Hormone pellets are small cylinders of testosterone or estradiol, about the size of a grain of rice, placed under the skin of the hip in a brief office procedure. They dissolve slowly and release hormone at a steady rate for three to five months. For patients who have a genuine need for hormone replacement and who want to stop thinking about it between visits, pellets remove the weekly injection or the daily gel from the routine.
At NYMD Center pellets are one delivery option among several, not the treatment itself. The treatment is hormone replacement, decided on the basis of labs and symptoms, and the route comes after. Injections, gels and oral therapy are offered through our hormone replacement service, and each has trade-offs. The main one for pellets is that once placed, the dose cannot be adjusted and the pellet cannot easily be removed, so we prefer to establish the right dose and confirm you tolerate it before committing to a route that lasts months.
Our men's hormone site, andromd.com, covers testosterone therapy in more depth.
Who it affects and the symptoms that bring people in
For men, the reason is low testosterone confirmed on morning blood tests, with symptoms to match: low energy, reduced libido, erectile difficulty, loss of muscle, gain of abdominal fat, low mood or poor concentration. Some men come to us already on testosterone from a clinic that started them without discussing that it would suppress their own production or affect their fertility, and are looking for a physician who will.
For women, the context is menopause and perimenopause: hot flashes, night sweats, sleep disruption, vaginal dryness, mood changes and loss of libido, or in some cases low testosterone contributing to fatigue and low desire. Pellets are one route for estradiol or testosterone replacement in that setting, chosen with our gynecologists.
Pellets appeal most to patients who are established on hormone therapy, know their dose, and find weekly or daily dosing a burden or a source of uneven levels.
How we evaluate it at NYMD Center
Every candidate is evaluated before a route is discussed. For men, that means a visit with a urologist or with our longevity medicine team, a review of symptoms, an exam, and morning labs through our on-site lab: total and free testosterone, ideally on two separate mornings, LH and FSH to show whether the problem is in the testicles or the pituitary, estradiol, prolactin when indicated, a blood count, PSA and a lipid panel. We ask about fertility plans at that first visit, because testosterone therapy suppresses sperm production and a man who may want children should hear about alternatives before starting.
For women, evaluation is with one of our gynecologists and covers menopausal status, bleeding history, breast and clotting history, and whether the uterus is present, which determines whether progesterone is needed alongside estradiol. Labs, a current mammogram and, where bleeding is irregular, an evaluation of the uterine lining come before treatment.
Treatment options
Address the cause first
Low testosterone in a man with sleep apnea, obesity or uncontrolled diabetes often improves when those are treated, and a woman in perimenopause with disrupted sleep may do better with sleep and cycle management before hormones. This costs nothing in side effects and is where we start when it applies.
Fertility-preserving options for men
Clomiphene or hCG stimulate the testicles to make more of their own testosterone rather than replacing it, and they preserve sperm production. They are the first recommendation for a man with low testosterone who may want children, and they are oral or self-injected. They work less reliably when the testicles themselves are the problem.
Injections, gels and oral therapy
Testosterone injections are inexpensive, effective and adjustable, with the trade-off of peaks and troughs between doses and a weekly or biweekly needle. Gels give steady daily levels but must be applied every day and kept from transferring to partners or children. Oral testosterone and, for women, oral or transdermal estradiol offer daily dosing that can be stopped quickly if side effects arise. For a new patient, one of these is usually where we begin, because the dose can be changed within weeks.
Pellets
Placed under the skin in about fifteen minutes and replaced every three to five months, pellets give steady levels with nothing to remember in between. The trade-offs are honest: the dose cannot be adjusted once placed, side effects have to be ridden out, a small number of pellets extrude or the site becomes infected, and levels can run high early and low late in the cycle if the dose is not right. Insurance coverage varies. Pellets suit patients whose dose is established and who value convenience over adjustability.
What every route shares
Testosterone by any route suppresses natural production and sperm counts, can thicken the blood, and needs periodic monitoring of testosterone, blood count and PSA. Estradiol by any route needs progesterone when the uterus is present and periodic breast and lining surveillance. We monitor all of it, on a schedule, regardless of the delivery method.
What to expect at your visit
The first visit, at the Manhattan or Forest Hills office, is the evaluation: history, exam and labs, with a follow-up to review results and decide whether hormone therapy is indicated and by which route. If pellets are chosen, the placement visit takes about thirty minutes in total. The skin over the upper buttock or hip is numbed, a small nick is made, the pellets are inserted through a narrow trocar, and the site is closed with a sterile strip and a dressing. You walk out immediately.
Keep the site dry for a day, avoid baths and swimming for a few days, and avoid vigorous lower-body exercise for about a week. Mild soreness and bruising are normal. Labs are repeated at about four to six weeks to confirm the level, and again toward the end of the cycle to time the next placement. Men have a blood count and PSA checked periodically; women are seen by gynecology on the usual schedule.
Questions patients ask
Are pellets better than injections or gels?
Not better, different. Pellets give steady levels with no daily or weekly task, which some patients value highly. Injections are inexpensive, adjustable and reversible within weeks. Gels are adjustable daily but must be applied consistently and kept away from partners and children. The right choice depends on your levels, your habits and how much you want the ability to change the dose quickly. We offer all of them and recommend based on you.
Will testosterone pellets affect my fertility?
Yes, in the same way any testosterone therapy does. Outside testosterone signals the pituitary to stop stimulating the testicles, so natural production and sperm production fall, sometimes to zero. This is reversible in most men but not all, and it takes months. If you may want children, we discuss alternatives that preserve fertility, such as clomiphene or hCG, before any testosterone is prescribed. This conversation happens first, not after.
What happens if I have side effects from a pellet?
This is the honest drawback of pellets. Once placed, a pellet cannot be adjusted and cannot easily be removed, so a dose that turns out too high, or a side effect such as acne, irritability or breast tenderness, has to be managed until the pellet wears down over several months. That is why we prefer to establish your dose and tolerance with an adjustable route first when there is any uncertainty.
Do estradiol pellets need progesterone?
If you have a uterus, yes. Estrogen given alone thickens the uterine lining and raises the risk of endometrial cancer; progesterone protects it. Women with a uterus receiving estradiol pellets take progesterone as well, usually orally at night. Our gynecologists manage this alongside the pellet schedule and monitor bleeding patterns.
How long does the procedure take and does it hurt?
About fifteen minutes. The skin over the hip or upper buttock is numbed with local anesthetic, a small nick is made, the pellets are placed under the skin through a narrow tube, and the site is closed with tape. Most patients describe pressure rather than pain. Expect mild soreness and bruising for a few days; keep the site dry for a day and avoid vigorous lower-body exercise for about a week so the pellets stay put.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, most major insurance accepted.