Dr. Michael Ligotti believes in using naturally-derived hormones whenever possible to balance hormones and treat symptoms of hormone deficiency.  In most circumstances it is possible to "balance" a patient using bio-identical hormones without the need to use synthetically-derived drugs.  Dr. Ligotti is experienced in the replacement of sex hormones in men and women.    

Upon arrival to our practice you will fill out new-patient paperwork.  You will then be weighed and have vital signs taken by our medical assistant.  Dr. Ligotti will then come into the room and begin the consultation.  Baseline labwork for hormone levels is required.  Periodic re-testing is recommended (frequency is individually determined) as this will correlate specific hormonal levels with symtomatology.  Once the patient is well-controlled on their regimen they can be seen as infrequently as annually to measure hormone levels. Dr. Ligotti has a substantial interest in the field of bio-identical hormones.  He works very closely with a compounding pharmacy in the area, or a pharmacy of your choice, to ensure that a very individualized formula is compounded exactly to your body's specifications and needs.  Make your appointment today to start feeling and living better naturally and under the care of a Board-Certified physician!

Symptoms of Relative Hormonal Imbalance:


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Estrogen Dominance:

• Water Retention
• Fatigue
• Breast Swelling (Normal for tenderness if 28 days)
• Fibrocystic Breasts
• Premenstrual-like mood swings
• Loss of Sex Drive
• Breast Pain is not good. Cell division caused by estrogen.
• Heavy or irregular menses (Cell division)
• Uterine Fibroids
• Craving for Sweets
• Weight Gain


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Estrogen Deficit:


• Hot Flashes (not only symptom)
• Shortness of Breath
• Night Sweats
• Sleep Disorders
• Vaginal Dryness(painful, cell division)
• Dry Skin
• Anxiety
• Mood Swings
• Headache
• Depression
• Memory Loss
• Heart Palpitations
• Yeast Infections
• Vaginal Shrinkage
• Painful Intercourse
• Inability to reach orgasm
• Lack of Menstruation


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Progesterone Dominance:

• Depression
• Somnolence
• Sleepiness


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Progesterone Deficit:

• Swollen Breasts
• Headache
• Low Libido
• Sleep Disorders                                                     
• Moodiness
• Fuzzy thinking
• Depression
• Food Cravings
• Irritability
• Insomnia
• Cramps
• Emotional Swings
• Painful Breasts
• Weight Gain
• Early Menstruation
• Bloating
• Inability to concentrate
• Painful Joints
• Asthma
• Acne

BIO-IDENTICAL HORMONES:

Estrone (E1)

Estrone (E1) is the estrogen most commonly found in increased amounts in post-menopausal women. The body derives it from the hormones that are stored in body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects.


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Estradiol (E2)

Estradiol (E2), the principal estrogen found in a woman's body during the reproductive years, is produced by the ovaries. Estradiol is very effective for the symptomatic relief of hot flashes, genitourinary symptoms, osteoporosis prophylaxis, psychological well being and reduction of coronary artery disease.

Because it is much more potent than Estriol, it can be more effective for symptomatic relief.  When Estradiol is replaced using a parenteral (sublingual, percutaneous, or transdermal) route, it is not subject to first pass metabolism by the liver, and therefore does no produce high levels of Estrone. Using these routes of administration a woman can mimic the physiologic release of estradiol from the ovaries, thus receiving natural hormone replacement.


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Estriol (E3)

Estriol (E3) is the weakest of the three major estrogens. In fact, it is 1000 times weaker in its effect on breast tissue. Estriol is the estrogen that is made in large quantities during pregnancy and has potential protective properties against the production of cancerous cells.

Estriol is the estrogen most beneficial to the vagina, cervix and vulva. In cases of vaginal dryness and atrophy, which predisposes a woman to vaginitis and cystitis, topical estriol is the most effective and safest estrogen to use. Because of this estriol is better than estradiol for the treatment of urinary tract infections.

Estriol is not available in most drug stores, although it has been used widely in Europe for over fifty years. Because estriol cannot be patented it does not hold much interest for the pharmaceutical industry. Its availability through compounding has caused its use to grow rapidly throughout the country.


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Biest

Biest is a combination of two estrogens: estriol and estradiol. It is most commonly found in a ratio of 80:20, estriol to estradiol. This combination allows for all of the protection of estriol while providing the cardiovascular and osteoporosis benefits along with the vasomotor symptom relief of estradiol.


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Triest

Triest is a combination of three estrogens: estriol, estradiol and Estrone. It is most commonly found in a ratio of 80:10:10, estriol, estradiol, and Estrone. This combination is very popular and contains all of the three major circulating estrogens. It is slightly weaker in its effect when compared to Biest. However, this can be compensated for by increasing the strength or by slightly changing the ratios.


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Progesterone

Progesterone is produced by the ovaries and the adrenal glands in women and, in smaller amounts, in the testes and the adrenal glands in men. One of its most important functions is in the female reproductive cycle. Progesterone prepares the lining of the uterus for implantation of a fertilized egg, and then helps to maintain it during pregnancy. If pregnancy does not occur it signals the uterus to shed this lining.

Progesterone also plays an important role in brain function and is often called the "feels good hormone" because of its mood enhancing and antidepressant effects. Optimum levels of progesterone can mean feelings of calm and well being, while low levels of progesterone can mean feelings of anxiety, irritability and even anger. Current research shows that progesterone may pay a role in the maintenance of the nervous system, the sense of touch, and motor function.


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Testosterone

Testosterone - Usually considered a male hormone or androgen, women also produce testosterone although in much smaller amounts than men do. Testosterone works differently in the bodies of men and women, but it plays a very important role in the overall health and well-being of both sexes. Often called the "hormone of desire" because of its powerful effect on libido, testosterone is also important in building strong muscles, bones, and ligaments as well as increasing energy and easing depression. Low levels of testosterone have been known to cause fatigue, irritability, depression, aches and pain in the joints, thin and dry skin, osteoporosis, weight loss, and the loss of muscle development.

As with all of the hormones, testosterone must be dosed properly to be effective without causing unwanted side effects. The dose in women is generally one-tenth that used in men. Because testosterone is not effective when it is taken orally it is usually prescribed as a topical gel, cream or as a sublingual tablet. Although testosterone was discovered more than sixty years ago, only very recently have we begun to fully understand and appreciate the power of testosterone.


DHEA-S
DHEA-S is a hormone produced in the adrenal glands whcih can serve as a precursor to estrogens or androgens (testosterone) depending on the individual and circumstance.  Production of DHEA-S typically wanes as an individual ages.  Correct replacement of this substance can provide the body with the "raw materials" by which to produce it's own hormones.  Deficiency of DHEA-S can also cause symptoms of fatigue and feeling "run-down"; again, effective replacement can diminish these symptoms as one ages.

DHEA and its principle metabolite DHEA sulfate were once consider unimportant and were overlooked by many researchers as simply weak androgens. However, scientists have found that DHEA levels drop in such illnesses as lupus and rheumatoid arthritis. A few studies have demonstrated low levels of DHEA in obesity, cardiovascular disease, non-insulin dependent diabetes, chronic fatigue syndrome and some types of cancer. There is speculation that low levels of DHEA might be partially responsible for age-related degenerative diseases and replacement therapy may be of value. Studies have also shown that DHEA stimulates the immune system.Many physicians feel that DHEA-S levels in the blood should be maintained in the range of 150-200 mcg/dl in women and 200-400 mcg/dl in men. A blood level test to determine your current status is available from you physician.

Side effects seems to be rare when patients maintain the above levels in their blood , however, at higher levels there is potential for adverse reactions. In women DHEA can be converted to testosterone which can cause acne along with oily skin and unwanted hair growth. This problem is minimized by keeping the daily dose at 50mg or less. Also, there is conversion to estrogen which may be dangerous in women with a history of breast cancer. Because DHEA is metabolized in the liver patients with a history of liver disease should be monitored closely to avoid toxicity. Men with enlarged prostates should discuss the benefits versus risks with their physicians due to the conversion of DHEA to testosterone.Recently, DHEA has been marketed as a nutritional supplement. However, we feel that it is more prudent to be under a physicians supervision while taking this or any other hormone.



Male Menopause

Menopause for men, you might ask? Unfortunately, yes! Andropause – the male menopause - is more gradual than that experienced by women, but it is just as real. It often starts as early as age 35. Because it is so gradual, men often reach their mid-forties before they are even noticing some of the signs and symptoms.

Andropause, like menopause, is caused by a decline in hormones. (Primarily testosterone and the secondarily growth hormone, along with DHEA) On the average, a man’s testosterone level begins to decline at a rate of 1% per year after age 40. It is estimated that 20% of men aged 60 to 80 years have levels below the lower limit of normal. The diagnosis of low testosterone levels is based on the presence of signs or symptoms and must be confirmed by laboratory testing. The extent to which declining hormone levels cause men to age is dependent on lifestyle issues of diet, exercise and stress.

Testosterone Replacement Therapy is only recommended for men whose testosterone levels are low. Your physician prior to the initiation of treatment should perform screening for parameters related to potential risks of androgen therapy. Once your physician has approved testosterone therapy and a written prescription for testosterone has been received, Martin Avenue Pharmacy’s compounding pharmacists can use Testosterone USP to compound numerous dosage forms. These dosage forms include transdermal (topical), sublingual, or intramuscularly.

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Typical Signs and Symptoms:

• Weakness
• Reduced Libido
• Atherosclerosis
• Erectile Dysfunction
• Low Sperm Counts
• Reduced Muscle Mass
• Reduced Cognitive Function
• Fatigue
• Osteoporosis
• Irritability
• Slow Wound Healing
• Depression
• Memory impairment
• Disturbed Sleep
• Heart Disease
• Insomnia
• Prostate Problems
• Anxiety
• Impaired Blood Cell Formation


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Prevention

A healthy lifestyle has been shown to be associated with higher hormone levels, and higher hormone levels seem to induce a more active, healthier lifestyle. When hormone levels decline, a person becomes less active and gain weight. As this weight gain occurs, hormones are stored in the fat and become unavailable to meet the body’s demands. Also, a lack of exercise, excessive alcohol use and many diseases can reduce bio-available hormone levels. For optimal results, it is vital that hormone replacement therapy be combined with exercise, proper nutrition and appropriate use of natural supplements.


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Goals of Testosterone Replacement Therapy in Adult Men (50 yrs or older)

• Improvement in psychological well-being and mood
• Improvement in erectile dysfunction
• Improvement in libido
• Increased muscle mass
• Increased strength and stature
• Preservation of bone mass
• Decrease in Cardiovascular risk

Testosterone replacement can also improve osteoporosis, cardiovascular disease and depression.