Bioidentical Hormone Replacement Pellet Therapy

BHRT Pellet Therapy demand is on the rise but so are the pitfalls.

BHRT Pellet Popularity on the Rise:

There have been incredible advances in the world of bioidentical hormone replacement therapy (BHRT) that have allowed providers to accurately customize BHRT to a patient’s specific needs. It is compounded in a variety delivery methods including creams, ointments, capsules, troches, lozenges, transdermal patches, liquids and pellets.

BHRT pellet popularity continues to grow rapidly because one treatment can last up to three months without the need for daily use like many other delivery methods. This is the preferred option for many providers and patients, however, not everyone is a good candidate since pellet treatment is irreversible for up to three months.  Many providers prefer to start with alternative methods until they can establish a baseline for patients to begin BHRT pellet therapy.


How are pellets inserted?

Patients are scheduled for a 10 to 20-minute procedure at the provider’s practice. The provider will administer a local anesthetic and make a small incision near the hip or on the buttocks to insert the pellets under the skin (subcutaneously). They will use a tool known as a trocar to insert up to ten pellets (testosterone, estradiol, and or progesterone) at a time. These pellets typically last up to three months, however, depending on the patient, it can range from two to six months.


Market Pitfalls: What’s being Reported

The popularity of convenience, the aspect that it is all natural, and having pellet therapy performed under supervision of a provider is a huge added plus. However, not all pellets are made equally!  Neither the provider nor the patient have much control over each lot produced by a compounding pharmacy.  An establishment of “trust” with every pellet order doesn’t provide the means of acquiring BHRT pellets made right every time.  This is because BHRT pellets are compounded and dispensed under less regulated standards of other HRT treatments. Not to mention, the minimal options for trocar kits that are available on the market to conduct these procedures properly.

Without a strong regulatory measure of the compounded pellet or the trocar kit, the provider must conduct the proper due diligence to ensure that patients are receiving the proper procedure and pellets. The FDA put out a statement on the matter to improve adverse event reporting to protect providers and patients by educating them of the unknowns (See: Statement of Improving Adverse Event Reporting of Compounded Drugs to Protect Patients)



Mitigate Your Practice from Malpractice Lawsuits & Seek Proper Protection:

Many providers tout the benefit of BHRT pellet therapy but fail to mitigate risk.  BHRT Pellet therapy is remarkable for thousands of patients, but like other treatments, it is not good for everyone.


Consider These Best Practice Principles:

1) Document Protection

Ensure your documents have the proper disclosure and consent forms.

2) Review your Policy

Review your policy for defense attorney coverage. Great surplus lines policies have defense coverage that can assist you as early as an investigation inquiry by an inspector or at the beginning of a claim or lawsuit filed. It is pivotal to have good policies implemented in your practice so you are not completely distracted by anything that may come your way. Not sure about your coverage, send us your policy and we will analyze it to assess your protection.

3) Vet Your Suppliers

You are the first person responsible for the BHRT pellet procedures and the patient outcomes. VET YOUR SUPPLIERS. If you are interested in vetting your current supplier or have questions or are looking for vendors that have good business practice, connect with us today!

4) Disclaimers and Disclosures!

Sales & Marketing cements the expectation of your current and potentially new patients. Stop listing the hundreds of things BHRT Pellets can do and advertise responsibly. Ensure your materials, website and any other promotions have the proper disclaimers and disclosures!


BHRT Pellet therapy demand will continue to grow and it’s important your practice is there in the long run to continue to service the demands of patients wanting a healthy and better life.  The advances in this market are impeccable, but rapid.  Applying the simplest changes in your practice will go a very long way and your patients will continue to love you for it!