Women’s Hormone Therapy FAQs


How did Dr. Maupin become so involved with bioidentical hormone pellets?

Dr. Maupin: “I had a hysterectomy when I was 47, and I tried every hormone product available in 2002, including other bioidentical preparations, and nothing worked. So, I did research and prayed. A nurse friend then introduced me to her brother, an OBGYN from California, who treated me and eventually trained me in the science and art of bioidentical hormone pellet therapy. It was as miraculous for me as it is now for my patients. I got my life and health back!”


Why do I need any hormone replacement?

Women need replacement if they desire to:

  • Delay the symptoms of aging
  • Reverse depression and anxiety
  • Regain libido
  • Preserve skin and muscle tone
  • Look younger
  • Increase energy
  • Strengthen the immune system
  • Improve physical stamina
  • Cure insomnia
  • Thicken hair
  • Protect against osteoporosis, dementia, diabetes, and heart disease
  • Prevent need for long term care from loss of ability to walk
  • Improve general health

Why are pellets better than patches, shots, or pills?

The reason we use pellets at BioBalance Health is because they contain the pure hormone and are not metabolized into byproducts that will cause side effects or inactivate the testosterone before you use them. This unique delivery system (pellets placed under the skin in the fat of the hip) allows this pure hormone to be delivered directly to the blood stream. Pellets act as a reservoir of hormone that allows your body to take as much testosterone or estradiol as your body needs at any one time. When you are exercising, you have an increased pulse and cardiac output so you absorb more hormone. Because BioBalance pellets are bioidentical, and because of their efficient delivery system, women are more likely to feel better on pellets than with any other form of estrogen or testosterone replacement.


What is Menopause?

Menopause is the third stage of aging. The first stage is losing your testosterone. The second stage is losing your progesterone. Menopause is when you enter the last stage of aging, and it it doesn’t end. You are in this stage until you die. That is why we need to learn how to treat it and live with it.


What symptoms are treated by BioBalance Health estradiol pellets?

Estradiol pellets adequately treat hot flashes, a dry vagina, painful intercourse, dry skin, and thinning hair.


What symptoms are treated by BioBalance Health testosterone pellets?

Testosterone pellets treat the symptoms of low libido, anorgasmia, depression, fatigue, muscle mass loss, weight gain, belly fat accumulation, immune system abnormality, autoimmune diseases, dry eyes, mental decline, loss of exercise stamina, loss of motivation, and many other symptoms of testosterone deficiency.


How is testosterone deficiency diagnosed?

Deficiency is diagnosed through its symptoms and a thorough medical history examination, in conjunction with a low free T in your blood level.


Can I take testosterone pellets if I am not menopausal and still cycling?

Yes. Most patients begin treatment sometime after 40 or if their ovaries are removed. Testosterone from the ovary disappears before menopause and should be replaced when a woman becomes symptomatic.


How is dosage calculated?

Every treatment plan is unique. We recreate what the normal daily production of testosterone and estradiol by a young ovary should be and deliver enough of that dose to last until the next pellet insertion. This dose is then adjusted according to body mass, exercise frequency, and any medications the patient is on.


Where are pellets inserted?

We place them in the upper-outer quadrant of the hip about 1.5 centimeters below the skin where they can dissolve and be picked up by capillaries.


How long will it take for the pellets to work?

It takes about 3-4 weeks to get the full effect. Pellets must be re-inserted every 4 months before symptoms recur.


How long will my pellets last?

Four months is typical. If you don’t get a lot of sleep, exercise, do stressful work, or participate in athletics, you will use them up more quickly and we may need to dose you with more pellets on the next insertion.


Do the pellets completely dissolved at the end of 4-6 months?

Yes. There is nothing left to be removed.


What is the cost of bioidentical hormone pellet therapy:

You can visit our Bioidentical Pellet Therapy Price List for questions regarding pricing.


Do estradiol or testosterone pellets cause weight gain?

Testosterone increases the thickness of bones and muscles which increase lean body mass. But, it also decreases fat at the same time. In general, women taking pellet hormones start by dropping sizes and don’t begin to lose weight for 9-12 months.


How long will it take for me to start losing weight?

That depends on how much you exercise you do, how over weight you are when treatment begins, and what other relevant medical conditions you have. We always try to help you with your weight loss by optimizing your pellet dose and balancing your other hormones.


How long can I take pellets?

You can take pellet replacement hormones as long as you wish. Bio-identical pellet replacement is the closest thing to your natural hormones that you can receive. The replacement of both estradiol and testosterone prevents many of the diseases of aging. We treat patients into their 90’s at Biobalance Health. Dr. Maupin says that she will be taking them as long as she is alive!


What diseases can be delayed or avoided if I take testosterone pellets?

The known diseases that testosterone can delay or prevent include:

  • Osteoporosis
  • Auto-immune diseases
  • Fibromyalgia
  • Immune Deficiencies
  • Dementia and Alzheimer’s Disease
  • Parkinson’s Disease
  • Frailty
  • Heart Disease and Stroke
  • Type II Diabetes
  • Obesity
  • Insulin Resistance

If I take testosterone pellets, will I need DHEA supplementation?

The reason someone might need DHEA is because their testosterone level is good, but they still have “sagging skin.” In this case, we recommend only 7 keto-DHEA in doses of 25 mg or less. Other types or doses above 25 can cause an increase in estrone which means weight gain and and increased risk of breast cancer.


If I have diabetes, will testosterone help me with my blood sugar?

Yes. Testosterone is very safe for diabetics and generally increases insulin sensitivity, which will decrease triglycerides and stabilize blood glucose. It will improve the status of your diabetes and help you lose weight.


Does testosterone improve depression and anxiety?

Yes. It often replaces anti-depressants (which decrease libido) after only one or two doses of pellets for patients whose anxiety and or depression began around age 40.


Why do you prescribe bio-identical progesterone to women with a uterus instead of synthetic oral Provera?

Oral progesterone, like bioidentical progesterone, can cause hunger and weight gain, with the side effects being worse with Provera. At BioBalance Health, we prefer bioidentical sublingual progesterone, or buccal lozenges, rather than oral progesterone because they are absorbed directly into the bloodstream and create less estrogen out of the progesterone than oral delivery systems for progesterone of any kind. The bioidentical hormone pellets are the least likely to cause side effects, but are best suited to women who don’t need a high level of progesterone, such as those women who have had an ablation.


What if I begin to bleed after menopause?

Prior to treatment, we ask you to get an ultrasound to evaluate whether you are likely to be at risk for bleeding with any ERT (estrogen replacement therapy). If so, we minimize the amount of estradiol you receive and increase the dose of progesterone. This helps to protect you from post-menopausal bleeding. If this does not work, then we send you to your gynecologist for a uterine biopsy, ultrasound, or the placement of a Mirena IUD which counteracts uterine bleeding by providing a small amount of progesterone inside the uterus.


How do cholesterol-lowering drugs affect testosterone?

Testosterone is made of cholesterol. When you take cholesterol-lowering drugs, you decrease the substrate that testosterone is made of, and generally decrease the level of testosterone. Testosterone replacement lowers cholesterol, so we recheck after the first dose and if your lipids are much lower. We then suggest that you do a trial without the medication to see if you still need it.


Do testosterone pellets cause breast cancer?

No. Testosterone pellets improve the immune system function so you can fight all types of cancers more easily than before you started treatment.


Do BioBalance testosterone pellets cause blood clots?

No, they do not.


Do BioBalance Health estradiol pellets cause blood clots?

No, they do not.


If I have used alcohol to excess or drugs like marijuana in the past, will I get the same effects as other women?

No. You will likely consume the testosterone more quickly than other women because your liver is hyper-activated to metabolize testosterone with the same enzymes that metabolize alcohol and drugs.

In addition, marijuana increases prolactin, the hormone that increases breast size in men and women. Prolactin not only decreases your testosterone level but decreases your sex drive and sexual stamina.  It is expected that if you take testosterone, you will stop using marijuana altogether and moderate your alcohol consumption.


Can I take birth control pills with testosterone pellets?

We strongly suggest that you do not because it dampens the effects of the testosterone pellets. Instead of oral contraceptives we encourage our patients to get a Mirena IUD or permanent birth control (like a tubal ligation or have their husbands get a vasectomy) instead of taking the pill. Many women who insist on continuing the pill (we are located in the Show-Me state) are disappointed in the resolution of their symptoms, and they decide after they experience the problem to seek out other birth control. Birth control is, of course, not needed after menopause.


What other medications inactivate or interact negatively with estradiol and testosterone pellets?

We suggest you look for alternative medications for the following drugs:

  • Corticosteroids such as prednisone
  • Medrol Dosepak
  • Tamoxifen
  • Progestins (not progesterone) such as Provera
  • DHEA that is not 7-keto DHEA
  • Other hormones given orally like oral contraceptives
  • Anti-depressants
  • Drugs for schizophrenia or bipolar disorder, which suppress the libido

I am a breast cancer survivor, can I take bio-identical testosterone pellets?

Yes. This is the safest form for you and it actually improves your immune system so that you can fight abnormal cells so they don’t grow, but instead are destroyed by T-killer cells.


What can I do about the belly fat that started to increase after I turned 40?

You should begin by taking non-oral estradiol and testosterone in the form of pellets. The pellets are the only form that bring the level of estrone back to young, healthy levels. Low estrone decreases belly fat.

If you are having trouble losing belly fat and have already accomplished the above, then take DIM ES 250 mg per day with food, take iodoral (iodine to bump your thyroid activity), eat 6 small meals each day with high protein and low carb, exercise with interval training, and always work out your abs by doing sit-ups and core exercises.

As a last resort, after you are at your ideal weight and that fat won’t budge (this is not common), we use our iLipo machine to dissolve the fat just in that area.


As a BioBalance Health patient when should I schedule a consultation appointment with Dr. Maupin?

Contact us for a consultation if:

  • You have been diagnosed with an illness that might interfere with or preclude hormone replacement
  • You have questions about your treatment
  • You are experiencing side effects that are not easily treated
  • You would like a yearly evaluation of your hormone tests

Under what circumstances would I have to stop BioBalance Health pellets?

About 5% of our patients are not “cured” of the problems they wanted to treat. Sometimes, this is because the pellets are causing an effect that does not fit their lifestyle, such as a libido when they are unmarried or feel they are too old to engage in intercourse.

In some cases, women will not experience healing as quickly as they would like. Patients with chronic fatigue are helped by testosterone replacement, but they don’t feel the resolution of symptoms as quickly as women who do not have that illness. Women who have psychiatric illnesses and are on multiple medications may not feel as healthy as women who do not have those illnesses. Lastly, if a patient develops breast cancer, then the estradiol pellets are not continued, although the testosterone pellets are safe to continue.


What if my genetics make me prone to convert testosterone into estrone?

We use a drug called Arimidex which blocks the enzyme that converts testosterone to estrogens (Aromatase Inhibitor). It is used “off label” for this indication, however it is indicated for prevention and treatment of breast cancer. We can also put arimidex generic in the pellets or prescribe it orally. DIM is a supplement that is weaker than the prescription arimidex. However, it works very well for most women.


How can I find a doctor in my area who provides pellet therapy?

Dr. Maupin is currently planning a training program in St. Louis for doctors from all over the world. If your doctor is interested in incorporating this type of hormone therapy to his/her practice, ask them to fill out our questionnaire atBioBalanceHealthAffiliates.com.

We currently have an office in St. Louis and Kansas City, and a BioBalance Health Affiliate in Pasadena, CA.


Will I grow unwanted hair from the testosterone?

Testosterone will not cause any more facial hair growth than what you had when you were in your 30’s. There is also less of a chance of excess hair growth with natural testosterone than with synthetic hormones.