Bioidentical Pellet Hormone Therapy FAQ

What is Bioidentical Hormone Replacement Therapy? 

  • Bioidentical hormone replacement therapy, or BHRT, is a form of hormone therapy using hormones that are structurally the same as those found within the human body. It has been used in the U.S. for many decades.
  • Taking bioidentical hormones can help those experiencing symptoms of low or unbalanced hormones, often seen in perimenopause, menopause, and normal aging.  

Who is a candidate for Bioidentical Hormone Replacement Therapy?

  • Women: Experiencing symptoms like hot flashes, mood swings, sleep disturbances, vaginal dryness, headaches, painful intercourse, night sweats, concentration problems, fatigue, and low libido.
  • Men: With low testosterone ("low T") or low-normal T which can cause sexual dysfunction, muscle loss, fatigue, irritability, anxiety, weight gain, and body hair loss.
  • Younger People: With hormonal issues like adrenal fatigue or thyroid disorders.

Who is not a candidate for Bioidentical Hormone Replacement Therapy? 

  • If you have or are at high risk of breast or prostate cancer, then hormone therapy may not be recommended.  Any risk would be carefully assessed and non-hormone treatments would be offered if needed. 

How is Bioidentical Hormone Replacement Therapy delivered?  

  • There are many delivery routes, including pellet therapy.  Pellets are placed under the skin of the rump and dissolve over a few months.  This is a cash-based service.  Daily treatment with creams, patches, troches, pills, and injections are also available. Those consultations and some of those medications may be covered by insurance.  

What are the steps to get Pellet Bioidentical Hormone Replacement Therapy?   

  • Initial 30 minute consultation: This is typically done in person so that labs can be done.  It can also be done remotely via telehealth.  During the consultation, Dr. Tomlinson will assess your medical history, current symptoms, treatment goals, and educate you about the therapy options.  Lab testing is done for men and premenopausal women.  Postmenopausal women are sometimes able to defer the baseline labwork.  
  • Laboratory resultsDr. Tomlinson will notify you of your lab results and if any treatment plans need to be modified.  
  • Pelleting:  postmenopausal women may be able to get pelleted the same day of their consultation.  Men and premenopausal women will need to have their lab results back prior to pelleting.  Pelleting is usually done a week after the initial consultation and takes about 20 minutes to do.  
  • Post-pellet labsthese are done yearly and after dose increases.  After pelleting, women are tested at 6 weeks and men at 4 weeks.  
  • How long do pellets last: Pellets typically last 3–4 months for women and 5–6 months for men, but the duration depends on factors like metabolism, weight, and activity level. 
  • How often to receive treatments: Typically, women receive treatments every 3 to 4 months, and men every 4 to 6 months.

What are Hormone Pellets? 

  • Hormone pellets are tiny tablets, about the size of a grain of rice, made from plant materials, and structurally the same as the hormone that the human body makes. 

How do Pellets work? 

  • Pellets release hormones directly into the bloodstream, just like your body naturally does. They adjust to your activity and stress levels, providing a steady hormone supply to reduce symptoms and side effects.

What are the pros of Hormone Pellets? 

  • Hormone pellets are very convenient. Instead of taking daily pills or using creams, you only need to visit your practitioner 2-4 times a year for pellet implants. They help maintain consistent hormone levels, making it easier to manage your life and health.

What benefits can I expect?

  • Treatment for symptoms including fatigue, mood swings, low libido, weight gain, insomnia, hot flashes, brain fog, muscle loss, joint pain, and low energy levels.
  • Personalized and precise dosing with bioidentical hormones.
  • Optimized testosterone levels for a resilient body.
  • Increased energy levels, restored sexual drive, consistent moods, relief from anxiety or depression, decreased body fat, increased mental clarity, and greater capacity for getting in shape.

Why are Bioidentical Hormones used? 

As you age, the levels of certain hormones in your body decrease, including estrogen, progesterone, and testosterone. Common effects of low hormones include:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Loss of interest in sex or painful intercourse
  • Problems sleeping
  • Loss of energy or fatigue
  • Weight gain
  • Mood changes
  • Memory loss or confusion

What are the care instructions after Pelleting?  

  • Avoid tub baths, hot tubs, or swimming pools after getting the pellets–3 days for women and 5 days for men.
  • Avoid major exercises involving the glutes (butt muscles)--3 days for women and 5 days for men.  This includes skiing, cycling, steep hiking, squats, crossfit, snowshoeing, etc.  Stairs, strolling, core work, and upper body work are OK.  days.
  • Showering is always allowed, but do not scrub the incision site until it is well healed (about 7 days).

What are the possible side effects?  

Side effects of any type of hormone replacement therapy will depend on dose, route, and a person's health history. Side effects include the following.  Most of these symptoms can be improved with treatments if they happen.  Most will improve with time.  

  • Acne
  • Bloating
  • Weight gain
  • Fatigue
  • Mood swings
  • Blurred vision
  • Increased facial hair
  • Headaches
  • Breast tenderness
  • Spotting
  • Cramping

With pellet therapy specifically, there can also be risks of infection and extrusion of the pellet.  (Especially if the aftercare exercise instructions aren’t followed)

How can I minimize side effects?

  • Healthy Lifestyle Choices: Eat a balanced diet, get enough rest and exercise, and limit alcohol and smoking.
  • Manage Stress: Identify ways to manage chronic health conditions like high blood pressure or elevated cholesterol levels.

What is the cost of treatment?

Consultation and Pellet Pricing:

  • Consultation with Labs (30 minutes): $249 (Men and Premenopausal Women)
  • Consultation without Labs (30 minutes): $149 (Postmenopausal Women)
  • Pellets for Women: $399 (Typically lasts 3-4 months)
  • Pellets for Men:
  • Standard Dose: $599 (Typically lasts 4-5 months)
  • Larger Dose: $799 (Typically lasts 5-6 months)
  • Post-Pellet Labs: Yearly or After Dose Increases: $125


Will Dr. Amy Tomlinson prescribe Hormones to everyone? 

  • While most individuals are candidates for hormone replacement therapy, Dr. Tomlinson will use her expert judgment to assess the safety and suitability of HRT for each patient.

Is this covered by insurance? 

  • No, but daily forms of hormone replacement may be covered. However, insurance typically does not cover any form of testosterone replacement for women.

Are results guaranteed? 

  • No, but Dr. Tomlinson is committed to working with you to find treatments that offer relief from any residual symptoms.

When will I see results? 

  • Some individuals notice changes within a week, while others may not see changes for a few months. If improvements are slow to manifest, daily hormone therapy can be prescribed to use until the pellets become effective.

How long should I stay on Hormone Replacement Therapy? 

  • Dr. Tomlinson will discuss this with you as it is a shared decision tailored to your unique medical situation. Generally, hormone levels decrease year by year as we age. If hormone replacement is discontinued, the body will return to a progressively lower hormonal state.

What are the alternatives to Pellet Therapy? 

  • Dr. Tomlinson can guide you through non-hormone options if desired. Other hormone delivery methods are available, including patches, creams, gels, troches, and injections.

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