The Next Evolution of Pellet Therapy

Updated on August 16, 2023

Pellet therapy is one of those things where everyone knows someone who has tried it. But what is the rest of the story—is it really effective? Is it the best method for hormone replacement therapy?

Dating back to the 1930s, pellet therapy is one of the oldest forms of hormone therapy and has re-emerged as one of the most effective methods of natural hormone replacement. However, the therapy is not without its skeptics.

The history of pellet therapy is littered with tales of unwelcome side effects and uncomfortable experiences during and after the procedure. Many practitioners eschew the therapy because the risks seemingly outweigh the benefits. However, researchers, scientists, and medical professionals are finding that many of the fundamental issues that have plagued pellet therapy can be fixed—when providers focus on two key components.

Transforming Healthcare

To understand the significance of modern pellet therapy and the imperative need for advancing methodologies, one must first examine the fundamental role hormone balance plays in long term health and the transformative impact it could make in the current healthcare model. 

Our healthcare system is built on reactive medicine and sick care. Each year, trillions of dollars are spent keeping people alive, but not helping them experience the true essence of living. Many chronic diseases that plague these individuals could be prevented if healthcare practitioners changed how they approach routine patient care.

Numerous ailments that afflict people as they age are not “normal,” but instead a result of hormone imbalance. Hormones are vital chemical messengers responsible for nearly every function in the body. Upon examination of the research on aging—in particular, what science and technology has allowed us to see and comprehend over the last ten years—it is evident that conditions of low estrogen or low testosterone put men and women of all ages at increased risk for disease.

A 2023 review on estrogen and neurovascular disease details multiple studies that show the loss of estrogen, often associated with menopause, increases the incidence of Alzheimer’s disease, dementia, and reduced cognitive function among women. 

One study, published in 2019 in the The Journal of Clinical Investigation, describes the benefits of estrogen for both men and women, as well as the role of androgens in both genders. The study begins by contradicting the antiquated and oversimplified categorizations of estrogen as “the female hormone” and testosterone as “the male hormone.”The article cites that these two hormones, “. . . play important developmental and functional roles in many organs of male and female humans, respectively. These roles include actions in the reproductive organs, brain, bones, heart and vasculature, and liver.” 

This research further demonstrated the protective benefits of estrogen by concluding that among men, “Estrogen stimulation of bone or blood vessel cell functions preserves the integrity of the organ, preventing disease. In pathological states, such as prostate cancer, complicated actions mediated through different estrogen receptor isoforms underlie both stimulating and suppressing actions in the various cells that make up the tumor.” While among women, “In the brain, androgens may improve sexual desire and performance, most notably in women with HSDD. In bone, androgens regulate bone size, perhaps by controlling cancellous bone volume. In the uterus, androgens may regulate parturition by modifying myometrial contractility and cervical remodeling. . .  In breast cancer, however, androgens may suppress growth when the ratio of AR/ERα signaling is low but may promote growth when AR/ERα signaling is high.”

This is why hormone therapy with the goal of hormone optimization is an essential component in shifting from a sick care model to a preventive care model. And why the right approach to pellet therapy is transformational for practitioners, patients, and the healthcare industry.

A Brief History of Pellet Therapy

Pellet therapy has been around for more than 90 years, beginning with estradiol pellets for women who had radical hysterectomies. 

It has fallen in and out of popularity across the decades, gaining significant momentum in the last ten years for hormone imbalance. Today, many patients experience report pain and/or are left with unsightly incisions from the procedure. Some have dealt with extrusions or the buildup of scar tissue, which can make the therapy altogether ineffective.

To date, however, pellet therapy remains the only modality that closely mimics the natural secretion process of hormones and supports patients in relieving symptoms of hormone imbalance without the risks and inconveniences of other modalities. Compared to creams, patches, pills, and injections, the benefits of pellets are greater. Pellets are simple for daily use, avoid risk of transference, and don’t require administration more than a few times a year—eliminating gaps in the treatment plan due to lost patches, forgotten pills or improperly applied creams.

In 2018, a new formulation hit the market that overcomes the most common issues with pellet therapy.

Pellet Therapy Done Differently

In 2009 in Phoenix, I learned about the benefits of hormone replacement therapy (HRT) and the newfound value of pellet therapy for men and women experiencing hormone imbalance. During this visit, I shadowed Gino Tutera, MD, a physician renowned for his research, testing, and analysis in the field of hormone therapy, especially the benefits of pellet therapy over other methods of HRT.

Though Dr. Tutera passed away in 2015, his legacy and research have lived on. He has been dubbed the father of pellet therapy in industry circles, paving a path that set the course for transforming healthcare and what it means to live better for longer. 

Following my experience with Dr. Tutera, a new path emerged, opening the door to breakthroughs in the field of hormone pellet therapy. 

Today, my goal is preventive care instead of reactive care. I am the owner of regenerative medicine clinics in Texas, as well as Chief Medical Officer for a medical training and consulting organization focused on helping practitioners learn and successfully incorporate integrative therapies into their private practice.

In 2018, I partnered with an outsourcing facility in Southlake, Texas, working with researchers and scientists to develop a new pellet formulation. The goal was to see how changes to the pellet ingredients, as well as the development process of the pellet, might impact patient experiences and outcomes. 

Collaboratively, a unique pellet formulation was realized—outside the standard developed by most compounding facilities. The outcomes were documented in a 2018 white paper, Subcutaneous Testosterone Pellet Implants: Understanding the Role of Triamcinolone. The research concluded that the unique formulation not only yielded patient reports of less pain and bruising compared to prior experiences, but the extrusion rate among males and females dropped by 50 percent.

In 2023, this pellet formulation was awarded a U.S. patent for its uniqueness, and it has rapidly become preferred by HRT pellet providers across the country. 

Houston OBGYN Johnny J Peet, MD, has prescribed and administered pellets for nearly a decade. He describes the new formulation as a game changer, stating, “In the 90-year history of pellet therapy, no one else has done this. These pellets and the insertion technique developed by Dr. DeNeui make the whole experience better for practitioners and their patients.”

Pellet Placement Matters

As more research emerges about the benefits of hormone therapy for optimal, long-term health, it will become vital that the modalities are practical for the modern lifestyle. That is why research was not limited to just the pellet.

Since 2015, there has been significant examination of various factors impacting the efficacy of the pellet therapy, including where and how it is placed within the body. The imperative now lies in educating and training other practitioners in hormone health with a focus on pellet therapy and its insertion techniques. To date, thousands of practitioners nationwide have been trained on pellet insertion and the benefits of the patented pellet formulation.

Happier and Healthier

Pellet therapy, and HRT for that matter, have endured a rocky path, however researchers and experts are finding that many of the people experiencing age-related declines have at least one hormone imbalance 1-3. The degree and severity of the imbalance is highly individualized, making the tailored treatment plans and integrative therapies key to preventive care and a longer, active life. 


  1. Horstman AM, Dillon EL, Urban RJ, Sheffield-Moore M. The role of androgens and estrogens on healthy aging and longevity. J Gerontol A Biol Sci Med Sci. 2012 Nov;67(11):1140-52. doi: 10.1093/gerona/gls068. Epub 2012 Mar 26. PMID: 22451474; PMCID: PMC3636678.
  1. Palacios S, Stevenson JC, Schaudig K, Lukasiewicz M, Graziottin A. Hormone therapy for first-line management of menopausal symptoms: Practical recommendations. Women’s Health. 2019;15. doi:10.1177/1745506519864009
  1. Glaser R, Dimitrakakis C. Testosterone Implant Therapy in Women With and Without Breast Cancer: Rationale, Experience, Evidence.Androgens: Clinical Research and Therapeutics.Dec 2021.94-110.

About EVEXAS Health Solutions

EVEXIAS Health Solutions is an emerging leader in the advancement of medicine toward a preventive care model that positively impacts patient lives while also allowing practitioners to grow their practice.

The EVEXIAS team has helped thousands of practitioners across the nation enhance patient care and expand their treatment plans through advanced medical education and training from industry-leading medical practitioners, researchers, and scientists, as well as providing access to leading-edge therapies and technologies that support the prevention of disease and improve quality of life. Every EVEXIAS program is backed by strategic business plans and operational practices exclusively developed for private medical practices to achieve the highest level of patient experience and outcomes for the practices served. 

Terri DeNeui
Terri DeNeui, DNP, ACNP, APRN-BC

Terri DeNeui, DNP, ACNP, APRN-BC is the founder of EVEXIAS Health Solutions and creator of the EvexiPEL Method of pellet therapy. She leads the EVEXIAS medical Advisory Board, hand selecting leading experts from around the globe to support the education and knowledge resources that provide the opportunity to experience a whole new way to practice medicine that is truly transformational for patients and practitioners.