Bio-Identical Hormone Replacement (BHRT)

Bio-Identical Hormone Therapy

Pellet therapy is a sustainable delivery method for bioidentical hormone therapy. Every six to twelve months a pellet or pellets made of bioidentical hormones is inserted just under the patient’s skin usually on the upper part of your buttocks. The pellets, which contain customized levels of estradiol or testosterone, react to the needs of the body, so they actually dissolve releasing the bioidentical hormones as needed.

Testosterone hormone therapy gives a man or woman their mental clarity, libido and muscle tone and mass. When this hormone is at low levels, men and women often complain of mental confusion, weight gain and poor muscle tone, even with regular exercise.

The effect of hormone deficiency on the brain, muscle, bone, heart and metabolism can be significant without hormone replacement therapy for both men and women, and it can be dangerous to long-term health. The brain needs normal amounts of testosterone in balance with estrogen to produce serotonin, which supports emotional balance. When lacking in these hormones, a man or a woman will experience emotional instability that often results in increased anxiety, irritability, sleep disturbances, anger, sadness and depression.

The musculoskeletal system is also adversely affected by the loss of testosterone. By not having bio-identical hormone therapy, the deficiency or imbalance of testosterone can lead to muscle atrophy, osteopenia, osteoporosis, and pain in the muscles and joints.

Bio-Identical Hormone Pellet Therapy — The Right Choice

The therapy is to provide an adequate supply of a deficient hormone in a form that is molecularly identical to that which your body produces. Logically, this should result in the hormone’s normal healthy physiologic effects being restored. Every person is unique. Therefore, it is sensible for you and I to work together to customize a BHT program based upon your individual symptoms and hormone levels. The precise dosing of each person’s therapy will be determined after consultation and evaluation of laboratory blood tests, and may be adjusted if needed.


How is the BHT Administered in Our Practice?

Bio-identical hormone pellets are obtained in various strengths from a highly rated commercially licensed compounding pharmacy. The hormones are derived from an ingredient found in many vegetables including Yams and Soy beans. (The pellets used in our office are Yam based.) Usually, only Testosterone (a necessary male and female hormone) is placed via time released pellets inserted in the body fat. They are extremely small, usually painless to insert, and provide a steady hormone level for months. Bio-identical Estrogen and Testosterone are not suitable for oral ingestion as they are chemically inactivated during the intestinal absorption process. Any estrogen or testosterone like drug taken by mouth should be assumed to be NOT bio-identical.

Goals of bio-identical hormone replacement therapy include:

Alleviation of the symptoms caused by decreased production of hormones. (Examples include: sleep problems, mood swings, increased body fat, decreased libido and sexual function, hot flashes, night sweats, anxiety,etc.)
Re-establishing the protective benefits which were originally provided by higher levels of your naturally occurring hormones. (Examples include: bone density, cardiovascular health, immune function, balance, etc.)
Reversal of diseases associated with aging (Examples: osteoporosis, loss of strength, fatigue, exercise intolerance, decreasing muscle mass, mental clarity, etc.)
Enhance the enjoyment, sense of well-being, and quality of life over the long-term.


Testosterone is vital to the health and well-being of BOTH men and women. Testosterone in men is mainly produced by the testicles and in smaller quantities by the adrenal glands. In women, testosterone is produced in both the ovaries and the adrenal glands. Testosterone contributes to muscle mass, strength and endurance, decreased fat, increased exercise tolerance, enhancement of the sense of well-being and psychological health. Testosterone protects against cardiovascular disease and reduces blood sugar. It leads to improved lean muscle mass, increased bone density, decrease in cholesterol, improved skin tone, improved healing capacity, and increased libido and sexual performance. It enhances the quality of life for both men and women by decreasing the diseases of aging. Cells that require Estrogen use Testosterone to manufacture Estrogen inside the cell by a chemical conversion that uses an enzyme called Aromatase. Testosterone is present and extremely important in both Women and Men, making adequate tissue levels very important for health in both sexes. (It goes without saying that women require substantially less of it!)


Estrogen refers to a group of similar hormones produced in the body. Like testosterone, Estrogen is a required hormone for the health of BOTH men and women. The main three are estrone (E1), estradiol (E2), and estriol (E3). Estrogens are believed to be protective against heart disease, stroke, osteoporosis, Alzheimer’s disease, and memory disorders. It also protects against vaginal atrophy, urinary incontinence, and prevents symptoms of menopause, including hot flashes and poor temperature regulation (e.g. “hot Flashes”). It can improve balance by the “visual somatosensory” system in the central nervous system. Estrogen deficiency is linked to: urogenital atrophy, incontinence, increased skin wrinkles of the face, fatigue, depression, mood swings and decreased libido. However, the vast majority of women we treat need only testosterone pellets (see above) as their body, like men’s, makes all the intracellular estrogen it needs from testosterone, thus avoiding the serious problems that can occur with high circulating estrogen levels in the blood. While estrogen supplementation is rarely necessary, it is important that any estrogen prescribed be a bio-identical estrogen and not a non-human estrogen. The non-bio-identical synthetic estrogens bind nearly 20 times stronger to your cell’s receptors and have been proven to be harmful.


Progesterone is primarily produced in the ovary just prior to and after ovulation. It is also produced in large quantities by the placenta during pregnancy and in small quantities by the adrenal glands. If you are on bio-identical estrogen, you should probably be on this hormone as well. It seems to protect against uterine and breast cancers, fibrocystic disease and ovarian cysts. Unfortunately, most U.S. women are prescribed a synthetic horse derived progestin (Provera) which can cause side effects such as bloating, headaches, fatigue, weight gain, and heart disease. Bio-identical progesterone does not have these side effects.

Other Supplements

There can be nutritional deficiencies encountered in the BHT patient that may affect BHT effectiveness. Examples include iodine, and other trace mineral and vitamin deficiencies. If this is suspected, inexpensive non-prescription supplements may be recommended. B-12 injections are offered monthly to those BHT patients who so desire. Many feel it helps.

What is Involved in Starting on Bio-identical Hormone Therapy?

You will fill out a brief medical history and a symptoms questionnaire. We will discuss your symptoms and review the results from your blood test (if you had it drawn prior to your visit.) Alternatively, you can receive a lab test form during your consultation and return in several days to discuss the results of the tests and your appropriateness for this therapy. Known risks and side effects are minor and uncommon, though these will be discussed with you as well. If you decide to proceed, it takes less than 5 minutes to insert the pellets. You can resume normal activities (except for swimming and strenuous exercise which require a 4 day wait). You can expect to feel some improvements with in the first week.

There is no age limit on treatment. Though uncommon, patients as young as 25 (such as and those with PCOS or severe PMS) as well as men and women in their 70s or older have had wonderful benefits from this therapy.