Small subcutaneous implants of testosterone and/or estradiol, usually compounded, inserted in the hip or buttock every few months. Convenient and hard to reverse if levels run high. Not first-line in major society guidelines.
Hormone pellets are rice-grain implants placed under the skin, typically in the hip, that release testosterone and/or estradiol over about 3–6 months. Longevity and med-spa clinics like them because patients do not have to remember a gel. The trade is dose inflexibility: if you are anxious, erythrocytotic, or bleeding, you cannot peel the dose off tonight.
What they are not
They are not a unique bioidentical technology. The hormone is still estradiol or testosterone. Most pellet programs in the U.S. use compounded implants, not the same evidence base as labeled patches and injectable testosterone. Brand names (BioTE and others) are business models. ACOG and NAMS have warned that custom compounded menopausal hormones lack the manufacturing and outcome data of FDA-approved products.
Practical problems
Extrusion, infection, scarring, and a lump at the site happen. Peak levels can overshoot, especially testosterone pellets in women. You still need labs and a uterus-protection plan if estradiol pellets are used with an intact uterus. Convenience is real; so is the clinic that inserts first and monitors later.
Hold blood thinners only if the inserting clinician directs it. Shower before; wear clothes that will not rub the incision. Know your last insertion date and any prior extrusions.
Keep the site dry per clinic instructions (often 24–72 hours). Watch for redness, fever, or a pellet working its way out. Avoid heavy glute work if that was the site, as advised.
Infection, hematoma, scarring, extrusion, pain, supraphysiologic levels that you cannot immediately stop, androgenic effects in women, erythrocytosis, and endometrial risk if estrogen is unopposed. Compounding variability is a quality risk.
NAMS 2022 hormone therapy position statement (Menopause, 2022).
https://doi.org/10.1097/GME.0000000000002028ACOG. Compounded bioidentical menopausal hormone therapy.
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2012/08/compounded-bioidentical-menopausal-hormone-therapyBhasin S. et al. Endocrine Society testosterone guideline (J Clin Endocrinol Metab, 2018).
https://doi.org/10.1210/jc.2018-00229FDA. Human drug compounding: questions and answers.
https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers© 2026 Longevity Clinic Finder. All rights reserved.
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People with a clear HRT/TRT indication who understand they cannot down-titrate quickly and who will still get monitored. Poor first choice if you have never tried an adjustable route.
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