Hormones for Healthy Aging, with Dr. Daved Rosensweet

Foreign.

Hello and welcome to the Five Journeys Feel Freaking Amazing podcast. 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 special 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 wing.

But thank you very much Wendy.

Good to have you here. My partner can't be here. He 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'd you get into this? Because you, you're not an ob GYN by training. So what had focus on this, on hormone management?

Well, I was, I started off really at the beginning of holistic medicine in the late 1960s and had a holistic medical practice in Santa Fe. And one of my patients 30 years ago that I knew very well, she was in her mid-40s and she was brilliant woman. She had retired in her mid-40s. Just think of that. Oh, and yeah, and she stormed into my office one morning before office hours. I was doing some paperwork, came up to my desk, pounded her fist on my desk and said look, I'm going crazy. I'm not even being as animated as she was. I'm going absolutely crazy. And don't pretend you know me. And serendipitously, although I don't think that's how the world works. I had been speaking to John Lee three weeks before and he had told me about a lot about progesterone. And I gave her some progesterone. And three weeks after that I got a letter from her. That's how it was done in those days, saying I can't believe that stuff. She said, I'm totally myself. Thank you so much.

Nice.

And that was very impressive as you know. I mean when a patient has a dramatic result like that. Well, I wasn't necessarily guiding my career but she was referring. And before I knew it I was seeing a lot of women in menopause and I love biochemistry and it was just a real medical fit for me. And so off we went and Then I decided to specialize in it because I couldn't get my arms around functional medicine anymore. The knowledge base was getting too big. And I really loved this field. So that's why I got there.

Yeah, I mean, it is a massive field. I remember when I sat for the exam, I was like, I'm never doing this again. It is the most data driven and I love data, but it was just so much data. So I totally get it. So are you in the camp that all women should take hormones? Are you in the camp that women should only take hormones as needed? Like, what camp do you fall in around hormones?

Well, you know, we can't. The words all. It's a funny word, Always and never, right?

I said, I mean it's always, never, never happened.

However, I'd say every human being, male and female, if you want to live strong and live long and avoid nursing homes and assisted living facilities and be happy and even be sexual into your 80s and 90s, well, let me just not even qualify it. I say yes to live the kind of life that you're going to want to live. You're going to. Replenishing these hormones is the optimal way to go. Are there exceptions? I don't know. I haven't met up one, but I can't. I can imagine a couple of scenarios, but I'd say everybody.

Yeah, I mean, I would say someone who had nasty, aggressive estrogen receptor, progesterone receptor positive cancer, then maybe I wouldn't give it to them. But we also had Heather Sandison on those podcasts who talks a lot about reversing Alzheimer's and hormones is a major pathway for, for dementia, brain related dysfunction. And so when you talk about hormones, if you're looking to have your brain work, hormones are a huge category so that you need to not step over. So you know, I'm in your camp, actually, I think we're on the same page.

So that one, I love that topic because people didn't have fear of hormones and fear of cancer, breast cancer, when I was growing up in medicine. And then along comes the WHI in 2002 and there's this explosion of false information. But I had already been practicing treating women and I dived into that information as well. This is my current conclusion based on a lot of communications with world experts on breast cancer and hormones, like Auburn Blooming, for example. Is it all right if I say what my own particular view is?

Please.

We're all at risk for thousands of diagnoses, a lot of them not good. We're all at risk for hundreds of cancers. As a male, I have an increased relative risk for prostate cancer, and that's newer and there's reasons for that. And women have an increased risk, relative risk for breast cancer. It's very prevalent cancer. But given that we're all at risk, women who are on hormones treated with hormones are at less risk for breast cancer, heart attack and stroke than women who are not treated with hormones. And this is the big one, this is why I wanted to address it. Women that have had breast cancer and have had that breast cancer properly treated have an increased relative risk of recurrence than a woman who's never had breast cancer. But if that woman has had that breast cancer properly treated, she has less risk for recurrence, less if she's treated with hormones and if she's not. That's the science. Now, what about positive receptor sites? Best information I have. It's not relevant. Oh no, it's gotta be relevant. No, it doesn't have to be relevant. And the world expert on this is Alvaren Blooming. And how he sees it is. Well, I heard it this morning on a podcast that every single cell in the body has estrogen receptor sites in a woman's body, head to toe. Abram Blooming described it to me once that he said, when you remove a breast cancer surgically and you look at the tumor, there's all kinds of cells in there and some of them are very primitive, out of control. Pathologists can't even recognize that they came from the breast. But some of them are very normal looking. There's all kinds of degrees of differentiation taking place in any given tumor, in any given biopsy sample, and you're going to get positive receptor sites. But they're not the cells that are giving you the trouble. It's the undifferentiated cells that don't respond to anything. They're the ones in a tumor that are giving you the trouble. So, yes, people are concerned about positive receptor sites. Well, he is the only physician I know and he's an oncologist who specialized in breast cancer. And he was treating women who had breast cancer with hormones for decades before the 2002 WHI. And he said, you can't tell. There is no, no one can substantiate that there's an increased risk from estrogen positive receptor sites than there is not.

Yeah, I mean, that wasn't in the who. I mean, the who. I was a resident when that came out. So we spent hours dissecting that study. And you know, the the, this was 2002. Women who got estrogen looked like they were at an increased risk of cancer, but it was all synthetic. You couldn't participate if you had symptoms. There were a lot of flaws in this study and it's, it's been shown like, this is a crappy study. Even though it was big, it was crappy study. So, okay, so let's, let's sort of go, okay, let's set the whi to the side and talk to me about what? I mean, you know, if you're a listener, I'm assuming that my listeners are going, okay, if you're postmenopausal, why would they want to do this? You know, obviously women don't walk in and say, protect my bones, protect my brains, protect my colon, protect my heart. They say, it's not working, fix me, or I'm having hot flashes, or my vagina is like sandpaper. Like they're really, they're experiencing the downsides and often in their early 40s. But so what are you telling these women? What are the risks? What are the benefits? Who should be on it? Who shouldn't be on it? Oh, you said it. You already told me who should be on it. So risks and benefits?

Well, the risks are, I would say they're almost. There's almost a near certainty that if women don't replenish hormones and men don't replenish hormones, and that's whether you have symptoms or not, there's going to be some long term consequences for many that as physicians, we get to see people in all decades of life, someone in their 40s isn't necessarily medically familiar with people in their 80s and 90s, but we were given heads up about this in our training. What happens to these older folks is, I'm not even talking about the acute symptoms is they lose their muscles, sarcopenia, they move from canes to walkers to wheelchairs. That's a defining moment for folks. It's tough to be taken care of at home. And they get incontinence, they get recurrent bladder infections. And as you mentioned, so many women have cognitive decline, dementia. So I'm mentioning that there's these long term things that people don't see. And as the gerontologist taught us in medical school, he said, here's what's really happening to old people. They're losing their muscles. They can't stand and walk with stability. They fall on their osteoporotic bones. And in those days they died. Now they get to live another year. But the short term stuff is so significant. You've got a woman midlife. She's at the pinnacle of her experience, her knowledge, her wisdom. And when your mind isn't working and you're waking up in the middle of the night and you're not sleeping, you know this so well. Wendy, I'm not talking to you about this. You know, know this. And, and you can't go back to sleep and you lose three nights sleep. Anyone lost three nights sleep lately? How's that going for you?

No, it's terrible. It's terrible. I mean, I'm postmenopausal and they're there. Before I was treated, I was like, oh, this is not going to end well for anyone really. It's going to be ugly.

And then you named it. I don't know if I have anything to add. You name the big ones.

What about the risks?

Well, the risks. What are the risks? Tell me what they are. You mean of not of being treated?

Of being treated? If you're treating a woman and you're saying, okay, look, here's the benefits, here's the risks, what are you telling her? The risks?

I see only one risk. How about this? You're going to love this. There's a couple. There's a couple. Really? One possible risk is if you don't get skilled treatment and a woman is giving too much estrogen, she is at risk for breast glandular cell proliferation, thus increasing breast density. This is an unhealthy breast. This is a more vulnerable breast. That can happen.

Can we pause there, David? If a woman has that, would she know? Would she say, okay, my breasts are getting bigger, they're sensitive, my nipples don't feel good. Or is she going to notice symptoms? Or is this something happening behind the scenes?

Well, a lot of women are going to feel it. They're going to feel breast tenderness. And the method we teach, we call it a no breast tenderness method. You can get breast tenderness in the beginning and it can easily go away. And there's ways to address breast tenderness. But if a woman has breast tenderness and breast fullness, one possibility, not all possibilities, is that she's developing increased proliferative proliferation of breast glandular cells. That's not an absolute risk. Cancer has so many complex causes, but it's one of the known risk factors for the breast not being healthy, even getting into cancerous changes. We don't want to over treat women. We don't want to produce breast glandular cell proliferation in a midlife woman. But good medicine is not going to do that.

So how do you, 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. And 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.

So 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.

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 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. And 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.

Sorry.

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 glandular, so 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. And there's really good information in there. And with the 24 year hormone test that we use the laboratory Agreed to publish. Our parameters are too much and too little. We know that if you don't get enough estrone 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 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 regularly menstruate and to be fertile and have term pregnancies. Other women need three times that much. 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 of that. So 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, if they, it can even go further than that. I mean you get overstimulation of the uterus, you can get bleed, you can get a uterine bleed pretty easily. It's not hard to produce the uterine bleeding with overdose. You can get cramps when you. We haven't had cramps for 10 years. 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. That's a whole story.

What are you giving them just to go down the rabbit hole? What are you giving them to change their breast density?

Iodine is the vanguard of it.

Are you doing. Are you painting? I remember reading a protocol that was like, IV. I think it was IVB 12, and painting the vagina with povidone. And I was like, oh, I'm not doing that. I can't cope with that.

It wasn't that. It was. I. I know. You know about Myers Cocktail. Well, John Myers had a lot of different things that he was great at. And he used to hold seminars for physicians. And prior to the seminar for physicians, he'd say, listen, if anyone, you've got a woman who's got fibrocystic breast pain, invite her to the seminar. And what he did is he lined these women up on the stage, draped them so the audience couldn't see the pelvic exam he was about to do. Painted the cervix with iodine, not povidone. He used pure iodine, not iodide, but iodine. And by the end of the lecture, the women who started out that lecture with breast pain, the breast pain was gone. Pretty dramatic.

Can give it orally.

Like I said, we're not painting anyone's cervix these days. Yes, iota. All is great. Lugol's works. I'm a big fan of David Brownstein, who's one of the world's. He's at the top of the mountain for knowledge about iodine. So he has a product. So we like David Brownstein's product, but he worked with Dr. Abram Guy Abraham, who invented Iodorol. So they're just about identical and more robust dosages than people are used to giving, which is an art because when you give 25 milligrams of iodine, for example, that's a high dose. But when you reduce someone's fibrocystic breast disease and you get a negative thermogram, prior to that, you had a positive thermogram. Like in our training program, I list serial thermograms of a woman who had breast pain and heat showing up on the thermogram, which is a sign of inflammation in her breasts, and she had breast pain. Then we gave her iodine. And then over Time the redness on the thermogram disappears and her pain went away. You have to monitor the thyroid very carefully. And you have to understand thyroid. You have to. If you see an elevation in the tsh, don't freak out. Is it okay to go in this level of detail?

Yeah, I love this level of detail. Actually. I prefer that than platitudes and sort of generalities. I think that's good.

Yeah. You're going to see an elevation of tsh rather dramatic, more than we're usually used to. But if you ask the woman patient who's on iodine of that dose. Well, how do you feel? Well, I feel good. That's not true of a true hypothyroid. They do not feel good.

Right.

And then if you do that, if you're also doing a free T3 and free T4, you're going to see a normal free T3 and free T4. Because iodine to be taken up by glands, glands love iodine. Thyroid gland loves iodine. Breasts, glands love iodine. But to get the iodine from circulation into the cells of the glands, you need something called an iodine symporter. And in order to do that, the pituitary participates in that by elevating the tsh, which will elevate the symporter, which will get the iodine into the glands. So you see this temporary elevation of the tsh, you just check in with your patient and keep monitoring it. Monitoring the patient. But to really reduce and eliminate increased breast glandular cell proliferation is a miracle.

That's very cool. I mean, I literally haven't done the protocol, but I remember reading it and thinking, that's a really cool protocol. So I want to go back to the hormone. So 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. And I was immediate fan of topical. And so I started out with topical and 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 in 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. And it works beautifully topically. And what I like for the estrogen is biased. And it really originates that in every woman's. You interrupt me, please, if I'm going too far afield.

You're fine so far. I will reel you in, I promise. If you're going too far.

Yes. In 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 for the possible fertilization and implantation of a fertilized egg. And 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. 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. Her breasts get less full. 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. 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, a 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 estriol. They had 1.3 on average times the amount of estrogel than they had the sum of the two most potent estrogens, estrone and estradiol. 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. So he proposed that we use biased. He originally proposed tries, but he had a sophisticated lab and he learned that you didn't need to use estrone. 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 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. 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. 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 in the solution. So you can administer identical dosages every time. 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'm a functional medicine doc and I'm encouraging everyone to detoxify. Meanwhile, I'm treating my menopausal women with a quart of per year of hormones for, you know, 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. So you don't get a bias, 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.

And do you recommend women cycle on their progesterone or you find the level and they stay at that level. Where do you approach them?

The one other thing I wanted to say is 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 all in one bottle because that was what they could actually manage.

Right.

Compliance wise. So we do make some. 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. And you know, I love math and I love spreadsheets and I've been treating women for quite a while, for 10 years. And 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, oh, 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'd you like that cycling thing? 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 study nine months ago.

That was a good idea.

Now every single patient. But along the way, Dr. Wright had said he has a 24 year in 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 seven, the medium number was on day 12, and the highest number was on day 21. So transdermal was not doing, was not mimicking the menstrual curves. That was one way I learned about this. 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 and only if she ovulates. So 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. And 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 the, 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'd like to take it every single day. I had a 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 fundraiser drug. Wonderful is progesterone. And 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. Then if they need to tailor that progesterone with a little more emphasis on what would be the second half of 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. We highly individualize it.

Do you ever do pellets?

Never.

It's so funny because I'm super commitment phobic and when I got married I said to my husband, I'll commit for 50 years, but I'm not committing for life because this is too long. 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.

Stuck for three months 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, 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 on. 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. I have yet to see anyone demonstrate to me that they're getting physiologic, not super physiologic levels. I. 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 sub specialize 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. But if you're. 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, 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 a. 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 the chicken and what's the egg? What comes first when you're doing lifestyle things? Where does it fit in this whole conversation?

You. I, I just really appreciate the bigger view here. When I, When I left medical school, I had an interest. What else is what tools work here? And what did I encounter? The. 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 preservers 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 I remember them.

They're really old. They're gone now. Right.

Well, Genova Great Smokies morphed into Genova.

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

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 want to be part of a team. So when I start seeing that there's these multitude of issues 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 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.

So I realized we spend most of the time talking about women. You also treat men, right?

Yeah, definitely.

Can we spend a few minutes talking about how would men know that their hormones are off? You know, we always talk. There's a lot of talk about women, but men get low testosterone and it's deadly for them. So how would they even know that they've got an issue?

We didn't know, nobody knew until this magic blue pill came out called Viagra. And explosively overnight it became a super popular drug. And what did we learn? That there was a tremendous number of men out there with erectile dysfunction who were not talking about it. The same process goes on that happens with women at the age 20. Their ovarian hormone levels at the absolute maximum they're ever going to be. Plus or minus a couple of years. And then they gradually decline until age 95. They always decline. And then there's a precipitous event that takes place around menopause men, same thing. Now, some go slower, some go faster. But the, the rule of thumb is a man really knows it. Just like women. Hot flashes, can't sleep, cognitive dysfunction in women, erectile dysfunction. They know it when this is not working well and they're very inspired by that. They do not like it.

Men love their penises, so like anything that's wrong with them, they're going to get their attention. So other than erectile dysfunction, what about belly fat, weight gain? Are there other things? So I'm assuming for men that when they have testosterone deficiency that their brain won't work well, their mood will be different. But what about in those things? Yeah, so the belly fat, the brain dysfunction.

We have an online questionnaire and we have a long list of symptoms for women that ferret out deficiency symptoms. And we have a long list for men, and there's a lot of them. But what brings them to the physicians is the erectile dysfunction. Now there's a certain group of men who, they're used to working out in the gym and they really care about their fitness and they start realizing that what they used to be able to build muscle and feel good, their routines are now they're winding up fatigued and they're, they're not, they're, they're not as strong as they used to and they're disturbed by that and, and they're health sensitive and they'll, we'll see a certain number of those men. And then a libido is another one that brings men in. And another thing that brings men in is their wives have picked up on compounded bioidentical hormones and their wives are saying, hey, listen, I'm getting interested again. What happened to you? So we see a lot of men from that way, but yeah, there's muscle loss, there's mood loss, there's motivation loss. Men who are, you know, they've, they've bought into every active and creative lives and that they start having cognitive issues, they start having motivation issues, they don't want to show up for work, they're grouchy around the house. So there are a long list of symptoms. But I wanted to return to the big one called erectile dysfunction. When that testosterone drops low, there comes a point where they cannot sustain an erection.

I feel like when you get to that point, that's like end stage renal disease. Right? You had this issue for years, and now what you really see is the final straw. But to me, the erectile dysfunction is also. There's a cardiovascular component to it that if you have atherosclerosis in your heart, you're going to have it in your smaller vessels that will get in the way of having the blood flow to get the erection. But to me, the lack of ability to get an erection is the end of the road. Right. So I'm trying to get to people before they're at the end of the road. So for me, it's like, okay, if you're caught, if your brain isn't working as well, if you have muscle loss, if you have easy fatigue, if you notice a decrease in your sex drive, then to me, those are the early red flags. And the late red flag is the loss of an erection. Like, that's really. That, to me, is like the diagnosis of all.

It's not as late as it used to be.

Now, why?

I mean, I totally respect your desire to pick it up early and for men to show up early, although they don't.

I don't see men at all. I only see their wives.

They don't tend to do it.

No.

And what's the final inspiration? But we're seeing young men who are having libido issues, erectile issues, as never before. This world has changed and my patient demographic has changed, and younger and younger men are having difficulty and they're hearing about low testosterone, and best case scenario, they come in before the erectile dysfunction has gotten. But there's a series of steps, and you could pick it up on an intake questionnaire. A young man should wake up with an erection. That's adequate testosterone. If you question him, do you still wake up with an erection? Well, no, it's been a while. Well, his testosterone has already dropped. So there are early signs. It's more like, practically speaking, when are the men going to show up? And a lot of young men are showing up these days. There's great popularity. They've heard about it. They've heard about the testosterone, and they show up for a variety of reasons. Some want better performance. Some are using them in an appropriate way. The athletes have been using it inappropriately, but I don't know that I can say more than that. They do show up. I can tell you that.

I'm glad they're showing up. Do you see a lot of patients who have a porn addiction? Because we've spoken to people who say porn is everywhere and young men are drowning in it, and that can lead to its own erectile dysfunction if you can only get an erection associated with escalating porn. So do you see that? Is that anything you screen for? You see that in your practice?

I haven't. But of course you're naming some real perils and some real gauges of consciousness deterioration that is so much more prevalent than we ever dreamed of. And that dysfunctionality, that's a big topic. That's a Pandora's.

That's a whole other thing. We won't go there. Okay. Is there anything I haven't asked you about that you feel that is really important for the listeners to hear?

I think if anything, I'd like to counter and just repeat myself by saying the science is that women who are treated with hormones are at less risk for breast cancer, heart attack and stroke than women who are not. And women who've had breast cancer and really in dire straits because they've been often thrown into a menopause that is really intense. You're at less risk of recurrence if you're treated with hormones than if you're not. I think that's the main myth I love to dispel and to help antidote the poison. And the same poison has touched the medical world for men, although it's not as strong a poison as the whi damage. And then, you know, take the long range view, it's a tough one to do. But if you take, if you try and picture how do I want to live when I'm 80 and 90 and have I had parents or relatives that have gone into assisted living facilities and nursing homes and how they felt about that and how did they do in those facilities? And you got a little doggy here.

I don't think you get out of those alive. It's not like you go in as a temporary measure. You go in and that's it, that's the end of it.

And then with some foresight, how do you get to prevent going in there if that matters to you? You pick up on hormones are going to. Like we have on our medical board, we have a woman who for many, many years she was working with nursing homes. And I asked her once, what percentage of women who are in nursing homes are there because of hormone deficiencies that 80, sarcopenia, cognitive decline, loss of bladder control, osteoporosis, hip fracture. That's why they're there. And so it's so challenging to announce a prevention as worth 32 tons of cure type of thing, but really investigate these hormones. And you know what? It doesn't matter when you, if you, if you're 75 and you've never done hormones, investigate it. I started treating my mother and my mother in law when they were in their mid-80s to advantage. There's extra precautions we take, there's a few extra things that we pay attention to, but anytime you think of it, figure it out, go for it. It's, it's really the best stuff out there.

And before, before I have you tell people how to find you, I have one last question, which is, are you doing anything to help women process their estrogen properly so that they can excrete it so they don't recycle more toxic forms of estrogen? Is that anything that you focus on?

Well, you're bringing up something that definitely occurs and you've obviously been doing this work and it is an issue. I don't find it in my patient demographic. I don't find it as commonly as we might suspect. And we will always see it in that 24 hour urine hormone test. But if you've got unexplainable estrogen dominance, you gotta investigate where's all this extra estrogen coming from and is it coming from the gut in a dysbiosis? And if the gut is in trouble, how's the liver doing? And is the liver having trouble? And if the liver is having trouble, trouble. As midlife livers are not youthful livers, there's a lot of water under the bridge there. So there are times when part of the process is you start identifying that there's metabolic processes that are problematic here. And the women are not processing, they're not biochemically changing the parent hormones into the metabolites. So why not liver and gut, that's the holy triad.

Adrenals, liver, gut. To me, that's holy triad. Okay.

And so sometimes we refer people out and say, we got some liver and gut repair to do here.

Yeah, you know, it's funny because if I do hormones on my patients, I'm saying that we gotta fix your gut and we gotta have your adrenals liver gut be optimized, otherwise you're dead in the water. Like we really have to do these simultaneously. We can't do them one at a time, otherwise you just won't get well. So, 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.

That'll be great. Do you have a link we can.

Put in the show notes yes. If you just contact Karina, she'll give you a link and you can put it in your show notes. And then our contact information there and it's. You can contact me directly, although someone on my staff will pick it up at drr. Dr. R. Drriobim.org.

We'Ll put that link in the. In the show notes. And then do you have a website for people?

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

Okay, 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. 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 in 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.

You too. Thanks for being here.

We're in the same medical tribe and I still respect what you're doing. It's. It's such a gift.

Right back at you. So thanks for being on the feel freaking amazing podcast. You're great.

Bye. Bye.