The most common question I get the morning of a pellet insertion is some version of "is this going to hurt?" The honest answer is that the procedure itself takes about ten minutes, the actual insertion is about thirty seconds of pressure, and most patients are surprised at how unremarkable it is. The bigger question is what happens in the eight weeks that follow — because that is where the clinical work actually shows up. This article walks through pellet day from the patient's perspective, start to finish, and explains what I am actually doing at each step and why.
I write this for the patient who has already done the workup, already had the lab review, and is now scheduled for insertion. If you are earlier in the process, the candidacy and lab discussion in our other hormone articles is the right starting point.
Before pellet day — what should already be done
By the time pellet day is on the calendar, three things should already be settled, and if they are not, the insertion itself is premature.
Comprehensive lab work confirming the indication. I want to see total and free testosterone, estradiol, progesterone (in women), DHEA-S, SHBG, full thyroid panel including reverse T3, fasting insulin, HbA1c, hs-CRP, lipid panel, and PSA in men over 40. The numbers are how I size the dose. Without them, I am guessing — and pellets are not the right delivery method for guessing, because once they are in, they are in for three to six months.
A clinical picture that fits the labs. Symptoms have to align with the lab pattern. A patient with normal hormone levels and a vague symptom list is not a pellet candidate, regardless of what they hope the treatment will do for them. A patient with symptoms that match a deficiency picture confirmed on labs is exactly who pellet therapy is built for.
A reasoned discussion of delivery method. Pellets are one of several legitimate delivery options. Transdermal creams, patches, oral progesterone, and injections all have appropriate use cases. I choose pellets when I want stable serum levels over months without the daily-application compliance burden, and when the patient's lifestyle and physiology make them a good fit. If a patient came in asking specifically for pellets but the data points elsewhere, I tell them.
If those three things are settled, pellet day is short and uneventful. That is by design.
What actually happens on pellet day, step by step
Patients show up to the Columbus location or Warner Robins location about fifteen minutes before the appointment. The procedure itself runs roughly forty-five minutes from check-in to walking back out the door, though the actual hands-on portion is closer to ten.
Check-in and consent review. I review the consent paperwork, the dosing decision, and the aftercare plan. If anything has changed since the last visit — a new medication, a new symptom, a new concern — this is when I want to know. Sometimes a small change in clinical picture means a small change in dose, and pellet day is the last reasonable point to make that adjustment.
Site selection and prep. Pellets go in the upper outer quadrant of the gluteal area, just under the skin in the subcutaneous fat layer. I pick the side based on patient preference and any history of prior insertions. The site gets cleaned with chlorhexidine, draped sterile, and infiltrated with lidocaine for local anesthesia. The lidocaine stings briefly. After that, the area is numb.
The insertion. I make a small incision — about the width of a grain of rice — with a scalpel, then use a trochar (a thin hollow instrument) to place the pellets one at a time into the subcutaneous tissue. Each pellet is about the size of a grain of rice. The number of pellets depends on the dose, which depends on the labs and the patient's clinical picture. Most women receive two to four testosterone pellets. Most men receive eight to twelve. The patient feels pressure but not pain. The whole insertion takes thirty to ninety seconds.
Closure and dressing. The incision is closed with a single Steri-Strip — no stitches needed because the incision is small enough to heal cleanly on its own. A sterile dressing goes over it, with a pressure bandage on top to minimize bruising over the first 24 hours.
Aftercare review before discharge. I walk through the activity restrictions, the dressing care, the warning signs that warrant a call back, and the timeline for what they should start to feel and when. The activity restrictions are real — I will get to them below — and patients who skip them are the ones who tend to call me about extruded pellets at day five.
That is the whole procedure. Ten minutes hands-on, an hour total if you count parking and discharge. Most patients drive themselves home.
The mechanism — why pellets work the way they do
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Pellets are compressed crystallized bioidentical testosterone (or estradiol, in some women's protocols), pressed into a small cylindrical form. Once placed in subcutaneous fat, they dissolve slowly and continuously over three to six months as the body's own enzymes break down the crystalline structure. The release rate is influenced by cardiac output and physical activity — when you are more active, blood flow to the subcutaneous tissue increases, and dissolution is slightly faster. When you are less active, dissolution slows. The result is a self-modulating delivery system that adjusts roughly to physiological demand.
This is mechanistically different from injection or transdermal delivery. Injectable testosterone produces a peak at 24 to 48 hours and a trough at the end of the dosing interval — the cyclical highs and lows that some patients tolerate well and some patients feel acutely. Transdermal delivery is more stable but requires daily application and produces lower serum levels for the same total dose. Pellets sit between the two, producing relatively stable levels for months at a time without daily application.
The clinical implication is what makes pellets worth the procedural effort: stable serum levels translate to stable subjective experience. Patients on injectable testosterone often describe a "best week" and a "worst week" within each dosing cycle. Pellet patients more often describe a steady baseline that does not oscillate. For some patients that matters a lot. For others the difference is minor and either delivery works fine.
I tell patients to think about delivery method as a question of fit, not a question of which is best. The best delivery method is the one that fits your physiology, your schedule, and your tolerance.
What to expect in the days after insertion
Days 1–3. The site will feel tender and may be bruised. Significant swelling, warmth, redness expanding outward, or drainage is not normal — call the clinic if any of those appear. The dressing stays on for 24 hours, then you can shower normally and let the Steri-Strip fall off on its own (usually day 5–7).
Activity restrictions for the first 72 hours. No swimming, no soaking baths, no heavy lower-body exercise, no horseback riding, no anything that puts shear force on the site. Walking and light upper-body activity are fine. Aggressive activity in the first 72 hours is the most common reason a pellet extrudes — rare, but almost exclusively in patients who skip the activity window.
Days 4–14. Soreness resolves. Most patients forget the insertion is there. The pellets themselves are not palpable from outside — they are too small and too deep.
Weeks 2–4. This is when most patients start to notice the clinical effect. Sleep usually improves first. Energy follows. Mood and motivation tend to lift in this window. Body composition changes take longer.
Weeks 6–8. Serum levels are typically near their steady-state range by this point. This is when I want to draw follow-up labs to confirm we hit the target range. Patients who skip this lab draw are the ones whose dose ends up being a guess on the next insertion.
What I look for at the follow-up lab draw
When the six-to-eight-week labs come back, I am looking at three things together. First, are the serum hormone levels in the target range — not the population reference range, the target range we agreed on at the treatment plan visit. Second, are the patient's symptoms aligning with the lab pattern, or is there a disconnect that needs investigating. Third, are there any side-effect markers that need attention — hematocrit, estradiol-to-testosterone ratio, lipid panel changes, PSA in men.
If the labs are in target and the patient feels good, we set the next pellet date for three to six months out depending on the dose and the patient's individual metabolism. If the labs are in target but the patient does not feel different, we look at adjacent factors — thyroid, sleep, stress, nutritional status — that may be limiting the response. If the labs are out of target, the next insertion gets dose-adjusted accordingly.
The follow-up lab draw is not optional in my practice. It is the loop that closes the system. Patients who skip it are essentially asking me to keep prescribing without data, and I will not do that for long.
How pellet therapy fits with the rest of the picture
Biote pellet therapy rarely lives in isolation. The patients who do best are usually the ones also addressing the adjacent factors that interact with sex hormone status. In women, that often means progesterone management, thyroid support if the panel warrants it, and attention to insulin and sleep. In men, that often means concurrent attention to thyroid and sleep architecture — and sometimes parallel work in the medical weight loss program when body composition is part of the goal. For men choosing between pellets and injection, the men's testosterone replacement page walks through both options in more detail.
The concrete next step
If pellet day is already on your calendar, the practical preparation is short: arrive 15 minutes early, wear loose-fitting clothing that does not press on the upper outer hip, plan to skip the gym and the pool for 72 hours, and put the follow-up lab date on your calendar before you leave the office. If you are earlier in the process and weighing whether pellets fit your situation, the right next step is the hormone health assessment followed by a consultation. Book a consultation through the online portal or call either clinic during business hours, bring any prior labs and your top three questions, and we will work through the data together.
Medical disclaimer: This article is for educational purposes only and does not constitute medical advice. Individual clinical decisions should be made in consultation with a qualified healthcare provider following appropriate evaluation. References to specific treatments, dosing, or protocols are informational.
Travis spent 17+ years in high-acuity clinical medicine — emergency, cardiac ICU, and cath lab — before founding Revitalize. He is a Certified Platinum Biote hormone therapy provider, the published author of You're Not Broken — You're Unbalanced, and the founder of the Rebuild Metabolic Health Institute. His clinical writing reflects the same precision he brought to critical care: specific, honest, and built around what actually works.
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