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Pellets of compounded oestrogen and testosterone are implanted under the skin and sold as a way to feel young again. The National Academies reviewed the evidence and told prescribers to restrict their use: the claim that compounded preparations are safer or more effective than approved hormone products is not supported, and nobody checks what is in them.
Compounded bioidentical hormone therapy is prepared by a pharmacy to a prescriber's formula rather than manufactured to a marketing authorisation, and is often given as a subcutaneous pellet that releases hormone over months. It is marketed for energy, libido, mood, body composition and 'hormone optimisation', and survivors of cancer are a target market because treatment leaves many of them with abrupt menopause or hypogonadism.
The National Academies of Sciences, Engineering, and Medicine reviewed it in 2020 in The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. The committee concluded that use should be restricted to specific circumstances, found insufficient evidence for the marketing claim that compounded preparations are safer or more effective than approved products, and identified the absence of FDA review for safety, quality and effectiveness as a public health concern.
Two further points apply specifically after cancer. A pellet cannot be removed easily once implanted, so a dose that turns out to be wrong, or a hormone that turns out to be contraindicated, cannot simply be stopped. And for hormone receptor-positive breast cancer, prostate cancer and some gynaecological cancers, systemic hormone exposure is the thing the treatment was designed to remove; whether and how to replace it is a decision for the treating oncologist, with licensed products at known doses, not for a clinic selling pellets. Licensed hormone products exist and have dose-controlled evidence behind them; this record is about the compounded pellet, not about licensed hormone replacement.
A fused pellet of crystalline hormone implanted in subcutaneous fat dissolves over three to six months, producing a long plateau that cannot be titrated or withdrawn. Serum levels from pellets are frequently supraphysiological, and there is no validated monitoring strategy for a compounded preparation of unverified content.
Query for this technology: (TITLE:"compounded bioidentical hormone" OR ABSTRACT:"compounded bioidentical hormone" OR TITLE:"hormone pellet" OR ABSTRACT:"hormone pellet" OR TITLE:"bioidentical hormone therapy" OR ABSTRACT:"bioidentical hormone therapy"). Results are unfiltered search hits about Compounded hormone pellets, not a curated reading list.
Shares Alternative medicine used instead of standard treatment, What actually works after treatment, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, unproven.
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Shares Alternative medicine used instead of standard treatment, What actually works after treatment, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, unproven.
Shares Alternative medicine used instead of standard treatment, What actually works after treatment, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, unproven.
Shares Alternative medicine used instead of standard treatment, What actually works after treatment, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, unproven.
Shares Alternative medicine used instead of standard treatment, What actually works after treatment, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, unproven.
Shares What actually works after treatment, Quality of life, Survivorship care and late-effects surveillance and the tags rejuvenation, survivorship.
Shares What actually works after treatment, Late effects and survivorship toxicity, Survivorship care and late-effects surveillance, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.