Biote Review (2024)

Biote is a company that specializes in hormone optimization using bioidentical hormone pellets, explains David J. Watson, M.D., an OB-GYN at Littleton Gynecology and Wellness in Littleton, Colorado, and a certified Biote medical practitioner.

Bioidentical hormones are similar to the body’s naturally produced hormones, with the exception that they’re made in a laboratory from plant compounds instead of the human body. They are commonly used to treat estrogen, progesterone and testosterone deficiencies.

“We think of hormones as being gender unique—testosterone is for men and estrogen is for women, but both hormones are produced by both men and women,” says Dr. Watson. And when you’re deficient in either of them, a variety of symptoms can occur, including fatigue and changes in sex drive.

Biote aims to supplement the body’s endocrine system with hormones that it’s lacking, no longer producing enough of or not producing at all. Biote utilizes hormones that are bioidentical to those found in the human body.

Biote works by delivering hormones to the body via pellet insertion at specific points, such as the fatty tissue near the hip or buttocks. These rice-like pellets contain hormones—either estrogen or testosterone—which are absorbed into the bloodstream over time. Like traditional hormone therapy, Biote affects how people feel by supplementing levels of key hormones.

There are two main types of HT: FDA-approved prescription forms pre-made in standard dosages and compounded drugs. Biote is the latter, as every dose is customized based on a patient’s consultation and lab work.

While there are some FDA-approved bioidentical hormone therapies, compounded hormone therapy, including the Biote method, is not. “Compounded therapies don’t go through the same rigorous quality testing and approval process by the FDA,” says Amy Roskin, M.D., a board-certified OB-GYN and The Pill Club’s chief medical officer. “That being said, some people might benefit from the customization or non-standard dosages from compounding.”

According to the American College of Obstetricians and Gynecologists (ACOG), “Customized compounded hormones pose more risk because they vary in strength and purity. That means you can take too little or too much of a hormone without knowing it. There also are safety concerns about a kind of compounded drug known as pellet therapy.”

For this reason, ACOG currently recommends using FDA-approved hormones versus compounded ones.

How Are Biote Pellets Inserted?

Biote pellet insertion is a quick, minimally invasive procedure. A certified provider—who often is a board-certified medical doctor— injects a small amount of local anesthetic to numb the insertion site.

Next, your provider makes a small incision and places the pellets directly inside, where they dissolve over time. The area is covered with a bandage until it’s fully healed.

After pellet placement, there may be some soreness or bruising at the insertion site. This discomfort can last several days as you heal. It’s important to follow post-pellet insertion care to ensure optimal recovery.

You should reduce activity levels immediately following insertion. Avoid strenuous exercise, baths and swimming until the bandage is removed and the incision is healed.

The pellets dissolve slowly over the course of six months. You need to have new pellets inserted at regular intervals—around two to four times a year—to continue receiving the benefits of Biote. The company notes it may take up to two insertions before you feel its full benefits.

The cost of Biote varies depending on the treatment plan and provider. “Women usually need to be pelleted every four months, with an average cost ranging from $400 to $500 per session,” says Mickey Karram M.D., a urogynecologist and pelvic surgeon in Ohio. “Men usually need to be pelleted twice a year, with average costs ranging from $600 to $700 per session.”

Pellet insertion isn’t the only fee associated with Biote. It’s also important to factor in ongoing costs for lab work and exams to monitor hormone levels.

In general, expect to pay for the following services:

• A pre-insertion consultation
• Pre-insertion lab work
• The pellet insertion procedure
• A post-insertion consultation
• Post-insertion lab work (typically four to six weeks after your first pellet insertion)

Maintenance costs associated with Biote include:

• Ongoing pellet insertion procedures. New pellets are inserted every two to four months.
• Annual lab work. Hormone panels and blood tests are required to monitor your hormone levels.
• Supplements. While optional, some supplements may be recommended alongside hormone replacement therapy.

Most traditional insurance companies don’t pay for Biote, although they may pay a portion of your lab work fees. However, you may be able to use funds in a health savings account (HSA) or flexible spending account (FSA) to cover the costs. Talk with your provider about what forms of payment they accept.

Biote helps replace hormones the body is no longer making in sufficient amounts, such as estrogen and testosterone. People often notice an improvement in their overall health as their hormone levels reach normal ranges.

Estrogen pellets may help ease the following, according to the company:

• Hot flashes and night sweats
• Vaginal dryness
• Lack of libido and sexual desire
• Loss of quality and enjoyment of life
• Extreme weight gain
• Hair damage or loss

Testosterone pellets may help ease the following, according to the company:

• Decreased sexual desire and function
• Mood swings and irritability
• Fatigue
• Loss of muscle mass or bone density

Note that these statements from the company have not been approved by the FDA. Furthermore, the ACOG states that there’s “no scientific evidence that compounded hormones are safer or more effective than standard hormone therapy” and recommends FDA-approved hormone therapy over compounded hormone therapy (like Biote).

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“There are several side effects associated with [BT], which some patients might experience more acutely in the beginning when they’re just starting treatment,” says Dr. Roskin.

The most common side effects of bioidentical hormone replacement therapy, she says, include:

• Acne
• Bloating
• Weight gain
• Fatigue
• Mood swings
• Increased facial hair in women

“As with any hormone administration or replacement, if the dosage is not optimized, then adverse events specific to that hormone can occur,” says Dr. Karram. “Usually these adverse events are mild and can easily be treated or will spontaneously resolve over time.”

Less than 1% of people receiving testosterone via bioidentical hormone replacement therapy report complications, according to a 2021 study in Therapeutic Advances in Endocrinology and Metabolism^[2]Donovitz GS. Low complication rates of testosterone and estradiol implants for androgen and estrogen replacement therapy in over 1 million procedures. Ther Adv Endocrinol Metab. 2021;12:20420188211015238. (note: the author of the study is the founder and chief medical officer of Biote).

However, ACOG does note that compounded therapies in general pose more risk, as they vary in strength and purity. “Like non-bioidentical hormones, bioidentical hormones can increase the risk of stroke, blood clots and gallbladder disease, and the risks may increase with long-term use,” explains Dr. Roskin. “Older women who use hormones may have an increased risk of breast cancer and heart disease.”

Biote might be a good option for those who are experiencing hormone imbalances related to estrogen or testosterone deficiency. While a Biote-certified provider can help determine whether it’s right for you based on an initial evaluation and hormone panel, consider reaching out to your primary care physician first, as they will likely give you their honest opinion about the therapy.

However, it’s important to keep in mind that compounded hormone therapy is not FDA-approved, nor does the ACOG recommend it over available FDA-approved therapies.

“Because they vary in strength and purity, customized compounded hormones pose more risk. Also, the risks and side effects associated with bioidentical hormones may vary depending on an individual’s medical history,” says Dr. Roskin. “So that you fully understand the benefits and disadvantages, I recommend talking to your healthcare provider first to see if you might be a good candidate for this type of treatment.”