Experience the Benefits of Balance

Our hormones are fundamental to everyday life, and changes in their balance require special management, whether it be due to a medical condition or a specific stage of life.

As men and women age, hormone levels – testosterone, estrogen, and others – naturally decline. However, hormone imbalance may happen to people as early as their 20s and beyond, due to the vast amount of toxins that enter the body from the environment, chemicals we consume in everyday products and toxic, stressful relationships.
The EvexiPEL method of bio-identical hormone replacement therapy (BHRT) with pellets provides a superior approach to optimize hormones and address health conditions and symptoms associated with unbalanced hormones in women and men.

Instead of daily treatments, most patients only have to visit a practitioner 2-3 times per year for pellet implants.

While convenience is important to patients, successfully alleviating the symptoms of imbalanced hormones is one of the main reasons patients turn to EvexiPEL practitioners for help. Thanks to the integrated approach implemented by EvexiPEL providers, patients can discover the underlying causes of their health concerns and receive a more balanced treatment plan which increases the likelihood of long-lasting positive results for their well-being.

Pellets deliver a steady stream of hormones – when the body needs it – mimicking the way the body naturally releases hormones.

While convenience is important to EvexiPEL patients, successfully alleviating the symptoms of imbalanced hormones is one of the main reasons patients turn to EvexiPEL practitioners for help.


First, let’s get these terms straight. You’ll see the phrases “BHRT” (bio-identical hormone replacement therapy) and “pellet therapy” scattered all over our website, but you may not know what the difference is, or how they’re related.

  • Pellet therapy is a type of bio-identical hormone replacement therapy.
  • BHRT is a way to deliver bio-identical hormones to your body.


There are several methods of delivering bio-identical hormones to your body. You can apply:

  • Patches
  • Creams
  • Pills

Each of these “solutions” has its issues, they:

  • Require constant maintenance
  • Require you to remember to do something every day
  • Can be messy
  • Aren’t even guaranteed to work

Pellet therapy is different. It consists of injecting a prescribed number of pellets (they are a little bigger than a grain of rice) into the fatty tissue underneath your skin.

The pellets contain hormones, which mimic (are bio-identical to) the effects of hormones in your body, and are gradually released into your bloodstream.
The pellets are released based on your cardiac output – how much physical activity you do, how much stress you’re under, etc.


BHRT is one of the most effective methods of addressing hormone imbalances or deficiencies. The following symptoms could be caused by a hormone imbalance in your body.

  • A lack of libido
  • Weight gain
  • Abnormal pain
  • Anxiety

One of the best ways to address this is to put the hormones you need back into your body. Which is exactly what we do with BHRT.

If you have questions about bio-identical hormone replacement therapy with pellets, we’ve got answers. Check out our FAQs below, and feel free to contact us with additional questions.

Hormone Therapy FAQs


Testosterone and estrogen can be supplemented in the form of pellets, but other hormones may be out of whack, too. Many patients also benefit from progesterone and thyroid optimization. Depending on the patient’s individual needs, he or she may also benefit from an appropriate detox program, probiotics, nutritional support in the form of supplements or IV therapy, weight loss programs and other treatments.

So, how can my doctor claim that bio-identical hormones are not safer that synthetic, chemical hormones?

Although some physicians and pharmaceutical companies claim that “bio-identical hormones are not safer than synthetic, chemical hormones”, this is not true.
Bio-identical progesterone (including FDA approved Prometrium®) does not increase the risk of breast cancer like the synthetic progestins. Progesterone, used vaginally, does not negate the beneficial effects of estrogen on the heart like the synthetic progestins. Estriol, an estrogen widely used in Europe is a bio-identical hormone, which has never been submitted for FDA approval in the United States . It does not bind strongly to estrogen receptors and does not stimulate breast tissue. Numerous studies have shown that vaginal estriol does not increase the risk of breast cancer (RR 0.7). It has safely been used in breast cancer survivors where it lowered the risk of recurrence and death. It is important to understand that balanced hormones are the key to health and disease prevention. There are FDA approved bio-identical hormones like Prometrium®, estradiol gels and patches, and the testosterone pellet. FDA approval is only required if a pharmaceutical company wants to market a drug to the public.


Hormone levels will be drawn and evaluated before therapy is started. This will include a FSH, estradiol, testosterone and free testosterone for women. Thyroid hormone levels may also be evaluated. Men need a PSA, sensitive estradiol, testosterone, liver profile and blood count prior to starting therapy. Levels will be reevaluated during hormone therapy, usually prior to insertion of the next set of pellets, 4-5 months. After the first year of therapy, hormones levels may be followed less frequently. Men must notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear as advised by their gynecologist or primary care physician.


While a number of different thyroid disorders exist, the most common is sub-clinical hypothyroidism, where the thyroid gland produces an adequate amount of thyroid hormone, but the body cannot get the hormone into the cells to do the work. This can be caused by toxicity, faulty receptors and inadequate thyroid hormone metabolism and often responds well to detox protocols and adequate nutrient supplementation.
When more severe, thyroid can also be supplemented to alleviate symptoms of hypothyroidism such as fatigue, pain, cold sensitivity, constipation, dry skin, hair loss, weight gain, depression and more.


Metabolic syndrome is a combination of several health conditions – elevated blood pressure, high blood sugar, excess fat around the waist and high levels of triglycerides. Unbalanced hormones can contribute to, and worsen, all of these conditions. By optimizing testosterone, BHRT can reduce the risk for and treat metabolic syndrome.

Should I Do Anything Before My Appointment?

Many providers encourage women to have a current Mammogram and Pap Smear test before the consultation. Get in touch with your nearest EvexiPEL provider to confirm.

How Can I Get Started With BHRT?

Find the EvexiPEL provider nearest to you and schedule your confidential consultation! Your provider will walk you through all of the benefits, and together you can decide if BHRT with pellets is the best option for your health goals and concerns. A comprehensive consultation with blood work and review of health history will determine if you are a good candidate.

Pellet Therapy FAQs


There are currently no known health conditions that exclude a person from undergoing bio-identical hormone replacement therapy with pellet implants. The majority of people with hormone imbalance are great candidates for the therapy.
However, EvexiPEL® practitioners take an individualized approach based on the patient’s medical history. The approach to bio-identical hormone replacement therapy should be modified for patients who are estrogen-positive breast cancer survivors and prostate cancer survivors.


Complications from the insertion of pellets may include: minor bleeding or bruising; discoloration of the skin; infection; and possible extrusion of the pellet. Other than slight bruising and skin discoloration, these complications are very rare.
The most common side effects are increased hair growth and possible skin breakouts with the first round of therapy, because the body is getting used to increased oil production in the skin. Patients may want to change their skin care regimen from heavy anti-aging products to lighter, oil-free skin care lines. Side effects may be avoided with decreasing doses on subsequent rounds of therapy.


Your EvexiPEL Provider will provide you with a symptom assessment upon arrival to their clinic. From there your provider will inquire about the patient’s health and wellness goals and concerns. Then he or she will perform a thorough exam and lab tests to find the root cause of any health issues and whether hormone imbalance is to blame. If the patient is diagnosed with hormone imbalance, the practitioner will prescribe an integrated treatment plan based on the patient’s test results and information the patient provides (health and family history, symptoms, etc.).


EvexiPEL® practitioners treat patients of all ages – from the 20s to the 90s – so there is no firm answer. Instead, the patient needs to decide how long they want to look and feel better, while experiencing the protective benefits of balanced hormones, which are many.

When you are tired of feeling good and would like to feel the aches and pains of life again, you can certainly stop optimizing your hormones.


Patients should take it easy and avoid strenuous exercise for a few days following the procedure – 72 hours for women and 4 to 5 days for men. This helps ensure the tiny incision heals properly and can prevent extrusion of the pellet from under the skin.

With EvexiPEL, patients report healing faster than when they used other pellet therapies. EvexiPEL uses proprietary pellets from our partner pharmacy FarmaKeio and FarmaKeio Outsourcing a 503B FDA Registered Manufacturing Facility. Not only do you heal faster with these pellets, you bruise less and have less downtime.
The key in this pellet formulation is that it reduces inflammation and therefore speeds up the healing process with less likelihood of the body rejecting the pellets as is common with most pellets providers can obtain at just about any pharmacy.


Most Women begin to “feel better” within 48 to 72 hours, though it may take a week or two for some women to notice a difference. Men can expect to experience the benefits of their pellet implants within 1 to 2 weeks. To achieve optimal health, living a healthy lifestyle – balanced diet and regular exercise – goes hand-in-hand with hormone balance.

While most people experience substantial benefits after the first round of therapy, many patients experience more pronounced benefits after the second round of pellet implants. Therefore, patients should expect to have the procedure performed at least twice before experiencing optimum results.

People don’t get out of balance overnight, so it often takes a few months to get back on track.


The procedure itself is quick and easy and takes just a few minutes. We use a mixture of Lidocaine and Epinephrine with Sodium Bicarb to numb the area so you won’t feel a thing during the actual pellet insertion process.


Pellet implants typically last 5 to 6 months in men (two visits per year) and 4 to 5 months in women (three visits per year).


Research consistently shows pellet implants offer a superior way to deliver hormones in women and men. Implanted in the fatty tissue under the skin, pellets release a constant stream of hormones into the body, 24/7/365, mimicking the way the body naturally releases hormones.
Convenience is also a key. With pellets, patients undergo the procedure two or three times a year and get on with life. Other modalities, like pills and messy creams, need to be used daily. Patches work a bit better, but the absorption of skin-based delivery methods is variable. People also lose sensitivity over time, which means patients will eventually need to find a new spot to apply the cream or adhere the patch


Pellets are made up of either estradiol or testosterone. The hormones are pressed or fused into very small solid cylinders. These pellets are larger than a grain of rice and smaller than a ‘Tic Tac’. In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials. Testosterone pellet production is highly FDA regulated.


Pellets deliver consistent levels of hormones for 3-5 months in women and 4-6 months in men. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. Estrogen delivered by subcutaneous pellets, maintains the normal ratio of estradiol to estrone. This is important for optimal health and disease prevention. Pellets do not increase the risk of blood clots and other untoward side effects like conventional or synthetic hormone replacement therapy.

In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal and andropausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response and performance.

Testosterone delivered by a pellet implant, has been used to treat migraine and menstrual headaches. It also helps with vaginal dryness, incontinence, urinary urgency and frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase sense of well being, relieve anxiety and improve memory and concentration.

Testosterone, delivered by pellet implant, increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of testosterone for optimal mental and physical health and for the prevention of chronic illnesses like Alzheimer’s and Parkinson’s disease, which are associated with low testosterone levels.

Even patients who have failed other types of hormone therapy have a very high success rate with pellets. There is no other ‘method of hormone delivery’ that is as convenient for the patient as the implants. Pellets have been used in both men and women since the late 1930’s. There is more data to support the use of pellets than any other method of delivery of hormones.


The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the lower abdominal wall or upper buttocks through a small incision, which is then taped, closed. The experience of the health care professional matters a great deal, not only in placing the pellets, but also in determining the correct dosage of hormones to be used.

Are there any side effects or complications from the insertion of the pellets?

Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women.
Testosterone stimulates the bone marrow and increases the production of red blood cells. This is called Erythrocytosis and is not dangerous at all. Many untrained medical providers will see this and determine that a patient has Polycythemia which is a blood disease. Testosterone does not cause Polycythemia. A low testosterone level in older men is a cause of anemia. Testosterone, delivered by implants or other methods, can cause an elevation in the red blood cells. If your medical provider sees your hemoglobin and hematocrit (blood count) get too high, they may request that a unit of blood may be donated. This is not necessary though and is why you should seek out EvexiPEL Certified Providers to optimize your hormones.

After the insertion of the implants, vigorous physical activity is avoided for 48 hours in women and up to 5 to 7 days in men. Early physical activity is a cause of ‘extrusion’, which is a pellet working it’s way out. Antibiotics may be prescribed if a patient is diabetic or has had a joint replaced. However, this is a ‘clean procedure’ and antibiotics may not be needed.

Why haven’t I heard about Hormone Pellets?

You may wonder why you haven’t heard of pellets. Pellets are not patented and have not been marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia. Pellets were frequently used in the United States from about 1940 through the late 70’s when oral patented estrogens were marketed to the public. In fact, some of the most exciting data on hormone implants in breast cancer patients is out of the United States. Even in United States, there are clinics that specialize in the use of pellets for hormone therapy.

Do Natural Pellets have the Risk of cancers as Synthetic Hormones?

Pellets do not carry with them the same risk of breast cancer as high doses of oral estrogens that do not maintain the correct estrogen ratio or hormone metabolites. Nor, do they increase the risk of breast cancer like the synthetic, chemical progestins used in the Women’s Health Initiative Trial. Data supports that balanced, bio-identical hormones are breast protective.

Testosterone, delivered by pellet implantation, has been shown to decrease breast proliferation and lower the risk of breast cancer, even in patients on conventional hormone replacement therapy. Clinical studies show that bio-identical testosterone balances estrogen and is breast protective. This is not true of oral, synthetic methyl-testosterone found in Estratest®, which gets converted to a potent synthetic estrogen, which can stimulate breast tissue. In the past, testosterone implants have been used to treat patients with advanced breast cancer. In 1940, it was theorized that treating patients with testosterone implants earlier, at the time of diagnosis, would have an even greater benefit, preventing recurrence. Androgens have also been shown to enhance the effect of Tamoxifen® therapy in breast cancer patients. References supporting these statements can be found in the data section of the website in the ‘Breast Cancer Folder’. A power point presentation ‘Nov 07’, summarizing the full text references, may be viewed.

Are there side effects to estrogen delivered by pellet implantation?

When a patient first starts on hormone therapy there may be mild, temporary breast tenderness, which resolves on its own. Hormone receptors may be very sensitive and take time to adjust. There may be a temporary water weight gain, which will also resolve on its own. Women, especially those who have not had a hysterectomy, may choose a different method of delivery of estrogen, as the risk of bleeding is significant.

Will hormone therapy with estradiol and testosterone pellets help with hair loss?

Hormone deficiency is a common cause of hair loss and treatment with estradiol and testosterone implants can help to re-grow hair. Hair becomes thicker and less dry with pellet therapy.


Some patients begin to ‘feel better’ within 24-48 hours while others may take a week or two to notice a difference. Diet and lifestyle, along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness.


The pellets usually last between 3 and 5 months in women and 4-6 months in men. The pellets do not need to be removed. They completely dissolve on their own.


The cost for the insertion of pellets is between $300-350 for women and $650-750 for males depending on the dose of the hormone and the number of pellets needed. Men need a much larger dose of testosterone than women and the cost is higher.

Pellets need to be inserted 2 to 4 times a year depending on how rapidly a patient metabolizes hormones.

When compared to the cost of drugs to treat the individual symptoms of hormone decline, pellets are very cost effective. There is more good, ‘unbiased’ data on pellets and bone density than any pharmaceutical drug on the market. It is beyond the scope of this handout to examine the cost of drugs used for insomnia, depression, sexual dysfunction, obesity, diabetes, hypertension and more.


Some insurance companies cover the cost of pellets, especially in men. Others do not. Most physicians require payment for their services. Patients may want to contact their insurance companies to see if their costs will be reimbursed. Prevention is much more cost effective than disease.

Although it is rare, some insurance companies will reimburse patients for pellet therapy. EvexiPEL® Certified Providers can provide patients with the paperwork necessary to seek reimbursement.

What Happens to the Pellets?

Because the pellets are all-natural and contain nothing other than the hormones your body naturally produces, the pellets will be completely dissolved and absorbed, leaving nothing behind in your body.

How Often Will I Need Pellet Insertion?

We recommend taking a break from lower body exercise, not including walking. You should avoid swimming, hot tubs, and bathtubs, but you can shower 24 hours after the procedure. Once you remove the bandage, you are safe to return to your normal activities. Consult your EvexiPEL provider for any specific questions or concerns.

What Happens in the First Week Following Insertion?

We recommend taking a break from lower body exercise, not including walking. You should avoid swimming, hot tubs, and bathtubs, but you can shower 24 hours after the procedure. Once you remove the bandage, you are safe to return to your normal activities. Consult your EvexiPEL provider for any specific questions or concerns.

What Can I Expect During the In-office Insertion?

You will go to the exam room and have your insertion site cleaned and numbed, most commonly this is the upper buttock. Once numb, a small incision is made for the pellets to be inserted and after pellets are placed, the insertion site is covered with a small bandage. This will take less than 15 minutes.

Are Any Tests Required Before Insertion?

Your EvexiPEL provider will perform a comprehensive blood panel and discuss your results with you after.

What Should I Do Before the Procedure?

Stop taking all blood thinners (NSAIDs, aspirin, ibuprofen, acetaminophen, naproxen sodium, etc.) one week before the procedure; however, if you required to take any of these daily, consult with your physician.

What Can I Expect from BHRT with Pellets?

Full optimization may take up to 6 months, but most patients report relief from some symptoms within 2-4 weeks. Your EvexiPEL provider will customize your hormone optimization treatment and give you a more accurate timeline based on your unique health history and health goals.

What is the Goal of Hormone Optimization Therapy?

BHRT seeks to relieve the various common, and debilitating, symptoms associated with aging, which are often left unaddressed by healthcare providers. Stress, fatigue, low libido, a foggy mind, and weight gain are among some of the most common symptoms. The goal of bio-identical hormone replacement therapy is to address the root cause of symptoms by optimizing hormone levels in men and women.

How Long Until I See Results?

Hormone optimization is just as unique as every patient. Once the pellets are inserted into the gluteal area, a consistent dose of bio-identical hormones enter the bloodstream and BHRT will begin to work within 7-10 days after pellet insertion. Most patients report some symptom relief within 2-4 weeks, but full optimization takes up to 6 months.

What is Bio-Identical Hormone Replacement Pellet Therapy?

Bio-Identical Hormone Replacement Therapy (BHRT) with pellets utilizes bio-identical hormones derived from natural, plant-based substances that are identical on a molecular level to those created by the body. Subcutaneous hormone pellets are often a preferred method of delivery as they metabolize in the body as the body intends. Hormones are released consistently over time and are less likely to cause fluctuations like other hormone treatments. Depending on your needs, your EvexiPEL provider may employ a combination of pellets and other hormone treatments to optimize your hormones.

Female Hormone Therapy FAQs


Estrogen loss puts women at risk for premature ovary failure, osteoporosis, heart disease, colon cancer, Alzheimer’s disease, tooth loss, impaired vision, Parkinson’s disease and diabetes. These risks increase the longer a woman suffers from estrogen deficiency.

However, women also need testosterone! Imbalanced testosterone levels in women may compromise mental clarity, libido and muscle tone and mass. The brain needs testosterone in balance with estrogen – and a healthy gut – to produce serotonin, which supports emotional balance.


Research repeatedly links hormone imbalance to an increased risk for cancer, osteoporosis, stroke, thyroid disorders, diabetes, heart disease and other age-related disease processes. During perimenopause, menopause and andropause (the male version of hormone depletion), declining health is considered the norm. But feeling poorly doesn’t need to be the norm, thanks to bio-identical hormone replacement therapy and other treatments EvexiPEL® practitioners may recommend.

Do patients need progesterone when they use the pellets?

Most times when estradiol is prescribed, progesterone is also prescribed even if the patient has had a hysterectomy. The main indication for the use of synthetic progestins, like Provera®, is to prevent the proliferation (stimulation) of the uterine lining caused by estrogen. However, there are progesterone (not progestin) receptors in the bone, brain, heart, bladder, breast and uterus where progesterone has been shown to have beneficial effects. Progesterone can be used as a topical cream, a vaginal cream, an oral capsule (Prometrium®), or sublingual drops. Only oral progesterone (100-200 mg) and vaginal progesterone (45-90 mg) have been studied and shown to protect the uterine lining from estrogen stimulation.

If a patient is pre-menopausal, she uses the progesterone the last two weeks of the menstrual cycle (day 1, the first day of bleeding). Hormone therapy with pellets is not just used for menopause. Women at any age may experience hormone imbalance. Levels decline or fluctuate contributing to debilitating symptoms. Pellets are useful in severe PMS, post partum depression, menstrual or migraine headaches, and sleeping disorders. Pellets may also be used to treat hormone deficiencies (testosterone) caused by the birth control pill.
Progesterone is NOT prescribed for males.

Can pre-menopausal women benefit from pellets?

Testosterone pellets may be used in pre-menopausal females (women who have not stopped menstruating). Testosterone has been shown to; relieve migraine or menstrual headaches, help with symptoms of PMS (pre menstrual syndrome), relieve anxiety and depression, and improve sex drive and libido. If a pre-menopausal female has a testosterone pellet inserted, she must use birth control. There is a theoretical risk of ‘masculinizing’ a female fetus (giving male traits to a female fetus).
In conclusion, estrogen and testosterone therapy by implantation of pellets is a safe and effective method of hormone therapy for both men and women. Long, continuous administration of hormones by pellets is convenient and economical for the patient.

Pellet implantation has consistently proven more effective than oral, intramuscular, and topical hormone therapy with regard to bone density, sexual function, mood and cognitive function, urinary and vaginal complaints, breast health, lipid profiles, hormone ratios and metabolites.

Male Hormone Therapy FAQs


Testosterone levels begin to decline in men beginning in their early 30’s. Most men maintain adequate levels of testosterone into their mid 40’s to mid 50’s, some into their late 70’s to early 80’s. Men should be tested when they begin to show signs of testosterone deficiency such as brain fog, memory loss, mood changes, anxiety, joint pain, insomnia and erectile dysfunction, to name a few. Even men in their 30’s can be testosterone deficient and show signs of bone loss, fatigue, depression, erectile dysfunction, difficulty sleeping and mental decline. Most men need to be tested around 50 years of age. It is never too late to benefit from hormone therapy.