Subcutaneous estrogen replacement involves placement of estradiol pellets in the subcutaneous area of the lower abdomen or buttocks. Physiologic levels of estradiol are obtained, and follicle stimulating hormone levels are suppressed, similar to values found during premenopause. Insertion is a minor office procedure, with the usual starting dose of 25 mg of estradiol placed; it provides climacteric symptom relief and osteoporosis protection as well as the many other benefits of estrogen replacement. Supplementation with testosterone pellets can be performed, if indicated, at the same time. Patients with an intact uterus require progesterone therapy to protect the endometrium, as do patients using other forms of estrogen replacement. Return of climacteric symptoms, combined with serum levels, can be used to determine the timing of redosing, which is about every 6 months for most patients.