BioTE is a bioidentical hormone pellet system with its own provider certification, dosing protocol and lab-monitoring schedule. Dr. Michael Temkin is a Certified BioTE Provider in San Ramon, California, and performs pellet insertions and the lab work around them in his own office.

What Is Hormone Pellet Therapy and How Does It Work?

Q: Can a pellet be removed?

Yes. It is not common, because dosing is guided by lab work before every insertion, but a pellet can be removed if needed. It is a minor in-office procedure using a small incision at the same site where the pellet was placed.

What Is BioTE, and How Does Hormone Pellet Therapy Work?

A pellet about the size of a grain of rice — containing bioidentical testosterone or estradiol, the same molecules your body makes — is placed just under the skin during a short office visit. Once it is in place, small blood vessels form around it, and the hormone dissolves off the surface of the pellet directly into your bloodstream. It keeps doing that, steadily, for about three to four months from that single insertion.

That delivery route is what makes pellets different. There is no skin absorption to vary with how much you sweat or shower, and no injection day followed by a trough at the end of the week. The pellet simply releases into circulation around the clock, so your levels stay in a consistent range rather than spiking and falling. And because one insertion covers a full three to four months, there is nothing to apply, swallow or inject in between — for most patients, hormone therapy becomes three or four appointments a year and nothing else. That combination of steady levels and almost no daily effort is the reason pellets are the delivery method Dr. Temkin uses most often in this practice.

BioTE is a bioidentical hormone pellet system, and Dr. Michael Temkin, DO is a Certified BioTE Provider in San Ramon.

Are Patients Actually Satisfied With Pellets?

Yes — more than with any other method, according to the data. A 2024 survey of 140 men on testosterone therapy, published in the International Journal of Impotence Research, found that men using subcutaneous pellets reported 90.0% satisfaction. That was the highest figure of any delivery method in the study, and well above the 62.7% average across the group as a whole. Patients on pellets were significantly more satisfied than patients on most other methods.

That result tracks with what the pharmacology predicts. When levels stay even and there is no daily routine to keep up with, patients feel better more consistently and are far more likely to stay on treatment long enough to get the full benefit. Satisfaction and adherence tend to move together, which is exactly what the survey found.

How Are Pellets Inserted?

It is a quick in-office procedure — usually only a few minutes. The site, typically the upper buttock or hip, is cleaned and numbed with local anesthetic. The pellet is then placed just beneath the skin through a tiny opening, and the site is closed with adhesive strips rather than stitches. Most patients describe the insertion itself as a brief pressure and nothing more, and go straight back to their day afterward.

Aftercare is simple: skip heavy workouts and swimming for a few days so the site settles and the pellet stays put, and expect the possibility of some mild bruising at the site, which fades on its own. After that, there is nothing to do until your next visit in three to four months.

Are Hormone Pellets Safe?

Yes — hormone pellets are safe when they are placed and monitored by a physician, and monitoring is where Dr. Temkin puts the emphasis. Every patient starts with a full baseline hormone panel, so the first dose is chosen from that patient’s own numbers rather than a standard starting dose. Levels are then rechecked partway through the first cycle, and again before every subsequent insertion. The dose is adjusted each time based on what the labs show and how the patient reports feeling.

That protocol is the direct answer to the caution you may see quoted from professional groups such as the Menopause Society, ACOG and the Endocrine Society. Their concern with compounded hormone preparations is about prescribing that happens without consistent lab follow-up, where a dose can drift without anyone noticing. A 2020 review commissioned by the federal government and conducted by the National Academies of Sciences, Engineering, and Medicine (NASEM) reached a similar conclusion: the gap it identified was a shortage of large, high-quality studies on compounded preparations, not evidence that pellets are unsafe. Regular lab monitoring by a physician who follows the numbers over time is precisely how that gap is closed, and it is the standard of care at Temkin Health.

Who Is a Good Fit for Pellet Therapy?

Most of Dr. Temkin’s pellet patients are starting hormone therapy for the first time, and pellets work well for that group. You are not asked to manage a dose yourself, remember a schedule or learn an injection technique — the baseline labs set the starting dose, and the follow-up labs refine it. The result is that new patients get the benefit of a carefully titrated dose without having to do anything except show up for their visits.

Pellets are an especially good fit if you:

Want the steadiest possible hormone levels rather than weekly peaks and troughs
Would rather not think about hormone therapy every single day
Have found gels messy, inconvenient or inconsistent
Travel often, or have a schedule that makes daily or weekly dosing hard to keep up with
Have tried another delivery method and not felt as even or as consistent as you hoped

Whether hormone therapy of any kind is right for you depends on your symptoms, your lab work and your health history. Dr. Temkin reviews all three at your consultation and will tell you plainly whether pellets are the right starting point for you.

About Dr. Michael Temkin, DO

Dr. Michael Temkin, DO is an internal medicine physician who has been in private practice in San Ramon for 25 years, and he is a Certified BioTE Provider. That certification means he has completed BioTE’s provider training in pellet dosing, insertion technique and the lab-monitoring protocol that goes with it.

At Temkin Health, hormone therapy is handled the way the rest of his internal medicine practice is handled: by him, in his own office. He orders and interprets the baseline labs, performs the insertion himself, reviews the follow-up levels and sets each subsequent dose — the same physician throughout, with the full picture of your health rather than a snapshot. Because Temkin Health is a concierge practice, appointments are unhurried and patients can reach him directly with questions between visits. Hormone therapy sits alongside the practice’s concierge primary care, the LeanMD medical weight loss program and its longevity medicine services, which means hormone optimization is managed in the context of your metabolic health as a whole rather than in isolation.

Frequently Asked Questions

What is BioTE?

BioTE is a bioidentical hormone pellet system with its own provider certification, dosing protocol and lab-monitoring schedule. Dr. Temkin is a Certified BioTE Provider, and performs pellet insertions and the lab work around them in his San Ramon office.

How long do hormone pellets last?

About three to four months, which works out to roughly three to four visits a year. Very active patients sometimes metabolize a pellet a little faster, which is one reason Dr. Temkin rechecks levels partway through the cycle and tailors the next dose accordingly.

Can a pellet be removed?

Yes. It is not common — dosing is guided by lab work before every insertion, so there is rarely a reason to — but a pellet can be removed if needed. It is a minor in-office procedure using a small incision at the same site where the pellet was placed.

Are pellets covered by insurance?

Pellet therapy is usually paid for directly rather than billed to insurance. Temkin Health quotes current pricing at your consultation, so you know what a full year of treatment costs up front, with no surprise billing.

Do pellets work better than gels or injections?

All three deliver bioidentical hormone effectively, but pellets deliver it the most evenly and with the least day-to-day effort: one insertion covers three to four months, with no daily gel and no weekly injection. Patients also report the highest satisfaction with pellets of any delivery method — 90% in a 2024 survey — which is why Dr. Temkin uses them most often.

Are patients happy with pellet therapy?

Yes. A 2024 survey of men on testosterone therapy found those using pellets reported 90% satisfaction, significantly higher than the group average and higher than any other delivery method.

Talk to Dr. Temkin About Pellet Therapy

If steady hormone levels without a daily routine sounds like what you have been looking for, the next step is a consultation and a baseline hormone panel. Call Temkin Health at (925) 866-3900 or request a consultation online.

About Temkin Health

Temkin Health is a concierge internal medicine practice at 1081 Market Place, Suite 300, San Ramon, CA 94583, led by Dr. Michael Temkin, DO, who has been in private practice in San Ramon for 25 years. The practice offers concierge primary care, the LeanMD medical weight loss program, bioidentical hormone replacement therapy for men and women, and longevity medicine. Dr. Temkin is a Certified BioTE Provider. Phone: (925) 866-3900.

Related Reading

Each of the above is part of Temkin Health’s San Ramon hormone therapy resource library.

Sources

The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 2022.
Endocrine Society. Position Statement on Compounded Bioidentical Hormone Therapy.
National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. 2020.
US Food and Drug Administration. NASEM Study on the Clinical Utility of Treating Patients with Compounded Bioidentical Hormone Therapy.
Biote. Bioidentical Hormone Replacement Pellet Therapy.
Loeb C, et al. Testosterone replacement therapy is associated with high satisfaction rates: results of a survey study. International Journal of Impotence Research, 2024.

Disclaimer

This article provides general health information and is not medical advice for any specific situation. Reading it does not create a doctor-patient relationship. Hormone therapy is a prescription treatment with risks as well as benefits, and suitability is determined at a medical consultation with a licensed clinician. Results vary between individuals; every figure cited describes findings in studied populations rather than a predicted individual outcome. Compounded preparations, including compounded pellets, are not FDA-approved, which means the FDA does not evaluate them for safety, effectiveness or quality. Consult a licensed healthcare provider to discuss all treatment options, including potential risks and benefits.

Last updated September 2026.