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

Important links:

My audience can download Dr. Daved Rosensweet's fantastic book, Happy Healthy Hormones, for free right here:  https://iobim.org/book/.

Please do your part and subscribe to my podcast so that you can learn how to advocate for your health, then share this episode with a friend so they learn as well.

Dr. Daved Rosensweet is the Founder of The Menopause Method &  I wonder, doctor https://iwonderdoctor.com/.  Dr. Rosensweet graduated from the University of Michigan Medical School in 1968. He has been in private medical practice since 1971.  He teaches health professionals about the treatment of women in menopause with bio-identical hormones.  Dr. Rosensweet is a nationally known lecturer and frequent presenter at A4M, a principal investigator for a scientific study of female hormones, the author of the books Menopause and Natural Hormones and Happy Healthy Hormones: How to Thrive in Menopause and the organizer of a National Summit Committee on the Treatment of Women in Menopause with Bio-Identical Hormones.

Ever wondered why menopause and andropause feel like such a dramatic shift in your life? Dr. David Rosensweet reveals that our hormone levels peak at age 20 and decline continuously thereafter, affecting every cell, tissue, and organ in our bodies. This isn't just about hot flashes or erectile dysfunction – it's about your long-term health and independence.

The conversation tackles one of medicine's most egregious failures: the false reporting of hormone therapy risks that scared millions away from treatment. What most people don't know is that the Women's Health Initiative study was retracted in 2017, acknowledging there was no increased risk of breast cancer, heart attacks, or strokes with hormone therapy. In fact, proper hormone optimization actually decreases these risks compared to going untreated.

Dr. Rosensweet explains the science behind "Bi-Est" estrogen formulations (80% estriol/20% estradiol) that mimic young women's natural hormone balance, and why testosterone is crucial for both men and women to maintain muscle mass, bone density, and cognitive function. His perspective on the consequences of hormone deficiency is sobering – approximately 80% of nursing home residents are there due to the effects of low hormones, including sarcopenia, osteoporosis, and cognitive decline.

Chapters

• 0:00 Introduction to Hormone Conversations
• 3:13 Dr. Rosensweet's Journey into Hormone Therapy
• 9:27 The Science of Hormonal Decline
• 17:47 Debunking Hormone Therapy Risks
• 35:46 Understanding Estrogens and Biased Formulations
• 51:05 Testosterone for Men and Women
• 1:03:55 The Truth About Hormone Testing
• 1:21:43 Finding the Right Hormone Provider

Transcript

Sandy Kruse: 0:02

Hi everyone, it's me, Sandy K of Sandy K Nutrition, health and Lifestyle Queen. For years now, I've been bringing to you conversations about wellness from incredible guests from all over the world. Discover a fresh take on healthy living for midlife and beyond, one that embraces balance and reason without letting only science dictate every aspect of our wellness. Join me and my guests as we explore ways that we can age gracefully, with in-depth conversations about the thyroid, about hormones and other alternative wellness options for you and your family. True wellness nurtures a healthy body, mind, spirit and soul, and we cover all of these essential aspects to help you live a balanced, joyful life. Be sure to follow my show, rate it, review it and share it. Always remember my friends balanced living works. Remember my friends balanced living works. Hi everyone, welcome to Sandy K Nutrition, health and Lifestyle Queen.

Sandy Kruse: 1:33

Today with me, I have a return guest. I have the amazing Dr Daved Rosensweet. He was on my podcast once before. That was such a popular episode. You can go and find it episode 214, originally recorded in April, april 15th, 2024. And then I actually had Dr Rosensweet's episode as part of my summer reboot series. So you can find it episode 281 on July 21st 2025, if vast, and he even brings in men and hormones into this conversation.

Sandy Kruse: 2:32

It is just such a pleasure to speak with somebody who has as much wisdom as Dr Daved Rosensweet, and I'm going to tell you why. There is a very crowded space nowadays in women's hormones especially, and menopause especially, and back when that New York Times article came out something about women have been misled about menopause, it just opened up the floodgates to absolutely everyone giving advice. So I think it's okay for people who are educated in hormones to not give advice but provide information. And then you want to go to your practitioner who knows you, who is trained in hormones, for your specific situation. You know you see a lot of people who are just very strong in their convictions. You know on social media, and we need to be careful and cognizant of the fact that these people don't know you, and neither does Dr Daved Rosensweet. But Dr Daved Rosensweet has worked with enough patients patients as an MD that he gets it, and he's done so much testing and research here that you know he just has such an amazing experience to share with all of us. So I'm going to ask you to please share this episode with one of your menopausal friends, or perimenopausal, because I think education is key. And then you're going to want to take that information to your practitioner, or who is a practitioner that is specifically trained in hormones, so that they get to know you and your body.

Sandy Kruse: 4:44

So with that, I am going to cut on through to this interview with Dr Daved Rosensweet. Be sure to rate and review my podcast wherever you're listening. Thanks so much. Hi everyone, welcome to Sandy K Nutrition, health and Lifestyle Queen. Welcome to Sandy K Nutrition, health and Lifestyle Queen. Today with me I have a return guest and he was just so wonderful I invited him to come back. I have Dr David Rosensweet. He is the founder of the Menopause Method. He graduated from the University of Michigan Medical School in 1968 and has been in private medical practice since 1971 and is currently in practice in Southwest Florida. Is that right, southwest Florida?

Dr. Daved Rosensweet: 5:39

Well, actually we moved to Asheville.

Sandy Kruse: 5:42

Oh, ok, so that's changed.

Dr. Daved Rosensweet: 5:44

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

Sandy Kruse: 5:45

That's changed. Yes, but Dr Rosensweet he teaches health professionals about the treatment of women in menopause with bioidentical hormones, is a nationally known lecturer and frequent presenter at A4M. He's also a principal investigator for the scientific study of Female Hormones, the author of the books Menopause and Natural Hormones and Happy Healthy Hormones, and he's the organizer of a National Summit Committee on the Treatment of Women in Menopause with Bioidentical Hormones. Now, dr Rosensweet and I had an amazing recording last year and today it's going to be a continuum of that conversation. We're also going to bring in men as well, because many of us are like, hey, I'm taking great care of myself as I age, but what about our partners? So Dr Rosen sweet has so much information, information to share with us.

Sandy Kruse: 6:50

Last year we recorded in I can't, I think it was in the spring last year, so about a year ago. It was episode 214. And it was called the Truth About Menopause and Hormone Therapy. So if you want to go to that one first, you can and then continue with this discussion. And with that, welcome, dr Rosensweet. Thank you so much for coming back.

Dr. Daved Rosensweet: 7:16

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

Sandy Kruse: 7:20

Yeah, it's good to see you. I was just saying to Dr Rosensweet he's got a beard, he looks very handsome. He's doing well. I am so happy to have you. So tell us a little bit about your history and how you got into this, because I think it's important if somebody didn't hear the first podcast to understand your story, because you were way ahead of your time, because a lot of women during that time were not taking hormone replacement therapy. So let us know what the deal is.

Dr. Daved Rosensweet: 7:53

Well, I graduated medical school loving medicine I love medical school and started asking the question right as I was in my senior year about, well, what tools do I have to help people heal? And I began searching and was on the ground floor of what's become functional medicine and was in my functional medicine office in 1992. And one of my patients that I knew really well, deborah. She came storming into my office before office hours. She was in her 40s, she was brilliant, she had retired in her 40s. Think about that, what it takes to do that. And she said I'm going crazy. I don't think you know me. I just feel awful, I'm going insane, please help. And the way the universe works, I just feel awful like I'm going insane, please help. And the way the universe works.

Dr. Daved Rosensweet: 8:50

The divine had connected me up with Dr John Lee, a pioneer in progesterone, a few months before and I gave Deborah some progesterone and three weeks later I got a letter from her saying oh my God, I'm myself again. And that was so dramatic to have that little of an intervention result in something that dramatic. So it really caught my attention because a lot of medicine can be a slow moving train. And, lo and behold, deborah referred. I got more interested and within a very short period of time I said I'm going to just hunker down on getting good at menopause. There's a lot to it. There's a lot of moving parts. We're playing with some powerful biochemicals here. I'm going to specialize in it and that's how it originated for me and it went woman to woman really. Referral to referral.

Sandy Kruse: 9:48

And here you are now. Yeah, okay, so you know things have changed in the last few years, where everybody's talking about menopause now and everybody's talking about menopause now and everybody's talking about hormones. But a lot of women are still being told you're too young for menopause, even in their 40s, and you know what is that cost to a woman in delay in treatment. If she has significant symptoms, it doesn't matter what her age is.

Dr. Daved Rosensweet: 10:29

Yeah Well, let me back up for a minute and give you a view of what is going on in women and in men. Same thing At the age of 20, we're at our absolute maximum output of ovarian or testicular hormones and they decline from that point on all the way into our 80s and 90s where they zero out pretty much and somewhere along the line these are the most powerful biochemicals in our body. Somewhere along the line the loss of those powerful biochemicals trigger stress responses, interfere with sleep, with mood, with vaginal health, with libido, with muscles, because these hormones they affect every cell, tissue and organ in our body. So very few women detect the early changes and very few men do. In the world of men, for example, a teenage, young man awakens with an erection every morning because his testosterone is so rich and then that goes away. But they don't necessarily notice that. Well, things are happening to women. Comparable Things are going away. They're changing a little bit but it's not dramatic.

Dr. Daved Rosensweet: 11:49

But sometime for 80% of women, somewhere in their late 30s or 40s or certainly by their 50s, the fall in hormone levels, even though they're still menstruating. The fall is so significant that strong symptoms develop. And I always think that that's a blessing because the symptoms are so strong, they interfere with day-to-day life so much that they inspire women to go out and ask the question, what's going on here? And to get some help. And I think that's the beauty of those symptoms they're awakening us to. We want to address something here. Same thing that's going on for men. They're noticing some mild changes and then a lot of men are losing their erection. How did we know that? We didn't know there was an andropause until this wild drug came out called Viagra, and it had explosive sales. And all of a sudden we realized something's going on with men here. So yeah, the symptoms occur for 80% and best case, they're the inspiration to seek and get excellent at their own internal hormonal system. You know, hundreds of years ago there was no menopause. No one was living that long, and now there is because we're living so long.

Dr. Daved Rosensweet: 13:23

So the best case scenario is that a woman gets a handle on this whenever she thinks to do so and has a major job to do at that point. It's technical enough and requires legal stuff enough that her job is to find someone who's excellent at replenishing these hormones. Her job is to find someone who's excellent at replenishing these hormones, go shopping until she finds someone who is really good at it, who she really trusts and really enjoys and enjoys the partnership of figuring it out together and getting it great. That's the main job. A lot of women, of course, definitely want to know more about it, and you have a link to a free copy of our book that women could download a PDF of. It's fun to know stuff about it, but I always like to start with. The main job is finding that provider who's really well-trained, loves the work, is specializing in it. Best case work, specializing in it best case.

Sandy Kruse: 14:25

I agree with that because you know I honestly, dr Rosensweet, I've been on my own little journey because I'm going through menopause without a thyroid gland and not a lot of people get into that, but a lot of the symptoms of thyroid dysfunction and my medications will work differently depending on what's going on with my estrogen and it gets so confusing. So having somebody who gets my unique situation, I think, has been a lifesaver for me. Absolutely what you're saying, because some people but here's another question, and I know a lot of women are still very anti-hormone. So and then you hear some women say, well, I don't have any symptoms, and I think that, okay, well, you hear about that. Some women have less symptoms than others. Some maybe are not as intuitive with their body and they don't really realize. You know, like you were saying at the beginning, if they're a little more subtle they're just like slough it off to meh, who cares? But the big question is does everybody need a little bit of bioidentical hormone to age better?

Dr. Daved Rosensweet: 15:52

Absolutely positively, with great certainty. Yes, the only caveat would be I wouldn't call it a little bit, I'd call it the right amount. So there were several subjects that you cruised through right there, and beautiful ones. I'd like to tease it apart a little bit. Yeah, yes, there's about 20% of women who do not experience symptoms, and those are the women I'm most concerned about. The rest of the women have life-stopping symptoms and they get inspired or they just ride it out because they're afraid of hormones. So let's look at fear of hormones. There wasn't any specific medication that hit the fear button like hormones have. None have. Many should have, but none have. And it was based on false information. Prior to 2002, the most popular and profitable drug for the pharmaceutical industry was hormones Premarin and PremPro. 18 million American women were on them. 40% of all American women in menopause were on these hormones. So it was going on royally and these women were doing better, that's for sure.

Dr. Daved Rosensweet: 17:14

And then out comes the false reporting of a study, the Women's Health Initiative, in 2002. And overnight that 18 million dropped to less than 2 million. Because it scared women. It said women who were on hormones were at increased risk for breast cancer, heart attack and stroke. Now that was false. Can you believe it? That's what the press got a hold of. There was two arms of the study. One of them was with Premarin alone. The women who were on Premarin alone had a 21% reduced risk for breast cancer. Taking Premarin reduced their risk for breast cancer. There was a statistically insignificant increase when it was PremPro Premarin combined with a very marginal, questionable, uncomfortable molecule called a progestin, but it had a statistically insignificant increased risk. But they reported it as increased risk. They didn't say statistically insignificant, scared the medical community, scared women all over the planet. Dropped from 18 million women being treated to 2 million overnight Tremendous consequences. And it's scared women and providers ever since.

Dr. Daved Rosensweet: 18:32

By 2004, they knew that there was no increased risk, not even statistically insignificant, but that didn't get public. That didn't get a widespread press release. A widespread press release In 2017, the original study committee reported in the original journal. They retracted. They said after 18 years of follow-up, there is no increased risk. Hardly anyone's heard of that Retracted. The same study committee retracted it. And so in medicine, it was such a unique and misogynistic event to. But the world is recovering and there's been some pioneers out there who have been teaching us that no, there isn't increased risk.

Dr. Daved Rosensweet: 19:20

So just for your audience, if I may, I know I've been speaking a lot, but I'd like to give you the science on risk because I think it's so fundamental. Now, here I will be talking about it. But anyone can do the research and they'll see the same thing. And I cover this in my book in chapter three, the Risk. And then there's well, there's a couple of terrific resources to back this up. And here's the science.

Dr. Daved Rosensweet: 19:52

All of us, women and men, we're at risk for thousands of medical diagnoses. We're at risk for hundreds of cancers. As a male, I'm at increased relative risk for prostate cancer. That's new. It wasn't so when I was in medical school. And there's reasons why that risk is increased. Women happen to be at increased relative risk for developing breast cancer over other cancers. That's new. That wasn't true when I was in medical school. Given that, we're all at risk, here's the science. Women who are treated with hormones are at less risk for breast cancer, heart attack and stroke than women who go untreated Less risk. It even goes so far as women who've had breast cancer and have been treated for that breast cancer properly, they have an increased rate of recurrence than a woman who has a developing breast cancer brand new. But if a woman has had breast cancer and had that breast cancer properly treated, she's at less risk for recurrence if she's treated with hormones than if she's not. And there's exact analogies with men and prostate cancer.

Sandy Kruse: 21:12

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

Dr. Daved Rosensweet: 21:20

I sure do.

Sandy Kruse: 21:21

Yeah, so I interviewed her a while ago because she for anybody who's listening she's a former breast cancer surgeon and she talks actually a lot about what you just mentioned about the different types of cancers and breast cancers, because there's different types of breast cancers too, because there's different types of breast cancers too. So what you're saying is that, depending on how you were treated and how like your outcome, you have a less risk of cancer, breast cancer on hormones.

Dr. Daved Rosensweet: 22:01

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

Sandy Kruse: 22:15

Okay.

Dr. Daved Rosensweet: 22:17

Heart attack and stroke too, less risk. Any woman who's had breast cancer and had the breast cancer properly treated. She has a risk of the breast cancer coming back. However, if she's treated with hormones, the risk of that recurrence is less than if she's not treated. And it doesn't matter receptor site, none of it matters, just in general. If she's had the breast cancer properly treated, she's at a lessened risk of recurrence if she's treated with hormones.

Sandy Kruse: 23:00

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

Dr. Daved Rosensweet: 23:23

I mean hormones are powerful, they contribute to our overall health. Diseases have a multitude of origins and causes. So I wouldn't be so globalist to say hormones put you in a much stronger position to do well with your health. But, oh boy, the whole world of illness and its causes. That's a big subject.

Sandy Kruse: 23:47

It is a big subject, isn't it?

Dr. Daved Rosensweet: 23:50

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

Sandy Kruse: 23:55

Well, here's the thing, dr Rosenzweig. I think that hormones, hormones provide you with a vitality. I actually wrote an article about this in my sub stack about, and so I write a lot of explorative articles, meaning just more like critical thinking. Obviously no medical advice, I'm not a doctor, I'm not but it's more explorative. And one of the things I said and I'm not saying this to shame people who have chosen not to take hormones but you can tell, when you just look at a 55 or 60-year-old woman, you can almost physically see the way she moves, see the way she looks, see the way she acts her vitality on whether she's on hormones or not on hormones.

Dr. Daved Rosensweet: 24:52

Yeah, hormone receptor sites are everywhere in a woman's body, in a man's body. Everything gets affected in a positive way. It's big too. I mean you talk about illness, women who were on hormones, or young women who had robust, rich hormones. They were at less risk for troubles with COVID. Better immune systems Runs that deep. Better metabolism, better energy production, better thinking. Oh my God, there are zillions of estrogen receptor sites in the brain. There's zillions of estrogen receptor sites in the intestinal tract and the bones. They're everywhere.

Sandy Kruse: 25:36

Speaking of bones, you know I find the whole subject very fascinating because you mentioned at the beginning that it's not about too much, it's not about taking just a little, it's about taking the right amount. And the first year that I started to experience symptoms of late stages perimenopause, this is the first year that I went from 12 periods to four and I started to have hot flashes. And then all of a sudden since then, dr Rosensweet, I had these weird things where I had, you know, I have permanent damage to a bone in my wrist and I'm like I don't remember hurting myself. Same thing with my foot. And then I started to see a very, very specific hormone practitioner who was really customizing my formula. And when I feel really balanced, the pain isn't so bad, but the damage is done. It's done Like I've had MRIs and the bone there's a problem.

Sandy Kruse: 26:44

It's called osteonecrosis, so there's like lack of blood supply to the bone here, issue with the bone in my foot. So how common are issues with the bone in women who are maybe not optimized with their hormones latter stages perimenopause or menopause?

Dr. Daved Rosensweet: 27:05

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

Sandy Kruse: 27:16

I know.

Dr. Daved Rosensweet: 27:16

There are super common, almost universal things that happens to women's bones. As soon as they go into menopause they start losing bone at a very rapid rate and they lose bone so much that you hear of the long-term consequences of this. You hear the word osteoporosis and to many younger folks this is just a word. But the bones get so weak that by the time you get elderly and you've gotten severe osteoporosis, all it takes is a fall and you fracture a hip. And you know very few women live beyond a year after a hip fracture and the same is going on in men. And yet, replenishing the hormones even if you've had bone loss, you can get bone replenishment. So whenever you pick up on the need for treatment for hormones, you can get bone restoration or bone stabilization. That's very, very crucial. It really brings up the topic of the long-range stuff. So many women know the short-range stuff hot flashes, night sweat, can't sleep, mood, dry vagina, pain and intercourse. The list goes on and on and on. And for the initial part of my career this was very exciting to treat because the results of treatment replenishing the hormones was so rewarding, because the women felt so much better. They felt great.

Dr. Daved Rosensweet: 28:49

But I started to realize over time that it was the long range stuff that mattered so much. For example, in medical school I was taught by a gerontologist that what's really happening to the elderly is they're losing their muscle, their bones and their mind. So you want to do something for them, take care of the sarcopenia. And sure enough, when women lose their testosterone, they lose their muscle and they wind up in canes, walkers, wheelchairs, adult diapers and then assisted living facilities and nursing homes.

Dr. Daved Rosensweet: 29:24

And I started realizing that the importance of replenishing hormones had consequences at the age of 80 or 90. And people's lives mean as much to them when they're 80, when they're 90, but they sort of have to surrender to the losses unless they protected their muscles. And in order to protect your muscles, if you're a woman or a man, you must have adequate testosterone and also work out. You gotta be active. So the long range stuff, protecting the bones, protecting the muscles these are hidden things. People don't necessarily think about it. And then I mean the number of osteoporotic fractures is astronomical. It's more of an illness than breast cancer is.

Sandy Kruse: 30:19

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

Dr. Daved Rosensweet: 30:33

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

Sandy Kruse: 30:38

No.

Dr. Daved Rosensweet: 30:39

Yes, my mother wouldn't let me get near being her doctor until it was time and so and there was some advantage to do that, and both of them had recoveries in certain ways. At recoveries in certain ways, we always say it's never too late. And then the ideal thing is to start working with hormones. When a woman's in her perimenopause, or a man is getting the first signs of loss of hormones in his 40s or his 50s, this is the easiest time to intervene and the easiest time to keep the ship steady, so to speak. Yet we'll do it at any time. If a woman's been without hormones for 10 years since her last period, there are special medical considerations we must take into account because of the consequence of being 10 years without hormones. So we work with women who haven't had them for a while in a very specific way, covering some other bases, to make sure they get treated safely. But yeah, the easiest time is in the premenopause. But we say, hey, listen anytime, anytime you think about it, go after it.

Sandy Kruse: 32:01

Wow, can you, like, just you know, very quickly say like what is it that you have to do different for a woman who, let's say, she went to menopause at 50? Because I know there's some people, you know I always say I reserve the right to change my mind because, you know, research changes. Just like we saw right, we saw that how much research can go from one extreme to the other. So what if you do change your mind? What do you need to be cognizant of if you're 60 and haven't had a period since you were 50?

Dr. Daved Rosensweet: 32:39

Well, the job becomes the same To find a provider, a medical doctor, an osteopathic doctor or a nurse practitioner who loves this work, has done extra training in it because we don't learn this in medical school or residency and is really good at it. That's the only job of the woman or the man. Then the job of the provider is to do the same thing that was done with you. You've told me enough to know that you reach the right kind of provider. They understand that every woman is individual. They don't make a big deal of it. They give you the resources to figure out your own internal amounts and balances and individualize it for your particular self. Well, it's the same thing when you're 60 and you haven't had a period for 10 years.

Dr. Daved Rosensweet: 33:39

Now there's a few extra things that we pay attention to, because there's been loss of the protection that estrogen has on the arteries. A woman who's been without these hormones for 10 years, she might have a special vulnerability to arteriosclerosis and a clot. So we have to do a little cardiac investigation. Not hard to do, that's the main thing. Sometimes we need to do coagulation stuff to make sure that the woman isn't going to have a blood clot, but the process is the same. We do tend to go lower and slower because 10 years without hormones means the hormones receptor sites in her body have gone dormant. So part of the treatment process includes a gradual awakening, reawakening of the hormone receptor sites. So we tend to start lower in the dosages and do the increases slower.

Dr. Daved Rosensweet: 34:43

But the process is the same as you went through. It's linking up with a provider that loves to team the thing. That's how I. When I first went into treating women in menopause, there was very little known, almost zero, and I knew enough about symptoms and stuff and hormones enough. But the hormones were going into the woman's body. So I figured out I would have to team up with the women and together we would have to figure out what was right for that individual woman because they were the ones experiencing the hormones and it was perfect. It was. It was a perfect system because invariably we'd start the women off on the four hormones and start them low and gradually increase them and we'd wind up adjusting them according to the balance and the amounts of that individual woman. Well, the same process needs to go on when you're 60. It's just a little lower and a little slower for most women.

Sandy Kruse: 35:45

That's what I love about you, because you're a doctor that actually listens to his patients. Because you know there's a lot of gaslighting out there with women and you know doctors who will still quote that old antiquated study, the Women's Health Initiative. There are doctors who don't really pay attention to the symptoms and, just like what you said, I actually work with a nurse practitioner and we talk about because you know you might be I know that you're a big fan of biased right? Do you want to talk a little bit about that, about how you can play with the ratios? That's why it's just such a cool way of doing estrogen, right?

Dr. Daved Rosensweet: 36:31

Yeah, you know there's. Really, when we're talking about replenishing hormones, we're talking about the hormones that come out of the ovary, and there's four of them. There's the estrogens progesterone, testosterone and DHEA. I said the estrogens. There is no hormone called estrogen. There's three of them, three major ones, three different estrogens, and one of them is estradiol, that's the most potent estrogen that the ovary produces, and the second one is estrone. It's about 80% as potent as estradiol. And there's a third one called estriol, that's about one-eighth as potent. Three estrogens. However, there's more estriol than there is the sum of estrone and estradiol. There's a prevalence there in which estriol is. There's more of it. So the original.

Dr. Daved Rosensweet: 37:31

There's a couple of pioneers who really brought this out to our awareness Dr Jonathan Wright, and he said if that's the way nature's designed, why don't we treat women like that? Well, he was really going much deeper than that. There was a medical doctor who was an oncologist at the University of Nebraska in the late 1960s, who was studying the hormonal patterns of young women and also the hormonal patterns of women who had breast cancer, wondering if there was a link, and he was doing 24-hour hormone testing, which has remained the gold standard since the 1960s, and what he discovered was there was more estriol in a young, healthy woman than there was the sum of estrone and estradiol. There was 1.3 times as much on the average estriol as there was the sum of the two most potent estrogens Women who had cancer. They had much, much less esterol and Dr Lemon proposed that esterol was cancer protective. And Dr Wright discovered his research in the 1980s.

Dr. Daved Rosensweet: 38:47

And Dr Wright said instead of using Premarin, I know that there's pure molecule, identical hormones out there. They're being produced. Why don't we see if we can get some? And he went to a compounding pharmacy who did find pure same molecule estradiol, testosterone, progesterone. Same molecule was being produced out of a plant source, beginning in Mexico, by an American. It's a fascinating story.

Dr. Daved Rosensweet: 39:27

And Dr Wright radically proposed look, if we're going to treat women, why don't we just copy nature? Why don't we just treat women instead of with just estradiol alone, because that's not what's going on in them. Why don't we treat with estriol plus estradiol? And he had a laboratory that was doing 24-hour urine hormone tests and he was fiddling with the ratios how much estriol compared to how much estradiol and he learned that for most women, if you give them 80% of a formulation of Estriol and 20% Estradiol. You're going to replicate the pattern, that's the young, healthy women, and that's the goal. Don't reinvent the woman, just do the original design. It's really amazing. And then in the 1990s I'm sorry if this is too detailed. How are you doing here?

Sandy Kruse: 40:20

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

Dr. Daved Rosensweet: 40:23

In the 1990s, along comes these researchers at Tulane that discovered the estrogen receptor sites and they discovered there was two major ones. They called ER alpha and ER beta. And when you look at a woman's menstrual cycle, every single month she is preparing for reproduction, the whole first part of her cycle. She's going through a phase in which the lining of her womb, the uterus, is being developed, new cells, brand new cells and ultimately to receive a fertilized egg if possible. What we also realize that the whole first part of that menstrual cycle this is from the first day you menstruate to about day 12, is also you're getting preparation for breastfeeding Every single cycle. Go figure, and women can feel this they're actually getting more breast glandular cells in their breasts and breasts get fuller throughout the course of many women's cycle. Many women feel this If there's fertilization, this goes on to pregnancy. If there's not fertilization, everything disappears. All the proliferation of the uterine lining and the proliferation of breast glandular cells. They disappear Ultimately, the uterine lining there's zillions of cells there it falls out and that's what menstruation is. And ultimately all those new breast glandular cells preparing for breastfeeding, they disappear by a process called apoptosis.

Dr. Daved Rosensweet: 42:12

I always liked that word. I thought that was pretty descriptive and my point is this that the whole first proliferation phase is under the inspiration of the receptor site ER alpha. When a hormone interacts with ER alpha, you get proliferation. When a hormone interacts with ER beta, you get deproliferation. So that cycle is divided in a menstruating woman into proliferation and deproliferation. Er alpha, er beta the main interaction with ER alpha proliferation is estradiol. Interaction with ER alpha proliferation is estradiol. The main interaction with ER beta is estriol.

Dr. Daved Rosensweet: 43:01

So Dr Lemon in the 60s says estriol is cancer protective because it supports deproliferation. But no one knew the actual mechanics until the 1990s. The bottom line in treating women in menopause is to do everything we can to prevent breast cancer. We don't want breast glandular cell proliferation in a midlife woman. They don't need new breast cells and that's a very vulnerable time in the life of a cell. You got cell division, you got exposure of genes and dna. You don't want to have mitosis and cell division. You want to have the emphasis on deproliferation. So this is why I favor treating with estriol, treating with bias. Really, estriol is beautiful, it's amazing, it's wonderful, and so is estriol, just copying nature. This is not rocket surgery here. That's why I like biased, because I love the emphasis on deproliferation.

Sandy Kruse: 44:03

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

Dr. Daved Rosensweet: 44:17

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

Sandy Kruse: 44:19

Yeah.

Dr. Daved Rosensweet: 44:20

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

Dr. Daved Rosensweet: 44:44

I really want to know what's true for young, healthy women. They said sure, and they gave me a lot of money and we interviewed 600 nursing students between the ages of 18 and 29. 100 of them were regularly menstruating, which allowed them to be candidates. 500 were not. Think about that. And we got the statistics. We ran 24-hour urine hormones on these young, healthy nursing students and Dr Lemon came up with 1.3 as an average. We came up with 0.9 as an average Very close Once again, much more estriol than there was either estradiol or estrone. So this wasn't just something based in the 1960s, it was based in 2010. We're in the process of publishing that study, actually.

Sandy Kruse: 45:37

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

Dr. Daved Rosensweet: 45:42

I was done Okay.

Sandy Kruse: 45:45

So I have a question, because you know we are bringing into young women into this conversation, because what you're doing is trying to almost mimic the part of the cycle of a younger woman where you're not building, building, building to get pregnant, from what I'm understanding. But why do you hear of women who have menstruation issues? They're not regular in their cycles. They get put on the pill, right right. This is what I'm saying Logically, dr Rosenzweig. It doesn't make a lot of sense to me because you just said a lot of women are not even having regular cycles, so how is that going to set them up for menopause, to have a healthier menopause?

Dr. Daved Rosensweet: 46:37

Well, what a question.

Sandy Kruse: 46:42

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

Dr. Daved Rosensweet: 46:45

Here's what's big about it. I'll tell you historically what it was like for me. I graduated medical school, I went into my rotating internship. These were very, very challenging years. Medical school was hard, really hard, and one of my very first jobs when I got done with my internship was I worked for Planned Parenthood and I went. Oh God, this is just like fantastic. I'm dealing with young, healthy women and I don't have all these just tremendously complex medical cases to deal with. So it was such a relief and I don't have all these just tremendously complex medical cases to deal with. So it was such a relief and I was getting a salary. It was a miracle to me. But within three months I resigned Because I started thinking we're giving young women a pill that's powerful enough to stop them from ovulating, even though they're called low dose.

Dr. Daved Rosensweet: 47:48

I went there's something wrong with this. We shouldn't be trying to interfere with ovulation in young women. And I got so uncomfortable about it that I actually resigned one of the best jobs I ever had, I think. Intuitively, at least for me, I went this is too big of an interference and I understand that contraception is extremely valuable and extremely important. Yet I grew up in an era when there was a lot of successful contraception. My dad told me here's a condom. It works great. Add a diaphragm and you'll be fine, and we're okay it's great.

Dr. Daved Rosensweet: 48:29

It's great. I'm saying that because, as much of a blessing people have considered the pill to be, we've learned over time that it's got some problems with it. You stop a woman from ovulating, you stop the progesterone in her cycle, you give her an artificial progestin. So I know this could be disruptive information, but my favorite colleagues and I, we look at this and we're not comfortable with the pill. So why have the pill be the remedy for menopause? I'll just drop the contraception issue for a moment and go why have a pill be a remedy for the perimenopause? What's going on in the perimenopause is very clear. Instead of having these rich youthful levels, you got less. So you interfere with the brain and the ovary and the signals get off and ovulation, like you, went from 12 periods to three periods a year. It's very understandable physiologic, but the remedy, once you understand it, it's such a blessing. Just replenish the hormones, use the same molecule, use an organic base to carry the topicals. I'll slip that in and adjust it for every woman, individualize it and do it for her whole life. Her whole life.

Dr. Daved Rosensweet: 49:57

Well, you talk to a man, for example, who lost his erection. Talk to a man, for example, who lost his erection and he gets on testosterone and his erection returns, as does his libido and his strength and his clarity of thinking. And you say to that man you may have to be on this for your whole life. And you know what the man says Hallelujah. You know, it's a miracle. And women have been frightened like there's something wrong with it for their whole life. No, it's a gift. It's part of the miracle of life that we've been given this gift of bioidentical hormones and a lot of knowledge on how to use it. So why would you ever want to stop? I'm sorry, I must have taken a diversion in the road there.

Sandy Kruse: 50:42

No, I mean you brought up a couple of really important points there, because there's the pill that is recommended for young women when they have period problems. The pill is also recommended for women in their 40s, when they're starting to go through perimenopause. So is the IUD. I know, you know, when I was 18, I was recommended, because I had heavy periods go on the pill. I went on the pill for one year. I had major issues. I went off the pill. Then again in my forties I had some issues and I was told go on the Marina, get the Marina IUD, get the Mirena IUD. I didn't do it, but it's like we keep getting these. I don't know band-aids.

Sandy Kruse: 51:33

So that was an important piece of this conversation. But I need to get on this because you're talking about testosterone and I know that testosterone is important for women and we've talked about that. I think we talked about that in the first podcast. But here's a question, because for men it's less talked about. You mentioned the erections. That's maybe an obvious or not obvious sign for some men. But then there's also things like mood and vitality and all those factors that come with a lower testosterone. You know the saying grumpy old men, right?

Dr. Daved Rosensweet: 52:13

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

Sandy Kruse: 52:17

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

Dr. Daved Rosensweet: 52:36

It's more like this. Okay, any man, let's say, for example, who's developed significant symptoms and loss of erection is a very significant symptom for most men, but you mentioned others mood, energy, muscle strength, drive, motivation, a lot of stuff. That is some of the finest qualities of a man. Being a man gone or diminished. Once a man starts getting interested in getting treated 40s in his 40s, in his 50s, even in his late 30s, because the symptoms have been coming on, we ask a very fundamental question Do you want to have children, any more children? And if the answer is no, we proceed to testosterone in most cases. If the answer is yes, I would like to have more children, then here's the caveat If we give a man testosterone, we're going to signal to the man's brain that, oh, there's enough testosterone and the man's brain is going to shut down the stimulating hormones that go from the pituitary gland to the testicles and there's going to be no more stimulation in the testicles to do their thing, which is to produce testosterone it's not needed, it's already being treated with it and to develop sperm, it's already being treated with it and to develop sperm.

Dr. Daved Rosensweet: 54:10

So once we give a man testosterone, we shut down his own testicles and he relies on the testosterone he's being treated with. Well, if he decides to have a child at that point and we stop the testosterone, will his testicles recover the ability to produce sperm? That's an unknown. So for a young man who still wants to have a baby, we don't jump in to just start treating him with testosterone. We give him something that will stimulate his testicles to just produce more testosterone, which is possible. There's a pill to do that and there's also injections, hcg. Hcg happens to be my favorite human chorionic gonadotropin. It behaves like the pituitary stimulating hormone to the testicles. So a young man who still wants to have a baby, we try and stimulate his own testicles with that or some version of clomiphene or enclomiphene, which is a pill. So we try and stimulate the young men who still want to have babies, but we treat with testosterone, for those days have passed.

Sandy Kruse: 55:15

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

Dr. Daved Rosensweet: 55:30

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

Sandy Kruse: 55:47

On testosterone.

Dr. Daved Rosensweet: 55:49

On testosterone. If their own testicles aren't working anymore, they shrink.

Sandy Kruse: 55:53

It's like an atrophy right.

Dr. Daved Rosensweet: 55:55

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

Sandy Kruse: 56:16

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

Dr. Daved Rosensweet: 56:36

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

Sandy Kruse: 56:51

Now you mentioned atherosclerosis. We talked about women. A woman hasn't been on hormone replacement. She decides that at 60, she wants to start. You take the necessary precautions to just be sure that it's safe for her. What if somebody has plaque buildup already? What if it's a man or a woman? Can they still safely do testosterone therapy?

Dr. Daved Rosensweet: 57:21

Yeah, and there's caveats there. There's a unique situation with a woman that, let's say she's gone 10 years with no estrogen. Well, estrogen is very protective to the arteries of her body and including the coronary arteries, the ones that go to the heart, and if she's lost that protection she's vulnerable to get arteriosclerosis. Not every woman does, but a lot do. Without the protection of the estrogen and atherosclerosis of the coronary arteries. It looks like a boat that's been in the water too long and has barnacles on it. That arterial surface looks like there's a bunch of barnacles on it, so to speak, cholesterol plaques, and they become a provocateur for a clot. It's never the atherosclerosis per se that gives someone a heart attack Very, very rare but the clots that form on that barnacle surface, they're the trouble. They block the circulation and, worst case, they can break off and that'll cause a heart attack. They'll lodge deeper in the heart, they'll block off part of their circulation to the heart and that'll cause a heart attack. They'll lodge deeper in the heart, they'll block off part of their circulation to the heart and that's a heart attack.

Dr. Daved Rosensweet: 58:48

Well, there's this very, very, very rare situation where if a woman has been without hormones for 10 years and we put her on estrogen for one year, she's at risk for a heart attack Only for one year If she has a clot, if she has a clot in that coronary artery. If she doesn't have a clot that risk is not there. But if she has a clot, that clot is at risk for breaking loose and giving her a heart attack and it's probably because of the relaxation of the coronary artery. I don't know the exact mechanism, but the medical science is that for one year she's at increased risk for getting that clot breaking loose and giving her a heart attack. So that's why earlier in this discussion I said women who are a little older and 10 years without hormones. We're going to do a little more investigation to make sure they don't have a clot in there. So there's relatively non-invasive testing, for example a stress ultrasound, and when, by someone who's excellent at the stress ultrasound, they can tell whether there's a clot in that coronary, that's the least invasive. There's other methods you can use.

Dr. Daved Rosensweet: 1:00:06

So yeah, heart attacks big deal, protection with estrogen big deal. And the whole issue with men is different. There was this myth going around like comparable to the myth that was going around with women. It was false. The myth for men was they were more vulnerable to heart attacks if they went on testosterone Wrong. And thank goodness there was a recent study in the last couple of years that just totally sort of in my mind proved for once and all that testosterone is beneficial for the heart and does not lead to increased risk for men we kind of talked more about women.

Sandy Kruse: 1:01:04

Is there a specific contraindication where under no circumstances should you even entertain the idea of going on hormone replacement therapy?

Dr. Daved Rosensweet: 1:01:13

I personally can't think of one, but I can think of the opposite, and I think you've led us into one of the most important topics of all the consequences of no hormones. I can give you a written guarantee Women loss of bones leading to osteoporosis. Loss of muscle leading to sarcopenia. Loss of vagina, vaginal atrophy coupled with loss of the muscle that holds up the bladder leads to adult diapers. It leads to chronic genitourinary For many, many, many, many women. Loss of hormones leads to cognitive decline all the way to dementia for some Big one. Brain fog is a very common symptom of the initial losses for women. And the list goes on and on of the losses, because these hormones are so universal and they're so powerful that the loss of them have definite biologic consequences.

Dr. Daved Rosensweet: 1:02:20

So we always talk about the risk of this or the risk of that. I say let's talk about the near certainty of these troubles occurring over time, so that by the time you're in your late 80s. Well, we have on our medical board, we have a doctor. She's been in her previous lifetime in medicine. She was the doctor for nursing homes and I asked her one day what percentage of women who are in nursing homes are there because of low hormones. She said 80. 80% of women who are in nursing homes are there because of low hormones. So it's a big deal. Talk about risks.

Dr. Daved Rosensweet: 1:03:05

And then, because I'm a doctor and I've treated people of all ages, I get to know what happens to women and men in their 70s and 80s, women and men in their 50s. They're not thinking, oh, this is what I'm going to be like when I'm 80. Even if they've got parents who are going through some rough stuff, this won't happen to me, it does happen to them and we see the perspective of oh my God, if you can prevent this. This is one of the most wonderful things Because, like I said, people in their 80s, their life means a lot and they want to stay at home. That's the thing they want to stay at home, that's the thing. They want to stay independent, walking, talking and with their families.

Sandy Kruse: 1:03:48

Dignity, dignity.

Dr. Daved Rosensweet: 1:03:51

Life. Family life Friends.

Sandy Kruse: 1:03:54

Okay. So here's a question. I know that you have explained 24-hour urine and how that is the most accurate way to measure hormones. What if? Because cost always comes into play, dr Rosenzweig. So it always comes into play, and I do feel that people are more. I think people are struggling more with the cost of living and that sort of thing. So what would we know? 24-hour urine is the most accurate. What would be the next best way to test hormones?

Dr. Daved Rosensweet: 1:04:34

I don't know that it exists. You know blood tests, for example. They are so excellent for a thousand things. They're terrific, but by the time you're treating a woman or a man with hormones, there's a principle called pharmacokinetics that makes blood tests not work. And the issue is and we've done these studies ourselves, but lots of people have done these studies You're taking topical hormones.

Sandy Kruse: 1:05:11

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

Dr. Daved Rosensweet: 1:05:23

Okay. So it totally depends what kind of reading we get on the estrogen, depending when you applied your hormones. So we've done studies of we've gotten a fasting blood draw on a woman, Then we apply her hormones, Then we draw her blood at one hour, two hours, three hours, four hours afterwards. And the real issue is what happens during that time. Well, some women they get their highest level at two hours. Other women get their highest level at four hours, Same for men. And it totally depends when you draw the blood. You could be deceived. You could see a real low number if you drew a fasting or if you drew a woman who peaks at two hours, if you draw three hours or one hours or four hours. So unless you do initial studies on every single patient to see when they peak, you don't get good information about a woman or a man you're treating with hormones. 24-hour urine hormone doesn't matter. You're doing a full 24 hours. It doesn't matter when the woman applies her hormones. It totally eliminates the pharmacokinetic issue.

Dr. Daved Rosensweet: 1:06:39

Well, there have been attempts to come up with new stuff ever since I've been doing this Salivary testing. I can tell you it doesn't work. I have strong opinions. People will argue with me, discuss with me, but I really love my opinions. And saliva for ovarian hormones not okay. And then there's these new dried urine tests where you take four samples or five samples. They become extremely popular because they've got a super strength called marketing. But they run into the same pharmacokinetic issue when did you apply your last hormones? According to their instructions, you apply your morning hormones, let's say, at 9 am. Your next urine draw that you collect is at 5 o'clock. That's eight hours difference. You could have missed the entire offloading there. Pharmacokinetics urinating on the filter paper, extracting sticky steroids from filter paper, relying on hydration there's many reasons why I'm a strong advocate that this is not the state of the art in hormone testing and people should choose the state of the art because it matters to get it right. So, yeah, that's my strong opinion.

Sandy Kruse: 1:08:04

That's okay.

Dr. Daved Rosensweet: 1:08:06

If I thought dried urine worked. But the thing is, we've done cross studies. We've taken an individual patient and we've submitted a sample in the same 24 hours to five different laboratories and we see these wild discrepancies and so we've been very on top of this one. And we see these wild discrepancies and so we've been very on top of this one. We've done studies on this one and my current conclusion is 24-hour urine. It's fantastic. It's as inexpensive as any of these. You can now get it for $250 for a test, and we just test once a year for $250 for a test. And we just test once a year. We never test a woman in perimenopause ever, by any method.

Dr. Daved Rosensweet: 1:08:51

Why is?

Sandy Kruse: 1:08:51

that Really?

Dr. Daved Rosensweet: 1:08:54

Really.

Sandy Kruse: 1:08:55

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

Dr. Daved Rosensweet: 1:09:01

Exactly. Well, here's why. If I draw in the air here what a menstrual cycle looks like as far as estrogen levels go throughout a 28-day month, day one, day 28, I'm drawing what estrogen levels look like Pretty low when she's menstruating. Then they start to rise, then at day 12, they peak, then they fall, and then they rise partially and then they fall. That's what estrogen levels look like according to a menstrual month. They're very variable like that, but it's very predictable in a young woman who's ovulating In the perimenopause, like I say, the hormone levels have dropped, so her brain and her pituitary gland go. Something's amiss here. We need more hormones. Maybe we can put out some more stimulating hormones to stimulate the ovary, and you do In the perimenopause. The lows are picked up by the brain and you get these bursts of stimulating hormones coming out of the pituitary and the ovary responds and you get a peak come out of the ovary but it can't keep it up. So instead of this nice smooth-looking curve over the course of a month, you get something that looks like this Very erratic. It's totally dependent on when you test, what day you test her. How did I learn this? I had just discovered 24-hour urine hormone tests. I was brand new. I had a woman in the perimenopause and she's having hot flashes and she can't sleep. Well, this is a certainty that she's low in estrogen. But I wanted to test her. So I'm handing her a report that shows high estrogens and I'm saying to her but I know you're low in estrogen, I want to treat you with estrogen. And she looks at me like I'm saying to her but I know you're low in estrogen, I want to treat you with estrogen. And she looks at me like I'm nuts. You're a doctor, you did a test on me. You see high estrogens. You want to treat me with more estrogens. It's only confounding Testing a woman by any mechanism when she's in the perimenopause. You run the risk of confusing her. So we don't test women's hormone levels in the perimenopause ever. There's no value. She's already told me the story. You already told me the story. You said I used to menstruate once a month and then I started menstruating three times a year or four times a year. Why, well, where's your hormone levels? They've gone way down. So now you're only menstruating. We already know they're low and then you tell me a few other symptoms because you will have them by that time. You're going to have other symptoms. That was not the only other symptom you were having there.

Dr. Daved Rosensweet: 1:11:59

We test a hundred percent of our women at a certain point. When a woman first comes in for menopause, she hasn't had a period for three months or a year. We never test her. How did I learn that? I tested women who hadn't had a period for a year and they got to pay $340 for me to tell them that their hormones were low. I already knew it from the story. They hadn't had a period to simplify it, and I went you're charging them to test their hormone levels when they've already told you that they're zilch. So we stopped doing that.

Dr. Daved Rosensweet: 1:12:43

Here's when we test all women when they're in the menopause and they say to us oh my God, I'm myself again. Oh my God, I feel good, this is great. Then we test 100% of our women. Then we test 100% of our women and it turns out it's important. We test them then, because symptom alleviation is not the final answer, because we did a study of 54 women who said I feel great and what we learned was 50% of them were on estrogen levels too low to protect their vagina and bones over the long haul and 25% of them were on estrogen doses robust enough that they were at risk for breast glandular cell proliferation, even though they didn't have symptoms. Only 25% of them were in what we consider to be the absolute optimal zone. So we test and we fine tune, and we only have to test them once, because if they've titrated their symptoms away, they're close and they usually need a tweaking. Then we test them once a year.

Sandy Kruse: 1:13:55

That's brilliant, because I've never quite heard it described like that, because, hmm, I have a lot of questions and I know we're running low on time. But you know, at what point does a woman's hormones stabilize? Is it that magical one year of no periods, Like? When does it happen? And is it? Listen, we are humans, we're not robots. Our bodies still have rhythms, even though our hormones are not being produced like they were when we were 35. So at what point does it stabilize?

Dr. Daved Rosensweet: 1:14:37

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

Sandy Kruse: 1:14:46

Yeah, because here's the thing you hear, dr Rosenstreet. You hear all the time one year, no periods. Okay, now you're in menopause, it's this definitive line that you cross. But I know from experience at 55, it's not a definitive line really.

Dr. Daved Rosensweet: 1:15:08

Yeah, it actually doesn't matter that much.

Sandy Kruse: 1:15:11

Okay.

Dr. Daved Rosensweet: 1:15:12

If you stick with the general principle that at the age of 20, you're here and at the age of 90, you're zero, and you can go through an erratic period here where it's a little trickier to get things balanced. I think nature is just amazing, though. It forces a woman into the PhD program of getting it right right away. Because it's a rodeo ride, because things are up and down, so it's a little erratic, so it's the hardest time to get things evened out. But it puts you in the PhD program right away because once you get out of the perimenopause it's a piece of cake from that for the rest of your life, because you went and figured it out.

Dr. Daved Rosensweet: 1:15:51

For one thing, you figured out what does low estrogen feel like in my body? Well, I think I need a little more estrogen today. Well, what does low testosterone feel like? Because you're forced to figure it out in the perimenopause. I think the design is amazing. But it doesn't matter. Somewhere along the line you say I think I want hormones, you begin the process. You go through a learning curve of getting what these hormones feel like, how they alleviate symptoms. You figure it out and then you're on a cruise and so many women just get so good at it midlife, and then they just adjust it as things get lesser because their own ovaries are just going down to zero, same with a man's testicles. Does that answer that question for you?

Sandy Kruse: 1:16:42

Yeah, it does, Because I think exactly what you said. You know, I'm sure you've seen women in all sorts of stages and all sorts of symptoms of perimenopause. You know, I happen to think I had three years of crazy ups and downs, Like I. You know, sometimes I didn't know whether I was coming or going, but but I knew enough to go. Okay, I think my estrogen is low or okay, I feel like I have low progesterone. It's mostly this interplay between those two that I really could feel it in my body and that's something that you teach women, don't you? Which I think is amazing, because you actually have a whole list of symptoms. Okay, here's what you might feel if you've got low progesterone. Here's what you might feel. Yeah, yeah, I love it, Dr Rosensweet.

Dr. Daved Rosensweet: 1:17:44

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

Sandy Kruse: 1:17:52

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

Dr. Daved Rosensweet: 1:18:00

Oh yeah.

Sandy Kruse: 1:18:15

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

Dr. Daved Rosensweet: 1:18:33

Yeah, sometimes the things are a little more subtle with men, but for many, many men, they lose their subtlety when the erection starts to wobble, lose their subtlety when the erection starts to wobble and that is a 90 alarm fire for a lot of men. They do notice it and it's shocking and it's scary to a lot of men. So we're in a very similar situation that women are in. Well, you've got this often dramatic stuff. And what is its message? Find you someone who really loves this work, knows what they're doing and can partner with you to where you figure it out, and then you're on a cruise for the rest of your life. You don't have to worry about that kind of stuff or the risks of not having hormones.

Sandy Kruse: 1:19:27

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

Dr. Daved Rosensweet: 1:19:43

It's arterial disease. It's the same disease that has affected the arteries that feed the heart, have affected the arteries that feed the penis and you get a hardening of those arteries. You don't get good circulation. So the consequence to the heart is one thing. The consequence to the penis is you can't get enough blood in the penis for it to become erect.

Sandy Kruse: 1:20:09

I find it really interesting the way that you know, I guess medicine views this. You know medicine. The way that they're taught is like okay, let's just give a pill Viagra, let's not investigate what's going on with your testosterone, let's not investigate whether there's issues with the arteries, let's just give a pill because this is common, dr Rosenzweig. So they're not checking the testosterone levels, they're not checking whether there know, whether there's potential issues. So you know, this is why I love what you do, because you're going to do the testing, let's see what's going on. But you're also saying that testosterone in and of itself is not a risk factor for somebody who may have issues with their arteries.

Dr. Daved Rosensweet: 1:21:04

Let me put it this way low testosterone has similar risks and other risks. What the male body functions best at is an optimal level of testosterone, and if you get shy of that optimal level, you start getting decreasing testosterone levels. You run into a long list of problems. Erectile is just one. Loss of muscle, loss of mood, loss of bone these are powerful and they affect everything. So we want to have the optimal amount.

Dr. Daved Rosensweet: 1:21:43

One thing that we need to be cautious of in men's medicine is that we don't give too much. Same with women's medicine. We're very precise around the parameters that we use for treating a man with testosterone. Yes, we want to alleviate his symptoms of insufficiency, but at the same time, if you give too much, we wind up seeing laboratory tests that show us there's too much. They get too much estrogen made out of the testosterone they get. They raise something called sex hormone binding globulin. They can raise their DHT too high. So it's a wonderful science, just like it is with women, to get it right and you can't go by symptoms alone. You can overdose a man or you can overdose a woman and they can say I feel great. Most people don't. Most people women and men who are overdosed don't feel right. But a certain percentage of them feel supercharged. So it's called super physiologic dosing and we don't want to do that for the long run. In the world of hormones giving too much is an error. So when you link up with someone for testosterone you want to get someone once again that's really good at it, that understands all these concepts and knows how to guide you both through your symptom situation and your laboratory situation to get it just spot on.

Dr. Daved Rosensweet: 1:23:01

Viagra is a whole different story. There are a certain number of men as they start getting erectile dysfunction they will benefit by Viagra, but invariably they're low in testosterone first. So in our method we're mostly seeing men who've got symptoms of low testosterone. That's why they're coming to us and we start with the testosterone and we see how much quote mileage we can get out of the testosterone. How much improvement can we get with treating a man properly with testosterone. Once we dialed in the testosterone we give 100% of the men Viagra. We actually give them Cialis to Dalafil because it's more long-acting and we do that for the cardioprotective effects and it can add something to the erectile function. But we want to see how much erectile function we can restore with testosterone alone. We're going to add to dialyphil for every man sooner or later, but not in the beginning. We want to see how much quote mileage we can get out of the testosterone itself Once we get that dialed in. Then we add the Viagra.

Dr. Daved Rosensweet: 1:24:05

Viagra and I mean the Cialis. These were developed as heart medicines to dilate the coronary arteries. That's what they were totally developed for and they're really great for that. Turned out that in their studies the men were reporting back. They were getting increased erections. That's why it became an erectile drug. It had nothing to do with the original intent there. It had everything to do with the side effect called improved circulation to the penis, better erections.

Sandy Kruse: 1:24:37

Does it increase nitric oxide in the body?

Dr. Daved Rosensweet: 1:24:41

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

Sandy Kruse: 1:24:47

I think it does, I think it does. You know what this has been. Such an amazing conversation Now, just so unique Because I've heard you speak on a few podcasts. It's always unique. It's always a very unique experience and conversation. But of course, everyone's going to ask well, how to get a practitioner like yourself, because I know you can't treat every single patient in the world, so how does one go about doing that? We've got all the links, by the way, will be in the show notes for your book and the free download.

Dr. Daved Rosensweet: 1:25:28

But let us know how someone can work with somebody trained like you at iobimorg, she'll be able to check our list of all that we've trained, because that's the main thing I do is we train and mentor physicians and nurse practitioners on how to treat women and men. So we have a long list. And yeah, katie, at iobimorg she can link you up with someone that we've trained, most likely are you, uh?

Sandy Kruse: 1:26:11

do you have practitioners worldwide or only in the us?

Dr. Daved Rosensweet: 1:26:15

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

Sandy Kruse: 1:26:25

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

Dr. Daved Rosensweet: 1:26:33

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

Sandy Kruse: 1:26:55

It's our synergy that made it fun and interesting. I agree, I agree. Thank you and help me to keep going and bringing these conversations to you each and every week. Join me next week for a new topic, new guest, new exciting conversations to help you live your best life.