What Is Hormone Pellet Therapy? How It Works and What to Expect

What are hormone pellets made of?

A hormone pellet is a small cylinder, about the size of a grain of rice, made of compressed hormone. For women, the two hormones used are estradiol (the main estrogen your ovaries made before menopause) and testosterone. Some clinics use one, some use both.

The hormones are bioidentical, meaning chemically the same as the ones your body makes. In the United States, pellets for women are prepared by compounding pharmacies for each patient. The FDA notes that compounded drugs are not FDA-approved, so they are not reviewed for safety, effectiveness or manufacturing quality before use. Branded programs such as Biote train and certify clinicians in pellet therapy, but the pellets are still compounded.

How does hormone pellet therapy work?

Once a pellet sits in the fatty tissue under the skin, it slowly dissolves and releases hormone into the bloodstream. A 2025 review of estradiol pellets found that levels rise to a peak in the first week, then stay fairly stable for four to six months. Because the hormone goes straight into the blood rather than through the liver, pellets behave more like a patch or gel than a pill in that respect.

You may read that pellets release more hormone when you exercise because of increased blood flow. That idea is common in clinic marketing, but it hasn’t been well established, so don’t rely on it to predict how long a pellet will last for you.

What happens during pellet insertion?

The procedure is done in a clinic and usually takes 15 to 30 minutes, most of it preparation:

Step by step

How pellet insertion works

1. 1Clean the siteThe clinician cleans an area on the upper buttock or hip.
2. 2Numb the skinA local anesthetic numbs the skin. You’ll feel a pinch and a brief sting.
3. 3Make a small incisionA small incision of a few millimeters is made.
4. 4Place the pelletsA hollow instrument called a trocar places the pellets in the fat under the skin. You may feel pressure.
5. 5Close and dressThe incision is closed with adhesive strips and a dressing, usually without stitches.

Recovery

Expect soreness and a bruise, sometimes a large one, for several days to two weeks. Most clinics ask you to avoid strenuous lower-body exercise, baths, hot tubs and swimming for a few days so the site can heal and the pellet doesn’t work its way out.

How long until you feel a difference?

Timelines vary. Some people notice changes in sleep, hot flashes or mood within a few weeks, and others take longer. The first pellet is an educated estimate, and the dose is often adjusted at the next insertion based on symptoms and sometimes blood tests. That is part of the process, not a failure. If you feel worse, or not better at all, tell your clinician rather than waiting for the next appointment.

How long do hormone pellets last?

Most women are re-inserted every three to six months, so two to four times a year. Clinics differ in how they decide when. The 2025 review cautioned that re-inserting too early, before the previous pellet has worn off, is one of the main ways hormone levels end up higher than intended. Ask how your clinic decides when you are due, and whether they check levels first.

What side effects are possible?

Common, usually short-lived effects include soreness and bruising at the site, breast tenderness, fluid retention and mood swings in the first weeks. Spotting or bleeding can happen in women with a uterus and should always be reported. Testosterone-related effects such as acne, oily skin, unwanted facial hair and scalp thinning are more likely at higher doses. Less common problems include infection at the site and a pellet working its way out. Because a pellet can’t easily be removed, side effects from a dose that is too high may last until it dissolves.

Pellets compared with other ways to take hormones

None of these is best for everyone. The Menopause Society calls hormone therapy the most effective treatment for hot flashes and night sweats and says the choice of type, dose and route should be individualized. For a closer look at one comparison, see hormone pellets vs injections.

Why testosterone is often part of pellet therapy

Women make testosterone too, and many pellet clinics include it. The evidence for testosterone in women is narrower than marketing suggests. The international consensus statement on testosterone for women says the only evidence-based use is low sexual desire causing distress in postmenopausal women, with doses kept in the normal female range. It found too little evidence to recommend testosterone for wellbeing, mood, cognition or bone health, and it advises against treatments that produce above-normal levels. Pellets can do that, especially at higher doses, which is why acne, unwanted hair and scalp thinning are among the most common complaints. See our guide to hormone pellet side effects.

Who might consider pellets, and who should not?

Pellets may suit some women who:

• Have already found a dose that works on another form of hormone therapy.
• Genuinely struggle with daily or weekly treatment.
• Absorb skin products poorly.
• Have a clinician nearby who follows up after each insertion.

What do medical groups say about pellets?

Estradiol pellets have been used for decades and do relieve hot flashes. But because they are compounded, they lack the standardized dosing and large safety studies of FDA-approved products. A 2022 review recommends FDA-approved therapy for most women and notes that pellets producing above-normal levels raise extra safety concerns. Ask your clinician why pellets suit you better than an approved option.

If you would rather avoid a procedure and keep the ability to change your dose, home-based options include FDA-approved patches, gels and pills, and compounded creams. Amie HRT+ is a compounded estradiol and progesterone cream, with the strength chosen by a licensed clinician after an online review. It is not FDA-approved, and a clinician decides whether it is appropriate for you.

Questions to ask before your first insertion

• Which hormones will you use, and why?
• How will you choose my dose, and what levels are you aiming for?
• If I have a uterus, how will you protect my uterine lining?
• When will you check in after insertion, and how do I reach you with side effects?
• How do you decide when I’m due for the next pellet?
• What will a full year cost, including labs and visits? Our hormone pellet cost guide can help you compare.

Looking for a clinic? Our guide to finding a hormone pellet provider covers what to look for, or browse the pellets and Biote hub.