rather than its predecessor products of synthetics used in the early days. In 1972 the FDA approved Testosterone pellets for HRT. Pellet therapy is currently popular in Europe and Australia and the US for both men and women.
Pellets in our Practice:
In 2009 a handful of patients who came to me and requested that I start doing pellet hormone implants so that they did not have to fly to Arizona to have their pellets placed. At that time a company in AZ had established themselves as the organization to train doctors to do pellet, claimed they had the best pellets and they essentially systemized the practice of placing hormone pellets.
As a doctor who is against the industrialization of medical practices, I began to search for more information on hormone pellets as a safe and effective treatment for my patients. Through one of our compounding pharmacies I became connected to an MD in California for training. Dr Werner was one of the first MD’s to be involved in the NIH study on pellets. The MD in our practice and I were trained in hormone pellet implants as a viable solution for patients wanting BHRT.
Fast-forward 9 years later when now organizations are beginning to have medical conferences about pellets rather than private companies training doctors only. I recently attended one of these conferences. As happens with most medical conferences, we get excited, recharged and inspired to help our patients with new methods, new ideas or even just a renewed enthusiasm for the practices we already do! And this is what I want to share with you. I tell all my patients, make a point to see your doctor after they have come back from a conference or vacation! We all get renewed and rejuvenated! We hope to see you soon for BHRT and possibly Pellets!
Nuts and Bolts:
There are Advantages and disadvantages to all forms of BHRT applications. Disadvantages to creams, pills, injections:
- Odor of the cream
- Wide ranges of hormone levels between uses
- Pain at the injection site
- Exposure to others in the house
- Forgetting to take the dose
- Variations in doses between preparations
- Dermal resistance and poor response
The main advantage to pellets is that tissue saturation is more consistent and patients feel better. Better tissue saturation for the central nervous system, brain and immune modulation.
Pellets are not for everyone. We do not place pellets in patients with the following health issues:
- Breast cancer active
- Endometrial cancer active
- Prostate Cancer active
- Acute thromboembolic disorder
- Acute myocardial infarction
- Undiagnosed vaginal bleeding
- Undiagnosed breast mass
- Severe liver disease
- Severe cardiac disease
We are cautious when using pellets in patients with the following health concerns:
- History of breast cancer
- Endometrial cancer
- Liver disease
- Enlarging uterine fibroids
- History of heart disease / valve replacement / pacemaker
- Atrial fibrillation on anticoagulant therapy
- CAD with 7‐10% risk
- Autoimmune disease
- Elevated PSA
- Estrogen‐dependent migraine
- Severe Psychiatric disorders
- Abuse and polypharmacy use
- Anaphylaxis of unknown causes
- Self assessed “sensitivities to Hormones”
Who is a candidate for Pellets?
- Men and women who want consistent hour to hour regulation of sex hormones.
- Men and women who don’t want the hassle of painful injections, daily applications of creams or remembering to take their tablets or place their patches.
- Women who have had a hysterectomy
- Men and women who want to optimize healthy body and mind and prevent aging
Call today to schedule a consult about BHRT and Pellet Implants.