Why I Chose Hormone Pellets | Empowering Midlife Wellness

Hello friends and welcome to this week's episode. I still get a lot of questions about

hormone

pellets

so I wanted to talk to you in a little more detail about

hormone

pellets

and specifically why I

chose

to use them on my own body outside of the There are other options for hormone replacement and there are other options with safety, so I'm not saying it's the only way, but let's talk about why someone might choose hormone pellets and we're just going to assume, for the sake of this conversation, that we're already on board with the idea that taking replacement hormonal is a good idea because it's been talked about a lot in the past on this channel, so let's say we're a postmenopausal or perimenopausal woman and we're looking at the options. about how we are going to replace those hormones that have decreased with age or have disappeared, as you know, when we are in menopause, estradiol, progesterone and testosterone fall to levels that are zero or very close to it and we all know all the symptoms . that goes along with that and if you don't refresh your memory by referring to some previous videos, now we present some options on what to do to replace those hormones, so talking about estradiol first, that is the main estrogen that we produce as women from puberty through Throughout our fertile life and then until menopause, which is when estrogen drops to zero or close to it, we know that the hormone is responsible for many important things, not only does it cause hot flashes, night sweats, vaginal dryness, dry skin , insomnia. a list of other nasty things when it drops to levels below about 40, we also know it increases the risk of osteoporosis, heart disease, colon cancer, sounds a bit like a broken record right now I know, but replacing estradiol it's a great idea.

So what are the rules, so to speak, on how to get this into our system in a safe way and also one that is workable with our lifestyle? Well, we know this from all the many, many, many studies that have been done on the acceleration of hormone replacement over time. In the last 20 years, since the Women's Health Initiative study, which we now know everything about, scared us into thinking that hormones were dangerous, there is a huge acceleration in studies to try to dig deeper into that. and find a better way to do it, even if it wasn't. dangerous, there are better ways to use hormones and one of the things we have known forever, long before I started practicing, is that taking estrogen orally can increase the risk of blood clotting situations, such as type of clots that form in the legs. that thing that goes to your lung we call it a pulmonary embolism or even a stroke and even girls who take birth control pills, for example, can occasionally have that complication, so we've known it forever and it's not surprising that we take estrogen orally .

If you're older, those risks are even a little higher. That said, your risk is still very small if you take estrogen orally, but if you use it in some kind of non-auditory form other than a pill, the risk goes away, so that's awesome, right? What are the options if we are going to choose estradiol in some type of non-auditory form and why did I choose the right granules? I didn't choose the pellets first. I'll tell you the little story of how that happened, so I started by using an estradiol patch and that's a great idea, there's nothing wrong with it and it's a very legitimate way to get estradiol into our system, so the estradiol patches Estradiol that you can get at your regular pharmacy does not need to come from a compounding pharmacy if you have insurance.

They will most likely cover some or all of it. They are small stickers. Different brands are now available in generics, about the size of a quarter. The current ones are a little square, they're actually not even round and you just stick them on your belly or wherever. you want, but I used to put mine under my underwear line partly so I could see it and confirm it was there because they do occasionally fall off, but the current estradiol patches are great and release estradiol into our bloodstream relatively evenly . Manner and I want to dig a little deeper into that because it's not as uniform as you might think, unfortunately we change them twice a week, now there's a brand that you change once a week, but that absorption is even less reliable, so let's say if we're making a patch in my opinion, the best would be the one applied twice a week.

There is a brand called vivel dot dot, which means it is small, but it is now available in generic form so you don't have to pay a lot of money for it. Vivel brand you can now get it generic because its patent ran out, which is always good when that happens, so you put the patch on it and change it. I used to change mine every Monday and Thursday and that was fine and eliminated that first pass through the liver, that happens if we take a pill that causes all the potential problems with blood clotting etc., sounds like a great idea , right?

But there are a couple of problems here and I don't want to say it's a bad idea, like I said. I used it myself for a couple of years, one would think that and the manufacturers tell me that you get a very stable level of estradiol with the patch, well not that when you put the patch on initially, the levels go up very high, so just say you put it in on Monday, if we draw your blood on Tuesday we will get a very high level and if we do it on Thursday right before replacing it with a new one, that level could be very low, so I understood the importance before.

When checking the hormone levels in the blood, I assumed they were the same all the time. Having done many of these blood tests in my office, we see, for example, that patients on the first day of a patch might have an estradiol level. up to a really high number of 250 which, by the way, is too high for a postmenopausal woman and then on the fourth day we might see a level of 20, which is too low for a postmenopausal woman, we really want to maintain the level somewhere midpoint. say 50 to 100 or so to get rid of all those unpleasant symptoms that appear when the numbers drop below 40 or so and provide no other side effects like breast tenderness, fluid retention, weight gain, bleeding, all kinds of things unpleasant.

Things happen when our estradiol gets too high, so we don't want it above a hundred and we don't need it above 100 to get all those health benefits, so there's a narrow window in which we get not only the benefit for our health, but also We also don't have any other side effects, so if you use a patch, this is something that happens to a lot of my patients, they may start having hot flashes on the fourth day because their levels get too low and they may have Breast tenderness the next day. one, so there are a lot of fluctuations up and down during the week and then there is a huge difference between what one patient might experience with exactly the same dose and another because we have different skin types we live in different environments with different temperatures we have different exercise patterns some of us swim for an hour every day and other people sit on the couch those women are going to have different levels of estradiol in their blood the patch is a sticker but there is a tiny amount of space between the patch and the skin and sometimes it will fall off.

He was doing a lot of triathlons when he was wearing the patch and he was swimming and sometimes he would fall and of course then it wouldn't work. I remember sometimes she would be in a very bad mood and whoever was on the other end might say, are you wearing your eyepatch? and I would look down and say no, but you're still an idiot. It probably wasn't true because my levels had plummeted and I felt horrible, so we just weren't feeling it. stable so creams are another option many patients choose just multiply all that by ten times very variable absorption when you use an estradiol cream we have no idea how much of that you are going to absorb its just a complete guess and We know it from the drawing.

The blood levels of patients who are using cream, if you put a cream on them, the level will shoot up very high shortly after applying it and then it will disappear. This is a common thing I have seen in my office, a patient who I put cream on 24 hours ago will have blood drawn and her estradiol is zero. I mean it could be so significant that it literally goes away so there is no way you are going to get a stable level of hormones if you use a cream and then surprisingly also when when you use a patch there are quite a few ups and downs so in my opinion and my experience As a menopausal patient I don't want my hormones to go up and down when I'm menopausal.

I want everything to be pretty stable, that's where we feel. The best you know is that when we were young and fertile, our hormones went up and down as they fluctuated without a period and that didn't always feel good. Did I remember PMS the week before our period? Sometimes we had breast tenderness around ovulation, one of the beautiful things about menopause is that we have the opportunity to have hormones that are stable all the time, so why wouldn't we choose that? Finally, after dealing with the patch for a couple of years, I felt pretty good, but I would have been hot. blinks sometimes on the fourth day it fell off and I didn't notice because it's not always obvious when it falls off and then I have red hair so I get little red circles everywhere my skin got irritated from the glue all those things were manageable if that was the only option available to me and many of you may not have a choice so it's a great option.

Don't get me wrong if you don't have access to hormone pellets so don't let the good be the enemy of the Great, if you can only get a hormone patch that's a fantastic idea, if you have access to a pellet let me tell you why It could be a little better or at least in my case it was a lot better, so the hormone balls are small things, I have a lot of videos on them. Estradiol pellets are actually very small, like smaller than a grain of rice, they come in different doses, so we can customize a dose for an individual patient which would be based on weight, age, and their initial estradiol level. , so for me it was based on a starting level of zero, as it might be for many of you, and then taking into account my weight and age, there is a little calculator published that providers can use frankly after doing a lot. of thousands of granules I no longer use them.

I can estimate that dose without doing that, but less experienced providers do well to use that calculator and another matter of wisdom is not to give the dose that the calculator suggests, but to lower it even from there because there is a subset of patients who just absorb things faster than others and they are more sensitive to things than others, so what we don't want to get with a pill is levels that are too high, so if your provider is using that little calculator because they may not have the experience to dose without it. I personally would ask them not to give you that dose, but they reduce it a little more because, in my opinion and my experience, that calculator is a little aggressive, so the estradiol pellets go under the skin, which is a fantastic idea because it avoids all those potential problems we talk about with creams and patches with differences in skin temperature if you are swimming, exercising, sweating or whatever, the absorption will be very unpredictable to say the least, so put this under your skin bypasses everything that has to do with it and now it's in the body fat about a centimeter under your skin.

I have many videos on how the granules are placed. It's so easy it literally takes 90 seconds. or less to put a pellet in and then they stay there for about three months, so in a pellet there is absolutely nothing except bioidentical hormone and then a packaged powder that is a benign powder of stearic acid or ethylcellulose just for the nerdy scientists who want to see that those are benign powders that the pills are packaged in, you have to stick them on something right and then they are pressed with a very fancy press to turn them into these little popsicles that are very, very dense and over time they dissolve quite a bit. evenly over that three month period, so estradiol, when we've done a lot of studies and people have done a lot of studies on granules, by the way, when doctors say there are no studies on granules, there's a lot of nonsense that they just have.

If I read them, there are hundreds of studies on hormonal pills, in any case, what we see is that the level of estradiol increases quite quickly because it is a very strong hormone. We've already talked about how estradiol is a stronger hormone than testosterone. So within three to five days you will see a complete resolution of your symptoms if you have hot flashes, night sweats, etc., if we draw your blood now, we generally don't do this outside of astudy, but if you started from scratch within five days or so you would be above 50 where your symptoms would resolve and then within seven to fourteen days you would reach a steady state and it would stay pretty much the same for about 12 weeks and then it would just drop into bite and it disappears, so we want to give the next pellet just as the other one starts to fall so that they cross each other and you don't end up in a hole, so with pellets in the right dosage administered by someone who knows how to do it.

Do them, your levels should stay pretty stable now there's a little fluctuation where maybe a little drop at the end of those 12 weeks and there are other things that affect absorption if you're a marathon runner or a triathlete like me. You have to do it a little earlier, so I actually give my pellets every 10 weeks, it's not common, but occasionally patients exercise enough to burn them off very quickly like I do, it's something you learn from experience, if we give it pellets, we'll follow you very closely and find the ideal interval for you, which is 12 weeks give or take a little bit.

Now, if you're a complete couch potato, you might be able to 14 weeks go by, so there's a bit of fluctuation, but it's enough to keep levels pretty stable 24/7 for quite a few weeks, which is great if you've been suffering through the ups and downs of perimenopause and the constant downs of menopause, then that could be an argument for why pellets are better now, it's exactly the same step, right, we're talking about estradiol Plant-based bioidentical, the way it is administered, you can choose the one that suits your lifestyle, a cream, a patch, a granule, even. a shot I didn't even mention them because I don't know anyone who wants to get a shot every week or two, but anything that bypasses the liver will be safe and then we just have to talk about the pros and cons that we've discussed so that You can see why pellets are so appealing that way and it's certainly a little bit of a pain to come every three months to get a new pallet and it's not something that's available to everyone because not everyone has a pallet supplier in their neighborhood, but yes.

If you are looking for one, you can check out the websites of Biot which is one of the biggest pellet manufacturers, Biot.com, another one that we mainly use in my Exeus office. We'll put those links below and they can show you, the suppliers in your local area, there are other pellet suppliers as well, but those are two that are based in Dallas and that have a great reputation and that we certainly use in our office and I I have used both on my own body, so with a lot of experience drawing blood in women who receive estradiol pellets, we certainly see a much more uniform birth than with any of the other options, so if having an even level of hormones is important to you, that might be something to consider now, what are the The arguments against pellets, well the main one I hear all the time is more fear, well what if I don't like it or if I have a problem with him and I stay with him for 12 weeks because you?

You are absolutely right that you can't get a pellet out now, being stuck with it is a good thing in my opinion because you don't have to do anything for three months, but the other side of the coin is that if you got the wrong dose you will be They gave too much in particular, you may have to endure some unpleasant side effects for three months and that's no joke if you have breast tenderness, bleeding, weight gain, fluid retention, you know it can be a big deal. I have seen patients elsewhere who were taking pellets and they had estrogen levels of 400 to 500 too high and they felt horrible, so anything that is too good is not a good thing and it is essential to see someone who knows how to dose correctly and , in my opinion, will start very conservatively. because if we start from scratch we don't need as much, we don't need to have an estradiol level of 300 which feels horrible. 50 would be fine for most patients and I feel great when mine is around 50 or 60 and I try to keep mine very low, high enough but not too high because I don't want to gain weight.

I don't want to have water retention, bad moods, breast tenderness, bleeding, I get it, who wants to have all those things that are horrible? trying to get rid of the side effects without introducing any new ones, so that's a very good argument or thought process. Well, what if I don't like it? There's really nothing there. You could be allergic to its benign dust that you have been exposed to. your entire life and this bioidentical hormone that you've been exposed to your entire life, so in addition to getting the right technician, placing a paddle is incredibly easy but it requires a significant amount of training, which is why, in my opinion, you want to have tosomeone. who is a gynecologist or someone trained by a gynecologist, a psycho women's health nurse practitioner who is who we use in our office to put our pellets in, of course I do them too, but a women's health nurse practitioner well trained will be a fantastic option if she is supervised.

It's critical because it's not too difficult to get the ability to put pellets in and you can do it with a chiropractor or a dentist or God knows who and some of them are probably very good, but let's say endocrinology is probably not their specialty. specialty, so you don't want me to straighten your back, you probably don't want me to pull your teeth out, but I'm pretty good at making balls and I have them in my own body, so that's the information on the estradiol portion of what I could go in the pellet and the other hormone that could go in the pellet you could get one or both and I would recommend both is testosterone and last week I talked about the benefits of testosterone so I won't talk about that again but same thing .

Exact logic applies, what options do we have for testosterone? Well, we don't even have a testosterone patch yet, hopefully we will one day, but it will have the same pros and cons as the estradiol patch. It would be wonderful if we could have a combination patch that would be fantastic FDA please do that for us, but in the short term we can get compounded testosterone from very good pharmacies in cream form, which I don't have a single patient who wants to do and I do it. I tried. myself and within 48 hours I threw it away because it's too hard, you have to measure it perfectly, which is impossible, put it on, dry your arms, don't touch the kids, don't touch the dog, don't go to the gym. means it's too high maintenance and then what we see with that, if patients commit to the hard work of putting cream on twice a day, is that you get a very high spike about a couple of hours after you put it on. the cream and then it disappears completely, so Even if you do it twice a day, we see this very high and low pattern.

In fact, patients who use cream have a much higher incidence of side effects, ironically because so many people talk about the side effects of granules, but because the level skyrockets. high with the cream you are much more likely to have oily skin acne hair growth things like that because we see very high levels like 500 or who knows what and then going down to zero is very, very difficult, it is actually impossible to get a stable level when If you are using a testosterone cream, another way to get it is to somehow have it dissolve in the mouth, so the testosterone could come in the form of what's called a trocha, those little things that dissolve under the tongue again, you'll want to do it twice a day. to get the most consistent level or dips or other shapes that Compounders can do and those are all good options and they also fall into the same list of problems that we've already talked about where it goes up and down and doesn't stay stable.

The pellets, on the other hand, and I talked a lot about this last week, are very stable for about 12 weeks, so with testosterone we will see the levels increase and in about two to four weeks they will reach their stable state and then it will remain stable. there and then it will go away again, so again we want to do the pill every 12 weeks for the average patient and we will see pretty stable levels, which sounds great to me and when I went from using a patch and tried using testosterone cream for a while, as you I mentioned the pill, I thought, Oh my God, why didn't I do this years ago?

What better option to be able to swim, I can run, I can travel, I can do whatever I want. and I'm taking some estradiol and testosterone all the time and I don't have to do anything and for those of us who are busy, we're certainly not lazy, but we are very busy, who wants to try to maintain? Taking something twice a day was too much for me, so in my opinion, my pellets are the preferred method of getting estradiol and testosterone, and again, every fear, almost without exception, in every Google review you've ever seen with a The negative opinion about the hormone pellets is because the patient took too much almost always took too much if it has anything to do with the side effects, she received too much all those things now of course if the testosterone is too high we will see effects masculinizing, even enlarging if the clitoris or deepening The Voice or growing a beard and people who transition transgender would do it on purpose, I mean, we know that high levels of testosterone can literally develop masculine characteristics in someone who born female, we don't want that if we are a cisgender postmenopausal woman, so I keep my testosterone level in the 100 to 150 range.

Other providers I have heard slight levels as high as 250. I don't think it's wise when we see levels above 200, side effects begin. go up and I like not to have any side effects in my practice so we try to keep our levels between 100 and 150 and the only way to know is to do some blood tests, about six weeks after your appeal we draw your blood check the levels see where we are, we made it, we got to that range of 50 to 100 for estradiol 100 to 250 for testosterone and you won't have much trouble if you have slightly high levels for a short time, the worst case scenario, if those levels are a little high after the first pellet, we'll just drop it the second time.

Now more than 90 percent of the time we get it right the first time, but if there's a mistake, we want it to be on the low side because it's very easy to give yourself a little more but obviously you can't take it away, so if it goes too high you can suffer. some nasty side effects for three months and we don't want to do that so be really very careful where you put the pellets and I would have a conversation with the provider and just ask them not to give you the amount that the dosage calculator suggests.

Now you need to defend it yourself, but I would ask you what dose you calculated for me. and please don't give me that much, really do that because that dosage calculator is too aggressive and if doctors use it, about 10 percent of patients will end up with side effects and that's too much for me. I don't want any side effects at all and I will practice how the rate of side effects is very small, so the third hormone, progesterone, does not go into the pill. Then why? There are a couple of reasons, one is that progesterone is actually a fairly large molecule and is not absorbed very well through the skin or even through subcutaneous tissue, so progesterone creams just don't do much.

There is no study showing that progesterone cream administered transdermally reduces the risk of uterine cancer for For example, it also doesn't make you sleepy, which is the main reason I take it. I take progesterone at night orally, it's very safe for the liver, it doesn't cause any blood clotting problems or anything else and it makes you sleepy, and like most of us we suffer from insomnia or have some kind of sleep interruption problems. sleep during the time of menopause. It not only reduces the risk of uterine cancer, but also helps you sleep well. It's also great for hair, skin, nails, mood, anxiety, headaches, and many other things. then the progesterone would be administered orally, estradiol and testosterone on the palate and I believe, as I said from my own experience as a patient and from treating thousands of women, that that is the best option for most women and I recognize that It is not available to everyone. so the patch is option number two if you can't get a pill and let's talk just for a second about men because hormone palettes for men I did a video on that recently and they're also very important um and of course they lose testosterone throughout their lives just as we do.

Hormone lollipops for men is a great idea, they get a lot more than we do of course, so the dosage for a man my age would be about 20 times the dosage I get,so we are looking for levels in men. about 800 to 1200 instead of 100 to 150 totally different doses, so because men get a lot more material in pellet form, there's a little more opportunity for things like bruising, swelling, pain, so using a pellet that has a little bit of an anti-inflammatory is actually very important for male pellet placement, I think and I talked about that in a previous video, we use Vexia brand pellets for men because they have a patent that was recently approved, I think this week about placement. an anti-inflammatory in the pill, so it really reduces pain, inflammation, bruising, all those things that mine had to suffer from occasionally with the pill placement before that breakthrough, so Alexius pills for men I think They are great because they have a little bit of triamcinolone, which is a steroid that acts as an anti-inflammatory, but it is such a minuscule dose that it has no systemic effect, for example, it does not increase blood sugar and It does not cause any other symptoms. that would be seen with steroids that are given at a high oral dose, just a little bit to reduce inflammation around the pellet site, so for the man I also think pellets are better than injections for reasons we've discussed. talked about before, but just to review, the injections are not bioidentical testosterone in general, they are testosterone propionate or cyprionate, who cares what that is, but your liver cares for it to be bioavailable, your livers still have to do a lot job, ironically he doesn't even manage it. mouth but it still has to go through the liver to clean it and that's why you have to check your liver enzymes regularly because it can be bad for the liver and who wants us to only have one liver and I want to keep it really healthy so testosterone pellets because for men or women because they areBioidentical testosterone is not bad for the liver.

The liver doesn't care at all because they don't do what's called a first pass through the liver, so you'll think of the liver as a giant washing machine that's cleaning everything we have. We are ingesting everything that is in our bloodstream, it is a critical organ and we want to give it time to do its other important job and not clean up nasty drugs and chemicals that it is exposed to, which is why bioidentical testosterone and pellet form mark all those boxes and For guys, you just have to get them every five months because they're getting a lot more natural, they last a little bit longer, so just a little bit more information on hormone pellets.

I have them in my own ass. We have many videos. here on our social media about how the pellets are placed, some recent videos showing the pellet placement and how quick and easy it is, so check them out if you like this episode, don't forget to subscribe and share it with your friends. I can not wait. to see you next week