Wellness
July 30, 2026·5 min read
Clients ask me this question almost every week: which is better — pellets, injections, or a cream? The honest answer is that there is no universally better option. There is only the right option for a specific person at a specific point in their care — and figuring that out is what an individualized evaluation is for. But understanding how each delivery route actually works makes the conversation at consultation a lot more productive. So here is what you need to know.
When we talk about bioidentical hormone replacement therapy (BHRT), the conversation often starts with which hormones — estradiol, progesterone, testosterone — and less often with how they get into your body. That second part matters more than most people realize.
Every delivery route has a different pharmacokinetic profile — meaning hormones absorb, peak, and clear from the bloodstream differently depending on the method. Oral preparations pass through the liver before reaching systemic circulation, which changes how some hormones behave. Topical creams absorb through the skin and avoid that first-pass liver metabolism, but absorption can vary significantly depending on where and how consistently you apply them. Injections deliver hormone directly into muscle or subcutaneous tissue and produce a peak-and-trough cycle — higher levels shortly after the injection, lower levels as you approach the next dose. Pellets sit beneath the skin and release hormone gradually over months, in response to physical demand.
None of these is inherently superior. Each has a clinical rationale. The goal is matching the right route to you — your symptoms, your lifestyle, your labs, and how your body has responded to therapy in the past.
Compounded BHRT disclosure: When compounded hormone preparations are used in your therapy, those preparations are not FDA-approved finished pharmaceutical products. They are dispensed under 503A patient-specific prescriptions following individualized medical evaluation by Marina Roloff, DNP, FNP-C. The benefits and risks of compounded BHRT compared to FDA-approved hormone therapy have not been established by the FDA.
Hormone pellet therapy involves a small, rice-sized pellet — compressed bioidentical hormone — inserted just beneath the skin, typically near the upper buttock, during a brief in-office procedure. At Enhance, we use the EvexiPEL® system, a structured pellet protocol with standardized dosing guidelines based on lab work and symptom history.
Once inserted, the pellet releases hormone gradually over roughly three to six months, depending on the individual. The release is influenced by physical activity and metabolic demand — which is one reason this route appeals to clients who want consistent levels without a daily routine.
The EvexiPEL® protocol requires lab work before each insertion to calibrate dose. There is no daily application or weekly injection schedule; the main commitment is the insertion appointment every few months and the follow-up labs that guide the next dose. For some clients, that predictability is a significant practical advantage. For others — particularly those who want flexibility to adjust dose more quickly — the multi-month duration of a pellet is a disadvantage worth discussing.
Research on pellet pharmacokinetics has shown that subcutaneous hormone pellets can maintain more stable serum levels over time compared to other delivery methods, though individual response varies and the clinical literature continues to evolve. The Menopause Society notes that while pellet therapy is used clinically, long-term comparative data on outcomes across delivery methods is still limited — which is why individualized monitoring matters regardless of route.
Testosterone cypionate and testosterone enanthate are the injectable forms most commonly used in hormone optimization programs. Injections are typically administered weekly or biweekly — either in-office or self-administered at home after proper instruction — and deliver hormone directly into muscle or subcutaneous tissue.
The primary characteristic of injectable testosterone is the peak-and-trough pattern. Levels rise in the days following an injection, then decline as the next dose approaches. Some clients adapt to this cycle without issue; others notice mood or energy shifts as levels fluctuate near the end of a dosing interval. Adjusting the dose frequency — for example, moving from biweekly to weekly injections — can flatten that curve for clients who are sensitive to the swings.
Injections offer a degree of dose flexibility that pellets do not. If a lab value or symptom picture calls for an adjustment, we can change the next injection rather than waiting out a multi-month pellet cycle. That adaptability is clinically useful early in therapy, when we are still dialing in an individual's optimal range.
Transdermal BHRT — creams, gels, or patches — deliver hormones through the skin and into systemic circulation, bypassing the liver's first-pass metabolism. This route is used most commonly for estradiol and progesterone, though compounded testosterone creams are also prescribed in certain cases.
The tradeoff with topical applications is consistency. Absorption varies based on where the cream is applied, the quality of the skin barrier, bathing and activity habits, and individual skin characteristics. Clients who use topical preparations need a reliable daily routine, and transfer to others through skin contact — particularly with testosterone — is a real safety consideration that requires clear guidance.
For some clients, a transdermal route is the right clinical answer, particularly when injection-related considerations or personal preference rule out other options. FDA-approved transdermal estradiol preparations exist, which is relevant to how we discuss evidence and monitoring with each client. The National Institute on Aging notes that FDA-approved hormone therapies — including transdermal options — have an established evidence base, and that discussions about delivery route should be part of any comprehensive hormone evaluation.
Hormone therapy carries known risks including breast tenderness, fluid retention, mood changes, and — depending on regimen — cardiovascular, thromboembolic, and endometrial considerations. A face-to-face consultation, lab evaluation, and ongoing monitoring are required.
I do not have a single preferred route. When a client comes in for a hormone evaluation, we start with labs and a detailed symptom conversation — not with a delivery method already decided. The route follows the clinical picture, not the other way around.
For clients who want a low-maintenance option and whose labs and history make them a candidate, EvexiPEL® pellets are often a good fit. For clients earlier in treatment, or those whose doses we are still refining, the adjustability of injections or topicals can be more useful. Some clients move between routes over time as their needs change. That is not unusual — it is how individualized care actually works.
You can read more about what a hormone evaluation at Enhance looks like on our health and wellness page. If you are earlier in the process of figuring out whether hormone therapy is appropriate for you, the post on bioidentical hormones explained is a good place to start, and our earlier post on perimenopause symptoms and when to ask about hormone therapy covers the symptom picture in more detail.
If you have been told your labs are normal but you are not feeling normal — or if you have heard about pellets and want to understand whether they make sense for your situation — I would rather have that conversation in a consult than leave you sorting through it on your own. Call us at 928.370.4480 or schedule a consultation through the link on our website.
Information on this page is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Individual results vary; outcomes shown or described are not guaranteed. Compounded medications referenced (including bioidentical hormone formulations) are prepared by licensed compounding pharmacies under 503A patient-specific prescriptions and are not FDA-approved finished pharmaceutical products. Consult an Enhance clinician for guidance specific to your situation. Images may contain models. © 2026 Enhance Aesthetics & Wellness.
Medically reviewed by Marina Roloff, DNP, FNP-C — 2026-07-30
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Marina Roloff, DNP, FNP-C — Enhance Aesthetics & Wellness, Yuma, AZ
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