If you’ve decided to explore hormone replacement therapy, you’ve probably noticed something frustrating. Every provider seems to have a favorite delivery method, and they all claim theirs is the best. No single method wins for everyone. 

At Defy of Indiana, our board-certified functional medicine team offers HRT for women and men across Carmel and Indianapolis. We’ll work with you to determine whether hormone pellets, creams, or pills best support your health needs.

Why Hormonal Delivery Methods Matter

Hormones don’t behave the same way in your body regardless of how they enter it. A pill gets processed through your liver before it reaches your bloodstream. Meanwhile, a cream absorbs through your skin and bypasses that first liver pass. A pellet sits under your skin and releases hormones steadily over months.

Those differences affect how stable your levels stay, how well your body absorbs the hormones, and how often you need to think about treatment. They also affect side-effect profiles and long-term cost.

This is the kind of nuance Dr. Tina Harrison, our Medical Director, brings to the table. She’s Board-Certified in Internal Medicine with more than 20 years of experience. She has spent years in the conventional system before integrating functional medicine. Dr. Harrison understands how hormones move through the body and how each delivery method interacts with your liver, your metabolism, and your overall health.

Option 1: BioTE Pellets

We’re a certified BioTE provider. Our nurse practitioners, including Haley Cook, FNP-C, AFMC, have completed specialized training in pellet therapy.

BioTE pellets are tiny, about the size of a grain of rice. We place them just under the skin, usually in the hip or buttocks, during a quick in-office procedure. The area is numbed first, so insertion is comfortable. Once in place, the pellets dissolve slowly and release a steady dose of bioidentical hormones over three to six months.

Who Pellets Work Well For

Pellets are BHRT treatments for men and women who want consistency without daily effort. No pills to remember, no creams to apply, no patches to change. Your levels stay stable between insertions, which many patients say feels smoother than methods that cause ups and downs.

We also see good results for patients who’ve struggled with absorption on other methods. Because pellets bypass the digestive system entirely, they can deliver hormones more reliably for some patients.

What to Know Before Choosing Pellets

The biggest trade-off is flexibility. Once a pellet is inserted, you can’t adjust the dose until the next one. If your body absorbs faster or slower than expected, you have to wait it out.

That’s why follow-up matters. We check your levels about six weeks after your first insertion, then again at each visit, so we can fine-tune your dose over time. Haley Cook’s functional medicine training is a real asset here because she’s trained to look at how your whole body responds, not just the lab number.

Option 2: Creams and Gels

Topical hormones are one of the most common delivery methods because they’re easy to adjust and widely available. You apply a cream or gel to your skin, usually on your inner arm, thigh, or abdomen. The hormones absorb through your skin and into your bloodstream, bypassing the liver’s first-pass metabolism. Most people apply them once or twice a day.

If symptoms change or levels need adjusting, your provider can tweak the amount without waiting months for a pellet to dissolve. That flexibility makes creams a good starting point for patients new to hormone therapy.

They’re also a good fit if you prefer to avoid procedures or don’t like the idea of something sitting under their skin.

What to Know Before Choosing Creams

The biggest challenge is consistency. Absorption can vary depending on where you apply it, how much you use, and even the formulation. Some peope find their levels fluctuate more on creams, especially if they miss an application or apply at inconsistent times.

Creams can transfer to other people through skin contact, so you have to be careful about application sites and timing, especially with young children or a partner. For some women, the daily routine becomes a chore.

Dr. Harrison pays close attention to absorption patterns when she reviews lab work. Her internal medicine background means she’s trained to spot inconsistencies that might point to an application issue rather than a dosing problem, which can save patients months of frustration.

Option 3: Pills

Oral hormone therapy is the most traditional option, and it’s still what many conventional providers prescribe first. You take a pill daily, and the hormones absorb through your digestive system. Before reaching your bloodstream, they pass through your liver, which is called first-pass metabolism.

Who Pills Work Well For

Pills are simple, familiar, and easy to stick with for people who already take daily medications. They’re also often covered by insurance, which can make them the most affordable option upfront.

What to Know Before Choosing Pills

That first-pass liver metabolism is the main drawback. It can affect how much hormone actually reaches your bloodstream and can put extra stress on your liver over time. Some patients also find pills cause more ups and downs throughout the day compared to pellets or creams.

If you have liver conditions, blood clotting disorders, or a history of hormone-sensitive cancers, you may not be a good candidate for oral hormones. Dr. Harrison has internal medicine training and is well-versed in the cardiovascular and metabolic factors that need weighing before prescribing oral therapy.

So Which One Is Right for You?

The honest answer: it depends. Anyone who tells you otherwise without looking at your labs, your history, and your symptoms isn’t giving you the care you deserve.

At Defy, we start with a comprehensive hormone panel and a real conversation about your goals. Some men and women thrive on pellets. Others do better with creams or pills. We won’t push you toward a method because it’s convenient for us.

If you’re in Carmel, Indianapolis, or anywhere nearby and want a provider who’ll explain the trade-offs honestly, call us at (317) 742-6127. You can also contact our functional medicine team online. Feeling like yourself again starts with a conversation.