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Network for Optimal Aging and Wellness
Located in Watkinsville,Georgia

Phone: 706.769.0720

 
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HRT Pellets for Women&Men

Pellet Benefits:

  1. Pellets can be placed in either Women or Men and have been used since the late 1930’s.
    1. Study: Testosterone and the Aging Male. To Treat or not to Treat?
  2. NEWS has been offering Pellet Therapy to women for nearly thirty years and to men for the last five years.
  3. They are convenient.
  4. Pellets hold their own and many times are superior statistically when compared to traditional HRT in relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, improvement in sex drive, libido, sexual response and performance.
  5. Pellets are useful in severe PMS, post partum depression, menstrual or migraine headaches and sleeping disorders. Pellets may also be used to treat hormone deficiencies caused by the birth control pill.
  6. Pellets help people have more energy, sleep better and feel happier.
  7. People see improvement in skin tone and hair texture, concentration and memory as well as overall physical and sexual health.
  8. Normally muscle mass and bone density will increase while fatty tissue decreases. This means patients may notice increased strength, co- ordination and physical performance.
  9. In men, normalizing testosterone can lower cholesterol, improve Osteoporosis and help control Type II Diabetes.
    1. The most significant result I’ve seen was in one of my former receptionists who at 40 had osteoporosis resulting from a complete hysterectomy 10 years earlier. With Pellet Therapy her osteoporosis completely reversed to normal over two years.
  10. Pellets do not increase the risk of blood clots like conventional or synthetic hormone replacement therapy.
  11. Estrogen delivered by subcutaneous pellets, usually maintains the normal ratio of estradiol to estrone; which is important in OptimalAging and disease prevention.
  12. Testosterone Pellet Therapy: Study: Beneficial effects of testosterone therapy in women (Glaser, Dimitrakakis)
    1. In women, has been used to treat:
      1. Migraine and menstrual headaches.
      2. Vaginal dryness, incontinence, urinary urgency and frequency.
      3. Breast cancer patients with menopausal symptoms or just fatigue.
        Study: Low testosterone levels in breast cancer patients (Dimitrakakis, Glaser)
        Study: Testosterone-Anastrozole in breast Cancer Survivors.
    2. In breastfeeding women, it has been used to treat:
      1.  depression / Poster Study: Safety of Maternal Testosterone Therapy During Breastfeeding
    3. In both men and women, it has been shown to:
      1. Increase energy, relieve depression, increase sense of wellbeing, relieve anxiety and improve memory and concentration.
    4. Both men and women need adequate levels of testosterone for optimal mental and physical health and for the prevention of chronic illnesses like Alzheimer's and Parkinson's disease, which are associated with low testosterone levels.
  13. A high success rate is seen in patients who have not received relief from traditional HRT.
  14. I have seen a high success rate in minimizing chronic immunological and psychological “dis-ease” states. I have seen Crohn’s, IBS, RA, MS, thyroiditis, anxiety, depression, etc. improve so as to allow the person to live a livable life.
  15. One aspect of Hormone Pellet Therapy that many physicians do not mention is its property of anti-aging. If the body stays healthier through proper hormone replacement, then life will be better and chronic disease will be pushed into our final few weeks of life rather than carrying on for decades.

The War on Pellet Therapy……

The reason you have not heard of Pellets is because they have been labeled “ALTERNATIVE.” You’re hearing more about them recently because Pellet Therapy is becoming “Vogue,” “Anti-Aging” and a financial avenue for some doctors in this Healthcare Economy. Many traditional doctors believe if it is not an FDA approved drug, then it is dangerous. I believe some doctors have been conditioned to follow rather than think for themselves! One would think that with all of the years of scientific learning they have accumulated they could do better than just do what they are told! But that is another subject.

Is there scientific data on Pellet Therapy?

You “betcha”…..
Pellets are not patented and not marketed in the United States, because they have been around for years, since the 1930’s. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of England and Australia with some from Germany and the Netherlands.
Here in the USA, Compounding Pharmacies make pellets with FDA approved drugs whose patents have expired and thus nothing is to be gain financially from them.  There is a 'FDA approved' 75 mg testosterone pellet.
Compounding Pharmacies can only make quantities for individual prescriptions, they cannot mass produce them, thus they too cannot benefit like Pharmaceutical Companies. So, NO MONEY, NO ADVERTISING….just word of mouth and you can depend on lobbying against Compounding Pharmacies by Pharmaceutical Companies to limit Compounding Pharmacies ability to supply pellets. A right we have to make sure never vanishes in this age of “giving up one’s freedoms.”

What are “Pellets” anyway?

  1. Pellets consist of compounded Bio-identical Estradiol or Testosterone or Testosterone/Arimidex compressed to a size smaller than a “Tic-Tac”
  2. Pellets consistently release physiologic doses of bio-identical hormones avoiding the fluctuations of hormone levels and unwanted side effects seen with other methods of delivery.
  3. Pellets are made by Compounding Pharmacists and come packaged sterile and ready to use. There is a 'FDA approved' 75 mg testosterone pellet; but it comes only in one size!
  4. Pellets usually begin to work within 24-48hrs or at times by 7 days of placement.
  5. Pellets, depending on the biochemistry and stress of the patient may last from 3-6 months in women and men.

How do we do this? Or Pellet insertion?

  1. The implant procedure is simple and no more painful than the injection used to numb the skin on your hip so a small incision can be made. 
  2.  Through this incision a small medical instrument is inserted so the pellets may be slipped under the skin.
    1. Pellets, sized smaller than a Tic-Tac, are either estradiol, a hard crystal of 17 beta estradiol-- the natural estrogen produced by the human ovary, and/or micronized testosterone in a dosage combination that is unique to each individual patient. 
    2. A bikini insertion can be used in those women not wanting a small incision scar on a possibly exposed area of their body.
  3. Then the instrument is withdrawn and the skin closed with a small stitch that is easily removed in three days by the patient.

How often do Pellets need to be replaced?

  1. The replacement timing is dependent on many factors but is usually between 4-6 months. Stress seems to be the biggest influence on timing. Intervals with more stress seem to necessitate earlier placement of pellets, less stress, later placement. Some women can go as long as 6 months; some men 9 months.
  2. But timing is individual and will be determined by blood work and symptoms. Symptoms I call “Little Red Flags.” Everyone has them and we need to determine what yours are.

 Can anyone place pellets?

  1. Experience counts!! NEWS has been offering Pellet Therapy to women for nearly thirty years and to men for the last five years. I can teach anyone to put pellets in. What takes REAL TALENT is in determining the correct dosage and combination of hormones to be used.
  2. Our Philosophy is to use Pellet Therapy as an adjunct to OptimalAging! When Pellet Therapy proves necessary, we use it. It is the “GLUE” that holds the body’s systems together.

Complications?

  1. Usually include minor bleeding, bruising, perhaps discoloration of the skin; after all an incision was made! What is uncommon is possible extrusion of the pellet. Rare still is infection. I have been inserting pellets since the 1980’s and I never have seen an infection with pellets.
  2. I have seen people be allergic to them! Pellets have, along with the hormone, steric acid and Povodone in them.  Povodone is Iodine; which is what I think people are reacting to. They can be made without this ingredient. It is used as a bactericidal agent.
    1. Many patients who develop a local reaction to the implant have low cortisol levels. Cortisol testing may be recommended.
    2. If needed, 25-50 mg of Benadryl works well for the itching. But be careful, Oral Benadryl is not encouraged in the eldering population (age greater than 65) and you might do better with the cream.
  3. Some common rules to follow when your pellets are inserted are:
    1. Avoid aspirin for 24 hours before and after the procedure!
    2. Avoid vigorous physical activity for 48 hours in women and up to 5 to 7 days in men.
    3. Take the stitch out after 3 days.

Are there risks?

I’ve seen people write that Pellets don’t have the same risk as “high doses of oral estrogens, like Premarin, that do not maintain the correct estrogen ratio or hormone metabolites.  Nor, do they increase the risk of breast cancer like synthetic, chemical progestins.” 
The fact is that estrogen, in any form, is carcinogenic!.. but only to some people and not others. The results from WHI proved to me that progestins like Provera are too! I am one Board Certified OB-GYN that can honestly say that she has not written more than three prescriptions for Premarin during her entire career and that was only because of patient’s insistence. One must remember that the Premarin-only arm of WHI did not see an increase in breast cancer only the Premarin/Provera arm did. So, I also have refused to promote Depo-Provera as a contraceptive or use Provera. 
In my 30 years using pellets, I have had patients on Pellet Therapy develop breast cancer. They all had been on the Premarin/Provera combination before pellets, so who is to say the damage was not already started.  But I’ve also had patients on no HRT develop breast cancer too.
Since I believe in “Biological Individuality,” I believe there are people that can do almost anything to themselves and survive; while others perish just having a toxic thought. Until we know the causes for these differences we can only guess and saying one therapy is better than another can only be statistical and not individual. THUS ANYONE CONTEMPLATING ANY HRT NEEDS TO ACCEPT THE RISKS AS WELL AS THE BENEFITS AND DECIDE IF IT IS QUALITY OR QUANITY OF LIFE THEY ARE AFTER.


Are there side effects?

  1. Temporary breast tenderness may be present for a few weeks. It usually gets better on its own. If it is too bothersome, a short term diuretic can be used.
  2. Temporary water weight gain which will also resolve on its own or the diuretic can be used. As the body tones up, bone density and muscle mass increase and fatty tissue decreases, you should begin to “feel better’.

Why do you “mainly” use Testosterone Pellets?

  1. It has been shown that symptoms, including hot flashes, are relieved with continuous testosterone alone. In addition, it does not have the unwanted side effects of estrogen therapy.
    1. A study by Sherwin in 1985 looked at testosterone, testosterone with estradiol, estradiol alone and placebo. The group of women who responded best (somatic, psychological and total score)…testosterone alone! The groups that did the worst…estrogen alone and placebo. Higher levels of testosterone were associated with a better response.
  2. Testosterone is the major ‘substrate’ for estrogen production in the brain, bones, vascular system, breast and adipose tissue.
    1. And one of the points many physicians do not appreciate is that giving a precursor that is “neutral” to the body and allowing the “individual person” to convert what they need into an “active” possible “negative” substance (estrogen) is “giving the lowest possible hormone necessary to get the job done.”
  3. Problems that may arise from using estrogen:
    1. Uterine bleeding. If a menopausal patient has bleeding, it is standard of care to notify her physician and have an evaluation, which may include a vaginal ultrasound and endometrial biopsy.
    2. Breast pain and cysts from estrogen stimulating breast tissue. Which may also increases the risk of breast cancer.
    3. Most women feel better the week after their cycle when estrogen levels are lower.
    4. Excess estrogen can cause anxiety, weight gain, belly fat, tender breasts, emotional liability, symptoms of PMS, and mood swings

Will hormone therapy with estradiol and testosterone pellets help with hair loss?

  1. Even though many people think testosterone causes hair loss, testosterone deficiency is a common cause of hair loss and treatment with testosterone implants can help to re-grow hair. Hair becomes thicker and less dry with pellet therapy, balancing other hormones and adding nutritional support.
  2. Click here for "How to Balance Hair and Hormones."

Do Pellets need to be removed?

  1. No, pellets completely dissolve on their own.

Are Pellets all I need?

  1. Women:
    1. Breastfeeding women:
      1. Testosterone pellet(s) is all you need.
      2. If a pre-menopausal female (this includes breastfeeding women) has a testosterone pellet inserted, she must use birth control. There is a theoretical risk of ‘masculinizing’ a female fetus (giving male traits to a female fetus) if she were to get pregnant.
    2. Pre-menopausal and Post-menopausal.
      1. Depends on what individual hormones need replacing. At times you may need to add some form of Progesterone and at times an Aromatase Inhibitor.
        1. Progesterone prevents the proliferation (stimulation) of the uterine lining caused by estrogen.
        2. Bio-identical progesterone (including FDA approved Prometrium®) has not been shown to increase the risk of breast cancer like the synthetic progestins.
        3. Progesterone, used vaginally, does not negate the beneficial effects of estrogen on the heart like the synthetic progestins.
        4. Progesterone therapy is NOT required if estrogen therapy is not prescribed. However, there may be other health benefits from the hormone, progesterone. It may help with anxiety or insomnia. Interestingly, progesterone implants have been used since the 1940’s.
      2. Again if a pre-menopausal female has a testosterone pellet inserted, she must use birth control.
    3. Breast Cancer Patients and Breast Cancer Survivors
      1. Testosterone pellet(s) and perhaps an Aromatase Inhibitor.
        **I once had an exchange of words with an Oncologist. He said I was using a “Chemotherapeutic Agent” when I used Arimidex. I told him that on the contrary he was using an “Aromatase Inhibitor.”  It reminded of the saying “…a rose by any other name is still a rose.” Aromatase Inhibitors came first, Arimidex, the drug, came second. It matters not what you call it, it matters that you know how to use it.
  2. Men: For men who Aromatize Testosterone to Estrogen, and we have run across many of them, adding an Aromatase Inhibitor helps. This can either be herbal or pharmaceutical.

How do we get started?

  1. Accept that everything has risks but potential benefits out weight the risks for you.
  2. Determine that you need HRT or TRT
    1. Women: Hormonal problems can start at any time pre or post-menopausal.  I am now seeing women in their late 30’s, early 40’s come in with complaints. What is more ominous is that for the 4th year in row, the infertility rate in the USA has gone down. I tell young people that it is not because they are “more careful” than my generation. There is something going on here! Years gone by I don’t think we saw as many menopausal women as we see today. I have noticed that the women in my practice that “lived clean” all their lives have an easier time with menopause.
    2. Men: Testosterone levels begin to decline in men beginning in their 30's. If you have been to Afghanistan with the military, it might even be in your 20’s. Men should be tested when they begin to show signs of testosterone deficiency.
      1. Take the Andropause Questionnaire to determine if you are a candidate.
    3. Be woman or man, it is never too late to benefit from hormone therapy. It can change your life and I have seen it save many a marriage.
  3. Perform Initial blood work:
    1. Women:  FSH, estradiol, testosterone and free testosterone, Mammogram or Thermogram, Breast Exam.
    2. Men:  PSA, estradiol, testosterone and possibly LH/FSH, prostate check.
      1. The PSA in men is followed every 6-12 months.
    3. Hormone levels will then be done prior to each pellet insertion.
  4. After being on HPT and stabilized for at least three months, a comprehensive hormone test evaluating the ability of the patient to metabolism estrogens, is done. If the patient does not do this normally, diet, exercise and supplementation is used to normalize the testing.

What does it cost for pellets?

  1. Initial Consultation Fee $227
  2. If other independent medical concerns arise at subsequent pellet placement visits, then an office visit fee is added.
  3. Initial Blood work $200 to $400 (in our lab, depending on the numbers of tests)
  4. Pellet insertion $250
  5. Pellets for women $52.50 (per E2 or T pellet) / $80 (T/Arimidex pellet)
  6. Pellets for men $70 (per T/200mg pellet) / $80 (T/Arimidex pellet)
    1. Men need a much larger dose of testosterone than women and so the cost will be a little higher.
  7. Before you go thinking this is expensive, price Androgel for 6 months. If you are doing generic oral drugs, nothing can beat that, but is it working for you? The one thing that most people desire is good health. Pellet Therapy in most people seems to add to that concept not detract from it.

Does insurance pay for this therapy?

  1. Most insurance companies do not recognize and will not pay for HPT; but there are a few insurance companies that will cover the cost of this procedure. They are more likely to pay for men’s pellets than women’s. (I guess it’s ok for women to be hypogonadal but not men. To me this is a gender bias!)
  2. Insurance companies generally cover the blood tests for women and men alike.
  3. What makes no sense to me is when compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective. So why don’t insurance companies pay?
  4. As a consumer of your insurance, you may appeal your insurance company’s decision; but you have to do the paper work. You have to relate that “Prevention” is much more cost effective than disease. If enough patients do this, we may again change the way insurance companies cover medical care.
  5. Sample “appeal Letter” Patients are able to ‘appeal' a denied claim.

HPT is the wave of the future for men and women. A handful of physicians have been out riding on this wave by themselves for a long time and Dr. Schultz has been one of them. Our wave is building, our time has come.

I f you wish to consult with Dr. Schultz for an evaluation for HPT please click here for an appointment

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Revised last: 12/2012