Balancing Hormones: What Your Doctor Never Told You with Dr. Daved Rosensweet - SUMMER REBOOT - Episode 281

Ways to connect with Dr. Rosensweet & grab a free PDF of his book:

https://www.menopausemethod.com/happyhealthyhormones/. 

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What if everything you've been told about menopause and hormone replacement therapy is based on outdated, misreported science? Dr. Daved Rosensweet, with over 30 years of specialized experience and founder of The Menopause Method, shatters common misconceptions while offering a revolutionary approach to hormone optimization.

The conversation begins with a bombshell revelation: the infamous 2002 Women's Health Initiative study that scared millions of women away from hormone therapy was retracted by its own research committee in 2017. The truth? Women who receive appropriate hormone therapy are at LESS risk for breast cancer, heart attacks, and strokes than those who go untreated. Yet this critical correction received minimal media coverage, leaving both patients and healthcare providers operating on faulty information.

Dr. Rosensweet explains that hormone decline affects virtually every system in the body, not just causing hot flashes, but impacting brain function, bone density, cardiovascular health, and immune function. He draws a crucial distinction between conventional hormone therapies (like Premarin, derived from pregnant mare urine) and bioidentical hormones that exactly match the molecular structure produced by human ovaries.

The discussion delves into the critical but often overlooked importance of progesterone, "the great calmer," which helps with sleep, anxiety, and even facilitates thyroid function. Perhaps most surprising is Dr. Rosensweet's emphasis on testosterone for women, calling it "the main hormone that'll keep women out of assisted living facilities" by maintaining muscle strength and bone density into advanced age.

Some of the most valuable insights include why topical application of hormones is safer than oral administration, why 24-hour urine testing provides a more accurate hormonal pictur

Chapters

• 0:00 Introduction to Sandy K Nutrition
• 6:49 Meet Dr. David Rosenzweig
• 11:53 Understanding Menopause and Hormone Decline
• 21:29 The Truth About Hormone Replacement Studies
• 34:04 Bioidentical vs. Synthetic Hormones Explained
• 46:41 The Critical Role of Progesterone
• 58:54 Hormones and Thyroid Connection
• 1:10:32 The Menopause Method and Testing
• 1:24:52 Topical vs. Oral Hormone Application
• 1:34:48 Estriol, Skin Health and Natural Formulations

Transcript

Sandy Kruse: 0:02

Hi everyone, it's me, sandy Kruse 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. Friends, balanced living works. Hi everyone, welcome to Sandy K Nutrition, health and Lifestyle Queen.

Sandy Kruse: 1:34

This is my checkpoint for my summer reboot series. I haven't recorded any preambles because, honestly, I'm enjoying my summer, my friends and I feel we all should do that and we all should take a step back and then recharge and then come back really in our own full, true power and essence. But today I thought I would check in just because this episode was one of my most popular. I think it was in 2024. And I have Dr David Rosensweet coming back again for part two in the fall. So I am going to ask you to do a couple of things for me. Number one share this episode with as many friends as you possibly can. Share it on social media. Share it wherever it is that you share information. Number two I'm going to ask you to follow me on Instagram. I am most active there. I am active there all summer long. I provide really informative insights on our wellness from all perspectives body, mind, spirit, soul. Number three I'm going to ask you to review my podcast. I think the best place to do that would probably be Apple or Spotify, and if you rate it and review it when I say review, that means provide me with a few kind words on how my podcast has helped you.

Sandy Kruse: 3:24

It is five and a half years now, or so, just shy of five and a half years that I have been bringing really important conversations with amazing people in the industry of wellness, not to dictate what health means for you or not to speak at you, but to provide you with just those breadcrumbs to help you understand your own wellness and if it applies to you. Because one thing I say all the time is that we are all bio-individuals and we are such complex human beings we are not robots. So anything I talk about on my podcast is really not advice for you. You'll need to go and speak with a practitioner who knows you and your own unique situation. One of the things I've been talking about for a while is how we become so accustomed to take advice from people through social media and podcasts when that's not really what it's meant for. We can't take advice from people who don't know us and our unique health history and our unique genetics and how we grew up and our traumas and all those things. So that's what this podcast is for. It's here just to give you those little breadcrumbs that you can take with you as information in your back pocket to speak with your own practitioner that knows you.

Sandy Kruse: 5:05

I just really really wanted to state that I've written a few amazing, amazing articles and not to toot my own horn. But I'm going to do that because they're amazing, because you're not going to hear about menopause like this, spoken about menopause like this, like I did in a few articles, recent ones, in Substack. So follow me there. It's sandycruzsubstackcom and it's S-A-N-D-Y-K-R-U-S-E. Be sure that you are subscribed to my podcast, so you're going to get all of my newest episodes coming this fall. Lastly, I want to thank you all for hanging in there with me all these years and supporting me and my primary goal, which is not to give you a million discount codes of products that I don't even believe in or even know. My goal is to share information with you so that you might use it to help you live your best life and age better. That's my goal. It's always going to be passion over profit for me, so I want to thank you all so so much for hanging in there with me and I hope you all have an amazing, amazing summer with family and friends.

Sandy Kruse: 6:42

Hi everyone, welcome to Sandy K Nutrition, health and Lifestyle Queen. Today with me I have Dr David Rosensweet. He is the founder of the Menopause Method and I wonder doctor. Dr Rosensweet graduated from the University of Michigan Medical School in 1968. Medical School in 1968. He's been in private medical practice since 1971 and has had offices in New Mexico, California and Colorado, and is currently in practice in Southwest Florida. Dr Rosensweet was the clinical physician involved in the very first nurse practitioner training program in the US and in charge of health promotion for the state of New Mexico. He teaches health professionals about the treatment of women in menopause with bioidentical hormones. Dr Rosen sweet 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 Bioidentical Hormones.

Sandy Kruse: 8:07

And today we're going to be talking about hormone replacement therapy using an approach that will be actually a very new concept for many women, and this is Dr Rosensweet's the Menopause Method. Now, that's quite the bio. Dr Rosensweet, I'm really happy to have you here and I'm excited and I want to understand you've got an extensive background and so much history what led you to where you are today? And you have to tell me how long has the menopause method been around. It's been a while, right, about 30 years, yeah, yeah. So I'm happy to bring this to light for many women, because this is not the standard of care. So tell us your history on why you got involved in women's hormones.

Dr. Daved Rosensweet: 9:00

Well, when I graduated medical school which I loved, I loved medical school I kept looking for other tools and got into nutrition and toxicity and what eventually became functional medicine or holistic medicine. Santa Fe, a patient that I knew really well, came storming into my office one morning before office hours and was desperate. It was so unlike her. She was so brilliant, she had retired in her 40s and to see her upset was really remarkable. And she said I'm telling you, I'm going crazy, don't pretend you know me, I am really miserable.

Dr. Daved Rosensweet: 9:43

And I had well, serendipitously, or there's always divine guidance in our lives, and certainly in mine and certainly in my career. And I had just spoken to a world expert on progesterone. This was 1992. And I gave her some progesterone. She was in her mid-40s and two weeks later I got a letter from her saying oh my God, I can't believe this stuff, it's helped me so much. I'm myself again and that was very impressive. But I haven't really taken hold of the reins of my career so much as it's unfolded. And before I knew it she referred other women and you know, there I was going down a pathway that was very familiar to me. I love biochemistry, I love hormones and sure enough, my practice was pretty much menopause and now andropause as well. That's how it happened, deborah.

Sandy Kruse: 10:43

Wow, that's amazing. So you know it's. I do believe that you know our experiences lead us to where we belong right, yeah.

Sandy Kruse: 10:52

And I have to say I hear on my end. So I'm a registered holistic nutritionist but a holistic health practitioner and I am certified in endocrinology and hormones for nutritionists and I hear so much, Dr Rosen, sweet, I hear women suffering, I hear it. It's a big problem and I'm sure that you read that huge article. Uh, women have been misled about menopause. It was in the New York Times last year. It was a big article and now it seems to have more and more people are actually paying attention that this is a very real thing. It's not in our heads and it can be very drastic for many women know it can be very drastic for many women. So perhaps define what is menopause and what's the difference between menopause and perimenopause.

Dr. Daved Rosensweet: 11:52

Well, give you a little background. Young women and young men put out their peak amount of ovarian for women, testicular, for men hormones at the age of 20. And there's a gradual decline over the years for both, and it never stops. That decline never stops. Women have this rather profound event midlife is there's no longer enough estrogen to form a lining to menstruate. So it's pretty clear that something went on there, and both for women and men.

Dr. Daved Rosensweet: 12:32

These are some of the most powerful biochemicals in our body and they're everywhere. They affect our brain, our bones, our arteries, our sexual functions, our sexual functions, our energy, and so when we get depleted in them, traumatic symptoms occurred. And that's been happening for a long, long time, and what was pretty silent about it was back in the 40s and 50s, 1940s and 1950s. There was remedies for this. So there was 40% of American women were actually on hormones. They were on horse urine-derived estrogens and sometimes with a cousin of it, and so it wasn't that big of a topic because the women who are a lot of women sought the help, got the pills. And then it become a much bigger topic because, in 2002, a false reporting of a study suggesting there was risk when it wasn't so, scared everyone away from the whole field. And 18 million American women who were on Premarin and PremPro and also some, compounded it, dropped down to less than 2 million.

Dr. Daved Rosensweet: 13:54

And the consequences of not being with these hormones at an age when women were speaking up, they collided and there was great misery because, uh, you know, it's actually a fortunate event that midlife so many 80 of american women have such tough symptoms to deal with, because it's the purpose of illness is to get to attract our attention and answer the question what's going on here? And the stronger those symptoms, the stronger the calling. And menopause has a very strong call to it, because for 80% of the women, the symptoms are so intense and then the ideal response is what's going on and what can I do about this? So it's a good thing that the symptoms happen, because they inspire many women to get the remedy. And just although it's not relevant for our talk, the same thing happens to men.

Dr. Daved Rosensweet: 14:59

Men have been losing their erection midlife for a long time and it's getting worse. It's occurring earlier and earlier. Yes, men experience the same losses. We didn't know about it. It was pretty silent until Viagra and Friends came out, in which we became one of the most popular drugs of all time, so it's not unique to women. And along with the loss of erection from men, there's a lot of other losses that have really changed the nature of men's life. So yeah, it's a big deal. Perimenopause menopause, you could say. Perimenopause begins at the age 20. Yeah.

Dr. Daved Rosensweet: 15:40

But nobody experiences those issues of the slight declines, or very few women do. But by 30, there's women out there who are having experiences that are different, and by 40, there's more women who are having experiences related to insufficient ovarian hormones. So it's a spectrum. Spectrum perimenopause. We define menopause when there hasn't been a period for 12 months. What do you think of that. It's pretty great because the decline never ends. Well into your eighties, women are still declining and reaching and approaching zero.

Sandy Kruse: 16:20

Okay, I have to ask you about that, because that whole wait one year before you do anything. A lot of women are suffering in that one year. You know they don't have a period, let's say for eight months. Their doctors won't help them. There's a misconception there, sandy.

Dr. Daved Rosensweet: 16:39

Yeah, the one year has to do with one thing, okay.

Dr. Daved Rosensweet: 16:44

The one year has to do with one thing Gynecologists have identified that women can still be fertile until one year without a period. That covers almost every single woman. It relates to fertility. It has nothing to do with when it's optimal to start dealing with hormonal decline. And we're dealing with hormonal decline right now in women in their 20s, women in their 30s, because these declines, which I describe very much in detail in my book Happy Healthy Hormones and your audience is welcome to the latest edition, If you wait a week, we're just publishing the eighth edition of it I define how that decline plays out first in the loss of progesterone, usually then so yeah, I'm glad you said that.

Dr. Daved Rosensweet: 17:40

It's only to fertility. I'm so glad Tell a man who's 45 that he's losing, and he's losing his erection, that well, he should probably wait till he's 50. It's absurd to wait.

Sandy Kruse: 17:58

That's not going to happen. There's a misconception there. Yeah, I mean, I'm so glad you said that because, yeah, there are so many doctors that A follow that study that you mentioned, that antiquated study that was pretty severely flawed, and B follow this one-year. No periods rule. Meanwhile, how much damage is being done, you know, to bone, to brain health, like in that one year of severe suffering.

Dr. Daved Rosensweet: 18:31

Well, you're bringing up the elephant in the room of menopause. Yeah. And I've never seen anything like it in medicine. There's no field of medicine that got such distorted information with such an adverse impact as the false reporting of that study, and let's look at that. Okay, of that study and let's look at that.

Dr. Daved Rosensweet: 18:52

In 2002, it was common practice for physicians of many, many different types to woman goes into menopause, give her treatment for it. Not a big hullabaloo was made about it because it was so available, like Premarin, was the most popular and profitable drug of all time at that time. So there wasn't much thought about it. And along the way from the 1980s, the compounding the holistic doctors we were getting onto compounded and the individualization could occur. So that was also occurring. Then in 2002, out comes this study that was falsely reported and what was reported was there was increased risk for breast cancer, heart attack and stroke if you're on hormones yes it scared providers and women all over the world.

Dr. Daved Rosensweet: 19:47

Yeah, I say false reporting because even in the study itself there was no legitimate scientific reason to come out and say that it was wrong reporting. And yet, once the press got a hold of that fear story it exploded and you couldn't put the cat back in the bag and very few people read the details. I did. I had been already treating women for many years by then and I read the report and I went wait a minute, women who are on Premarin in this study. They have a reduced risk of breast cancer in the study. And wait a minute, they're reporting increased risk with PremPro. But they are saying in the study it's statistically insignificant. What that means in medical science is don't draw any conclusions. But it was way too late. It scared everybody and 18 million women on hormones went down to less than 2 million Wow. And for all these years it's not become the real scientific truth has not come out. So I'd like to give you what that is.

Sandy Kruse: 20:56

Yeah, tell it to us.

Dr. Daved Rosensweet: 20:59

And that we're all at risk for thousands of diagnoses. We're all at risk for hundreds of cancers. As a man, I'm at a relatively increased risk for prostate cancer, and there's reasons for it. And women have a small increased relative risk for breast cancer, and there's reasons for this. But given all these risks, the actual medical science is this Women who are treated with hormones are at less risk for breast cancer, heart attack and stroke than women who go untreated. Women who've had breast cancer and have had that breast cancer properly treated with surgery and chemo or whatever, they happen to have an increased relative risk for recurrence than a woman has for developing cancer brand new. But given that increased relative risk, they're at less risk if they've had breast cancer and had that breast cancer properly treated, if they are then treated with hormones, than if they are not treated. Wow.

Dr. Daved Rosensweet: 22:12

Now. This information became public when the original study committee published in the original journal a retraction of the 2002 study 2017, they published it. They said after 18 years of follow-up, there is no increased risk. But so few people have heard about that, so few medical professionals. So if you go to a traditional medical doctor or a nurse practitioner, they don't want to hurt their patients. They're still swimming in what they falsely learned and they haven't become aware of the retraction. That did not get the press. It's leaking in. There's warriors out there trying to awaken the medical profession and women all over the world that that was false information and actually the opposite is true. It doesn't mean we're not at risk. There's risk, but women who are treated with hormones are at less risk for breast cancer, heart attack and stroke than women who are not treated.

Sandy Kruse: 23:19

So why is that, Dr Rosenzweig? Why are we at less risk if we optimize our hormones?

Dr. Daved Rosensweet: 23:36

our hormones. Well, the science has not been done on this, but it's pretty easy for me as a physician to understand why. Just the mechanism of cancer. You know, you've got these genetic abnormal cells developing in us all the time. But we also have a protection to those abnormal cells. We've got an immune system that can identify those cells and get rid of them. And the immune system is a very powerful system and but but it's it requires a lot of energy.

Dr. Daved Rosensweet: 24:07

And what we know about our lives is that over time, for various various reasons, we lose energy. We lose, I mean, older people are usually more tired, weaker, and I mean, what did COVID show us? Yes, what every plague has ever shown us that it was the older people who were so vulnerable because they didn't have the immune systems to handle the virus. So what does the immune systems to handle the virus? So what does the immune system need? It needs everything functioning on full cylinders, and without hormones you lose everything. You lose the ability to produce the amount of energy and vitality and have a vital immune system. Women who have estrogen had less trouble with COVID. It's that direct, that adequate hormones lead to a healthy metabolism, which lead to a healthy energy production and the immune system is heavily energy dependent. Just to give you one simple reason why the risks increase Well, okay.

Sandy Kruse: 25:20

Now the other thing. I hear a lot and, by the way, dr Rosenzweig, it's so interesting when you're talking about these studies, how it triggers some people. So I actually had a post where I just simply said estrogen in and of itself doesn't cause cancer. Right, it's like what's going on with the estrogen in your body. So many people were so triggered by that because they you know, they refer to the study that you were saying and nothing was ever mentioned about the study. That was the follow-up. Nobody hears the good. Nobody hears about that 2017. So I'm going to make sure that I link it in this description. I think it's very important.

Dr. Daved Rosensweet: 26:07

There is an oncologist, a cancer specialist who, specialized in breast cancer, has written, along with his scientific partner, a book that goes into the details about what I just summarized In chapter three of the book that you're welcome to have your followers can download a free copy. In chapter three I describe the whole subject in a little more detail than I have on this podcast, but the real reference is this book by Dr Avram Blooming and Carol Tavris. It's called Estrogen Matters.

Sandy Kruse: 26:55

I've heard of that.

Dr. Daved Rosensweet: 26:57

For the scientific amongst you, you will really get the details of what I just said and you know the human race. Since we were born, since we've all been around, we've had this element in us called fear. And it really speaks to the need, as part of our healing process, to put in a lot of time, energy, commitment and courage to healing our emotions. Lot of time, energy, commitment and courage to healing our emotions, Because if we don't uncover and unravel and heal this tremendous burden of fear that we're all walking around with, save for those who've really done the heavy lifting, that fear will jump out and grab anything and get its hands on, including be the source of a lot of unbeneficial human behavior. And so what sells? When someone puts out an article that we're at risk for breast cancer, that's even false. Oh man, that spread like an explosion when someone, when that gets retracted by the very same study committee that published the original study in the very same journal, hardly anyone's heard of it. Yep.

Dr. Daved Rosensweet: 28:19

So you know human life. Yeah exactly. There's some complexities to it.

Sandy Kruse: 28:24

So another thing that I hear quite often is well, our ancestors didn't need hormone replacement therapy. My grandmother certainly didn't use it, didn't need it, so why would I need it now? What would you think of that?

Dr. Daved Rosensweet: 28:43

Well, one of the main reasons that our ancestors didn't need it is because they were dead.

Sandy Kruse: 28:50

Yes, that's one thing I say. They don't live as long.

Dr. Daved Rosensweet: 28:55

Throughout human history, menopause was a rare event because women didn't live that long. Yeah. And men lived even shorter lives. And then, yes, your grandmother. But if you die, you're not going to want the health of your grandmother necessarily, and there are some examples. And there was cleaner living. And you, as a health coach, you know some of the details about this.

Dr. Daved Rosensweet: 29:22

But very few of these women had libido, Very few of these women had vaginas that were able to have penetrative intercourse with. A lot of these women their bladders weren't working. And if you really get down to it, you know, 50 years ago, when I was in medical school, 55 years ago, we had a lecture from a gerontologist. That's an expert in aging, specializes in what happens to older people, and the gerontologist told us you know, you medical students, you know thousands of diagnoses. That's great.

Dr. Daved Rosensweet: 30:00

Let me tell you what's really happening to old people. They're losing their muscle. They can't. They're going from canes to walkers, to wheelchairs, and that moment from wheelchairs to walkers is where they have very much trouble living at home. They wind up in assisted living facilities and nursing homes. They've lost their bladder and many have lost the ability to think. So there are the rare exceptions of the grandma or grandpa who did really well, could walk and talk. Let's put it that way. Didn't mean the men were having erections, Didn't mean the women were having a lot of other benefits. But yeah, when those hormones fall midlife, the majority of folks don't do well. Yeah.

Dr. Daved Rosensweet: 30:47

And it's worse. Now there's other challenges to our hormones. They have to be factored in and as a health care coach, you know a lot about the other stuff that's really changing human life here.

Sandy Kruse: 31:01

Oh, I agree, I agree. I mean we could talk about food in and of itself and have a whole podcast on how food affects our health, right? But yes, I would agree, there's that factor. Now, you know, here's something really interesting. I know you'll find this interesting. So the first time I had a hot flash was in October 2022. And, as a physician, you may find this I know it's an N of one, but you've probably seen this During that same time, I, as a nutritionist, became I guess you could say I was in a pre-diabetic state. My HbA1c climbed to 6.1 and I developed chronic pain in my wrist, which I mean. Since then, I have started bioidentical estrogen and I've been on progesterone a while now. But you know, we talk a lot about symptoms and we don't. It's like mysterious. It's like why did all this begin right around the same time I started having hot flashes? Is there a correlation? I know we can't go back and test now, but in your clinical experience, it's possible.

Dr. Daved Rosensweet: 32:16

Why do so many things happen midlife?

Sandy Kruse: 32:18

Why did that happen, right around the time that I was clearly having symptoms of dropping estrogen, like? The pain in your wrist the pain in my wrist, higher HBA1C. It was like sure I was having almost like a little cluster of symptoms right around the same time that obviously I was having changes in my period.

Dr. Daved Rosensweet: 32:41

I was having hot flashes starting, so I was feeling physically many different symptoms many different symptoms, yeah, and the list of midlife symptoms in a woman whose hormones are declining, and men as well it's really long, yeah, and I list, and anyone could Google, what are symptoms of menopause and you'll go whoa, there's a lot of stuff there, there and they all have an explanation.

Dr. Daved Rosensweet: 33:19

And in order to maintain a good hemoglobin a1c, which means that you're really managing glucose well, you have to have a lot of things going for you, including your hormonal system, and once you lose hormonal contribution to glucose regulation and the stress comes in, because stress is a glucose raiser you've time and dietary indiscretions and I'm not saying that's true about you, but there's a lot of things that coincide midlife. The pain issue is a really interesting one. Why should women develop joint pain so commonly Severe? I had a 55-year-old woman patient who was a high-end real estate agent who was on OxyContin. Wow.

Dr. Daved Rosensweet: 34:14

For her joint pain, for her hip pain, and what turned out is that when we started treating her menopause, five weeks later I meet up with her in the health food store parking lot. She said I can't believe it, I have no more pain, I'm no longer on OxyContin. She dropped cold. She was not an OxyContin addict, like I had been concerned. She was having. Severe pain, went away. When you look at the inflammatory conditions that can occur and the vulnerability of joints, well, there are many symptoms that relate to hormonal decline, outside the obvious hot flashes right, yes, yes, which are very stressful, by the way, and can lead to increased adrenaline and cortisol, which can give your immune system trouble. So the knee bones connected to the thigh bone and you wind up with a lot of stuff yes that go away wonderfully.

Dr. Daved Rosensweet: 35:11

Not perfectly, not necessarily everything, but this is what I teach to physicians when a woman of midlife comes in with a long list of symptoms, treat her menopause first, prior to doing any some significant major medical workup, and see what symptoms remain. And very often they're astounded it's like, oh my God, so many things related to the loss of hormones. No big surprise. These are amongst the most powerful biochemicals in our body. We don't do well when we lose our powertrain. There goes in our body.

Sandy Kruse: 35:52

We don't do well when we lose our power train there. And then you know there's a lot of you know you mentioned vitality we were talking about. You know. I know myself I feel better now than I did in my 40s. I had thyroid cancer in my forties so it took me a while to get back up to that feeling vital again, but now I never want to go back. I never want to go back to that, and so I won't stop at, you know, doing my own research. But what you do is you individualize hormones for women.

Dr. Daved Rosensweet: 36:39

How is what you do different than what most doctors that prescribe hormones do. Well, most doctors that prescribe hormones have not taken on the treatment of women in menopause or men in andropause as a specialty. They have broad-based practices and treatment of menopause and andropause is a small portion of that practice, which is a very unusual thing in medicine. When I was growing up in medicine, specialization was occurring Like wild. Instead of generalists, you had this army of specialists take place and at first I was critical of it until I realized what was going on is that no single physician can get their mind around and become expert at the whole field of medicine.

Sandy Kruse: 37:29

No.

Dr. Daved Rosensweet: 37:31

And so what people started doing is, like urologists started, focusing in on the kidneys and the bladder and the prostate. And when you narrow it down like that, you can get so much knowledge and so much experience that you can become an expert at it. And it's very rewarding to be an expert and that's a wonderful thing, that specialization. But because of that Women's Health Initiative in 2002, when all medicine was differentiating out into specialties, nothing happened in the world of menopause. When you look at these various bodies of knowledge urology, neurology, internal medicine, diabetology you see these tremendous expertise occurring and in those fields there might be some discussion at the periphery, but the core body of knowledge and practice is really solid as gold. Not so in hormonal medicine, because there hasn't been a specialty. I'm one of the few physicians I've ever met that have specialized only in this and that's a big deal and there is no standard of care and it's like the wild west. So when you go out to your standard provider, they haven't specialized in it. Well, we're working on that. We have. I have a big team. We're working to create standard of care. We believe we already have and get board certification and the most significant thing about it is I don't even think we have a method. We called it the menopause method. But what happened is, when I started out, there was so little known, and what I did is I just started paying a lot of attention to what was going on in women and partnering with them to find our way to. How do you do this right? Yeah, 30 years later. So all I think we did is what the urologist did, is what the cardiologist did. They paid a lot of attention, got a lot of experience and figured out how to work with it best, and so it's not a method. It's not a method we apply to menopause. What it really is is how do you take women and men and treat them excellently? And here's one of the first discoveries Women vary individual to individual enormously, as do men.

Dr. Daved Rosensweet: 40:06

Like you have some young women that they have a lower amount of estrogen, but they're perfectly healthy, they're fertile, they have regular menstruations. They can carry a pregnancy to term. You have other women that need three times that amount three times that amount to be perfectly healthy, carry a pregnancy to term, regularly menstruate. There's tremendous individual variation in there. There's a lot of different other variables in there. It's not a problem If you start out with the intention of figuring each woman out. She'll arrive at what is an optimal program for her and all you have to do is partner with the woman and listen to her symptoms. See whoa. Is she estrogen rich? Is she progesterone rich? Let's start out with low doses. Gradually increase those doses. Have symptoms disappear. Discover the perfect balance just by symptom alleviation. Don't go too high or you'll get symptoms of overdose. You back down and then we do 24-hour urine hormone testing on all women.

Sandy Kruse: 41:15

Oh, I was going to ask you about that, because just doing a point-in-time blood work is, I mean, just because we're in menopause it doesn't mean we're flat and we're the same all the time, right?

Dr. Daved Rosensweet: 41:27

Well, the opposite is actually true and you're really uncovering something that matters. Yeah, well, the opposite is actually true, and you're really uncovering something that matters, yeah, Is that even a young, healthy woman whose clockwork, menstruating clockwork, I mean every 28 days, every 27 days, those women are ovulating and those women we know when in the month we have to test them.

Sandy Kruse: 41:53

We have to test them on week three. Yes, yeah, like day 19. Right, it's usually right. Yeah, that's when you test however, um, these aren't.

Dr. Daved Rosensweet: 42:02

The women are showing up to doctor's offices because they're doing really well, so testing is really a challenge in women's hormones. In the the perimenopause, everything gets worse Because a woman's general body levels of estrogen are declining. Her pituitary gland and brain are trying to reawaken the ovaries and it pumps out these surges of stimulating hormones to the ovaries to get them to wake up again. Yeah.

Dr. Daved Rosensweet: 42:31

And it works. You get a low estrogen. You put out some extra fsh to stimulate that ovary. It puts out a level of estrogen that is higher than a woman ever had in her young life, but the ovary can't keep up with it. So you get highs and lows in the perimenopause, that is. But the good news is you don't have to test the perimenopause. It's a waste of money to test because we can tell by symptoms that the woman's low. She's having hot flashes in the middle of the night, she's not sleeping, her mood is down. Yeah, so we don't test in the perimenopause, and that's a very, very important thing. And then testing in the menopause. 24-hour urines work great. They're gold standards since the 1960s. Everything else does not, and there's reasons, and there's a lot of popular testing methods out there. It's the Wild West in testing, but the one that works is the 24-hour urine hormone test and nothing else does.

Sandy Kruse: 43:32

Are you referring to the Dutch or no?

Dr. Daved Rosensweet: 43:36

Well, I'm referring to the dried spot urine.

Sandy Kruse: 43:41

Because the Dutch is also dried urine. I mean, everybody talks about the Dutch.

Dr. Daved Rosensweet: 43:45

I'm just going to talk about the dried spot urine. Okay, just to be politically correct.

Sandy Kruse: 43:52

I understand, but it's pretty obvious, it's possible.

Dr. Daved Rosensweet: 43:54

But we've done cross-testing on this. We do not see the evidence that we need to see that it correlates. Well, we're still doing cross-testing on it. Split specimens. We have women that we're testing by 24-hour urines and by spot urines. But there's a lot of scientific weaknesses in the dried urine, so I will not. I'm just going to give you my best shot. Yeah. What I know is great is 24 hour urine hormone testing. Okay. Everything else no. Okay.

Dr. Daved Rosensweet: 44:26

And blood testing is fabulous for so many things, thousands of things. However, when you have a woman who's being treated with hormones, when do you draw her blood? After she put on her morning hormones? An hour after, before she put on her hormones? When a woman puts on her hormones, you get a rise and then you get a fall. So it's very hard to be specific with each woman is how high is she really getting? Are you going to test her every half hour to find out when she is an individual peaks and then you're going to. You're going to keep checking that this work has not been done. It's too impractical to do it. I love blood testing for a thousand things, but not for hormone levels, that is, in a woman that we're treating with hormones.

Sandy Kruse: 45:19

Okay, so that's good to know. So you're saying when a woman is taking hormones it's best to do the 24 hour urine?

Dr. Daved Rosensweet: 45:29

Yeah, absolutely.

Sandy Kruse: 45:30

Most accurate, Absolutely Okay, that's good to know. Now we started to touch on symptoms. I want to get back to that because you may you raised a really important point. You are working with each patient, you're understanding their symptoms, you're kind of, you know, you're, you're customizing, and I think that very few doctors have that time and that expertise to hone in on that customization. So this is probably why you see a lot of women go on antidepressants when they're going into menopause, because it's easier to just let's just treat the mood issues and you must see that a lot or know of that happening with but apparently that is one of the treatments for menopause, right? Instead of getting to the root of why is that mood dysregulation?

Dr. Daved Rosensweet: 46:33

Exactly the symptoms for most women are coming from the low hormones, so you'd want to treat with hormones.

Dr. Daved Rosensweet: 46:41

I'd like to say that when a woman goes into menopause and gets hormonal treatment almost of any kind from a decent provider, they're going to benefit, yep. And then the question is what do you want? Do you want something that's pretty general that's going to make you sort of good, or are you going to want something that's individualized? And to me it was really obvious that what women and men really want is a high degree of skill. Women and men really want is a high degree of skill. Like, for example, if you're a man and you've got a prostate issue and you need surgery, you're going to want to go out there and spend a lot of time finding out who's the best knife, of course, of course, and you're going to want to go for the best methods developed by the people who care about it the most. You could get some decent work from almost anyone who's trained, but these kind of things matter so much that you're going to want to seek out good stuff.

Dr. Daved Rosensweet: 47:45

It's like we do in anything in life, and it's true in the world of hormones too. So almost any hormones done decently, without symptoms of overdose, have benefits. And yet you're going to want something that's individualized to your body the balances, the type of administration, the carriers. There's a lot of detail there. I describe it in the book, so I mentioned this word. Well, you're going to pay attention to the details. Why go into the details in Happy, healthy Hormones?

Sandy Kruse: 48:19

Okay, so we talked a little bit about the symptoms, but here's where it gets really confusing, because sometimes the symptoms of too much hormones can be the same as too little. Much hormones can be the same as too little Like is that when you test or is that when you back off? And the reason I say this and we will get into the differences. Maybe we should get into the differences between what is bioidentical hormones versus what is a regular HRT. That might be a better place to start, because there's also a lot of confusion there, where I have actually had numerous women say oh yeah, yeah, I've been on progestin for a while and they don't understand that it's not progesterone. So maybe you can explain the difference. That would be really helpful.

Dr. Daved Rosensweet: 49:10

There's two good topics there.

Sandy Kruse: 49:13

Oh yeah, we got two. We got lots to talk about.

Dr. Daved Rosensweet: 49:18

I think what you're identifying is a bigger subject. I should go there, but I can also go to that other one which is very interesting.

Sandy Kruse: 49:26

Well, maybe let's first describe what is bioidentical versus regular. So that's got to be clear.

Dr. Daved Rosensweet: 49:36

So the human body, the human ovary, puts out very chemically specific hormone structures. They have a very specific molecular structure. It's highly technical and it's highly exact. And when hormones were first, when we have record from hormones first being given to human beings, it's been about a thousand years ago first being given to human beings, it's been about a thousand years ago the Chinese figured out to collect the urine of young women and dry it out and the powder residue was fed to the aristocrats because hormones were in that urine. And they did the same thing with men. They collected the urine of young men. So back in the day it was bioidentical. Wow, the same molecule, interesting.

Dr. Daved Rosensweet: 50:34

That was being given to the Chinese aristocrats. Wow.

Dr. Daved Rosensweet: 50:44

And then time went on and in the 1940s, when people were becoming aware that women were living longer and that these menopausal symptoms were a much bigger deal than they were made out to be Prior, the pharmaceutical industry wanted to come up with a way to develop hormone products for women. And they knew that the hormones were in the urine. And they actually did a bout of collecting urine and drying it out, but that disappeared, that that that never materialized. They actually chose the horse, the pregnant mare. But the big animal puts out a tremendous amount of urine with a tremendous amount of hormones in it, especially when pregnant. They collected the urine of pregnant mares, dried it out and came out in the 40s with this pill form called Premarin from pregnant mare urine. And you know what Premarin did a lot of good. I myself was never attracted to it. I've never written a prescription because when I came along other things were available.

Dr. Daved Rosensweet: 51:54

And then they realized that if they fed estrogen alone, pregnant Mary urine alone, to women that had a uterus, they increased the rate of endometrial cancer. So they wanted to copy nature somewhat. So they instead of choosing pure progesterone, which they could have. But they can't patent pure progesterone. You cannot patent a molecule that already exists in the human body. They took that progesterone molecule and messed with it and produced something called a progestin that you named. Took that progesterone molecule and messed with it and produced something called a progestin that you named as a progestin. And on our medical board we've got a wonderful medical board. We have a world expert who did the original molecular research on progestins to point out the problems that they were.

Dr. Daved Rosensweet: 52:45

But the original major treatment prior to 2002 was a combination of Premarin and Prempro. If a woman had a uterus, a combination of Premarin and Provera and a Progestin, well, if that's the only tool you have, it's pretty good. But like I was sitting having lunch with a pharmacist once a compounding pharmacist and he said to me did you ever wonder why Premarin had such a thick coating? I had never seen Premarin. I said no. He said well, I did so. I bit into it and out comes this profound odor of urine.

Dr. Daved Rosensweet: 53:28

No way, they were trying to disguise the urine odor and there was something that didn't appeal that to me. And chemically it doesn't either, because 50% of the estrogens in Premarin are unique only to horses. The human female has never seen them. But, like I say, premarin and Prembro did a lot of good.

Sandy Kruse: 53:46

Yeah, it's kind of like a better than nothing situation, right.

Dr. Daved Rosensweet: 53:50

Yeah Well, it was a breakthrough. Yeah. Because you want to manufacture it so a lot of women could have advantage of it. Yeah. Well, in the early 1980s, almost at the same time, a wonderful medical doctor, Jonathan Wright.

Sandy Kruse: 54:11

I know who he is Dr Jonathan Wright.

Dr. Daved Rosensweet: 54:14

Oh, yeah, yeah, yeah, I know who he is. Yeah, he thought you know. What I have a suspicion is the pharmaceutical industry has learned how to produce pure bioidentical hormones same molecule because they've come out with it in the birth control pill. The estrogen in the birth control pill begins with estradiol. It's changed, but they've got pure estradiol. So he asked a compounding pharmacist could they find pure same molecule as is in the female body? And they did, and they came up with these bioidentical same molecule.

Dr. Daved Rosensweet: 54:51

It turned out that the pharmaceutical manufacturers, in order to produce birth control pills, were buying up soy fields and extracting a precursor to steroid hormones called diastrogenin. Because plants are not that different than us. They got the precursors to these hormones too and extracting and putting them through a process very elegant, very exquisite process and so they take that diastrogenin from soy you can get it from yams too. It's very rich in yams, but there's not as many yams out there and you put it through a very sophisticated chemical process and you wind up with pure estradiol. That's what the ovary is putting out same molecule yeah pure estriol, same molecule that the ovary puts out.

Dr. Daved Rosensweet: 55:40

Pure testosterone same molecule the ovary puts out. And lo and behold, the male testicles put out same molecule. And when that came along and there was also a pharmacist who did the same thing, he got a hold of the pure estradiol, put it in a gel for his wife who was in that phase.

Sandy Kruse: 55:59

Jim.

Dr. Daved Rosensweet: 55:59

Pertzer in Dallas, bioidentical hormones became available and by the time I came around, these compounding pharmacists were procuring these ultra pure same molecule hormones and I thought gee, horse versus bioidentical. I think I'm going to go for the same molecule type thing. Yeah, yeah. And so it's wonderful you got right. These days you got 8,000 compounding pharmacies in the United States putting together these individualized prescriptions. Yeah.

Dr. Daved Rosensweet: 56:36

So I can get highly specific, individualizing it to the individual woman, about what we give her and what we're giving her is molecularly pure. So that's the difference. That's great. And, like I say, decent medical treatment by a caring and somewhat knowledgeable physician or nurse practitioner, with almost any hormone that they can get a hold of, can have some merit and value. But what do you want? What do I?

Sandy Kruse: 57:05

want Right value. But what do you want? What do I want Right? So just before we get into the symptoms, I have to ask you treating a woman with estrogen only, is that safe? Or should you always have a little bit of progesterone, always kind of balancing the two?

Dr. Daved Rosensweet: 57:31

of progesterone, always kind of balancing the two.

Speaker 3: 57:32

Well, I'm going to look at it from a different perspective.

Dr. Daved Rosensweet: 57:33

Okay, a woman's body puts out four different hormones from the ovary, puts out estrogens, a family of them, three major ones, yep and it puts out progesterone every single month. And it puts out, molecule for molecule, 100 times more progesterone every month and it puts out the most potent estrogen. So, gee, why in the world would we want to invent a different human being? Yeah. Biologically at least. There's a lot of perfection in the human being, so anyone who paid a lot of attention to this wouldn't dream of leaving out progesterone. Yes.

Dr. Daved Rosensweet: 58:18

In fact would lead with progesterone, because it's usually the deficiency that strikes first.

Dr. Daved Rosensweet: 58:24

Yes, that strikes first, yes, and so good treatment. If you want to copy nature, as Dr Wright coined pretty good idea to copy nature you put a lot more progesterone in any formulation than you're doing, than you do estrogen, because that mimics. Now, when you get down to the weeds, in the sense that you really pay attention to the merits of progesterone, you wouldn't dream of leaving it out. It's so important for mood and sleep and bones, just to name a few. Huge, Not only to mention protecting the uterus, and it's got a myriad of important functions. So one of the things we do with progesterone is we always like the word optimize, but really optimization in the world of progesterone is maximizing it. Keep on increasing the dose of a woman with progesterone until we go so high, we go over the top and she's got symptoms of overdose, and then back her down. Keep her up at optimal, robust levels of progesterone, because that's what her body did and that's what's really good for her.

Sandy Kruse: 59:39

Yeah, I mean, I started progesterone way before estrogen and it was my lifesaver when I saw that I wasn't sleeping well. And I mean, let's face facts. I don't know about men I can't really say for men, but as women, if we have children, that's when sleep really, from when they're babies to when they're grown up, we still they have an effect on our sleep, let's just say, and our nervous system too. So progesterone helps with that right.

Dr. Daved Rosensweet: 1:00:14

Oh yeah, it's well. Progesterone is the great calmer. It's a very unusual, powerful, biochemical, powerful hormone. Most hormones are energizing. They can even be recruited for fight or flight. Progesterone is the great calmer. If I were to inject progesterone at the right dose into anyone's veins IV including my own I could be put to sleep so deep that surgery could be performed on me.

Dr. Daved Rosensweet: 1:00:46

Wow to sleep so deep that surgery could be performed on me Wow. So when women start losing their progesterone, sleep is one of the first things that goes, and progesterone is so related to calm mood. You've got some young women in their 20s and 30s. They're doing fine with the stresses of life, but they got this weird thing that they feel like they've got this anxiety. It doesn't make sense. They're strong, they're doing well. They've got this anxiety. You can bet most of those women do not have enough progesterone even in your 20s. Yeah.

Dr. Daved Rosensweet: 1:01:21

Yeah, so we really want to become aware of that and assist these young women with progesterone to sleep and mood.

Sandy Kruse: 1:01:29

So progesterone is essentially pretty safe on its own, even at a younger age, if it's needed.

Dr. Daved Rosensweet: 1:01:42

Yeah, I mean, let's look at it again from the flip side. A young woman is used to cruising on a very robust amount of progesterone. What happens when she doesn't have it? That I would call unsafe. Yeah. It's too powerful a hormone and, let's just face it, anyone lose a night's sleep or two lately. How's that go for you? Or mood A person can develop a self-image. A young woman can develop a self-image like she's got anxiety disorder.

Sandy Kruse: 1:02:17

Yes.

Dr. Daved Rosensweet: 1:02:19

Most of these women don't have anxiety disorder. The stresses of life have thrown off their period. They're either lower in progesterone than they ought to be, so they lose the calmer, or they're not ovulating, in which case there are basement levels of progesterone.

Sandy Kruse: 1:02:37

Right.

Dr. Daved Rosensweet: 1:02:38

And so the unsafety for living and there's more to it too. I mean progesterone is so profound that in order for thyroid hormone to work well, you have to have adequate progesterone. What fascinated me when I first figured it is this too much information. Sandy, how are you doing?

Sandy Kruse: 1:03:02

Oh no, you want to talk thyroid? Listen, I don't have one. I love talking thyroid and it's all connected, right it's super connected.

Dr. Daved Rosensweet: 1:03:11

Yes, I mean, I didn't ever get this. What I knew as a medical student and as a young doctor was that if you want to know if a woman's ovulating, one of the ways you can tell is if her temperature goes up mid-cycle. So if she takes her temperature every day and she sees a rise, she's probably ovulating.

Dr. Daved Rosensweet: 1:03:34

If she does not see that rise, she's probably not ovulating and I never put two and two together. Why does that? Why does her temperature go up? Because, well, one thing we know is that mid-cycle if a woman ovulates, she gets this burst of progesterone huge amount. If she doesn't ovulate, there's no burst, it's just the low amount of progesterone.

Dr. Daved Rosensweet: 1:03:58

And it turns out that progesterone facilitates the action of thyroid hormone. And one of the major multifunctions of thyroid is to inspire metabolism, which is how you combine oxygen that you breathe with the food that you eat. You burn it, you oxidize it and the rate of metabolism determines how much energy you get and how much heat you put out. So if thyroid is working really well, mid-cycle for a woman, you get so much more heat that you can actually measure it Because progesterone facilitated the action of thyroid. So the knee bone is connected to the thigh bone, so progesterone figures into adequate metabolism. Holy mackerel, remember I said the immune system needed energy. Yes, remember I said the immune system needed energy. A young woman, to be healthy and to not gain weight, needs a really honking metabolism to burn off some of that food. So hypothyroid, low progesterone, I mean the knee bones connected to the thigh bone. It's amazing.

Sandy Kruse: 1:05:10

Fascinating. And then even still, if you were to bring estrogen into the conversation, as it relates to thyroid. When estrogen goes off, that also can affect thyroid function, like when you have a severe drop in estrogen.

Dr. Daved Rosensweet: 1:05:23

Your body wants the same amount, the right amount.

Speaker 3: 1:05:26

Yeah, it wants the right amount of estrogen and it wants the same amount, the right amount, yeah.

Dr. Daved Rosensweet: 1:05:28

It wants the right amount of estrogen and it wants the right amount of thyroid. And if you give too much estrogen treatment, you throw off the thyroid. So when a woman's been without estrogen and she's cruising around long with her thyroid and you give her estrogen and she's taking thyroid, by the way, you have to pay attention to what happens to the thyroid because, again, everything is so interrelated and so. But all you have to do as a healthcare provider is understand the field and you know about these things. So a woman who's hypothyroid and is on thyroid medication to alleviate it, it's great, great stuff. Who's hypothyroid and is on thyroid medication to alleviate it, it's great, great stuff. When you're treating her in menopause, you, somewhere along the line, like in the beginning, you do some sophisticated thyroid tests on her and then see what's happening three months later to make sure that you've got these two exquisite hormones in balance.

Sandy Kruse: 1:06:25

Trust me, I know I'm going through menopause without a thyroid and taking bioidentical hormones, so I'm lucky that I have an endocrinologist that does check my levels regularly, because I've seen a lot of this in the last couple of years.

Dr. Daved Rosensweet: 1:06:43

Are you on T4 and T3?

Sandy Kruse: 1:06:46

So I'm on a beautiful mix of T4, t3, and desiccated because I wanted to have more of the symphony of the thyroid, which is why we added in the porcine, because I had done so much research on it and I do understand my body and I do understand my body and I do understand symptoms. But it gets a little hazy when we're talking about symptoms, because some symptoms can be menopause, some symptoms can be too much estrogen, too much progesterone, or maybe it's my thyroid, and they all can kind of intertwine and get very confusing. This is a great segue into symptoms, right? What do you think?

Dr. Daved Rosensweet: 1:07:33

And it is a great segue. And you're also bringing up, though, prior to speaking about that segue, how important it is to become somewhat familiar with your own body. Yes, to become somewhat familiar with your own body, yes, and you know, if we didn't live into these midlife years, we wouldn't maybe not have to. But when you start losing hormones and you start taking nutritional supplements and paying attention to your health, it's nice to know a little bit and to do what you're doing, because ultimately, these hormones are going into your body and women vary and men vary, and so you know a little bit, and this is how I figured it out. Really, I knew a certain amount. I knew the hormones were going into a woman's body, we teamed it and we did what you did. We adjusted this, we adjusted that, we tested, and so it's good to individualize. You can do a lot of good without individualizing. I don't want to underplay that. But when you want to feel really good, you really get specific.

Sandy Kruse: 1:08:50

I think some women are also more sensitive than others.

Dr. Daved Rosensweet: 1:08:54

You betcha.

Sandy Kruse: 1:08:55

You know, like some of us, I know that even if I take certain supplements and I know that, for example, if I take my thyroid medications too close to having my coffee I have one cup of coffee a day, but I make sure that I don't I don't take it within two hours so I pay attention to these things because I can see and feel a difference when I don't. So, educating women, which is something that you do, which is so powerful, because we have this wisdom within and we need a great doctor to help us be like an advocate, to help us feel our best.

Dr. Daved Rosensweet: 1:09:37

Yeah, it's like me and my auto mechanic. Without that auto mechanic, I can keep my older cars going. It's much more important, it's much better. How you said it?

Dr. Daved Rosensweet: 1:09:52

And being super sensitive, you know, I think we all are that sensitive, but some people are more conscious of it. Yes, we need that sensitivity and it's the sensitive ones amongst us who are teaching us how to do the rest of the work. And you know, I've had many patients who were super sensitive. I know this one really well and I began to realize about them that at a very early age you're forced to a level of detail to work well with your own body that can make you an expert at it for your whole life, whereas other people who aren't feeling these things, yeah well, you know. So it's a, it's a, it's a power the sensitivity and we train all of our physicians and nurse practitioners that you want to treat the sensitive ones differently. We want to. We want to go lower, start slower, go lower. Sensitivity does exist and it needs to be respected. When you're designing these ovarian hormone replenishment programs, we definitely pay a lot of attention to sensitivity.

Sandy Kruse: 1:11:04

So you would treat my husband very differently than myself because he doesn't notice anything. And I would treat my husband very differently than myself Very because he doesn't notice anything.

Dr. Daved Rosensweet: 1:11:11

And I'm like your husband. Well, I could. I could take a gallon of something and not feel it. It would still have the same effects on me. Yeah, Ultimately.

Sandy Kruse: 1:11:22

Yeah, exactly. So I have to ask you this because I didn't ask about. Um. I've heard and researched a lot as it relates to estrogen orally. What is your take on oral estrogen?

Dr. Daved Rosensweet: 1:11:43

Well, like I said in the beginning, um, almost any hormones that are out there, especially if there's been some pharmaceutical manufacturing or bioidentical compounding involved, are going to do some good. And then there's what's the good, the better and the best In order to get a hormone level up in the body when you take it by mouth, you've got to give someone quite a bit of a bigger dose. Because the very first thing that happens when you give an oral hormone is it goes into the stomach, then the small intestine and then it's picked up by the liver immediately and the liver does its thing and 80 to 90% of it is totally metabolized, never made it to the full body. So you got to give quite a bit higher dose, and that's part of the issue, because we don't want higher dosages and we don't want to deal with a bunch of liver metabolites. But that's not the main reason.

Dr. Daved Rosensweet: 1:12:48

When the birth control pill came out that has oral estrogen in it, and what we learned? That a small number, but significant number of women were getting blood clots in their legs called thrombophlebitis, and some of those women were having pulmonary embolus. That clot was breaking loose, going to the lungs, and even some women died from that and that was from the oral estrogen. And what we've learned about oral estrogen is that it promotes and I think it's through this first pass, through the liver coagulation proteins to be produced and inflammation proteins to be produced in the liver be produced and inflammation proteins to be produced in the liver. So we have a general rule and I've only given oral estrogen to one human being over 30 years because she was old enough that she couldn't put together applying things to her skin.

Dr. Daved Rosensweet: 1:13:45

She had enough dementia that she couldn't figure it out. So her pill giver could give her a pill but couldn't deal with the topicals. Our rule is give every woman topical estrogen and topical testosterone. Start every woman with topical progesterone. Some women are going to need oral progesterone which is safe, which doesn't have to be.

Sandy Kruse: 1:14:07

That's what I'm on now. I had to upgrade, yeah.

Dr. Daved Rosensweet: 1:14:12

Well, part of the reason you did is that until recently, you couldn't get the higher milligrams on topical progesterone. It was unaffordable. That's changed. That's changed with our method. So we have a new way to do that. So we have a new way to do that. But yeah, oral progesterone is fine, but not oral estrogen. Why would you in the world, would anyone, take oral estrogen if it's going to promote increased coagulation and increased not everyone's going to get a clot, but the ones who have other vulnerabilities around coagulation. They're the ones that you got to watch out for. And so we always give estrogen topically, apply it to your skin, and we always give testosterone to 100% of the women. It's one of the most important female hormones that exist is testosterone. It's the main hormone that'll keep women out of assisted living facilities and nursing homes the main one.

Sandy Kruse: 1:15:08

Really Not Astrodial, not Astrogen.

Dr. Daved Rosensweet: 1:15:13

Well, they all matter. Yeah. But the gerontologist told us. Here's what's happening to old people they're losing their muscle. Yes, they can't stand or walk with stability. They fall on their osteoporotic bones, they fracture a hip and they die. Yes.

Dr. Daved Rosensweet: 1:15:29

You want to help older people, help them retain their muscle. For over 90% of the people, even if they're good exercisers and of course there is no you can't live on this earth and not exercise. You pay way too big of a price. But without the testosterone treatment of women, they lose their skeletal muscle and they wind up with canes. Why do women wind up with canes, walkers and wheelchairs Loss of testosterone.

Dr. Daved Rosensweet: 1:16:01

So I think one of the greatest services that we do for women. Everyone gets excited about the short-term benefits, but I see all different ages and I've experienced directly what it's like to have relatives go into nursing homes. This is a living facility. This is a definitive moment in most women's lives if they have to do that. And we have another doctor on our board. She spent 30 years of her career assisting nursing home patients and I asked her once what percentage are in there because of low hormones. She said 80. 80% of the women in nursing homes are there because of low hormones ovarian hormones and most of them are there because of low hormones ovarian hormones and most of them are there because of low testosterone. So we always replenish testosterone and we always replenish testosterone topically.

Sandy Kruse: 1:16:56

Is it possible for okay, I'm going to assume that you do the estrogen or the testosterone topically Is there less probability of it kind of metabolizing down that more androgenic pathway when you do it topically than taking capsules? Well because women are always afraid of hair growth on their face and you know, I'm sure you've heard the story many times- Well, here's what happens to 100% of women.

Dr. Daved Rosensweet: 1:17:30

They put out rich testosterone levels when they're young, and then midlife the testosterone starts declining and by three years of no period, every single woman that we've ever tested has way, way low, low, low, low, way too low testosterone levels. So the idea is replenish testosterone, but the right amount. If you give too much testosterone, you're going to get hair growth. Yeah, no, thanks you don't want it, but that's not the objective. Our objective is not to give too much of anything. These are the most powerful biochemicals and we know what the right levels are.

Sandy Kruse: 1:18:09

Okay, Then that's key. I know you're a big fan of Biast for estrogen. Now isn't that always an 80-20 estradiol with estriol, but then different levels?

Dr. Daved Rosensweet: 1:18:26

Should I explain what Biast is Sure? Sure, the female ovary puts out three different estrogens Estradiol, estrone and Estriol. And Estradiol is the most potent one. And then here's what else happens to women. Once a month, in this magical thing called the menstrual cycle, women prepare for pregnancy. They produce brand new cells in the uterus to become a cushion and a garden for the receiving of a possible fertilized egg New cells, endometrial lining of a possible fertilized egg, new cells, endometrial lining. If there is no fertilization, that whole endometrial lining sheds. All the new cells disappear once a month.

Dr. Daved Rosensweet: 1:19:18

It's amazing, not only that, every single cycle a woman prepares as if she was going to get pregnant. So she starts preparing for breastfeeding, and most women that I've ever spoken to, they could feel it. Their breasts would get fuller as the cycle advanced. Yep, that fullness is about new cells. There's new breast glandular cells being formed, there's cell division and that's how you get new cells Mitosis, a very vulnerable time in a cell's life.

Dr. Daved Rosensweet: 1:19:53

And if there's no fertilization, these cells disappear by a process aptly named apoptosis. Well, that whole proliferative phase where the uterine lining is being formed, where the breast glandular cells are multiplying, that's under the inspiration of hormones, it's under the inspiration of estrogens, and the main estrogen that is inspiring proliferation is estradiol. If there's no fertilization, there's a whole deep proliferation. These cells are disappearing. That's action of a second estrogen receptor site called estrogen receptor site beta, and the primary stimulant of the estrogen receptor site beta is estriol. Every single cycle, young women put out more estriol than they do the sum of estrone and estradiol. How do I know that? That's medical studies, wow, studies that took place in the 1960s, in which an oncologist, a cancer specialist, hope this isn't too much information. No.

Dr. Daved Rosensweet: 1:21:11

A specialist at the University of Nebraska tested the urine of young, healthy women and women who had breast cancer and that oncologist saw that the young healthy women had 1.3 times as much estriol as they did the sum of estrone and estradiol in their urine. Wow.

Dr. Daved Rosensweet: 1:21:38

I was funded, given quite a grant of a lot of money, to repeat that study in the early 2000s and we enrolled 600 nursing students. A hundred of them were regularly menstruating. We couldn't work, we couldn't gather samples on anyone else. Think of that. One out of six nursing students were menstruating regularly. We did the same test and we came up with 1.1 times as much estriol as the sum of estrone and estradiol. This is 50 years later. Same technology.

Dr. Daved Rosensweet: 1:22:19

It was 24-hour urines used in the 1960s by Dr Lemon, and that's what we did for repeating that study. So the main thing is there must be a reason for some of these hormones. There must be a reason why estriol is there. Well, we didn't know anything about this. Dr Lemon postulated that estriol was protective. He had no understanding. It wasn't until the 1990s that the estrogen receptor site alpha, the proliferative receptor site, and estrogen receptor site beta, the deproliferative receptor site stimulated by espriol primarily, were discovered. The reasons discovered 30 years after.

Dr. Daved Rosensweet: 1:23:03

What the actual biology was? Moral of the story we like to copy nature as Dr Wright came out with in the 80s. He didn't want to give out pure estradiol, he said rocket surgery. Why don't we just copy nature? Yeah, and so nature. In order to produce that 1.3 in most women you need to administer 80% estriol, 20% estradiol, even though estradiol is eight times as potent as estriol. That's where the 80-20 came up. But when we do 24-hour urines, sometimes we don't see the right ratio. So we tweak the ratio of the treatment. We'll go to 70-30, 60, 40, but I recommend as an absolute don't be playing with that ratio until you see the 24 hour urine and you've got a reason, because 80% of the women that we treat over 30 years, they do great with 80, 20. Okay, 20% need a different ratio. Okay, that makes sense.

Dr. Daved Rosensweet: 1:24:06

Yes, that's what we're trying to do. We're trying to copy nature.

Sandy Kruse: 1:24:09

That makes sense. Yeah, I reversed it. I said 80% estradiol. I meant estriol, what you said, yeah, and then 20 estradiol. So isn't estriol the hormone that is highest when a woman is pregnant? Because I've done a little research on estriol myself and I don't know what you're going to think of this, dr Rosensweet, but when I started to see a little bit of crepiness in my skin, I started to put just a little estriol under the eyes and a little here. And you know, because I was doing some research, I'm like, hmm, you know, pregnancy glow, women who have that pregnancy glow, that beautiful skin Isn't Estriol really high when a woman's pregnant?

Dr. Daved Rosensweet: 1:24:55

Well, they're all high.

Sandy Kruse: 1:24:56

They're all high Okay.

Dr. Daved Rosensweet: 1:24:58

Estriol is high. Estriol is high, Progesterone is high, they're all super high, like super high. But gee whiz, what are you saying here? What are you saying, Sandy? That Estradiol could be good for the skin?

Sandy Kruse: 1:25:14

I'm saying it could be pretty amazing because you know you would laugh at me. But I had a viral TikTok. Dr Rosen. Sweet, because women are like what, what is she doing? And then you know the research that I saw. It said estradiol could cause melasma. I'm like nobody wants that when you're over 50. But still I'm like estradiol is pretty.

Dr. Daved Rosensweet: 1:25:36

Let me give you a little history about that.

Sandy Kruse: 1:25:38

Okay.

Dr. Daved Rosensweet: 1:25:40

This has been known for 100 years, 150 years, 100 years, 150 years. What's also been known is that the French were putting estrogens in their expensive skin creams and not revealing it, not listing it as an ingredient. Oh, and every single compounding pharmacy in the United States there's about 8,000 of them. They got their favorite facial combination and they all have estriol in it. But here's how I found out about it. 30 years ago, women patients would come to me and say this estrogen is good for your skin. What would it be like if I put some on my face and my neck and the back of my hands? It's so vulnerable. And I said, well, I don't see any reason. I don't think you should put estrogen on your breasts, but it makes sense to me. Sure, do it. And they said, well, we already have. And take a look at my skin.

Sandy Kruse: 1:26:42

I'm telling you it's I'm. I'm a big beauty skincare buff. I like to take care of my skin. Obviously, it starts in the inside. What are you feeding your body? Are you exercise, Like all those things? Sunscreen on the face. But I like to explore other things, and this by far has been better than any other skin cream that I've ever used, is just straight up Astral.

Dr. Daved Rosensweet: 1:27:09

So okay, yes, yes, yes, that is absolutely true.

Sandy Kruse: 1:27:13

I and it doesn't like it's. It shouldn't raise your urine or will it?

Dr. Daved Rosensweet: 1:27:23

It will, but so what? I mean you're looking for the right amount and if you're eventually doing 24-hour urines and paying attention to symptoms, no matter where you put it on your body, it's going to absorb.

Sandy Kruse: 1:27:36

Yeah, there's got to be a downstream yeah.

Dr. Daved Rosensweet: 1:27:40

What women told me is they would rub their hands, they would put most of it on their inner arms, but they'd save a little bit and rub the final amount onto their face. So they're still getting the same amount.

Sandy Kruse: 1:27:50

Yes, that makes sense.

Dr. Daved Rosensweet: 1:27:53

So every time that they put the bias on their forearms, they wouldn't put all of it on their forearms, they'd save a little bit on their skin, on their hands and rub it on their face, neck and back of hands. And that's in our book. That's been in.

Sandy Kruse: 1:28:08

It is. I got to get your book.

Dr. Daved Rosensweet: 1:28:11

That was in the. Yes, you'll be able to download a free copy of it. Okay, that was in the. Let me say something else about skin. Okay. If I can.

Dr. Daved Rosensweet: 1:28:21

Yes 15 years ago my pharmacist sent a bias prescription that he usually mailed to my patients to my office and I had been treating women well. It was about 20 years ago for 10 years without ever seeing the hormone. I would fax in a prescription to the pharmacist. He'd ship it to the patient.

Dr. Daved Rosensweet: 1:28:44

So this white cosmetic jar arrives I'm sure you've seen them Full of bias and I was fascinating and I broke the seal on it and opened it up and out came this really strong odor. And I did some research and I learned that these very poorly soluble steroid hormones were being put up in strong solvents and as a health coach you know about solvents. They're not safe. And I did the math and I was detoxifying my patients, at the same time asking the women to apply a quart a year of these potentially toxic solvents, because over 99% of what was in that jar was the base or the solvent that dissolved up poorly soluble steroids. So my son and I went on to develop and even patent an organic oils formulation for the delivery of the hormones. Oh, amazing.

Sandy Kruse: 1:29:42

Certified organic oils formulation for the delivery of the hormones oh amazing.

Dr. Daved Rosensweet: 1:29:43

Certified organic oils.

Sandy Kruse: 1:29:46

That's amazing.

Dr. Daved Rosensweet: 1:29:48

So we have 35 compounding pharmacists in the United States that are already dispensing in these organic oils. So why do I want to say that? Because there's all kinds of spectrum, almost any hormones decently done, without an overdose or an underdose, a lot of underdosing going on A lot yeah.

Dr. Daved Rosensweet: 1:30:08

Yeah, is good. And then there's what makes it great when you tailor it for each individual woman, when you apply estrogen and testosterone to the skin and when you use as your base an organic oil and you test with 24-hour urine hormone testing and you learn about individual dosing through starting low and gradually increasing until you get the right amount and right balance, and then you test to confirm and there is good treatment of menopause. In a nutshell, 10 seconds. I laid down the whole road, man there you go.

Sandy Kruse: 1:30:48

Okay, I have to ask a couple more questions. I can't leave you yet. We did cover a lot, though. Um, what about protective adjuncts like sulforaphane? You know broccoli, cruciferous, cooked cruciferous vegetables. They say that that helps you to metabolize your estrogens down a healthier pathway. What are your thoughts on that?

Dr. Daved Rosensweet: 1:31:14

I sure have suggested a lot of those products, dim, I know you know what that is yeah, yeah.

Dr. Daved Rosensweet: 1:31:26

What we're really talking about is affecting how your body processes estrogens, and there are these wonderful biochemical pathways that are normal, and then there's some ways of processing them that are different than normal, and so I like to ask the fundamental question why are some people not processing biochemically in the most standard ways that most women process this? And usually it comes down to a liver issue. The liver is not as healthy as it ought to be, and when you're dealing with the liver, you know the whole route here, you know the whole roadmap. This is what your bread and butter is. You're dealing with the liver, you better look at the gut and you better look at that nutrition and you better look at toxicity. So that's what you're trying to overcome with these abnormal metabolic pathways, and so I always say go right to the liver and go right to the gut. Why? Because I sure suggested a lot of DIM and I3C indole-3.

Sandy Kruse: 1:32:37

Yeah, indole-3 carbonyl yeah.

Dr. Daved Rosensweet: 1:32:39

Yeah, and I sure gave out a lot of it, and because I had the privilege of seeing how the hormones were metabolizing, I didn't see the improvement that was touted to occur. And then I started thinking deeply into it and I said, yeah, by the time you're not processing this stuff in a healthy way. Why Is it merely a broccoli deficiency? Yeah. Because that's where this stuff comes from. Good stuff, I mean. I like to eat broccoli every day. Sure.

Dr. Daved Rosensweet: 1:33:10

For a lot of good reasons, and my beloved just showed me a head of broccoli yesterday that I that's the healthiest head of broccoli I've ever seen and it tasted amazing and but that's what a lot of these products are derived from. I say go to the source. When you, when you're looking at a 24-hour urine hormone test, you can see abnormal patterns of biochemical processing called metabolizing. You want to do the whole functional medicine. You want to do the whole functional medicine. Search for why.

Sandy Kruse: 1:33:45

Yeah, I agree. What about genetics? Like I, well, I already know I have gut issues because they're directly tied to thyroid disease, which I had for many years before I had thyroid cancer. It's face facts. But I didn't know the signs, I wasn't educated on the symptoms. This is going back so many years ago. But do you think genetics comes into play?

Dr. Daved Rosensweet: 1:34:09

Well, man Sandy, these topics you have.

Sandy Kruse: 1:34:13

I'm just throwing them all out at you.

Dr. Daved Rosensweet: 1:34:15

You're just throwing out a little mannered question here.

Sandy Kruse: 1:34:18

I know. But you know, like, I wonder, see, I had an aunt that, yes, had an aunt that because my aunt died of uterine cancer. So but I also, I'm also believing that I want to optimize, but I want to do what's the most protective for me. Knowing my family genetics, I've run them up and down and all sorts of ways.

Dr. Daved Rosensweet: 1:34:40

So let me come in on what I think genetics are. Okay. Ideally we'd be genetically perfect, we'd be designed for perfect health for 100 years or 200 years, and then we'd pass on. But the human race I don't know if you've noticed there's a little vulnerabilities and weaknesses and imbalances that are sort of run through the whole human race. Yes.

Dr. Daved Rosensweet: 1:35:08

And they show up on every level. Everything is multidimensional. Anything that's present on any level is present on every level. And genetics is a very unique position. It's right at the junction of information and physicality. In other words, something's talking to these genes and they're behaving in a certain way and if they're talked to properly, they behave in the direction of health. And if you mess with the genes, you can throw off a physical body.

Dr. Daved Rosensweet: 1:35:41

And there's a lot of things that will mess with genes, right down from the mind and thoughts and beliefs down to toxicity and all kinds of things In general. I find most of us are genetically designed for health. But if we mess with the genes by throwing threats at the human body, the genes are going to be the point that are going to have the power to alter how we respond. So, for example, if there's constant exposure to some kind of toxin, the human body, as it's designed, had better adapt, or it's not, it's going to get poisoned. So the best, the only place of adaptation, or it all begins with change the genes to change the outcome. So it's a very unique position. You can change things if you talk to the genes, right or wrong. I want to look at it. So how we talk to our genes through the very thing you're devoting your professional life to, which is talk to these genes properly, especially if you've got vulnerabilities, and everybody's got vulnerabilities. I agree, everybody does Yep.

Dr. Daved Rosensweet: 1:36:56

And when you look at how someone developed an illness, and when you look at how someone developed an illness, you'll see that there was a myriad of adversities that eventually added up to a diagnosis. Yes.

Dr. Daved Rosensweet: 1:37:10

And you could probably name yours. The way I like to do it is I say this to a patient. I say see that wall over there. Pretend I have a video of your whole life, that a videographer took photos, took videos of you from the time you were conceived until yesterday. And then the videographer took all that material and had a magic editing button and they pressed that button and all the good stuff disappeared from the footage. All the good food you ate, all the good exercise you did, all the fun you had, all the good thoughts you had, all the love that you felt, all the giving that you did. Got rid of all the good stuff. What would be left behind would be a trail of tears. Yes.

Dr. Daved Rosensweet: 1:37:56

When you didn't eat right, when you didn't exercise right. That's what throws the body off, and it throws it off at every juncture, including genes. So I don't want to overcomplicate it. I want to look at it another way. You asked the question. Yeah yeah, I'm merely.

Sandy Kruse: 1:38:16

Let's go there.

Dr. Daved Rosensweet: 1:38:18

I had a privilege of working with a world-famous holistic neurologist for a while and his father had Alzheimer's. And we know about genetics of Alzheimer's. A certain number of people have this double ApoE gene, yeah, and those that do are at special vulnerability for developing Alzheimer's as well as a few other things. And, as this doctor said, I said, did you ever test out your own genetics? And he said no. And this is a world expert holistic physician. He said I didn't want to know If the genetics were not good.

Dr. Daved Rosensweet: 1:39:00

I still have the exact same thing that I need to do, it's take care of my health in every way I possibly can. Speak kindly and lovingly to my genes in the language that they understand, which is nutrition, detoxification and all the rest of the stuff. And so he never wanted to find out his genetics because he didn't want to also hurt himself by running into some vulnerabilities there when his action was going to be the same. So you know there's a lot of ways to look at it. Genetics is fascinating. It was one of the most fascinating college courses I ever took. But as far as practical, well, my granddaughter is playing with CRISPR. I mean, she got her degree in college with genetic alterations. So I don't want to rule anything out, but in this space industry we're not at the point where we can take a thyroid vulnerability and alter the gene and you won't ever develop issues. So I say shy of that. Take care of yourself, just like you've devoted your professional career to.

Sandy Kruse: 1:40:07

Yeah, no, it all makes sense. But you know, the way that I look at it is I try and educate my children on some of their potential vulnerabilities to perhaps and again, it's always going to be in their hands that maybe they can do things differently than I did. You know, I used to be a smoker and I, like I didn't even think about this. I was like a 1970 baby. Oh yeah, like you know, when I was in the eighties, everyone was smoking as a teenager. Now it's vaping.

Sandy Kruse: 1:40:41

So you know, we all do our best with our knowledge and I think that we were never educated like, say, my kids are, so they're told, do not smoke. So they don't smoke, but they vape instead, right? So I guess we all do our best. I guess we all do our best right, and maybe some of us don't and don't care. So this has been such an amazing conversation, dr Rosensweet. I so thank you. I mean I could talk to you all afternoon, but I'm sure you have other things you've got to get to. So please let us know. Where can we find more information?

Dr. Daved Rosensweet: 1:41:24

Karina, who you've spoken to, can give you access to the book, so all of your listeners can have a free PDF copy of the book. There is a printed copy, but you can have a free PDF copy of it.

Sandy Kruse: 1:41:39

Amazing.

Dr. Daved Rosensweet: 1:41:40

And I want to pause for a moment and say these are always co-creations. Sandy, your vitality, your love of the work that you do. It was you and I just coming together and synergizing, so this particular interview is a combination of both of us here. I can tell the difference, you can tell the difference. So thank you for your devotion and what you're doing out there.

Sandy Kruse: 1:42:00

And thank you so much. So thank you for your devotion and what you're doing out there and thank you so much. I hope you enjoyed this episode. Be sure to share it with someone you know might benefit and always remember when you rate, review, subscribe, you help to support my content 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.