Subcutaneous estrogen pellets are not FDA-approved and offer less flexibility in dose adjustment compared to patches, requiring 5-6 months to assess efficacy.

“there are osto estrogen pellets that can be inserted in the subq space into the fat really and they're also not FDA approved but you know they're still used pretty liberally uh by physicians who know how to put them in uh I used to do this for my female patients I anymore uh I just tend to prefer the patch truthfully because it gives a more steady state level dose of the estradi and you can fix you can make adjustments easily with the pellets you put it in there you got to wait five or six months before you figure it out again and decide what to do”