It’s well established that bio-identical pellet hormone therapy is the most effective method of hormone replacement therapy for women and men. But each patient must have an extensive evaluation to ensure effective therapy and avoid any adverse responses.


I began inserting hormone pellets almost 40 years ago. Since then, there have been advances in patient evaluation — allowing for the most comprehensive and beneficial treatment to date for those who have been found to be good candidates for this therapy. One of the most significant advances has been in the study on Intracrinology — what occurs inside the cell once a hormone, nutrient, or other chemical enters it.


What happens to testosterone once it enters a given cell? There are numerous enzymes inside the cell that could convert testosterone to estrogen or another hormone called dihydrotestosterone. All cells are different and what’s inside the cell can’t be measured in a typical blood test. Healthcare professionals must know what enzymes are in the cell and what causes those enzymes to become more or less active.


What effect does insulin resistance have on converting testosterone to estrogen? It so happens that insulin increases an enzyme called aromatase, which converts testosterone to estrogen. If the recipient of a testosterone pellet is a postmenopausal female with insulin resistance, she will convert her testosterone to estrogen, stimulating the glands that line the uterus (endometrial glands), leaving her with an increased risk of postmenopausal bleeding.


There are numerous medical conditions that increase aromatase enzyme, not just insulin resistance. Shouldn’t that have been evaluated prior to insertion of the pellets and corrective actions taken to prevent postmenopausal bleeding?


Now let’s say another postmenopausal patient receives a testosterone pellet and an estradiol (estrogen) pellet. A few weeks later, she develops significant hair loss, a conditional called androgenic alopecia. Back to the study of Intracrinology. The enzyme that coverts testosterone to dihydrotestosterone is called 5 alpha reductase, type 1 and 2. The major side effect of excess dihydrotestosterone is hair loss, as there is an abundance of this enzyme in the hair follicle. Many healthcare professionals will say the hair loss couldn’t be caused by the pellet because the blood test for dihydrotestosterone is normal. But the study of intracrinology says it’s not in the serum — it’s in the hair follicle, causing hair loss.


Shouldn’t healthcare professionals ask if patients have any risk factors that would increase their risk of developing hair loss prior to insertion of the pellets?


These are two examples that demonstrate the need for an extensive evaluation by a healthcare professional who has knowledge of the field of Intracrinology.


Now let’s go deeper into the evaluation of a patient for pellet therapy. Healthcare professionals should do everything possible to determine the causes of decreased hormone production and return patients to their own natural hormone production. There is no hormone therapy to match physiologic production of hormones in a healthy individual.


A good place to start is asking why the patient needs hormone replacement therapy. If the patient is female, is she menopausal and symptomatic? If so, has that been documented by laboratory testing, i.e., elevated LH, FSH, low estradiol, progesterone, testosterone and DHEA? Is she in the menopausal age range?


If she is premenopausal, why are her hormones low? Is the problem originating in the brain, pituitary gland or ovaries? Is there something decreasing the signal from the brain to the pituitary gland, such as insulin resistance, leptin resistance, low adiponectin, elevated BMI or age, just to name a few?


Is she hypothyroid? Are her cortisol levels abnormal? Does she have low melatonin? Is her prolactin elevated? The list goes on, but every possibility must be considered. If her healthcare professional can determine the cause of the low hormone levels and resolve the problem, her normal physiology will be restored and she can produce her own hormones more efficiently than other forms of bio-identical hormone replacement therapy, including hormone pellets.


It also must be asked if potential hormone pellet recipients have any risk factors that may alter how the pellets will be metabolized. Are they on any medication, face any unusual stress, experience sleep disturbance or follow a special diet? Do they exercise, smoke or drink alcohol; have they been exposed to toxins, or do they taking recreational drugs?


If the patient is male, does he have elevated LH, FSH, low total and free testosterone, low DHT, and low estradiol? Is he at the age consistent with decreased hormone production? If hormone levels are low in a younger male, why? Healthcare professionals must go through the same vigorous evaluation as described above to determine the cause of men’s low hormones. Do they have any risk factors that may alter how the pellets will be metabolized? Ask the same questions noted above.


There are numerous medications that lower testosterone and many that increase estrogen. If you’re a woman and you notice your sexual partner developing enlarged breasts or increased belly fat, crying at movies, loving your purses or shoes, and enjoying going to Victoria’s Secret with you, those are good signs that he has too much estrogen, which will decrease his natural testosterone production.


If a 40-year-old female presents to a healthcare provider complaining of decreased libido, does she have acute hormone pellet deficiency, or could it be the result of stress, problems with her sexual partner, low thyroid, excess insulin (insulin resistance), medications, nutritional deficiencies, environmental toxins, heavy metals, gene mutations, a gastrointestinal problem, neurotransmitter disorder, and the list goes on and on! Pellet therapy is very profitable for healthcare professionals, so before you get started, be sure the decision is based on an extensive evaluation. Ask to see the results of your evaluation and have them explained to you in great detail.


If a woman presents at age 40 with menopausal symptoms, shouldn’t the healthcare provider ask why she has these symptoms at such a young age? If her laboratory tests reveal low hormone levels, instead of simply inserting hormone pellets, shouldn’t the question again be why? By inserting hormone pellets without asking the why questions first, what potential conditions are being masked by the symptomatic treatment and how is that going to affect her long- term health? The same concept applies to younger men presenting with low testosterone.


Pellet hormone therapy is a very effective means to provide bio-identical hormones to individuals who have had extensive evaluations to determine the need for therapy. Then, the therapy must be monitored carefully to ensure the hormones are being metabolized in safe and effective manner.


Hormone Pellet Therapy is Coming!

Starting May 18, 2018!

Potential candidates for pellet therapy will have an extensive evaluation prior to pellet insertion. I will make sure that it is done correctly!

Douglas C. Hall, M.D.