Susan's Place Transgender Resources

I started HRT back in February of 2016 and had issues with getting my estrogen levels up to where they needed to be.
So my doctor had recently told me that she was doing hormone pellets for her trans patients. She said they are usually used on cis-women who undergo HRT for menopause or full hysterectomy. They last for 4 months and they slowly release estrogen without the need for pills or injections!
I was just wondering if anyone else has had them done and their opinion on them!

I just had mine put in 3 days ago!

-Quinn 💖

I too am curious about pellets.  Injections after a year+ is starting to get old.  I can only imagine in 5, 10, 20, 30 years.

I have moved your thread to Hormone Replacement Therapy where it will be seen. There are members on the site who use pellets and they are pleased with the results. It may take a few days for them to check in as pellets aren't commonly used in the United States. They are available but aren't normally used.

Quote from: Dena on January 05, 2018, 10:32:32 PM
...pellets aren't commonly used in the United States. ...

Dena - do you know why?  My GP doesn't use them. I asked.

Quote from: Denise on January 05, 2018, 11:00:20 PM
Dena - do you know why?  My GP doesn't use them. I asked.

I don't know the reason but I have heard several possibilities. Pellets seem to be the most expensive way to receive HRT, they require a surgical procedure which many doctors aren't trained in, I have heard it may require more than one pellet and the pellets are not common so they are produced by a compounding lab. It may even be for some reason other than the ones I mentioned so you should ask your doctor why pellets aren't available.

Pelleted HRT (oestrogen) is not commonly commercially available through the large pharmaceutical companies and are generally made by a compounding chemist.
They are popular in Australia as several of the leading endos like them and have a steady supply. They require a local anaesthetic, a small cut and then insertion of the pellet, about the size of a rice grain.  followed by a stitch to close the wound.

They last from 4-12 months and give steady levels of E.

Disadvantages, the medic has to know how to put the pellet in and many family doctors don't. They can be extruded by physical exercise (very rare) if the wound has not healed. HRT cannot be stopped if so desired. They break down at the end of their life and E levels can rocket for a week or so that confuses the blood picture. They have to be available. You have a series of small scars where they are inserted.

Advantages, steady levels, don't have to remember to take E, cheap (in Australia).

They are usually only used when the E levels have been stabilised by other methods and any medical side effects have been dealt with and when the client is happy to be on E and has no intention of stopping.

I was on them for years and the stopped and went to patches as I could not find a medic to keep implanting them.

Quote from: Cindy on January 05, 2018, 11:44:15 PM
Pelleted HRT (oestrogen) is not commonly commercially available through the large pharmaceutical companies and are generally made by a compounding chemist.
They are popular in Australia as several of the leading endos like them and have a steady supply. They require a local anaesthetic, a small cut and then insertion of the pellet, about the size of a rice grain.  followed by a stitch to close the wound.

They last from 4-12 months and give steady levels of E.

Disadvantages, the medic has to know how to put the pellet in and many family doctors don't. They can be extruded by physical exercise (very rare) if the wound has not healed. HRT cannot be stopped if so desired. They break down at the end of their life and E levels can rocket for a week or so that confuses the blood picture. They have to be available. You have a series of small scars where they are inserted.

Advantages, steady levels, don't have to remember to take E, cheap (in Australia).

They are usually only used when the E levels have been stabilised by other methods and any medical side effects have been dealt with and when the client is happy to be on E and has no intention of stopping.

I was on them for years and the stopped and went to patches as I could not find a medic to keep implanting them.

I am also in Oz and am a very happy user of hrt implants.  In my case they are replaced 6 monthly and my E levels have been stable for a number of years.  My endo does not use a stitch to close the incision.  He has also prescribed E tablets and allows me discretion to take them if I sense that my E levels are falling prior to the next scheduled implant.  To me implants are convenient and effective with no downside.  I am surprised that they are not more commonly used in the US.

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Quote from: Aisla on January 06, 2018, 12:05:25 AM
I am also in Oz and am a very happy user of hrt implants.  In my case they are replaced 6 monthly and my E levels have been stable for a number of years.  My endo does not use a stitch to close the incision.  He has also prescribed E tablets and allows me discretion to take them if I sense that my E levels are falling prior to the next scheduled implant.  To me implants are convenient and effective with no downside.  I am surprised that they are not more commonly used in the US.

And I wouldn't touch them again for all the tea in China.. Stupid waste of my time and money - all I got from day 1 was lower and lower E levels.

As to why they aren't so popular in the US, I'd hazard a guess and say it's because injectables are fairly easily available from large pharma companies - pellets/implants are not.

Quote from: kelly_aus on January 06, 2018, 12:17:08 AM
And I wouldn't touch them again for all the tea in China.. Stupid waste of my time and money - all I got from day 1 was lower and lower E levels.

As to why they aren't so popular in the US, I'd hazard a guess and say it's because injectables are fairly easily available from large pharma companies - pellets/implants are not.

Kelly
How long did you try them? I used a single pellet for 12 months then increased to 2 pellets.  My endo swears by them.  Any ideas as to why your experience was not as positive?

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Quote from: Cindy on January 05, 2018, 11:44:15 PM
Pelleted HRT (oestrogen) is not commonly commercially available through the large pharmaceutical companies and are generally made by a compounding chemist.
They are popular in Australia as several of the leading endos like them and have a steady supply. They require a local anaesthetic, a small cut and then insertion of the pellet, about the size of a rice grain.  followed by a stitch to close the wound.

They last from 4-12 months and give steady levels of E.

Disadvantages, the medic has to know how to put the pellet in and many family doctors don't. They can be extruded by physical exercise (very rare) if the wound has not healed. HRT cannot be stopped if so desired. They break down at the end of their life and E levels can rocket for a week or so that confuses the blood picture. They have to be available. You have a series of small scars where they are inserted.

Advantages, steady levels, don't have to remember to take E, cheap (in Australia).

They are usually only used when the E levels have been stabilised by other methods and any medical side effects have been dealt with and when the client is happy to be on E and has no intention of stopping.

I was on them for years and the stopped and went to patches as I could not find a medic to keep implanting them.

What is the difference between the pellets and patches? What you found in your experience? and whichever is better?

important subject thanks  everyone
I think this would be useful
http://derosamedical.com/hormonal-pellet-faqs/

Quote from: auroratrans on January 06, 2018, 01:46:17 AM

Quote from: Cindy on January 05, 2018, 11:44:15 PM
Pelleted HRT (oestrogen) is not commonly commercially available through the large pharmaceutical companies and are generally made by a compounding chemist.
They are popular in Australia as several of the leading endos like them and have a steady supply. They require a local anaesthetic, a small cut and then insertion of the pellet, about the size of a rice grain.  followed by a stitch to close the wound.

They last from 4-12 months and give steady levels of E.

Disadvantages, the medic has to know how to put the pellet in and many family doctors don't. They can be extruded by physical exercise (very rare) if the wound has not healed. HRT cannot be stopped if so desired. They break down at the end of their life and E levels can rocket for a week or so that confuses the blood picture. They have to be available. You have a series of small scars where they are inserted.

Advantages, steady levels, don't have to remember to take E, cheap (in Australia).

They are usually only used when the E levels have been stabilised by other methods and any medical side effects have been dealt with and when the client is happy to be on E and has no intention of stopping.

I was on them for years and the stopped and went to patches as I could not find a medic to keep implanting them.

What is the difference between the pellets and patches? What you found in your experience? and whichever is better?

important subject thanks  everyone

For me exactly the same. I was fully me before I changed to patches. I just maintain my E levels to suit my physiology. (Under medical supervision).

Hi Quinn,
I am not in pellets yet. I see my endo on the 15th of this month where he will be inserting a pellet (or 2?). He uses them with many of his trans patients and they are sourced from a compounding pharmacy. I am in Australia by the way. The Dr tells me to expect the first pellet to last about 6 months and each subsequent pellet would last a little longer. Time will tell how I feel about the pellets long term. I am looking forward to having this done.

Jayne

I use pellets and Love it.  It's not thinking  about it, and lasting for months really gets me going.  It's not cheap though.  for me, it took a while to get the right number to implant.

Personally it's the best method for me.  I have a history of quitting when on hrt.   Implants force you to stay on it.

bari jo

Quote from: Cindy on January 06, 2018, 01:53:36 AM
What is the difference between the pellets and patches? What you found in your experience? and whichever is better?

important subject thanks  everyone





For me exactly the same. I was fully me before I changed to patches. I just maintain my E levels to suit my physiology. (Under medical supervision).

Thank you
Love ♡

Quote from: Aisla on January 06, 2018, 12:41:33 AM
Kelly
How long did you try them? I used a single pellet for 12 months then increased to 2 pellets.  My endo swears by them.  Any ideas as to why your experience was not as positive?

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Well, there was no encapsulation and no issues with the implantation.. In the end, a defective pellet is a possible answer..

I love pellets, but once my surgeries are done I'd like to move to just pills so I don't keep acquiring 1cm scars.

I've been on implants e or 4 years, and am now 15 months between new ones. The scars are almost impossible to see.

I absolutely love them and have no intention of ever going back to anything else.

I tried a progesterone implant, but it got rejected.

So from what I understand I need to move to Australia for cheaper pellets! Lol
I'm liking it so far. The only thing that is making me anxious is that it's not covered by my insurance so I have to pay for it out of pocket ($350). I'll be going to get my levels checked in two months and i'll Post an update then! Thanks for all of your input about it!
So many different viewpoints and opinions really helps! You're all so awesome! ☺️☺️☺️

-Quinn💖

Quote from: Quinn_Elizabeth on January 06, 2018, 03:29:20 PM
So from what I understand I need to move to Australia for cheaper pellets! Lol
I'm liking it so far. The only thing that is making me anxious is that it's not covered by my insurance so I have to pay for it out of pocket ($350). I'll be going to get my levels checked in two months and i'll Post an update then! Thanks for all of your input about it!
So many different viewpoints and opinions really helps! You're all so awesome! ☺️☺️☺️

-Quinn💖

It seems a lot of trans-related costs are less expensive here in Australia. Like laser hair removal and HRT.

I don't understand why though.

Quote from: Ellement_of_Freedom on January 06, 2018, 07:44:17 PM
It seems a lot of trans-related costs are less expensive here in Australia. Like laser hair removal and HRT.

I don't understand why though.

That's because Australia is the land of Kangaroos, Hugh Jackman, and Tim Tams!
You all have everything going for you!! Lol.

-Quinn💖

Mmmmm TimTams. I wouldn't mind some of those right now.

I have heard wonderful things about pellets. In the medical literature I have read comparing various hormone delivery methods, the pellets were able to achieve the highest serum concentration in the bloodstream, second best was injections.

With the people who complain that they didn't get good results I suspect the reason why is that their physician didn't use an aggressive enough dose. In California Doctor John O'dea who specializes in HRT for transgenders is willing to use an aggressive dose if his patients desire it and everything I have read here from his patients has been very positive. 

Quote from: Bianka Allure on January 08, 2018, 01:27:24 AM
I have heard wonderful things about pellets. In the medical literature I have read comparing various hormone delivery methods, the pellets were able to achieve the highest serum concentration in the bloodstream, second best was injections.

My levels have gotten as high as 4,000 pg/ml with injections, I've read studies where levels were above 6,000 pg/ml. I never came across anyone having such high levels on pellets.

Quote from: Bianka Allure on January 08, 2018, 01:27:24 AM
With the people who complain that they didn't get good results I suspect the reason why is that their physician didn't use an aggressive enough dose. In California Doctor John O'dea who specializes in HRT for transgenders is willing to use an aggressive dose if his patients desire it and everything I have read here from his patients has been very positive.

Just curious what you would consider an aggressive dose.  Don't say the dose, just the e level.  My doctor is targeting close to 400 using pellets for me.  She's upping the dose this week, so if I'm going to say anything about others going higher, I'd love to know:)

Bari Jo

From all I've read, 200 -> 400 is the goal.

My second blood test came in at 740.  My Dr walked in to the exam room and said "oh look, you're ovulating.". I love my Dr; he's a riot.

By the way, last blood test was 919 and T below 10. I do weekly injections considered to be "transition dosage." I may cut them down in size if it stays up that hi. 

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Quote from: Quinn_Elizabeth on January 06, 2018, 08:10:31 PM
That's because Australia is the land of Kangaroos, Hugh Jackman, and Tim Tams!
You all have everything going for you!! Lol.

-Quinn💖

I love Tim Tams! Best part of joint assignments with the Aussies.  Yummy!

Quote from: Denise on January 11, 2018, 06:58:50 AM
From all I've read, 200 -> 400 is the goal.

For my doctors, the goal is not a number. Levels may fluctuate over time, they may not reflect levels inside the cells, no studies have established an optimal level in transwomen and sensitivity to levels may vary across individuals. Levels also range widely in ciswomen, from 20 to up to 75,000.

Instead, the goal is (sustained) feminization, health and well-being. Blood tests are taken regularly.

QuoteBy the way, last blood test was 919 and T below 10. I do weekly injections considered to be "transition dosage." I may cut them down in size if it stays up that hi. 

So far, studies seem to show that even those higher levels don't pose a significant a health risk to even women and men of a certain age, more so if bio-identical estrogen is taken non-orally. I've been on injections before, with levels in the 1,000-4,000 range. Both my endocrinologist and family doctor reviewed my blood test panels on several occasions and deemed it was safe to continue. I was on injections for three years.

I'm on implants and not due for another one until 6 months from now. However I recently visited my endo because I've been feeling very lethargic for the last few months and wanted to find out what was wrong with me. Turns out the implant was running down early and my estrogen level was low - 880 pmol/L. I realise I've felt like this before, sometimes when it's been 1100.

I can't imagine how I'd survive on the even lower levels that many doctors aim for.

I may also experiment with increasing my testesterone levels a bit, though that's a bit scary.

Quote from: AnonyMs on January 11, 2018, 11:53:24 AM
I'm on implants and not due for another one until 6 months from now. However I recently visited my endo because I've been feeling very lethargic for the last few months and wanted to find out what was wrong with me. Turns out the implant was running down early and my estrogen level was low - 880 pmol/L. I realise I've felt like this before, sometimes when it's been 1100.

I can't imagine how I'd survive on the even lower levels that many doctors aim for.

I may also experiment with increasing my testesterone levels a bit, though that's a bit scary.

My levels have been 770 pmol this last time.  I was hoping the new implant today would be double, but it wasn't.  I doubt I'll be in the magic range for this time, disappointed:(

I'll check levels in six weeks to find out.

Bari Jo

Quote from: Bari Jo on January 11, 2018, 02:02:26 PM
My levels have been 770 pmol this last time.  I was hoping the new implant today would be double, but it wasn't.  I doubt I'll be in the magic range for this time, disappointed:(

I'll check levels in six weeks to find out.

Bari Jo

I check levels a week before getting the new one, so 9 months post-implant recently and a year on the one before that. In the weeks after the implant I expect my levels are in the thousands.

Thanks.  I'll mention that to my doctor.  I'm not sure if she will go for that, but I'm hoping.

Bari Jo

That was fast.  My doctor agrees with everything here.  She's saying that an absolute minimum value of 1100 will be the floor of my cycle.  The target is more 1450, but sometimes it'll be above, sometimes below.  If it's ever around 1100 though, time for more implants. This is all new for me, so I'm glad I'm learning about my treatment

Bari Jo

Quote from: AnonyMs on January 11, 2018, 11:53:24 AM
I may also experiment with increasing my testesterone levels a bit, though that's a bit scary.

I brought my dosage of anti-androgen down and it's been great. Just a little, tiny bit of T makes a difference. I'm not as tired and I actually have a mild sex drive now. It's nice.

Quote from: Ellement_of_Freedom on January 11, 2018, 08:05:21 PM
I brought my dosage of anti-androgen down and it's been great. Just a little, tiny bit of T makes a difference. I'm not as tired and I actually have a mild sex drive now. It's nice.

I'm suffering from tiredness. Not sure what libido's meant to be like these days, but its certainly nothing like it used to be.

Quote from: Ellement_of_Freedom on January 11, 2018, 08:05:21 PM
I brought my dosage of anti-androgen down and it's been great. Just a little, tiny bit of T makes a difference. I'm not as tired and I actually have a mild sex drive now. It's nice.

I'm post-op and since adding some T, my sex drive has definitely increased, skin has improved considerably (softer, more supple, shinier and plump) and my energy seems to have increased somewhat. A little T makes a difference in my case too. :)

My T levels are super low. But I've never had any issues with having fun time with the boyfriend. I think that's just because he's such a cutie. ☺️

-Quinn💖

I've been on the pellet implants for a few years.  I love them!  They deliver a much higher E level than was observed with any of the other methods of administration.  Unlike tablets, they do not pass through the liver, but are directly delivered to the bloodstream. They keep the levels very stable which is good for my emotional wellbeing.  And they are cheap (at least, in Australia).  Best of all, I don't have to remember to take a tablet throughout the day. 

I get a new one put in every 6 months, which takes about 20 minutes at the endo's office.

I'm considering moving to the US very soon, and I've heard they are not available there which has me a bit worried.

I'm thinking about whether I can plan trips home to visit the family around visits to the endocrinologist...

I love my 'hip ovaries'.  :-)

Quote from: Claire_Sydney on January 16, 2018, 06:52:23 AM
I'm considering moving to the US very soon, and I've heard they are not available there which has me a bit worried.

I'm thinking about whether I can plan trips home to visit the family around visits to the endocrinologist...

I love my 'hip ovaries'.  :-)

Pellets are available here in the states.  I'm on them.  Pellets aren't common here though.  It's not cheap here either.  I'd say about twice as much as pills if you bought outright.   Pellets aren't covered by my insurance either.

Bari Jo

Quote from: Claire_Sydney on January 16, 2018, 06:52:23 AM
I love my 'hip ovaries'.  :-)

"Hip ovaries" I love it!! I might steal that term for myself. I just got my hip ovaries on Monday and I am thrilled to have them.

Jayne

Quote from: Jayne01 on January 17, 2018, 05:05:50 PM
I just got my hip ovaries on Monday and I am thrilled to have them.

Do you feel the difference yet? It usually takes me a few days, then I feel really good.

Quote from: AnonyMs on January 17, 2018, 06:04:08 PM
Do you feel the difference yet? It usually takes me a few days, then I feel really good.

I'm not feeling any different as far as the level of hormones I'm receiving. That may be masked by the high I am on since the moment the dr injected the local anaesthetic. So far the psychological benefit for me has been incredible. The knowledge that something inside me is releasing the correct hormones all day, every day for the next 6 months is VERY comforting. As I come of this crazy high I'm on, I might start noticing more of the medical effect.

Jayne

I usually get a high/euphoria a few days later. I've had so many implants at this point I'm over the excitement of actually getting it, but I do notice how happy I feel later on. I guess in your case the two causes will merge together and you won't be able to separate them out, this time anyway. Next time you might.

I've also found that I feel really down and lethargic towards the end of the implant. Even at 1000 pmol/L I feel like crap.

I'm also wondering about these "pellets" because I wouldn't want to do pills everyday for the rest of my life.
The issue, and my question is: How is it with scars? Are they permanent? How can people have almost no scars from major surgeries but can get scars from incisions that are big enough for a rice sized pellet?

Quote from: Dena on January 05, 2018, 11:27:38 PM
I don't know the reason but I have heard several possibilities. Pellets seem to be the most expensive way to receive HRT, they require a surgical procedure which many doctors aren't trained in, I have heard it may require more than one pellet and the pellets are not common so they are produced by a compounding lab. It may even be for some reason other than the ones I mentioned so you should ask your doctor why pellets aren't available.

It's kind of funny, because TestoPel is quite common and a great way for Testosterone to be delivered for those with Low T.

Pellets are quite common in Oz  A small incision, 1 or 2 pellets are then inserted and no stitches are required  Repeat every 6 mths  Much better results, less hassle and less stress on the liver

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