Interview with Dr. Rosensweet | Author of Happy Healthy Hormones

Hello everyone, Dr. Stillman here with Amy Arp, and we are joined by Dr. David Rosensweet, expert in menopause medicine. Dr. Rosensweet, thank you for joining us.

My pleasure, Leland and Amy.

So I like to start by asking for the story behind the doctor or the practitioner. When did you decide to become a doctor and what was the story behind it?

Well, the story to me would be mysterious, but by the time I was 13, I knew I was going to be a doctor.

How did that happen?

I don't know, but I would— I remember the first thing I remember is writing a high school physics paper, um, civics paper, and what are you going to be when you grow up? And I said, well, I'm going to be a doctor. And I knew it.

You have no other recollections of why? No doctors in the family?

My two favorite uncles both were general practitioners, and I used to hang out on one of my uncle's beds and read his, uh, his, his journal articles while he was sitting there studying in his, uh, and seeing the cigarette ads in the journals.

That's different time. Yeah, what a different time. So tell me what those uncles were like.

Um, it's a really excellent question. Um, they both embodied physician. They both had it. And I remember once I was very, very, very, very ill. It was some kind of flu or something, but I felt miserable. I was maybe 11, and my mother called my Uncle Leonard and wanted to bring me in on a Saturday, and I was sitting in a wheelchair in his, in his office feeling absolutely miserable. And he walked— maybe 11, 10, something like that.

Okay.

Feeling absolutely miserable. And he walked in this room and he was big and tall and he had this huge smile on his face and he just welcomed me. He said, oh, you're going to be fine, right away, you know. And I tell you, everything changed for me. I thought I, I, and I started feeling different right away. How about this? Yeah. And you know, so many folks in the medical profession, it's our dharma. It's so deep within us and our bones and our heart and our soul. And I run into it all the time. And it's a beautiful, beautiful gift that we were given. And man, my uncles both had it.

Is that so? What vintage were they? What would their medical school class perhaps have been?

Well, one of them probably would have been the '50s, and the other one would probably be in the '30s, 1930s. Yeah. Wow. And even in my medical school, I mean, I love being— I love medical school. I thought it was like going to a synagogue or a church for me. It felt holy to me. It felt sacred. And my professors, the majority of them felt like these majestic human beings that were just the state of the art and science of it. And I was deeply moved by the whole experience.

Where did you train?

Michigan, University of Michigan, in the 1960s, '64 to '68. And it was a challenge, as I'm sure you know, Leland Stillman. But, uh, God, I thought it was amazing.

Very interesting.

Then to put on a white coat and start seeing patients when I was a junior.

Yeah, that's wonderful.

And it's only gotten better. I'm at the pinnacle of my career. It's gotten more and more interesting, more and more fascinating.

And you're how old now?

82.

So it's only up, is that it?

That's, that's what it's been for me.

That's great. So that was your archetype of the physician, somebody who comes in, changes the game, the mood.

Yeah, and you know, that, that possibility is there for all of us, from janitor in a hospital to neurosurgeon. Uh, we can make that kind of difference. We're not going to make the whole difference necessarily, but, uh, just turning on someone's consciousness that healing is possible, really awakening that in them.

I agree.

Yeah, it's beautiful.

It really is. It really is. And I, I don't know how along the way I tapped into that, but it became very clear to me that how I approached the therapeutic encounter was critical, not from a technical perspective, but, you know, I used to walk into hospital rooms and ask patients funny, ridiculous things like, are you having fun yet? And I, I used to leave— I always try to leave, leave things on a lighthearted note. And I would leave, and if, let's say it was like granddad was in the hospital bed and he had a, you know, 7-year-old granddaughter sitting there with this family, I would say things like to the granddaughter, the 7-year-old, I'd say, you're in charge until I get back.

That's beautiful, Leland. That's beautiful. I totally see that, uh, that picture.

And it's very important.

Yeah.

So you went on to become a— what's— what specialization did you pursue in residency?

I, you know, it was— I got out in 1968. And I did a rotating internship and marched right into general practice as my uncles had done. And I never did a residency. I just walked right into the fur— the, the heat of it all. There wasn't a general practice residency back then. They were, they were just beginning.

Yes.

And man, I thought I would just jump right in. Well, you never get, you never get to avoid the rigors of training one way or another, as though facing patient by patient by patient.

So then what was your early career like before you got into menopause medicine?

Well, I delivered my son at home just after my internship, and I, I, it was a time in history we moved to Santa Fe, New Mexico, and I became the, the go-to guy for the community that was interested in health and home birth and herbs and homeopathy and nutrition. And that, that was exactly what I wanted to do.

So you were already interested in all that?

In, in 1968, I got interested as a senior medical student.

Did you?

I love medical school. I, and, um, boy, it serves us enormously to go to medical school. My God. But I was looking for extra stuff, like in medical school I heard wind from patients that their general practitioner was giving them B12 injections and it really made a difference, and they were going on thyroid and it was really making a difference even though their tests were normal.

Absolutely.

And I went, boy, there's these clinical pearls, they're called. You're very familiar with the language. These, these things that people have learned that can really help. So I, I was looking for that stuff in the beginning.

Now Oftentimes the conventional medical system, particularly medical school faculty, can take a very dim view of these things and these interests. Did you face any adversity at medical school over your interests in these things?

Well, in medical school, I would— our professors were really amazing. They were the crème de la crème back then, and they weren't bought by Big Pharma at that time. It was probably just beginning, but it was not in full swing. So their integrity and their stature as human beings and as physicians was very high. So I didn't run into anything like that. And I did run into it in the medical streets, but I don't know, I've had this desire to— why bother with conflict? Why go there? You know, absolutely. Don't, don't— if someone is set in their way— and I met surgeons, I did some emergency room work early on, and I would meet surgeons that, uh, man, they were really questioning who I was. I haven't had long hair then, and, uh, they really were concerned about me. But what we, what we saw in each other was good doctor. And that's an easy thing to recognize when someone is a good nurse or a good doctor. You can feel it in them. And so there was respect there, even though there might have not have been full political agreement. And my desire was I could see a good doctor even though I was a political polarity from them and a medical polarity from them, including my interest in nutrition, like you were suggesting there, and supplements. Et cetera. But I decided, just don't have it be part of the conversation. Don't, don't try and convince them. They're not— that's not what they want. And get to know each other on a different basis. Now, that didn't always work out, that's for sure.

Mm-hmm.

But to this very day, uh, it served me really well. I've never been challenged. No one's ever, uh, really gone after me in some way. And because I'm not, I'm not out there looking for medical trouble. And I respect good doctors, and I'm just not asking them to go outside their lane, you know.

I understand. Great. So then when did your career turn into menopause?

Well, right out of the gate, I was functional medicine.

And, uh, you know, that's in 1960 or '70.

'68.

It didn't have functional medicine even a thing.

No, it wasn't, and there was no name for it. But like, I was, I was looking for really good stuff, you know, who— and I got interested in nutrition. I sort of figured out that these illnesses are caused by things.

Duh.

And I had it pretty figured out that between nutritional issues, toxic issues, dysfunctional response to stress, and poor exercise habits, and then a mystery factor. That those were the 5 causes of illness, and you wanna, you wanna do something about it, you better go down to the cause. And I had that figured out. So I sought after nutritional masters, and then I, I, I knew Jeff Bland. He and I were friends. We met in the early '80s. And, uh, I got really interested in what he knew. And there was a lot of pioneers— Jonathan Wright, and I got to be there with him. Alan Gaby, I got to shadow Alan Gaby. So John Lee, John Lee, I had John Lee sent me a copy of his book before it was ever published. And wow, yeah, I did many private calls with him. He's a very generous-hearted man. Wow. And, uh, so that was fun. It's big fun to, to meet up with these folks in their infancy or in their adolescence, their medical adolescence, right?

Absolutely. Now I find that there is usually— it's easy to get these theories and these ideas, these notions that people will recover their health when they start to live differently or make different changes to their diet and lifestyle. Let alone adding things like hormones. But I have a sneaking suspicion that behind every clinician who does that kind of work and becomes passionate about it, that there's one or two really pivotal stories in their career, patients who just, you know, you see the theory come alive and you think, oh my gosh, I've really got something. So can you tell us an early story from your career that really changed your mind and solidified your thinking on this?

Well, the biggest story of all was my own healing. And, uh, it, uh, and I was, uh, happy. I grew up with, uh, who I thought were the greatest parents on the, on the, in my whole community, happily married. And, uh, I had a lovely childhood, but I, I didn't enter the world of intimate relationship very well. I didn't I didn't have the skills or the internal whatever it took. And I just— I decided at a certain point after a divorce early on that, uh, no matter what else was going on, I did not know how to love. And I had some losses to take me there to get it. And it was so impactful to me that I decided to devote myself with the same commitment I brought to medical school to the healing of myself, my emotions, and my mind. And I went on a several-decade journey to really get the information, get the tools, get the guides, get the mentors. And when I was deep, deep into that and sealing— seeing the emotional unconsciousness errors that led to poor health habits and not happy life, because living is really healthy thing. Living and, and living a facsimile of what living is is not too healthy. And I went, my God, I'm a pretty decent human being without any trauma. How's it going for everybody else? And what is the stress response?

Yes, indeed.

And what, what role is the biology of fight or flight playing in in this whole story. And, you know, through personal experience and through the gift I was given and, and the, and the work that I did, I got a really inside view of the whole issue that we sort of lump together in stress, you know. And then that, that leads to all the poor choices around nutrition and and toxicity. And so, and then, yeah, that's, that's the main story. That's, that's where I really, uh, I really developed the muscles and saw what was going on in human beings.

Was there a moment that you can recall where this knowledge that was theoretical made that transition into something you were really living? And embodying that you can recall?

Well, let me take you to the second event. There was coming a time in, in being in holistic medicine that I realized I couldn't get my arms around the whole subject anymore, that it was out of integrity for me. Like, if I had someone with serious cognitive decline, it wasn't really proper for me to take that case on. I needed someone who is doing 24/7 Dr. Bredesen's protocols and living in that world.

Yes.

And I felt the same thing about cardiovascular. Yes, I— my, my largest room in my office was an IV room, but when someone came in with major cardiovascular stuff, chelation was no longer enough. I needed someone who is 24/7 doing Dr. Houston's work.

How old were you at the time?

Well, this was in the early '90s, and then I had this big event.

You were already 25, 30 years into your practice.

Oh yeah, yeah, exactly.

Got it.

Then I had this event where the Deborah came into my office before office hours. She was in her mid-40s. She was brilliant. She had retired in her mid-40s. Think about that, what it takes to retire in your mid-40s. Wow.

Well, with or without a husband, because it's a totally different—

oh no, she was, uh, she was single.

Yeah, a lot of women retire in their 40s thanks to marital income.

Yeah, not her. No, this was all self-generated.

Yeah, that's a different story.

And she comes storming into my office and walks right up to my desk. This— I'm doing paperwork before office hours— pounds her fist on the desk, angry at me. And says, "You better believe me. I'm telling you, I'm losing it. I'm telling you, I'm going crazy. Don't make this a little vitamin thing. Don't make this some vitamin thing." Did she say exactly that? Yes, she did. It's in the opening to Happy Healthy Hormones, actually. I tell that story.

I love it. I love it.

And I was shocked because I knew her as someone entirely different. And I believed her. And, you know, serendipitously, a couple weeks before that, I had my first conversations with Dr. John Lee, and he was telling me about progesterone. And I gave her some progesterone. Serendipitous, you know, we all have divine relationship to life itself and into our profession, so it wasn't serendipitous at all. And I gave her some progesterone. 3 weeks later, I get a letter from her, because that's back in the day, saying, 'I can't believe this stuff. I'm totally myself again. Thank you so much.' And you know this very well, uh, by the time someone seeks a medical consultation, they usually are not doing that well, and it can be a slow-moving train to help walk them through to a healing, if you can. And this had happened, oh, you know, relatively overnight with a little progesterone cream. Well, that caught my attention.

So let's, let's unpack that for a minute because I think that's really important. You had been in practice for 25 or 30 years. You had not really begun to wield bioidentical hormones, right?

That was the first.

You'd been doing everything from chelation to nutrition to homeopathy to home birth and on and on, right?

Right.

You'd surveyed the whole integrative, natural, functional, holistic medical world, however you want to call it, and suddenly you find this new thing and your thoughts were, my God, I've never seen anything work so well. Hold on a minute. Anything? Even all the other things we talked about?

They were slower things.

Uh-huh.

I'd never seen— I trusted, uh, Deborah. I didn't, uh, I didn't discuss anything with her. I thought she felt like she was going crazy. And, uh, so, so yeah, I had never run across anything like that that works so well. But, you know, all of our lives and practices, they've got other other originating factors that have nothing to do with the, you know, trying to figure it out, you know. But logistically, she referred a couple women to me in menopause. And by the way, I hadn't discovered it before because I sort of grew with my practice. I grew up with home birth, and that— and I was young. And then as I grew older, I was working with menopausal age folks.

Absolutely.

That was one of the main reasons. But, um, she referred a couple of patients to me and I started getting similar results. And I, you know, I, I learned from some pharmacists and I, I was enchanted. And, and then it, it, it led me to want to specialize in it a lot because I could not keep my arms around the whole functional medicine database anymore.

Have you heard my Have you heard my joke about subspecialization?

No.

I say subspecialization is for doctors who are not ambitious enough to try to know everything, and that's not my problem.

But I do have to admit— Say that again.

Subspecialization is for doctors who are not ambitious enough to try to know everything, and that's not my problem.

Yeah, that's great.

But I have to admit that I heard— I, I, I, I say that jokingly because We do refer out. I do not know— try to know everything. It is impossible. But as I think you did in your early career, you couldn't help but want to learn all the tools.

Yes. Yeah, I wanted everything.

There's something incredibly— I don't know how to put it, um, when you start to see them work, it's, uh, because I, I, I collect testimonials on a regular basis now. And I never know what's going to move the needle for someone. And so somebody has an earth-shattering testimonial for vitamin C, and someone else has an unbelievable testimonial for phototherapy devices, or the sun, or circadian rhythms, or anything else that we do, let alone hormones. And you just don't know. I say to the patients, it's always the last place you look.

So yeah, yeah, it's a mystical, magical journey. Yeah, it is.

It's a journey with a lot of uncertainty.

It was right up my alley too because I love biochemistry. I love the— I love the roadmaps and the pictures of these atoms and molecules.

Absolutely.

And so it was And then I met up with the 24-hour urine hormone testing right out of the gate.

Did you now?

I did, yeah. And boy, I started seeing in living technicolor what was going on in someone's body with the hormones. So this was fascinating to me. Yes, that I had actual visual proof of— and what's too much and what's too little. So off I went and everything got more fun because I love the medical literature. I— but I couldn't— I was— I couldn't— once I started focusing on menopause and andropause, everything I read was relevant to my day-to-day practice. So that became fun too.

Absolutely. So in your book, you have a section called Menopause in a Nutshell, and in that section you go over some of your core principles by which you practice and that you recommend to patients that they identify a practitioner who's, uh, who shares these, these principles with you. I'm very curious because the hormone space is very— there are a lot of experts, there are a lot of disagreements, different ways of practicing replacing hormones. I don't know if we're gonna have time, but I'd love to get into why you picked— because it's a pretty short list. And so I just think we'll go through them one by one. And we'll start with the whole premise of this, which you, you state on page 5. Because you really always— this comes back with patients too— is the, is the juice worth, worth the squeeze? And am I going to end up with risk that I wish I hadn't taken. And you state clearly, the short answer to all that is that taking bioidentical hormones not only reduces medical risk but also changes women's lives for the better. Women on properly managed bioidentical hormone regimens have a reduced occurrence of breast cancer as well, which is their number one objection in my— and I'm sure your— experience to the use of bioidentical hormones. Is that fair?

Well, it even goes beyond that. Although we're all at risk for thousands of diagnoses and we're all at risk for hundreds of cancers, and as a male, I'm at especially increased relative risk for prostate cancer, and women are increased relative risk for breast cancer. This is new stuff too. This is, this is not, this was not the case when I was in medical school. Very interesting.

How do you mean?

Well, I just read a paper that came out of the 1960s by an oncologist who said the rate of breast cancer was 6%. It's now 14%. Wow.

Now that's lifetime risk.

That's right.

And that was '60s to today.

That's right.

And if you back those numbers up, it would imply that the risk at the turn of the 19th 1900s or the 20th century, the risk was almost zero. And that is something that physicians have told me who were trained in your, your era, that when they were medical students and there was a patient on the wards who had a certain type of cancer that now today is common, they would often be told, hey, there's a lung cancer on Ward 8, we're all going to go see it. Now you walk into the average oncology ward today, there's more lung cancer patients than you could see in a whole day. Tragically.

Yeah.

And this is of course being normalized, and people are being told this is just life in 2024, which is tragic because I don't think that's the case at all.

Correct. And of course, we all— there's a lot of reasons for this. It's, it's not just a mystical thing. And they all, they all come down to, well, let's just take on toxic exposure. But to get back to Um, what risk is for a woman, for example, even though we're all at risk for all kinds of things including cancer, women who are treated with hormones are at less risk for breast cancer, heart attack, and stroke than women who did not receive treatment. That's for all hormones. That's coming actually, and there's a wonderful book on this, and I know that you know what it is, and I mentioned in Chapter 3, I go into some depth Yes, risk, because I think it's imperative, because I think every woman that I've ever sat in front of has got this concern that if I do hormones, I could put myself at risk because some false information that exploded out into the public in 2002— it was false. It was false at the time. It was false in the original paper.

It's been retracted even.

It's been retracted in the same journal by the same committee, the same research committee that published the first one, but hardly anyone's heard of that. But to repeat, women who are treated with hormones— not just bioidenticals— women who are treated with hormones, who are treated with Premarin and Prempro, are at less risk for breast cancer, heart attack, and stroke than women who are not treated. Even, even women who've had breast cancer, they happen to be at an increased relative risk for a recurrence of that breast cancer than a woman has of developing it from brand new. But given that increased risk of relative recurrence, they're at less risk for that recurrence if they're treated with hormones than if they are not.

And the book you're referring to is Estrogen Matters, I believe.

You got it.

Which we'll be covering next week on the podcast.

Amazing.

Yes, it's a wonderful book. We're gonna go through it in detail.

That's, that's brilliant.

Thank you. Um, I don't want to get too deep into that because there's so much— particularly estrogen matters, we're going to spend so much time unpacking it.

Beautiful, beautiful.

Yeah, but there's, but there's something also very personal in, in your book that you include before you jump into Menopause in a Nutshell, which is that your mother and your mother-in-law started taking hormones in their late 80s and had a profound result. And the reason this is so important is that a lot of— people don't put this in the right context. Their, their health is declining. They're losing mobility. The things they love to do are becoming inaccessible to them. They're not able to even relate to their families cognitively, forgetting people's names, forgetting birthdays, forgetting special moments, not being able to recall anything short-term or long-term. And they're worried about cancer when their life is slipping away, we have to put this— these things in perspective because a lot of those problems, this, this slipping into debility and old age, can be in some cases dramatically reversed with hormones. Is that fair, Dr. Rosensweet?

It's very fair. And like, for example, we have on our medical board a physician that spent a lot of her early career being the doctor for nursing homes. And I once asked her, what percentage of women and men in nursing homes do you think are there because of low hormones? She said 80. Oh yeah, you lose your androgens, you lose your muscles, you develop sarcopenia, loss of muscle. You move from cane to walker to wheelchair. That's very definitive, that change, walker to wheelchair. You lose your ability to hold, uh, for your bladder to function properly. You're in adult diapers. And so many of these folks are losing cognition. Although every— let's take women— every case of cognitive decline is not related to hormones, a lot of them are. And of the women who show up in my office in early menopause— and by the way, the earlier that you get a are started addressing this stuff, the better. Yes, we treat anyone of any age, but much better to start with the perimenopause or midlife for men too. It's much easier to sustain something than to recover it. You can recover stuff in later age, but it's not ideal.

It's, it's, you have to be far more consistent. You have to be far more dedicated, detail-oriented. It is so much easier to address this when you're younger.

Hmm. So these hormones are the most powerful biochemicals in our body.

Without a doubt.

And their loss is tremendously consequential.

Would you tell us the story of your mother and mother-in-law?

Yeah, my mother-in-law was on her third heart attack, a third bypass.

Ooh, so that's not just— yeah, it's third open heart surgery.

Well, um, well, coronary bypass, open chest surgery for sure. I think they're replacing—

yeah, sorry, I meant coronary arteries, right?

And, um, and she had developed really significant sarcopenia, so she had moved from the cane to the walker, and then she was standing in her kitchen and she turned because of her instability. She fell on her tile floor and she fractured her humerus and her clavicle and her pelvis and was in rehab for 3 months. And it all dated back to what a gerontologist told us senior medical students, uh, in 1968. They said, you folks know a lot of diagnoses, you're University of Michigan senior medical students. Let me tell you what's really happening to old people. They're losing their muscle. They can't stand and walk with stability. They fall on their osteoporotic bones and they die from a fracture of the hip. And, and, or they're losing their mind and they, they can no longer function with their families. So what was back to what your focus is— this is big fun for me, by the way, Leland Stillman, to have to talk to a real comrade in arms here. The, um, this is what happens to old people. You know, people in their 50s, 60s, they don't often think about, well, what's, what, what's my life going to be? Yes, I had to assist my mom into the nursing home, but that'll never happen to me. Or they're not thinking this clearly.

There's a denial.

Yeah. And you know, most people very often we're just paying attention to what's really right there in our face. What am I doing today? And all this stuff is so consequential. To lose your muscles because you lost your androgens, to lose your mind because you can't think clearly, and lose the— women to lose their vagina, men to lose their erection, lose your bones, lose your arteries. That's how powerful these hormones are. Whereas replenishing of them is a sweet process. It's a process, not that hard. And so it's a big deal. It can really make a difference in staying at home for your whole rest of your life and walking and talking and thinking, which I find everyone wants to do. How about that? I find when they— when an elderly person is facing the reality that they're they're entering into an assisted living facility, it's a shocker when the family can no longer take care of them at home. And so much of that is, is our doctor says, uh, 80% of them, this is, uh, preventable. Yeah, there's some dementias that, uh, go way beyond just hormones.

Sure, sure. But I, any case of cognitive decline in the practice, hormone optimization is something that we urge patients to pursue, at least be open to. And, you know, frequently our, our progress with them is frustrated when— or frustrated, it's slow when they're not willing to try a full protocol for hormone replacement because they all play a role and you cannot get by on just one or two. We had the question the other day on a webinar if you were going to recommend only one hormone to replace, what would it be? But, you know, and Lauren, our nurse practitioner, said, you know, you really— you really can't ask this question and have us give you a clear, strong answer because it's— there's this symphony of these hormones going on. To the clinician who uses them, it's something of a tragedy to only want one.

That's beautiful.

Yeah, but what was the result with your mother and mother-in-law, if you don't mind my asking?

Well, my mother-in-law— we have a video of my mother-in-law about 3 months after rehab when I— when she— I started replenishing hormones for her. She's sitting on a low couch, one of those low leather couches. She's got her arms outstretched and she stands up without using her hands. That was dramatic. We also have a video of my mother, who was walking with a cane, walk with the cane and then set the cane down and walk towards us without the cane. This is a very big deal for her, of course. Yeah, so yeah, there's— they're powerful, they're dramatic. They're not everything.

No, they're not everything.

But they're a big deal.

Absolutely. They could, uh, well, that's, I think, part of why there was such a concerted effort to discredit them intellectually, uh, which hasn't really been borne out in the literature, as you've mentioned and documented in your book, and as we're going to go over in Estrogen Matters next week. In a couple weeks, but yes. Was it a couple weeks? What are we doing next week, Amy? Remind me. I will look at the schedule, but it's in a couple of weeks. Oh, I think we're interviewing Richard Brooke next week.

Yes, Richard. Mm-hmm.

That's right. Okay. So you've got a couple of principles that you recommend patients steer by. Their goal should be, and I'm going to go through them and then we can, we can deal with each one of them quickly and individually. Healthy vagina and healthy breasts, zero breast and nipple tenderness, muscles, energy, and libido matter. 24-hour urinary hormone testing is imperative, and you should work with a specially trained medical professional. So starting with the healthy vagina and healthy breasts, I don't think that this makes the list of women's top concerns coming into consultations with me, maybe because they're uncomfortable. It's a very sensitive, intimate issue. But I really think that it should be, and obviously it made literally the top of your list for the criteria that a woman should address her menopausal medicine and hormones based on? What's so important about having a healthy vagina and healthy breasts?

Well, I, in reviewing this list that you've just told me, I'd say, could I reverse the list? Did I really write it like that? You did. You did.

Maybe it's time for another edition.

But yeah, we've been working on this edition, and I, I didn't, I, I didn't totally recognize that. That the very first thing is that I would recommend, if it's okay, Leland Stillman Stillman, sure, um, is that hormones are powerful, they're complex, there's a lot of moving parts. I think that the job for every woman and every man, there's a job, and it's called go shopping to find someone who really loves this field, has taken time out of their career to acquire the additional knowledge and skills, best cases even being mentored. And, uh, that's the job. And someone that they're, they're really compatible with. They, they sit, they sit down with the provider and they go, wow, This is a good person. We're going to have a— they're going to listen to me. I feel good with that. That's the job, because you don't want to try and do this yourself, and you can't. So you're writing prescriptions for— you can't write a prescription for prescription items. You need someone who really knows what they're doing, and it's a good thing that you can't do this yourself.

Well, this is a very important misconception that we actually need to talk about for a moment. Which is that there is no substitute for hormones. You will not get the same outcomes with herbs, supplements, nutrients, homeopathics, energy medicine, magical thinking, you know, motivational speaking. Nothing will replace hormones. As much as I love all these other things and respect them, You need the hormones if you're gonna really get their effects.

Yeah, so many women have sleep disturbance, you know, maybe three-quarters of women going for very specific reason because the hormones are so related to sleep. And it is not a Xanax deficiency. You don't want to address— no, it's not Xanax or the mood disorders. It's not It's not a SSRI, a Prozac deficiency. It's this very specific thing that can be molecularly replenished. But then you just made me see why I listed the breasts, because what should we, what should we be concerned about? Breasts and vagina. Because if a woman has a healthy vagina and she's being treated, she will not have a healthy vagina. Because vaginal health is so dependent on adequate hormones.

Yes.

A man's erection— the rumors out that men care about when they lose their erection, I, I hear it's just a rumor, just kidding. My God, it, it shakes men to their core when they're no longer going to have an erection. And, uh, the— well, a man cannot sustain an erection. Very few do. Very few make it into their elder years. Very few men make it with a good erectile function. A few do, but very few. And almost zero women make it in— into midlife after a year or two of no hormones, as far as the health of their vagina, their libido, their ability to have intercourse, their ability to have intercourse without pain. And there's a lot of women— this is a big deal.

There's a few pieces of that that are really important, because as vaginal health deteriorates or declines, and I, and I I hesitate to use that phrase. Maybe I'll rephrase it. As the hormone levels drop, the vagina changes profoundly. And as they drop over longer and longer periods of time, and as women age, there's two, two really powerful things in my view that happen to women as a consequence of this. And number one is potentially the decline or complete cessation of their sex life. Which, particularly if libido and sexual function is not matched in the couple as they age, can really impact a marriage, even be the kiss of death for it, which is sad. Women particularly who are older than their partner need to be aware of that because that's not something I think you're going to see in a lot of marriage manuals. And I don't know if marriage counselors deal with that, but it's important for them to be aware of. And the second thing is that many, many women end their lives battling chronic urinary tract infections or interstitial cystitis and many other genitourinary issues. They wind up having surgeries. They need all kinds of pelvic interventions. I mean, of all the things women face as they age, that might be one of the most distressing, difficult, and ultimately life-shortening and quality-of-life-reducing changes that they face. And keeping your bioidentical hormone— keeping your hormones at appropriate levels can mitigate a huge proportion of those complications. Is that fair?

Beautifully said.

Thank you.

And became extremely real to me when I took over the healthcare of my mother when my father passed. And here she is in her 80s, and I'm going out into the local supermarket to purchase some adult diapers, and I look at the real estate in the supermarket taken up by adult diapers, and I went, this is a real thing here.

And that was in—

that was in, in the '90s.

It's gotten worse.

No, that— no, I'm sorry, it got— it was really in the early 2000s. I mean, there's— you're naming I just want to give an example of how profound it is that it's almost a certainty that a woman is going to develop bladder and urethral issues and ultimately incontinence because of the health of the— the deterioration of the health of the vagina, because the bladder empties right into the end of the vagina there, and that opening becomes very, very vulnerable to the actual cellular changes that take place with loss of hormones, loss of vaginal health, loss of loss of cells. It's a great one to feature here because this is what's happening to older people. This is what they don't want.

Yes.

And it does happen.

And I always tell patients we're either treating numbers or we're treating signs and symptoms. And the reason why I like the focus on the reproductive organs of women in the— in how you're gauging their response to therapy is that if they're breasts, their vagina remain healthy, you have the levels of hormones that you need to not only protect those organs but the brain, their bones, their muscle organs that they may not be as aware of. So we treat that sign or symptom, these changes of these organs, in order— as a surrogate marker essentially for where we are on the continuum of hormones. And that brings me to the next point, which is the second item in your list, which is zero breast and nipple tenderness. And this is because, Dr. Rosensweet—

well, you bring up this stuff, and I would just like to emphasize something. When a woman has a healthy vagina, what we know that she has enough hormone level to protect her bones. That's why that's such an important bottom line sign. If a woman is not having a healthy vagina, she's any— if she has to use a lubrication, for example, If she's had intercourse without lubrication and she makes the change over to where she needs lubrication, those are changes in the vagina, and those are guaranteed. They, they go hand in hand with the bones. And I'm just making— I'm making that up. That's in the medical literature. There's been beautiful studies there. At the upper end, to answer your, your question about breast tenderness, nipple tenderness, one thing we don't want to see in a midlife and beyond woman is overstimulation of breast glandular tissue. Hmm. Because that can lead to increased breast density. And that's one of very few risks for an unhealthy breast slash really unhealthy breast, breast cancer. So how do you prevent this stuff? You don't create increased breast density in a woman that's being treated. So it's an important thing to fall shy of breast tenderness. And nipple tenderness. Young women, every single month, who are having regular periods, they're feel— they're feeling— they're experiencing their breasts get fuller, and part of that fullness is new breast cells in actual preparation each cycle. Go figure. Want to believe in the divine? Study the woman's menstrual cycle. Each month she's preparing not only for possible implantation, she's preparing for breastfeeding. Each month, more breast glandular cells, cell division, mitosis. And then if she doesn't get pregnant, everything reverses, the extra cells go away. We don't want to be creating in a midlife woman who doesn't necessarily have the vigor of an immune system to spot aberrant cells that have resulted from a vulnerable mitotic event— I hope I'm not getting too technical here— It's great. We don't want to increase breast tenderness. And so that's the sign in a woman who's just working in the world of hormones that, oh, too much. And it's fine for a short period of time, and it doesn't— hormones don't cause cancer. So, but we want— what do we want to do? We want to create an approach to heat, to treating women in menopause that is excellent as we can possibly get it. So no breast tenderness, no nipple tenderness to be— to last for a while. No permanent breast tenderness, no overstimulation of breast glandular tissue.

Absolutely, yes. And so that's why, you know, I— like I said, we are either treating signs and symptoms or we're treating numbers. And you can back off therapies when you're getting too much of an effect, whether it's hormones or anything else. So then your next point is muscles, energy, and libido matter. Personally, I find that as people age or just fall ill, symptoms sneak up on them and they forget how much energy they had and they forget how much libido they might have had. And I like when I'm counseling patients initially, whether it's hormones or anything else, to get them to really answer definitive questions like, how often, you know, did you have sex when you were in your 30s in a week? Because that's another marker for, well, have we fully repleted the hormone to the level that we even remotely need for— and I'm not saying that people should be having sex in their 80s as often as they may have in their teens or their 20s or whatever, because I don't think that's practical. And that may actually be excess, uh, hormones, which we'll talk about when we get to the testing. But what's your perspective on muscles, energy, and libido? And I'm particularly curious what questions you ask patients to try and make sure that you're addressing these adequately and not leaving them undertreated.

I love it. This is the question you're asking. They're such profound markers. Just to give a sneak preview to what's possible, and this is not a direct answer, I have patients in their 60s, 70s, and 80s, women, who are having more enjoyable sexual intimacy than they've ever had because their lives— they've become more conscious, their partnerships have in many cases refined. The, the depth of intimacy can increase in those who care about that, and the profundity of the intercourse and orgasm can get stronger. Just to give you an idea what's possible. And I know this for myself as well. Startling. So that's the upside of replenishing these hormones. And like you were hinting at, or actually suggesting, you don't get to have this without the hormones. A man does not get to have an erection without adequate testosterone. And, uh, now, gosh, you, you said a couple other fascinating questions, and I took a version.

I'm, I'm, I'm very curious because like I said, I think patients lose the, the plot, so to speak. Yeah, they start something, they say, I feel better, but they don't maybe recognize that if they were to double the dose— not that that's always the right answer, obviously— but they may still be only at 50% of the therapeutic value of the thing that they've got. And sometimes the difference between 50 and 100 I mean, there's a big difference between going 0 miles an hour and 30, and 30 and 60. And I don't ever want my patients to come back to me and say, you know, Dr. Stillman, I feel you, you know, I wish you'd told me to take this more seriously.

Right. And, and it's a challenge. Well, To take some of that on, we once did a study, um, before I was— I used to teach annually at this big organization, and I like to bring in stuff that I'd learned that year. So I looked at 54 24-hour urine hormone tests on women that I was treating in menopause. And we do the 24-hour urine hormone test 99% of the time when a woman says, wow, I feel good, I'm myself again. That's when we test. That's the important time to test. That's the only valuable time to test in most instances. And what we discovered was that 50% of the women who said, I feel great, my symptoms are alleviated, were not on sufficient estrogen to protect their bones and vagina over the long haul. And 25% of them who said, I feel great, They were on a too robust a dose of estrogen that actually put them at risk at breast glandular cell proliferation. So the numbers count also. And then to answer another question you said about muscles, you know, I, I'm just, I'll be repeating the same thing. As a senior medical student, the gerontologist told us what happens to older people. They lose their muscle. And why do they lose their muscle? Because they don't have sufficient androgens. So testosterone— well, young women have twice as much testosterone as they have their most potent estrogen, estradiol. Twice as much. Testosterone is a human hormone. And when women lose their testosterone, well, you can see it in Florida, where I lived for a long period of time. For one thing, you don't get to see a lot of elderly people walking the beach. You'd think you'd see a ton of them because Florida has got a lot of elderly people in it. But what you do see when they are walking the beach is very thin upper, lower extremities, very thin thighs, very thin calves because they—

pardon? They skip leg day.

They skipped leg day at the gym. Yeah, well, that matters. You're bringing up another, uh, important thing that matters. Yeah, but they lose their androgens, they lose their muscle. It's sarcopenia, and that's what leads to the wheelchairs. So it's no mystery.

So the other thing— sorry, go ahead, please.

Go ahead.

I was just going to add that one of the number one complaints that women have when they come to us in perimenopause or menopause is that they want to lose weight. So it's funny about the, the thin legs, the thin upper extremities, is that it's also often accompanied by central fat, adipose tissue, the muffin top. And women are extremely frustrated by how hard it is to change their body composition as they go through menopause. And they'll often ask us, is it possible and what we'll explain to them is there are very few women who maintain a youthful body composition as they move into old age, even at the beginning, their 50s and 60s. And they have to be extremely diligent. They have to lead a low-stress life. They have to be very well adjusted emotionally and psychologically. They have to really I mean, they have to know almost as much about nutrition as a lot of doctors and nutritionists. They have to understand macros and micronutrients. They have to understand things like carb loading and, you know, what a protein-rich diet actually looks like. And they have to weight train. And a lot of women don't realize, if you're not prepared to go lift weights 45 minutes to an hour eat a very, very, uh, precise diet— if you're not cut out for that, you are not going to lose the muffin top. You are not going to put on the muscle mass. It's not going to happen. And it's not— it's not your fault. It's the fact that your hormones dropped out. And the 25-year-old girl who just skips a meal and like walks by the gym and loses 5 pounds, it's her estradiol. It's her testosterone, it's her DHEA. It's not that she's special or blessed or different from you, it's that she's got a lifetime of less stress and a lifetime of less toxic burden and a life— and all these hormones that are at these high youthful levels. So we often have to really explain this to women in a lot of detail, and they— and we explain to them that Life's trade-offs. Medicine is trade-offs. You know, you want to get an outcome that's really— you know, bioidentical hormones make the outcome very achievable, but you don't want to use them, then you're going to have to be unbelievably sometimes strict with your diet and your lifestyle. And a lot of the men—

when we zero in on that, yes. The main reason that people have developed fear of hormones we've already hinted at.

Yes.

And it was huge, and it poisoned this world. Talk about misogynistic events that took place. I've never seen anything like it in my whole career, where out comes a single medical study that falsely reports increased risk because there— it wasn't there. Affect a medical profession, but more important, women on this earth. Well, there was 18 million women on hormones in 2002 when this came out, 40% of all American women in menopause. Then it dropped to low, less than 2 million. The fear was so severe, and the severe persists even though, like you said, that study was retracted by this original study committee that reported it. That has not made it out into the public and has not made it out into providers, and it stunted the whole world of hormone treatment. So while other specialties are developing— neurology and diabetology, you know, you're, you're, you, you name it— the many specialties that did not happen in hormones, in, in, uh, in ovarian and testicular hormones. So it's the Wild West. So that's another subject But the poison and fear— this is why we get this fear in the office of taking hormones. And the other one is, I want to live life naturally. This is not a natural lifestyle. I hear this quite frequently.

I have a really fun response to it. I'm really curious to hear what your response is.

No, I want to hear yours first because I'm always looking—

this one If you insist, Dr. Rosensweet. So I just explained to people that, you know, you know, natural is a really loaded term because here's the thing. If you want the short version of natural medicine, it's sell all your worldly possessions, move to a tropical location, and eat a local seasonal diet. And not a lot of people are a) willing to do that, even if they could afford to do it, although to be fair, you can You can live on dollars a day in Latin America, which is a tropical location. But human beings break a lot of rules, you know. Is it natural for us to make stone tools? Is it natural for us to harness fire? Is it natural for us to cut the skins off of other animals and then wear them on our bodies so that we can move to latitudes where we would otherwise freeze to death on a chilly day? And you say, well, it's natural because we can do it. And I say, hey, listen, that none of the other animals are doing this, right? And if I might add, none of the other animals are, you know, um, none of the other animals— I sometimes joke with patients about diet. I say, look, all the other animals eat a local seasonal diet and they don't struggle with diseases that are linked to diet. And you know, we're the only one that does. Isn't that something, right? Isn't it remarkable that we argue about this endlessly? We've got an endless list of different diets you could be on, and yet we have all these diet-linked diseases. I think it's ironic and funny, and I get patients laughing about this. And as you go down the list of things we've done that are natural, right, you just sort of start to wonder, well, where do I draw this line in the sand of what's natural? Not— is it natural to take an elevator up to the 14th floor Is it natural to get in a car and drive, you know, 2,000 miles to Seattle from Florida? Is it natural to fly in an airplane? If you really want to restrict what you're going to do to natural, you're probably going to be remarkably healthy compared to the average American. But you're also going to get to die the way that people did before modern medicine. And if you read— I— one of my favorite chapters in any book ever, Dr. Rosenzweig, is— it's the preface to Robert O. Becker's book The Body Electric, where he talks about what it was like to be a medical student on the wards at Bellevue Hospital in Manhattan when they invented penicillin. And he describes that they had this incredibly intricate knowledge of what it was like for someone to die of a pneumococcal pneumonia. They knew how they presented and what they sounded like and how they behaved, and then how they would spike a fever, and then how the fever would progress, and then how they would gradually go into septic shock and die. It was called The Old Man's Friend. And look, you can live a totally natural life, but you get into your 60s and your 70s and your 80s, and there's a lot of things that happen that you don't like. And those things do happen to people living a very natural life, like hunter-gatherer tribes. You know, the studies they've done on them, they've got things like, um, oh, the word's escaping me right now. They've got things like hernias, they've got things like central adipose tissue. You know, they did not look like GQ models. They're not on the COVID of Sports Illustrated. So, you know, you've got to pick and choose your battles. This is not unnatural in my book, and I'm perfectly comfortable with it. I turned to my wife when we were dating and I said, when we get older, we're going to get on hormones, because I needed her to be on the same page as me with that, because I don't— I don't want to be 80 and look 60 and feel 60 and have her be 80 and feel 80 and look 80. That wouldn't be good maritally, right?

Beautiful. There's other things I say too, is that, you know, we're also meeting up with the widespread distrust of medicine, of anything medically, and there's tremendously deep reason for this. And there's a lot of people out there expressing the how, how bad things have become medically. And so that's a whole story. And I've, I've heard the best iteration of it by an interview of a brother and sister, a medical doctor and an ex, uh, ex-lobbyist for, uh, uh, big agriculture. And maybe some of you are familiar with it. And if you look up Tucker Carlson's recent interview, no matter what you think of Tucker Carlson, It's a genius interview of this brother and sister who describe how deep, how deep illness runs and how deep, uh, what these causes are and why the distrust is there for medicine. So when a medical doctor gives an advice like, why don't you take hormones, people are also a little concerned about what's happened in the medical world. Sorry to take such a diversion there, but that's one of the things we're talking about.

It's really important.

One of the things we're trying to antidote here is a lack of faith. This is not my Uncle Leonard people are facing. This is a whole new era and people realizing they have to take their health in their own, own hands, uh, to, to achieve, to retain health. And they have a deep distrust of doctors and, uh, our advice. And the other thing is, is natural, I mean, living a natural life like you were also recounting. I mean, what was natural in the good old natural days where everything was natural, people didn't have menopause because they didn't live that long.

Yeah, in many cases that's the case.

We're in a whole transition of the whole human species where people are living into their 50s, 60s, and 70s. How do you want to address it? Do you want to take vitamins? Do you want to go spend some extra money on some good food or not? You get a choice. You want to take hormones? You have the choice. So I don't know, I'm not here to convince anyone, really. How do we inspire people to get over very significant hurdles that they face?

Well, I think, I mean, I like how this naturally segues into the 24-hour urinary hormone test because you have got very strong feelings about this test. And what I find interesting about that is that, you know, I'm around other doctors like me often enough, reading their books, attending seminars, conferences, etc. Not everyone is married to the 24-hour urine test like you are. And I really would love, you know, your thoughts on why you think it's the, the test, and that you really can't or shouldn't— or I don't know if I should say can't or shouldn't because they're very strong words in medicine— but why are you so in love with this test, Dr. Rosensweet?

Okay, well, for one thing, blood— I do hundreds of blood tests, and over my career, my God, I've done thousands of them, and they have tremendous value. They're not the be-all and end-all in every case, but man, can you learn stuff about what's going on and get sneak, get sneak previews into some real trouble about to come down the line. Because some of the early stuff shows up in the blood before it shows up in the people. But when you're treating a man or woman with hormones, you're in a whole different world because you're at the mercy of when did they take their last dose and when did you draw the blood.

Absolutely.

So testing a young woman's hormone levels, if she's perfectly regular, you're going to get some information. Once she goes irregular, you're, you're, you're not going to get the kind of information you need. But when you're treating a man and woman—

that's irregular cycles, just for the record.

Thank you. Um, when you, when you're treating someone, it's dose dependent. It's like, okay, I put my hormones on after my shower at 10 o'clock. Well, when did you draw the blood? Mm-hmm. How do I know this? Because we've had many interests and we have many ongoing studies. In fact, we've just done a recent one that we're in the final stages of, is we took 2 men and 2 women who are on hormones and we sent the, uh, urines off to 5 different laboratories, 5 different methods, and we, on the same day, we drew their blood prior to the application of the hormones, 1 hour after, 2 hours after, 3 hours after, 4 hours after. And we've been correlating the data and working with statisticians because, man, you get into these weeds, you're at the mercy of reference ranges.

Not to get too technical, you need some mathematical experts around to make sure that you don't make any mistakes.

Yeah. And what I found is that the 24-hour urine hormone test made sense to me because you're not— you're no longer time-dependent. It doesn't matter just so long as someone is regularly taking their hormones.

And it, it may, it may be worth explaining that I like to explain this to patients in terms of volume. And the reason I like that is that I think, I think it makes sense to them. And I sometimes will say to them that the blood is like the body's checking account. It's the last place to run out. It's the first place to be replenished. If you're really broke on your checking account, things are probably pretty bad. And if you're really flush, things are probably pretty good. But, you know, Bill Gates and the millionaire next door could have the same checking account. And it's not a marker for tissue levels of things, which is very important with some of the hormones, particularly like progesterone, which tends to accumulate in fat tissue. And as you were saying, with the, with the urine, the blood, you've got something like 5, 6 liters circulating blood in the average human body. That's not very much to test. The whole rest of your body is not really being measured. And as you mentioned, when you do hormone testing in the blood, you get these incredible fluctuations in almost all of the metabolites. Particularly dependent upon dosing, which is what we're curious about in people who are using the hormones. But then on top of that, what's emerged as the alternative to blood testing— because people hate needles, they don't want to leave the house, I get it— but they also are very resistant, or at least somewhat resistant, to collecting all of their hormone for a 24-hour period, which is what the urinary hormone test is. You can't leave the house, and even if you did, you'd have to find a way to save your urine when you left the house if you had to pee while you were gone. Not a, uh, uh, not an irrelevant—

let me address that. Yes, because when I first started working with hormones and I tried saliva and it didn't work, it did not correlate, um, with my patient's symptoms, which is interesting because someone you mentioned, John Lee, really worked almost exclusively via salivary hormones. Yeah. And that's why I started out that way, but it didn't work. And for anyone who's got any experience, and we've done comparative testing many times over several years, and the one that is definitely does not correlate is saliva. It's, it just doesn't correlate with symptoms.

Wow.

I mean, everyone's gonna find their own path to—

does it correlate with blood or 24-hour urine?

No, not at all. Terribly. And amongst the, the, my, the colleagues that I respect the most, the physicians and nurse practitioners, most of them who have tried saliva have this conundrum. It didn't, didn't seem to correlate, so they move on. So then I met up with, uh, then I was talking to my friend Jonathan Wright in, uh, early on in the early '90s, and he said, man, just do 24-hour urines. It's beautiful. You'll get— you're going to learn everything you want. And he had already established the 24-Hour Urine Hormone Lab. And in the, in the 1960s, 24-hour urines were the gold standard. So I started doing it, and I started seeing this wonderful correlation with the 24-hour urines, and it made sense to me. You can't do spot checks. You can't do 4 samples and see—

Absolutely.

During a 24-hour— you know, you, you collect the whole thing. But here's, here's what I found out, is that once I started seeing this fabulous correlation, and it also correlated with the medical literature, and I was able to define what's too little and what's too much— for example, with women and estrogen— because I was able to do that, I went into the medical literature to find it, and it's printed out on our 24-hour urine hormone testing lab. This is too little, This is too much. And I learned, I knew in my backbone that it was right. And I have not had any pushback ever from any patient for 26 years that I've been doing this testing.

Really?

No one has said to me ever that, gee, that was too hard, or I can't do this. The thing was they trusted me and I knew what was true.

Mm-hmm.

That's a bold statement. I knew what was true. Well, I did. You know, you learn things and they are. And so they never get, but when someone is unsure about the 24-hour urine and they say, well, I think we wanna check on, the patient picks up on this and there's all kinds of pushback.

Mm-hmm.

So once someone's sure, like someone's got diabetes and they want, they want you to treat them.

Mm-hmm.

You could say, well, I think I want some blood tests. Just to assess your diabetes. And they say, well, no, I don't think so. I'm not going to go get my blood drawn. What do you say? You say, I'm very sorry, I don't want to do it with you. You're going to go find someone else. If I can't assess what your blood glucose levels are— so when someone knows that, as every doctor and nurse practitioner on the planet Earth and physician's assistant knows, you can get some beautiful information about blood glucose by drawing blood and not just blood glucose, insulin, et cetera, hemoglobin A1C, on and on. So I think it's, it comes down to if the, if the provider knows then, and they say to the patient, this is what we're gonna do, then the patient doesn't balk at all. And it turns out logistically because we've done all these things, uh, the, the 24-hour urine is easier than the 5-point to do. The urinary 5-point to do. Easier, simpler. When you do, I don't know, you get to, you get to figure that out. But when you do the 5-point, you realize, oh my God, that same issue of when did they take the last hormone.

Yes.

And when did you collect that urine that's going to reflect what, a peak, a trough? No, you, you can get in the same trouble you can around blood drawing. Sorry to go too deep in the weeds, But you ask me, why do I love this thing so much? If these other methods work, um, that'd be fabulous. There'd be a lot of choices there, but they don't. But I don't— I can't find them to work.

They're not as reproducible. So do you want to be reliable with the data that you're basing your health decisions on, or do you want to potentially be wildly, wildly wrong?

Yeah.

And that to me is not really a negotiable one. So we're very confident in the recommendation. What I've found is more so that people will say, well, what about the spot checks? And let me define this for people who, who may not be familiar with all this. So the 24-hour urine is you collect 24 hours worth of urine, pretty, you know, obvious from the name. But people then started to say, well, okay, it's not everyone's favorite day of the year to have this big jug of urine sitting in their refrigerator right next to their cauliflower and peas or steak. Maybe what we can do is we can just have them do little small checks throughout the day, and they do this in various different ways, you know, small liquid volumes. They'll sometimes put it on a piece of paper that then they dry out. But the issue that I take with this is that and, you know, Dr. Rosenzweig and I have talked about, he's taught me about, is that if you think about it, you're asking an extremely small proportion of what's coming out of the body. And because it can vary immensely, you know, many, many, many times in concentration from morning to midday to afternoon to evening to overnight, you have no idea what you're actually getting as it bears or as a reflection of what's really going on in that person. Is that fair, Dr. Rosensweet?

It is. And again, it, it really comes back to when was the last dose though, cuz we're really, absolutely, we're really measuring people we're treating. And then there's issues around comparing it to creatinine and there's issues around muscle mass and creatinine and there's issues around paper and collection methods. There's a lot of issues there, but we went ahead hoping, uh, splitting the specimen between many labs, and, and the issue that we're running into is no, they do not correlate. So which one are you going to believe? Well, the one that makes the most sense to you. They don't, they don't line up. You don't see 24-hour urine and the 5-point go, oh, look at that, they're the same level. There's the— what are they? What do we want to know? Should we keep the dose where it is, or is the patient actually on too little and we want to increase the dose, or do we want to decrease the dose? This is what it comes down to, and you get different suggestions from the same, uh, the same person. So that's the, that's the short version of the long story of gotten me into statisticians who are boggling my mind with these 1 and 2 standard deviations and reference ranges. That I remember back in my statistics course, right?

And this now has been the last 20 years of your practice exclusively, or almost exclusively. Yeah, yeah, 30 now. Yeah. And, uh, you've never left the 24-hour urine hormone test.

I know, there's so many moving parts. But that makes it fun. You know, we, we have an opportunity to navigate in the world of human beings and use a lot of tools and have a lot of ways to assess it. And that, that's, that's a contribution that can turn out to have really good outcomes for people to feel better and heal. So That's the bottom line. And sometimes we, we don't, we don't nail it, and people move on to their next person who's— they've got the next answer.

Oh boy, that's a whole nother podcast for us, Dr. Rose, this week. You know, we can call that one When Hormones Go Wrong or something like that, because I've seen some really interesting cases, uh, and I, I have my suspicions about what was going on. In each of those cases. But, you know, I mean, it goes back to what we began with, which is number one, well, you need to have other elements of all this in order— healthy diet, lifestyle, etc. That's a whole— that's a lot of what we spend our time working on people with. But in addition, it really— there is no do-it-yourself hormone replacement. And it really takes, like you said, a team that specializes in it, which is what we now do. So, closing thoughts, Dr. Rosensweet? It's been a real pleasure having you on.

Yeah, it's fun to connect with you, Leland Stillman, and Amy Stillman. It really, uh, inspires my heart Good. That I know that wonderful stuff is being done by a lot of people, and I've known you for quite a while, Leland Stillman Stillman. So it's— I, I— that, that is really reassuring to me that this work goes on, and, uh, how you address things, how— what, what you're— it's— you're just inspiring, and I appreciate that. And, uh, and I know that there's a lot of folks out there that are, and this is the future of medicine, and I'm in a different stage of, uh, my whole approach to that. I'm at the most active stage I've ever been, by the way.

I hear you. Fueled, fueled, I fueled, no doubt, by hormones.

Yes, yes, I am.

Yes, they are.

Yeah. And, um, so I, so I, I, it's a pleasure to hang out and, cause this is how we're, we're spending the moments of our lives. And it's great to, um, participate with real colleagues.

And it has to be part of the future. And, and it's actually very important to me for people to understand that because Dr. Rosensweet and I know all too well what it costs to take care of people into the end of life. And we've seen it without hormones, and we've seen it with hormones. And if you want to know why it's, you know, $4.4 trillion in 2022 spent on healthcare, $14,000 per person, 90% of it on preventable healthcare problems, a huge proportion of that on people who are post-50, andropause, menopause, declining hormone levels. There's a reason why the conventional system is so hostile to hormones, and it's because of very much a, a economic vested interest in people having all of these illnesses.

Look where you're going.

Hey, my audience knows this, and they're, they're perfectly comfortable with it because they've, you know, I mean, the pharmaceutical industry has said this in as many words You know, they'll have meetings where they say that the goal is to make everyone a customer. Well, if everyone's a customer, everyone's spending more money on their healthcare, and you want to have them as— have as many diseases as possible. So it's not even a conspiracy theory. These are publicly acknowledged statements. But I digress. Thank you for, for joining us.

Yeah, my, my honor, my pleasure.

All right, everyone, thanks for tuning in. We'll see you all in the next episode, which will be Richard Brooke, who will be interviewing, uh, next week in the afternoon. Yes.