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SottoPelle Hormone Replacement Therapy;
What You Should Know

Routes of delivery:
Bio-identical hormone can be given by different route such as oral, transdermal, sublingual or subcutaneous implant. The route of delivery can change the response and side effect of treatment. Transdermal estrogen has a lower risk of gall stone formation and blood clot formation compare to oral route, transdermal use of estrogen also lowers blood pressure significantly, Oral progesterone cause more sedation than transdermal route. The advantage and disadvantage are summarized as following:

	advantage	disadvantage
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

Transdermal route is the easiest to use and safer than oral route, estrogen patch such as vh/elle dot works well but testosterone or progesterone does not come in the patch form. Bio-identical hormone cream can be formulated to contain all 3 hormones but not everybody absorbs well and the absorption can varies day to day. Sublingual has ail three hormones but give you more up and downs of the hormone level. If you want the best result with the most physiological route, pellet implant is the 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 function 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 combined with estrogen continuously, 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, combine use of estrogen and progesterone increase insulin level,thus increase the incidence of heart attack , stroke and diabetes. 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 test or saliva test can monitor the hormone levels but I find the blood level is more reliable. I usually do a baseline level, repeat once a month after the treatment started or changed until the desired result is achieved. Usually if the estrogen level is too high, you may experience breast soreness or spotting. If the level is too low, hot flush or night sweat may return. If the testosterone level is too low, the energy level or the sex drive remains low.

-Disclaimer-
This is not a SottoPelle® office. Dr.Karen Sun has only been trained by Dr. Gino Tutera and SottoPelle®
Dr. Tutera bears no responsibility for management of Dr. Sun's patients.