Pellets, Creams, or Injections?

The delivery method is not a detail

Patients often assume the hormone is the decision and the delivery is an afterthought. It is closer to the opposite. The same hormone delivered three different ways produces three different experiences, and the difference shows up in how steady you feel and whether you stay on treatment at all.

Creams and patches

Applied daily. Convenient, adjustable, and genuinely effective for some patients. The difficulties are absorption and adherence: uptake varies with skin, application site, body composition and timing, and there is transfer risk to partners and children. A meaningful number of patients never reach adequate levels on topicals no matter how faithfully they use them.

Injections

Effective and inexpensive, with a well-understood profile. The pattern is the issue — a peak after each injection and a trough before the next. Many patients describe cycling with it. Weekly self-injection also asks something of people that not everyone sustains.

Pellets

Inserted under the skin in a short office procedure and released continuously as the tissue absorbs them. Pharmacokinetic study of subcutaneous testosterone pellets found sustained serum levels over roughly 100 to 120 days per insertion.¹

The largest published safety analysis of the method — more than 1.2 million insertions across 376,000 patients — reported an overall complication rate under 1%.²

The figure I find most telling from that analysis is adherence: 93.3% of patients continued therapy after their second insertion.² Compliance is where hormone therapy most often fails. A pellet works whether or not you remember it.

Why we recommend pellets for most patients

Steady levels rather than cycling. Adherence that does not depend on daily habit. No transfer risk. And for anyone who travels, nothing to refrigerate, no syringes through airport security, and no application timing to manage — three or four visits a year and it is handled.

Insertions here are performed by me, Sarah Dottolo or Cristel Capone. For patients who travel, who have struggled with daily regimens, or who simply have not felt right on other methods, pellets are usually where we start — when it is clinically appropriate.

Other methods are the right choice for some patients, and we will say so when that is the case. Read more about hormone pellet therapy.

One more pattern

Some women conclude that hormone therapy did not work for them. Frequently the therapy was not the problem — the delivery was. If levels were never adequate, the treatment was never really tested.

References

1. Pastuszak AW, Mittakanti H, Liu JS, Gomez L, Lipshultz LI, Khera M. Pharmacokinetic evaluation and dosing of subcutaneous testosterone pellets. J Androl. 2012;33(5):927–37.
2. Donovitz GS. Low complication rates of testosterone and estradiol implants for androgen and estrogen replacement therapy in over 1 million procedures. Ther Adv Endocrinol Metab. 2021;12:20420188211015238. Note on this source: the author is the founder of a pellet therapy company, and the data come from that company's provider network. It is the largest published series available and the figure is worth knowing — and so is who published it.

Keep reading

This article is educational and is not medical advice. It does not create a patient relationship. Treatment options may be available when clinically appropriate, and results vary from person to person. If you are experiencing a medical emergency, call 911.