Affordable Natural Hormone Replacement With Pellet Implants

Subcutaneous implantation of estrogen hormone pellets in women can relieve persistent menopausal symptoms in perimenopausal and postmenopausal women. Testosterone pellets can increase sex drive, energy, focus, lean muscle tissue, and decrease irritability in both men and women.  The result of this simple 10 minute—minimally invasive— procedure is an enhanced quality of life, restoration of sex drive and often an overall sense of well being.  These rice grain sized pellets, which have been around since the late 1940’s, but are just now becoming a popular alternative to traditional modes of hormone replacement therapy, are inserted under the skin approximately every 4 to 6 months. They are bioidentical (exact molecular match of human hormone) and consist of pure estradiol, the most important of the three female human estrogens, and if needed testosterone. Pellets are synthesized from soybeans. Other than a small amount of stearic acid, as is common in pharmaceuticals, there are no other ingredients. They dissolve completely with no residual under the skin.  

Pellets are inserted into the subcutaneous tissue generally in the buttock or stomach areas. The hormones are released into the bloodstream in minimal doses specifically designed to deliver the lowest amount for optimal results while avoiding any fluctuations due to mental or physical stress which wear down the body and facilitate the need for more hormones. When this happens the body will respond and deliver an additional dose accordingly. It is this consistent dosing into the blood makes pellet therapy very effective.  

There are many methods of hormone treatments in addition to pellets.  There are oral medications and topical creams/drops, which may not be absorbed into your system, and intramuscular injections which require a monthly trip to the doctor’s office Oral estrogen, creams and drops which must be administered daily may not be absorbing into the system and in addition may be ineffective due to compliance.  Intramuscular injections must be administered regularly, by the doctor, and are often inconvenient . Approximately 30% of women will not tolerate the testosterone shots due to acne that may present.

Hormone pellets may be superior to all of these methods. The pellets, which are better tolerated by both men and women, often last  4-6  months thus affording greater convenience, compliance, and freedom—particularly for the patient who is has a busy schedule.

Symptoms for Treatment

Typical menopausal symptoms in women may include hot flashes, night sweats, weight gain, irritability, anxiety & depression, bloating, and loss of libido. Typical andropausal symptoms in men and women may include loss of drive and motivation, loss of libido, loss of strength & stamina, poor recovery, poor muscle tone & loss of lean muscle tissue, abdominal weight gain & increased fat, brain fog and a lack of mental clarity.

Getting Started

Hormone blood levels are checked prior to insertion (unless you are post menopausal and not on HRT) as well as approximately 6 weeks after insertion to insure proper levels. Often after pellets are initiated it is only necessary to check hormone levels periodically.  In women the estrogen levels should be between around 100pg/ml. and the testosterone about 75pg/ml.  Testosterone levels in men are age related as follows:  18-39 300-1000ng/dl, 49-59 300-900 ng/dl and 60 and older 300-720 ng/dl. 

It is important to maintain these limits in order to prevent undesirable effect

General Side Effects

The plant-derivative based therapy results in very few side effects, most of which are temporary and mild. You may experience breast and nipple tenderness, bloating and possibly a pellet site could get infected or the pellet may dislodge itself from the body. Some women will need progesterone to prevent a return of menstrual type bleeding. The testosterone pellets, in women, have produced occasional incidences of increased or darker hair growth or mild acne. These issues are generally minor and can be easily managed and minimized with hormone adjusting or discontinuance of therapy. If discontinued these symptoms will go away.

How The Pellets Are Inserted

Using a local anesthetic, the pellets are painlessly inserted under the skin of the hip, through a tiny incision, using a small insertion insertion device. After the pellets are inserted, a small piece of tape is placed to close the incision and covered with a Band-Aid. The whole process takes about 10 minutes.

Post Pellet Insertion Instructions

  • Remove Band-Aid in about 3 hours leaving the steri-strip or foam tape in place.
  • Put a fresh Band-Aid over the wound for a few days to catch any oozing that might occur.
  • Keep wound completely dry until the following day.  After that, showering is OK.  Avoid soaking in tubs, pools, or baths for at least 3 days.
  • Leave steri-strip or foam tape on wound until it falls off (usually 2-3 days).  
  • Avoid vigorous exercise for 72 hours to reduce chance of bruising, oozing, or infection, or delayed wound healing. Avoid massage therapy at pellet site.  

A little redness, bruising, and swelling for 3-4 days is normal.  The area may be tender for 4-14 days (possibly more for men). 

If you have continued bleeding, significant redness, pain (without putting pressure on the wound), warmth, or pus from the wound, call us immediately—you might need an antibiotic.  This happens rarely, but infection is always a possibility with any kind of invasive procedure.

Location and Payment

The consultation for HRT as well as any labwork performed can be filed with your insurance company. Labwork results can be accepted from your Primary Care Physician also.

Because of inadequate reimbursement (often not even covering the cost of the materials) the actual pellets need to be picked up by the patient at the designated compounding pharmacy. Insertion will be filed with your insurance company. You may file your insurance yourself for the actual pellets and in most cases receive at least some reimbursement. You should check with your insurance carrier to determine coverage.

All pellets will be inserted at Dr. Cothren’s office located at:

345 23rd  Avenue North Suite 209           
Nashville TN 37203
(615) 815-2350

Cost of Pellets

Charge for insertion:  $250.00
Charge per pellet: $35.00

Total $275 two or three times per year.


As compared to other local clinics which charge a flat rate of $2.500 -$3,000 per year, Hormone Replacement Therapy with The Nashville Center for Cosmetic Gynecology are affordable. The cost (depending on the frequency of insertion) is much less than other local clinics.

Call us today to get started with your Hormone Replacement Therapy or to ask questions. 615-815-2350.

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