Hormone levels should be optimized for your age, your sex, and your personal health. Women’s testosterone peaks in their 20s and decreases by half at age 60. Ongoing evaluation is important. It is optimal for our patients to test, discuss, and adjust recommendations over time.
We participated in over 100 trials of women’s health involving hormonal options and safety. Hormone levels should be optimized for your age, sex, and overall health — and that requires an individualized plan. Testing, discussion, and regular adjustments ensure that your treatment remains both safe and effective over time.
Hormones regulate metabolism, mood, energy, sleep, and sexual health. Declines or imbalances may occur naturally with aging, menopause, or andropause, but can also result from stress, medication use, or chronic illness. Restoring balance often improves vitality and quality of life — but the method of delivery can significantly influence how well therapy works for you.
Pellet Hormone Therapy
Pellet therapy involves inserting small, bioidentical hormone pellets — typically containing testosterone and/or estradiol — beneath the skin. Men have over 30 tesotsterone products approved, women must receive compounded therapy.These pellets gradually release hormones over three to six months, providing steady levels and minimizing peaks and troughs that are common with oral or injectable forms.
Advantages:
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Delivers consistent blood levels
- Can improve the production of nitric oxide a molecule that relaxes muscles around the clitoris and allows for greater blood flow
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Eliminates daily dosing
- Has extensive research corelating dosage and blood levels, and how that changes with other hormonal conditions such as thyroid deficiencies
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Provides testosterone replacement in women, for which few other forms are available
Considerations:
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Insertion requires a small in-office procedure
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Some activity restrictions for 24–48 hours afterward
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Possible site tenderness or extrusion (rare)
- Will have some out of pocket costs
Pellets are often ideal for patients who want sustained release and fewer fluctuations but should be managed by a provider skilled in bioidentical hormone therapy.
Oral Hormones
Oral formulations are available for contraception, menopausal symptom management, and hormone replacement. These pass through the liver (first-pass metabolism), which influences their systemic effects.
Advantages:
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Convenient, many formulations, and widely available
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Effective for many menopausal symptoms and contraceptive needs
- Reduces acne, PMS, PMDD, PCOS, and endometriosis
- Significantly reduces risks of uterine and ovarian cancer
- Progesterone only contraceptives are now available direct to consumers without an office visit
Considerations:
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May increase triglycerides, inflammatory markers, and blood pressure
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Associated with a slightly higher risk of gallbladder issues or GI irritation
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Some forms (especially synthetic estrogens) may alter clotting factors enough to lead to DVTs
Because of their impact on the liver, oral estrogens are often avoided in women with a history of blood clots or liver disease. Transdermal options are generally preferred when possible.
Injections
Hormone injections (such as testosterone cypionate or estradiol valerate) are used less frequently in women but remain common in some male hormone protocols.
Advantages:
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Rapid symptom improvement
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Flexible dosing intervals (weekly to biweekly)
Considerations:
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Blood levels can fluctuate widely, causing symptom swings
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Injection site soreness
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Oil-based suspensions may cause allergic reactions
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Limited long-term data compared to transdermal or oral routes
Topical or Transdermal Creams
Hormone creams, gels, and patches deliver hormones through the skin directly into circulation, bypassing the liver. They are commonly used for estrogen and progesterone therapy. Testosterone comes as cream, gel, or injection, but not currently is available as a patch.
Advantages:
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Steadier blood levels than oral forms
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Lower risk of clotting or liver effects
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Easy, noninvasive application
Considerations:
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Must be applied daily
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Variable skin absorption
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Risk of unintentional transfer to others (children, partners, pets)
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Can be influenced by body temperature, sweat, or skin thickness
Choosing the Right Method
The best hormone delivery method depends on your:
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Health status and medical history
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Symptom profile and treatment goals
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Personal preference and tolerance for procedures
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Desired convenience and consistency
For women, a transdermal or pellet approach offers stable hormone levels and favorable safety profiles. However, oral or injectable methods may be preferred for specific cases or short-term treatment goals.
The Bottom Line
Hormone optimization is not one-size-fits-all. It’s a collaboration between you and your clinician — guided by lab testing, symptom monitoring, and ongoing conversation. Your hormones are powerful chemical messengers, and with careful management, balance can restore vitality, cognition, libido, and overall wellness.
