Find Your Ideal Hormone Balance, with Dr. Daved Rosensweet

Over 99% of what was in that cosmetic jar was the strong solvent. There's medical studies done on those strong solvents showing that there's possible problems from the toxicity there. And here I am, a functional medicine doc encouraging everyone to detoxify. And meanwhile, I'm treating my menopausal women with a quart per year of hormones.

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Hello and welcome to the Five Journeys Feel Freaking Amazing podcast. I. I'm Dr. Wendy Trubo and we have an amazing guest today. I say that all the time, but we really do. Our guest today is Dr. David Rosensweet. He is the founder of the Institute of Bioidentical Medicine and the Menopause method with over 30 years of experience specializing in andropause and menopause treatment. Currently, he spends the majority of his time training medical practitioners to specialize in menopause and andropause medicine using his organic and solvent free methods. David, welcome. We're so happy to have you here today. I know I'm speaking the royal we.

But thank you very much. Wendy.

It's good to have you here. My partner can't be was here earlier so it's like a rare animal in the sighting in the wild sighting. But he's not here with us today, so it'll just be you and me. So tell me, how are you testing women? Are you doing blood? Are you doing urine? Are you doing nothing? Like how do you evaluate the right level for women? How do you approach that?

In a lot of different ways. But as far as hormone levels go, we use 24 hour urine hormone testing. It's been around since the late 60s. I love it. And our particular organization, we've run cross testing, split specimens. We've sent it out to many different labs, including several you're familiar with. Right now I stand by. I want to give you my best shot. 24 hour urine hormone testing is the best to me by far.

Women are collecting their urine for 24 hours and then they send it in. And you're measuring the levels?

That's right.

Okay. And so based on that, so based on that, you're going to either increase, decrease or stay the same depending on what you see?

Yeah, well, there's several factors. I mean, so many women, as you know, they arrive at the practice and they got a lot of symptoms. And each woman is individual. So what I learned a long time ago was to isolate out the, the estrogen that we're going to administer, the progesterone. And for most women, right out of the gate, testosterone and dhea. And we're going to start low and we're going to gradually increase and define methods of doing this. Best case scenario, they feel better, oh my God, the hot flashes went away. I'm not waking up in the middle of the night. If they keep on increasing and they go too high, they're going to get symptoms of overdose most of the time. For example, women will get breast glandrosil overstimulation, they'll get breast tenderness. We outline all this on cards that we give to women that list symptoms. And so if they go too high, we have them back down. And what are we listening for? The woman said, oh my God, I think I found my sweet spot. And women vary. Some women emphasize the estrogen and less progesterone. Other women need much more progesterone than there's the testosterone out here. But we're looking for this clinical sweet spot. So we don't test women's hormones ever until the three, four or five month mark when they say, wow, I feel good. Now what I did is I went into the medical literature decades ago to try and define, yeah, you feel good. What's too much and what's too little. There's really good information in there. With the 24 hour urine hormone test that we use, the laboratory agreed to publish our parameters of too much and too little. We know that if you don't get enough estrogen and estradiol in the urine, if you drop below 8 micrograms for 24 hours, you're at risk for vaginal atrophy and bone loss. Minimal. We know that the good studies have been done. If you go too high, you're at risk for breast glandular cell proliferation. We define an optimal range for treating women in menopause. That turns out, let's look at young women. Some young women, they need this amount of estrogen to have regular menstruate and to be fertile and have term pregnancies. Other women need three times that. There's that much variation in young, healthy women. Where we find the optimal menopause zone is right below that. We define that on the 24 hour urine hormone test. Now, are there exceptions? Yes, there are what the medical literature is very clear about is you might be able to define the lower limit for bone loss and vaginal atrophy, but not for dementia, not for cognitive decline. There's some women who really need robust doses of estrogen to rescue their brains. We'll go all out. I know stories, I know physicians who've worked with this. And if you're curious, I can tell you how we handle that. Sometimes you make exceptions, sometimes you deliver more hormones based on risk and benefit. And dementia is a big deal. So to rescue someone from dementia, you need robust estrogen doses in many cases.

I'd like to go back to the symptoms. So when a woman's over treated, she's going to have breast, so she's going to notice her breasts get bigger and more sensitive. Are there any other things that you're having your patients look out for as a sign of too much estrogen?

Yeah, I mean, you can get irritable, you can retain water. The big one is the overstimulation of the breasts and those are the big ones. Water retention, irritability and the breast symptoms, it can even go further than that. I mean, you get overstimulation of the uterus, you can get bleeds, you can get a uterine bleed pretty easily. It's not hard to produce the uterine bleed with overdose. You can get cramps when you haven't had cramps for 10 years. So those are the main symptoms and they're pretty reliable and they're not 100% reliable. And it's one of the reasons we do confirm everything with the 24 hour urine hormone test. Now, up until recently, mammography, routine screening, mammography was very much a part of how we monitor women. Like if a woman has increased breast density on mammography, we want to treat those women, we want to give them things to reduce or halt the progress of breast density.

When you're dosing women, do you have a favorite form? Are you a patch guy? Are you a cream, Are you pellets? Where do you land on this?

Well, I started out out of the gate having a compounding pharmacist that had been doing it for quite a while. I was immediate fan of topical. I started out with topical estrogen. You don't want to administer estrogen orally. You know this, of course, you have to administer larger doses. You go get first pass through the liver. And there was a certain number of women when they took estrogen orally, they got clots in their lower extremities and even their lungs. Because estrogen orally can promote coagulation and can promote inflammation, the development of those proteins in the liver. They don't want to get estrogen orally. It works beautifully topically. What I like for the estrogen is biased. It really originates that a normal young woman's menstrual cycle. There's two different phases of it. In the initial part of the cycle, she's preparing for the possible fertilization and implantation of a fertilized egg. What she does is she proliferates. She forms new cells in the lining of her uterus to form a brand new receiving bed for a fertilized egg. Proliferation, new cells, mitosis. And this is staggering to me. She also begins preparation for lactation. She gets increased production of breast glandular cells, cell division, cell mitosis, every single month, every single cycle. Women, a lot of women feel this, their breasts get fuller, even more tender as the cycle progresses. And that's called the proliferation phase, preparation for pregnancy. If the woman does not get pregnant, she deproliferates. The cells break down in the uterus and she menstruates the breast, glandular cells disappear by a process called apoptosis. I love that name. And her breasts get less, less full. And the first half of that cycle, the proliferation phase, is inspired by a receptor site, estrogen receptor site alpha. The interaction of estrogen with alpha is what moves towards proliferation. The principal stimulant of the three estrogen hormones is estradiol, the most potent of the woman's hormones. It's the promoter of proliferation. If she deproliferates, this is under the inspiration of estrogen receptor site beta. And the principal stimulant of that is another estrogen called estriol. I grew up in an era where Dr. Jonathan Wright had already exposed the world to some work. He did this in the 80s. He exposed the world to some research done by an oncologist, medical doctor at the University of Nebraska, who took the urine samples, 24 hour urine hormone testing on young healthy women. He also took 24 hour urine hormone samples on women who had breast cancer. He found a difference. The difference he found is the young healthy women had a preponderance of estrogen. They had 1.3 on average times the amount of estrogel than they had the sum of the two most potent estrogens, estrone and estrodio. And the women who had breast cancer had more estrone and estradiol than they had estriol. Dr. Wright had this radical proposal to copy nature and not invent a new human Being and just do what nature did there. This was before the receptor sites were discovered. They weren't discovered until the 90s. He proposed that we use biased. He originally proposed trias, but he had a sophisticated lab and he learned that you didn't need to use estronegation. So we've been using biased ever since. So I love estrogen, I love biased.

What percent are you talking? 50, 50 or talking 80, 20 or some other ratio?

We always start 80 20, always. And 75% of the women over 30 years are going to stick with 80 20. What we wait for is the 24 hour urine hormone test. And there's going to be a certain number of women that they need a little more estradiol to meet to copy nature. And so we will change that ratio, but only when we're looking at a 24 hour urine hormone test.

Okay, that makes sense. And then are there people who balk at it who say, I want it covered by insurance. I'd rather do a patch and oral progesterone. Like what? Or are you. Is your line in the sand that cream or bust? How do you fall on this?

Well, there's two things I'd like to say. One is the carrier, but I'll go through the second one first. I've had this extraordinary privileged career where I get to work with the most intelligent, health motivated, caring women. And once they see that they're entering something that makes sense to them with someone they can talk to, I don't get pushback. They just. It's been a great privilege. I know that people negotiate over what are you going to use? But I don't negotiate over at it at all. And I don't have to. That's a story. Another story is, though, 10 years into treating women in menopause with hormones, I had never seen a hormone. I was using a pharmacist in Albuquerque who was shipping my prescriptions directly to the patient. And one day he shipped a bias by mistake to my office instead of the patient. And I was fascinated. They came in these white cosmetic jars and it had a seal on it. And I went, I'm breaking that seal and opened up that jar and out come this very strong odor. And I did a lot of investigating into that odor. And the carbopol. This is one of the. What I learned is steroid hormones are very poorly soluble. You need strong solvents to get them up into solution. So you can administer identical dosages every time. And 99%, over 99% of what was in that cosmetic jar was the Strong solvent. And there's medical studies done on those strong solvents showing that there's possible problems from the toxicity there. And here I'm a functional medicine doc and I'm encouraging everyone to detoxify. And meanwhile, I'm treating my menopausal women with a quart per year of hormones for 5, 10, 15, 20, 30 years. So my son and I went on to do a lot of testing look into organic oils. And we dispense our hormones in a certified organic oil. It's a suspension, so you have to shake before you apply it. But that's my favorite delivery system is an organic oil. There's no solvents in there and suspension works really good. We've tested it.

And are you mixing estradiol and progesterone and testosterone in the same vial or are you keeping them separate?

Great question. I like twice daily administration of biased morning and evening. I think that produces the technically medically optimal way to administer biased. You don't get a biased a single peak, you get two peaks and that's more mimics what the ovary did. The ovary didn't wake up in the morning and dump all the estrogen into the system. And peaking in the world of hormones is associated with some challenges. So we at least break it up into twice. Progesterone I really like at night it can have so much sleep benefits. So we don't mix the bias in progesterone and DHEA and testosterone can be combined. We do that. So there's a total of three bottles that the women that we work with get. And the testosterone is better given in the morning. It's more of an energizing thing. Or it can be given prior to anticipated intercourse, but it's energizing and you don't necessarily want to give that. So that's how we do it. Three different bottles. And for the elderly, for women in their 70s, 80s and 90s, we combine everything and put some pregnenolone in there. Because I worked with my mother and my mother in law when we originally invented this. We call it MM elder. It's, it's all in one bottle because that was what they could actually manage compliance wise. So we do mix them. It's not optimal, but hey, get some hormones in there is a great thing.

Yeah, I mean I say to people, they say, man can't do it perfectly. I'm like, I'd rather you do it imperfectly than not do it at all. So anything is better than nothing. So okay. And then are you at one level Are you cycling? How do you approach that?

Well, at one point, I love math and I love spreadsheets and I've been treating women for quite a while, for 10 years. I was looking at the menstrual cycle one day and I say, man, if we're going to copy nature, I've been administering the identical daily dose to women every single day. I was aware of cycling progesterone, but I said, why don't I take the total amount of each hormone that we're giving over the course of the month and redistribute it. They're getting the same total amount because they've titrated to symptom alleviation. We know what their individual amount is, but with an Excel spreadsheet and a little math, I was giving these women these Excel spreadsheets that gave them four different dosages following the menstrual curve. I was telling Dr. Wright about it and he was very excited because now we're really copying nature. Then I did it with every single one of my patients. Then we have an annual follow up. Here's what I learned on the annual follow up. I said, well, how did you like that cycling thing? And the women said this. Well, I thought it was a good idea, but I much preferred my daily steady dose. So I stopped doing it. I've been taking the same thing.

Nine months ago that was a good idea.

Now back to every day, every single patient. But along the way, Dr. Wright had said he has a 24 year hormone lab. He said, why don't we test these women three times during the cycle? And we did. We tested them day 7, day 12 and day 21. And the results were different Than what? They didn't match the menstrual curve. The lowest number was on day 7, the medium number was on day 12, and the highest number was on day 21. Transdermal was not doing, was not mimicking the menstrual curves. That was one way I learned about this. And then the other way I learned about it is I would cycle progesterone initially. I would have a perimenopausal woman who's used to getting this major robust output of the ovary of progesterone mid cycle if she ovulates, only if she ovulates, I would give her progesterone during the second half of the cycle to my patients. I said, let's do it the way nature does it. Then this is what I would hear from my patients. You know, those two weeks that I take that progesterone I feel really good. Would there be anything wrong with me taking it earlier than the two weeks? Because when I'm not taking it, I don't feel good. And what did I know? I mean, we were co creating these protocols along with the women. I said, sure, go ahead, try it. I don't see any harm. These hormones are so beautiful. And here's what I heard from the women. Well, I already have been and you know, I like to take it every single day. I have very strongly independent demographic, so we did it together. So between all of that information, I no longer cycle it like that. Although I'll say to a young woman in her 20s, if she's having anxiety in irregular periods, thus it's unlikely that she's ovulating and that anxiety is severe. My number one, go to wonder drug, not funder drug. Wonderful is progesterone. And we, I just so much believe in individualization. I'll give patients different dosage possibilities. But I always say to women, let's figure it out together. Let's figure out your body together. And I wrote a book for women thinking that if they had enough information, we'd be able to, because when I started out there was very little knowledge. So I said, well, I'm going to give the women a certain amount of information and together we're going to figure out how to individualize these things. And in young women, I think it's very important to not go in with any preconceived ideas. But first let them get a trial of progesterone. And then if they need to tailor that progesterone with a little more emphasis on what would be the second half their cycle, bravo. If they don't need to tailor it, if they really need the anxiety alleviation with the same dose every day, we do that. So we highly individualize it.

Do you ever do pellets?

Never.

That's so funny, because I'm super commitment phobic and when I got married I said to my husband, I'll, I'll commit for 50 years, but I'm not committing for life because it's too long, right? I don't know why. 50 years, fine, but life was too much and, and I feel the same way about pellets. I just, I can't, I don't, I don't want to commit to something that I can't reverse, right? If I, if I don't like the cream or the patch or the pill, I just don't take it, don't give it to them. But a pellet, you're stuck. So I have a particular bias against.

Them and I've done a lot of testing. Now, women with pellet failures are the ones who come to come. I see. And there's a lot of problems with them. And, you know, I think I don't. You never say never. I think there's some providers out there who really figured pellets out, bless their hearts. But that's not what I see. And I had the opportunity to testify in front of the National Academy of Science, and I know what the bugaboo is. I know their list, and pellets is at the top of their list. And we're very vulnerable for the kind of medicine that's being practiced with pellets. And I keep asking pellet enthusiasts, would you please show me sequential daily blood draws and testosterone levels, for example? Because I've seen outrageous serum testosterone levels. Because I wait for a woman, I'm not going to give her testosterone if she's still running a super high testosterone because she had the pellet in there three months earlier. And I have yet to see anyone demonstrate to me that they're getting physiologic, not super physiologic levels. So I don't. I shouldn't say more. Not a fan.

No, I'm not a fan either. So I was wondering if you did them. I was like, I really hope he's not a guy. Okay, talk to me about. So you have this basis in functional medicine and you subspecialize in hormones, but basically, when you look at women and they come in and they're suffering, are there lifestyle things that you're saying to them? I recommend you must do, or you do this first. Or is it, you know, because. Because when you take a big step back, David, if you have amazing adrenals and you have no stress and your body is perfect and your holy triad, which is your gut, your levels, your liver and adrenals are all functioning theoretically, you should enter menopause and the post years and be fine because your adrenals will pick up production through the DHEA pathway of testosterone and estradiol. Except those are only people who live in a bubble, and I don't know any of those people. So typically, most people come into my practice and their adrenals are tapped out. They're super busy, they're super stressed, their guts a mess, their liver's a mess. So I say to them, well, we're going to need to go right to hormones because your adrenals literally can't Pick up the slack. But that's theoretically, in an ideal world, we would say, okay, get your adrenals functioning perfectly optimally, and your symptoms of menopause should go down. So what are the lifestyle things that you add in with women? And what's. What's the chicken and what's the egg like? What. What comes first when you're doing lifestyle things? Where does it fit in this whole conversation?

Well, I started out when I left medical school. I had an interest. What else is what tools work here? And what did I encounter? The world of nutrition, the world of toxicity. Eventually, it began to be named holistic medicine, and then it became functional medicine. And, oh, my God, that knowledge base, as you know, you have deep familiarity with it. That knowledge base got so huge, fantastic. And I made a personal choice for a lot of reasons. And here's how it happened to me. Like, I knew a lot about the intestine. I had been. I. I had been working with a Nigerian parasitologist, and I was sent overnighting him fresh stool specimens with no preservatives in them and using Nigerian herbs to treat gut issues. I KNEW all about Dr. Amin in Phoenix, and the Genova was doing it well. Metametrics was doing the greatest job, I thought, at the time, and so was Great Smokies. Now, Genova, God, I remember them.

They're really old. They're gone now, right? I haven't heard them in years.

Well, Genova Great Smokies morphed into Genova.

Thank you. I'm like, I haven't heard Great Smokies in at least 20 years.

So I know. And. And I, of course, I get it. I mean, my dysbiosis and how we treat our gut and what nutrition and what, what poor nutrition does, and all the toxicity that comes in through nutrition and, you know, the story is so huge. And then I started having these issues happen when I get a patient with dementia, for example, And I could see this person is a year or two away from total loss and debilitation. I said, you know a lot about dementia, David. You've even worked with David Perlmutter. You know a lot about it, but it's out of integrity as a doctor to treat this person. They need to see someone who's deep in the Bredesen protocol if they're going to get rescued. You can do the hormone part, but. And the same thing happened with cardiovascular. I said, you've gone to Dr. Houston's lectures, you've read his books, but you got someone who's, you know, got already Got plaque and is chest pain. You need to see someone who's, they're doing it 24 7. And I started realizing I wanted to choose Elaine and I chose my favorite lane. And so we, we want to be part of a team. So when I start seeing that there's these multitude of issues that some that someone comes to my office with and they need to address diet and they need to address their dysfunctional response to stress and they need to detoxify, what I'll say is I'll make an evaluation like, and it's a common evaluation, I'll start them with the hormones because these are the most powerful biochemicals in our body and we can gain so much goodness from hormones. And what I say to the who we teach, I say when you got a midlife woman or man who has got a long list of possible differential diagnoses, treat them with the hormones and see what's left. And I have been surprised by that. And then often these people feel better and they get inspired, they've had a health change. And then you start mentioning, we want you to go see this health coach who's really knowledgeable in nutrition because you've got a process to do here, a five year plan where you've got to move this diet that's contributing to your weight and et cetera, et cetera. Or we'll do the same for the gut. When I see a significant gut issues, I'm no longer an expert in it and I want to send someone to a functional medicine provider who really is. So that's how we handle it.

Okay. This has been really cool. David, where can people find out about you? Where can they reach you?

They can download a free copy of our book PDF copy. If you want, you could offer that to them.

We'll put that link in the, in the show notes and then do you have a website?

Yeah, we do. We have several of them. And if you just put my name in Google, you'll, you'll, I'll pop up.

We'll put all that in the, in the show notes. So thank you for being on the show. This has been, this has been really interesting because it's near and dear to my heart, having recently transitioned into the next phase of life. So I'm really grateful that you were able to shed some light on this and I'm sure the listeners will like it. So thank you for being here. Here, if you're just tuning in, go back and listen to the beginning. But this is Dr. David Rosensweet and we're talking about hormones and how to optimize them in for both men and women and all the different phases of life. So, David, thanks for being here on the show. This has been really great.

Wendy, it's an honor to meet you. We're in the same medical tribe and I so respect what you're doing. It's such a gift.

Right back at you. So thanks for being on the Feel freaking amazing podcast. Don't go it alone.

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