Bioidentical Hormones: Why Capsules and Creams Are Superior to Pellet Therapy

Author: Lucia McEntee, RPh

Bioidentical Hormones: Why Capsules and Creams Are Superior to Pellet Therapy

In today’s world, bioidentical hormone replacement therapy has gained widespread popularity among both women and men who have experienced the remarkable health benefits it has to offer by restoring hormone balance.

As more healthcare providers are delving into the realm of bioidentical hormone replacement therapy, we are committed to empowering you with the knowledge needed to make an informed decision and the best choice for your health.

Many people have asked us which is the best form to take: capsules, creams or pellets? While pellet therapy has recently become popular with some providers, it is not an effective delivery method, and we will explain why.

Bioidentical Hormones

Bioidentical hormones have the exact molecular structure as hormones produced by your body, so when you restore them, your body knows what to do with them. Just as a key fits perfectly into the right keyhole, bioidentical hormones do the same in your cells.

Common Symptoms of Hormone Decline and Imbalance

Some very common symptoms of hormone decline which indicate that a woman or man can benefit from bioidentical hormones are as follows:


  • Low energy
  • Weight gain
  • Brain fog
  • Hot flashes/night sweats
  • Loss of libido
  • Difficulty sleeping
  • Anxiety
  • Mood swings
  • Headaches/migraines
  • Irregular menstrual cycles


  • Low energy
  • Weight gain
  • Difficulty sleeping
  • Lack of initiative, assertiveness and drive
  • Decline in sense of well-being and self-confidence
  • Depressed, irritable moods
  • Increased body fat around the waist
  • Decline in sexual ability
  • Indecisiveness
  • Decreased mental sharpness
  • Lessened stamina and endurance
  • Loss of muscle mass, strength, and tone
  • Sleep apnea

Methods of Bioidentical Hormone Delivery

While there are several methods of delivering bioidentical hormones to your body, today we will focus on three and explain why we believe capsules and creams are superior to pellet hormone therapy.

Capsules are able to deliver the exact dose that is prescribed by your doctor. You don’t have to rely on a “one size fits all” pill – you can take the dose that is needed for your particular health needs and symptoms. Capsules allow your doctor to individualize your dose and also make it easy to adjust your dose as you work with your doctor to find the right dose to alleviate your symptoms. With capsules, you can administer a higher dose than with creams.

Creams, which deliver the hormones directly into your blood stream through your skin, may allow for lower absorption of hormones than capsules. Absorption depends upon time of year (humid or dry) and condition of your skin (hydrated, dry, irritated). All body sites are not as equally permeable. Application sites for the cream must be rotated, for instance, absorption could be different between the inner arm and inner thigh. The higher the dose you need, the more cream you have to apply to your body. So if you are needing a higher dose, then capsules may be the best fit for you.

Capsules vs. Creams

Choosing between capsules and creams depends upon a few factors: a) the dose needed, b) the patient’s preference, and c) what works best. For those patients who have experience with bioidentical hormones in both capsules and creams, many have found better results by taking them orally. Conversely, some patients prefer creams.

With capsules and creams, if a woman still has symptoms of a hormone deficiency, then the doctor is able to increase the dose immediately so symptoms can be resolved in a matter of hours or days. If the dose is too high, then skipping a dose for a few days is usually all that is needed to eliminate symptoms.

Pellet Therapy

Pellet therapy involves implants that are placed under the skin that release hormones into your body. The pellets, which are a little larger than a grain of rice, contain hormones (either estradiol or testosterone) which are pressed or fused into very small cylinders. (Note that progesterone can’t be used in pellets because it dissolves too quickly.) Then pellets are inserted under the skin through a small incision (either lower abdomen or upper buttocks) with local anesthesia. The incision is then closed with sutures or sterile tape strips. The pellets are replaced approximately every 3 to 5 months. They do not need to be removed – they are dissolved by the body. Patients can begin to feel relief starting anywhere from 48 hours up to 2 weeks after the pellets are implanted.

Hormone Overdosing/Underdosing with Pellet Therapy

Pellet therapy has its limitations and is suboptimal if the dose is delivered incorrectly. If too much is given, it cannot be removed. It requires frequent visits to the doctor and pellet placement.

These implants are supposed to release small doses of hormones consistently, however this is not always the result. If the dose is too high, then that person is stuck with the negative symptoms for several months until the pellets dissolve.

For instance, doctors have witnessed a man who became so irritable from an overdose of testosterone pellets that he couldn’t interact with his clients and had to take a leave of absence from work.

Conversely, if the pellet dosing is too low, a patient could take supplemental hormones, however it would be challenging for a physician to know how much to add and the dosing would be guesswork.

Restrictions After Pellet Insertion

To avoid the pellets from working their way out of the body, there are post-op instructions one must follow. After the insertion of the pellets, vigorous physical activity, bathing and swimming should be avoided for approximately 5 days. A shower may be taken as long as the incision isn’t scrubbed until it is well healed, after about a week.

Negative Side Effects of Pellet Therapy

  • Discomfort at the injection site for the first week
  • Minor bleeding
  • Bruising
  • Swelling
  • Discoloration of the skin
  • Infection
  • Pellet extrusion
  • Redness and itching at the implant site

Hormones can be tricky for a doctor to dose, so they must be knowledgeable and experienced in  prescribing bioidentical hormone replacement therapy. While it may sound more convenient to have pellets inserted once every few months rather than take pills or apply creams, doctors still need to know what they are doing. Keep in mind that pellet therapy is a revenue stream for doctors, which is why so many of them have added it to their treatment regimen.

Order Your Bioidentical Hormones Today

At Physicians Preference Pharmacy, we are committed to providing you with the highest-quality bioidentical compounded prescriptions and ensuring optimal outcomes with your treatment. We pride ourselves on maintaining the strictest quality standards in compounding to ensure your well-being and satisfaction.

Bioidentical hormones are available by prescription at Physicians Preference Pharmacy. Speak with your provider about a prescription and please call our pharmacists with any questions at 281-828-9088. It will be our privilege to serve you!