Head-to-head · Hormone pellet networks
BioTE vs. EvexiPEL vs. SottoPelle: Subcutaneous Pellet Dosing Algorithms, Insertion Fees, Nutraceutical Upsells & Patient Risk Audit
BioTE, EvexiPEL and SottoPelle are not clinics. They are pellet-therapy networks that train and support independent practices, each with its own dosing method and, in some cases, branded supplements. The clinic sets your price: typically $200–$350 for a consult and labs, then $600–$1,200 per female insertion, repeated three to four times a year.
That puts a year of pellets at roughly $2,150–$5,450 before optional supplements ($80–$180 a month), with near-zero insurance reimbursement. FDA-approved transdermal estradiol with oral progesterone typically costs $430–$1,240 a year through insurance. Pellets themselves are compounded and not FDA-approved.
On this page
- How pellet networks work (and who actually sets your price)
- Head-to-head cost ledger: three networks and the FDA-approved alternative
- Dosing algorithms: what they do and what they cannot do
- Patient risk audit: what to watch for on pellets
- Hidden costs, supplement bundles and contract questions
- Who should choose which — or none of them
- Frequently asked questions
01How pellet networks work (and who actually sets your price)
When a clinic says it is a “BioTE provider” or offers “EvexiPEL” or “SottoPelle” therapy, it usually means the clinicians completed that company’s training and use its dosing method, ordering pathway and patient materials. The clinic remains an independent practice. It decides what to charge you, how often to schedule insertions and which add-ons to recommend.
What the networks typically provide
- Training and certification in pellet insertion technique and the company’s approach to dosing.
- A dosing method — a proprietary algorithm or software that suggests estradiol and testosterone pellet doses based on factors such as weight, symptoms and lab values.
- Sourcing support for pellets made by compounding pharmacies or 503B outsourcing facilities.
- Marketing and practice support, and in some cases a branded supplement line the clinic can sell.
The three, briefly
BioTE is the largest and most visible network, operated by Biote Corp., a publicly traded company. It describes a proprietary dosing method, provider training and a branded nutraceutical line. EvexiPEL is the pellet method of EVEXIAS Health Solutions, which offers provider training and practice support along with its own supplement products. SottoPelle markets one of the longer-standing pellet methods, with its own trained-provider network and dosing approach.
Because each network supports many independent clinics, two BioTE practices in the same city can charge very different prices. Comparing brands tells you about the method and support; comparing clinics tells you about price. Get a written quote either way.
None of the three dosing algorithms has been compared head-to-head in published randomized trials, and none makes pellets FDA-approved. Pellets are compounded drugs regardless of which method a clinic follows.
02Head-to-head cost ledger: three networks and the FDA-approved alternative
The ranges below are typical published and quoted prices from network clinics in 2026 and IntegrativeGyn.com estimates; they overlap because clinics, not brands, set fees. The highlighted column is the FDA-approved alternative most guidelines prefer.
| Line item | BioTE-network clinic | EvexiPEL-network clinic | SottoPelle-network clinic | FDA patch + progesterone |
|---|---|---|---|---|
| Consult | $200–$350 | $200–$350 | $200–$350 | $30–$60 copay or $150–$300 |
| Baseline labs | $150–$295 or bundled | $150–$295 or bundled | $150–$295 or bundled | $0–$250 via insurance |
| Per female insertion | $600–$1,200 | $600–$1,200 | $600–$1,200 | n/a |
| Insertions per year | 3–4 | 3–4 | 3–4 | n/a |
| Hormone cost | Included in insertion fee | Included in insertion fee | Included in insertion fee | $15–$45/mo copay |
| Branded supplements | $80–$180/mo if used | $80–$180/mo if used | Varies by clinic | $0 |
| Codes billed | 11980 + J3490/S0189 | 11980 + J3490/S0189 | 11980 + J3490/S0189 | 99214 + pharmacy NDC |
| Insurance outcome | Usually denied | Usually denied | Usually denied | Usually covered |
| Year-one total | $2,150–$5,450 (+$0–$2,160 supplements) | $2,150–$5,450 (+$0–$2,160) | $2,150–$5,450 (+$0–$2,160) | $430–$1,240 |
Table 1 · Clinic fees are typical published or quoted ranges and IntegrativeGyn.com estimates; each clinic sets its own price. S0189 is the HCPCS code for a 75 mg testosterone pellet; estradiol pellets are usually billed as unclassified J3490. Confirm current pricing in writing.
Price the full three years, including supplements and booster visits, in the BHRT pellet vs patch calculator.
03Dosing algorithms: what they do and what they cannot do
Each network’s dosing method aims to turn your weight, symptoms and baseline labs into a pellet dose for estradiol, testosterone or both. The methods are proprietary, so their exact formulas are not published for independent review. That is a business choice, not evidence of a problem, but it means you cannot compare them on published outcomes.
The pharmacology every method shares
A pellet is a small compressed cylinder of hormone placed under the skin of the hip or buttock through a tiny incision (11980). It releases hormone over roughly three to six months, with higher levels in the first weeks and a gradual decline. Studies of pellet users have documented testosterone levels well above the normal female range in many patients, especially in the weeks after insertion. Unlike a patch or gel, the dose cannot be lowered once it is in; removal is uncommon and not always practical.
Questions that apply to any algorithm
- What testosterone and estradiol blood levels does the method target, and how do they compare with the normal female range?
- When are follow-up labs drawn, and will the next dose be reduced if levels are high?
- How is the uterine lining protected if you have a uterus and receive estradiol pellets? You need a progestogen, typically oral micronized progesterone.
- Does the clinic check hematocrit, since testosterone can raise red blood cell counts?
There is no FDA-approved testosterone product for women in the US, and testosterone is a Schedule III controlled substance. The international consensus on testosterone for women recommends transdermal dosing that keeps blood levels in the premenopausal female range, mainly for distressing low sexual desire after menopause. Pellets make that target harder to hold. Our compounded vs FDA-approved comparison covers testosterone dosing in more detail.
04Patient risk audit: what to watch for on pellets
Pellets help some people feel better, and many patients report satisfaction. The risks below are the ones guidelines and published case series point to; discuss each with your clinician before an insertion, not after.
- High testosterone effects
- Acne, oily skin, scalp hair thinning, unwanted facial or body hair, and voice deepening. Voice changes may not reverse after levels fall.
- Erythrocytosis
- Testosterone can raise hematocrit. A CBC (
85025) before and after insertions is a reasonable safety check. - Endometrial stimulation
- Estradiol pellets without adequate progestogen can thicken the uterine lining. Unexpected bleeding needs evaluation.
- Insertion-site problems
- Bruising, infection, and pellet extrusion (the pellet working its way out) are reported.
- Dose you cannot undo
- If side effects appear, you usually wait months for levels to fall rather than stopping the next day.
- Limited long-term data
- Compounded pellets have not gone through FDA review, and ACOG and The Menopause Society recommend FDA-approved hormone therapy over compounded preparations for most patients.
If you are already on pellets and want out, you do not need to wait for the full schedule to end before seeing another clinician. Bring your last lab results and insertion dates. Transition plans usually start a patch or gel as the pellet wears off; our pellets vs patches page explains what changes.
06Who should choose which — or none of them
If you are set on pellets
Choose the clinic, not the logo. Pick the practice that gives you an itemized written quote, checks blood levels before each re-insertion, adjusts doses down when levels are high, prescribes progesterone if you have a uterus, and does not require supplements. Brand affiliation matters less than these habits.
- Pick a BioTE-network clinic if you value a large, established network with many locations and consistent training materials.
- Pick an EvexiPEL-network clinic if a local practice you trust uses it and meets the checklist above.
- Pick a SottoPelle-network clinic on the same basis: the clinician’s monitoring habits and written pricing.
Consider FDA-approved transdermal therapy first if…
- You want the option to change or stop your dose quickly.
- You want insurance to cover your hormones (typically $15–$45 a month in copays).
- You have a uterus, a history of high hematocrit, acne or hair loss, or a voice-dependent job.
- Your main goal is hot flashes, sleep and mood, which transdermal estradiol treats well.
If testosterone is the reason
Ask a menopause-trained clinician about a transdermal testosterone trial dosed to female levels, with blood tests at baseline and a few weeks after starting. It is off-label, but it can be adjusted or stopped. Our menopause longevity protocol lays out the monitoring.
Not sure your current pellet plan makes sense? You can request a second opinion on the contract and dosing through the form on this page.
This comparison is educational and not individual medical advice; discuss treatment choices with your clinician.
FAQFrequently asked questions
Is BioTE better than EvexiPEL or SottoPelle?
There is no published head-to-head trial comparing the three dosing methods, so no one can say one network produces better outcomes. All three use compounded pellets that are not FDA-approved, and all are delivered by independent clinics that set their own prices. Compare the specific clinic instead: written pricing, how it monitors blood levels, whether it lowers doses when levels are high, and whether supplements are optional.
How much do hormone pellets cost per year?
Typical female pricing is $600–$1,200 per insertion, three to four times a year, plus a $200–$350 consult and lab costs. That is roughly $2,150–$5,450 in year one before any supplements, which can add $960–$2,160 a year at $80–$180 a month. Prices are set by each clinic and change, so ask for an itemized written estimate.
Does insurance cover hormone pellets for women?
Usually not. Clinics bill the insertion as CPT 11980 and the drug as J3490 or S0189, but commercial plans commonly deny female pellet therapy as investigational or not medically necessary because the pellets are compounded and not FDA-approved. Some patients use HSA or FSA funds. Plan as if you will pay the full fee yourself.
Can a pellet be removed if I have side effects?
Removal is uncommon and not always practical, because pellets begin dissolving soon after insertion. In most cases you wait for levels to decline over weeks to months while your clinician manages symptoms. That is the main practical difference from a patch or gel, which you can lower or stop the same day. Ask the clinic about its side-effect plan before your first insertion.
Do I have to buy the clinic’s supplements?
You should not have to. Branded supplements such as DIM or vitamin D/K blends are sold separately from the pellet procedure. Ask the clinic to mark each recommended product as optional or required, explain the evidence for you specifically, and confirm your pellet treatment does not depend on buying them. If a clinic makes supplements a condition of care, that is worth questioning.
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