Ep. 454 Menopause, Memory & Hormones: What You Need to Know with Dr. Daved Rosensweet

Today, I am excited to connect with Dr. Daved Rosensweet, the founder of The Institute of BioIdentical Medicine and The Menopause Method, a leading expert in andropause and menopause treatment, and an internationally recognized lecturer and presenter with over 30 years of experience. Dr. Rosensweet has written three books, including his latest, Happy Healthy Hormones. 

In our discussion today, we dive into factors that influence long-term health and cognitive function during menopause, exploring strategies to help you avoid becoming a nursing home patient. We look at the role of hormone replacement therapy, the neurocognitive shifts that occur in perimenopause and menopause, why pellet therapy may not be the best choice for most women, and the impact of the Women’s Health Initiative. Dr. Rosensweet also shares valuable insights on the differences between compounded and synthetic HRT, the importance of testing, and the best routes of administration, and we examine what happens to hormone receptors more than a decade into menopause and how to support brain health by maintaining optimal estrogen levels. 

This insightful conversation with Dr. Rosensweet is invaluable, so you may want to listen to it more than once.

IN THIS EPISODE YOU WILL LEARN:

• Why hormones, exercise, and protein are crucial for maintaining muscle mass and overall health as women age

• Why testosterone is essential for muscle mass maintenance, mood, and cognitive function

• The role of estrogen in maintaining cognitive function and potentially reversing dementia in women

• Dr. Rosensweet shares his concerns about pellet therapy

• The benefits of using bioidentical hormones 

• Some alternative forms of HRT

• Why patients and clinicians must share decision-making  

• How long-term hormone deficiency affects women's health 

• Why it is essential to monitor hormone levels 

• The benefits of addressing progesterone deficiency early 

Bio: Dr. Daved Rosensweet

Daved Rosensweet, MD, is the Founder of The Institute of BioIdentical Medicine and The Menopause Method, as well as the author of three books on the subject, including his latest "Happy Healthy Hormones". With over 30 years of experience specializing in andropause and menopause treatment, Dr. Rosensweet is an internationally known lecturer and presenter. Early in his career, he trained the first nurse practitioners in the United States and was in charge of health promotion for the State of New Mexico. Currently, Dr.Rosensweet spends the majority of his time as the Medical Director of The Institute of BioIdentical Medicine, where he trains medical practitioners to specialize in menopause and andropause medicine.

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“So much of what passes for dementia in women is a result of insufficient estrogen.”

-Dr. David Rosensweet

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Connect with Cynthia Thurlow  

• Follow on Twitter

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• Check out Cynthia’s website

• Submit your questions to support@cynthiathurlow.com

Connect with Dr. Daved Rosensweet

• The Institute of BioIdentical Medicine

• Connect with Dr. Rosensweet’s training program at Brite or the Institute of BioIdentical Medicine  

• Download a free PDF copy of Dr. Rosensweet’s book, Happy, Healthy Hormones

Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:29] Today, I had the honor of connecting with Dr. Daved Rosensweet. We discuss ways to avoid being a patient in the nursing home, the impact of hormone replacement therapy, neurocognitive shifts that we see in perimenopause and menopause, why pellets are not the greatest option for most women, and the impact of the Women's Health Initiative, HRT options in terms of compounding versus synthetic, differences between estradiol and Bi-Est, why testing is so important, as well as route of administration and what happens in women 10 plus years into menopause in terms of dormant receptors and lastly, concerns around neurocognitive effects of the menopausal transition and how to help navigate ensuring that your estrogen levels are at an appropriate level at this time to protect your brain. This is an invaluable conversation with Dr. Rosensweet, one you will likely want to listen to more than once.

[00:01:34] I do think that, I was excited when you reached out on social media about doing a podcast together, largely because you have left such an enormous imprint on women's health, hormonal health, talking about HRT, empowering women to take care of themselves. And I thought it might be an interesting segue into our first vignette that we'll discuss. What are the things that you think as a clinician that can help women avoid ending up in the nursing home? And the reason why I'm asking this question is that I'm in the sandwich generation. I have teenagers, one of who’s in college, I have parents that are getting older. And these are the types of discussions that I'm starting to have with my parents. My father is predeceased, my mother. But having discussions with them about the things that they can be doing now or certainly when they're younger to avoid ever needing to be in a facility for Alzheimer's care, lack of mobility, a lot of the sequelae that we see in our patient population as they get older. Tends to be a pretty organic conversation, but as I was thinking of ways to differentiate this conversation with other ones that I've had around women in middle age, I was like, you know, this is something I'd love to ask you. What are the things that you feel are really important for women to know as they are navigating their 30s, 40s, 50s and beyond, to help avoid ending up in circumstances where they are in a nursing home. 

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Dr. Daved Rosensweet: [00:03:07] Yeah.

Cynthia Thurlow: [00:03:08] I'm not talking about assisted living, I'm talking about nursing home care where they're not able to do their activities of daily living and are largely dependent on others to help take care of them. 

Dr. Daved Rosensweet: [00:03:18] I would say this is the most interesting question that when people are in menopause, perimenopause, early andropause, hardly anyone thinks of, well, what's it going to be like 40 years from now or 30 years from now? And yet what I find is as people enter their 70s, 80s, 90s, they love their life just as much as anyone does at any other stage. And when they start seeing that progression into assisted living in nursing homes, it's one of the hardest things in the world to do, is to leave home. And you might have been through this already. I didn't quite hear that you were. But going through with a parent when they're making that transition, I remember doing it with my mother and, wow, it was a rough time for her because she loved being at home and she couldn't be there. 

[00:04:19] Sorry for so many words. The number one thing that is so critical here are the hormones. Turns out hormones and exercise and the hormones for several reasons. Let's take women. Well, it began for me in medical school in 1968 when a gerontologist was lecturing to a senior medical students and said, you all know thousands of diagnoses. Let me tell you what's really happening to older people. They're losing their muscles through a process called sarcopenia, and they can't stand and walk with stability and they fall on their osteoporotic hips. And at that time, they died. You know, very few made it through. And these years they can make it through an extra year or something. You want to help old people, help them with their muscles and their mind, because that's what's getting them. 

Cynthia Thurlow: [00:05:14] Yeah, I mean, I think that I've shared very openly with my community that my father was living with my stepmother and they were in independent living. They sold their house, which was a good decision because they had a house that was way more than they could manage. My stepmother was a bit older than my father, but had very early signs of progressive Alzheimer's, and so he was really devoted to her care and their retirement. And the saddest thing for me, when my dad ultimately became sarcopenic, had significant issues with falling, ended up developing a massive subdural hematoma or a head bleed, and, wanted to die on his terms. He didn't want surgery. He would not have been a good surgical candidate.

[00:05:56] And my brother and I lovingly took care of my stepmother for the rest of her natural life, which was only about four months after my father passed in hospice. And it just reaffirmed for me why it is so important to have these conversations. Because in our 40s and 50s, we're not thinking about that slow decline and how menopause really accelerates this loss of sex hormones. We start really redistributing fat in our body with this muscle infiltration. I always say we want our muscles to resemble filet and not ribeye as delicious as ribeye is, that's what you get, this fatty infiltration of the muscle. And what many people don't realize, they think that muscle mass is more about body composition and helping them understand that muscle loss leads to frailty, frailty leads to falls. 

[00:06:46] Whether you fall and break your femur, break your hip, you get a head bleed. I mean, these things are so-- they seem so normal. And certainly, as a nurse practitioner, I saw thousands and thousands of these kinds of situations when I was rounding on patients. And I think for so many of us, we tend to be reactive and not per se, proactive. And that's why when I was thinking about our conversation, it was like, “What are the things that we probably should talk about that maybe many people who are not fortunate enough to have worked in medicine for as many years, certainly as you have, and certainly as I have, may not even have this on their radar. Maybe their parents are slowing down, but they're not thinking about why they're slowing down.”

[00:07:27] They may be encouraging their patients to remain active, but they may not realize that frailty almost seemingly comes overnight. Because my mother and stepfather during the pandemic were obviously, like many retirees, kind of hunkered down in their houses. And the frailty difference in my mother in one year's time was so significant that I kept saying to her, you have to keep moving. You have to be mobile. And she thinks she's being mobile and she's moving. But it's not enough to circumvent what has transpired over that whole year of the pandemic when many of us were not doing the things that we were normally doing. So, when you're talking to patients about that perimenopause to menopause transition, the hormone piece and remaining mobile and maintaining muscle mass are certainly important. 

[00:08:18] Do you think that there's enough discussion around the importance of testosterone therapy for women? I feel like it's still, in many instances, I hear a clinician saying to patients, “Oh, you don't need testosterone.” Testosterone is not important. And yet it's the most potent sex hormone that we have in our bodies as women.

Dr. Daved Rosensweet: [00:08:35] Tell a man, “Oh, you don't need testosterone.” [Cynthia laughs] It's not a big deal that you lost your erection. [laughs] 

Cynthia Thurlow: [00:08:41] Yeah, yeah, exactly. exactly. 

Dr. Daved Rosensweet: [00:08:45] Yes. People don't understand this, that every young woman has more testosterone than she's got her most potent estrogen, estradiol. And, yeah, it's a human hormone and it's critical. And that's really what we're talking about as far as muscle goes, is you need testosterone, exercise, and protein to maintain muscles. Without any one of those, and you lose your muscles, you get sarcopenia, the bane of the elderly. Yeah. Testosterone for so many reasons, for mood. I mean, these are the most powerful biochemicals in our body, some of them, and we don't do well without them, but we don't do well on these deep levels. That's the big one, the mood and muscle. I'm repeating muscle because I think people don't quite make the connection, never mind libido. There are women and men who are having active sexual intimacy in their 80s and 90s, and you bet you they are, keeping up on their [laughs] smart phones.

[laughter]

[00:09:46] They figured it out and kept it going. And then estrogen for the mind. So, much of what passes for dementia in women is a result of insufficient estrogen. Yes, there are other causes of loss of cognition, but in women, most of it is reversible. It caught at the early stages, not so easy at the later stages. I have experience with this, and yeah, so much cognition can be recovered back to normal in even women who feel quite compromised with adequate estrogen. So, yeah, bones. We left out bones. Testosterone is important for the bones. 

Cynthia Thurlow: [00:10:32] Yeah. I think that a lot of us, and I say us, as women in middle age, we fear the loss of neurocognitive status. We fear the thought of dementia, Alzheimer's, being a burden to our families. And so, I think for many women, I think about researchers like Dr. Lisa Mosconi and her work around the role of estrogen, estradiol signaling in the brain, why it's so important. I feel like when I first became a nurse practitioner, it was predeceased The Women's Health Initiative. So, I got to watch that first wave and I was neatly tucked away in cardiology. I got to hear patients talking about being taken off their hormones, but I wasn't prescribing hormones at that stage. 

[00:11:16] And I retrospectively think back now and think about how an entire generation of women, entire generation of clinicians, fearful to prescribe, fearful to take. And maybe things are starting to come back around. Maybe, perhaps my generation has been amplifying the need for discussions just like this to bring good information to people. But when I think about estrogen in particular, I think there's still this fear around, I'm going to say as an umbrella. I think many people fear taking hormones because they might gain weight. They fear that they might not feel like themselves. But I can assure everyone listening that most women, when they start using some degree of hormonal replacement therapy, they feel so much better and they start to realize that they had many years of living in this abyss. 

[00:12:02] Either they were anxious or depressed, or their sleep wasn't optimized, or they had no libido, or they lost executive function. They get off the couch, go to the gym, get things done. That neurocognitive piece for me, I know that estrogen for me, I was initially prescribed a compounded and I'm hoping that we'll talk about this compounded estradiol, estriol. And I just wasn't absorbing it enough. And actually, I do better on the patch, but the patch isn't per se equivalent to Bi-Est. But I think for a lot of individuals it's a degree of experimentation with your clinician to find what works best for you. I'm curious what your thoughts are on pellets. I know that this is a very controversial topic.

[00:12:46] I know as I've interviewed many, many GYNs and physicians and nurse practitioner leaders, there are very strong opinions one way or another. I don't know if you have an opinion on this topic. Do you feel like supraphysiologic dosing is beneficial? Do you think that it has a place for certain individuals? Where do you fall on that continuum? 

Dr. Daved Rosensweet: [00:13:07] Well, I love to copy nature and not try and reinvent the human being. And there's been ever since, like you mentioned, the Women's Health Initiative, this whole field of menopause got stunted in a way that no other medical specialty did. Cardiology, amongst every specialty, it's got a core body of knowledge that everyone agrees on it's standard of care. There might be some discussions at the periphery, but not around the core stuff. And that evolved over time, these specializations. These people got fantastic at this stuff. Not in hormonal medicine. That WHI stunted and set back a century, the whole field of treating women with hormones. And then what grew up in its place? All kinds of wild ideas. I've never seen so much discrepancy in differences of opinion in any other field of medicine than in hormone.

[00:14:12] And it's because it didn't get the general humongous participation of those who love the work. Very few specialists exist in this field, sorry for the diversion there. But into the field of hormonal medicine, there's stuff that I think is fabulous and common knowledge. You know, physiologic, beautiful. And there's other stuff at the other end of the spectrum that's pretty iffy to me. And if I had only one tool in the world called pellets, I'd figure out how to do them right. I don't think they're being done very well by very many pellet inserters. But how do you get something to last three months that you insert in the skin? In order to get it to last three months, you got to give a super high dose and then it gradually deteriorates. In the end of three months, it's run out. 

[00:15:09] So, supraphysiologic is the perfect word. I don't feel comfortable with supraphysiologic in any way. Now, humans are resilient and probably a lot of folks are not going to be damaged by it. But we've got medical history, evidence of supraphysiologic doing a lot of harm. So, I don't like to see it anywhere. I don't love it in the patch. I mean, the patch has got to give an estradiol dose that lasts three and a half days. If they had daily patches that at least more mimic nature. But so, you get a peak and you get a gradual decline. These peaks in hormone medicine are problematic. Now, patch is much kinder than a three-month thing, but super physiologic not-- the thing that always baffles me. When I started out in hormone work, not a lot was known.

[00:16:07] This was 1993 and I had the brilliant idea that I'm going to have to figure this out from scratch with women. And so, I shared a certain amount of knowledge with women how these hormones behaved, what the symptoms were. And I started them on low doses and they gradually increased the dosages daily. And together we learned how to figure it out. And here's some of the things I figured out. Number one, individuality, Holy mackerel. [laughs] You try and do one dose fits all for women in menopause. [laughs] You know what? If it was the only tool I had, I would do it. Even Premarin and Prempro, which is not something I love. They did a lot of good on this planet. They were a single dose or maybe two different dosages for all women. 

[00:16:59] But one of the things I learned right out of the gate is that some women, they needed this much hormone to feel really good and to test out really well. Other women need four times that much. And then there's everything in between. And then you've got three hormones. You've got the estrogen family, you've got progesterone, you got testosterone. And women vary as to the relative balance of all three of these. So, the thing I could never figure out about pellets is you stick that thing in there, you're making a guess. I could never make that guess. I remember maybe you know, this name. I was shadowing someone who was really expert in thyroid. His name was Alan Gaby. And we were going patient to patient in his office. 

[00:17:44] And we go in and interview this woman, and we walk out of the room, and he says, “She's hypothyroid.” And you know what? You haven't got a clue as to what to write down on your prescription pad. You don't know what her dose is. And I'm sitting there going, “Really?” in my mind. And then he says, “But no problem, we'll have her find her own dose.” And I go on, “This guy went to medical school. I went to medical school. No one told us, find your own dose.” And sure enough, you start low, you alleviate symptoms of insufficiency. If you go too high, you get symptoms of excess. These things are so powerful. Mostly they do give symptoms of excess. And so, my point is the same. 

[00:18:27] It's like it's no problem at all if you realize that you individualize every woman and you individualize all three major hormones. She'll find her way there, and you'll test her, and you'll do tweaking if you need to. That's the main thing I couldn't figure out about the pellet is if they miss that dose, like, if they give too much, for example, it doesn't come out for three months. You don't get to remove that pellet. And so, it was just the fine tuning of the dosages that was such a core day to day, every single patient phenomenon that I thought, this is not good medicine and it's got a financial motivation in there for the providers. And tell me, do you really want to go into your doctors every three months or your nurse practitioner and get an injection? And so, there's other things. 

[00:19:20] So, I'm not a fan of pellets. And I testified in front of the National Academy of Science Committee to Protect Compound and Bioidenticals in 2019. And I learned a lot prior to going in there and I learned what their bugaboos were and what they were really after. And pellets was number one. They led my day off with a state's attorney general who was given a half hour. We were given six minutes to testify. He was given a half hour about how egregious pellets were. So, I also am concerned about that which puts bioidentical hormones in jeopardy and compounding in jeopardy and pellets do. Now in the hands of some really knowledgeable nurse practitioner physician, that could be a different story. 

[00:20:06] And I think there's a lot of satisfied pellet folks out there and I think there's a lot of pellet folks who get high on supraphysiologic. But supraphysiologic is a long-term strategy. We have so many-- I'm just repeating myself. We have so many actual historical stories of people who got in trouble. Too much cortisol. Yeah. Got high. Oh, yeah. You give someone too much cortisol, they love it. They don't want to come off of cortisol, [laughs] but the trouble it causes. So anyway, I am not a fan of pellets and I like to actually take a stand and say don't do it well. 

Cynthia Thurlow: [00:20:43] Well and I think if you're working with the right clinician and as you very astutely said, bio-individuality is really what drives shared decision making with your patients. I think if you're working with the right clinician, they are going to be very conscientious about fine tuning the dosing for estrogen and progesterone and if needed, testosterone. And I would agree with you that we've had women in programs that we've done testing on and they'll say, I know my testosterone's low because my pellet was done three months ago and I'm dragging and I'm exhausted. And sure enough, they are still super physiologic in testosterone. It's actually their cortisol is low and that is why they feel really drained really poor. And I would actually say that I probably have met several physicians that are very savvy with pellets, but they're very conservative.

[00:21:34] There are not the cowboys of medicine that are out there, using pellet therapy and doing it in a way where women run around feeling good, maybe the first pellet that's inserted and with subsequent pellets they feel like they are still chasing that high, that experience they had with their very first pellet insertion. And so, I would say there's so many other really great options. And I'm so appreciative of the work that you do advocating for women. Let's talk about alternatives to some of the conventional bioidentical hormone options. So, let's talk about estrogen first. You mentioned and I know what you're getting at about estradiol, just taking estradiol. And we'll definitely loop that into the conversation. Of the current available options for estrogen, I know many women want products that are covered by their insurance and I totally understand that. 

[00:22:24] It can get expensive if every product is being compounded. And I'm on a combination of some compounded, some not compounded. And that's just what has worked out well for me. And that includes thyroid medicine. With that being said, when you're having conversations with your patients and you're working with a new woman that's in menopause, she's interested in bioidentical hormone therapy. Are you integrating solely just compounded estrogen options? Do you ever consider using patches or rings or some of the other options that are available? The reason why I'm asking these are the kinds of questions that I receive, which I love to ask of my guests, because you're far more savvy with these options than even I am.

Dr. Daved Rosensweet: [00:23:12] Well, there's a lot of decent options out there. And like I say, the thing, the option that was the most popular on the whole planet, it was horse urine-derived estrogens, 50% of which a woman's body never saw. And this artificial progestin molecule that's problematic and just repeating myself again, a lot of women did really well on that. And there was 18 million women on it in the United States, 40% of all women in menopause were on Premarin or Prempro in 2002. But in any field or anything we can think about, there's stuff that's good, there's stuff that's better, there's stuff that's even better. And there's stuff that's best. And I tend to have gravitated all the way to the best stuff. And then there are other considerations. Finances are a consideration. The best stuff tends to be more expensive.

[00:24:11] The best automobiles, the best clothes, you got to pay for it. And so how to bring insurance into it. Well, I got a call from my favorite lobbyist just the other day who's trying to set up a path to get compounded hormones covered by insurance. He knows the pathway. I see the pathway. And we're trying to set up a meeting to see if we can pull it off. That would be very good because a lot of folks do have insurance and that does matter. And a lot of good can be done by that, which insurance covers. Like, you can get a decent estrogen in the patch or in gels, and you want to do estrogen topically, safe, whereas pills, they're good, but they've got some downsides, including some risky stuff. So, I wouldn't do estrogen by mouth. 

Cynthia Thurlow: [00:25:01] I was going to say it's interesting because in the perimenopause, menopause space and it's mostly physicians, but they're talking about, they have some patients that don't tolerate the adhesive from a patch. They don't absorb enough estrogen, whether it's compounded, so they've started them on oral estrogens. And I know some of the concerns that we'll probably discuss is that and I don't know the statistics offhand, but in a small amount of women, it increases their likelihood of developing thromboembolic events. Looking at DVTs, deep vein thrombosis, which have the propensity to travel. I always say in cardiology we don't love clots for a variety of reasons because clots tend to move. The greatest concern of which, pulmonary emboli. So, blood clots in the lungs. 

[00:25:47] I am curious if over the past, 40 plus years of your medical career, at any point were you prescribing oral estrogens? Was that something you did towards the beginning? If we're talking about Prempro and pregnant mare's urine, that's-- crosstalk

Dr. Daved Rosensweet: [00:26:00] I never did. As soon as I entered the field, I knew Dr. Jonathan Wright and he was already prescribing Tri-Est and Bi-Est at that time and sure sounded good to me. Why not copy nature. You know, that was his mantra. [Cynthia laughs] Yeah, there are these options available, and then that's one end of the spectrum. But I'd like to go to what I think is the very best. Like, here's what we know about a woman's body. She does not just have estradiol. She's got more estriol, which is another estrogen. Then she's got the sum of the two most potent estrogens, estrone and estradiol. That design must be there for a reason. And this was proposed, Dr. Wright uncovered this research. The research was done by an oncologist in the 1960s saying that estriol was probably protective against breast cancer. 

[00:26:48] And Dr. Wright saw that and saw the reasons why there's more estriol than a young woman body and proposed that we give estriol along with the estradiol. And that's what I started with was Bi-Est right out of the gate because I saw that research and I thought, yeah, why not just do what nature did? There must be a reason. Well, in the 1990s, scientists at Tulane uncovered these estrogen receptor sites. And I don't know if this is going too deep in the weeds, so you tell me, feel free to interrupt me at any time. But in a young woman's cycle, she goes through the whole first part of her menstrual cycle, proliferating. She creates new cells. She creates new cells in the uterus, the line uterus, to receive a possible fertilized egg. She also prepares for breastfeeding right there every single cycle.

[00:27:42] She proliferates new breast glandular cells, new cells developed by mitosis. Her breasts get fuller. For most women, feel this. And if she does not get pregnant, there's a de-proliferation whole second half the cycle if there's no fertilization. And the de-proliferation in the womb eventually leads to menstrual flow and the de-proliferation in the breast leads to the breast getting smaller because there's cell loss there. That de-proliferation is under the auspices of estrogen receptor site beta. The proliferation is primarily guided, inspired by estrogen receptor site alpha. The principal stimulator of the proliferation is estradiol, great. Definitely want it, need it, love it. The de-proliferation is primarily under the auspices of estriol, de-proliferation, what do we want in a menopausal woman? We don't want new cells. So, it's a little vulnerable time there. You get cell division and stuff, mitosis and stuff. 

[00:28:47] But really, we just want to copy nature? So, I always prescribe Bi-Est and I always prescribe it topically. And then we've gone to another step. I was prescribing compounded Bi-Est back in the early 90s and I had never seen the hormone. I was writing the prescriptions. My compounding pharmacist was shipping it to my patients and then in the early 2000s, they misshipped a Bi-Est prescription to my office rather than to my patient. I was fascinated. Came in this white cosmetic jar and I broke the seal. I wanted to see what a hormone looked like and out comes a strong odor. And these gels, these creams, they are over 99% base. That's what's in a jar. There's the base and then there's the hormone. And these bases are very strong solvents. They need to be. 

[00:29:42] These steroid hormones are not soluble unless you use a strong solvent. So, here I was, a functional medicine doc telling my patients to detoxify. And I did the math. I'm asking women to apply a quart a year of these gels. So, we went on to investigate, develop patent organic oil way of delivering these. So, to me, the very best way for a woman to take estrogen is to take Bi-Est twice daily. 

Cynthia Thurlow: [00:30:18] Oh.

Dr. Daved Rosensweet: [00:30:18] Yeah, more copies. Nature, you don't get those peaks. We don't want peaks. 

Cynthia Thurlow: [00:30:23] Peaks and troughs. Yeah.

Dr. Daved Rosensweet: [00:30:24] Yeah. So, Bi-Est twice daily in our organic oil base. I think that represents the very, very best. 

Cynthia Thurlow: [00:30:32] So, the question that I have, that I'm sure listeners will have as well. So, even if we have our hormones compounded, whether it's versa base or any of these compounded solvents that hormones are being placed into, which we then apply to our bodies. I'm curious, what are they made of? You mentioned that you had a strong odor when you opened up the jar. I'm curious, what are most-- I'm going to say most, what are most compounding pharmacies utilizing as the reservoir to apply these hormones in.

Dr. Daved Rosensweet: [00:31:04] Strong solvents in a gel form or a cream form. So, versa based Lipoderm, Carbopols is the most ancient of them. That's what the drug companies picked up when they prepare their gels. And in medicine, you know this so well, it's sort of risk benefit, benefit of having hormones applied to your skin is so great. And we're very resilient in many ways, but not so in others. I mean, how much leeway do I want to take on a daily basis with my health factors? Not too much, but at any rate, that's what's being used is these strong solvents. So, even though estrogen and testosterone in women, for example, are best [unintelligible 00:31:53], applying to the skin, no doubt about it, there's better ways to carry those hormones into the skin. And we love our organic oil. We think that's the best thing. 

Cynthia Thurlow: [00:32:06] Are you at liberty to share what kind of organic oil it is? Because again, these are the questions I can say without a doubt people will listen, they'll want to learn more, they're curious. 

Dr. Daved Rosensweet: [00:32:15] It's certified organic and because our patent is being breached, I'm not going to mention it over the air. 

Cynthia Thurlow: [00:32:21] Okay, okay. But you want to be conscientious about the carrier product with which your hormones are in. So curious, again, more questions. I'm seeing a lot of functional med, integrative med docs, NPs, PAs that are using subcutaneous testosterone in women or even injectable IM into the muscle. Again, dealing with, in some instances supraphysiologic dosing. Has there ever been a place or in your conversations with women where women are now asking for this? It's interesting and I asked this just from like a personal perspective, as an observational. I can tell the people on social media that are taking supraphysiologic doses of testosterone because they have very sinewy looking muscles and it's not to suggest women in menopause can have muscles, but it's a very distinctive look. And you can tell that their testosterone is not in a range that is optimal. 

[00:33:17] Its again, the supraphysiologic dosing that has very specific physical characteristics that I can now, like, I'll see someone, I'm like, “Oh, I know that person's got very high testosterone. And it's not from PCOS. Before someone asked me that. It is not someone who has polycystic ovarian syndrome. It is someone who's just taking very high doses of testosterone for a female. 

Dr. Daved Rosensweet: [00:33:38] Yeah. And the biology of it is very clear cut. Like the body does not like excessive doses of any of these hormones. So, it's got some protective mechanisms. So, you can get away with high doses, but not for very long because what it'll do without going into the details is it will bind up the excess that you're making. So, if your body picks up on, “Wow, we're getting a little too much testosterone there, maybe we ought to do something about this. We don't like excessive dosages.” So, it produces an increased level of this binding protein called sex hormone binding globulin. It'll also raise. It's going to get converted to other stuff too. It's also going to get converted to a testosterone metabolite called DHT. Problematic in women and men. And it can really be problematic around hair loss.

[00:34:42] Like men who have too high DHT. These tend to be the men who lose their hair and women's hair loss is a big deal. Now, the interesting thing about hormones is that very few people like excessive doses, these super physiologic doses. Like a woman who gets too much testosterone, she's going to get oily skin, pimples, hair on her chin, hair in the mustache area, irritable, too testosterone-ish. But the remarkable thing is not every single woman or man who gets overdosed actually has symptoms. Like you were saying there, some people get high off these things and they don't have these adverse symptoms. So, they tend to be the ones who are trying to get away with it. But biologically it's not a good idea. Like the classic example is young women on birth control pills. 

[00:35:36] Here they are, they're at the absolute peak output of their ovary of estrogen and you give them more estrogen and their body goes too much estrogen. What can we do about this to protect ourselves? Well, let's just bind up more of it, let's just produce more of this sex hormone binding globulin and it winds up also binding up some of their testosterone. And there's a certain percentage of young women on birth control pills that lose their libido because of the sex hormone binding globulin. So, I say caveat emptor, be careful. You're going to go into it, you're going to experiment with your-- science experiment with your own body. I mean, the classic example was cortisol. It came out in the 1950s. They learned how to synthesize it and healthcare providers were shoveling it out the door. Their patients couldn't get enough of it. 

[00:36:29] And then a year or two into it, they started seeing these very, very severe side effects of these excessive doses of cortisol. Faces ballooning out to look like a moon. That's what it's called, moon facies. 

Cynthia Thurlow: [00:36:44] Yeah, buffalo hump, yeah. 

Dr. Daved Rosensweet: [00:36:43] Fat deposits on the back, suppression of the immune system. The body does not like too much and it does not like too little either. It likes just the right amount. So be careful. You're going into those high dosages and you might get away with it for a while and then you try and repair these folks. Not a guarantee that people have been on excessive dosages are going to get themselves back. Like there's a lot of athletes who are messing around with androgens and lo and behold, they became infertile and they're not that easy to recover. 

Cynthia Thurlow: [00:37:16] Well, and I think there has to be a healthy amount of respect for hormones. I think we know quite a lot. But I think that each patient, each individual has a degree of bio individuality. Some things you can account for, some things you may not be able to. What I loved as I was preparing for this conversation was you have this cardinal rule of hormones, which is what we're really speaking to. Don't give too much. Is that cardinal rule, that Goldilocks effect, finding the right dose, not assuming that everyone, just like when I was in cardiology, I could have 10 patients, same age, same kidney function. I can assure you I did not give those 10 patients the same dose of antihypertensives. I did not give those patients the same dose of lipid-lowering agents. 

[00:38:04] Because you really have to take that bio-individuality piece into account. And I think that I would much rather someone be conservative as opposed to being a cowboy, because I think there are noisy cowboys in the space, meaning they're well meaning, but they tend to be a little cavalier. And I think some people are just more sensitive. Do you find that you have patients that are just much more sensitive? Like a little bit of hormone can do quite a bit and they don't. Yeah, exactly. I'm one of them myself. 

Dr. Daved Rosensweet: [00:38:34] Yeah. In our teaching program, we say one of the initial discriminations you as a provider must make is are you dealing with a woman who has specific sensitivity? And because women often tell me, they say, “Look, whatever dose you give to your other patients, give me about a fifth of it.”

[laughter]

[00:38:54] Because I'm telling you, I'm sensitive to everything. So, a lot of women have identified this and I went, “Okay, because what did I know?” [laughs]

Cynthia Thurlow: [00:39:02] Well, I mean, if a patient declares themselves. I mean, actually my integrative med doc looks at me all the time and he says, “You are super sensitive.” He said, “We'll dosages changes every two weeks on thyroid medicine until we get you to where we need to be. As long as you're open to that.” Because if I hit you too hard, too fast, you're not going to want to take it, you're going to be miserable, you're going to be unhappy with me. And I was like, “No, no, no, no.” But I do think when a patient tells you that they are sensitive, you better believe it because more often than not-- [crosstalk] 

Dr. Daved Rosensweet: [00:39:33] That’s right, they are. 

Cynthia Thurlow: [00:39:34] They are, absolutely. And it's not anything wrong with that patient. That's just part of what makes them who they are. So, we've touched on Bi-Est. You mentioned Tri-Est. Dr. Wright had worked with Tri-Est and Bi-Est, it sounds like in many instances Bi-Est is what many practitioners are using now. How do we measure hormones? This is a very individual. When I ask clinicians this, some clinicians will tell me they don't measure hormones. Some clinicians will tell me they just go based off of symptoms. I think you and I are in agreement. I do like to measure hormones. But when you're working with your patients, are you looking at serum, are you looking at urine, are you looking at saliva? How do you make dosage adjustments with your patients in particular? 

Dr. Daved Rosensweet: [00:40:18] Let's stay with women from to begin with, right out when I started up, I had been speaking with Dr. Wright and I got enchanted with saliva. I mean, women could do the test at home. And I did about three of those and I went, “Man, these results, they don't make any sense compared to what's going on in a woman.” This says she's too low, she's having symptoms of excess. I'm going with the symptoms of excess. And I talked to Dr. Wright about it. He says, “Yeah, saliva does not work.” He said 24-hour urine is the gold standard. It's been so since the late 1960s. And so right out of the gate, I started doing 24-hour urines. Now I've done a zillion blood tests. They're excellent for so many things. We can learn so much from the blood, but not from a woman that we're treating with hormones. There's this thing called pharmacokinetics. It's like, “When did you draw the blood?” Did you draw it prior to them applying their daily Bi-Est? Did you draw it an hour later? 2 hours, 3 hours, 4 hours? So, our group, we have a lot of projects going on. And for decades we've had laboratory projects going on and we've done these studies we've drew blood on, starting with myself, my son, my daughter-in-law and my beloved partner-

[laughter]

Dr. Daved Rosensweet: [00:41:35] We drew our blood before and then every hour after. And there's a big difference as to when you draw that blood, that is not a problem. When you collect urine for 24 hours, it doesn't matter when you apply your hormones, but it does and that includes these dried urine tests which are. I would like to put out a warning on this. We've done cross studies where we took an individual patient's and we sent off in a 24-hour period to five different laboratories. And there's a lot of discrepancy there. And the dried urine has several problems associated with it, but one of it is pharmacokinetics. When was the urine collected according to when they applied their hormones. And so, 24-hour urine takes care of it. I have 30 years experience with it and I've seen it over and over again. And another thing we were able to do with the 24-hour urine was to go into the medical literature and get additional information about what's too much and what's too little. And I find testing is really important. And it relates to a study we did. 

[00:42:45] I took 54 patients in one year that had said to me, women who had said to me, “Wow, I got it, I was feeling awful. Now I've been taking these hormones and I figured out my dose, I've got it.” And at that point we test 100% of our patients. That's when we test them. And of those women, 50% of them were not on enough estrogen to protect their vagina and bones, which is a fairly minimal amount compared to what it takes to protect the brain and the arteries, for example. And 25% of them were on dosage is that were excessive enough to raise the risk of increased breast glandular cell proliferation, increased breast density. We don't want that. So, even though they said they were feeling great, there was 75% that weren't in the zone that we consider optimal. 

[00:43:35] And so that's why we test 100% of our patients. There are those who say don't test, the North American Menopause Society, for example, the American College of Obstetricians and Gynecologists. Well, they're right about it because they know that there's issues around blood testing and they think saliva is out to lunch. But they have no comment about 24-hour urines because they're not aware of it. So, they say go by symptoms alone. Well, I wanted to see if that was true and it was not true. And I've had this privileged demographic of some of the most intelligent, health motivated women on the planet earth. And we figured this out together. And even with them, you needed that final tweak of the 24-hour urine hormone testing. So, I feel very strongly about that.

Cynthia Thurlow: [00:44:23] Well, it's funny, my functional med doc had me do a 24-hour urine and trying to explain to my husband, I'm going to keep this 24-hour urine jug in a specific place upstairs because I have teenage boys and trying to explain to them. So, every time I needed to use the bathroom for 24 hours, I ran up to that particular bathroom and I do think it yielded some very interesting information. Is there an inconvenience factor for one day? Yes, but I would agree with you that the information from that seemed to connect with some of the other things that we were doing. 

[00:44:57] Now, a common question that I receive is if a woman is five years, 10 years into menopause and she has a thorough evaluation by her provider about the appropriateness of hormone replacement therapy, what are your thoughts on those dormant receptor sites? So, let's say it's been five years, 10 years since those receptor sites have had the opportunity to interact with a particular hormone, let's just say estrogen. What has been your experience? Does it sometimes take longer for these women to feel relief if they're having symptoms? And I would imagine most women, if they're 10 years into menopause, they're definitely having genitourinary symptoms. They may still have some vasomotor symptoms. In fact, I jokingly say I'm like, when I interact with a woman that's 15, 20 years into menopause and she has never been on hormones, I'm just like, “How are you functioning?” 

[00:45:47] Because I just know how I would probably be feeling by that point with this loss of estrogen in particular. But when you have women that have had long periods of time without stimulation of those receptor sites, does it take them then longer to see relief of symptoms? Or can it be some degree of receptor dis-connectivity related to the lack of stimulation over a long period of time? 

Dr. Daved Rosensweet: [00:46:10] Simple question, important question, longer answer. 

[laughter]

Dr. Daved Rosensweet: [00:46:18] It takes us back to individuality again. And one of the aspects of treating woman whose body hasn't seen hormones for 5, 10 years is those receptor sites. Because hormones, how they behave in our bodies, you've got the hormone and then you've got what it meets up with inside the cell, which is a receptor site. And when the hormones go away, the receptor sites, like you say, they go dormant. So, you have to be more careful when you're making the choice to treat these women. I say making the choice, there's other factors to consider and I'd like to go into those. That's why I said there was a complexity to this answer. [Cynthia laughs] 

[00:47:01] But you want to go lower and slower in general because when they're young and they've got a zillion receptor sites open and you give them a lot of hormones, they're ready. When they're 10 years without hormones, you give them the usual dose and it just overwhelms the receptor sites and you don't get the on/off phenomena. So, it doesn't work well. So, you got to really respect it. The process is the same. You start low, maybe lower and slower. We do. Woman's body hasn't seen hormones for 10 years. Our usual protocol minimum, we cut it in half. We are doing lower doses, slower. [laughs] 

Cynthia Thurlow: [00:47:44] Low and slow.

Dr. Daved Rosensweet: [00:47:45] And when you do that dance with that receptor sites and your horizon is long. I'm going to take a while. No big worries here. You just go slower and if you do the dance to where you open them up with just the right amount, they can do very well. The other thing about when woman has been-- If I can go here if it's okay, Cynthia? 

Cynthia Thurlow: [00:48:06] Yeah, absolutely. 

Dr. Daved Rosensweet: [00:48:08] Yeah. Definitely lower and slower. And then we say any age that a woman gets it, that she may want hormones is the right time to start. I didn't start my mother who wouldn't let me get at or be her hormone doctor or any doctor until she was in her late 80s. 

Cynthia Thurlow: [00:48:26] Wow. 

Dr. Daved Rosensweet: [00:48:28] And yeah, and my mother-in-law and we didn't start treating them until their late 80s. And both of them had significant advantage. But it's so much more challenging. The very best thing a woman can do or a man can do is when you start getting the hints like in your 30s or 40s, pick up on it, then it's the best time. It's so much easier to preserve the functions that you are near and dear and you love. It's not so easy to recover them. And a woman goes 10 years. Well, a certain number of women who go 10 years without hormones, they're going to get some significant arterial damage. Estrogen is so protective to the arteries. Let's talk about your original field, cardiology. You know this? 

Cynthia Thurlow: [00:49:14] Yeah. 

Dr. Daved Rosensweet: [00:49:15] These women have so much. You don't hear of young women having a heart attack necessarily, but you occasionally hear about, “My God, he was in his 40s,” never sick a day in his life, and he had a heart attack on a tennis court. 

Cynthia Thurlow: [00:49:31] Yep. Or riding their bike. We used to see right about-- Absolutely. 

Dr. Daved Rosensweet: [00:49:35] But because the young women are very much protected by estrogen and its effect on the arteries, you remove that effect and women become vulnerable to heart attacks too. And sometimes when a woman's been 10 years out, that's sort of the magic number. We want to put them through a cardiac evaluation? 

Cynthia Thurlow: [00:49:54] Absolutely. 

Dr. Daved Rosensweet: [00:49:55] There is this rare instance where they did develop arteriosclerosis. And that wasn't the big deal, as you know better than I do. It was like you mentioned earlier, it was the clot that formed on that barnacle coronary artery surface. And when you start a woman on estrogen, there's a small number of them where they'll get initial vasodilation, the clot will break loose. That's called an embolus. That's a heart attack. So, this is very, very, very unusual. But it's enough that when I see a woman who's 10 years out, we'll want to put them through at least. And I'd like your opinion on this. I've talked to cardiologists about this. We want at least a stress ultrasound. We're going to be able to pick up with some coronary artery compromise of flow with that, minimal. We want that. 

[00:50:46] And then some of these women need to have some coagulation studies too, because again, it's not the arteriosclerosis as much as it is the clot that forms [laughs] there. Now, 10 years is sort of the magic number. We don't hold that to be so when a woman has a family history of where a mom had a stroke, her aunt had a heart attack. No, we're doing this evaluation much earlier. Like they're five years, three years, whatever it is. So, there's a complexity to women who pick up on these, the need for hormones or the desire for hormones later. How much of an evaluation are we going to put them through? Now, having said that, sometimes you don't get to put older people through an evaluation. They ain't going to do it. My mother was not going to go to a cardiologist, neither was my--

[laughter]

Dr. Daved Rosensweet: [00:51:40] So, it's risk benefit again. And sure enough, we'll go ahead and treat, so long as the patient knows what they're getting into. 

Cynthia Thurlow: [00:51:48] Well, it's that cost benefit analysis. It's that shared decision making. And I think that what I hear from a lot of women, because either between social media, the podcast people that work in groups with us, they'll say, “Well, I'm so many years into menopause.” And they told me no. And I was like, “Excuse me?” I was like, “First of all, everyone needs vaginal estrogen unless there's a specific contraindication.” And we know it's not a question of if, but when, when we develop genitourinary-- 

Dr. Daved Rosensweet: [00:52:14] As in everyone.

Cynthia Thurlow: [00:52:16] Yes, exactly. [Dr. Rosensweet laughs] And just thinking about, how many patients I saw in the ICU, in the ER that were menopausal females that had never been offered vaginal estrogen, that were septic, that ended up in urosepsis, that ended up in the ICU, that almost died. Usually in the constellation of their hospitalization, they'd have a myocardial infarct, they'd have a heart attack, they'd have a whole amass of things that could have been completely prevented by something as simple as vaginal estrogen. 

[00:52:46] With that being said, if someone is 10 years into menopause, you're right, it's doing this very thorough evaluation. And I sometimes will talk about, still we have the traditional kind of allopathic model that just looks at traditional lipids. And I'm like, “No, no, no” Everyone needs an Apolipoprotein B. Everyone needs at least once an Lp(a). Whether or not we decide to do a CAC or specialized carotid ultrasound, or if you need a CT angio and/or seeing cardiology. For people that are higher risk, we know that women are more than likely to die of.

[00:53:19] It's one in three were to die of heart disease. So, really being conscientious, if you are considering and have a high family history or you've got crappy lipids, like I always tell people what my lipids look like in perimenopause is very different than what they look like in menopause without HRT. So, for many, many reasons, I think hormone replacement therapy, those conversations are really, really important. And thank you for sharing, your own personal experiences with your family members. I think my mom missed the boat. She was part of that WHI, post WHI taken off all of her HRT, had terrible arthritic symptoms in her feet, was working until she was 75, what's interesting to me, and my mom talks openly about this and gives me permission to talk about this. 

[00:54:06] The difference for many women, when they're still working and have a lot of intellectual stimulation versus what they're doing in retirement can have a large net impact on that neurocognitive status. What I find for a lot of women, especially those that aren't on hormone replacement therapy, they get forgetful. They're just not having that stimulation and that socialization that we know is so important, especially as we're getting older. Now, when you're speaking to women, maybe a person who's gone 10 years without hormone replacement therapy is thinking about hormone replacement therapy. Are there specific levels of hormones that you like to see when you are looking at your lab work? I know you mentioned you really like the 24-hour urine that are neuroprotective. Because I think for probably every woman listening to this podcast, that is my greatest fear. 

[00:54:57] And I believe hopefully that I'm going to do everything to prevent that happening. But I think for a lot of individuals, they feel like there's not enough information. It's like estrogen is protective. But how much estrogen, how do we find that Goldilocks effect to protect our brains? Because again, I think that's what most of us are concerned about. Bones are important, yes, but like brain, if your brain's not working well, nothing's working well. 

Dr. Daved Rosensweet: [00:55:21] Right on. There's different assessment tools for different things. And even a medical history tells me so much. And like you said, 100% of women are going to get vaginal atrophy. And if a woman has, for example, any kind of pain on intercourse or didn't need a lubricant, if she's having penetrative intercourse in her 20s, but now needs a lube, there's been vaginal atrophy. And that's a magic number, the amount of estrogen it takes to protect that vagina. We know that number, but a woman could tell us, I can tell whether she has enough estrogen. Do you have any pain in intercourse? Do you have to use lubrication? And if she has vaginal atrophy, she's too low in general for all of the effects, protective effects of estrogen. So, one of our primary clinical goals is help that vagina be healthy. 

[00:56:17] And it turns out that the same number, the same estrogen levels that it takes to protect the vagina happen to protect the bones. That number is known. On the 24-hour urine hormone report, we even identify that number. You got to have this much to protect your bones. And like I say, “A woman can say, well, I feel much better.” Yet 50% of them don't have enough to protect their vagina and bones. That's the bottom line. Where it gets more challenging is how much does it take to protect the arteries? We don't know that number. How much does it take to protect the brain? The medical literature is very clear that can take a lot, a lot more, a lot, lot more. That number is not defined. 

[00:57:01] But what is defined is that some women to protect their brain, they need a rather rich amount of estrogen. So, if it's okay to tell, one of the most poignant stories that I've ever had is that same National Academy of Science. There was several of us who were testifying and I did research on who was going to testify with me and I learned that one of the doctors was on this particular program that the committee had already identified as another bugaboo. It was pellets and this other thing that they had already given me the clues. And I knew she was on it and I knew she was going to testify. And she said, “No, I'm not going to say this. She winked her eye at me.” I went out to lunch with her and her son and she was 65. 

[00:57:47] And she told me when she was 55, she started to get a cognitive challenge. And it really scared her because her mom had dementia and her mom's sister, that’s her aunt, had dementia and she got scared. And she was reaching the point in her medical practice, she wasn't remembering names, she wasn't remembering medical histories, and she got frightened she was going to have to go out of practice. So, she told me that what she started doing is she started taking estrogen because she had heard of this relationship with estrogen in the brain. And she started to clear up a little bit and she took some more and cleared up more and took some more and cleared up more. And she kept on taking more estrogen until she cleared up 100% and it turned out her period returns. 

Cynthia Thurlow: [00:58:32] Oh, geez. [laughs] 

Dr. Daved Rosensweet: [00:58:35] Yeah. And so, you never say never. And I happen to know how much it takes to get a period to recover. You have to take so much estrogen that you produce on 24-hour urine hormone assessment, estrogen levels that are three to eight times the upper limit of normal of a 20- to 29-year-old. That's how much you need, an enormous amount. So, you never say never. And you ask the question, “Well, how much does it take?” Well, in most women who start getting cognitive challenge, all you need is the optimal dose to treat their menopause and they clear up. Let me define that. Take a little break to define that optimal amount. Some young women need this much estrogen to regularly menstruate, to be fertile, to have term pregnancies, to be healthy. Other young women need three to four times that amount. 

[00:59:27] Same thing, healthy, regularly menstruating, fertile. There's a tremendous wide variety there. Three to four times. What this is, what we learn in menopause is that it takes this much for most women because when they start getting to this much. They start getting breast glandular cell proliferation. It took these young women this much to menstruate, to proliferate, to get breast glandular cell proliferation. We're treating most, but not all women in menopause with this much. Totally, does it for them. Libido, vaginal health, bones but there are these exceptions, and this one doctor was the perfect example. So, most women are going clear up with this lower amount.

Cynthia Thurlow: [01:00:11] Yeah, I think most women-- [crosstalk] 

Dr. Daved Rosensweet: [01:00:13] Most will say, go for it. Because you said it, Cynthia. You said it, cognition is so important that we will make exceptions, and we'll keep increasing that estrogen until that brain clears up, even if their period returns. So, what's the big deal? Well, yeah, I mean, the male saying, [Cynthia laughs] no big deal. [laughs] But what we do in that case is we just monitor for proliferation. It's not a big deal. You get the period to return, you're using large amounts of estrogen. We don't want to make sure she's not getting excessive breast glandular cell proliferation. And so, we monitor this very carefully. And, yeah, that doctor taught me sky's the limit folks. And she was at the age of 65. This is 10 years after she was as absolute clearer, clearer than I was sitting at that table having lunch. So, you never say never in medicine. 

[01:01:10] It's an individual thing, and you do what it takes to protect that brain, like you were suggesting. 

Cynthia Thurlow: [01:01:16] Yeah, I think it's really important. I think about the fact that I continue to learn and be stimulated. And I just finished writing my second book. And it's funny, my older son is my business CTO, so when he's home during breaks from college, he's organizing a lot of my technical stuff. And he did such a good job of reorganizing my iPhone that I'm standing in the airport and I'm like, “Which part of my phone did he put all of my airline apps.” And I'm standing there thinking to myself, I had this brief moment of panic, and I found it. But I thought to myself, this must be what people that are dealing with some early cognitive. I mean, it's that first of all, you're aware of it. 

[01:01:56] But number two, it's that understanding why it's so important to continue to challenge ourselves and to not get complacent, because our brains, much like a muscle in our body. It's designed to be challenged. And if it's not being challenged, like for me opening up my phone and trying to find this one app, I'm like, “Okay, he did such a good job organizing the apps. Now I can't find the app I need.” Having said, “That just reaffirms why it is so important to be conscientious.” And even for myself, I mean, that's always the rhetorical question I have in my mind. Are my estrogen levels high enough that I'm protecting my brain? Because I know that the genitourinary system is in check. I know my bones are doing well, and I'm doing all the things to support that. 

[01:02:37] But the brain seems like it's a little bit more ambiguous. And I think for so many of us that are conscientious about cardiovascular health, it's like, “Okay, I know what my numbers are.” I know that everything that we've done diagnostically shows that I'm not a 53-year-old on paper.” I am chronologically, but physiologically, I'm much younger than that, just by virtue of some of the things that we're doing. I've so enjoyed this conversation. I want to ask one last question. For a lot of women that are in perimenopause when they're having heavy menstrual cycles, the standard milieu, because this is what I was offered, especially as I was telling my GYN in my annual exam, my periods are very heavy. This was 10 years ago. And she said, “No problem. We've got four ways to fix this.” 

[01:03:21] Number one was oral contraceptives, number two was an IUD, number three was an ablation, and number four was a hysterectomy. Because obviously, 10 years ago, I was done having children. And I'm just curious, when women come to you that are dealing with these same challenges, they're perimenopausal, they've got relative estrogen dominance because their ovaries are producing less progesterone. And for listeners to understand, our ovaries are our pacemaker of aging. Ovarian senescence is a real thing. What are some of the preferred alternatives that you'd like to use for these women? Because obviously, everything I mentioned, if that is what works well for you, and that is what you and your physician or nurse practitioner or PA have decided is what's your best option? None of those were acceptable to me. What are the conversations that you typically will have with patients? 

Dr. Daved Rosensweet: [01:04:08] Another great question, [Cynthia laughs] because it's so common and you named it, a woman's ovarian hormones and a man's testicular hormones, we all peak at about the age of 20, plus or minus a couple years, and then comes the decline. And then halfway through the decline is so significant in women, there's not enough to menstruate, but the decline continues well into your 80s and 90s till you hit zero. That's the decline. Well, let's just take two of the four ovarian hormones. Let's look at the estrogen family and the progesterone family. Or this will be estrogen, this will be progesterone. They don't necessarily decline at the same rate. In fact, what's far more common is the progesterone declines faster and earlier than the estrogen does.

[01:05:00] So, even a woman in her 40s who's got less estrogen than she's ever had, she's got way less progesterone. And these hormones, they balance one another. Estrogen stimulates. It stimulates the formation of cells in the uterus, stimulates breast glandular. It energizes. Progesterone is the great calmer. It balances the stimulatory effect of estrogen. And the most common story is when that progesterone is dropped out, there's no longer the balance and you get overstimulation. So, you get overstimulation in the uterine lining. You get heavy periods, you get cramps, you get overstimulation of the uterus, you get mood issues. So, my very favorite thing to do is to bring to awareness to young women that this could be happening to you and how young women can identify this.

[01:05:52] Even women in their 20s, if they've got this anxiety that they didn't have before, they're missing, a big calmer, their progesterone. They're starting to get heavy periods and period cramps, progesterone-- Bring in that progesterone and bring it in rich but woman's body has a hundred times more progesterone than it does estrogen. It's really needed. That calmer is needed. So, the very, very best thing that can be done as early as someone can become aware of it, is to start taking progesterone topically on the skin. You can get it over the counter even. And what do we do? You got a young woman who's got some anxiety that she's got the usual stresses of life. She used to do well with them. We all got them. But now she's got this new thing called anxiety.

[01:06:48] You increase that progesterone until she does not have anxiety, until she says, “Wow, I'm calm again.” And that's the best prevention of getting into those uterine issues.” Because I didn't like the sound and I'm a man, I didn't like the sound of hysterectomy, ablation. Yeah, let's just go down and have an ablation. [laughs] Birth control pills, not very fond. We've got to take contraception into account here. But even the progestin IUDs, they're problematic to me. Whereas a copper IUD can be a great solution. Give you birth control and not give you the progestin. So, there's a variety of choices we have, but I love to get it early. You get that progesterone in there early and you're not afraid to give. You can give so much progesterone. It's rather daunting how much progesterone a young woman can take if she needs it, she's not going to need an unreasonable amount. 

[01:07:56] The over-the-counter stuff can do wonders. It's got enough in it. It's got lower doses than I would use, but it's got enough in it. But that's the best thing. An ounce of prevention is worth 82 tons of cure. Get it early. Can you stop when a woman's really getting heavy periods and maybe has a fibroid in there that was caused by the loss of progesterone? Sometimes you can. Sometimes you can quiet that uterus down, sometimes you can stabilize a fibroid. So, the moral of the story is progesterone in rich amounts, go wild with it. [Cynthia laughs] Because what's going to happen if a woman takes too much progesterone, she's going to get too calm. So, let's say she takes it at sleep time.

[01:08:41] She's going to wake up the next morning feeling groggy, like she had an overdose of a sleeping pill. That's the big consequence of too much progesterone. Or if you take too much during the day, you're going to get a little groggy. So don't operate heavy machinery, but if you go slow enough on the increase of the dosages, you're not going to get in any trouble at all. And even if you go too fast, the most you're going to have to do is take a nap. [Cynthia laughs] So, yeah, progesterone, progesterone, progesterone as early as you possibly can. 

Cynthia Thurlow: [01:09:12] Well, and I think for so many of us, had I known in my 30s, when I was having kids at 34 and 36 and thinking in my late 30s it was because I worked a stressful job, my husband traveled, I had two young kids at home and it was probably that very early, the insomnia before my menstrual cycle, the anxiety that I never-- I'm a very calm, cool, collected person. I had no idea because 15 years ago at least in my girlfriend circles, we were not having these conversations, at least openly. And so now I hope that my generation, our conversations, podcasts, etc., can alert young women to the possibility that maybe at 35, maybe at 36, they need to start considering transdermal progesterone. 

[01:09:57] And then maybe later on in the conversation with their GYN or their internist or whomever, maybe they need a little bit oral progesterone as this progresses farther into perimenopause. Well, I've so enjoyed this conversation. Please let listeners know how to connect with you outside of this podcast. Obviously work with you if you're taking patients or if you're a clinician listening and you'd like to connect with Dr. Rosensweet and be mentored by him. 

Dr. Daved Rosensweet: [01:10:25] Well, Cynthia, one thing, I think my staff has already informed you that your folks can download a free copy of the book that we wrote for women on menopause.

Cynthia Thurlow: [01:10:34] Oh. Thank you. 

Dr. Daved Rosensweet: [01:10:36] Yeah. Please contact Katie because we can give you a link to a free PDF copy of Happy Healthy Hormones. It's a lot of knowledge for women. I wrote it originally for women because I was trying to figure it out together, remember? [laughs] So, and in there's contact information. The main thing I do is train and mentor providers and along with a lot of science projects that we got going on, but we have providers. We have 160 providers that we've trained there and actively using our method all over the country. So, if a woman reaches out to www.brite.live or iobim.org, you can connect up with our staff and find a provider that is using the methods and yeah, providers, that's the main thing I do is train providers. So, that's iobim.org, I-O-B-I-M dot org will connect you up with the training program. 

Cynthia Thurlow: [01:11:38] Awesome. Thank you so much for your time today. 

Dr. Daved Rosensweet: [01:11:40] Thank you, Cynthia. It's fun. 

Cynthia Thurlow: [01:11:43] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.

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