Hormone Replacement Therapy for Women

The following information is provided by Nurse Practitioner Christy Collins:

Bioidentical Hormone pellets helps women diminish and often eliminate the symptoms related to testosterone deficiency and menopause. Our bioidentical hormone replacement pellet therapy is effective in treating symptoms including insomnia, loss of balance, inability to concentrate, anxiety, migraine headaches, low libido, lack of energy, loss of muscle tone, and more. We use sub-dermal, all-natural testosterone and estradiol pellets that usually last three to six months in women.

Testosterone Deficiency

Testosterone Deficiency Syndrome

Testosterone Deficiency Syndrome (TDS) is a collection of symptoms some people recognize as aging, an untreatable condition of humanity. However, many symptoms of aging are treatable and therefore not inevitable!

This hormone is integral to maintaining balance and health in our body and mind. When it disappears, we begin to age rapidly. This “secret hormone” is not acknowledged by the medical community as important to women, and therefore this syndrome has no official name in the medical world. We have named it Testosterone Deficiency Syndrome (TDS), for women. Women are ten years ahead of men in this condition. They begin the onset of these symptoms at age 40, or when their ovaries are removed through surgery. Men begin the condition around the age of 50.



As women move past their childbearing years, the transition from perimenopause to menopause can last up to ten years, which can mean ten years of life-changing symptoms caused by hormone imbalance. When the reproductive system stops ovulating and menstrual cycles become less frequent, then eventually disappear, the physical results of this can include weight gain, migraines, insomnia, and low sex drive. Mentally, depression and anxiety can stop the most active pre-menopausal women in her tracks, causing her to struggle to even get out of bed.

Thankfully, with Bioidentical Hormone Replacement Pellet Therapy (HRT), these problems don’t have to be an inevitable fact of life. Most HRT patients see immediate and dramatic results – they feel better, younger and more vibrant than ever!

Symptoms of Decrease in Testosterone and Estrogen

Symptoms associated with progressive decrease in the level of testosterone and estrogen in women:

Loss of Libido:

For those who had a healthy sex drive before, the subtle loss of libido is one of the most devastating changes that occurs in their 30s and 40s. If you are wondering, “Why don’t I think of, dream of, or want sex anymore?” a lack of testosterone is most likely your problem. During our consultations, we discuss symptoms, how testosterone affects your libido, and what treatments are available.

Anxiety and Depression:

Anxiety and depression are two of the symptoms that actually ARE all in our head! They are mood disorders, and when they occur after 40, they can be related to andropause and menopause. Even though life-long mood disorders worsen at this time, we only treat those problems that are NEW during your 40’s and 50s. So don’t go off your antidepressants yet—we must treat you for at least 6 months before you can go to your treating doctor to be weaned off your medication.


Some of the most common complaints from our patients are that they can’t sleep longer than 4 hours, they never wake up rested, and that they are unable to focus at work because they are sleep deprived. During our consultations, we review many of the problems associated with insomnia and compare the therapies for insomnia.

Migraine Headaches:

If you are one of the many women who developed migraine headaches after the age of 35, a visit to our office might improve your quality of life. Many of our patients have seen their headaches completely disappear once they begin repaving testosterone and estradiol in the pellet form.

Memory Loss:

Not being able to remember names and do your job well can be alarming.  This problem generally responds well to replacing the hormones you are missing. Sometimes it can just mean you have too much on your plate, but if you have had an obvious change in your ability to think during your 40’s and 50s, we will be happy to discuss treatments.

Hot Flashes:

This is the most frequently treated female hormone disorder. Hot flashes are not necessarily always “hot.” Any episodic spell you experience after you stop having periods that wakes you from sleep, causes brief periods of sweating, crawling skin, headaches, or anxiety is referred to as a “hot flash.”

Chronic Fatigue:

Fatigue is one of the most frequent complaints. If you’re experiencing fatigue for the first time in your 40s and 50s, it can be related  to hormonal imbalance. Fatigue can also be due to many other diseases unrelated to hormones. We will help you learn the difference. Some other causes of fatigue that occur in our 40s are an under active thyroid gland and low blood sugar, (also referred to as insulin resistance). It is essential to become aware of what is triggering your symptoms.  Bringing you back to health means treating all your deficiencies to make you whole again.

Changes in Body Composition:

Sadly, when you lose your testosterone, your body loses muscle, collagen, connective tissue and all the wonderful components that defied gravity until now. To make things worse, your metabolism slows and you become more insulin resistant, so most of the carbohydrates you eat become fat instead of energy. Did you wake up one day and look in the mirror and see your mother’s body? If you have accumulated belly fat, your breasts are lower, your back has collected ugly pockets of fat, and you don’t see any improvement with exercise and weight training, Bioidentical hormones can help you.

Dry Vagina:

This is a very frequently diagnosed problem and one that is usually easy to treat. In gynecology this is referred to as atrophic vaginitis.  During our consultation, we will describe what is happening to you, the traditional therapy, and how Bioidentical Hormone Pellets can help.

Dry Eyes:

It is expected that as you age your eyes will change and you may need glasses to read. However, dry eyes keep many people from being able to wear contacts and they have to use multiple eye drops just to be able to see. This condition is related to the level of Testosterone and Estradiol in your blood. These hormones stimulate your tear glands to lubricate your eyes, and without tears we are miserable!  Bioidentical hormone replacement pellets may be able to help with these symptoms. 

Women's Hormone Therapy Frequently Asked Questions

Women's Hormone Therapy FAQs

Why do I need any hormone replacement?

Women need replacement if they desire to:

  • Delay the symptoms of aging
  • Reverse depression and anxiety
  • Regain libido
  • Preserve skin and muscle tone
  • Look younger
  • Increase energy
  • Strengthen the immune system
  • Improve physical stamina
  • Decrease or eliminate insomnia
  • Thicken hair
  • Help protect against osteoporosis, dementia, diabetes, and heart disease
  • Improve general health

Why are pellets better than patches, shots, or pills?

The reason we use pellets at Indulge is because they contain the pure hormone and are not metabolized into byproducts that can cause side effects or inactivate the testosterone before you use them. This unique delivery system (pellets placed under the skin in the fat of the hip) allows this pure hormone to be delivered directly to the blood stream. Pellets act as a reservoir of hormone that allows your body to take as much testosterone or estradiol as your body needs at any one time. When you are exercising, you have an increased pulse and cardiac output so you absorb more hormone. Because pellets are bioidentical, and because of their efficient delivery system, women are more likely to feel better on pellets than with other forms of estrogen or testosterone replacement.

What is Menopause?

Menopause is the third stage of aging. The first stage is losing your testosterone. The second stage is losing your progesterone. Menopause is when you enter the last stage of aging, and it doesn’t end.  

What symptoms are treated by Bioidentical estradiol pellets?

Estradiol pellets adequately treat hot flashes, a dry vagina, painful intercourse, dry skin, and thinning hair.

What symptoms are treated by Bioidentical testosterone pellets?

Testosterone pellets treat the symptoms of low libido, anorgasmia, depression, fatigue, muscle mass loss, weight gain, belly fat accumulation, immune system abnormality, autoimmune diseases, dry eyes, mental decline, loss of exercise stamina, loss of motivation, and many other symptoms of testosterone deficiency.

How is testosterone deficiency diagnosed?

Deficiency is diagnosed through its symptoms and a thorough medical history examination, in conjunction with a low free T in your blood level.

Can I take testosterone pellets if I am not menopausal and still cycling?

Yes. Most patients begin treatment sometime after 40 or if their ovaries are removed. Testosterone from the ovary disappears before menopause and should be replaced when a woman becomes symptomatic.

How is dosage calculated?

Every treatment plan is unique. We recreate what the normal daily production of testosterone and estradiol by a young ovary should be and deliver enough of that dose to last until the next pellet insertion. This dose is then adjusted according to body mass, exercise frequency, and any medications the patient is on.

Where are pellets inserted?

We place them in the upper-outer quadrant of the hip about 1.5 centimeters below the skin where they can dissolve and be picked up by capillaries.

How long will it take for the pellets to work?

It takes about 3-4 weeks to get the full effect. Pellets must be re-inserted every 4 months before symptoms recur.

How long will my pellets last?

Four months is typical. If you don’t get a lot of sleep, exercise, do stressful work, or participate in athletics, you will use them up more quickly and we may need to dose you with more pellets on the next insertion.

Do the pellets completely dissolved at the end of 4-6 months?

Yes. There is nothing left to be removed.

What is the cost of bioidentical hormone pellet therapy?

Please visit the Practitioners & Services Page for Christy Collins for pricing information.

Do estradiol or testosterone pellets cause weight gain?

Testosterone increases the thickness of bones and muscles which increase lean body mass. But, it also decreases fat at the same time. In general, women taking pellet hormones start by dropping sizes and don’t begin to lose weight for 9-12 months.

How long will it take for me to start losing weight?

That depends on how much you exercise, how over weight you are when treatment begins, and what other relevant medical conditions you have. We always try to help you with your weight loss by optimizing your pellet dose and balancing your other hormones.

What diseases can be delayed or avoided if I take testosterone pellets?

The known diseases that testosterone can delay or prevent include:

  • Osteoporosis
  • Auto-immune diseases
  • Fibromyalgia
  • Immune Deficiencies
  • Dementia and Alzheimer’s Disease
  • Parkinson’s Disease
  • Frailty
  • Heart Disease and Stroke
  • Type II Diabetes
  • Obesity
  • Insulin Resistance

If I take testosterone pellets, will I need DHEA supplementation?

The reason someone might need DHEA is because their testosterone level is good, but they still have “sagging skin.” In this case, we recommend only 7 keto-DHEA in doses of 25 mg or less. Other types or doses above 25 can cause an increase in estrone which means weight gain and and increased risk of breast cancer.

If I have diabetes, will testosterone help me with my blood sugar?

Yes. Testosterone is very safe for diabetics and generally increases insulin sensitivity, which will decrease triglycerides and stabilize blood glucose. It will improve the status of your diabetes and help you lose weight.

Does testosterone improve depression and anxiety?

Yes. It can replace anti-depressants (which decrease libido) after only one or two doses of pellets for patients whose anxiety and or depression began around age 40.

What if I begin to bleed after menopause?

We refer you to a gynecologist for a uterine biopsy and ultrasound to rule out potential problems.

How do cholesterol-lowering drugs affect testosterone? 

Testosterone is made of cholesterol. When you take cholesterol-lowering drugs, you decrease the substrate that testosterone is made of, and generally decrease the level of testosterone. Testosterone replacement lowers cholesterol, so we recheck after the first dose and if your lipids are much lower. We then suggest that you do a trial without the medication to see if you still need it.

If I have used alcohol to excess or drugs like marijuana in the past, will I get the same effects as other women?

No. You will likely consume the testosterone more quickly than other women because your liver is hyper-activated to metabolize testosterone with the same enzymes that metabolize alcohol and drugs.In addition, marijuana increases prolactin, the hormone that increases breast size in men and women. Prolactin not only decreases your testosterone level but decreases your sex drive and sexual stamina.  It is expected that if you take testosterone, you will stop using marijuana altogether and moderate your alcohol consumption.

Can I take birth control pills with testosterone pellets?

We strongly suggest that you do not because it dampens the effects of the testosterone pellets. Birth control is not needed after menopause.

What other medications inactivate or interact negatively with estradiol and testosterone pellets?

We suggest you look for alternative medications for the following drugs:

  • Corticosteroids such as prednisone
  • Medrol Dosepak
  • Tamoxifen
  • Progestins (not progesterone) such as Provera
  • DHEA that is not 7-keto DHEA
  • Other hormones given orally like oral contraceptives
  • Anti-depressants
  • Drugs for schizophrenia or bipolar disorder, which suppress the libido

What can I do about the belly fat that started to increase after I turned 40?

You should begin by taking non-oral estradiol and testosterone in the form of pellets. The pellets are the only form that bring the level of estrone back to young, healthy levels. Low estrone decreases belly fat.If you are having trouble losing belly fat and have already accomplished the above, then take DIM ES 250 mg per day with food, take iodoral (iodine to bump your thyroid activity), eat 6 small meals each day with high protein and low carb, exercise with interval training, and always work out your abs by doing sit-ups and core exercises.

Under what circumstances would I have to stop BioBalance Health pellets?

In some cases, women will not experience healing as quickly as they would like. Patients with chronic fatigue are helped by testosterone replacement, but they don’t feel the resolution of symptoms as quickly as women who do not have that illness. Women who have psychiatric illnesses and are on multiple medications may not feel as healthy as women who do not have those illnesses. Lastly, if a patient develops breast cancer, then the estradiol pellets are not continued, although the testosterone pellets are safe to continue.

Will I grow unwanted hair from the testosterone?

Testosterone will not cause any more facial hair growth than what you had when you were in your 30’s. There is also less of a chance of excess hair growth with natural testosterone than with synthetic hormones.