Hormone Replacement

Richard Lorenzo, DO -  - OB-GYN

Complete Healthcare for Women

Richard Lorenzo, DO

OB-GYN located in Richland, WA

During perimenopause and menopause, your production of estrogen and progesterone slows down. This causes the tell-tale symptoms of hot flashes, night sweats, and vaginal dryness. Dr. Richard Lorenzo can help ease these symptoms with hormone replacement therapy. If you live around Richland, Washington, make an appointment at his practice, Complete Healthcare for Women, to learn more.

Hormone Replacement Q & A

What is hormone replacement therapy?

Hormone replacement therapy corrects imbalances of estrogen and progesterone that occur later in life when your cycle changes and ultimately ceases. You take synthetic or natural hormones to replace the hormones you no longer produce.

Why would a woman need hormone replacement therapy?

When your hormones fluctuate in the years just before your period ceases, hormone replacement therapy may help level them out so you don’t experience as many mood swings and hot flashes, or mental fog and vaginal dryness. Correcting hormone imbalances can improve your energy levels and make you feel better overall.

Women who have a hysterectomy prior to menopause experience “surgical menopause,” and may also benefit from hormone therapy. Whether used after a hysterectomy or natural menopause, hormone replacement offers possible protection against heart disease, unexplained weight gain, and osteoporosis.

Who is the ideal candidate?

Women who benefit from hormone therapy are those with severe menopausal symptoms. You may also consider the therapy if you have a family history of osteoporosis.

Women who’ve undergone surgical menopause after a hysterectomy usually benefit from estrogen-only hormone therapy.

When you undergo natural menopause, a combination of estrogen and progesterone is appropriate. Just taking estrogen increases your risk of cancer of the uterine lining. Adding progesterone encourages you to still shed this lining, so the risk of developing cancerous cells diminishes.

When should a woman start hormone therapy?

The average age of menopause is 51, but many women begin sooner or later. Consider therapy when you start to have symptoms that interfere with your life, not before. You can safely continue therapy for four or five years.  

How do you take hormones?

Hormone replacement is available in a variety of forms. Talk to Dr. Lorenzo about the one that is best for your lifestyle and symptoms. Pills, a patch, time-released pellets, vaginal rings, creams, and gels are all options.

Are there risks with hormone therapy?

Women with a heightened risk of breast cancer or with a history of blood clots should not use hormone therapy. If you don’t experience menopausal symptoms, the therapy is unnecessary, too. Hormone therapy can increase some women’s risk of developing breast cancer, heart disease, and stroke. Discuss your concerns and your health history with Dr. Lorenzo. In many cases, the benefits of hormone therapy outweigh any risks.



Overwhelming data supports the fact that testosterone implants effectively treat symptoms in both men and women. Implants, placed under the skin, consistently release small, natural doses of hormones providing optimal therapy without adverse effects.


What are Pellets?

Pellets or implants are made up of bio-identical hormones (i.e. testosterone or estradiol that are the exact chemical formula, identical molecular structure, to what your body produces) and are derived from natural plants that are pressed into very small solid cylinders. These are larger than a grain of rice and smaller than a “Tic-Tac”. In the United States, the majority of pellets are made by compounding pharmacists since “big pharmaceutical companies” can’t profit from the production of unpatentable, natural substances.


Why Pellets?

Pellets deliver consistent, healthy levels of hormones for approximately 4 months in women and 5 months in men. The pellets dissolve completely on their own during this time. They avoid the fluctuations or ups and downs of hormone levels (roller coaster effect) seen with EVERY other method of delivery. This is important for optimal health and disease prevention. Pellets do not increase the risk of blood clots or other complications that which conventional/synthetic hormone replacement therapy has been associated. In studies comparing pellets to conventional hormone replacement therapy, pellets have been shown to be superior for the relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in sex drive, libido, sexual response, and performance. Testosterone delivered by a pellet implant has been used to treat migraine and menstrual headaches. Testosterone also helps with vaginal dryness, incontinence, urinary urgency, and frequency. In both men and women, testosterone has been shown to increase energy, relieve depression, increase the sense of well-being, relieve anxiety, and improve memory and concentration. Testosterone delivered by pellet implant increases lean body mass (muscle strength, bone density) and decreases fat mass. Men and women need adequate levels of testosterone for optimal mental and physical health and for the prevention of chronic illnesses like Alzheimer’s and Parkinson’s disease, which are associated with low testosterone levels. Even patients that have not had success with other types of hormone therapy have a VERY high success rate with pellets. There is no other “method of delivery” that is as convenient, effective, and safe for the patient as implants. Implants have been used in both men and women since the late 1930s. There is significant data that supports the use of testosterone implants in both men and women.

How long until a patient feels better after pellets are inserted?

Some patients begin to “feel better” within 24-48 hours, while others may take 10-14 days to notice a difference. Diet and lifestyle (exercise), along with hormone balance are critical for optimal health. Stress is a major contributor to hormone imbalance and illness. Side effects and adverse drug events from prescription medications may interfere with the beneficial effects of the pellets.

How long do pellets last?

The pellets usually last between 3-5 months in women and 4-6 months in men.  The pellets do not need to be removed. They completely dissolve on their own . . . And remember, not all pellets are created equal. We have dedicated significant resources and research to finding a compounding pharmacy that produces the best pellets in the country.

Do female patients need progesterone when they use the pellets?

Women who are treated with testosterone implants alone (no estrogen therapy) do not require progesterone therapy. However, if estradiol or other estrogen therapy is prescribed to a woman who still has her uterus, progesterone is also needed. The main indication for progesterone is to prevent the proliferation (stimulation) of the uterine lining caused by estrogen. Progesterone therapy is NOT required if estrogen therapy is not prescribed. However, there may be other health benefits from the hormone, progesterone. It may be used in addition to other hormones to help women who have difficulty with sleep, hot flashes, tension, or anxiety.  Testosterone and progesterone have beneficial effects on the brain and nervous system. Progesterone implants have been used since the 1940s.

How are hormones monitored during therapy? Hormone levels will be drawn and evaluated before therapy is started. Every patient will have individualized dosing that is calculated from these lab values, height, and weight.  This type of specific hormone dosing guarantees

That you will receive the exact amount that your body needs. These labs include FSH, estradiol, and testosterone for women. Men need a PSA (prostate-specific antigen), sensitive estradiol, testosterone (free and total), liver profile, and a complete blood count prior to starting therapy. Thyroid hormone levels will be evaluated along with Vitamins D, B12, and Ferritin.

In men, follow-up levels, including a PSA, blood count, total testosterone, and estradiol, may be obtained prior to subsequent testosterone implantation. Men must notify their primary care physician and obtain a digital rectal exam each year. Women are advised to continue their monthly self-breast exams and obtain a mammogram and/or a pap smear as advised by their gynecologist or primary care physician.

Is there a role for testosterone implants (pellets) in premenopausal females?

Testosterone pellets may be used in premenopausal females (women who have not stopped menstruating). Testosterone has been shown to relieve migraine and menstrual headaches, help with symptoms of PMS (premenstrual syndrome), relieve anxiety and depression, increase energy, help with sleep and improve sex drive and libido. If a premenopausal female has a testosterone pellet inserted, birth control is recommended. There is a “theoretical risk of masculinizing” a female fetus.

Can a patient be allergic to implants?

Very rarely, a patient will develop a local zone of redness (3-8 cm) with itching at the site of the pellet. There is minimal or no tenderness and no other signs of infection. Pellets are made up of testosterone, and stearic acid.   If needed, 25-50 mg of Benadryl works well for the itching. 


Insurance does not cover Pellet Hormone Replacement therapy. 

It is considered an elective procedure. You will responsible for payment at the time of the procedure.


Most Insurance Plans Accepted

At Complete Healthcare for Women, we participate with most insurance carriers. Here is a short list of plans we accept. Please contact our office if you do not see your insurance plan. If determined, we do not participate with your insurance company, we will submit claims for you as a courtesy. If the insurance company does not pay within 45-days, you will be responsible for payment of all charges.

Assurant Health
Asuris Northwest Health
Community Health Plan of Washington
First Choice Health
Molina Healthcare
Premera Blue Cross
United Healthcare