HRT: Beyond the Pellet

When people think of bioidentical hormone replacement therapy (BHRT), pellets often get the spotlight — but they’re just one delivery method. Depending on your needs, preferences, and health factors, there are several other effective options:

💊 Options Beyond Pellets

1. Transdermal (through the skin)

• Creams & Gels: Applied daily to areas like the inner arms, thighs, or abdomen. Flexible dosing but can be inconsistent if absorption varies.

• Patches: Deliver a steady, controlled dose. Good for estrogen (commonly used in women), less so for progesterone/testosterone.

2. Oral (by mouth)

• Capsules or Tablets: Bioidentical estradiol, progesterone (micronized), or DHEA. Convenient but go through the liver (first-pass metabolism), which may influence clotting/lipid profiles.

3. Sublingual / Buccal (under the tongue or inside cheek)

• Troches or drops dissolve in the mouth → absorbed directly into the bloodstream, bypassing the liver. Can provide more stable blood levels than oral pills.

4. Injections

• Intramuscular or subcutaneous injections (often testosterone or combination therapies). Dosing is usually every 1–2 weeks, though longer-acting formulations exist.

5. Vaginal

• Creams, suppositories, or rings → mainly for local estrogen/progesterone support (vaginal dryness, urinary symptoms) but can provide some systemic absorption.

⚖️ Pros & Cons Compared to Pellets

Pellets:

✔ Long-lasting (3–6 months)

✔ No daily dosing hassle

✘ Harder to adjust (once inserted, dose can’t be lowered easily)

✘ Requires minor surgical procedure

Other methods (creams, patches, injections, troches, oral):

✔ Easier to start/stop or adjust

✔ No minor surgery

✔ More flexible in titrating dose

✘ Require regular compliance (daily or weekly)

✘ Some forms less steady in blood levels

👉 The best method often depends on:

• Your symptom pattern (steady vs fluctuating relief needed)

• Risk factors (blood clots, cardiovascular disease, breast/uterine health)

• Lifestyle and preference for convenience vs flexibility

• Which hormone(s) you’re replacing (estrogen, progesterone, testosterone, DHEA)

Call or email our office to schedule a consultation if you’d like to receive a personal evaluation and treatment plan.