One of the most common questions I get is:
“Why don’t you do pellets?”
And it’s a fair question. Pellets have helped many women. I know women who have had amazing experiences with them. So this is not about saying pellets are “bad.”
It really comes down to alignment with how I practice, how I prioritize safety, and how I individualize care for each woman I work with.
Here’s why I don’t offer them.
1. It’s an Invasive Procedure
Pellets are small, compressed hormone cylinders inserted into the subcutaneous fat of the upper buttock.
Even though it’s considered a minor procedure, it is still a procedure.
I regularly see women who have had:
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Unexplained nerve irritation or numbness
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Scar tissue buildup
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Pellet extrusion
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Local infections
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Persistent tenderness at insertion sites
The body recognizes a pellet as a foreign object. For some women, that’s not an issue. For others, the inflammatory response can create problems. For those of you with any auto-immune diseases, you’ll definitely understand this.
From a cellular perspective, we know that chronic low-grade inflammation drives many of the symptoms we’re trying to improve with hormone therapy in the first place. So, adding a foreign body that can potentially stimulate local inflammation doesn’t align with my “reduce inflammatory load” approach.
If I can deliver the same hormone in a non-invasive way, I will.
2. You’re Committed for 3–4 Months
This is probably my biggest concern.
When you insert a pellet, you cannot adjust it.
And hormone optimization is nuanced. If you’re my patient, you know I say this all the time!
Some women:
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Under-absorb and still have symptoms
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Over-respond and develop acne, hair loss, irritability, anxiety, or voice changes
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Convert testosterone and estrogen differently based on stress, thyroid status, insulin resistance, or inflammation
With pellets, if the dose is too high, you wait it out.
If the dose is too low, you wait it out.
That doesn’t sit well with me.
When I use injections or vaginal/scrotal creams:
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I can adjust doses quickly.
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I can fine-tune frequency.
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I can respond to symptoms in real time.
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I can truly individualize therapy.
The first 3- 4 months of HRT are about “dialing you in.”
I wouldn’t want to lock us into one dose before we even see how your body responds.
3. Hormone Levels Are Not as Stable as People Think
Pellets are often marketed as “steady and stable.”
But pharmacokinetically, they:
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Take 2–4 weeks to reach peak levels
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Often peak higher than intended
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Gradually decline after 8 weeks
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Leave many women symptomatic again before their next insertion
That rollercoaster isn’t ideal.
With low-dose injections or carefully titrated creams, we can:
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Mimic physiologic production
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Maintain steadier serum and free hormone levels
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Adjust based on symptoms, not just labs
And since I treat based on symptoms first, this flexibility matters.
4. They Don’t Align With My Philosophy of Individualized Care
My approach to hormone therapy is:
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Treat the person, not just the lab.
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Address multiple hormonal imbalances simultaneously when appropriate.
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Start thoughtfully and adjust as needed.
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Use hormones as a stepping stone for lifestyle change, not a “set it and forget it” solution.
Pellets are, by design, less flexible.
I prefer methods that allow us to:
- Modify testosterone dosing if stress levels change, thyroid function shifts, metabolic health improves, or side effects arise like acne, hair changes, irritability, or overstimulation.
- Adjust estradiol strategically — especially because estrogen is a growth hormone and more sensitive to metabolic and inflammatory shifts. If breast tenderness, mood changes, fluid retention, or uterine bleeding occur, I want the ability to respond quickly.
- Adjust progesterone freely based on sleep, anxiety, inflammation, or cycle changes (since progesterone isn’t delivered in pellets, we can and should still individualize this thoughtfully).
- Titrate therapies as your metabolism improves. As insulin resistance, thyroid function, sleep quality, and body composition change, your hormone needs can change too.
Hormones are dynamic & your treatment should be too.
That said…
If pellets are working beautifully for you?
If you feel amazing?
If your labs and symptoms align?
I 100% support that.
I’m not here to convince you that my way is the only way. That’s not how I practice. I got into this work to help men and women feel their best — supported, confident, and healthy in their bodies. Whether that’s with me or with another trusted provider, what matters most is that you feel heard and cared for.
And if pellets are the right fit for your physiology and lifestyle, I will happily refer you to a trusted, highly educated hormone provider who offers them.
The Bottom Line
Pellets work wonderfully for some women.
They are not inherently “bad.”
They just don’t fit how I practice hormone medicine.
I prefer:
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Adjustable
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Individualized
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Least invasive
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Symptom-guided therapy
Because hormone optimization is about partnering with your body, not locking you into a dose.
And as women, we know our bodies are constantly evolving, so our treatment should be able to evolve with us.
I hope this helps!
Lindsey Conditt, FNP
