Pellets: Best Form of Delivering Bioidentical Hormone Therapy
The use of hormone pellets is superior to injections. After placing pellets in clients for over 8 years the comparison to injections are superior.
The procedure is safe and performed in the office under local anesthesia.
The chief complaints of BHRT administration with creams and gels are daily administration and a high likelihood of transferring hormones to spouses, children, pets, goldfish and other assorted lovers. Creams and gels take up to eight weeks to become effective.
Injectables are painful, must be performed once or twice a week, inconvenient for travelers, and subject at times temperature swings. Injectable, on average, take four weeks to become effective.
Enter BHRT pellet administration. Modern BHRT pellets release physiologic doses of plant-based, chemically the same as we produce ourselves, hormones, providing optimal therapy. Pellet therapy is quick, easy, nearly painless following our protocol, cost-effective, and is the quickest onset set of action, four to seven days, of any method of BHRT treatment.
What are Pellets?
BHRT pellets, estrogen or testosterone, are pressed cylinders, smaller than a grain of rice, made specifically for the Regen Medical Center by a PCCA certified compounding pharmacy. The FDA approved a 75-mg testosterone pellet in 1972.(1)
Pellets provide consistent, healthy hormone level for 3-5 months in women and 4-6 months in men. In our experience, after two or three cycles, the effects of the pellets may last up to 6 months in both men and women.
Pellets avoid fluctuations in hormone levels, maintain normal ratios of one hormone to another, important for optimal health and disease prevention, and do not increase the risk of blood clots as conventional synthetic hormone replacement therapy does.
Pellets are superior in relieving menopause symptoms, maintaining bone density, restoring sleep patterns, and improving sex drive, libido, sexual energy, response and performance. (2)
Testosterone pellets in women treat migraine and menstrual headaches, vaginal dryness, urinary incontinence, urgency and frequency. In both men and women, testosterone increases energy, lean body mass, strength, bone density, a sense of well-being, improves memory and concentration. Testosterone is an anti-depressant and anti-anxiety agent and decreases fat mass. Adequate levels of testosterone are necessary for optimal mental and physical health. Associated with Alzheimer’s and Parkinson’s disease, multiple sclerosis and diabetes mellitus, type 2, low testosterone levels are problematic at any age.
Bioidentical pellet therapy is the most popular form of treatment at Regen Medical Center. We perform four to five pellet procedures daily. First described in 1938, no other form of hormone delivery is as convenient or effective as implant therapy.
How Can They Not Hurt
The procedure does not hurt and takes about 15 minutes to perform. After local anesthesia a small incision is made and the pellets are placed with a trocar beneath the skin into the fat. Steri-strips applied and cover dressing placed over the surgery site.
Insertion complications parallel any incision based procedure: Minor bleeding or bruising, skin discoloration, infection, and possible pellet extrusion. These are rare. As we use one time only disposable kits, inadequate sterilization of instruments is not an issue.
Excess testosterone metabolism can cause oily skin and hair, “acne,” typically a skin breakout on the neck and shoulders and, in women, a slight increase in facial hair. If your beginning testosterone is low, you may experience a temporary “surge.”
Supplements to lower testosterone for women include reishi mushrooms, red clover, black cohosh, chasteberry, maca root, and saw palmetto. Lowering total saturated fats, decreasing high-glycemic index foods, adding fiber and consuming phytoestrogenic foods such as tofu, soya milk, and flaxseed are remedies on the dietary end.
Spironolactone is a potassium-sparing diuretic that blocks the side effects of testosterone excess.
In our experience, these symptoms resolve in 10-20 days at which point we discontinue the supplements and medications.
We treat men with testosterone excess with saw palmetto, metformin spironolactone.
Estrogen excess results in breast tenderness, gynecomastia, vaginal bleeding, water weight gain and emotional lability. For women we double our progesterone dose until the symptoms resolve. In men we may add Progesterone Cream, Chrysin, DHEA and pregnenolone, and, if extreme, anastrozole 1 mg 1-2x/wk.
Testosterone stimulates bone marrow production of red blood cells. Testosterone therapy administered by any method, may cause an elevation in the red blood cells. Though testosterone does not cause a change in clotting factors, if the hemoglobin and hematocrit (blood count) reach a level of 18.5 and 55 respectively, we recommend a blood donation.
Post op concerns are surprisingly few. Theoretically vigorous activity within 48 hours of insertion may cause pellet expulsion. If the patient is immunocompromised or has had a joint replacement we add in a low dose antibiotic.
Do pellets carry the same danger of breast cancer as other forms of hormone replacement therapy?
The great hormone cancer scare of 2002 courtesy of the Women’s Health Initiative studied oral synthetic hormones derived from horse urine. It is no surprise that the body would protect itself against these foreign invaders by forming cells around the affected tissues, in this case the breast, ovaries and uterus. Excess cells, by definition, are cancer. The hullabaloo does not include pellets as they are bioequivalent in composition. In fact, using bioidentical hormones decreases breast and uterine cancer by ten percent over using no hormone replacement at all.
Testosterone, decreased breast proliferation and lowered the risk of breast cancer, by 50% over those who use no hormonal therapy. In 1268 pre-and postmenopausal women, 142/100,000 in the testosterone group and 390/100,000 in the control group developed breast cancer. The testosterone-treated group exhibited half the breast cancer risk of the not treated group. Put another way, the no testosterone group had more than double the risk of breast cancer than the treated group.(3)
Breast cancer treatment often includes anti-estrogen therapy. Menopausal symptoms, including hot flashes, sleep disturbance, depressed mood, irritability, and fatigue, often severe, are common due to treatment-induced hormone deficits.
43 breast cancer survivors were implanted with two 60 mg of bioidentical testosterone along with 4 mg. of anastrozole pellets every 90 days. The 43 patients have undergone a total of 75 subcutaneous insertion procedures.93% of the patient’s reached therapeutic goals of serum estradiol levels were ≤30 pg./mL and testosterone (range 120 to 518 ng/dL). (4)
No significant adverse effects occurred in any breast cancer survivors treated. No breast cancer has had disease recurrence after three years of therapy.
Three patients with metastatic breast cancer exhibited no disease progression since the onset of treatment. Testosterone implant therapy for advanced breast cancer dates back to the 1940’s.
Bio-identical progesterone, including FDA approved Prometrium does not increase the risk of breast cancer as does synthetic progestins. Progesterone, used vaginally, does not negate the beneficial effects of estrogen on the heart like the synthetic progestins. Estriol, an estrogen widely used in Europe is a bio-identical hormone does not bind strongly to estrogen receptors and does not stimulate breast tissue. Numerous studies indicate that vaginal estriol does not increase the risk of breast cancer (RR 0.7). Estriol lowers the risk of recurrence and death in breast cancer survivors.
Balanced hormones are the key to health and disease prevention.
Imbalances in estrogen, testosterone, and thyroid hormones are common causes of hair loss. Pellet implants thicken hair and moisten scalp hair.
What is the onset of action in pellet therapy?
Most patients notice a significant difference with 4-7 days of the implant. Rarely ten days go by without improved symptomatology. Of course, diet, lifestyle, stress reduction, blood sugar balance and total hormone balance are critical for optimal health.
How long do pellets last?
In women, pellets last between three and five months and in men, four to six months.
What about Progesterone?
Progesterone and synthetic progestins are not one in the same.
Progesterone (not progestin) receptors reside in bone tissue, the brain, heart, bladder, breast and uterus.
FDA approved in 1998, Prometriumâ, is a commercially available bioidentical hormone. Also available as a compound, topicallyoras a vaginal cream, or asan oral capsule, progesterone delivery is versatile. Unfortunately, due to its nature the progesterone pellets are not yet ready for prime time.
Only oral progesterone (100-200 mg) and vaginal progesterone (45-90 mg) protect the uterine lining from estrogen stimulation.
Pre-menopausal patients’ progesterone therapy is cycled, i.e. administered on nights 14-25. Doses range 6.25 mg up to 250 mg orally, and 3 to 30 mg transdermal, depending on symptoms and lab values.
Other Pellet Indications
Pellets address every indication for oral and transdermal hormone therapy. Severe PMS, post-partum depression, menstrual or migraine headaches, sleeping disorders, sexual dysfunction, and hormone deficiencies (testosterone) created by any form of contraception are rife for pellet therapy.
Every patient undergoes a laboratory evaluation before beginning any hormone therapy.
We repeat labs before each insertion for the first year, then once or twice a year after that.
The Final Word
Bioidentical hormone pellets are a safe and effective alternative for both men and women. Pellets are convenient, economical, and provide a stable, predictable, hormonal environment. Pellet results are as or more effective than oral, intramuscular or topical hormone administration in regards to bone density, sexual function, mood, cognitive function, urinary incontinence, vaginal dryness, breast health, lipid profiles, hormone ratios and metabolites.
When it comes to double chins, there’s a new game in town.
Kybella® non-surgically eliminates fat and tightens the skin in the neck and under the chin.
When the fat is gone, it is gone! No scars, no surgery, and no residual hanging skin.
Kybella®, a purified form of deoxycholic acid, is a secondary bile acid active in the gallbladder. It acts like laundry detergent, destroying cells on contact. Strategically injected under the chin, Kybella liquefies fat while simultaneously (micro)-irritating the skin. This micro-inflammatory process stimulates collagen growth and closes pores resulting in thicker, tighter skin over its’ “scaffold,” the chin.
Kybella® , via injection, destroys affected cells within hours, releasing cell contents into the interstitial space of the neck cavity. A slight burning and reddening of the skin surface indicate the micro-irritant process is underway. The emulsified cell content residue is absorbed through the lymphatic system and eliminated by the liver.
The Kybella Experience
It is important to distinguish between fatty tissue under the chin and loose skin. Fat responds to Kybella. Loose skin injected with Kybella will, after the healing phase, look no different. Loose skin is, non surgically, treated with dermal fillers, the PDO Thread Lift, and radio frequency (Thermi-Smooth.)
Before treatment, Dr. Mitchell will discuss all treatment options to determine which are the most efficacious and beneficial for your situation. If Kybella is right for you, before injection, we apply a laser grade anesthetic cream, followed by a treatment grid consisting of a series of dots. The grid is our outline or roadmap guiding the process while avoiding vital nerve and vascular structures.
Using an ultra fine gauge needle, inject Kybella just outside of each dot.
We expect some surface redness and swelling which subsides quickly. Your homework assignment is to apply ice to cool the treated tissue.
KYBELLA® injections offer a new, noninvasive way to improve your profile by removing, moderate to severe fat from under the chin.
Are you a good candidate for Kybella double chin therapy?
This treatment is tailor-made for removing a double chin or submental fat. Excluding the obvious, an infected treatment area, bleeding and blood clotting disorders, and allergy to its’ ingredients, mainly, deoxycholic acid, most everyone is the perfect candidates for Kybella injection.
Is Kybella painful?
Due to the number injections involved, 12 to 20, per treatment session, Dr. Mitchell will administer, before injection, a custom blended 20/8/8 laser grade anesthetic solution to the treatment zone. Patients tolerance varies, but a usual report is “mild stinging to a slight burning.”
Do I have to wait for results? I want instant gratification.
On average, it takes four to six weeks for the cellular debris left by the destroyed fat cells to be absorbed and eliminated. Each Kybella treatment can is roughly a 20% solution. Depending on the sharpness of the chin desired, retreatment occurs at four-week intervals for as many as six treatments. (Average is 2-4)
I’ve heard Kybella is permanent.
Yes, it is. Kind of, maybe. Treatment results are forever as the solution destroys fat cells permanently. Without a proper diet and exercise regimen to place, new fat cells can develop. Typically, Kybella treatments consist of a single treatment cycle only.
What about downtime?
It is import to apply ice to the area after treatment as bruising, and swelling is the result of the destroyed fat cells being reabsorbed by the body. You should plan on an evening of rest the night of your Kybella treatment and only light exercise the next 3-4 days. Avoid blood thinners including alcohol, aspirin, ginkgo biloba, fish oil and Vitamin E.
Applying over the counter Arnica gel or its’ souped up brother Traumeel, and taking Arnica or Traumeel tablets speed healing.
What can go wrong?
Pain, numbness, and redness
Swelling and firmness
Nerve weakness with an asymmetric smile or facial muscle weakness.
The most common side effects are swelling, looking like a “bullfrog” almost, for a few days, redness, bruising, pain or numbness. All subside, for the most part, in 3 to 7 days. A perusal of the literature relates rarely seen muscle weakness with difficulty smiling, an uneven smile or nerve damage.
Can Kybella be used anywhere else on the body for fat reduction?
Kybella currently is FDA approved for double chin fat only. In Europe, Kybella is indicated for:
“Bra” or back fat that is emphasized by undergarments
Under arm fat, located in the area under the axilla
Stomach fat in fit people
Above the knee fat or elbow fat
The safety and effectiveness of Kybella are not FDA approved for body fat reduction in areas other than the double chin.
4-8 weeks after Kybella injections in these areas, we recommend our PDO Thread Lift to tighten the skin around the treated area.
The Lipodissolve solution contains 4x deoxycholic acid than KYBELLA® and has been used for over two decades in France and Italy for spot fat reduction of stubborn fat in various areas of the body. We use KYBELLA® for spot fat reduction of submental fat (double chin) in Flower Mound and Lipodissolve for spot fat reduction of stubborn fat on different areas of the body. Just like KYBELLA®, the Lipodissolve treatment leads to the breakdown of fat cells and release of fat which is removed by your body’s lymphatic and vascular systems. We have seen excellent results with Lipodissolve for non-surgical spot fat reduction and body contouring. We do not recommend Lipodissolve for weight loss.
*Lipodissolve in safe ONLY if obtained from a reputable, PCAB accredited pharmacy and the treatment performed by a medically trained, experienced injector
How Is The Lipodissolve Spot Fat Reduction Done?
For your Lipodissolve spot fat reduction, you will be evaluated by Dr. Mitchell to make sure that you are a right candidate for this treatment. We do not recommend Lipodissolve for individuals with severe and uncontrolled systemic medical illnesses such as uncontrolled diabetes, uncontrolled high blood pressure, severe liver or kidney disease. We do not recommend Lipodissolve if there is a localized skin infection. Your stubborn fat areas, treatment goals, the possible number of treatments needed, and realistic expectations are discussed before the treatment. The treatment area is marked, photographed and cleaned with a surgical cleanser. The Lipodissolve medication is injected with a very fine needle into the excess fat.
What To Expect After The Lipodissolve Spot Fat Reduction?
There is swelling, redness, tenderness and sometimes itching and heat sensation starting immediately after the injection. This is due to histamine release from the medication. An over the counter oral antihistamine such as Benadryl or Zyrtec may help reduce these symptoms. You may take ibuprofen 200-400 mg every 6-8 hours for 3-4 days to reduce discomfort for 2-3 days following your spot fat reduction. We recommend that you apply ice packs for a few hours after the treatment and wear compression garments for certain areas such as the lower abdomen, thighs, love handles and saddle bags for 2-3 days to contain swelling. We re-evaluate your treated area 3-6 weeks after the each treatment for the need of successive treatments.
How Much Fat Will I Lose With Lipodissolve?
You are expected to have 20-25% reduction in localized fat deposit with each Lipodissolve treatment, individual results vary widely with genetics, lifestyle, the size of the fat deposit and other factors that determine your unique fat metabolism. Most of our patients get their desired results for each treated area with 3-4 treatments placed 3-6 weeks apart.
* The use of Lipodissolve for spot fat reduction is considered “off-label” and is at physician discretion. Off-label use of medications is very common in practice of medicine is completely legal.
*A FEW YEARS AGO, LIPODISSOLVE GAINED RAPID POPULARITY IN THE MEDIA AND THERE WERE SEVERAL LESS THAN OPTIMAL TREATMENTS PERFORMED BY “SPAS” WITH SUB-STANDARD LIPODISSOLVE PREPARATION AND NON-MEDICAL INJECTORS, THIS LED TO COMPLICATIONS SUCH AS SKIN INFECTIONS, ULCERATIONS ETC AND FDA ISSUED A WARNING.
ACCORDING TO THE FDA WARNING LETTER DATED APRIL 7, 2010 :
” The U.S. Food and Drug Administration today issued warning letters to six U.S. based medical spas and a company in Brazil for making false or misleading statements on their Web sites about drugs they claim will eliminate fat in a procedure called “Lipodissolve,” or for otherwise misbranding Lipodissolve products. The U.S. companies involved have made claims that the drugs they use for their Lipodissolve procedures are safe and effective; however, these products have not been evaluated or approved by the FDA for this use. Lipodissolve is a procedure involving a series of drug injections intended to dissolve and permanently remove small pockets of fat from various parts of the body. It also is known as mesotherapy, lipozap, lipotherapy, or injection lipolysis. The most commonly injected drugs are phosphatidylcholine and deoxycholate, usually in various combinations with one another.
What is PRP, AKA Vampire Facial?
Platelet Rich Plasma (PRP) Facial Rejuvenation is an extremely safe, more natural option, because the procedure uses your body’s own stem cells, stimulating collagen production. It’s hydrating, provides nutrition and healing properties in the form of concentrated plasma, and helps to repair delicate tissue – such as the thinner skin under the eyes. A boost in collagen creates a more youthful appearance, and results can last for months to years after a PRP Facial Rejuvenation treatment. Typically, one to two treatments 4 weeks apart then once a year for maintenance.
Ideal candidates for PRP Facial Rejuvenation have these skin concerns:
· Dark circles under the eyes
· Aging skin
· Volume loss
· Fine lines
Micro-Needling (also referred to as collagen induction therapy or CIT) is a skin therapy that involves puncturing the skin using a grouping of tiny sterile needles. The purpose of micro-needling is to promote healing without scars and encourage new collagen production similar to fractional laser treatments. Unlike the laser, there are minimal side-effects or downtime associated with micro-needling.
WHAT CAN BE TREATED USING MICRO-NEEDLING?
Micro-Needling is very commonly used to treat thin line and wrinkles, scarring from acne, surgeries, burns, etc. It has also shown great success in the treatment of stretch marks.
WHAT HAPPENS DURING A MICRO-NEEDLING TREATMENT?
A micro-needling treatment begins with an in-depth assessment of your skin’s current state. The provider will assess the potential treatment areas and work with you to decide on an appropriate treatment plan.
After the assessment is done, the provider usually applies a topical anesthetic cream and afterwards will begin treating the agreed-upon areas. The provider will make several passes over the area in a gentle motion passing up and down.
HOW LONG DOES IT TAKE?
Plan to be with us for an hour to an hour and a half, depending on how many areas need to be treated.
DOES IT HURT?
We offer pain management (in the form of a topical anesthetic cream) or by injection of an anesthetic if the provider recommends it. Most patients feel the pressure of the micro-needling instrument.
HOW LONG IS THE RECOVERY TIME?
Micro-needling is not something that really requires downtime. For the most part, your skin will be red and swollen in the treatment areas for up to four (4) days. It is recommended that you avoid exposure to sunlight as much as possible for the next day or two as your skin will be hyper-sensitive. Avoid direct exposure for at least 10 days post treatment if possible. Alcohol based skin products may not be used for 14 days post treatment. Makeup may not be worn for at least 12 hours after treatment unless it is a mineral makeup approved by the provider. You may resume wearing regular mineral makeup the day after treatment.
IS IT SAFE?
Micro-needling is very safe! The risk of infection is minimal since the needles are sterile and the skin is cleaned and prepped beforehand.
CAN ANYONE DO IT?
No. Micro-needling is only to be used with caution and physician approval. It should not be used on anyone with an active skin infections. Micro-needling can NOT be used on anyone with scleroderma, collagen abnormalities, vascular disease or cardiac abnormalities. It can also not be used if you have rosacea, blood clotting problems, are on blood-thinning medication or an immune-suppressing medication, or if you have an active bacterial or fungal infection.
HOW MANY TREATMENTS ARE NEEDED?
Typically, there are 3-4 treatments, 6 weeks apart
Beginning around age 30 our brain, and the rest of our systems, begin to slow. In the past, this was considered a natural, “shelf life” and was accepted as entirely “normal.” As we extend life towards 100 years of age and beyond, those of us in the “middle” want and need to remain vibrant, healthy and productive.
Enter Bioidentical Hormone Replacement Therapy (BHRT). Like a finely tuned, high-end race car, our bodies need certain fluids and filters to operate at maximum capacity. Chevy’s and Maserati’s both need oil, brake and transmission fluid to function optimally. Testosterone, DHEA, Vitamin D, adequate thyroid hormones, peak nutrients, and low levels of inflammation are middle age man’s fluids and filters necessary to function optimally.
Testosterone is the big dog in this hunt and rightly so. It is the “juice,” that makes a guy a guy. (Don’t fret ladies. Women need testosterone too. We will cover that in BHRT for Women.)
Testosterone is the main male sex hormone produced in the testicles and adrenal gland and secreted in the testes.
Passing between life Cycles 4 and 5, around age 35, men produce approximately 1-2% less testosterone per year. An estimated 20% of men over the age of 50 have abnormally low testosterone levels. (2) Between ages 35 and 75 men experience a 30% decrease in total testosterone and a 50% decrease in unbound (usable) free testosterone. (3)
Signs and Symptoms of Testosterone Deficiency:
Low libido and an inability to maintain an erection
Weight gain, decreased fitness level and decreased effectiveness of workouts
Low self esteem
Thin drying hair, sagging cheeks, droopy eyelids, thinning lips
Thin, pale, dry skin, with poor turgor
Memory loss, joint pain
Loss of drive, competitive edge
Increased brain aging
Cardiovascular Aging; Increased Incidence of Heart Attacks and Strokes
Irritable, nervous and hesitant
Increased fat in hips, abdomen, and breasts
Benefits of Restoration of Adequate Testosterone Levels:(4)
Increased sexual interested and sexual performance
Increased sense of well-being
Increased muscle mass, strength, endurance, and exercise tolerance
Improved skin turgor
Decreased body fat
Maintained bone strength, protection against osteoporosis
Elevated brain norepinephrine enhancing memory and cognition.
Decreases in inflammatory markers interleukin 6, c-Reactive Protein, TNF-alpha.)
Increases anti-inflammatory markers IL-4, IL-10
Reduced clotting factors (PAI)-1 and Fibrinogen.
Reduced LDL (bad) cholesterol and improved insulin sensitivity
Protection against high blood pressure, arthritis and excess body fat
Protection against diabetes, insulin resistance and multiple sclerosis
Prevention and treatment of depression.
Prevention of Alzheimer’s disease and dementia
Relief from Dry Eye Syndrome
Adjunct therapy for chronic lumbar pain and chronic pain associated with fibromyalgia.
The combination of a progressive decline of testosterone along with the excess production of a binding protein, sex hormone binding globulin, rendering the remaining testosterone even more ineffective, results in “male menopause,” or “andropause.”
Andropause is implicated in the development of many chronic diseases of aging including diabetes/metabolic syndrome, dementia, Alzheimer’s Disease, coronary artery disease and myocardial infarctions, Frailty Syndrome, osteoporosis, and chronic inflammation.
The Question of the Day is:
Do I Have Low T?
The answer, of course, is maybe. ReGen Medical Center employs a variety of diagnostic tests including blood, urine and saliva to test not only testosterone, but estrogen, human growth hormone, insulin, DHEA, thyroid function, cholesterol, blood sugar and blood count.
Subjectively, we can infer a possible or probable deficiency by reviewing the symptoms listed above or by taking this short quiz.
Testosterone Quiz (5)
Never (0) Always (1)
My face has gotten slack and more wrinkled.
I’ve lost muscle tone.
My belly tends to get fat.
I’m constantly tired.
I feel like making love less often than I used to.
My breasts are getting fatty.
I feel less self-confidant and more hesitant.
My sexual performance is poorer than it used to be.
I have hot flashes and sweats.
I tire easily with physical activity.
Add up your Overall Score ____________: 3 or less: Satisfactory level: Between 4 and 7: Possible Testosterone Deficiency: 8 or more: Probable Testosterone deficiency.