Pellet Bio-Identical Hormone Therapy
1. What are hormone pellets?
2. Why are pellets optimal for hormone replacement?
3. How and where do you insert the pellets?
4. Are there any side effects or complications from the insertion of pellets?
5. What changes can occur after pellet insertion and how long before I feel the effects?
6. How long do the pellets last?
7. Do patients need progesterone when they use the pellets?
8. Is hormone pellet therapy only for women in menopause?
9. Is there a need for testosterone in women?
10. Do men need hormone therapy?
11. How are the hormones monitored during therapy?
12. Will insurance cover the pellets and insertion?
13. Will insurance cover the pellets and insertion?
14. Are there differences in pellets among different providers?
1. What are hormone pellets?
Pellets are made up of either pure bio-identical estradiol or bio-identical testosterone hormone (99.8%) with a small of amount (0.2%) of a natural fatty acid, stearic acid, which is found in our bodies, and which helps to hold the hormone pellet together; there are no other fillers or ingredients of any kind in the pellets used by Dr. Dagstani. The estradiol and testosterone are formed into their own separate pellets so that the doses can be individually controlled. The hormones are pressed or fused into very small solid cylinder shapes, about the size of a grain of rice. They are made by a compounding pharmacy and delivered in sterile glass vials.
2. Why are pellets optimal for hormone replacement?
Pellets deliver consistent, healthy levels of hormones typically for 3 – 5 months. They avoid the ups and downs of hormone levels seen with other delivery methods- creams, oral capsules, injections, patches, etc. It is often the fluctuation in hormones that causes many of the unwanted side effects and lack of symptom relief that a patient can experience. Due to the consistency in the level of hormone in the bloodstream achieved through the pellet delivery method, even patients who have failed other types of hormone therapy tend to have a high success rate with pellets. In addition, there is no other method of hormone delivery that is as convenient for the patient as pellets.
3. How and where do you insert the pellets?
The insertion of pellets is a simple, relatively painless procedure done following the injection of a local anesthetic. The pellets are inserted in the hip or buttocks area through a small incision, which is taped closed. The experience level of the health care practitioner counts, not only in the placing of pellets but in determining the correct dosage of hormones to be used. Dr. Dagstani has been working with the pellets for over 5 years and has performed more than 14,000 pellet procedures.
4. Are there any side effects or complications from the insertion of pellets?
Possible complications include minor bleeding, bruising, discoloration of the skin, infection, and possible extrusion (coming out) of the pellets. Other than slight bruising or discoloration of the skin, these complications are very rare. In order to minimize the possibility of the pellets being extruded or infection, extended exposure to soaking (swimming, hot tubs, bath tubs) and vigorous physical activity are avoided for 48 hours in women and up to 7 days in men.
5. What changes can occur after pellet insertion and how long before I feel the effects?
Estrogen typically produces many of its effects much more rapidly than testosterone. Often in only a few days there is relief from night sweats and hot flushes. It usually requires a few weeks before noticing:
* Increased energy levels
* Restored or increased sexual drive
* Consistency in moods
* Relief from anxiety and depression
* Increased mental focus and clarity
* Decreased body fat
* Greater capacity for getting the body in shape
* Improved sleep
6. How long do the pellets last?
Typically between 3 – 5 months in both men and women
7. Do patients need progesterone when they use the pellets?
Any time estradiol is prescribed and a woman still has her uterus, progesterone must be prescribed. Progesterone is most effective as an oral capsule, and tends not to hold together well in pellet form, so it is generally not used in pellet form.
8. Is hormone pellet therapy only for women in menopause?
Definitely not! Women at any age may experience hormone imbalance. Levels can decline or fluctuate at any age, contributing to debilitating symptoms. Pellets are useful in PMS, post partum depression, menstrual or migraine headaches, and sleep disorders. Pellets may also be used to treat hormone deficiencies caused by the birth control pill.
9. Is there a need for testosterone in women?
Absolutely! Unfortunately still today many patients and even health care practitioners consider testosterone to be a “male hormone”. This, however, is definitely not the case. The role of testosterone in women is just as important as it is in men; women simply need less of it. Women benefit from the proper amount of testosterone with, among other benefits:
* Increased energy levels
* Restored or increased sexual drive
* Consistency in moods
* Relief from anxiety and depression
* Increased mental focus and clarity
* Decreased body fat
* Greater capacity for getting the body in shape
10. Do men need hormone therapy?
Oh yes! Testosterone levels in men tend to decline in their 40s, and often earlier than that. Men should be tested when they begin to show signs of testosterone deficiency, which are similar for both men and women. Testosterone deficiency can also be part of the cause for male erectile issues.
11. How are the hormones monitored during therapy?
Hormone levels will be drawn and evaluated prior to therapy. Hormone therapy is NOT for everyone, it is for those who have decreased levels on lab testing, and/or display hormone deficiency symptoms. Lab testing for women includes FSH, estradiol, testosterone, and thyroid (tsh). Men need to test PSA, estradiol, testosterone, and thyroid. Levels will be reevaluated at 4 to 6 wks and again a week or two prior to the next insertion procedure. After testing levels following the first 2 or possibly 3 insertions, blood work will only be necessary on an annual basis.
12. Will insurance cover the pellets and insertion?
Unfortunately, extremely rarely. It is always wise, however, to check with your specific insurance company.
13. Why do so many providers say “there is no data to support the use of pellets”?
If your healthcare practitioner says this, they are wrong! There is of course a big difference between “no data” and not having read the data. It is much easier for busy practitioners to say this and dismiss the patient than it is to question their beliefs and do the research.
14. Are there differences in pellets among different providers?
Hormone pellets are always produced by either a compounding pharmacy, or, in the case of testopel, a drug manufacturer. There is not a single medical practice in the U.S. that produces its own pellets or that has an exclusive relationship with a pharmacy which produces pellets. Today there are a number of pharmacies creating pellets and quality can vary from one pharmacy to the next. Dr. Dagstani acquires his pellets from only one specific pharmacy that has been producing pellets for more than 45 years and sends pellet samples to a third party lab for independent testing. There are a few medical practices today that focus exclusively on providing pellet hormone therapy and attempt to create the illusion that they are utilizing a specialized form of pellets and pellet hormone therapy. This is simply a marketing strategy and not factual. The difference among the medical practices is typically not in the pellets but in the knowledge and skill level of the practitioners, i.e. dosing knowledge, procedure skill, problem resolution abilities, etc. Dr. Dagstani has performed thousands of pellet procedures and has acquired a level of expertise in pellet hormone therapy possessed by only a handful of others. In his current practice, Dr. Dagstani provides more than pellet hormone therapy to his patients because he does not believe that there is any single treatment method that is the answer for all patients or all health issues.
Pellet Bio-Identical Hormone Therapy
1. What are hormone pellets?
2. Why are pellets optimal for hormone replacement?
3. How and where do you insert the pellets?
4. Are there any side effects or complications from the insertion of pellets?
5. What changes can occur after pellet insertion and how long before I feel the effects?
6. How long do the pellets last?
7. Do patients need progesterone when they use the pellets?
8. Is hormone pellet therapy only for women in menopause?
9. Is there a need for testosterone in women?
10. Do men need hormone therapy?
11. How are the hormones monitored during therapy?
12. Will insurance cover the pellets and insertion?
13. Will insurance cover the pellets and insertion?
14. Are there differences in pellets among different providers?
1. What are hormone pellets?
Pellets are made up of either pure bio-identical estradiol or bio-identical testosterone hormone (99.8%) with a small of amount (0.2%) of a natural fatty acid, stearic acid, which is found in our bodies, and which helps to hold the hormone pellet together; there are no other fillers or ingredients of any kind in the pellets used by Dr. Dagstani. The estradiol and testosterone are formed into their own separate pellets so that the doses can be individually controlled. The hormones are pressed or fused into very small solid cylinder shapes, about the size of a grain of rice. They are made by a compounding pharmacy and delivered in sterile glass vials.
2. Why are pellets optimal for hormone replacement?
Pellets deliver consistent, healthy levels of hormones typically for 3 – 5 months. They avoid the ups and downs of hormone levels seen with other delivery methods- creams, oral capsules, injections, patches, etc. It is often the fluctuation in hormones that causes many of the unwanted side effects and lack of symptom relief that a patient can experience. Due to the consistency in the level of hormone in the bloodstream achieved through the pellet delivery method, even patients who have failed other types of hormone therapy tend to have a high success rate with pellets. In addition, there is no other method of hormone delivery that is as convenient for the patient as pellets.
3. How and where do you insert the pellets?
The insertion of pellets is a simple, relatively painless procedure done following the injection of a local anesthetic. The pellets are inserted in the hip or buttocks area through a small incision, which is taped closed. The experience level of the health care practitioner counts, not only in the placing of pellets but in determining the correct dosage of hormones to be used. Dr. Dagstani has been working with the pellets for over 5 years and has performed more than 14,000 pellet procedures.
4. Are there any side effects or complications from the insertion of pellets?
Possible complications include minor bleeding, bruising, discoloration of the skin, infection, and possible extrusion (coming out) of the pellets. Other than slight bruising or discoloration of the skin, these complications are very rare. In order to minimize the possibility of the pellets being extruded or infection, extended exposure to soaking (swimming, hot tubs, bath tubs) and vigorous physical activity are avoided for 48 hours in women and up to 7 days in men.
5. What changes can occur after pellet insertion and how long before I feel the effects?
Estrogen typically produces many of its effects much more rapidly than testosterone. Often in only a few days there is relief from night sweats and hot flushes. It usually requires a few weeks before noticing:
* Increased energy levels
* Restored or increased sexual drive
* Consistency in moods
* Relief from anxiety and depression
* Increased mental focus and clarity
* Decreased body fat
* Greater capacity for getting the body in shape
* Improved sleep
6. How long do the pellets last?
Typically between 3 – 5 months in both men and women
7. Do patients need progesterone when they use the pellets?
Any time estradiol is prescribed and a woman still has her uterus, progesterone must be prescribed. Progesterone is most effective as an oral capsule, and tends not to hold together well in pellet form, so it is generally not used in pellet form.
8. Is hormone pellet therapy only for women in menopause?
Definitely not! Women at any age may experience hormone imbalance. Levels can decline or fluctuate at any age, contributing to debilitating symptoms. Pellets are useful in PMS, post partum depression, menstrual or migraine headaches, and sleep disorders. Pellets may also be used to treat hormone deficiencies caused by the birth control pill.
9. Is there a need for testosterone in women?
Absolutely! Unfortunately still today many patients and even health care practitioners consider testosterone to be a “male hormone”. This, however, is definitely not the case. The role of testosterone in women is just as important as it is in men; women simply need less of it. Women benefit from the proper amount of testosterone with, among other benefits:
* Increased energy levels
* Restored or increased sexual drive
* Consistency in moods
* Relief from anxiety and depression
* Increased mental focus and clarity
* Decreased body fat
* Greater capacity for getting the body in shape
10. Do men need hormone therapy?
Oh yes! Testosterone levels in men tend to decline in their 40s, and often earlier than that. Men should be tested when they begin to show signs of testosterone deficiency, which are similar for both men and women. Testosterone deficiency can also be part of the cause for male erectile issues.
11. How are the hormones monitored during therapy?
Hormone levels will be drawn and evaluated prior to therapy. Hormone therapy is NOT for everyone, it is for those who have decreased levels on lab testing, and/or display hormone deficiency symptoms. Lab testing for women includes FSH, estradiol, testosterone, and thyroid (tsh). Men need to test PSA, estradiol, testosterone, and thyroid. Levels will be reevaluated at 4 to 6 wks and again a week or two prior to the next insertion procedure. After testing levels following the first 2 or possibly 3 insertions, blood work will only be necessary on an annual basis.
12. Will insurance cover the pellets and insertion?
Unfortunately, extremely rarely. It is always wise, however, to check with your specific insurance company.
13. Why do so many providers say “there is no data to support the use of pellets”?
If your healthcare practitioner says this, they are wrong! There is of course a big difference between “no data” and not having read the data. It is much easier for busy practitioners to say this and dismiss the patient than it is to question their beliefs and do the research.
14. Are there differences in pellets among different providers?
Hormone pellets are always produced by either a compounding pharmacy, or, in the case of testopel, a drug manufacturer. There is not a single medical practice in the U.S. that produces its own pellets or that has an exclusive relationship with a pharmacy which produces pellets. Today there are a number of pharmacies creating pellets and quality can vary from one pharmacy to the next. Dr. Dagstani acquires his pellets from only one specific pharmacy that has been producing pellets for more than 45 years and sends pellet samples to a third party lab for independent testing. There are a few medical practices today that focus exclusively on providing pellet hormone therapy and attempt to create the illusion that they are utilizing a specialized form of pellets and pellet hormone therapy. This is simply a marketing strategy and not factual. The difference among the medical practices is typically not in the pellets but in the knowledge and skill level of the practitioners, i.e. dosing knowledge, procedure skill, problem resolution abilities, etc. Dr. Dagstani has performed thousands of pellet procedures and has acquired a level of expertise in pellet hormone therapy possessed by only a handful of others. In his current practice, Dr. Dagstani provides more than pellet hormone therapy to his patients because he does not believe that there is any single treatment method that is the answer for all patients or all health issues.
