Pellet Therapy vs. Injections: Which One Best Fits Your Lifestyle?

Man considering pellet therapy vs. injections.
Once you and your doctor decide you are a candidate for hormone replacement therapy, you will have some important decisions to make. This includes choosing a delivery method. Your doctor will make recommendations, but ultimately, it’s up to you.  The first thing to consider is whether you prefer daily dosing with pills, creams, gels, or patches or a more long-term solution. If you decide that a long-term therapy best fits your lifestyle, you will then need to decide between pellet therapy vs. injections. By considering the risks and benefits of each, you will be empowered to choose the best option for you.

Pellet Therapy vs. Injections: A Look at the Major Differences

Pellet therapy and injections have been around for decades, so both methods have a proven track record. With these options, you don’t have to think about taking a pill or applying a cream every day. You don’t have to worry about a gel transferring to your partner or experiencing daily hormonal fluctuations from short-acting medication. But despite these similarities, there are some important differences.

Pellet Therapy

Implantable pellet therapy begins in your doctor’s office with a minor insertion procedure under local anesthesia. Once the insertion area on the abdomen or buttock has been cleaned and numbed, the pellets are inserted through a small incision. A sterile tape is put in place. The procedure takes just minutes, and the recovery time is a few days during which the area must be kept clean and dry to facilitate healing.  Here’s how pellets work:
  • Pellets are compressed solids just larger than a grain of rice. Once placed in the fatty tissue under the skin, solid pellets dissolve at a slow and steady rate, providing a stable dose of hormone throughout the implant duration.
  • While there are several pellet types available, compounded bioidentical hormone pellets are created for you according to your doctor’s specifications. They contain hormones made from plant sources to match the chemical structure of your body’s own hormones.
  • Since implantable pellets last 3-6 months, the insertion procedures are only required 2-4 times per year.
The primary advantage is that pellets are the longest-lasting delivery method for hormone therapy. They also offer slow, steady, and personalized dosing that mimics your body’s natural release of hormones. This means you can truly set it and forget it. Pellets have historically had a slight risk of insertion site inflammation that could lead to scarring or extrusion of the pellets through the skin. However, recent innovations in pellet formulations have incorporated a very low dose of an anti-inflammatory steroid to combat these complications and ensure faster, more complete healing. 


Hormone injections may be given in your doctor’s office. If you prefer the convenience of self-injection, you can learn to administer your hormone injections at home. In this case, the staff at your doctor’s office will work with you until you feel comfortable with the self-injectable procedure. In both cases, the injection site will be cleaned before the hormone is injected and covered with a band-aid after.  Here’s how hormone injections work:
  • Hormone injections deposit a liquid depot of hormone suspension in a gluteal or thigh muscle. The hormone is then absorbed or metabolized into the bloodstream.
  • Self-injections decrease the number of required visits to the doctor’s office but do not change the number of times an injection must be given.
  • Short-term injections may be required weekly, biweekly, or monthly, whereas long-term injections may last as long as ten weeks.
While injections are longer-acting than most other administration methods, they can cause significant hormonal fluctuation; hormones are absorbed rapidly after each injection and levels decrease over time. Fluctuating hormone levels are often responsible for the uncomfortable symptoms that may occur as a result. 

What Does the Research Say About Pellet Therapy vs. Injections?

To investigate the differences in delivery methods for hormone replacement therapy, researchers at the Baylor College of Medicine compared the long-term effects of men receiving various forms of testosterone therapy over a three-year period. Three groups of hypogonadal men were monitored every 3-6 months: the first group receiving topical testosterone therapy, the second receiving injections, and the third receiving implantable pellets. The results revealed:
  • All methods of hormone delivery raised testosterone levels. The highest levels and greatest fluctuations were seen with injections.
  • An increase in estrogen levels is a side effect of testosterone therapy. The highest estrogen levels were seen in the group receiving injections. When estrogen levels exceeded 5pg/ml, the men were treated with aromatase inhibitors which resolved the problem.
  • None of the hormone therapy methods raised the risk of new or recurrence of previous prostate cancer.
  • Erythrocytosis, an increase in red blood cells that may be dangerous, was observed with all delivery methods. It reached a level that necessitated action (change in dosage or therapeutic blood draw) more often with injections (66.7%) as opposed to pellets (35.1%) and topicals (12.8%).
Though all three methods of hormone administration were effective in raising testosterone levels, the topical and pellet methods had more even and steady serum hormone levels. When comparing pellet therapy vs. injections, pellets offered more reliable, consistent dosing over time.

Choosing the Therapy Best Suited for You

When it comes to hormone replacement therapy, each administration method has unique pros and cons. The key to having the best possible experience is finding a doctor who specializes in hormonal health and has the expertise to provide meaningful guidance. With their support, you can get personalized care and real recommendations that suit your needs and your lifestyle.    Talk to your doctor about the critical window theory and its implications for your midlife wellness. Well-timed hormone replacement therapy can help you find fast relief from current symptoms, but it also supports long-term wellness to help you feel your best in the future 
If you want to know more about the critical window theory of hormone therapy, the doctors in the EVEXIAS Health Solutions network can help. Contact us to learn more about our innovative treatment approach.
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