Bioidentical Hormones Explained: Midlife Health for Women (and Men Too!) with Dr. Daved Rosensweet - Episode 290 - Sandy K Nutrition - Health & Lifestyle Queen

Episode Transcript
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Sandy Kruse (00:02):
Hi everyone, it's me, Sandy K of Sandy K Nutrition
, health and Lifestyle Queen.
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Discover a fresh take onhealthy living for midlife and

(00:26):
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Join me and my guests as weexplore ways that we can age
gracefully, with in-depthconversations about the thyroid,

(00:49):
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(01:10):
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Always remember my friendsbalanced living works.
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Hi everyone, welcome to Sandy KNutrition, health and Lifestyle

(01:32):
Queen.
Today with me, I have a returnguest.
I have the amazing Dr DavedRosensweet.
He was on my podcast oncebefore.
That was such a popular episode.
You can go and find it episode214, originally recorded in

(01:54):
April, april 15th, 2024.
And then I actually had DrRosensweet's episode as part of
my summer reboot series.
So you can find it episode 281on July 21st 2025, if vast, and

(02:27):
he even brings in men andhormones into this conversation.
It is just such a pleasure tospeak with somebody who has as
much wisdom as Dr DavedRosensweet, and I'm going to
tell you why.
There is a very crowded spacenowadays in women's hormones

(02:51):
especially, and menopauseespecially, and back when that
New York Times article came outsomething about women have been
misled about menopause, it justopened up the floodgates to
absolutely everyone givingadvice.
So I think it's okay for peoplewho are educated in hormones to

(03:19):
not give advice but provideinformation.
And then you want to go to yourpractitioner who knows you, who
is trained in hormones, foryour specific situation.
You know you see a lot ofpeople who are just very strong

(03:45):
in their convictions.
You know on social media, andwe need to be careful and
cognizant of the fact that thesepeople don't know you, and
neither does Dr Daved Rosensweet.
But Dr Daved Rosensweet hasworked with enough patients
patients as an MD that he getsit, and he's done so much

(04:07):
testing and research here thatyou know he just has such an
amazing experience to share withall of us.
So I'm going to ask you toplease share this episode with
one of your menopausal friends,or perimenopausal, because I

(04:29):
think education is key.
And then you're going to wantto take that information to your
practitioner, or who is apractitioner that is
specifically trained in hormones, so that they get to know you
and your body.
So with that, I am going to cuton through to this interview
with Dr Daved Rosensweet.

(04:50):
Be sure to rate and review mypodcast wherever you're
listening.
Thanks so much.
Hi everyone, welcome to Sandy KNutrition, health and Lifestyle
Queen.
Welcome to Sandy K Nutrition,health and Lifestyle Queen.
Today with me I have a returnguest and he was just so
wonderful I invited him to comeback.

(05:13):
I have Dr David Rosensweet.
He is the founder of theMenopause Method.
He graduated from theUniversity of Michigan Medical
School in 1968 and has been inprivate medical practice since
1971 and is currently inpractice in Southwest Florida.

(05:36):
Is that right, southwestFlorida?

Dr. Daved Rosensweet (05:39):
Well, actually we moved to Asheville.

Oh, ok, so that's changed.

That's changed.
Okay, so that's changed.

That's changed.
Yes, but Dr Rosensweet heteaches health professionals
about the treatment of women inmenopause with bioidentical
hormones, is a nationally knownlecturer and frequent presenter
at A4M.
He's also a principalinvestigator for the scientific
study of Female Hormones, theauthor of the books Menopause

(06:09):
and Natural Hormones and HappyHealthy Hormones, and he's the
organizer of a National SummitCommittee on the Treatment of
Women in Menopause withBioidentical Hormones.
Now, dr Rosensweet and I had anamazing recording last year and
today it's going to be acontinuum of that conversation.

(06:32):
We're also going to bring inmen as well, because many of us
are like, hey, I'm taking greatcare of myself as I age, but
what about our partners?
So Dr Rosen sweet has so muchinformation, information to
share with us.
Last year we recorded in I can't, I think it was in the spring

(06:55):
last year, so about a year ago.
It was episode 214.
And it was called the TruthAbout Menopause and Hormone
Therapy.
So if you want to go to thatone first, you can and then
continue with this discussion.
And with that, welcome, drRosensweet.
Thank you so much for comingback.

Yes, well, thank you so much, sandy, good
to see you.

Yeah, it's good to see you.
I was just saying to DrRosensweet he's got a beard, he
looks very handsome.
He's doing well.
I am so happy to have you.
So tell us a little bit aboutyour history and how you got
into this, because I think it'simportant if somebody didn't
hear the first podcast tounderstand your story, because

(07:42):
you were way ahead of your time,because a lot of women during
that time were not takinghormone replacement therapy.
So let us know what the deal is.

Well, I graduated medical school loving
medicine I love medical schooland started asking the question
right as I was in my senior yearabout, well, what tools do I
have to help people heal?
And I began searching and wason the ground floor of what's
become functional medicine andwas in my functional medicine

(08:16):
office in 1992.
And one of my patients that Iknew really well, deborah.
She came storming into myoffice before office hours.
She was in her 40s, she wasbrilliant, she had retired in
her 40s.
Think about that, what it takesto do that.
And she said I'm going crazy.

(08:36):
I don't think you know me.
I just feel awful, I'm goinginsane, please help.
And the way the universe works,I just feel awful like I'm
going insane, please help.
And the way the universe works.
The divine had connected me upwith Dr John Lee, a pioneer in
progesterone, a few monthsbefore and I gave Deborah some

(08:59):
progesterone and three weekslater I got a letter from her
saying oh my God, I'm myselfagain.
And that was so dramatic tohave that little of an
intervention result in somethingthat dramatic.
So it really caught myattention because a lot of
medicine can be a slow movingtrain.

(09:19):
And, lo and behold, deborahreferred.
I got more interested andwithin a very short period of
time I said I'm going to justhunker down on getting good at
menopause.
There's a lot to it.
There's a lot of moving parts.
We're playing with somepowerful biochemicals here.
I'm going to specialize in itand that's how it originated for

(09:41):
me and it went woman to womanreally.
Referral to referral.

And here you are now.
Yeah, okay, so you know thingshave changed in the last few
years, where everybody's talkingabout menopause now and
everybody's talking aboutmenopause now and everybody's
talking about hormones.
But a lot of women are stillbeing told you're too young for

(10:12):
menopause, even in their 40s,and you know what is that cost
to a woman in delay in treatment.
If she has significant symptoms, it doesn't matter what her age
is.

Yeah Well, let me back up for a minute and
give you a view of what isgoing on in women and in men.
Same thing At the age of 20,we're at our absolute maximum
output of ovarian or testicularhormones and they decline from
that point on all the way intoour 80s and 90s where they zero

(10:52):
out pretty much and somewherealong the line these are the
most powerful biochemicals inour body.
Somewhere along the line theloss of those powerful
biochemicals trigger stressresponses, interfere with sleep,
with mood, with vaginal health,with libido, with muscles,

(11:13):
because these hormones theyaffect every cell, tissue and
organ in our body.
So very few women detect theearly changes and very few men
do.
In the world of men, forexample, a teenage, young man
awakens with an erection everymorning because his testosterone

(11:35):
is so rich and then that goesaway.
But they don't necessarilynotice that.
Well, things are happening towomen.
Comparable Things are goingaway.
They're changing a little bitbut it's not dramatic.
But sometime for 80% of women,somewhere in their late 30s or

(11:56):
40s or certainly by their 50s,the fall in hormone levels, even
though they're stillmenstruating.
The fall is so significant thatstrong symptoms develop.
And I always think that that'sa blessing because the symptoms
are so strong, they interferewith day-to-day life so much

(12:19):
that they inspire women to goout and ask the question, what's
going on here?
And to get some help.
And I think that's the beautyof those symptoms they're
awakening us to.
We want to address somethinghere.
Same thing that's going on formen.
They're noticing some mildchanges and then a lot of men
are losing their erection.

(12:42):
How did we know that?
We didn't know there was anandropause until this wild drug
came out called Viagra, and ithad explosive sales.
And all of a sudden we realizedsomething's going on with men
here.
So yeah, the symptoms occur for80% and best case, they're the

(13:06):
inspiration to seek and getexcellent at their own internal
hormonal system.
You know, hundreds of years agothere was no menopause.
No one was living that long,and now there is because we're
living so long.
So the best case scenario isthat a woman gets a handle on

(13:27):
this whenever she thinks to doso and has a major job to do at
that point.
It's technical enough andrequires legal stuff enough that
her job is to find someonewho's excellent at replenishing
these hormones.
Her job is to find someonewho's excellent at replenishing
these hormones, go shoppinguntil she finds someone who is

(13:49):
really good at it, who shereally trusts and really enjoys
and enjoys the partnership offiguring it out together and
getting it great.
That's the main job.
A lot of women, of course,definitely want to know more
about it, and you have a link toa free copy of our book that
women could download a PDF of.
It's fun to know stuff about it, but I always like to start

(14:14):
with.
The main job is finding thatprovider who's really
well-trained, loves the work, isspecializing in it.
Best case work, specializing init best case.

I agree with that because you know I honestly, dr
Rosensweet, I've been on my ownlittle journey because I'm going
through menopause without athyroid gland and not a lot of
people get into that, but a lotof the symptoms of thyroid

(14:45):
dysfunction and my medicationswill work differently depending
on what's going on with myestrogen and it gets so
confusing.
So having somebody who gets myunique situation, I think, has
been a lifesaver for me.
Absolutely what you're saying,because some people but here's

(15:07):
another question, and I know alot of women are still very
anti-hormone.
So and then you hear some womensay, well, I don't have any
symptoms, and I think that, okay, well, you hear about that.
Some women have less symptomsthan others.

(15:27):
Some maybe are not as intuitivewith their body and they don't
really realize.
You know, like you were sayingat the beginning, if they're a
little more subtle they're justlike slough it off to meh, who
cares?
But the big question is doeseverybody need a little bit of

(15:48):
bioidentical hormone to agebetter?

Absolutely positively, with great
certainty.
Yes, the only caveat would be Iwouldn't call it a little bit,
I'd call it the right amount.
So there were several subjectsthat you cruised through right
there, and beautiful ones.
I'd like to tease it apart alittle bit.
Yeah, yes, there's about 20% ofwomen who do not experience

(16:17):
symptoms, and those are thewomen I'm most concerned about.
The rest of the women havelife-stopping symptoms and they
get inspired or they just rideit out because they're afraid of
hormones.
So let's look at fear ofhormones.
There wasn't any specificmedication that hit the fear

(16:41):
button like hormones have.
None have.
Many should have, but none have.
And it was based on falseinformation.
Prior to 2002, the most popularand profitable drug for the
pharmaceutical industry washormones Premarin and PremPro.
18 million American women wereon them.

(17:03):
40% of all American women inmenopause were on these hormones
.
So it was going on royally andthese women were doing better,
that's for sure.
And then out comes the falsereporting of a study, the
Women's Health Initiative, in2002.
And overnight that 18 milliondropped to less than 2 million.

(17:24):
Because it scared women.
It said women who were onhormones were at increased risk
for breast cancer, heart attackand stroke.
Now that was false.
Can you believe it?
That's what the press got ahold of.
There was two arms of the study.
One of them was with Premarinalone.
The women who were on Premarinalone had a 21% reduced risk for

(17:49):
breast cancer.
Taking Premarin reduced theirrisk for breast cancer.
There was a statisticallyinsignificant increase when it
was PremPro Premarin combinedwith a very marginal,
questionable, uncomfortablemolecule called a progestin, but
it had a statisticallyinsignificant increased risk.

(18:11):
But they reported it asincreased risk.
They didn't say statisticallyinsignificant, scared the
medical community, scared womenall over the planet.
Dropped from 18 million womenbeing treated to 2 million
overnight Tremendousconsequences.
And it's scared women andproviders ever since.

(18:32):
By 2004, they knew that therewas no increased risk, not even
statistically insignificant, butthat didn't get public.
That didn't get a widespreadpress release.
A widespread press release In2017, the original study
committee reported in theoriginal journal.
They retracted.

(18:52):
They said after 18 years offollow-up, there is no increased
risk.
Hardly anyone's heard of thatRetracted.
The same study committeeretracted it.
And so in medicine, it was sucha unique and misogynistic event
to.
But the world is recovering andthere's been some pioneers out

(19:14):
there who have been teaching usthat no, there isn't increased
risk.
So just for your audience, if Imay, I know I've been speaking a
lot, but I'd like to give youthe science on risk because I
think it's so fundamental.
Now, here I will be talkingabout it.
But anyone can do the researchand they'll see the same thing.

(19:37):
And I cover this in my book inchapter three, the Risk.
And then there's well, there'sa couple of terrific resources
to back this up.
And here's the science.
All of us, women and men, we'reat risk for thousands of medical
diagnoses.
We're at risk for hundreds ofcancers.

(19:59):
As a male, I'm at increasedrelative risk for prostate
cancer.
That's new.
It wasn't so when I was inmedical school.
And there's reasons why thatrisk is increased.
Women happen to be at increasedrelative risk for developing
breast cancer over other cancers.
That's new.
That wasn't true when I was inmedical school.

(20:19):
Given that, we're all at risk,here's the science.
Women who are treated withhormones are at less risk for
breast cancer, heart attack andstroke than women who go
untreated Less risk.
It even goes so far as womenwho've had breast cancer and

(20:45):
have been treated for thatbreast cancer properly, they
have an increased rate ofrecurrence than a woman who has
a developing breast cancer brandnew.
But if a woman has had breastcancer and had that breast
cancer properly treated, she'sat less risk for recurrence if
she's treated with hormones thanif she's not.

(21:06):
And there's exact analogieswith men and prostate cancer.

I was going to ask you about that because the other
thing too, with so do you knowwho Dr Jen Simmons is?

I sure do.

Yeah, so I interviewed her a while ago
because she for anybody who'slistening she's a former breast
cancer surgeon and she talksactually a lot about what you
just mentioned about thedifferent types of cancers and
breast cancers, because there'sdifferent types of breast

(21:41):
cancers too, because there'sdifferent types of breast
cancers too.
So what you're saying is that,depending on how you were
treated and how like youroutcome, you have a less risk of
cancer, breast cancer onhormones.

Yes, let's see if I can say it in a
different way.
Any woman who's being treatedwith hormones is at less risk
for developing breast cancer.

Okay.

Heart attack and stroke too, less risk
.
Any woman who's had breastcancer and had the breast cancer
properly treated.
She has a risk of the breastcancer coming back.
However, if she's treated withhormones, the risk of that

(22:38):
recurrence is less than if she'snot treated.
And it doesn't matter receptorsite, none of it matters, just
in general.
If she's had the breast cancerproperly treated, she's at a
lessened risk of recurrence ifshe's treated with hormones.

I think we talked about this the last time because
hormones I think you saidsomething about that hormones
just in and of itself puts youat a less risk of all diseases
as you age.
Do you remember something likethat?
Well?

I mean hormones are powerful, they
contribute to our overall health.
Diseases have a multitude oforigins and causes.
So I wouldn't be so globalistto say hormones put you in a
much stronger position to dowell with your health.
But, oh boy, the whole world ofillness and its causes.

(23:45):
That's a big subject.

It is a big subject , isn't it?

It narrows down to very simple stuff,
though, really.

Well, here's the thing, dr Rosenzweig.
I think that hormones, hormonesprovide you with a vitality.
I actually wrote an articleabout this in my sub stack about
, and so I write a lot ofexplorative articles, meaning
just more like critical thinking.

(24:17):
Obviously no medical advice,I'm not a doctor, I'm not but
it's more explorative.
And one of the things I saidand I'm not saying this to shame
people who have chosen not totake hormones but you can tell,
when you just look at a 55 or60-year-old woman, you can

(24:38):
almost physically see the wayshe moves, see the way she looks
, see the way she acts hervitality on whether she's on
hormones or not on hormones.

Yeah, hormone receptor sites are
everywhere in a woman's body, ina man's body.
Everything gets affected in apositive way.
It's big too.
I mean you talk about illness,women who were on hormones, or
young women who had robust, richhormones.
They were at less risk fortroubles with COVID.

(25:15):
Better immune systems Runs thatdeep.
Better metabolism, betterenergy production, better
thinking.
Oh my God, there are zillionsof estrogen receptor sites in
the brain.
There's zillions of estrogenreceptor sites in the intestinal
tract and the bones.
They're everywhere.

Speaking of bones, you know I find the whole
subject very fascinating becauseyou mentioned at the beginning
that it's not about too much,it's not about taking just a
little, it's about taking theright amount.
And the first year that Istarted to experience symptoms
of late stages perimenopause,this is the first year that I

(25:58):
went from 12 periods to four andI started to have hot flashes.
And then all of a sudden sincethen, dr Rosensweet, I had these
weird things where I had, youknow, I have permanent damage to
a bone in my wrist and I'm likeI don't remember hurting myself

(26:23):
.
Same thing with my foot.
And then I started to see avery, very specific hormone
practitioner who was reallycustomizing my formula.
And when I feel really balanced, the pain isn't so bad, but the
damage is done.
It's done Like I've had MRIsand the bone there's a problem.

(26:44):
It's called osteonecrosis, sothere's like lack of blood
supply to the bone here, issuewith the bone in my foot.
So how common are issues withthe bone in women who are maybe
not optimized with theirhormones latter stages
perimenopause or menopause?

Well, as far as bone goes, there are
uncommon things that happen tobones and you're naming uncommon
.

I know.

There are super common, almost universal
things that happens to women'sbones.
As soon as they go intomenopause they start losing bone
at a very rapid rate and theylose bone so much that you hear
of the long-term consequences ofthis.
You hear the word osteoporosisand to many younger folks this

(27:41):
is just a word.
But the bones get so weak thatby the time you get elderly and
you've gotten severeosteoporosis, all it takes is a
fall and you fracture a hip.
And you know very few womenlive beyond a year after a hip
fracture and the same is goingon in men.
And yet, replenishing thehormones even if you've had bone

(28:06):
loss, you can get bonereplenishment.
So whenever you pick up on theneed for treatment for hormones,
you can get bone restoration orbone stabilization.
That's very, very crucial.
It really brings up the topicof the long-range stuff.
So many women know theshort-range stuff hot flashes,

(28:30):
night sweat, can't sleep, mood,dry vagina, pain and intercourse
.
The list goes on and on and on.
And for the initial part of mycareer this was very exciting to
treat because the results oftreatment replenishing the
hormones was so rewarding,because the women felt so much
better.
They felt great.
But I started to realize overtime that it was the long range

(28:52):
stuff that mattered so much.
For example, in medical schoolI was taught by a gerontologist
that what's really happening tothe elderly is they're losing
their muscle, their bones andtheir mind.
So you want to do something forthem, take care of the
sarcopenia.
And sure enough, when womenlose their testosterone, they

(29:16):
lose their muscle and they windup in canes, walkers,
wheelchairs, adult diapers andthen assisted living facilities
and nursing homes.
And I started realizing that theimportance of replenishing
hormones had consequences at theage of 80 or 90.
And people's lives mean as muchto them when they're 80, when

(29:40):
they're 90, but they sort ofhave to surrender to the losses
unless they protected theirmuscles.
And in order to protect yourmuscles, if you're a woman or a
man, you must have adequatetestosterone and also work out.
You gotta be active.
So the long range stuff,protecting the bones, protecting

(30:02):
the muscles these are hiddenthings.
People don't necessarily thinkabout it.
And then I mean the number ofosteoporotic fractures is
astronomical.
It's more of an illness thanbreast cancer is.

I have a question surrounding, because I think you
mentioned something just thereabout at any like you can't
start hormone replacementtherapy when you're like 80, can
you?

I started treating my mother and my
mother-in-law when they were intheir late 80s.

No.

Yes, my mother wouldn't let me get near
being her doctor until it wastime and so and there was some
advantage to do that, and bothof them had recoveries in
certain ways.
At recoveries in certain ways,we always say it's never too

(31:00):
late.
And then the ideal thing is tostart working with hormones.
When a woman's in herperimenopause, or a man is
getting the first signs of lossof hormones in his 40s or his
50s, this is the easiest time tointervene and the easiest time
to keep the ship steady, so tospeak.

(31:24):
Yet we'll do it at any time.
If a woman's been withouthormones for 10 years since her
last period, there are specialmedical considerations we must
take into account because of theconsequence of being 10 years
without hormones.
So we work with women whohaven't had them for a while in

(31:45):
a very specific way, coveringsome other bases, to make sure
they get treated safely.
But yeah, the easiest time isin the premenopause.
But we say, hey, listen anytime, anytime you think about it, go
after it.

Wow, can you, like, just you know, very quickly say
like what is it that you haveto do different for a woman who,
let's say, she went tomenopause at 50?
Because I know there's somepeople, you know I always say I
reserve the right to change mymind because, you know, research
changes.
Just like we saw right, we sawthat how much research can go

(32:26):
from one extreme to the other.
So what if you do change yourmind?
What do you need to becognizant of if you're 60 and
haven't had a period since youwere 50?

Well, the job becomes the same To find a
provider, a medical doctor, anosteopathic doctor or a nurse
practitioner who loves this work, has done extra training in it
because we don't learn this inmedical school or residency and

(33:00):
is really good at it.
That's the only job of thewoman or the man.
Then the job of the provider isto do the same thing that was
done with you.
You've told me enough to knowthat you reach the right kind of
provider.
They understand that everywoman is individual.

(33:22):
They don't make a big deal ofit.
They give you the resources tofigure out your own internal
amounts and balances andindividualize it for your
particular self.
Well, it's the same thing whenyou're 60 and you haven't had a
period for 10 years.
Now there's a few extra thingsthat we pay attention to,

(33:43):
because there's been loss of theprotection that estrogen has on
the arteries.
A woman who's been withoutthese hormones for 10 years, she
might have a specialvulnerability to
arteriosclerosis and a clot.
So we have to do a littlecardiac investigation.
Not hard to do, that's the mainthing.

(34:03):
Sometimes we need to docoagulation stuff to make sure
that the woman isn't going tohave a blood clot, but the
process is the same.
We do tend to go lower andslower because 10 years without
hormones means the hormonesreceptor sites in her body have

(34:24):
gone dormant.
So part of the treatmentprocess includes a gradual
awakening, reawakening of thehormone receptor sites.
So we tend to start lower inthe dosages and do the increases
slower.
But the process is the same asyou went through.

(34:45):
It's linking up with a providerthat loves to team the thing.
That's how I.
When I first went into treatingwomen in menopause, there was
very little known, almost zero,and I knew enough about symptoms
and stuff and hormones enough.
But the hormones were goinginto the woman's body.
So I figured out I would haveto team up with the women and

(35:10):
together we would have to figureout what was right for that
individual woman because theywere the ones experiencing the
hormones and it was perfect.
It was.
It was a perfect system becauseinvariably we'd start the women
off on the four hormones andstart them low and gradually
increase them and we'd wind upadjusting them according to the

(35:34):
balance and the amounts of thatindividual woman.
Well, the same process needs togo on when you're 60.
It's just a little lower and alittle slower for most women.

That's what I love about you, because you're a
doctor that actually listens tohis patients.
Because you know there's a lotof gaslighting out there with
women and you know doctors whowill still quote that old
antiquated study, the Women'sHealth Initiative.

(36:06):
There are doctors who don'treally pay attention to the
symptoms and, just like what yousaid, I actually work with a
nurse practitioner and we talkabout because you know you might
be I know that you're a big fanof biased right?
Do you want to talk a littlebit about that, about how you
can play with the ratios?

(36:26):
That's why it's just such acool way of doing estrogen,
right?

Yeah, you know there's.
Really, when we're talkingabout replenishing hormones,
we're talking about the hormonesthat come out of the ovary, and
there's four of them.
There's the estrogensprogesterone, testosterone and
DHEA.
I said the estrogens.
There is no hormone calledestrogen.
There's three of them, threemajor ones, three different

(36:59):
estrogens, and one of them isestradiol, that's the most
potent estrogen that the ovaryproduces, and the second one is
estrone.
It's about 80% as potent asestradiol.
And there's a third one calledestriol, that's about one-eighth
as potent.
Three estrogens.
However, there's more estriolthan there is the sum of estrone

(37:20):
and estradiol.
There's a prevalence there inwhich estriol is.
There's more of it.
So the original.
There's a couple of pioneers whoreally brought this out to our
awareness Dr Jonathan Wright,and he said if that's the way

(37:41):
nature's designed, why don't wetreat women like that?
Well, he was really going muchdeeper than that.
There was a medical doctor whowas an oncologist at the
University of Nebraska in thelate 1960s, who was studying the
hormonal patterns of youngwomen and also the hormonal

(38:03):
patterns of women who had breastcancer, wondering if there was
a link, and he was doing 24-hourhormone testing, which has
remained the gold standard sincethe 1960s, and what he
discovered was there was moreestriol in a young, healthy
woman than there was the sum ofestrone and estradiol.
There was 1.3 times as much onthe average estriol as there was

(38:27):
the sum of the two most potentestrogens Women who had cancer.
They had much, much lessesterol and Dr Lemon proposed
that esterol was cancerprotective.
And Dr Wright discovered hisresearch in the 1980s.
And Dr Wright said instead ofusing Premarin, I know that

(38:50):
there's pure molecule, identicalhormones out there.
They're being produced.
Why don't we see if we can getsome?
And he went to a compoundingpharmacy who did find pure same
molecule estradiol, testosterone, progesterone.
Same molecule was beingproduced out of a plant source,

(39:13):
beginning in Mexico, by anAmerican.
It's a fascinating story.
And Dr Wright radically proposedlook, if we're going to treat
women, why don't we just copynature?
Why don't we just treat womeninstead of with just estradiol

(39:35):
alone, because that's not what'sgoing on in them.
Why don't we treat with estriolplus estradiol?
And he had a laboratory thatwas doing 24-hour urine hormone
tests and he was fiddling withthe ratios how much estriol
compared to how much estradioland he learned that for most
women, if you give them 80% of aformulation of Estriol and 20%

(39:59):
Estradiol.
You're going to replicate thepattern, that's the young,
healthy women, and that's thegoal.
Don't reinvent the woman, justdo the original design.
It's really amazing.
And then in the 1990s I'm sorryif this is too detailed.

(40:19):
How are you doing here?

Is this okay, no, it's good, it's good.

In the 1990s, along comes these
researchers at Tulane thatdiscovered the estrogen receptor
sites and they discovered therewas two major ones.
They called ER alpha and ERbeta.
And when you look at a woman'smenstrual cycle, every single

(40:43):
month she is preparing forreproduction, the whole first
part of her cycle.
She's going through a phase inwhich the lining of her womb,
the uterus, is being developed,new cells, brand new cells and
ultimately to receive afertilized egg if possible.

(41:04):
What we also realize that thewhole first part of that
menstrual cycle this is from thefirst day you menstruate to
about day 12, is also you'regetting preparation for
breastfeeding Every single cycle.
Go figure, and women can feelthis they're actually getting

(41:25):
more breast glandular cells intheir breasts and breasts get
fuller throughout the course ofmany women's cycle.
Many women feel this If there'sfertilization, this goes on to
pregnancy.
If there's not fertilization,everything disappears.
All the proliferation of theuterine lining and the

(41:51):
proliferation of breastglandular cells.
They disappear Ultimately, theuterine lining there's zillions
of cells there it falls out andthat's what menstruation is.
And ultimately all those newbreast glandular cells preparing
for breastfeeding, theydisappear by a process called
apoptosis.

(42:12):
I always liked that word.
I thought that was prettydescriptive and my point is this
that the whole firstproliferation phase is under the
inspiration of the receptorsite ER alpha.
When a hormone interacts withER alpha, you get proliferation.

(42:34):
When a hormone interacts withER beta, you get deproliferation
.
So that cycle is divided in amenstruating woman into
proliferation anddeproliferation.
Er alpha, er beta the maininteraction with ER alpha
proliferation is estradiol.

(42:55):
Interaction with ER alphaproliferation is estradiol.
The main interaction with ERbeta is estriol.
So Dr Lemon in the 60s saysestriol is cancer protective
because it supportsdeproliferation.
But no one knew the actualmechanics until the 1990s.
The bottom line in treatingwomen in menopause is to do

(43:16):
everything we can to preventbreast cancer.
We don't want breast glandularcell proliferation in a midlife
woman.
They don't need new breastcells and that's a very
vulnerable time in the life of acell.
You got cell division, you gotexposure of genes and dna.
You don't want to have mitosisand cell division.

(43:38):
You want to have the emphasison deproliferation.
So this is why I favor treatingwith estriol, treating with
bias.
Really, estriol is beautiful,it's amazing, it's wonderful,
and so is estriol, just copyingnature.
This is not rocket surgery here.
That's why I like biased,because I love the emphasis on

(44:03):
deproliferation.

That was the most brilliant explanation I've never
heard, because I've intervieweda lot about menopause.
I've never heard that explainedso well.
Thank you for that.
Heard that explained so well.

Thank you for that.
Just to take it further, if Imight.

Yeah.

In 2009, a very major American functional
medicine laboratory came to meto ask me to develop a 24-hour
urine hormone test.
I said why would you want to dothat?
There's two good labs.
They said well, we have our ownclients.
They all want us to be one stop.
And I said why would you wantto do that?
There's two good labs.
They said, well, we have ourown clients.
They all want us to be one stop.
And I said I'll do that if wecan redefine the reference

(44:43):
ranges.
I really want to know what'strue for young, healthy women.
They said sure, and they gaveme a lot of money and we
interviewed 600 nursing studentsbetween the ages of 18 and 29.
100 of them were regularlymenstruating, which allowed them
to be candidates.

(45:03):
500 were not.
Think about that.
And we got the statistics.
We ran 24-hour urine hormoneson these young, healthy nursing
students and Dr Lemon came upwith 1.3 as an average.
We came up with 0.9 as anaverage Very close Once again,

(45:24):
much more estriol than there waseither estradiol or estrone.
So this wasn't just somethingbased in the 1960s, it was based
in 2010.
We're in the process ofpublishing that study, actually.

That's amazing.
Sorry, were you done?
I don't want to interrupt.

I was done Okay.

So I have a question, because you know we
are bringing into young womeninto this conversation, because
what you're doing is trying toalmost mimic the part of the
cycle of a younger woman whereyou're not building, building,
building to get pregnant, fromwhat I'm understanding.

(46:06):
But why do you hear of womenwho have menstruation issues?
They're not regular in theircycles.
They get put on the pill, rightright.
This is what I'm sayingLogically, dr Rosenzweig.
It doesn't make a lot of senseto me because you just said a

(46:27):
lot of women are not even havingregular cycles, so how is that
going to set them up formenopause, to have a healthier
menopause?

Well, what a question.

I know it's a big question, right, it's a big
question.

Here's what's big about it.
I'll tell you historically whatit was like for me.
I graduated medical school, Iwent into my rotating internship
.
These were very, verychallenging years.
Medical school was hard, reallyhard, and one of my very first

(47:05):
jobs when I got done with myinternship was I worked for
Planned Parenthood and I went.
Oh God, this is just likefantastic.
I'm dealing with young, healthywomen and I don't have all
these just tremendously complexmedical cases to deal with.
So it was such a relief and Idon't have all these just
tremendously complex medicalcases to deal with.
So it was such a relief and Iwas getting a salary.

(47:26):
It was a miracle to me.
But within three months Iresigned Because I started
thinking we're giving youngwomen a pill that's powerful
enough to stop them fromovulating, even though they're
called low dose.

(47:48):
I went there's something wrongwith this.
We shouldn't be trying tointerfere with ovulation in
young women.
And I got so uncomfortableabout it that I actually
resigned one of the best jobs Iever had, I think.
Intuitively, at least for me, Iwent this is too big of an
interference and I understandthat contraception is extremely

(48:12):
valuable and extremely important.
Yet I grew up in an era whenthere was a lot of successful
contraception.
My dad told me here's a condom.
It works great.
Add a diaphragm and you'll befine, and we're okay it's great.
It's great.
I'm saying that because, asmuch of a blessing people have

(48:36):
considered the pill to be, we'velearned over time that it's got
some problems with it.
You stop a woman from ovulating, you stop the progesterone in
her cycle, you give her anartificial progestin.
So I know this could bedisruptive information, but my
favorite colleagues and I, welook at this and we're not

(48:57):
comfortable with the pill.
So why have the pill be theremedy for menopause?
I'll just drop thecontraception issue for a moment
and go why have a pill be aremedy for the perimenopause?
What's going on in theperimenopause is very clear.
Instead of having these richyouthful levels, you got less.

(49:18):
So you interfere with the brainand the ovary and the signals
get off and ovulation, like you,went from 12 periods to three
periods a year.
It's very understandablephysiologic, but the remedy,
once you understand it, it'ssuch a blessing.
Just replenish the hormones,use the same molecule, use an

(49:43):
organic base to carry thetopicals.
I'll slip that in and adjust itfor every woman, individualize
it and do it for her whole life.
Her whole life.
Well, you talk to a man, forexample, who lost his erection.
Talk to a man, for example, wholost his erection and he gets

(50:06):
on testosterone and his erectionreturns, as does his libido and
his strength and his clarity ofthinking.
And you say to that man you mayhave to be on this for your
whole life.
And you know what the man saysHallelujah.
You know, it's a miracle.
And women have been frightenedlike there's something wrong
with it for their whole life.
No, it's a gift.
It's part of the miracle oflife that we've been given this

(50:29):
gift of bioidentical hormonesand a lot of knowledge on how to
use it.
So why would you ever want tostop?
I'm sorry, I must have taken adiversion in the road there.

No, I mean you brought up a couple of really
important points there, becausethere's the pill that is
recommended for young women whenthey have period problems.
The pill is also recommendedfor women in their 40s, when
they're starting to go throughperimenopause.
So is the IUD.
I know, you know, when I was 18, I was recommended, because I

(51:03):
had heavy periods go on the pill.
I went on the pill for one year.
I had major issues.
I went off the pill.
Then again in my forties I hadsome issues and I was told go on
the Marina, get the Marina IUD,get the Mirena IUD.
I didn't do it, but it's likewe keep getting these.

(51:24):
I don't know band-aids.
So that was an important pieceof this conversation.
But I need to get on thisbecause you're talking about
testosterone and I know thattestosterone is important for
women and we've talked aboutthat.
I think we talked about that inthe first podcast.
But here's a question, becausefor men it's less talked about.

(51:51):
You mentioned the erections.
That's maybe an obvious or notobvious sign for some men.
But then there's also thingslike mood and vitality and all
those factors that come with alower testosterone.
You know the saying grumpy oldmen, right?

So there's a lot of reasons it's a big
deal.
It's a big deal.

I have to ask this, though, because a lot of times,
men will be offered somethinglike HCG injections before
testosterone.
Because once you starttestosterone, don't you weaken
the receptor sites Like you haveto be on it?

It's more like this.
Okay, any man, let's say, forexample, who's developed
significant symptoms and loss oferection is a very significant
symptom for most men, but youmentioned others mood, energy,
muscle strength, drive,motivation, a lot of stuff.
That is some of the finestqualities of a man.

(52:57):
Being a man gone or diminished.
Once a man starts gettinginterested in getting treated
40s in his 40s, in his 50s, evenin his late 30s, because the
symptoms have been coming on, weask a very fundamental question
Do you want to have children,any more children?

(53:18):
And if the answer is no, weproceed to testosterone in most
cases.
If the answer is yes, I wouldlike to have more children, then
here's the caveat If we give aman testosterone, we're going to
signal to the man's brain that,oh, there's enough testosterone

(53:41):
and the man's brain is going toshut down the stimulating
hormones that go from thepituitary gland to the testicles
and there's going to be no morestimulation in the testicles to
do their thing, which is toproduce testosterone it's not
needed, it's already beingtreated with it and to develop

(54:02):
sperm, it's already beingtreated with it and to develop
sperm.
So once we give a mantestosterone, we shut down his
own testicles and he relies onthe testosterone he's being
treated with.
Well, if he decides to have achild at that point and we stop
the testosterone, will histesticles recover the ability to

(54:24):
produce sperm?
That's an unknown.
So for a young man who stillwants to have a baby, we don't
jump in to just start treatinghim with testosterone.
We give him something that willstimulate his testicles to just
produce more testosterone,which is possible.
There's a pill to do that andthere's also injections, hcg.

(54:48):
Hcg happens to be my favoritehuman chorionic gonadotropin.
It behaves like the pituitarystimulating hormone to the
testicles.
So a young man who still wantsto have a baby, we try and
stimulate his own testicles withthat or some version of
clomiphene or enclomiphene,which is a pill.
So we try and stimulate theyoung men who still want to have
babies, but we treat withtestosterone, for those days

(55:12):
have passed.

Yeah, I've heard of some who will you know, if the
man is, even if he doesn't wantto have babies, if he still
wants to see if he can get thatstimulation through?
The man is, even if he doesn'twant to have babies, if he still
wants to see if he can get thatstimulation through the HCG,
but then they have to go on likean estrogen blocker or
something right Is?

that right ?
Not really, no.
No, there's another reason tomen going on HCG is they want to
keep their testicles stimulated, even if they're being treated
with testosterone, because somemen will experience shrinkage of
the testicles.

On testosterone.

On testosterone.
If their own testicles aren'tworking anymore, they shrink.

It's like an atrophy right.

That's right.
It doesn't happen to all men,but it happens to enough that a
lot of men who want theirtesticles to be of a certain
size go figure.
There's no biologicalconsequences that we can detect.
But if they care about that,then we also stimulate them
while they're on thetestosterone with HCG usually.

Here's a question for you because I and maybe you
can clarify this.
I have heard that havingoptimal testosterone as a man
ages is prostate protective andheart protective.
Is this true?

Exactly true, just like for women, women
who are treated with hormonesare at less risk for breast
cancer.
Men who are treated withtestosterone are at less risk
for prostate cancer.

Now you mentioned atherosclerosis.
We talked about women.
A woman hasn't been on hormonereplacement.
She decides that at 60, shewants to start.
You take the necessaryprecautions to just be sure that
it's safe for her.
What if somebody has plaquebuildup already?

(57:13):
What if it's a man or a woman?
Can they still safely dotestosterone therapy?

Yeah, and there's caveats there.
There's a unique situation witha woman that, let's say she's
gone 10 years with no estrogen.
Well, estrogen is veryprotective to the arteries of
her body and including thecoronary arteries, the ones that

(57:43):
go to the heart, and if she'slost that protection she's
vulnerable to getarteriosclerosis.
Not every woman does, but a lotdo.
Without the protection of theestrogen and atherosclerosis of
the coronary arteries.

(58:03):
It looks like a boat that'sbeen in the water too long and
has barnacles on it.
That arterial surface lookslike there's a bunch of
barnacles on it, so to speak,cholesterol plaques, and they
become a provocateur for a clot.
It's never the atherosclerosisper se that gives someone a

(58:24):
heart attack Very, very rare butthe clots that form on that
barnacle surface, they're thetrouble.
They block the circulation and,worst case, they can break off
and that'll cause a heart attack.
They'll lodge deeper in theheart, they'll block off part of
their circulation to the heartand that'll cause a heart attack
.
They'll lodge deeper in theheart, they'll block off part of

(58:44):
their circulation to the heartand that's a heart attack.
Well, there's this very, very,very rare situation where if a
woman has been without hormonesfor 10 years and we put her on
estrogen for one year, she's atrisk for a heart attack Only for

(59:07):
one year If she has a clot, ifshe has a clot in that coronary
artery.
If she doesn't have a clot thatrisk is not there.
But if she has a clot, thatclot is at risk for breaking
loose and giving her a heartattack and it's probably because
of the relaxation of thecoronary artery.
I don't know the exactmechanism, but the medical

(59:28):
science is that for one yearshe's at increased risk for
getting that clot breaking looseand giving her a heart attack.
So that's why earlier in thisdiscussion I said women who are
a little older and 10 yearswithout hormones.
We're going to do a little moreinvestigation to make sure they
don't have a clot in there.
So there's relativelynon-invasive testing, for

(59:52):
example a stress ultrasound, andwhen, by someone who's
excellent at the stressultrasound, they can tell
whether there's a clot in thatcoronary, that's the least
invasive.
There's other methods you canuse.
So yeah, heart attacks big deal,protection with estrogen big
deal.

(01:00:12):
And the whole issue with men isdifferent.
There was this myth goingaround like comparable to the
myth that was going around withwomen.
It was false.
The myth for men was they weremore vulnerable to heart attacks
if they went on testosteroneWrong.
And thank goodness there was arecent study in the last couple

(01:00:35):
of years that just totally sortof in my mind proved for once
and all that testosterone isbeneficial for the heart and
does not lead to increased riskfor men we kind of talked more
about women.

Sandy Kruse (01:01:04):
Is there a specific contraindication where under no
circumstances should you evenentertain the idea of going on
hormone replacement therapy?

Dr. Daved Rosensweet (01:01:13):
I personally can't think of one,
but I can think of the opposite,and I think you've led us into
one of the most important topicsof all the consequences of no
hormones.
I can give you a writtenguarantee Women loss of bones
leading to osteoporosis.

(01:01:34):
Loss of muscle leading tosarcopenia.
Loss of vagina, vaginal atrophycoupled with loss of the muscle
that holds up the bladder leadsto adult diapers.
It leads to chronicgenitourinary For many, many,
many, many women.
Loss of hormones leads tocognitive decline all the way to

(01:01:56):
dementia for some Big one.
Brain fog is a very commonsymptom of the initial losses
for women.
And the list goes on and on ofthe losses, because these
hormones are so universal andthey're so powerful that the

(01:02:16):
loss of them have definitebiologic consequences.
So we always talk about the riskof this or the risk of that.
I say let's talk about the nearcertainty of these troubles
occurring over time, so that bythe time you're in your late 80s
.
Well, we have on our medicalboard, we have a doctor.

(01:02:36):
She's been in her previouslifetime in medicine.
She was the doctor for nursinghomes and I asked her one day
what percentage of women who arein nursing homes are there
because of low hormones.
She said 80.
80% of women who are in nursinghomes are there because of low

(01:02:57):
hormones.
So it's a big deal.
Talk about risks.
And then, because I'm a doctorand I've treated people of all
ages, I get to know what happensto women and men in their 70s
and 80s, women and men in their50s.
They're not thinking, oh, thisis what I'm going to be like

(01:03:20):
when I'm 80.
Even if they've got parents whoare going through some rough
stuff, this won't happen to me,it does happen to them and we
see the perspective of oh my God, if you can prevent this.
This is one of the mostwonderful things Because, like I
said, people in their 80s,their life means a lot and they
want to stay at home.

(01:03:41):
That's the thing they want tostay at home, that's the thing.
They want to stay independent,walking, talking and with their
families.

Dignity, dignity.

Life.
Family life Friends.

Okay.
So here's a question.
I know that you have explained24-hour urine and how that is
the most accurate way to measurehormones.
What if?
Because cost always comes intoplay, dr Rosenzweig.
So it always comes into play,and I do feel that people are

(01:04:18):
more.
I think people are strugglingmore with the cost of living and
that sort of thing.
So what would we know?
24-hour urine is the mostaccurate.
What would be the next best wayto test hormones?

I don't know that it exists.
You know blood tests, forexample.
They are so excellent for athousand things.
They're terrific, but by thetime you're treating a woman or
a man with hormones, there's aprinciple called

(01:04:55):
pharmacokinetics that makesblood tests not work.
And the issue is and we've donethese studies ourselves, but
lots of people have done thesestudies You're taking topical
hormones.

I am taking progesterone bio-compounded
progesterone capsules and I'mtaking topical estriol estradiol
estriol it's a biast.

Okay.
So it totally depends what kindof reading we get on the
estrogen, depending when youapplied your hormones.
So we've done studies of we'vegotten a fasting blood draw on a
woman, Then we apply herhormones, Then we draw her blood

(01:05:44):
at one hour, two hours, threehours, four hours afterwards.
And the real issue is whathappens during that time.
Well, some women they get theirhighest level at two hours.
Other women get their highestlevel at four hours, Same for
men.
And it totally depends when youdraw the blood.
You could be deceived.

(01:06:05):
You could see a real low numberif you drew a fasting or if you
drew a woman who peaks at twohours, if you draw three hours
or one hours or four hours.
So unless you do initialstudies on every single patient
to see when they peak, you don'tget good information about a
woman or a man you're treatingwith hormones.
24-hour urine hormone doesn'tmatter.

(01:06:29):
You're doing a full 24 hours.
It doesn't matter when thewoman applies her hormones.
It totally eliminates thepharmacokinetic issue.
Well, there have been attemptsto come up with new stuff ever
since I've been doing thisSalivary testing.
I can tell you it doesn't work.
I have strong opinions.

(01:06:49):
People will argue with me,discuss with me, but I really
love my opinions.
And saliva for ovarian hormonesnot okay.
And then there's these newdried urine tests where you take
four samples or five samples.
They become extremely popularbecause they've got a super

(01:07:09):
strength called marketing.
But they run into the samepharmacokinetic issue when did
you apply your last hormones?
According to their instructions, you apply your morning
hormones, let's say, at 9 am.
Your next urine draw that youcollect is at 5 o'clock.
That's eight hours difference.
You could have missed theentire offloading there.

(01:07:32):
Pharmacokinetics urinating onthe filter paper, extracting
sticky steroids from filterpaper, relying on hydration
there's many reasons why I'm astrong advocate that this is not
the state of the art in hormonetesting and people should
choose the state of the artbecause it matters to get it

(01:07:54):
right.
So, yeah, that's my strongopinion.

That's okay.

If I thought dried urine worked.
But the thing is, we've donecross studies.
We've taken an individualpatient and we've submitted a
sample in the same 24 hours tofive different laboratories and
we see these wild discrepanciesand so we've been very on top of
this one.
And we see these wilddiscrepancies and so we've been
very on top of this one.

(01:08:26):
We've done studies on this oneand my current conclusion is
24-hour urine.
It's fantastic.
It's as inexpensive as any ofthese.
You can now get it for $250 fora test, and we just test once a
year for $250 for a test.
And we just test once a year.
We never test a woman inperimenopause ever, by any

(01:08:51):
method.
Why is?

that Really?

Really.

So then, how do you know what to start her on?

Exactly.
Well, here's why.
If I draw in the air here whata menstrual cycle looks like as
far as estrogen levels gothroughout a 28-day month, day
one, day 28, I'm drawing whatestrogen levels look like Pretty
low when she's menstruating.
Then they start to rise, thenat day 12, they peak, then they

(01:09:23):
fall, and then they risepartially and then they fall.
That's what estrogen levelslook like according to a
menstrual month.
They're very variable like that, but it's very predictable in a

(01:09:44):
young woman who's ovulating Inthe perimenopause, like I say,
the hormone levels have dropped,so her brain and her pituitary
gland go.
Something's amiss here.
We need more hormones.
Maybe we can put out some morestimulating hormones to
stimulate the ovary, and you doIn the perimenopause.
The lows are picked up by thebrain and you get these bursts

(01:10:07):
of stimulating hormones comingout of the pituitary and the
ovary responds and you get apeak come out of the ovary but
it can't keep it up.
So instead of this nicesmooth-looking curve over the
course of a month, you getsomething that looks like this

(01:10:28):
Very erratic.
It's totally dependent on whenyou test, what day you test her.
How did I learn this?
I had just discovered 24-hoururine hormone tests.
I was brand new.
I had a woman in theperimenopause and she's having
hot flashes and she can't sleep.
Well, this is a certainty thatshe's low in estrogen.

(01:10:48):
But I wanted to test her.
So I'm handing her a reportthat shows high estrogens and
I'm saying to her but I knowyou're low in estrogen, I want
to treat you with estrogen.
And she looks at me like I'msaying to her but I know you're
low in estrogen, I want to treatyou with estrogen.
And she looks at me like I'mnuts.
You're a doctor, you did a teston me.

(01:11:09):
You see high estrogens.
You want to treat me with moreestrogens.
It's only confounding Testing awoman by any mechanism when
she's in the perimenopause.
You run the risk of confusingher.
So we don't test women'shormone levels in the

(01:11:30):
perimenopause ever.
There's no value.
She's already told me the story.
You already told me the story.
You said I used to menstruateonce a month and then I started
menstruating three times a yearor four times a year.
Why, well, where's your hormonelevels?
They've gone way down.
So now you're only menstruating.
We already know they're low andthen you tell me a few other

(01:11:51):
symptoms because you will havethem by that time.
You're going to have othersymptoms.
That was not the only othersymptom you were having there.
We test a hundred percent of ourwomen at a certain point.
When a woman first comes in formenopause, she hasn't had a
period for three months or ayear.

(01:12:12):
We never test her.
How did I learn that?
I tested women who hadn't had aperiod for a year and they got
to pay $340 for me to tell themthat their hormones were low.
I already knew it from thestory.
They hadn't had a period tosimplify it, and I went you're

(01:12:35):
charging them to test theirhormone levels when they've
already told you that they'rezilch.
So we stopped doing that.
Here's when we test all womenwhen they're in the menopause
and they say to us oh my God,I'm myself again.
Oh my God, I feel good, this isgreat.

(01:12:56):
Then we test 100% of our women.
Then we test 100% of our womenand it turns out it's important.
We test them then, becausesymptom alleviation is not the
final answer, because we did astudy of 54 women who said I
feel great and what we learnedwas 50% of them were on estrogen

(01:13:20):
levels too low to protect theirvagina and bones over the long
haul and 25% of them were onestrogen doses robust enough
that they were at risk forbreast glandular cell
proliferation, even though theydidn't have symptoms.
Only 25% of them were in whatwe consider to be the absolute
optimal zone.
So we test and we fine tune,and we only have to test them

(01:13:44):
once, because if they'vetitrated their symptoms away,
they're close and they usuallyneed a tweaking.
Then we test them once a year.

That's brilliant, because I've never quite heard
it described like that, because,hmm, I have a lot of questions
and I know we're running low ontime.
But you know, at what pointdoes a woman's hormones

(01:14:15):
stabilize?
Is it that magical one year ofno periods, Like?
When does it happen?
And is it?
Listen, we are humans, we'renot robots.
Our bodies still have rhythms,even though our hormones are not
being produced like they werewhen we were 35.
So at what point does itstabilize?

Yeah, I can give us a little extra time
here if you want.
Would you like that or no?

Yeah, because here's the thing you hear, dr
Rosenstreet.
You hear all the time one year,no periods.
Okay, now you're in menopause,it's this definitive line that
you cross.
But I know from experience at55, it's not a definitive line

(01:15:07):
really.

Yeah, it actually doesn't matter that
much.

Okay.

If you stick with the general principle
that at the age of 20, you'rehere and at the age of 90,
you're zero, and you can gothrough an erratic period here
where it's a little trickier toget things balanced.
I think nature is just amazing,though.
It forces a woman into the PhDprogram of getting it right
right away.
Because it's a rodeo ride,because things are up and down,

(01:15:37):
so it's a little erratic, soit's the hardest time to get
things evened out.
But it puts you in the PhDprogram right away because once
you get out of the perimenopauseit's a piece of cake from that
for the rest of your life,because you went and figured it
out.
For one thing, you figured outwhat does low estrogen feel like
in my body?
Well, I think I need a littlemore estrogen today.
Well, what does lowtestosterone feel like?

(01:15:59):
Because you're forced to figureit out in the perimenopause.
I think the design is amazing.
But it doesn't matter.
Somewhere along the line yousay I think I want hormones, you
begin the process.
You go through a learning curveof getting what these hormones
feel like, how they alleviatesymptoms.

(01:16:20):
You figure it out and thenyou're on a cruise and so many
women just get so good at itmidlife, and then they just
adjust it as things get lesserbecause their own ovaries are
just going down to zero, samewith a man's testicles.
Does that answer that questionfor you?

Yeah, it does, Because I think exactly what you
said.
You know, I'm sure you've seenwomen in all sorts of stages and
all sorts of symptoms ofperimenopause.
You know, I happen to think Ihad three years of crazy ups and
downs, Like I.
You know, sometimes I didn'tknow whether I was coming or

(01:17:02):
going, but but I knew enough togo.
Okay, I think my estrogen islow or okay, I feel like I have
low progesterone.
It's mostly this interplaybetween those two that I really
could feel it in my body andthat's something that you teach

(01:17:25):
women, don't you?
Which I think is amazing,because you actually have a
whole list of symptoms.
Okay, here's what you mightfeel if you've got low
progesterone.
Here's what you might feel.
Yeah, yeah, I love it, DrRosensweet.

And of course the women could download
the book, and that card is inthe book Happy, healthy Hormones
.

I think every woman and truly I think it would be
beneficial for men as well.

Oh yeah.

Because men and I know, because I got two in my
house they're not, you know,it's so, oh yes, little bit of
this or a little bit of that indinner.
So maybe you need a reallyhealthy meal, and then I've got
my husband, who'll be like.
I have no self-awareness, Idon't know how I feel.

Yeah, sometimes the things are a
little more subtle with men, butfor many, many men, they lose
their subtlety when the erectionstarts to wobble, lose their
subtlety when the erectionstarts to wobble and that is a
90 alarm fire for a lot of men.
They do notice it and it'sshocking and it's scary to a lot

(01:18:57):
of men.
So we're in a very similarsituation that women are in.
Well, you've got this oftendramatic stuff.
And what is its message?
Find you someone who reallyloves this work, knows what
they're doing and can partnerwith you to where you figure it
out, and then you're on a cruisefor the rest of your life.

(01:19:19):
You don't have to worry aboutthat kind of stuff or the risks
of not having hormones.

So not having erections for a man could be a
few causative factors, one beinglow testosterone.
One could be heart disease,right, yeah, it can be.
That can be another reason, andhere's a question.

It's arterial disease.
It's the same disease that hasaffected the arteries that feed
the heart, have affected thearteries that feed the penis and
you get a hardening of thosearteries.
You don't get good circulation.
So the consequence to the heartis one thing.
The consequence to the penis isyou can't get enough blood in

(01:20:04):
the penis for it to become erect.

I find it really interesting the way that you
know, I guess medicine viewsthis.
You know medicine.
The way that they're taught islike okay, let's just give a
pill Viagra, let's notinvestigate what's going on with
your testosterone, let's notinvestigate whether there's

(01:20:32):
issues with the arteries, let'sjust give a pill because this is
common, dr Rosenzweig.
So they're not checking thetestosterone levels, they're not
checking whether there know,whether there's potential issues
.
So you know, this is why I lovewhat you do, because you're
going to do the testing, let'ssee what's going on.
But you're also saying thattestosterone in and of itself is

(01:20:55):
not a risk factor for somebodywho may have issues with their
arteries.

Let me put it this way low testosterone
has similar risks and otherrisks.
What the male body functionsbest at is an optimal level of
testosterone, and if you get shyof that optimal level, you
start getting decreasingtestosterone levels.

(01:21:26):
You run into a long list ofproblems.
Erectile is just one.
Loss of muscle, loss of mood,loss of bone these are powerful
and they affect everything.
So we want to have the optimalamount.
One thing that we need to becautious of in men's medicine is

(01:21:46):
that we don't give too much.
Same with women's medicine.
We're very precise around theparameters that we use for
treating a man with testosterone.
Yes, we want to alleviate hissymptoms of insufficiency, but
at the same time, if you givetoo much, we wind up seeing

(01:22:08):
laboratory tests that show usthere's too much.
They get too much estrogen madeout of the testosterone they
get.
They raise something called sexhormone binding globulin.
They can raise their DHT toohigh.
So it's a wonderful science,just like it is with women, to
get it right and you can't go bysymptoms alone.
You can overdose a man or youcan overdose a woman and they

(01:22:28):
can say I feel great.
Most people don't.
Most people women and men whoare overdosed don't feel right.
But a certain percentage ofthem feel supercharged.
So it's called superphysiologic dosing and we don't
want to do that for the long run.
In the world of hormones givingtoo much is an error.
So when you link up withsomeone for testosterone you

(01:22:48):
want to get someone once againthat's really good at it, that
understands all these conceptsand knows how to guide you both
through your symptom situationand your laboratory situation to
get it just spot on.
Viagra is a whole differentstory.
There are a certain number ofmen as they start getting
erectile dysfunction they willbenefit by Viagra, but

(01:23:10):
invariably they're low intestosterone first.
So in our method we're mostlyseeing men who've got symptoms
of low testosterone.
That's why they're coming to usand we start with the
testosterone and we see how muchquote mileage we can get out of
the testosterone.
How much improvement can we getwith treating a man properly
with testosterone.
Once we dialed in thetestosterone we give 100% of the

(01:23:33):
men Viagra.
We actually give them Cialis toDalafil because it's more
long-acting and we do that forthe cardioprotective effects and
it can add something to theerectile function.
But we want to see how mucherectile function we can restore
with testosterone alone.
We're going to add to dialyphilfor every man sooner or later,

(01:23:55):
but not in the beginning.
We want to see how much quotemileage we can get out of the
testosterone itself Once we getthat dialed in.
Then we add the Viagra.
Viagra and I mean the Cialis.
These were developed as heartmedicines to dilate the coronary
arteries.
That's what they were totallydeveloped for and they're really

(01:24:17):
great for that.
Turned out that in theirstudies the men were reporting
back.
They were getting increasederections.
That's why it became anerectile drug.
It had nothing to do with theoriginal intent there.
It had everything to do withthe side effect called improved
circulation to the penis, bettererections.

Does it increase nitric oxide in the body?

I you know , sometimes I lose some of the
details, but I'm pretty surethat that's one of the
mechanisms that it does.

I think it does, I think it does.
You know what this has been.
Such an amazing conversationNow, just so unique Because I've
heard you speak on a fewpodcasts.
It's always unique.
It's always a very uniqueexperience and conversation.
But of course, everyone's goingto ask well, how to get a

(01:25:11):
practitioner like yourself,because I know you can't treat
every single patient in theworld, so how does one go about
doing that?
We've got all the links, by theway, will be in the show notes
for your book and the freedownload.

But let us know how someone can work with
somebody trained like you atiobimorg, she'll be able to

(01:25:49):
check our list of all that we'vetrained, because that's the
main thing I do is we train andmentor physicians and nurse
practitioners on how to treatwomen and men.
So we have a long list.
And yeah, katie, at iobimorgshe can link you up with someone
that we've trained, most likelyare you, uh?

do you have practitioners worldwide or only
in the us?

mostly in the us is what?
But we're already working oncanada and the uk and australia,
yeah.

I love it.
I love it.
I love my conversation with you.
Dr Rosenzweig, I really want tothank you for today.

You're so welcome, and it's a co-creation.

It's our synergy that made it fun and interesting
.
I agree, I agree.
Thank you and help me to keepgoing and bringing these
conversations to you each andevery week.
Join me next week for a newtopic, new guest, new exciting
conversations to help you liveyour best life.

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Bioidentical Hormones Explained: Midlife Health for Women (and Men Too!) with Dr. Daved Rosensweet - Episode 290

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Bioidentical Hormones Explained: Midlife Health for Women (and Men Too!) with Dr. Daved Rosensweet - Episode 290