The Pellet Placement Procedure
Wednesday 06/15/2022

What is the Pellet Placement Procedure?

The pellet placement procedure is the part of BHRT that seems to cause the most trepidation in those considering this therapy. It is a quick, simple, and safe procedure most of my patients get used to in no time at all.

Pellet Placements are performed in my office every four months. Most of my patients receive new pellets every four months. However, that is a general estimate, as the period between placements varies from person to person. How fast you metabolize your pellets is dependent upon age, weight, the ratio of body fat to muscle mass, diet, how often and how intensely you exercise, and your metabolic rate. Those who have faster metabolisms will tend to absorb the pellets more quickly and will need pellet placements slightly more often, perhaps every three months. Once we start regularly checking your bloodwork and doing your pellet placements, we will discover the optimal schedule to keep you feeling your best at all times.

The pellet placements are performed at Optimal Bio clinics during regular business hours, Monday to Friday. You will be seen in the privacy of one of our comfortable exam rooms, where we will have the opportunity to talk briefly and address any new questions you might have.

Your appointment time will last fifteen minutes. The pellet placement itself takes only five minutes. You may remain fully clothed. Only the area that needs to be treated will be exposed. It is best to wear sweatpants or something comfortable. You will be asked to lie down on your side, and the hip area where the pellets will be inserted will be covered with a sterile drape sheet.

Placement involves a simple, sterile incision into the fatty area of one side of the buttocks. After cleaning the area with betadine and alcohol, the incision site is numbed with a 2% lidocaine solution. 

The Pellet Placement Procedure


A small, straw-like instrument called a trocar is inserted at a thirty-degree angle, and the pellets are inserted into the fattiest part of the tissue, approximately one inch under the skin. This part of the procedure is virtually painless, because the area has been numbed. The incision is closed with wound closure tape strips, then covered with a transparent medical film, and finally, a sterile pressure bandage.


The only part of the procedure you will feel is the insertion of the needle containing the anesthetic, which is not entirely painless, but most of my patients experience only minor discomfort. Very few people stop pellet therapy because of the pain of the needle!


Post-Procedure Instructions

Patients should abstain from vigorous exercise for five days after a pellet placement. It is normal to have swelling for one to five days, and the incision may be slightly sore or itchy for up to two weeks afterward.There will be a bruise around the incision, which usually takes one to three weeks to fade completely. All this is normal. We cannot remove your pellets for any reason. As with any incision, there is a minimal risk of infection. It is rare, but if it occurs, we will prescribe an oral antibiotic.


The Optimal Bio Pellet

We take pride in offering you the purest type of pellet possible. Over the years, we have worked with compounding pharmaceutical companies that produce the best and most effective pellets money can buy. We use organic yams as the primary ingredient from which the testosterone is made. The pellet is 99.5% pure yam-hormone. The other 0.5% of the pellet is stearic acid (a naturally occurring fat), which acts as a lubricant and binding agent to hold the pellet together in proper form. It is important to note that the stearic acid is never absorbed into your system. We don’t want the pellet to be too hard; otherwise, it won’t dissolve. And we don’t want it to be too soft, or it won’t hold together. The stearic acid allows the pellet to dissolve at the optimal rate.

Typically, a man will receive anywhere from six to twelve pellets at a time, depending on his lab levels. His pellets will contain bioidentical testosterone, with each pellet having a dosage of 200 mg. His total testosterone dosage, per placement, will range between 1,200-2,400 mg. The dosage amount is based upon a precise mathematical algorithm individualized for every person.

The pellets we use for women contain bioidentical testosterone and estrogen. Depending on their lab work, all our female patients receive somewhere between 75-150 mg of testosterone, and somewhere between 6-25 mg of estrogen. In some instances, if women are still ovulating, or have a tendency toward estrogen dominance, they may receive no estrogen at all. Each patient’s case is evaluated carefully to determine the best course of action for her as an individual.


Pellet Expulsion

The standard literature about this procedure estimates that approximately 5-10% of men will expel one or more pellets per procedure. For women, the rate is much lower—about one in one thousand. These statistics are influenced by many factors, including how hard the pellets are, what your body fat percentage is, and how high your level of physical activity is the first few days after receiving your pellets.

We try and minimize the rate of expulsion as much as possible. We’re proud of the fact that our accidental expulsion rate at Optimal Bio is only 2% for men and .1% for women. Nationally, this rate is significantly higher, but because of the high quality of the pellets we use and the technique of placement, we see an extremely low expulsion rate.

If one or more of your pellets is expelled, you will see the pellet when you remove your bandage. It will look like a tiny, white cylindrical object like a long grain of white rice. It is always a good idea to remove your bandage carefully and check for any expulsions. You will need to look closely.

So, what happens if a pellet is expelled? Simply call our office, come back in, and we will re-insert a replacement pellet. It’s relatively easy.

To avoid expelling your pellets in the first place, we recommend you refrain from vigorous physical activity, particularly on the first day, but also for up to five days after your placement so your incision has a chance to heal.Try to relax and put your feet up. Read a book. Watch a movie or two and avoid lots of walking and heavy lifting. Under no circumstances should you run, do squats, or do deep knee bends.

If you have little body fat, you will have a higher likelihood of expelling your pellets, so lean individuals should be extra careful during this time. If the area the pellet is placed in has a good amount of fat to cushion and surround it, there is only a small chance of expulsion. That is why on average, women retain their pellets better. If the area around the gluteus maximus is hard with little fat, the pellets are more easily pushed out if that muscle is contracted, which is why men have a higher rate of expulsion. That, coupled with the fact that men always receive more pellets than women do, increases the expulsion rate. So, it is primarily my male patients who will need to slow down and take it easy for the first few days after their placements. 

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