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.

What is the difference between "progestin" and "progesterone?"
The main difference is in the derivative. Progestins are synthetic (i.e. man-made) molecules developed to act like natural progesterone. Natural progesterone is a molecule that is plant derived and is bio-identical to the hormone produced in our bodies. Progestin’s do not have as broad a spectrum of activity as natural progesterone, and have a wide range of side effects. Whereas progesterone may cause some mild to moderate drowsiness, progestins can cause:

  • Breast tenderness
  • Acne
  • Depression
  • Vision changes
  • Bloating
  • Migraine headaches
  • Thrombosis
  • Decreased glucose tolerance
  • Gastric regurgitation

A natural part of aging? Yes.

However, many people, including doctors would like you believe that you have to live with it. Then as symptoms get worse and your lack of sleep makes you even more of a basket-case, your doctor may write you a prescription for sleeping pills; sleeping pills leading to metabolites that create a "morning after hangover". Or even worse, you may be prescribed medications that further distort your remaining hormone levels. So after having the babies and ensuring the survival of the species you are just suppose to sit back and accept the inevitable.

  • Accept sagging skin
  • Sleepless nights
  • Fragile bones
  • Hot flashes
  • Headaches
  • A dry vagina
  • Loss of sex drive
  • Loss of mental focus and multitasking skills?

For those who decide that these symptoms are unbearable, they often resort to synthetic pharmaceutical hormone replacement products. These synthetic hormones are the ones that the Women's Health Initiative (WHI) utilized, and were found to lead to increase cardiovascular and cancer risk.

Fortunately, Bio-equivalent hormone therapy (BHRT) offers a more alternative solution. They not only offer potential relief from menopausal symptoms, but they can also offer increased quality of life in several areas.
Aging skin is often the result of declining estrogen levels. Collagen matrix formation is dependent on health estrogen levels. When estrogen levels decline, the collagen matrix suffers, and the result is seen in the face. The "falling face" or increased nasal-labial creases occur with age. Firm and supple skin is replaced with sagging dry skin, flattening of upper lips, loose sagging cheeks, and the infamous "turkey neck".

Why live with the changes while safe available therapies are available?

* Several methods of physiological BHRT exist. Creams, patches, drops, and gels are just some of the common ways to approach this therapy. I prescribe all the different forms, however, I prefer the SottoPelle ® Method.

Hormones that are supplemented in women:
Estrogen, Testosterone, Progesterone

Please remember that the WHI Study determined that estrogen replacement therapy resulted in a slight increase in risk for breast and uterine cancer, as well as stroke.
This study utilized conjugated estrogens and medroxyprogesterone. The hormones we utilize are bio equivalent estradiol and progesterone.

Testosterone Replacement in Women:
Yes, in women. Women make testosterone also, albeit about 1/10th about as much as a man. But testosterone is important in women also, so correcting deficiency is important. During a woman's reproductive years, her ovaries not only make estrogen, but also testosterone. As she ages, or after she has had children, these levels decrease, even before menopause. Often the deficiency starts in their early thirties. Testosterone is important for sexual function, sexual response, and libido. Estrogen rules the brain, testosterone rules the body. A woman's body can't respond appropriately to sexual stimuli without testosterone. Additionally, testosterone helps maintain lean body mass, or muscle, as opposed to fat. It also has positive effects on those suffering from osteoporosis.

Other functions of Testosterone:

  • Prevents aches, pains and arthritis
  • Protects against cardiovascular disease
  • Protects against Alzheimer and dementia
  • Helps to stabilize blood sugar
  • Reduces breast cancer
  • Aids in the prevention of headaches/migraines


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