Sotto Pelle Hormone Therapy The Ultimate HRT LifeChangeNaturally

Sotto. Pelle® Hormone Therapy The Ultimate HRT Life…Change…Naturally® www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Disclosure No part of this notebook and/or the materials contained within may be reproduced , stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical, photocopy, recording or otherwise – without the prior written permission of Sotto. Pelle®. This also includes mailing copies to other parties for their own use. Copying is also prohibited for future use, or for other clients, or for other potential clients. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Gino Tutera, MD, FACOG Founder of Sotto. Pelle® ● ● Dr. Tutera was a pioneer and leader in the field of bio-identical hormone therapy (BHRT) Over 0 years experience in treating PMS, menopause, and hormonal imbalance Pellet Therapy has over an estimated 70+ years of documented research Dr. Tutera opened his first PMS clinic in 1979, devoting his practice to OB/GYN as well as HRT. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

What Is Sotto. Pelle® Therapy? § Italian for “under the skin” § Helps returns your body to a more normal and natural hormonal balance and physiological state § Based on: Delivering the right kind of hormone (bio-identical) In the right amounts (individualized dosing) Using the right delivery system (pellets) www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

What You Need To Know § Not all hormone therapies are created equal § Hormone Replacement Therapy (HRT) is not a “onesize-fits-all” approach § You need an EXPERT! www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Additional HRT Methods Synthetic Hormones: Ø Pills Ø Patches Ø Injectables Bio-identical Hormones: Ø Pills Ø Patches Ø Creams/Gels Ø Pellets www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Hormone Pills § § § § Peaks and Valleys First Pass Metabolism “Sludge” Through the Liver Breast Stimulators Take Something Everyday Vaginal Bleeding Blood Clots Headaches www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Hormone Patches § Estradiol levels better than pills, but not as good as pellets § Potential of having an adhesive problem § Need to be changed throughout the week § Patients have reported some weight gain, but less fluid retention than being on synthetic or horse estrogen www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Hormone Creams/Gels q q Did you apply enough? If some falls on the floor, then what? What if I forget? How long do I have to wait to get dressed? § § Must remember to rub it in daily Applied topically onto the skin Can transfer to others Now carry a “Black Box” warning www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Hormone Pellets § § § § Helps to keep the Estradiol to Estrone ratio at 2: 1 Biologically identical to the natural production Constantly available to the body Absorbed directly, not taken orally Steady state of hormones No roller coaster effect Minimal weight gain, if any Hassle-free www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Natural Estrogen Comparison www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Estradiol Levels Implant Patch Estradiol Level Oral 0 0 1 2 Days 3 4 Smith R/ Studd, J WW Brit Jour Hosp Med, 1993, Vol 49, No 11 www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

About Pellets § Natural, plant-and-soy derived compounds § Same molecular structure as the human body § Lasts longer than other treatments § Provides a steady stream of hormone in your blood stream 24/7 § Individualized dosing www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

About Pellets Cont. § Inserted under the skin § If you have a uterine problem, the pellets will expose it i. e. , Uterine fibroids, endo. Polyps § Not all pellets are the same and can cause problems in inexperienced hands www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

History of Pellets § Developed in 1939 for women who had radical hysterectomies (Salmon, U. , et al. : Use of estradiol subcutaneous pellets in humans. Science 1939, 90: 162. ) § Discussed the use of Estradiol and Testosterone pellets for the symptoms of menopause. (Greenblatt, R. (1949). American Journal of OB/GYN 57, 244 -301. ) § Widely used around the globe www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Reported Symptoms from Female & Male Patients ü ü ü ü Tired Mood Swings Tension Lack Of Sleep Memory Loss Decreased Sex Drive Depression ü ü ü ü Hot Flashes Night Sweats Weight Gain Joint Pain Migraine/Severe Headache Fatigue Loss Of Erectile Ability www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Estimated Relief of Symptoms Present before treatment (% of patients) Complete relief (% of patients with symptoms No relief (% of patients with symptoms) Hot flashes/sweats 81. 7 90. 8 0. 0 Headaches 77. 5 66. 7 6. 5 Insomnia 73. 5 61. 4 11. 4 Palpitations 45. 0 59. 3 11. 1 Bone pains 60. 0 54. 2 9. 7 Dyspareunia 50. 0 71. 6 8. 3 Loss of libido 83. 3 67. 0 9. 0 Irritability 84. 2 73. 3 4. 0 Poor memory/concentration 70. 0 63. 1 8. 3 Depression 79. 2 75. 8 1. 0 Lethargy 75. 8 65. 9 2. 2 Urethral syndrome 20. 8 44. 0 20. 0 Symptoms Cardozo et al, Am J OB/GYN, 1984 www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Estimated Symptom Reduction Over Time 30 25 Lack of sexual interest 20 Vasomotor discomfort Somatic symptoms 15 Depression 10 Anxiety 5 0 Baseline 8 16 24 weeks Cravioto et al, Menopause, Vol 8, 2001 www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

“Why Do We Need Any Hormone Therapy? ” § § § § Can help patients regain energy Stabilize emotional lability Helps to regain libido Helps to preserve skin and muscle tone Potential decrease abdominal fat Supports immune system Potential to help with protection from Dementia, Osteopenia/Osteoporosis, and Insomnia www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

“What’s Your Menopause Type? ” by Dr. Joseph Collins Today’s Truth is This: “There is no magic hormone or combination of hormones that can be indiscriminately used by all women. Each woman is an individual and hormone balance must be the ultimate goal for all women. ” www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Hormone Replacement Therapy (HRT) Ø It is estimated that everyday approximately 3500 women enter menopause Ø Symptoms of menopause may begin close to 5 years earlier that diagnosis Ø Male hypogonadism is approximately 20% of males > 50 years of age www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

“Does Pellet Therapy Really Work? ” Studies & Informational Graphs www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Susan Davis, et al Menopause Vol. 7, No. 6, pp. 395 -401 Ø Study conclusion: Estrogen replacement with pellets has effects on body fat in post menopausal women that are associated with improved lipid parameters. Decreased Total Chol & LDL Increased HDL Decreased Triglycerides Ø Addition of Testosterone does not negate the favorable effects of estrogen on LDL Cholesterol. Marked reduction in fat mass was seen in the estrogen plus testosterone group after two years. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Estradiol: Estrone Ratio Goal and Ideal Ratio of Estradiol: Estrone is 2: 1 This can help with breast tissue protection § § § Additional Ratios Examples for HRT: Menopause changes the ratio to reversed 1: 2 Synthetic oral HRT 1: 10 Bio-identical Sub-lingual 1: 2 Bio-identical Gel 1: 2 Transdermal Patch 1: 5 Pellet Therapy 2: 1 www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Roger NJ Smith/John WW Studd et al Recent Advances in Hormone Replacement Therapy, British Journal of Hospital Medicine, 1993 Ø No reported increase in thrombotic activity with pellet therapy. Ø Helps to reduce cardiovascular risk compared to oral therapy. Ø Does not increase the risk of breast cancer incidence. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

“What About Breast Cancer Developing With Pellets? ” Patient Concerns Addressed www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Breast Cancer § Testosterone delivered by pellet implants may not increase risk of breast cancer unlike oral, synthetic methyl-testosterone § Testosterone implants reportedly have shown less stimulation of breast tissue § Treatment with Testosterone and Estradiol implants may not increase the risk of breast cancer, even in breast cancer survivors www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Breast Cancer Research Studies Breast Cancer Studies § J. W. W. Studd (1989) Lancet, showed no evidence that pellet therapy increased or decreased the incidence of breast cancer § Darelaar’s 25 -year study of 261 women showed the women on Estradiol pellets were found to have less cancers occur than the control group who received no HRT www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Archives of Internal Medicine § Oral, synthetic, chemical methyl testosterone increased the risk of breast cancer § Estratest § Non-oral, testosterone (hormone) prevents the stimulation of breast tissue and lowers the risk of breast cancer www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Conventional HRT Women's Health Initiative Trial § 41% increase in stroke § 29% increase in heart attacks § 26% increase in breast cancer § Twice the rate of blood clots www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

E. M. Davelaar et al Ned. Tijdschr Geneeskd 1991, April 6: 13 (14): 613 -15 Study showed no increase in the incidence of breast cancer with Estradiol pellets Conclusion: § No increase in the incidence of breast cancer during the use of subcutaneous estradiol in 261 woman followed from 1972 to Mid 1990’s. § Less cancers overall than the control group who were on no estrogen replacement therapy. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

P. Natrajan and Gambrell et al Am. Journal of OB/GYN, Vol 187, No. 2, Aug 2002 Estrogen replacement therapy in women who previously had Breast Cancer Conclusion: § ERT (Estrogen Replacement Therapy) does not increase either recurrence of breast cancer or mortality rates. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Breast Cancer Incidence with Pellets 1992 -2002 Time on Pellet HRT Number of Patients Cases of Breast Cancer 0 – 2 years 352 1 3 – 5 years 471 0 5 – 25 years 153 0 976 1 Reduction of Breast, Endo, Ovarian Cancer by Tutera 2003 www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Reported Positive Effects of Natural Testosterone Enhanced Erectile Ability Enhanced Libido Cardiovascular Protection Increased Bone Strength Increased Muscle Strength ü Cognitive Clarity ü ü ü Lower Cholesterol ü Increased Energy and Vitality ü Feeling Of Overall Well. Being ü Reducing Body Fat ü Depression Relief www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Memory Depends on Testosterone § Testosterone & Estradiol Pellet treatment can help Neurotransmitters and memory respond quickly § Studies have shown it is possible that Dementia and Alzheimer's may be delayed if it is instituted before or during first 10 years after menopause www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Patients with Alzheimer’s Disease Ø Studies show that women may get Alzheimer's Disease 8: 1 over men Ø Women on Estrogen may be 50% less likely to develop Alzheimer’s Disease Ø Men with low Testosterone can be 3 x more likely to develop Alzheimer’s Disease www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Progesterone Why Patients Need Progesterone: Progesterone helps protect the lining of the uterus, which in turn can help the uterus from developing abnormal cells that may progress to cancerous cells www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Injectable Hormones § Potential uneven absorption § Patients can experience a significant “roller coaster” effect § Most injectables are a reported 99% synthetic hormone www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Potential Side Effects of Hormone Pills § Recent advances in HRT have noted that oral estrogen can result in minor increase in clotting as well as studies consistent with recent examples showing no improvement in heart attack and stroke. (J. W. W. Studd (1993)British Journal of Hospital Medicine) www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Nurses Health Study § Estimated a participation of 121, 700 nurses § Study reflected Conjugated Estrogens may increase risk of breast cancer (RR 1. 32 ( 1. 14 -1. 54)) § Estrogen plus Testosterone reportedly had no increase risk of breast cancer (RR 1. 64 ( 0. 53 -5. 00)) Colditz NEJM 1995 www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Pellet vs. Pills § No increase in thrombotic activity with pellet therapy reported § Pellets can help reduce cardiovascular risk compared to oral therapy § Does not increase the risk of breast cancer incidence www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Pellet vs. Patch § Pellets produce more reproducible estrogen levels faster and remain steady longer than patches § Patients report significant increase in HDL at 12 weeks with pellets, but only at 24 weeks with patches Frank Z. Stanczyk et al. American Journal of OB/GYN, Volume 159, No. 6 A Randomized Comparison of Non Oral Estradiol Delivery in Post Menopausal Women. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Pellets vs. Pills & Patches Osteoporosis & Estradiol Ø Pellets demonstrated four-fold increase in bone density over oral estrogen and 2. 5 times greater than patches Ø 8. 3% per year for pellet therapy Ø 3. 5% per year for patches Ø 1 -2% per year for oral estrogen Ø J. W. W. Studd (1990) AM, Journal OB/GYN www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Patient Testimonial “After two appointments of hormone replacement pellet therapy, my life has really changed. People at work have commented on how sharp my memory is. My energy level is higher than most of the younger people I work with. And since my wife is also receiving pellet therapy, we are both thrilled at the change in our libido. We are back to the way we were when we first met; our marriage really couldn’t be better!” William H. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Patient Testimonial “I got my life back! I feel like I am 25, not 54. I am able to work out and be active again. This is a miracle that continues to amaze me and everyday I am thankful for it. ” Kristie B. www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

How Do You Tell If You Are a Candidate for Hormone Replacement? Ask Them: ü Do You feel healthy? ü Am You tired all the time? ü Have You lost the joy in life? ü Is pain a daily theme? ü Is sex a drudgery? ü Are You tired when You wake up from poor sleep? ü Is Your waist-line disappearing? ü Do You just survive life? www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED

Contact a Sotto. Pelle® Trained Certified Provider Today to Make Your Appointment www. sottopelletherapy. com Sotto. Pelle® _ Sept. 2020 All Access To & Use of Document is Subject to the Privacy Policy and Governed by the Terms of Use. Copyright Sotto. Pelle®, Inc. ALL RIGHTS RESERVED