During our recent visit to the AMMG conference in Miami, I attended a seminar on hormone replacement therapy delivery systems where the benefits—and in some cases potential drawbacks—of different hormone therapy delivery mechanisms were reviewed. This made me reflect on how much information is out there, and how confusing it could become for patients. If you do a Google search about HRT, the results can seem endless and sometimes even conflicting. Injectables, oral supplements, gels, sprays, patches, lotions, pellets, suppositories, vaginal rings…
To break it down, I’d like to explain the primary HRT delivery systems, and some of the key takeaways you should know about each. It is important to always remember that no two patients are the same and your specific situation might warrant different therapies or approaches. For any specific questions about your individual needs, we can schedule a free screening to discuss your options in more detail.
Far and above the most effective and efficient delivery mechanism for hormone replacement therapy is by injection. The high bioavailability of injectables means the hormones are immediately available to the body, getting to work for you faster. With other therapy formats, the hormones have to transfer through the skin, digest in your gut, or make their way into your system through other processes. The bioavailability of injections is more predictable, more easily adjustable and more rapidly incorporated into the system.
The biggest drawback with injections is a widespread fear of needles. We regularly talk to patients that are reticent to use needles, especially if it means using a needle on themselves. It’s natural. But once patients receive their individual training and understand the injection is subcutaneous, entering painlessly into the initial fat layer of the skin, that fear of needles quickly dissipates. A large percentage of our patient population actually prefers self-injection. That’s because they can do this in the comfort of their own home. But for those who simply don’t feel comfortable administering their own injections, we gladly welcome them into our office to complete the injections for them.
You may also read about the risk of infection, but when practicing proper hygiene practices with injections, the risk of infection from an injection is small.
Topicals (creams, gels and lotions)
Topicals are an option for those who are needle phobic. In my opinion, the reason creams and gels have been promoted heavily by providers and pharmaceutical companies in the past is that they require no training. It’s easy to market a testosterone cream to the masses, because applying lotion is something we can all do!
Many practices don’t take the time to train their patients how to properly inject their hormones. Instead, they give them a cream, and if they believe injections are warranted—which many times is the case—they make their patients come into the office.
This is not to say I am against topical applications. They can indeed be a good option for some. However, the ease of application comes with some significant drawbacks. Among them is that creams and gels can leave residue on the skin, which means patients have to be extremely careful about transfer onto loved ones, pets, children, etc.
Another perhaps bigger issue is that these topicals have to absorb through the skin to get into the body, and the skin has an enzyme called 5a-Reductase. This enzyme converts testosterone to DHT, so from the very beginning we need to carefully monitor DHT levels to combat and balance this hormone based on your body’s needs.
Pellets are another option that are increasingly popular, particularly because women only need to come in once every four months or so to get new pellets placed. Pellets can be an excellent option for female HRT, however due to the larger doses of testosterone and potentially more adjustments in the first few months of therapy, there are a few more moving parts we must consider when it comes to pellet therapy in men.
For men in austere conditions, or who are in a place where they cannot give themselves injections, this can be a viable option. For example, when they are away for extended periods of time and don’t have access to needles, they are being deployed, or are away on a long-term work trip.
For women, it’s no surprise this is becoming such a sought-after HRT delivery mechanism. With minimal downtime and long spans between pellet insertions, pellet therapy is a strong alternative for those who are not interested in HRT injections.
If you’re interested in learning more about whether hormone replacement therapy might be right for you, give us a call to get started with your completely free screening.