By James Staheli D.O.Testosterone replacement therapy (TRT) for women is a generally polarizing topic, but among the delivery methods, one option—testosterone pellets—tend to raise the most questions.
As a physician who treats women in perimenopause and menopause with testosterone when clinically appropriate, I’ve seen a direct correlation between TRT and increases in energy, endurance, mood, mental acuity, and muscle strength.
Testosterone pellets, in particular, are favored by some women for their convenience. However, research on all forms of TRT in women, including pellets, is limited, making it challenging to parse out credible information.
Here’s what I tell my patients about testosterone pellets, including the current evidence around them, how they work, their potential benefits, and why some medical organizations remain cautious.
What Are Testosterone Pellets?
Testosterone pellets—which are about the size of a Tic Tac—are inserted beneath the skin, typically in the upper buttock. They deliver a steady release of testosterone over 3 to 6 months. 1
These pellets are compounded by specialized pharmacies and contain bioidentical testosterone—chemically identical to what your body naturally produces. They may also contain binding agents like stearic acid or cholesterol.
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Let’s Get StartedWhy might a woman consider pellets?
Testosterone starts to decline around the age of 30 in women and can drop by half by the time they reach menopause. Women whose blood tests indicate low testosterone may consider TRT, including pellets, to manage symptoms like low libido, fatigue, mood disturbances, poor sleep, and muscle loss. 2
Testosterone is FDA-approved to treat Hypoactive Sexual Desire Disorder (HSDD, also called Female Sexual Interest/Arousal Disorder or FSIAD) in women, a condition marked by a reduced interest in sex. The agency hasn’t approved TRT, including pellets, for relief of broader menopause symptoms, though many providers, myself included, use it off-label when clinically warranted. 3
When I discuss TRT with women as part of a menopause hormone therapy plan, I review the risks, benefits, and delivery mechanisms, which include pellets, injections, creams, gel, troches (lozenges), or transdermal patches. The right choice depends on your symptom profile, treatment goals, preferences, and willingness to monitor and adjust as needed.
Whichever option you choose, your provider should review the procedure for the treatment and explain what to expect. Before receiving TRT, you should sign an informed consent form giving your permission for care, treatment, or services.
Why Are Testosterone Pellets Controversial?
Like other forms of TRT, testosterone pellets are controversial for women, primarily because there haven’t been a significant number of long-term studies to determine how safe and effective they are for treating menopause symptoms other than low libido conditions like HSDD/ FSAID.
There are three main concerns I share with women considering testosterone pellets:
Lack of FDA approval
While testosterone pellets have been FDA-approved for use in men since 1972, they remain an “investigational” treatment for women.
That doesn’t mean they’re inherently unsafe—many medications that aren’t FDA-approved provide valuable off-label benefits. But it does mean long-term safety data is limited.
Many healthcare providers, including myself, hope more research and FDA approval will come soon; in the meantime, many prescribe TRT off-label as they deem appropriate.
Compounded formulations = less regulation
Because testosterone pellets are compounded, there is a risk they could deliver inconsistent hormone levels, making side effects more likely.
Compounded hormones are not required to meet the same potency and purity standards as FDA-approved medications, raising questions about dosing accuracy, quality, and safety. 4 That said, many reputable compounding pharmacies are FDA-inspected and follow strict sterility protocols.
They can’t easily be removed
Once testosterone pellets are inserted, they cannot be easily removed to adjust the dosage or pause the treatment. If the dose is too high, patients may experience unwanted side effects, such as acne, oily skin, facial hair growth, scalp hair loss, a deepened voice, or clitoral enlargement. 5 For this reason, I take a conservative approach to dosing to avoid achieving supraphysiologic levels of testosterone and adjust based on follow-up labs.
There are oral medications available that can help minimize these effects as testosterone levels naturally decrease over time.
The Potential Benefits of Testosterone Pellets for Women
TRT is currently only approved for treating sexual dysfunction in women. However, a growing body of research suggests there may be other potential benefits of testosterone for women.
Although more studies are needed, some research suggests that in women, TRT may 6 7 8 9 10:
- Increase sense of emotional well-being
- Increase muscle mass, strength, and physical performance
- Help maintain memory
- Help plump the skin
- Decrease excess body fat
- Help maintain bone strength
- Boost mood, focus, and attention
- Reduce stress
- Increase motivation
- Enhance memory
- Aid in pain control
- Decrease the risk of cardiovascular disease
In perimenopause and menopause, testosterone pellets may be helpful in treating genitourinary syndrome of menopause, however the science on this is mixed and more research is needed.
Additionally, testosterone pellets prescribed to women in menopause offer:
- Convenience
- Lower risk of transference
- Stable hormone levels
- Privacy
Convenience
Unlike daily creams or gels, testosterone pellets require insertion every few months. Much like long-release birth control methods, pellets let women take a “set-it-and-forget-it” approach to hormone therapy, reducing the risk of missed doses.
Less risk of transference
With pellets, there’s no risk of inadvertently exposing others to testosterone. If testosterone cream isn’t fully absorbed by your skin, or your hands aren’t thoroughly washed after applying it, you could unintentionally transfer some onto children or pets. Prolonged exposure to testosterone can cause genital enlargement, pubic hair growth, and aggressive behavior in children.
Stable hormone levels
Compared to short-acting formulations, testosterone pellets deliver stable, consistent hormone release. If the dosage is correct, pellets avoid fluctuations in testosterone.
Privacy
Testosterone pellets are administered to women in the privacy of a clinical setting. While your healthcare provider makes a small incision at the insertion point, it’s less visible than a transdermal patch.
Downsides of Testosterone Pellets for Women
Some health organizations, including the Menopause Society (NAMS), the American College of Obstetricians and Gynecologists (ACOG), and the Endocrine Society caution against testosterone pellets for women in most cases. They cite the lack of FDA approval, the inability to adjust the dose between insertions, as well as side effects and other concerns.
Side effects
Studies indicate pellets may carry a higher rate of side effects compared to other forms of TRT, particularly if the dose is too high. These include: 11 12 13
- Mood swings
- Anxiety
- Acne
- Hair growth on face and body
- Hair loss on head
I stress to patients that careful titration and ongoing lab monitoring significantly reduce these risks.
Risk of infection
Because testosterone pellets require a minor surgical procedure for insertion, they carry a small risk of infection, bruising and swelling, extrusion (pellets working their way out of the body), and encapsulation (scar tissue forming around the pellets, affecting absorption). 14
These complications are rare when performed by a skilled provider using proper sterile procedures. To minimize these risks, choose a trained healthcare professional and follow their recommended post-insertion instructions.
Not all providers are trained to inject pellets
There are many opportunities for healthcare providers to become trained and certified in pellet insertion. However, not all providers administering testosterone pellets have received proper training.
Poor physician technique can lead to infection, improper placement, the pellet working its way out of your body (extrusion), or an uneven release of hormones. Women considering testosterone pellets should thoroughly vet their provider to ensure they’re experienced and certified in pellet insertion.
Cost
Because testosterone pellets aren’t FDA-approved as an HRT treatment for women, they’re not covered by insurance plans. Each pellet costs around $300 to $350. The total expense can range from $600 to $1,800 or more per year, plus additional charges for office visits and bloodwork. As more clinics offer the service, costs are likely to decrease.
Risk of high doses
If the incorrect dose is given, testosterone pellets can cause side effects including excessive hair growth, acne, weight gain, and mood swings.
A 2019 article published in The Endocrine Society’s Endocrine News reported that “an alarming number of patients have been appearing in endocrinologists’ offices with symptoms caused by high testosterone levels from custom-compounded bioidentical hormone implants.” 15
Such instances highlight the importance of regularly monitoring hormone levels and working with a trained and certified provider who titrates testosterone levels to prevent side effects.
How Are Testosterone Pellets Inserted?
Testosterone pellets are inserted just beneath the skin, typically in the upper buttock. The procedure is quick, performed under local anesthesia, and requires minimal downtime.
A healthcare provider cleans the treatment area, numbs the area with lidocaine, and makes a small incision, then uses a medical device called a trocar to place the pellets in the fatty tissue. Depending on the dosage, one or more pellets may be inserted. Once in place, the incision is closed with steri strips and covered with a protective dressing.
Over the next few months, the pellets slowly dissolve, releasing testosterone into the bloodstream. To maintain consistent hormone levels, new testosterone pellets are typically inserted every three to four months. While the procedure is generally well tolerated, proper technique is essential to minimize the risk of bruising, infection, pellet extrusion, or encapsulation.
Comparing Testosterone Pellets to Other TRT Delivery Methods
| TRT Method | Pros | Cons |
| Testosterone pellets | Long-acting (3-4 months), stable hormone levels, no transference risk. | Irreversible dose (may have to use oral medications if testosterone levels get too high), minor surgical procedure, costly, not FDA-approved |
| Testosterone cream or gel | Easy to apply, adjustable dose, FDA-approved options available for men that can be prescribed off-label to women. | Requires daily application, risk of transferring testosterone to others. |
| Testosterone injections | Inexpensive, stable release of hormones, adjustable dosing | Requires self-injection (once a week), possible bruising at the injection site |
| Testosterone troches | Convenient (lozenge, by mouth), non-invasive, adjustable dosing | Less stable release of hormones, requires daily use |
| Testosterone patches | Convenient (self-application), non-invasive, adjustable dosing, continuous release of testosterone | Visible, requires daily application, potential skin irritation, absorption can vary, cost |
Who should use testosterone pellets?
Testosterone pellets may be appropriate for women who:
- Have clinically low testosterone confirmed by lab tests.
- Have persistent symptoms that have not responded to lifestyle interventions.
- Prefer a long-acting, low-maintenance TRT option.
- Understand and accept the risks associated with pellet therapy, including dose irreversibility and the need for a minor surgical procedure.
Before starting pellets or another form of TRT, it’s essential to have a thorough consultation with a provider experienced in hormone therapy to determine the safest and most effective approach. TRT has the potential to increase the risk of developing or exacerbating certain conditions and/or complications associated with those conditions, such as breast cancer, sleep apnea, and heart, liver, or kidney disease.
Who should avoid testosterone pellets?
Testosterone pellets are not recommended for women who:
- Are pregnant or planning to become pregnant
- Have a history of hormone-sensitive cancers, such as breast cancer
- Have uncontrolled high blood pressure, cardiovascular disease, or clotting disorders
- Have untreated liver or kidney disease
- Have a known hypersensitivity or allergy to possible TRT ingredients
- Have untreated obstructive sleep apnea
The Bottom Line
Testosterone pellets for women are designed to offer a sustained dosage of testosterone to the bloodstream over three to four months. They are only approved by the FDA for treating sexual symptoms of menopause but are sometimes prescribed off-label for other symptoms like mood. Several organizations advise against pellets as a form of treatment due to concerns with dosage and side effects.
