Frequently Asked Questions by Women

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Dr. Maupin and Brett address the concerns women have when pursuing hormone replacement therapy.

This week we are taking an opportunity to discuss the most frequently asked questions from women who are considering Hormone Replacement Therapy from BioBalance Health. These questions reflect specific concerns women have about whether or not the replacement of the hormones they have lost through the aging process. We find that there is a lot of misinformation and incorrect information out in the public dialogue in today’s world. We are attempting to provide correct, up to date and accurate information for women to help them make good decisions and be well informed consumers of their own health services.

Why do I Need Any Hormone Replacement?

The Answer is that 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
  • Increase immune system’s strength
  • 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 estrogen and testosterone patches, shots and pills?

They are the pure hormone and are not metabolized into byproducts that will cause side effects or inactivate the testosterone, because they are delivered directly to the blood stream.  Pellets allow your body to take as much testosterone as your body needs and when you are exercising and have increased pulse and cardiac output you absorb more. Because they are bio-identical and because of their delivery system, women feel better on pellets than any other form of estrogen and testosterone replacement.

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 more symptoms of testosterone deficiency.

How do you diagnose testosterone deficiency?

By your symptoms, in conjunction with low free testosterone levels, as well as your medical history and symptoms.


Why Do You Check So Many Tests?

My goal for all of my patients is make them healthier so they can age without diseases, or impairments, and keep their quality of life.  Testosterone replacement does assist to a great deal in this quest, however one hormone does not work alone, so I test one hormone from every gland and treat other hormones that are out of balance, to help you regain total health.  I also do cardiac risk screening tests to see if you are at risk for heart disease and then treat what is within my skill set to prevent further damage, or future damage is no heart attacks or strokes have occurred yet. I do health testing (Blood count, Metabolic panel for liver and kidney function) to help me adjust the dosage for liver or kidney dysfunctions. Special testing for existing problems that might get worse with T treatment (ferritin, blood count), and finally I test prolactin to rule out a pituitary tumor that if untested, can cause me to misdiagnose a pituitary tumor as hormone imbalance.

Follow up labs are abbreviated based on what was abnormal, and I check all hormone levels again at 3 months.

Why Are the Normals Different On The Lab Tests That We Have Drawn Before We Come For Treatment?

Because medical beliefs are still archaic, the “normal” for testosterone are based on testing older women disregarding the fact that T drops after 40 years of age as well as ignoring sexual libido in women and the presence of symptoms at these low levels that are called “normal”.

In the Bone Density test women are compared to the bones of 29 year old females, because bones thin every year after 40.  Likewise, estradiol and testosterone decrease with age and are gone by menopause, yet standard blood tests compare women to other women their age! Recently the groups of Anti-aging doctors have done studies that take into account both symptoms and young healthy levels (age 20-40), and I compare my patients to youthful levels of both hormones, always taking into account that treatment levels necessary to resolve symptoms are different for everyone

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

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

How is dosage calculated?

We recreate the normal daily production of testosterone and estradiol by a young ovary and deliver that dose times the number of days your pellets will be dissolving until the next pellet insertion.  This dose is then adjusted for body mass, exercise frequency, and medications you are taking.

How long will it take for my pellets to work?

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

Where are pellets inserted?

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

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

Yes.  There is nothing left to be removed.

Do estradiol or testosterone pellets cause weight gain?

Testosterone increases the thickness of bones and muscle so increase lean body mass, but it also decreases fat at the same time.  In general women taking pellet hormones lose weight after 9-12 months but lose size prior to that.

How long will it take for my body to get back to lean normal?

That depends on how much you exercise and workout with weights, how much over weight you are to begin with and other medical conditions you have that might slow down the process. We always try to help you with your weight loss by optimizing your pellet dose and balancing your other hormones.

How long will my pellets last?

Four months is typical.  If you don’t sleep much, exercise many hours a day, do stressful work, or are an athlete, you will use them up more quickly and we may need to dose you with more pellets on the next insertion.

How long can I take pellets?

You can take pellet replacement hormones as long as you desire to receive the benefits that they have given you. Bio-identical pellet replacement is the closest thing to your natural hormones that you can receive. The replacement of both estradiol and testosterone prevent many of the diseases of aging.  We treat patients into their 90’s at Biobalance Health. Dr. Maupin 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 of 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, and 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 have “sagging skin “  anyway.    I recommend only 7 keto-DHEA in doses of 25 mg or less.  Other types or doses above 25 can cause an increase in estrone and that means weight gain 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 those women who have pre-diabetes, in fact testosterone 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 by increasing muscle mass and so you burn more calories each day.

Does testosterone improve depression and anxiety?

Yes. It improves mood and in some circumstances can replace anti-depressants (which decrease libido) after only one or two doses of pellets.  This is possible  if your anxiety and or depression began after age 40, when testosterone begins to plummet.

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

Oral progesterone like even bio-identical progesterone cause hunger and weight gain, with the side effects the worst with Provera. We prefer bio-identical 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 BI hormone pellets are the least likely to cause side effects, but they are best suited to women who don’t need a high level of progesterone, such as those women who have had an ablation.

What do you do 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, which 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 then we suggest 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?


Do BioBalance Health estradiol pellets cause blood clots?


If I have used alcohol to excess or drugs like marijuana in the past, will I get the same effect 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.  Of course birth control is 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: All corticosteroids such as prednisone, Medrol dosepak, tamoxifen, progestins (not progesterone) like Provera, DHEA that is not 7-keto DHEA, other hormones given orally like oral contraceptives, as well as anti-depressants and drugs for schizophrenia and 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 my belly fat that started to increase after I turned 40?

First you should take non-oral estradiol, and also take testosterone in the form of pellets.  This is the only form that brings the level of estrone back to young healthy levels, and 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, iodoral (iodine to bump your thyroid activity), eat 6 times a day, small meals with high protein and low carb, exercise by doing 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 (small set of cases) we use the 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?

  • You have been diagnosed with an illness that might interfere with or preclude hormone replacement
  • You have many questions about your treatment
  • Experience side effects 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” for the problems they came to the office for, or they have an effect of the pellets that does not fit their lifestyle, such as a libido when they are unmarried or feel they are too old to engage in intercourse.

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 but testosterone pellets are not continued because they are safe.

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 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 scheduling doctors from all over the world for training in St. Louis Missouri.  If your doctor is interested in changing over to this type of hormone therapy practice, then ask him to fill out our questionnaire at

We currently have a BioBalance Health Affiliate in Pasadena CA, and St. Louis, and we plan to train a doctor in Vancouver Canada and London.

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.

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