Your physician determines suitability after reviewing your history, symptoms and lab results, and will discuss FDA-approved alternatives. Pellets are not appropriate for everyone.

• Once placed, a pellet’s dose can’t easily be adjusted, and pellets are not easily removed.
• Insertion-site pain, bruising, bleeding, swelling or infection can occur. [B1]
• A pellet can work its way out through the skin (extrusion). [B2]
• Once inserted, a pellet’s dose can’t be adjusted, and stopping treatment may require removing the pellets, which isn’t always possible. [B3]
• Hormone levels can rise above the normal range (supraphysiologic levels), especially early after insertion, which may increase side effects. [B4]
• Testosterone pellets carry the testosterone risks listed on our Hormone Therapy page, including higher red blood cell levels, prostate effects in men, increased blood pressure, acne, fluid retention, sleep apnea, reduced fertility and blood clots. [B5]
• The only FDA-approved hormone pellet is a testosterone pellet (Testopel) for certain men with low testosterone. Compounded pellets, including estradiol pellets and compounded testosterone pellets for women or men, are not FDA-approved. That means the FDA has not reviewed them for safety, effectiveness or quality. [B6]
• Talk with your clinician about your personal risks, benefits and FDA-approved alternatives before deciding. [B7]
• Sources: FDA-approved labeling for conjugated estrogens (Premarin), current version June 2026 — DailyMed · FDA-approved labeling for testosterone pellets (Testopel) — DailyMed · Endocrine Society, Testosterone Therapy in Men With Hypogonadism (2018) · Endocrine Society, Treatment of Symptoms of the Menopause (2015) · The 2022 Hormone Therapy Position Statement of The North American Menopause Society · ACOG, Compounded Bioidentical Menopausal Hormone Therapy (2023)
• Last reviewed: October 29, 2026

Before: evaluation and labs. During: a short in-office procedure with local anesthetic. After: follow-up labs and visits; your provider decides whether and when to repeat. Pellet placement requires an in-person visit in Naples.

Hormone Therapy overview