Dr. Carr is pleased to offer an alternative to hormone creams, shots, gels or pills for optimizing levels of estradiol and testosterone for women, and testosterone therapy for men. Having performed thousands of hormone pellet insertions over the past several years, Dr. Carr is one of the most experienced physicians currently practicing this type of hormonal therapy in the area.
Bioidentical hormones can be administered orally, transdermally (gels, creams, and patches), by injection, and by the insertion of pellets under the skin. Although subcutaneous implantation of bioidentical hormone pellets is a less common method of hormone therapy, this method of hormone treatment has been used clinically since the 1930's and has recently re-emerged as a viable alternative to other delivery methods.
Some patients taking hormone creams or gels do not get optimal levels in the blood due to poor absorption through the skin. Other problems that can be seen with hormone cream or gel therapy include erratic absorption, difficulty in accurate dosing, inconvenience of applying the cream one or more times daily, and, perhaps most important, the risk of transfering the hormone through casual skin contact to others, especially children. Many patients do well with injection therapy, but for some having to self-administer a weekly shot of testosterone or estradiol is not appealing, and can result in variances in blood levels (peaks and troughs) that may become symptomatic . Hormone pellet therapy circumvents these problems by allowing for slow release of hormones into the bloodstream that, depending on many individual factors, may last for 2 - 6 months.
Another major benefit of using pellets is that they are the closest delivery system currently available as an "on-demand" system. Because the rate of absorption depends upon blood flow across the pellets, when blood flow is increased such as during exercise or stress, more hormone is absorbed. When heart rate (hence blood flow) diminishes, such as during sleep, the rate of hormone absorption is appropriately less.
Potential problems with pellet therapy include, as with all surgical procedures, risk of infection. Dr. Carr performs all pellet insertions using strict surgical sterile technique to minimize the risk of infection. In addition, some patients may experience an extrusion, wherein the pellet is "pushed" out through the incision site. Perhaps the biggest drawback of pellet therapy is the inability to modify the dose of hormone once inserted, which injections and creams do allow for. That is, once the pellets are inserted, they cannot be removed if the dose is too high. The experience Dr. Carr has not only with the procedure itself but also with dosage determination make this less likely than is seen with less experienced physicians. Depending on the patient and the circumstances, Dr. Carr may recommend creams or shots instead of pellet therapy.
As a board-certified Internist with more than 15 years experience in hormonal therapy, Dr. Carr is able to offer all modalities of hormonal optimization therapy. Because of that experience and the time Dr. Carr spends getting to know you and your individual needs, he is uniquely positioned to offer an unbiased opinion as to the type of hormone therapy that is right for you.