Dr. Tabatha Barber explains how hormone pellets work and their tradeoffs. Only estrogen and testosterone come as pellets, not progesterone. They're convenient but cause spikes in hormone levels and can't be removed once inserted, so she recommends trying patches, creams, or capsules first.
Hi, I'm Dr. Tabitha, the gutsy gynecologist. I'm a triple board certified, OB, GYN and Functional Medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyne health and your overall health. And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more band aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. Okay. I keep seeing women go on pellets for their hormones. Do I need to do this? Is this the best thing for me? That is a question from Patty in Arkansas. That's a great question. Okay. Hormone pellets, they are very popular. There is a whole movement from a company, I'm not going to name names that really pushes pellet therapy as the only way to do bioidentical hormone replace placement, but there's a couple issues with hormones as pellets. Let me be completely transparent and say that I do offer hormone pellets in my office locally, but I don't do very much of them. I think they are a good option for some women. They are not a good option for all women, and here's why. So, hormone pellets are a pretty hefty dose. You often get a supraphysiologic response, meaning your levels are going to be higher than any normal range that you would shoot for in a normal situation because the pellet gets put in and it goes to this high level and it gets slowly released every single day until it wears off three to four months later and the levels drop down really low again. And so some women tolerate it well and they feel amazing, like they get their pellet and two weeks later they're on top of the world. They're super productive. They're doing all the things they're like, life is awesome. This is fabulous. And then three months later they're in the toilet and they don't want to function. And so it can be that dramatic for some women, it's a little, it's not as obvious. It's like, oh, yeah, I'm feeling Good. And then the three or four month mark, depending on how quickly their body is utilizing it and going through it, metabolizing it. They're like, oh, I think I'm ready for my next hormone pellet. But the hormone pellets, they look like a little piece of rice. They are a device that you have to have inserted under the skin. So you have to have a procedure. Mind you, it's in the office. It's not a big deal. We lay you on your side, we clean off the skin, inject a little lidocaine under the skin, make a tiny little cut, and use a device to shove the pellet in a few inches away from that incision and then put some Steri strips on there and close you up and it heals up in like 48 hours. But it's a procedure. There's a risk of damaging some blood vessels, having a little bleeding, getting bruise. There's a tiny risk of infection, knock on wood. I've never seen that happen. But you are entering the skin, you're going into the subcutaneous fat layer. You're putting that pellet in there for it to slowly release every day into the subcutaneous fat. That procedure costs money, right? It's the doctor taking or the provider taking their time to do that procedure. But the biggest point is that once the pellet's in, it's in. You cannot go and take the pellet out. Like I said, it's as small as a grain of rice. So I would do a ton of damage if I tried to go in and retrieve that pellet. And to find it in your fat layer, it would just never happen. So you want to be sure that you are going to feel good on this hormone that you're receiving. So what I recommend is if you are interested in pellets, that you get that hormone in a different form and see how your body tolerates it. See what kind of level of dosage you need before you make that commitment to getting something put in your body for three or four months that cannot be removed. That's the biggest point. So only estrogen and testosterone come in pellet form. Progesterone does not. So you still want to take a progesterone capsule at bedtime. If you're getting an estrogen pellet or a testosterone pellet. So you're not going to bypass other means completely altogether. I would say start with an estrogen patch or estrogen cream, testosterone cream, something to see how you tolerate these hormones and what kind of dose do you need at this Time and then we can try a pellet and see how you do. I've had many women who have used testosterone cream and for whatever reason, their body doesn't absorb it to any physiologic level that makes them feel better. We repeat their labs and their labs are still low. Or there are a few women, you have to be careful who don't glucuronidate their testosterone well, meaning they don't metabolize it appropriately. Someone with Gilbert's syndrome, they don't glucuronidate things, they don't put this garbage tag on there to remove it from their body. And so you might not tolerate testosterone therapy at all. If you have Gilbert syndrome, you might take a little bit of testosterone cream and it will build up in your system very quickly and you'll get very high levels. And so you absolutely wouldn't want a testosterone pellet. You would probably end up with some acne and chin hair or maybe even hair loss on your head. Those are common symptoms of too much testosterone. So this kind of stuff is important to know. If you are going to a hormone therapist, a hormone specialist, a hormone doctor, whatever they want to call themselves, I want you to go to someone who does more than just pellets. Because if they only do pellets, then they have a very close minded view of how all of this works. That means they did a weekend training course and that is all they know. And so you might get stuck in a situation that you don't feel good in after the fact after you get the pellets. So just be wary. I want you to be educated. You are a consumer. You are buying a product, you're buying a procedure. You are a consumer and you need to go into this because they might not be giving you the full picture or all of the options. So preferably you should go to someone who prescribes hormones in different modalities, not just creams, not just pellets, not just synthetics from the conventional gynecologist. Go to someone who understands all of this. Go to someone who can give you the different modalities and figure out what works best for you. Because we're all individuals and we all respond to medications and hormones completely differently, depending on our genetics, how we metabolize things, how well our liver is functioning, our lifestyle, all of it. So I hope that answers the question. I am for pellets in some women who are a good candidate. Not everybody's a good candidate, so I hope that helps. All right, take care.
