SottoPelle Hormone Replacement Therapy
SottoPelle® Therapy was founded by Gino Tutera, MD, F.A.C.O.G. and is now being taught to physicians across the nation. Dr. Tirpack was Trained by Dr. Gino Tutera on May 2008 and is Certified in the SottoPelle® method

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Bio-identical hormones are identical in structure and function to the hormones naturally produced in our bodies. They are hand compounded and plant derived, unlike synthetically produced pharmaceutical hormones.

Routes of delivery:

Bio-identical hormones can be given by different routes such as oral, transdermal, sublingual or subcutaneous implant. The route of delivery can change the response and side effects of treatment. Transdermal estrogen has a lower risk of gall stone formation and blood clot formation compared to oral route. Transdermal use of estrogen also lowers blood pressure significantly. Oral progesterone causes more sedation than a transdermal route.

The advantages and disadvantages are summarized as following:

Advantages Disadvantages
Oral convenient
reliable absorption
more side effects
1st pass - 90% goes to liver
Transdermal flexible
bypass liver
absorption less reliable
Sublingual bypass liver reliable absorption
Pellet Implant most physiological delivery
long lasting - 4 to 6 months
minor surgical procedure

The transdermal route is the easiest to use and safer than oral route. The estrogen patch such as the Vivelle dot works, but neither testosterone nor progesterone come in the patch form. Bio-identical hormone cream can be formulated to contain all 3 hormones but not everybody absorbs creams well and the absorption varies day to day. Sublingual can provide all three hormones, but gives you more up and downs in the hormone level. If you want the best result with the most physiological route of delivery, the pellet implant is the only way to go.

To have a period or not to have a period.
If you use cyclic progesterone (2 weeks out of a month ) and estrogen daily, which is how our body functions when we are young, you are going to have the period back, unless you had a hysterectomy. But if you use lower doses of progesterone continuously combined with estrogen, you probably will not have menstrual bleeding.

Which way is better?
There are different theories. The theory for cyclic use of hormone is it's more natural. Combined use of estrogen and progesterone may increase insulin levels. Another theory is continuous use of progesterone can help to reduce breast cancer. Both theories have no solid scientific prove. So there is no certain way that is the best way. What is best for you is the best way.Monitor the hormone levels.

It is important to monitor the hormone levels because if the hormone level is too high, too low, or not balanced, you will not feel good. Both blood tests or saliva tests can monitor the hormone levels, but I find the blood level is more reliable. I usually do a baseline level, repeat in a month after the treatment is started then repeat the hormone levels as needed until the desired result is achieved.

There has been controversy on the topic of Hormone Replacement Therapy (HRT) for the last 15 years.