In this episode, we're picking back up where we left off last, exploring the different options for hormone replacement therapy. One method not covered yet is injectable therapies, which really do not exist for estrogen. However, injectable testosterone is available for women. But remember: Testosterone given via injection is not bioidentical, and there is no established approved dose for women.

Injectable testosterone has high bioavailability, but it's only in your system for a few days. Furthermore, typically with this type of administration you're hit with a "hormone bomb"—a dose that floods your system with a high amount of hormones right away. An alternative yet similar solution to traditional injectables is pellet hormone therapy.

Pellet hormone therapy comes in the form of small, compounded beads. These are inserted into the body through injection using a large needle, but local anesthesia ensures you don't feel anything. It's not a widely available option, but they usually last between two and a half to four months.

The unique benefit of this option is an internal regulatory mechanism: Your heart rate. Of all the methods you can choose from, pellet therapy is the most reliable. For a few weeks, you can expect steady hormone levels, and nothing else on the market for hormone replacement therapy can match that. Pellet hormone therapy also offers convenience and guaranteed compliance.

There are some concerns regarding accumulation of estradiol with long-term pellet implantation, which is something that should be monitored by your health care professionals. Typically, this is seen in women who have been estrogen dominant (and therefore prone to high estrogen) throughout their life. While not approved by the FDA as a medication, pellets can be sourced from compounding pharmacies offering custom products.