Pellets, in a medical context, are tiny compressed cylinders of hormones that get inserted under your skin and slowly release medication over several months. Each pellet is roughly the size of a grain of rice, made from crystalline hormone that dissolves gradually once placed in the fat layer beneath your skin. They’re most commonly used for hormone replacement therapy, delivering a steady stream of testosterone or estradiol without the daily routine of creams, patches, or pills.
How Hormone Pellets Work
Unlike a pill that spikes your hormone levels and then drops off, pellets release hormones through a process of surface erosion and gradual dissolution. Think of it like a slowly dissolving tablet buried just beneath your skin. As the outer layer erodes, small amounts of hormone enter your bloodstream continuously. This steady-release design avoids the fluctuations in blood levels often seen with creams, patches, or injections, where levels can swing between doses.
Pellets typically last three to six months before they fully dissolve and need replacement. Most people end up getting new pellets inserted two to four times a year to keep their hormone levels stable.
What Hormones Come in Pellet Form
The most common hormones delivered by pellets are testosterone and estradiol (the primary form of estrogen). These can be used alone or combined, depending on the condition being treated. Several other hormones have also been studied in pellet form, including gestrinone (used for endometriosis) and nestorone (a type of progestin studied for contraception).
The only pellet-style implant with full regulatory approval as a drug product is the etonogestrel contraceptive implant, sold as Nexplanon. Most other hormone pellets are made by compounding pharmacies, which is an important distinction. The FDA has noted that compounded hormone pellets are not evaluated for safety, effectiveness, or manufacturing quality in the same way that approved drugs are. Some compounders market these products as more “natural” or superior to FDA-approved hormone therapies, but the FDA has pushed back on those claims, emphasizing that there is no assurance of safety and efficacy for compounded formulations.
Conditions Treated With Pellets
Testosterone pellets are frequently used for men with low testosterone (hypogonadism) and for postmenopausal women experiencing low sex drive, particularly those with reduced androgen levels after menopause or surgical removal of the ovaries. Some clinicians also use testosterone pellets for women with broader symptoms of androgen deficiency, and smaller studies have looked at their use for migraines.
Estradiol pellets target menopausal symptoms like hot flashes, night sweats, and vaginal dryness. They’ve also been studied in postmenopausal women with low bone density. Combination pellets containing both estradiol and testosterone have been used for women dealing with a wider range of menopausal symptoms, including those who’ve had a hysterectomy.
The Insertion Procedure
Getting pellets inserted is a brief in-office procedure, not a surgery. You’ll lie on your side or stomach while the provider works on the upper outer area of your buttock. The skin is cleaned and numbed with a local anesthetic, first at the surface and then deeper into the fat layer where the pellets will sit.
Once you’re numb, the provider makes a small incision, about 3 millimeters (roughly half an inch). A thin tube, about the size of a coffee stirrer, slides through the incision into the fat between your skin and muscle. The pellets are loaded into the tube and pushed into place with a thin rod. After all the pellets are placed, the tube comes out, the incision is closed with a small piece of medical tape, and the whole area is covered with gauze and a clear adhesive bandage.
The incision is small enough that it doesn’t require stitches.
Recovery and Aftercare
Recovery is minimal. You can remove the outer dressing after about 24 hours, though the tape strips closing the incision should stay on for up to seven days or until they curl up and fall off on their own. Showering is fine once the outer dressing comes off, but you should avoid submerging the area in water for 48 hours, so no swimming or soaking in a bathtub.
There are no major activity restrictions, but you’ll want to skip exercises that put pressure on the insertion site for 48 hours. Squats and hip thrusts, for example, could push the pellets out before they’ve settled into place.
Complication Rates
Pellet insertion has a low complication rate overall. A large review covering more than 1.2 million procedures found that adverse effects occurred in roughly 1% of cases. The most common issue was pellet extrusion, where the pellet works its way back out through the skin before it dissolves. This happened in less than 1% of insertions in women and about 2.5% in men.
Infection at the insertion site was rare: about 0.4% in men and less than 0.1% in women. Some people develop minor skin darkening at the incision site or a small area of firmness under the skin from scar tissue. That firmness typically resolves on its own by the time the next insertion is due. With repeated insertions over time, the buildup of scar tissue can make the procedure slightly more difficult, but it doesn’t usually cause problems for the patient.
Extrusion rates also improve with practitioner experience. Early studies showed rates as high as 40% when clinicians were learning the technique, dropping to 5% or lower after gaining experience.
Pellets Compared to Other Delivery Methods
The main advantage of pellets over creams, gels, patches, or injections is convenience and consistency. You don’t have to remember a daily application or schedule regular injections. Once the pellets are in, they deliver a steady hormone level for months. Creams and gels require daily use and can transfer to other people through skin contact. Patches can irritate the skin and may peel off. Injections, whether given weekly or biweekly, produce peaks and valleys in hormone levels between doses.
The tradeoff is that once pellets are in, you can’t easily adjust the dose if side effects appear. With a cream or patch, you can simply stop using it. With pellets, the hormone will continue releasing until the pellet fully dissolves. This makes accurate dosing before insertion especially important. Clinicians typically base the dose on bloodwork, symptoms, and body composition, then monitor levels after insertion to calibrate future doses.