Hormone Pellet Therapy at Valley Vital Medicine

Hormone pellet therapy is one of the most effective and underutilized tools in functional medicine today. For patients who have spent years feeling tired, flat, foggy, or simply not themselves, it can produce a meaningful shift in how they feel, how they think, and how they function, often within weeks.

At Valley Vital Medicine in Fargo, ND, Trevor Hausauer, FNP-C, and Kali Boyer, FNP-C, are both certified in the EvexiPEL Method and have seen firsthand how consistent, sustained hormone optimization changes lives. Because pellet therapy is still relatively unfamiliar to many patients, we get a lot of questions. This post answers the ones we hear most often.

What is EvexiPEL and how is it different from other hormone therapies?

EvexiPEL is a bioidentical hormone replacement therapy delivered through small pellets inserted just under the skin. Bioidentical means the hormones in the pellets are molecularly identical to the hormones your body naturally produces. Unlike synthetic hormones, which are structurally similar but not identical, bioidentical hormones may integrate more smoothly into the body's existing hormonal pathways.

What sets EvexiPEL apart from other pellet systems is the quality and design of the pellet itself. The pellets are manufactured at an FDA-registered 503B outsourcing facility, which holds to a higher standard of quality control than standard compounding pharmacies. They are compressed under high pressure through a patented process that produces a smooth, consistent hormone release, without the sharp peaks and rapid drops that can occur with lower-quality pellet products. Each pellet also contains a trace amount of triamcinolone, an anti-inflammatory compound that helps reduce post-insertion discomfort, minimize scar tissue formation, and lower the risk of pellet extrusion.

The result is a therapy that tends to feel smooth and stable throughout the treatment window, with a gradual onset and offset rather than the roller-coaster effect some patients report with other delivery methods.

What symptoms suggest I might be a candidate?

Hormone imbalance shows up differently in everyone, but common symptoms that may point to suboptimal hormone levels include fatigue that sleep does not fully resolve, low libido or sexual dysfunction, difficulty building or maintaining muscle, increased body fat especially around the midsection, mood changes including irritability, low motivation, or emotional flatness, brain fog, poor focus, and difficulty with memory, disrupted sleep, reduced stamina and slower recovery from exercise, joint aches, and a general sense of not feeling like yourself.

These symptoms are relevant for both men and women. Testosterone, in particular, is often overlooked in women, but it plays a critical role in energy, mood, muscle, bone strength, and cognitive function in both sexes.

How does the process work?

The process begins with a comprehensive symptom review and lab work. At Valley Vital Medicine, we look at total testosterone, free testosterone, sex hormone binding globulin, estradiol, and other relevant markers as part of what we call the wellness experience. Without that data, we are guessing. With it, we can build a picture of where your hormones actually stand and what optimization may look like for you.

Once labs are reviewed and you are confirmed as a candidate, the first insertion appointment is scheduled. Trevor and Kali use the Evexias dosing protocol, which accounts for height, weight, physical activity level, lab values, health history, and risk factors to calculate a starting dose designed to land close to the target from the first round.

The insertion procedure takes roughly 10 to 15 minutes for women and a little longer for men. A small numbing agent is applied to the area above the hip or upper buttock, a small incision is made, the pellets are inserted into the fatty tissue just beneath the skin, and the incision is closed with a small adhesive strip. No stitches are required. Most patients resume normal activity the same day.

How long do the pellets last?

For women, pellets typically last approximately three months. For men, the window is closer to five months. How quickly the pellets are absorbed depends on cardiac output and activity level, meaning more active patients may metabolize the hormones faster.

We schedule a follow-up lab check four to six weeks after the initial insertion. That is when hormone levels are at their peak, which gives us the best picture of how you are responding and whether any dose adjustment is needed going forward. After that, a comprehensive lab panel is recommended once per year unless significant changes in weight or lifestyle occur.

When will I start to feel different?

Most patients report the first noticeable changes in mood, energy, mental clarity, and libido within three to six weeks. Brain-related benefits tend to come first.

By around three months, sleep quality often improves, body composition may begin to shift, and workout recovery tends to feel easier.

The more meaningful long-term changes, including measurable improvements in lean muscle mass, cholesterol markers, and bone density, generally become more visible in the six to twelve month range with consistent therapy. This is why we encourage patients to commit to at least three full rounds of pellets before assessing the full benefit.

What about blood work and ongoing monitoring?

Labs are not required before every insertion. After the initial blood work and the four to six week follow-up check, we recommend a full lab panel annually, or sooner if there are significant changes in weight, health status, or how you are feeling.

Monitoring matters because testosterone does influence red blood cell production and, in men, estrogen levels can shift as some testosterone converts to estrogen. We track both, and we address anything that needs attention before it becomes a concern.

Are the pellets FDA approved?

This is a nuanced question worth answering clearly. The ingredients used in EvexiPEL pellets are all FDA-approved substances. The facility where they are manufactured is FDA-registered at the 503B outsourcing level, which carries rigorous quality and sterility standards. The individualized dosing and the insertion procedure itself, because they are customized to each patient, fall outside the FDA approval process in the same way that compounded medications generally do. This is not unusual. Compounding has been part of medicine for centuries and allows for personalized care that standardized mass-produced drugs cannot provide.

It is worth noting that in April 2025, the FDA removed the cardiovascular risk language from the black box warning on all approved testosterone replacement therapy products, following the results of the TRAVERSE trial, which found no association between testosterone therapy and increased risk of major cardiac events including heart attack or stroke.

What are the possible side effects?

EvexiPEL is generally well tolerated. Possible side effects include mild acne or oily skin, some minor fluid retention, increased red blood cell counts (which are monitored and managed appropriately), and in women, occasional minor increases in facial hair growth. Voice deepening and significant hair changes are rare at the therapeutic doses we use. If any side effects do occur, we address them directly and work with you to find the right balance.

For men, it is important to understand that testosterone therapy may temporarily reduce sperm production while active. If fertility is a current goal, that conversation needs to happen before starting pellets.

What if I am already on another form of HRT?

Transitioning from creams, patches, pills, or other hormone therapies to pellets is straightforward. At your consultation, Trevor or Kali will review your current therapy, your labs, and your symptom history to determine how to approach dosing appropriately. The goal is continuity of care and a smooth transition, not starting over from scratch.

What about breast cancer history?

This requires an individual conversation with a provider. Bioidentical hormones, including testosterone, have not been shown to increase breast cancer risk when used within appropriate physiologic dosing ranges, and in the case of testosterone specifically, the Global Consensus Position Statement from 11 medical societies found no signal for elevated breast cancer risk at premenopausal testosterone dosing levels. That said, every patient's history is different, and the decision to proceed with hormone therapy for someone with a personal or family history of breast cancer deserves a careful, thorough clinical conversation. If you have questions about your specific situation, we encourage you to schedule a consultation rather than making assumptions in either direction.

How do I get started?

If you are a current Valley Vital Medicine patient, reach out to Trevor or Kali directly through the patient portal to discuss whether pellet therapy fits your current plan. If you are new to Valley Vital, the first step is a free discovery call with Lori, our certified health coach. She will spend time understanding your symptoms, your goals, and your health history to help determine whether a wellness experience and hormone evaluation makes sense for you.

Call 701-532-1926 or visit www.valleyvitalmedicine.com to schedule your free discovery call and find out whether EvexiPEL hormone pellet therapy may be the right next step for your health.

Medical Disclaimer: The information in this article is for educational purposes only and does not constitute medical advice. Hormone therapy decisions should be made in partnership with a qualified healthcare provider based on your individual health history, symptoms, and lab work. Compounded hormone therapies are not FDA-approved drugs. The procedure described is performed at the discretion of a licensed healthcare provider.

References:

Evexias Health Solutions. EvexiPEL Method clinical overview. 2024.
Lincoff AM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE Trial). N Engl J Med. 2023;389:107-117.
FDA. Labeling changes for testosterone replacement therapy products removing cardiovascular risk warning. April 2025.
Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019.
Glaser R, Dimitrakakis C. Testosterone therapy in women: myths and misconceptions. Maturitas. 2013;74(3):230-234.

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Protecting Muscle, Metabolism & Hormonal Health During GLP-1 Weight Loss

By Trevor Hausauer, FNP-C • June 5, 2026

GLP-1 medications are everywhere right now. Semaglutide, tirzepatide, Ozempic, Wegovy. You can't scroll through social media or walk past a medspa without seeing them advertised. And for good reason. These medications can meaningfully reduce appetite, improve blood sugar control, and produce significant weight loss results that traditional dieting often fails to achieve. But there is a conversation that is not happening nearly enough: what kind of weight are people actually losing? At Valley Vital Medicine, that question is at the center of everything we do when it comes to weight loss support. Because the number on the scale does not tell the whole story, and in many cases, it is hiding a serious problem. What Are GLP-1 Medications? GLP-1 stands for glucagon-like peptide-1, a hormone naturally released from the intestines when you eat. GLP-1 receptor agonists work by mimicking that hormone, reducing appetite, slowing gastric emptying, and improving blood sugar regulation. Semaglutide (Ozempic, Wegovy) is a single GLP-1 receptor agonist. Tirzepatide (Mounjaro, Zepbound) is a dual agent, activating both GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) receptors, which can further improve insulin sensitivity and fat metabolism. Retatrutide, still investigational and not yet FDA-approved, adds a glucagon receptor component that may also support a higher metabolic rate. Each of these medications works differently, and which one may be appropriate for a given person, if any, is a conversation worth having with a qualified provider who understands the full picture. The Hidden Problem: You May Be Losing the Wrong Weight Research published in Circulation found that semaglutide has been associated with lean mass comprising up to 40% of total weight loss in some studies. A 2024 systematic review and network meta-analysis found that across GLP-1 receptor agonists, lean mass loss can account for roughly 25% of total weight lost. A 2025 analysis found that tirzepatide was associated with greater lean body mass loss than semaglutide at every measured time point across a 12-month period. To put that in plain terms: if someone loses 100 pounds on a GLP-1 medication without taking steps to protect their muscle, a meaningful portion of that loss may come from lean tissue rather than fat. That matters enormously. Muscle is not just about appearance or athletic performance. Muscle is your metabolism. It is what keeps your body burning calories efficiently at rest. It supports insulin sensitivity, healthy aging, and your ability to function in daily life, including getting up from the floor, climbing stairs, and staying independent as you get older. Why This Gets Worse When the Medication Stops One of the most serious concerns with GLP-1 use is what happens after. Research has shown that stopping GLP-1 therapy without the appropriate lifestyle foundation often leads to weight regain. And if lean tissue was lost during the weight loss phase, that muscle does not automatically come back when the weight returns. The result can be a body composition that is worse than before treatment began, with more fat relative to muscle, a slower resting metabolic rate, and a harder road ahead for anyone who tries to lose weight again in the future. This is not an argument against GLP-1 medications. It is an argument for doing them right. What "Doing It Right" Actually Looks Like At Valley Vital Medicine, we do not believe in handing someone a prescription and sending them on their way. Here is what a comprehensive approach to GLP-1 support looks like. Resistance training. Exercise sends a signal to the body to hold onto muscle tissue. Without it, caloric restriction, whether from medication or diet, increases the likelihood that the body will draw on lean tissue for energy. 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Starting at lower doses and increasing only when needed can reduce side effects significantly and give the body more room to adapt in a way that supports rather than undermines overall health. The Goal Is Not Just to Weigh Less Weight loss and body composition optimization are not the same thing. Someone can lose significant weight and end up metabolically worse off if that loss comes at the expense of their muscle, their hormones, and their metabolic foundation. The goal we work toward with every patient is sustainable fat loss with preserved lean tissue, so that when the work is done, the body that remains is stronger, healthier, and capable of maintaining those results without being dependent on medication indefinitely. If you are currently on a GLP-1 medication, considering one, or have come off one and are concerned about where things stand, we would love to have a conversation. Our free discovery calls are a no-pressure way to learn more about what comprehensive weight loss support looks like. Call 701-532-1926 or visit www.valleyvitalmedicine.com/call to schedule your free discovery call and learn how a functional medicine approach to weight loss can help you protect your muscle, your metabolism, and your long-term health. Medical Disclaimer: The information in this article is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before beginning or modifying any weight loss program or medication regimen. References: Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. Prado CM, et al. Muscle and GLP-1 receptor agonists: Adaptive or maladaptive response to weight loss? Circulation. 2024. Bikou A, et al. Effect of GLP-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis. Metabolism. 2024. Chavez AM, et al. Nutrition support whilst on GLP-1 based therapy. Curr Opin Clin Nutr Metab Care. 2025;28(4):351-357. Frontiers in Clinical Diabetes and Healthcare. GLP-1 agonists and exercise: the future of lifestyle prioritization. 2025.

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