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Bioidentical Hormone Therapy: BioTE

What is the difference between taking a pill orally vs other routes?

Oral hormones pass through the liver in the process of metabolism and a result of this liver pass, the liver increases the production of proteins which are involved in blood clot formation. This is why increased risks of stroke and heart attack are reported in women taking oral hormones. The pellets subcutaneous route of delivery directly into the blood stream of active hormone substantially reduces this risk.

What about the estrogen patch? Won’t it provide good hormone levels comparable to the pellets? It is easy to wear and I change it weekly?

No. Blood estradiol levels on the patch are not as high nor as consistent and even as they are on the pellets. The other disadvantage of the patch is that it only contains estradiol or estradiol with a synthetic progesterone. The pellets offer a combination of estradiol and testosterone, which are complimentary to one another. Estrogen eliminates the hot flashes, night sweats, insomnia and vaginal dryness. Testosterone increases energy, enthusiasm, and sex drive.

Why do I have to take progesterone with the estrogen replacement pellets?

Traditional hormone replacement requires the prevention of unopposed estrogen stimulation onto the uterine lining as this can cause uterine hyperplasia, and potentially uterine cancer. Progesterone prevents this overgrowth in most cases so that your risk of cancer of the uterus from estrogen exposure is back to the population’s standard risk. If a woman has had a hysterectomy, progesterone replacement is not necessary because there is no uterus to protect from the estrogen stimulation.

How often do I need to have the pellets inserted?

Timing of pellet insertions is an individual matter but typically the hormone pellets last 4 months (sometimes 3 months and in other sometimes 6 months). You will sense when your pellet hormone replacement levels are getting low and should call the office to have an evaluation for another dose of the pellets.

What are the side effects of hormone pellets?

Most women feel great on the pellets and have minimal to no side effects. But when side effects are reported, the most commonly reported ones are breast tenderness due to the estrogen stimulation of the breast tissue and mild acne from the testosterone and even rarely hair growth. If these symptoms develop, we reduce the dose of the pellets. Rarely side effects can include facial hair growth, weight gain, or fluid retention.

I have heard that estrogen increases my risk of breast cancer. Is this true?

At this time, we have no evidence that estrogen alone increases a woman’s risk of developing breast cancer. The Women’s Health Initiative Study done in 2002 showed an elevated risk of breast cancer in women starting the hormone replacement 10 years post onset of menopause and only in those on synthetic (oral equine estrogen + synthetic progesterone) combination hormones (PremPro) if used for over 4 yrs duration.

If estrogen does stimulate breast cell growth, it appears that testosterone counteracts that process and may be protective against breast cancer development. We do know that estrogen users who do develop breast cancer appear to have a lower mortality from the disease and it is thought this could be due to earlier detection. Our recommendation is to stick with non-oral bioidentical estrogen when possible and testosterone (for libido) and if progesterone is necessary, use bioidentical instead of synthetic.

Any time one uses any medication she must come from the perspective of whether the risks of using the medicine are outweighed by the benefits or are the benefits outweighing the risks. Whether to use HRT a woman must determine these risks for herself with medical professional guidance and use her individual well being and health as a guide to make her decision.

I want protection from bone loss. Will the pellets help with this too?

Yes. Estrogen therapy, especially when combined with Testosterone, has been shown to maintain the mineral content and strength of bones after menopause. In fact, reports also show a yearly rate of increase of 8.3% of bone density in users of bioidentical Estrogen combined with Testosterone.

This is better than most pharmaceutical company products for osteoporosis treatment! The consistent level of estrogen achieved by the pellets is especially effective in preventing bone loss. And one must combine this with adequate intake of calcium and vitamin D daily.

Do the pellets leave me at risk for blood clots?

Oral estrogen, because liver metabolism is required, increases the risk of blood clots. Pellets deliver the estradiol directly into the blood stream without passing through liver metabolism and therefore without increasing the clotting factor production by the liver.

Because of this route of delivery they do not appear to increase the risk of blood clots, and consequently do not appear to increase the risk of strokes or heart attacks that are thrombotic in nature.

How soon will I feel the effects of the hormone pellets?

Fairly rapidly usually. Within a few days to a week.

My sex drive is low and has been for a long time. Can this help?

It appears that estrogen alone is not effective in increasing sex drive. The addition of testosterone, however, increases not only drive, but sexual enjoyment and orgasmic potential. Women who are receiving both estrogen and testosterone report more frequent sexual fantasies, desire to initiate sexual interaction, and pleasure associated with sexual activity.

Combining bioidentical HRT with treatment of the other modalities of loss of libido (life stresses, physical illness, partner/relationship issues, etc) can help drastically to improve your libido (sex drive).

Since the menopause, I have noticed significant mood alteration. I feel depressed and have easy crying fits and difficulty sleeping. Can HRT help?

Yes, estradiol replacement can significantly help this common symptom of menopause.

I have read that hormones cause heart disease. I have a strong family history of heart disease and I do not want to end up with a heart attack. Should I stay away from hormones?

You may wish to discuss this further with your healthcare provider. If you have a strong family history of stroke, breast cancer or heart attack you may wish to avoid HRT altogether. However, it is only true in certain circumstances that estrogen can be a problem and in fact if estrogen replacement is started at the onset of menopause it can actually protect against heart disease.

Studies have shown that in women who experience removal of their ovaries in their 40s (early onset surgical menopause) and did not receive estrogen replacement, they actually had a much higher incidence of heart disease and neurologic disease in the next 30 years than the general population.

Who should not take hormones?

Your provider will evaluate your personal and family history at the time of your consultation and determine if you are a candidate for hormone therapy but generally if you have a history of breast cancer you should probably avoid Estrogen hormone replacement. You may be a candidate for Testosterone pellet therapy though especially if it contains Anastrozole.

Can I get all of my Gynecologic care at this office, or just my pellets?

All of your Women’s Healthcare needs can be addressed at this office and we hope you will take advantage of our extensive menu of expertise! Because of dispensing laws, you will need to receive your pellet therapy procedure at Dr Gulinson’s Millennium Laser and Aesthetics office located at West Thunderbird Rd, Suite b-104, Peoria, AZ 85381.

You must have a full evaluation prior to the onset of any medication and pellet placement HRT is no different. A pelvic examination to evaluate the health of your uterus and ovaries and a breast examination as well as a thorough review of your health and desires is necessary to establish your candidacy for hormone replacement therapy and pellet placement.

A baseline evaluation of your endometrial lining may be required by ultrasound and possibly an endometrial biopsy as well if any abnormal bleeding patterns exist. You may certainly have your initial evaluation and consultation done in Dr Gulinson’s Thunderbird OBGYN office with lab work and review done there. The pellets procedure itself is done at Millennium Laser and Aesthetics Center just a couple blocks away and that number is 623-412-2229.

Where can I find more bio identical hormone replacement pellet information?

Please look to
Dr Gulinson is a provider for “BioTE” bioidentical hormone replacement therapy. Please call for an appointment for your hormone optimization consultation. 623-412-2229 or 602-678-1111.