Medically reviewed by Crea Rose, FNP-BC, APRN-FPA
· NPI 1366184053
· Last reviewed:
Hormone replacement therapy (HRT) restores hormones — most often estrogen, progesterone, or testosterone — that the body no longer produces in adequate amounts. At Revival Health & Wellness Clinic in Salem, IL, Crea Rose, FNP-BC offers Biote bioidentical hormone pellet therapy alongside other HRT options, with treatment matched to your symptoms, lab values, medical history, and personal preferences.
Hormone therapy is a clinical decision, not a wellness fad. We work through it carefully — labs first, conversation about goals and risks, then a treatment plan you understand and consent to.
WHAT HORMONE THERAPY TREATS
Most patients come to us for HRT because of one of these patterns:
- Perimenopausal and menopausal symptoms in women — hot flashes, night sweats, sleep disruption, mood changes, vaginal dryness, painful intercourse, brain fog, joint aches, low libido
- Premature ovarian insufficiency or surgical menopause — when ovarian function ends earlier than expected
- Low testosterone in men (also called hypogonadism or “low T”) — fatigue, loss of muscle mass, reduced libido, erectile dysfunction, low mood, decreased motivation
- Postmenopausal bone loss — when estrogen replacement is appropriate to preserve bone density alongside other osteoporosis prevention measures
HRT is not a one-size treatment. The same set of symptoms can have very different underlying patterns on labs, and the right therapy depends on what those labs and your history actually show.
HOW BIOTE PELLET THERAPY WORKS
Biote pellets are small, rice-grain-sized cylinders containing bioidentical estradiol (for women) or testosterone (for men and some women). They are inserted just under the skin in the upper buttock during a brief in-office procedure that takes about 10–15 minutes. The pellets dissolve gradually and release a steady level of hormone over roughly 3–4 months for women and 4–6 months for men.
The clinical case for pellets compared to creams, patches, gels, oral capsules, or injections is steadier serum hormone levels and the convenience of not having to remember a daily or weekly dose. The trade-off is that once the pellet is in, the dose can’t be quickly reduced if side effects appear — that’s why thorough lab testing and history review beforehand matter.
Crea Rose is a Biote-certified provider, having completed Biote’s clinical training program in pellet method, dosing, and patient management.
REVIVAL HORMONE OPTIMIZATION
OTHER HRT OPTIONS WE OFFER
Pellets are not the right delivery method for every patient. Depending on your preferences, history, and labs, we may recommend:
- Transdermal estradiol patches — FDA-approved, applied weekly or twice-weekly
- Topical creams or gels — daily application, easier to titrate dose
- Oral micronized progesterone — typically taken at bedtime; commonly used in women with an intact uterus alongside estrogen
- Testosterone injection or topical preparations — for men whose labs and symptoms warrant treatment
- Vaginal estrogen — low-dose local treatment for genitourinary symptoms; minimal systemic absorption
WHO IS A CANDIDATE FOR HRT
You may be a candidate if:
- You have symptoms consistent with hormonal deficiency
- Recent labs confirm lower-than-optimal levels of the relevant hormones
- You do not have an absolute contraindication (see below)
- You and your provider have weighed the benefits against the risks for your specific situation
Hormone therapy is not appropriate for everyone, and we say so when it isn’t. Some patients benefit far more from sleep, stress, exercise, weight, and thyroid optimization than from added hormones.
WHAT TO EXPECT ON YOUR FIRST VISIT
- Initial consultation (45–60 minutes). We review your symptoms, full medical and family history, current medications, and goals. Bring a list of your medications and any recent lab work.
- Lab work. We typically order a comprehensive hormone panel (estradiol, total and free testosterone, FSH, LH, progesterone where relevant, sex hormone–binding globulin), thyroid panel including TSH and free T4, complete blood count, comprehensive metabolic panel, lipid panel, and PSA for men over 40. Labs can usually be drawn at our clinic.
- Follow-up visit to review labs and discuss options. Together we decide whether HRT is appropriate, which delivery method fits your situation, and what dosing to start with.
- Treatment. If you proceed with pellets, the insertion is done at a follow-up visit. If you proceed with topical or oral therapy, we send the prescription to your pharmacy.
- Re-check labs in 6–8 weeks for non-pellet HRT, or with each pellet insertion. Doses are adjusted based on how you feel and what your labs show.
RISKS, SIDE EFFECTS, AND CONTRAINDICATIONS
Hormone therapy is medication. Like any medication, it carries risks that we discuss before treatment.
Possible side effects may include breast tenderness, bloating, mood shifts, acne or oily skin, hair changes, water retention, and (with testosterone) increased red blood cell count. Pellet insertion sites can occasionally bruise, bleed, or in rare cases extrude.
More serious risks identified in long-term studies of various HRT regimens include increased risk of blood clots, stroke, certain cancers (notably breast cancer in some women’s-health study contexts), and gallbladder disease. The size of these risks depends heavily on which hormone, which delivery route, your age, your time-since-menopause, and your personal and family history. We discuss your specific risk profile in detail before starting therapy.
Absolute contraindications typically include:
- Known or suspected estrogen-sensitive cancer
- Active or recent blood clotting disorder, deep vein thrombosis, or pulmonary embolism
- Active liver disease
- Unexplained vaginal bleeding
- Pregnancy or breastfeeding
- Recent stroke or heart attack
Some relative contraindications can be navigated with adjusted dosing, alternative delivery routes, or close monitoring; we evaluate these case by case.
FDA STATUS OF BIOIDENTICAL AND COMPOUNDED HORMONES
Some bioidentical hormones — including transdermal estradiol patches and oral micronized progesterone — are FDA-approved manufactured medications. Other bioidentical preparations, including compounded pellet therapy, are prepared by licensed compounding pharmacies under different regulatory rules and are not separately FDA-approved as drug products. This regulatory distinction does not mean compounded preparations are inherently unsafe, but it does mean the patient and clinician carry more of the responsibility for monitoring response, side effects, and dose adjustment over time. We use established compounding pharmacies and we monitor patients with serial lab testing to manage that responsibility.
COST AND INSURANCE
HRT consultations are generally billable to insurance the same as any office visit. Pellet therapy itself is typically self-pay because most insurance plans do not cover compounded pellets. We will provide pricing during your consultation; cost varies by hormone and dose. We accept HSA and FSA payment for self-pay portions where the IRS recognizes the expense as medical care.
FREQUENTLY ASKED QUESTIONS
How long does it take to feel a difference after starting HRT?
Most patients feel changes in sleep and energy within 2–4 weeks. Vasomotor symptoms (hot flashes and night sweats) usually improve within 4–8 weeks. Sexual function and mood often respond on a similar timeline. Bone density changes take much longer — months to years — and are tracked with periodic DEXA scans rather than how you feel.
How often do pellets need to be reinserted?
For most women, pellets last 3–4 months. For most men, 4–6 months. We schedule reinsertion based on symptom recurrence and follow-up labs rather than a fixed calendar.
Can I do HRT through telehealth?
The initial consultation can sometimes be done by telehealth for established Illinois patients. Lab draws and pellet insertions must be done in person. Most patients prefer the first visit in person regardless, because the conversation is detailed.
Do I need a hysterectomy or specific cancer screenings before starting?
No — but if you have a uterus and are considering systemic estrogen, we typically pair it with progesterone to protect the uterine lining. Routine age-appropriate screenings (mammogram, Pap, colonoscopy, PSA for men) should be up to date, and we will discuss your screening status during your consultation.
Will HRT affect my fertility?
Hormone therapy can suppress fertility, especially in men starting testosterone. If you are considering future fertility, tell us before treatment so we can discuss alternatives or fertility-preserving options.
What if I want to stop?
You can stop hormone therapy at any time. With pellets, the hormone effect tapers naturally as the pellet finishes dissolving — there’s no abrupt withdrawal. With patches, gels, or oral preparations, we typically taper to minimize symptom rebound.
SCHEDULE A HORMONE CONSULTATION
If you’ve been told your symptoms are “just stress” or “just aging” and the answer hasn’t satisfied you, a thorough hormonal workup is a reasonable next step. Call (618) 740-2240 to schedule a consultation with Crea Rose, FNP-BC. We accept new patients of all ages and offer same-week scheduling for most consultations.
SOURCES AND FURTHER READING
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. menopause.org
- Stuenkel CA et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100(11):3975–4011. endocrine.org
- Bhasin S et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744.
- U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers. fda.gov
- National Institute on Aging. Hormone Therapy for Menopause Symptoms. nia.nih.gov
About bioidentical hormone replacement therapy.
Bioidentical hormone pellet therapy uses compounded hormone preparations. Individual compounded preparations are not separately reviewed or approved by the FDA in the way that mass-manufactured prescription drugs are. Pellet therapy carries risks including bleeding, infection, hormonal imbalance, and side effects that vary by individual. Discuss your full medical history (including personal or family history of breast, uterine, or prostate cancer; blood clots; or stroke) with Crea Rose, FNP-BC before initiating therapy. This therapy is not appropriate for everyone.