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  • Writer's pictureMonica Bell

What is Hormone Replacement Therapy, and Pros and Cons of Different Forms

What is Hormone Replacement?

Hormone replacement therapy (HRT) is a medical treatment used to replace hormones that the body no longer produces in adequate amounts for health and well-being. Bioidentical hormone replacement therapy (BHRT), which is what we use at Optimal Hormone Health,  is the use of hormones that are chemically identical to those naturally produced by the body. BHRT is a more effective and safer form of hormone replacement. Some characteristics of hormone replacement:

  • BHRT uses hormones that are derived from plant-based sources such as soy or yam and mimic the molecular structure of estrogen, progesterone, and testosterone. BHRT  alleviates symptoms associated with hormonal changes that occur during menopause in women or andropause in men. BHRT hormones can be compounded at a compounding pharmacy to your individual specifications.  

  • Women experience a decline in estrogen, testosterone, and progesterone during perimenopause and menopause, leading to significant symptoms such as hot flashes, vaginal dryness, loss of libido, mood swings, bone density problems, and sleep disturbances. 

  • In men, andropause (also known as male menopause) is associated with a gradual decline in testosterone levels, which can lead to symptoms such as reduced libido, erectile dysfunction, fatigue, and mood changes. Hormone replacement therapy for men typically involves testosterone replacement to restore hormone levels to normal levels and alleviate associated symptoms.

We will review your labs, goals, and symptoms during your consultation to ensure you get an individualized plan. A significant part of your consultation is deciding on the best forms of hormone replacement. Let’s review the various forms of hormone replacement so you can, with our input, make the best choice for your circumstances.


Forms of Hormone Replacement

Fortunately, there are several forms of hormone replacement for both men and women. Personal preference, effectiveness, and cost are all considerations. At Optimal Hormone Health, we will review your lifestyle, symptoms, and risk factors and recommend the best hormone therapy for you.

For Men


We prefer that you use the compounded cream on the scrotum daily, (we avoid using Androgel here as is it alcohol based, ouch) and its absorption is much more predictable than on other skin parts. 

  • Pros: Easy to use. Cost-effective. Better for erectile dysfunction.

  • Cons: You must use it daily or twice daily. It is possible to transfer it to partners and children. Absorption is less predictable than injections or pellets.


Testosterone can be injected once or twice a week. 

  • Pros: Cost. Good absorption. Good for men who have not absorbed cream well in the past or have sensitivities. 

  • Cons: Once-a-week injections can cause irritation at the injection site. Often, twice a week is required to maintain stable blood levels. Some patients won’t be comfortable with injections due to discomfort with needles.



Pellets are placed in the hip or the flank and are done every 4-6 months. 

  • Pros: Set it and forget it; suitable for those who have difficulty remembering to use cream or do injections. Pellets maintain stable hormone levels. 

  • Cons: Possible infection and encapsulation of the pellets. Cost. Bruising and pain at the insertion site. No heavy leg workouts for one week after insertion. Men require many pellets to achieve ideal testosterone levels, which increases the risk of infection.

For Women


Pellets are my personal favorite for women. You can use pellets for testosterone and estradiol (estrogen) but will need to take progesterone orally or vaginally.  This is the smoothest, most convenient way to do hormones, giving adequate levels consistently over time.  Pellet is how I chose to do my own HRT. However, you may have concerns about the dosing of pellets, considering that once they are in, your dosage cannot be changed until the next insertion. We start with lower dosing and then adjust based on your labs and how you feel. 

  • Pros: Set it and forget it; suitable for those who have difficulty remembering to take medications. Pellets maintain stable hormone levels and are more effective for libido and menopausal arthritis.

  • Cons: Possible infection. Cost. Bruising and pain at the insertion site. 

Creams or Vaginal Inserts

All the hormones can be delivered via cream or vaginal inserts, with the exception of progesterone which cannot be delivered via cream. I prefer that you use the cream vaginally as the absorption is much more predictable than the skin, and usually, lower doses are needed. 

  • Pros:Easy to use. Cost-effective. Soothing to vaginal tissues and encouraging tissue repair. 

  • Cons: Must use daily or twice daily—possible transference to partners and children. Absorption is less predictable.


Estradiol and progesterone can be given in capsules. However, there are a few circumstances when estradiol in capsule form is not ideal, such as a history of blood clots or stroke or patients undergoing breast cancer treatment. 

  • Pros: Easy to use. Cost. Stable blood levels. Progesterone capsules can help sleep. 

  • Cons: You must remember to take it daily. You might feel sleepy in the morning from the progesterone. Vaginally inserted progesterone can reduce feelings of sleepiness. 


Testosterone and estradiol can be injected once a week. 

  • Pros: Cost. Good absorption. 

  • Cons: Once-a-week injections. Often, twice a week is required to get stable blood levels. Some patients will not be comfortable with injections due to discomfort with needles. Side effects may be greater and injections may have less predictable blood levels.


Hormone Replacement and You

It is hard to overstate the critical importance of assessing your individual situation and hormone replacement. Finding the best hormone replacement entails a different healthcare approach involving patience, commitment, and flexibility. With our input, you may decide to change your original form of hormone replacement due to comfort, cost, or response level. And that is ok. At Optimal Hormone Health, we are on the journey with you and expect changes to be part of the process. The goal is to improve your health, mood, and well-being consistent with your goals.

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