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BHRT & Hair Repair with Stephen Nunn, PA-C

"Dr. Tutera really figured out how to customize that and follow the patient and set of protocols. And so, the fact that that you've got science, you've got guidelines, the...

INTRODUCTION: Welcome to Qualgen's podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.   

 JP: Hi everyone! Thank you for taking time out of your day to listen in. Today I am talking with Steve Nunn, a director of training at Tutera Medical and Sottopelle who has a wealth of expertise, including 44 years of continuous experience as a clinical PA. Stephen, Thank you so much for joining me today! 

 SN: Glad to be here, Jennifer. Thank you.  

 JP: Absolutely. So, just to start us off, how did you get introduced in this more functional medicine approach of medicine?  

 SN: Well, really, it was kind of a natural progression most of my career has been in gyn and infertility and, and of course, as things progress, you get women who are hormonally deficient and even entering into menopause. And really what we were doing traditionally wasn't working. If you follow the package recommendations that were available by the manufacturer, you were constrained by different doses and by maximum doses and, and it just really wasn't working and when I found out about Dr. Tutera and Sottopelle and his method. It just made so much sense. It was such an aha moment. You know, let's customize this to the patient. Let's dose them and we give them what they need and they're feeling well and give them that quality of life throughout the rest of their life. So, it's just such a, a wonderful fit works for our patients. And I'm, and I'm so happy about that.  

 JP: So, how did you get introduced to Dr. Tutera and Sottopelle?  

 SN: And so actually, I was working in a situation that I was very unhappy with and, and ran across the a name of a physician assistant that I worked with years before in the, in the particular office I've been dealing with and, and called her up and said, is it me or is this job? She says it's, it's the job you're in, they're terrible people. But I worked for Dr. Tutera. This is perfect. It's right down your alley. So once I just looked into it, I was, couldn't get out of the other place fast enough to get working with Dr. Tutera as soon as I could. So that's part of being at the right place at the right time. And I've now been here, I'm on my 16th year. So obviously a great fit.  

 JP: Yeah. So you got to train under Dr. Tutera? 

 SN: Yeah, we worked side by side for years and then I started helping him with the training and unfortunately, when he passed away about six years ago. That was really unfortunate for us, but I was able to step into that role.  

JP: Well, that's good then. I mean, that's a blessing in disguise. So, what is your role at Tutera? And what do you do there?  

SN: Well, besides, you know, putting pellets in, consulting with patients, and dealing with that on a day-to-day basis, I train all the providers who work with us and I train almost all of the providers who come to us from the rest of the nation and even the rest of the world. I have trained physicians from Vietnam and Switzerland and Brazil. And, you know, we've got groups in Germany and Spain that keep moving on.  

JP: That's amazing. If anybody wants to train with you, what do they need to do?  

 SN: Well, I really just go to the Sottopelle therapy website and there's a picture there and then a little link that's become a provider and lots of information there for both patients and providers.  

 JP: Perfect. So, what is it about the Sottopelle therapy that stands out to you?  

 SN: Well, I think really a lot of it is the customization of it when Dr. Tutera started doing this, back in the early nineties, it was sort of one size fits all as, you know, pellets have been around the US since 1939 and they basically, you know, it's either if you're this size, you get that pellet. If it's, if you're half that size, you get half a pellet. Now is about all the things that happened and, and Dr. Tutera really figured out how to customize that and follow the patient and set of protocols. And so, the fact that that you've got science, you've got guidelines, the patients respond to it is what really stands out. It is that personalized customized care that you're giving the patient.  

 JP: And what are some of the main symptoms that patients come in with that are experiencing a hormonal imbalance?  

 SN: Well, certainly for estrogen deficiency in women, hot flashes, night sweats, waking up in the middle of the night for no good reason and not able to get back to sleep in extreme circumstances, vaginal dryness, things that get measured, but they may not know about until it happens or osteoporosis fractures, you know, their lipids  become dyslipidemic and, and a lot of those things. And then the testosterone issues are the same for men and women, which is short term memory, you know, why did I come in this room, brain fog, they can't process information. The decisions tend to make themselves by the time they get around to it. Energy, which is a huge one that's being able to get through the day, working out, getting results, recovering, going back for more, moods – a big one, irritability tends to go away. You don't overreact to things. A lot of individuals are very anxious when their testosterone gets low. And that's a symptom that I'll hear when people come in and go. Oh, I know it's time. And then the last one, which is also a huge one is Libido. Libido is gone. I mean, I can't tell you how many couples have told me that, this has literally saved their marriage.  

 JP: Yeah, we hear that all the time too and it's just amazing that, you know, such a little pellet can make such a huge difference in so many people's lives. So, can you just walk us through for those that don't know the BHRT process when somebody comes to you with symptoms? Where does it go from there? What happens next?  

SN: Well, obviously everybody gives, you know, some sort of inpatient intake form. So we ask them a lot of the questions about their symptoms, their, their history, their medications, what they've used in the past, what's worked, what hasn't worked and all the patients come in with their full lab work and we sit down and talk to them about what their labs show what we think will work for them. We use, we have a dosing program, we call Dosaggio - the provider puts in the data and it will give them a recommended dose. So they, they get the discussion, they get the explanation. We explain to them all about pellets and the therapy and what to expect. And then we go in and put their pellets in. We follow them up at 4 to 6 weeks, which is a peak timing to get labs. Give them a call and say, hey, you know, this is what they were, this is what they are. And if everything is great, we then usually see them back in 3 to 4 months with another set of labs to see what we need to adjust. So, the first set I tell them is the, how bad are you labs? The second set is the, how good are your labs or at least what we hope it is and 90% it is and then the, the third set is the adjustment. You know, what do we need to adjust if anything, the dose or the timing or whatever and kind of follow them through there. Most women, almost everybody first to second insertion is 3.5 to 4 months and then you adjust from there. A lot of women will get to 4-4.5, sometimes five because of potential side effects. We don't go past that and then eventually usually make it after 5.5 to 6.5 months.  

 JP: And how important is it to use supplements during/getting BHRT?  

 SN: Well, it's a very individualized process. So, you know, there are probably two or three main supplements that, that we would recommend. One of them is Dr. Tutera’s Hair Repair Formula. That he put together while it was there when I showed up and, and, you know, 16 years ago. So, it is saw palmetto, which is the main ingredient in it, which is great because it both competes for the DHD receptor sites and is an aromatase inhibitor. So, it helps block some of the DHD production.  

 JP: Oh, so that's in the hair repair? 

 SN: That's in hair repair. Saw Palmetto, have some chrysin in it and chrysin is a product you don't see in a lot of things. There's data out there that says, yeah, can really help in preventing some of the hair loss from the scalp, hair or hair growth for women on base in particular and there are other studies that say my gosh, we're not sure it works but God, it can't, it can't hurt. Then it also has a biotin, selenium and zinc which are really more for promoting new hair growth. That's, that's one of the really big ones. It's a lot of patients love it and they've been using it for a long time. We also have another product called ADK, which is vitamin D combined with vitamins A and K, which help it work much better in the body. And of course, very important for helping to keep your bones strong and healthy. We will sometimes use DIM, Diindolylmethane, but that's really, I call it a hormone optimizer. I don't use it routinely.  Some practices, not affiliated with us, will have every patient walk out with it. But I don't think, you know, I use it when I see a need for it.  

JP: OK. So, and dim, that's used as an aromatase inhibitor as well. So what's the difference between that and the saw palmetto, that's in the hair repair formula?  

SN: I have to tell you that I have heard that dim is an aromatase inhibitor. I have actually tried using it on some of my male patients who have an elevated estradiol and I do not see a change. I do not see it really having an effect that's measurable. If we really have aromatization, I'm going to use Letrozole or anastrozole. So, I mean, I, I want something that really works. I'm just not finding that in my practice.  

 JP: Yeah. Absolutely. Well, I think that's all great information. Is there anything additional you would like to add?  

 SN: You know, not really, except that, you know, this is just such a great practice, patients can use this lifelong unlike the stories you hear about all the other hormone supplements that are, that are promoted by Big Pharma and, and I have patients who have been on this over 30 years. My oldest female is 96. My male who had passed away, made it to 101. And so, I mean, this, this is quality of life that is lifelong. 

 JP: Absolutely. We always hear, you know, people are living longer now and you want to feel great while you living longer. You want to look great. You want to feel great too. So it all just kind of goes hand in hand.   

 SN: Absolutely. 

JP: Thank you so much for joining me! For more information on Steve, Sottopelle or Tutera Medical please visit Thank you everyone for listening, please make sure to subscribe and follow us on social media to stay up to date on Qualgen! Thank you, Steve.  

 SN: Thank you, Jennifer. Have a great day.  

 JP: You too. 


Disclaimer: The information, including but not limited to, text, graphics, images and other material contained on Qualgen’s website and podcast are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.   

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