1. Understand bio-identical hormones. It is important that you fully understand Testosterone, Estrogen, and Progesterone hormone replacement in men and women. You must be able to prescribe creams, injections, and capsules with your own knowledge of these hormones and by listening to the patient. If all you know is how to insert bio-identical hormone pellets you will come across a patient they are not appropriate for, and you will cause more harm than good.
2. Buy a quality auto-clave. Even though there are disposable pellet insertion kits, I do not advise them. They are difficult to use, do not offer the same high-quality experience, add to community landfill waste, and are costly to you and the patient. Invest in a quality auto-clave and quality reusable pellet insertion equipment. You will spend more upfront, but you will spend less in the long run. You will also find that the pellet insertions are smoother and easier for you and the patient.
3. Use a 31 gauge needle when injecting the local anesthetic, creating a small weal on the surface of the skin. Then switch to a 25 gauge 1-inch needle to provide deeper anesthesia. By using the 31 gauge needle first, you will offer a more comfortable experience for the patient. It is worth the extra investment.
4. Buy a small freezer and reusable ice packs. Immediately after the pellet procedure, I like to place an ice pack on the area. This minimizes any pain or discomfort. A reusable ice pack, such as Therapearls, is easy to clean after each patient and they work much better than disposable ice packs. (Plus it minimizes extra waste in our community’s landfill)
5. Create a follow-up system for re-pellets. Once you know the patient’s re-pellet frequency, either have them book ahead for their next pellet insertion or create a reminder system at your office. I found that many patients would forget to come in and then would call in a panic trying to get in at the last minute. It is easier on your office and your patients if you remind them 1-2 weeks before they are due for a re-pellet.
6. Create a post-care handout for patients. Instruct them verbally on icing the area, minimizing activity, avoiding baths/pool, etc for the proper amount of time afterward but also give them a handout to reiterate the instructions. Once a patient has had their first two pellet insertions I recommend just verbally reminding them.
7. Buy a comfortable table for pellet insertions. I like using a massage table that has a footswitch to move it up and down easily and it has a protective cover that is easily cleaned and sterilized. On top of that, I put table paper that is changed in between each patient. A table that is cushioned is more comfortable for the patient and a table that can be easily moved up and down is more comfortable for you.
These are my top 7 tips for adding bio-identical hormone pellets to your medical practice. Of course, you must learn the procedure of pellet insertion and have the supplies needed for pellet insertion, on top of general bio-identical hormone training.
Dr. Laurie Blanscet