Why Hormone Pellets Are My First Recommendation for Hormone Therapy in Women 

By Dr. David LaMond, Medical Director and Founder — BlueSky MD 

If you’ve come to us for a hormone consultation, you’ve probably noticed we talk about pellet therapy early in the conversation—often before creams, patches, or pills come up at all. That’s not an accident, and it’s not because pellets are the only option. It’s because, for most women I see, they’re the best option, and I want you to understand why. 

In short: hormone pellets deliver a steady, physiologic dose of estradiol and testosterone without the daily maintenance of a cream or patch, they carry a strong long-term safety record backed by over a million documented procedures, and the research on testosterone specifically points toward breast health benefits rather than risk. 

That’s the case I make to my own team of providers, and it’s the same case I want you to have in your hands before your consultation. 

What are hormone pellets? 

A hormone pellet is a small, rice-grain-sized cylinder of bioidentical hormone, that delivers estradiol, testosterone, or both and is inserted just under the skin, usually in the hip area, through a quick in-office procedure with local numbing. From there, it dissolves slowly and releases hormone into your bloodstream continuously, day and night, for roughly three to five months depending on your dose and your body’s absorption. 

That continuous release is the whole point. Your body doesn’t naturally produce hormones in a once-a-day dose. Rather, it releases them in a steady rhythm, and pellets are the delivery method that comes closest to mimicking that. 

I tell my patients, “it’s like filling up a gas tank, you drive for about 3-4 months, your body uses what it needs in real time. When the tank is empty, we refill it.”

Why I start with pellets instead of creams, patches, or pills 

Every delivery method has a role, and I still prescribe topical and oral options when they’re the right fit for a particular patient. But when I’m making a first recommendation, three things push me toward pellets: 

1. Steadier levels, fewer swings. 

Creams and gels depend on how well your skin absorbs them that day — sweat, showering, exercise, even how it’s rubbed in can change how much actually gets into your system. Pellets sidestep that variability almost entirely. 

2. Far less daily maintenance. 

One in-office visit covers three to five months. No daily application, no remembering a patch change, no risk of transferring cream to a partner or child through skin contact. For most of my patients, that alone is worth a lot. 

3. Easier to dose accurately over time. 

Because absorption is so predictable, I can adjust your next pellet dose based on how you responded to the last one—not guess at whether a cream is under- or over-dosing you. That makes fine-tuning your therapy more precise, visit over visit. 

The safety data behind that choice 

I don’t ask my patients to take safety on faith, and I don’t ask my providers to either. The largest published safety analysis of pellet therapy followed over 1.2 million procedures in more than 376,000 patients across seven years. The overall complication rate (things like minor bruising or a pellet needing to be removed) came in under 1%. Patients who completed a second insertion continued therapy over 93% of the time, which is a strong vote of confidence from the people who’d actually lived with it.

That same body of research found no increased risk of blood clots with pellet therapy, which matters. Oral estrogen is processed through the liver in a way that can raise clotting-factor production. Pellets bypass that pathway entirely. 

What about testosterone and breast cancer? 

This is the question I get most often, and it deserves a direct answer: for testosterone specifically, the research points the other way from what most people assume. 

A 10-year prospective cohort study following women on subcutaneous testosterone pellet therapy found a lower rate of invasive breast cancer than the expected rate in the general population. An earlier study from the same research group found the same pattern—reduced, not increased, incidence among women treated with subcutaneous testosterone.

The estrogen side of the conversation deserves its own honesty. Most people have heard that hormone therapy raises breast cancer risk. That idea traces back largely to the Women’s Health Initiative study from the early 2000s.

But the 20-year follow-up on that same trial, published in JAMA in 2020, found that women who took estrogen alone actually had a lower rate of breast cancer than women who took a placebo. The risk signal from the original WHI results was specific to a synthetic progestin used alongside estrogen, not to hormone therapy as a category. A large French cohort study of more than 80,000 women found the same reassuring pattern when estrogen was paired with micronized progesterone instead of a synthetic progestin.

None of this means hormone therapy is risk-free or right for every patient. As with any medical treatment, it isn’t risk-free, and that conversation belongs in your consultation, not a blog post. But it does mean the blanket fear many women carry into that conversation is based on an incomplete picture, and I think you deserve the fuller one. 

A side benefit a lot of patients don’t expect: weight and muscle 

Patients often come to us for menopausal symptoms (poor sleep and mood, hot flashes, low libido, etc.) and are surprised to learn hormone optimization also plays a role in body composition, especially muscle mass.

In our own practice’s outcomes tracking, women who combined hormone optimization with our medical weight-control program lost more weight on average than weight control alone, and testosterone specifically helps preserve lean muscle during weight loss, which matters a great deal if you’re also using a GLP-1 medication, since a meaningful share of the weight lost on those medications alone is muscle rather than fat. 

Is pellet therapy right for you? 

Probably. But “probably” isn’t good enough for something going into your body, which is exactly why this isn’t a one-size-fits-all recommendation. Your candidacy depends on your symptoms, your hormone levels, your personal and family health history, and what you’re hoping therapy will do for you. Some women are better served by a topical or oral option, at least to start, and that’s a legitimate outcome of a good consultation too. 

What I can tell you is this: when a patient is a reasonable candidate for hormone therapy and has no specific reason to avoid pellets, they’re where I start the conversation—not because it’s the only path, but because the evidence and my own clinical experience both point there first. That approach is also consistent with the international consensus statement on testosterone therapy in women, which supports its use for appropriately selected patients based on the same safety and outcomes literature discussed above.

Let’s talk about it 

If you’re curious whether pellet therapy is a fit for you, the next step is simple: schedule a consultation, and we’ll walk through your history, your goals, and your options together—no assumptions, no pressure. 

Get started by contacting us to schedule your labs or by taking our short online-health assessment to assess your symptoms to see if testing for a hormone deficiency is your next logical step.