Dr. Jill teams up with Dr. Daved Rosensweet, a pioneer in Bioidentical Hormone Replacement Therapy (BHRT), to provide you with a comprehensive guide to navigating hormone health. Whether you're new to the concept of hormone replenishment or looking for advanced insights, this episode has something for everyone.
Key Points
- Bioidentical Hormone Replacement Therapy is not only safe but very important for longevity and optimal performance for men and women who are aging
- Safety of BHRT discussed along with the real data about lowing breast cancer risk
- Why topical hormones are most often a better option than oral replacement
Our Guest – 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.
https://www.davedrosensweetmd.com
https://www.facebook.com/davedrosensweetmd
https://iobim.org
https://www.instagram.com/menopausedoctor/
https://brite.live/
Dr. Jill Carnahan, MD
Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy.
As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs.
A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.
Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names.
The Podcast
The Video
The Transcript
217: Resiliency Radio with Dr. Jill: A Hormone Replenishment Roadmap: What to do When and Why!
Dr. Jill 00:01
Hello, and welcome to Resiliency Radio, your go-to podcast for the most cutting-edge insights in integrative and functional medicine. I'm your host, Dr. Jill, and with each episode, we dive into the heart of healing and personal transformation. Join us as we connect with renowned experts, thought leaders, and innovators who are at the forefront of medical research and practice, empowering you with knowledge and inspiration and aiding on your journey to optimal healing.
Dr. Jill 00:24
Hey, guys. If you have not heard, our movie, Doctor/Patient, is now available online, streaming for rent, for gift, for purchase. You can go to DoctorPatientMovie.com and check that out. If you haven't yet seen it, please do take a look and let me know what you think.
Dr. Jill 00:41
Today, I have the honor of interviewing my guest, Dr. David Rosensweet. He's 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.
Dr. Jill 00:56
I know with my audience, there are a lot of women who've experienced these symptoms, so stay tuned because we're going to dive in to give you some great tools and resources in your journey. Whether it's you, your daughter, your mother, your sister, or if you're a man—we often have a lot of men listening—your wife, your loved one, or another person in your life who needs this information, I hope you will listen and pass it on.
Dr. Jill 01:19
Dr. Rosensweet has over 30 years of experience specializing in andropause and menopause treatment. He's 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, he spends the majority of his time as a medical director of The Institute of Bioidentical Medicine, where he trains medical practitioners to specialize in menopause and andropause.
Welcome, Dr. Rosensweet!
Dr. Daved Rosensweet 01:47
Thank you so much. It's so good to be with you, Jill.
Dr. Jill 01:51
Yes. We were just talking cows and farms and menopause and movies right before we got on here. I want to start with your story. I always love to hear: How did you get into medicine? And then, how did the trajectory go from [being a] medical practitioner to bioidentical hormones and menopause and andropause?
Dr. Daved Rosensweet 02:12
I love that question. Little did I know when I was young that it was my dharma. It was in my bones. It was in my heart. By 12, I knew I wanted to be a doctor, so my high school civics paper was on me wanting to be a surgeon. I just knew it. I also had some experiences along the way—you were telling me about your new movie—that I think is such a crucial piece.
Dr. Daved Rosensweet 02:43
One day I remember I was so ill. I had a flu of some kind and I was like 11. I felt as awful as an 11-year-old can possibly feel. My mom took the liberty of calling up my uncle Leonard, who was a general practitioner. I met him in his office. It was on a Saturday. I was sitting in a chair just slumped over, feeling awful, feeling like: “Is this the end of the world?” My uncle Leonard was about 6'4″; a very large human being, larger than life. He walked into the room with his big smile and his white coat on. He said: “Oh, it's so good to see you. Oh, you're going to be fine.” And I transformed internally. What he said to me, who he was, and his energy—I felt immediately much better. I knew I was going to heal. You've elaborated on this so much that I'm not going to take up our time here.
Dr. Daved Rosensweet 03:43
Then I went to medical school. I loved it. The University of Michigan. It was like going to a synagogue or church for me. Immediately in 1968, when I was a senior, I started getting interested in: “What other tools are out there?” I started learning about what the GPs in the outback used to do—B12 and the Armour Thyroid—and it began my journey into functional medicine before it had a name back then.
Dr. Daved Rosensweet 04:11
Then in 1992, when I was practicing in Santa Fe, Deborah walks into my office before office hours. I'm sitting at my desk doing paperwork. She's in her mid-40s. I knew her to be brilliant and a happy person. She had retired in her mid-40s. Think about that one—what it took to do that. She walks right up to my desk, pounds her fist on my desk, and says: “Listen, don't think you know me. I'm going crazy and I mean it. And don't tell me some minor thing.” Serendipitously, so to speak—although I think there's divine guidance always involved—I had been speaking to John Lee in 1992. He was extolling the virtues of progesterone and mood, for example. And I gave her some topical progesterone.
Dr. Daved Rosensweet 05:00
Three weeks later, I get a letter from her saying: “I can't believe this stuff. I'm totally myself again.” That was dramatic. How often in medicine, by the time someone has made an appointment with us, it's often a slow-moving train to help them restore their health? And here, this dramatic thing had happened overnight. But I wasn't thinking. She started referring her friends to me. Before I knew it, I had a practice that was half menopause. And it suited me beautifully. I love biochemistry. I love hormone roadmaps. And off I went.
Dr. Daved Rosensweet 05:36
Then the functional medicine knowledge base was growing so much, I couldn't keep my arms around it. There was Dr. Bredesen's work and Dr. Houston's work. I didn't feel like it was an integrity to treat people who had severe cognitive decline or hypertension. Long story short, I decided to specialize 30 years ago. The story blossomed from then. That was a big decision for me.
Dr. Daved Rosensweet 06:03
Then halfway along the line in working with compounding pharmacists, I opened up a jar of Biest, seeing it for the first time. It had a strong odor coming out of the jar. I was fascinated. I'd never seen a hormone, but there was a misshipment to my office. I went: “What's this? What is this?” I learned that the topicals were in these strong solvents because they needed to be because they're poorly soluble. So we went on to develop an organic oils base for the topicals.
Dr. Daved Rosensweet 06:36
It just got better and better and more interesting and more interesting. I feel very blessed. We have a big team. We have a big mission. We'd like to help women and men, millions and millions and millions, experience the powerful benefit of bioidentical hormones and good menopause and andropause medicine because there are a lot of moving parts in there. So that's part of the story.
Dr. Jill 07:01
I love that so much. There are so many pearls in your story. First of all, the first experience as a teenager or young person in your uncle's office—I often say to patients, “You can borrow my faith in the process, my belief that you will get well”—what he did was loan you his faith that you were going to be fine. At that moment, bestowing upon you his belief in you was just enough medicine to transform you.
Dr. Jill 07:31
And you and I were talking before; that is so powerful. Not that we have all the answers. I am very humble with my limitations, but I also know that the Divine gives me wisdom that I don't deserve sometimes. As I embrace that and then share that with a patient, like, “No, I know you're going to be okay,” it is powerful medicine. I love that it started there. And then I love all the trajectory, the serendipity of those experiences. You clearly are one of the forefront leaders as long as you've been doing this in functional/integrative [medicine] and bioidentical hormones, so I love that.
Dr. Jill 08:07
Having personally just gone through menopause myself, I knew this stuff well. I was kind of like you in residency when I was the only one who was doing hormones. I had tons of the community. Do you know how [in] resident clinics maybe indigenous or different populations are served? All of a sudden I had the wealthy housewives of the suburbia coming to me because I was the only one doing hormones back in the day. Just like you, I, right from the beginning, loved the complexity of the biochemistry and physiology that we go into medicine to learn and then sometimes we forget by the wayside. So I love that story on so many levels.
Dr. Jill 08:40
You have really made it a practice. Now you're just teaching and training clinicians, which I love. Right now, I think there's a landscape where more and more women are realizing hormones are critical and there's a shift in the tide. I even know some of my conventionally trained, maybe OB-GYN colleagues and stuff, are starting to say: “Jill, what do you know about this? Where do you see the tide turning?” Where do you see things headed in this realm?—because women deserve to know about their hormones and optimal health even after menopause.
Dr. Daved Rosensweet 09:13
I think there are several aspects to the turning of the tide. No branch of medicine that I ever witnessed gets so stunted by something as impactful as the Women's Health Initiative study. While [in] so many of our other aspects of medicine we're differentiating into specialties, the Women's Health Initiative scared the public and the providers. There were 18 million women in 2002 on Premarin or Prempro. That was 40% of the American women in menopause. Then that went down to about 2 million overnight because of the frightening and false information that was blasted out into the world. While other specialties were developing, there was no specialty in treating women and men, and it scared the patients away.
Dr. Daved Rosensweet 10:07
I think one of the monumental moments of change occurring is finally trickle by trickle, molecule by molecule. The true information about risk for women and for men is filtering its way into, first of all, the inquisitive American women led by hundreds and hundreds of thousands—if not a few million—American women who tend to wake up earlier than others and get health-concerned and concerned about life. And they're sourcing it on their own. If it's useful to your audience, I'd like to review the risk information.
Dr. Jill 10:51
That's exactly where I'd like to go because they deserve to know the facts. And especially if their doctor hasn't updated their knowledge base, they might be getting told about risks that aren't true and valid. So yes, let's outline that.
Dr. Daved Rosensweet 11:02
That's great. For one thing, your audience can download a free PDF version of the book. In chapter three, I cover risk. And then there's a Bible about risk that I'll refer everyone to in a moment for those who want to dive deep into the science. But here is the science: All of us, every human being, is at risk for thousands of diagnoses. A lot of them are rough ones. We're also at risk for hundreds of cancers. As a male, for example, I have an increased relative risk for getting prostate cancer. That's new and that's recent, and that increased relative risk is there for reasons. Women have an increased relative risk for developing breast cancer. And that's changed. That's dramatically over the decades that I've been in practice.
Dr. Daved Rosensweet 11:54
Yet, given that we're all at risk, the 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 are treated with hormones—and that's a broad class there—are less at risk than women who are untreated. To take it a little further, just to put an exclamation point on it, women who have had breast cancer and had that breast cancer properly treated happen to be at an increased relative risk for recurrence than a woman who's never had breast cancer. Given that she is at increased risk, that risk is lessened if a woman is treated with hormones than if she's not. That's the science. That's the science.
Dr. Daved Rosensweet 12:49
If you want to read the Bible about it, there's a book called Estrogen Matters. It's written by an oncologist, Avrum Bluming, and Carol Tavris. It's got 450 references for those who love to dive deep into the science. But that's the science.
Dr. Jill 13:06
One of my favorite books is on my bedside. And I just want to speak from a woman who was diagnosed with aggressive breast cancer at 25 years old, a little over 20 years ago: I personally have a very big vested interest in the truth because my life is at risk if I weren't to know the truth. And I will publicly say I am on hormone replacement therapy for menopause. There is zero question in my mind about the positive benefits of that for my brain, for my bones, for my heart, and for my breast. I just want to second that and publicly say that I'm a living example of having gone through this, understanding the risk, and taking that into account with my choices.
Dr. Daved Rosensweet 13:46
Yes. And I knew this information decades ago, even when the Women's Health Initiative came out. I've treated many. I'm currently treating women who've had breast cancer. It's a great thing.
Dr. Jill 14:01
There's still misinformation, so I'd love for you to address [it]. Right around the time I came out of medical school was 2001, a year before this WHI study came out, even I—who was very open-minded and functionally trained in integrative medicine right out of the chute in residency—succumbed to the false belief that there was a big risk there just like the media told us. I know you can speak to this, but if I recall, it got out in the media before the researcher had a chance to specifically give the statistical significance, which wasn't even there. Do you want to talk a little bit about why this came out in the media and then why things aren't as they seemed from that year?
Dr. Daved Rosensweet 14:47
I'd like to dive into what you suggested there—that the original report of a study committee studying hormones in women did not say that there was increased risk. What the press grabbed a hold of was a misunderstanding. For example, women on Premarin, horse urine-derived estrogen, had 21% less of a risk for developing breast cancer than women who were not on Premarin in menopause. The issue was around this molecule called Prempro. It was a combination of Premarin with medroxyprogesterone acetate, a progestin—a very different molecule than progesterone. Even in the original study, it said that there was a 1.26 increased relative risk, and it's followed by the words, “which was not statistically significant.” In medicine and science, every scientist on the planet knows that when you see there's no statistical significance, you don't want to draw any conclusions.
Dr. Daved Rosensweet 15:55
This original study committee went on to follow these women and in 2016 published a follow-up in the Journal of the American Medical Association—the original study committee—that after 18 years of follow-up, pretty much quoting them, there is no increased risk of breast cancer, heart attack, and stroke. They rescinded that original statement that poisoned the minds of the world. But hardly any physicians or women have heard about this recanting.
Dr. Jill 16:30
That's why I was so excited about having people like you because women need to hear this and need to feel safe. I have women who are coming to the office, and they've been terrified by their primary doctor or their gynecologist. Say we have a 35- or 40-year-old woman who is in perimenopause and still cycling but is starting to be like that woman who came and put her fist on your desk and said: “I don't feel like myself! I'm moody. I have” maybe “breast tenderness” or symptoms. Do you want to take us through what you might do with a 35- or 40-year-old woman versus maybe a 55-year-old who stopped having cycles? Talk us through—if someone would come in at those different ages—how you would treat them or test them.
Dr. Daved Rosensweet 17:11
Sure. For one thing, a man's and woman's hormones—we peak at the age of 20, plus or minus two years, and then we decline. Men and women. These are the most powerful biochemicals in our body, so the loss of them has widespread effects on the brain, sleep, mood, sexual performance, and skin. The list is very long. So 80% of the women—and you're naming the ages—start feeling it. They start developing sleep issues. They're putting on weight. That's surprising them. They're getting mood issues. They're getting dry vaginas and hot flashes even, but they're still menstruating. They're in decline.
Dr. Daved Rosensweet 17:56
One of the maxims is: You can learn so much by the woman's story. As a physician, this is what we're trained in. Listen to the people and come up with some ideas in 100% of these women who are open to it. We have a magic line just to back up a little bit. We proactively speak to every woman about the risk because I've never sat in front of a woman who didn't have it on the back of her mind or was willing to say it out loud: “If I take hormones, I'm at risk.”
Dr. Daved Rosensweet 18:30
We go through what I just did as part of our initial process, and then we start these women on hormones. We don't test them. If they're still having periods, the perimenopause is so erratic in hormone levels that if a woman's having hot flashes and waking up in the middle of the night, yet you test her on a day when her pituitary gland is trying to wake up those ovaries and bring them back to youth and pushing out a big stimulus, you can get a high hormone reading.
Dr. Daved Rosensweet 19:00
How did I learn this? I did a 24-hour urine hormone test on a woman who was still menstruating. She was having hot flashes at night, vaginal dryness, and a list of symptoms for low hormones. She looks at my test report and it says ‘high' in all the hormones. They are so erratic that if you test on the wrong day, you're going to baffle the clinician. Our teaching is: Don't ever test a woman for hormone levels in perimenopause. We test 100% of our women at the right time.
Dr. Daved Rosensweet 19:34
Because women are so individual and men are so individual, we developed a process that I learned from—I'm standing on the shoulders of some giants here—our forebears. I learned that you can titrate dosages. You can start with low dosages. We know what hormones are missing. We can tell just by the history in 80% of the women. We start with low doses of estrogen. We prefer Biest—in fact, we are passionate about Biest—progesterone, testosterone, and DHEA. We start on low dosages, and we first titrate the Biest and the progesterone. What I mean by this [is that] we gradually increase this dose. We don't rapidly increase the dose. It's taken 20 years for these hormone levels to decline and all the receptor site adjustments. I'm throwing in a little bit of a technical quirk there. We awaken them gradually at a proper pace.
Dr. Daved Rosensweet 20:36
What happens to the woman? If we're right—and 99% of the time we are correct because it is not rocket surgery here—they're going to reach a point where they're starting to get alleviation of the symptoms.
Dr. Daved Rosensweet 20:51
And you started with perimenopause; we don't test them. But in a woman in menopause, the process is similar. She has just stopped menstruating. That means her ovaries aren't putting anything out, so there is no erratic underplay there. When the woman in menopause says, “Oh my God, I feel myself again; thank you so much”—I'm waiting for the happiness—we test 100% of these women with 24-hour urine hormone testing.
Dr. Daved Rosensweet 21:16
This is a subject unto itself because it turns out that even if a woman titrates the symptom alleviation, 50% of those women are not on enough estrogen to protect their vagina and bones, and 25% are on more robust doses of estrogen, which put them at risk for breast glandular cell proliferation. We don't want new breast cells that occur every month in a young woman. We don't want to see the mitosis—best-case scenario, there are exceptions—in a 50-year-old woman. The process is the same. We've got symptoms. We start low and gradually increase the dosage. The woman starts feeling better. The same with men. The process is the same for men. You've got a midlife man who's got erectile issues, and he is low in testosterone. You gradually replenish it in a proper way and test the very moving parts and his erection returns and his life changes.
Dr. Jill 22:15
Like you said, both men and women. It's a whole other topic but [with] our environmental toxic load and all of this burden on our immune system and stress and physiology—I've seen this more acutely at younger ages, too, for both men and women—now it's not uncommon for me to see a 30- or 35-year-old man with a testosterone [level] of 300 or 250, these crazy low levels. Usually, there are other things like infection, toxic load, and other things that are going on. But it's very real and very present, and it's part of our environmental load. So I love that you explained that.
Dr. Jill 22:48
I also wanted to just laughingly share that to the perimenopausal women who are still cycling, I'm like: “Your hormones are like the last bit of ketchup out of the tube where there's this spurting of ketchup.” They laugh and are like, “Yeah!” because they know that whole up and down. And I love that you said that too, because there's no sense in testing when you're getting those spurts and you don't know which spurt you're catching. But it's important to treat. Say someone who is cycling and starting to have sleep issues and mood issues and maybe is cyclically driven. Do you typically start with just progesterone in those women until they have estrogen deficiency symptoms?
Dr. Daved Rosensweet 23:26
Once again, as you know so well, it's such an individual story. Women are going to tell you the story of what hormones are low. And like you were saying, oh my God!—25-year-olds who are having anxiety that they never had before. They don't relate to the word ‘anxiety,' but now they know what it is and they've got irregular cycles. These young women are in great shape for progesterone because progesterone is the great calmer. So much good could be done on this planet by starting off with progesterone alone in the youngest of women.
Dr. Daved Rosensweet 24:00
Why? Gosh, you mentioned the elephant in the room. I find people often have a tough time grasping how pervasive these poisons are in our food supply, in the air, and in the water bottles we're drinking—how profound an effect they have. One of the things they've done is act like estrogens, for example. The average age of the onset of having a period happens to be five years earlier than it was when I was growing up. These toxins are a big deal. And I just didn't want to pass on other than emphasizing what you're saying there. And it's a real call to become an expert in cleaning up your own life and reducing your toxic exposure the best you possibly can because they are very impactful.
Dr. Daved Rosensweet 25:04
By the time women show up to my office, it's most common that their whole hormonal system, especially progesterone, is the first to go and it's usually the deepest. It can fall earlier and deeper than the estrogen decline. So there's often an imbalance. If a young woman is having breast tenderness where she didn't have it five years ago, you want to lead with progesterone. But very often these young women are also low in their estrogen, so we do independent variables. And they're going to tell us about the low estrogen. They're going to give us symptoms. So we start progesterone and estrogen at the same time, and we titrate them at different rates. We want to maximize their progesterone. There's so much relief that can occur from progesterone. But by the time they show up in my office, they're often low in estrogen.
Dr. Daved Rosensweet 25:57
It's different than when I started out in practice, when there were a lot of women who went into perimenopause with increased androgens. It's a way for their body to make up for the loss of estrogens. It used to be common that we'd be cautious around perimenopause in administering testosterone. These are days long ago. I'd say 85% of the women who are 45 and still menstruating [have] exhausted, so to speak, their androgens as well. And they're giving low androgen symptoms. You can hear it from them.
Dr. Daved Rosensweet 26:35
Quite often, we'll first titrate the progesterone and the estrogen and get a small and steady dose of the testosterone and DHEA. When we've alleviated these two variables and the symptoms derived from them, we're going to start titrating that testosterone. Then the 24-hour urine hormone test is going to tell us when they're in the good zone—not too much and not too little.
Dr. Jill 26:58
I couldn't agree more. I really like that you specified that. I always like to do the estrogen and progesterone first with a much lower dose and then later do the other two.
A couple of things: First of all for those listening, you and I could, in our sleep, spout off the symptoms of progesterone deficiency and estrogen deficiency. Do you want to give a tiny bit of an overview for those listening so they might know where they lie and what typical different hormones show for symptoms for a woman?
Dr. Daved Rosensweet 27:24
Sure. Progesterone is the great calmer. That's a very unusual biochemical and biological process. Most of these hormones, including ovarian hormones, are activating. They're stimulating. They could energize. For example, there are a lot of young women athletes who are not menstruating anymore because their bodies are recruiting estrogen and testosterone for the fight or flight that they're doing through their rigorous training programs. Progesterone is different. It's the great calmer. If we were to inject the proper dose intravenously of progesterone… We're not doing this, but just as an example. We don't have to get progesterone intravenously ever. Oh, yes, we do. There are some exceptions in trauma. But if we give the right dose to you or me, we could be put to a sleep so deep that surgery could be performed on us. I'm saying this because think calm.
Dr. Daved Rosensweet 28:24
A young woman who feels relatively emotionally balanced—there is human life and there are the challenges of human life and we have some emotional ups and downs—if a young woman tells me she's getting anxious, even though she's regularly menstruating, she needs the great calmer. She needs the progesterone to calm her down and help her. Sometimes it's magical that she used to consider herself having anxiety and getting a diagnosis of anxiety, and then she's calm again. That's the main one. But progesterone also calms for sleep. When women are having a sleep disturbance, for example, they're having trouble falling asleep, that's a big one for progesterone too. Calm. You restore progesterone and you can contribute to the sleep disturbances.
Dr. Daved Rosensweet 29:15
Estrogen has some different qualities. The fall of estrogen in a woman's body to lower levels than what she likes is stressful. You're going to trigger the biology of fight or flight. The biology of fight or flight is led by adrenaline. She's going to get adrenaline in the middle of the night and wake up and not go back to sleep because her midlife liver doesn't process the adrenaline at the same rate as her 20-year-old liver did, so she gets to stay awake with a very, very active mind. That's a different type of sleep disturbance where they can even wake up with a hot flash.
Dr. Daved Rosensweet 29:56
These often come so close together that we're working the estrogen deficiency along with the progesterone by the time a woman shows up in the office. The exception for me is the young woman who has adequate estrogen often, but the progesterone is dropped off because she's not ovulating. In order to produce the robust amount of progesterone that a young woman produces each cycle, she must ovulate. If she doesn't, she's got a very low amount. So, anxiety in a young woman—progesterone.
Dr. Jill 30:31
Yes, I couldn't agree more. And typically, because of the effect of the postcursors of GABA with progesterone, are you using oral progesterone in young women or both transdermal and oral? Do you have a preference?
Dr. Daved Rosensweet 30:43
We grew up with that—if you want to start with oral if a woman's having sleep disturbance and the very effect that you were talking about, technically. But we've been able to, through the organic oils, administer rather robust dosages of topical progesterone. The other hormones, [specifically] estrogen—we do not want to give estrogen by mouth.
Dr. Jill 31:08
I agree. Yes.
Dr. Daved Rosensweet 31:10
I'm not going to go into the list of trouble that can occur. And we don't want to give testosterone by mouth; we want to give it topically. There are reasons for that. But progesterone is different. Progesterone is safe to give orally. We love to start with the topical because when you give something orally, about 10% to 20% of it makes it by the liver into your body. What happens to that 80%? It becomes metabolites. There's so much safety around oral progesterone that we would never accuse the principle of metabolite—the 80% or 90% that gets produced and the body never sees—of being problematic. But we'd rather copy nature. We'd rather not overload a liver. So, we're 100% of the time starting with topical. If we can't achieve the levels or results we want with topical, we'll switch women to oral to the extent that half the women in my practice are on oral and half are on topical.
Dr. Jill 32:13
Love it. You've been doing this a while and it's so profound to see because you are really a leader in this. But what do you wish you could have told yourself 30 years ago about what you know now as it relates to hormones and integrative approaches to medicine?
Dr. Daved Rosensweet 32:35
Let's see. I think some of the major principles that matter so much to women are that ultimately we're dealing with prescriptive items. I say to most women: “There's a job. You've got a job. The job is to seek out a licensed healthcare provider that really knows what they're doing.” They've gotten training beyond what we learned in medical school—which, we didn't learn any of this stuff. They've gone out and they reached into the courses and the teaching that's abundant these days. So your job, to every woman, is to find a provider that you feel good with. Just like Jill was saying, you want to sit in the presence of that provider and go: “Wow, this is the person for me.” You go shopping, really, and you find that provider. That's the one main recommendation I have to women.
Dr. Daved Rosensweet 33:31
There are so many women who are scientifically oriented that they want to know more and learn more, and there are a lot of resources for that. And I have a lot of fun with this scientifically because it's an interesting synergistic situation with them. And you can, but that's not your main job. Your job is to get a prescriber that you really feel comfortable with.
Dr. Daved Rosensweet 33:53
To get down to the mechanics of that, for one thing, menopause and andropause medicine lends itself beautifully to telemedicine. We do not have to see a patient in person. Do I like seeing patients in person? Yes. What you described, Jill, in the movie—this is a big deal. But it also works to do telemedicine with this work. You've got access to providers who are licensed in your state.
Dr. Daved Rosensweet 34:30
How do you find these providers? There are 7,500 compounding pharmacists in the United States. What I suggest is you walk into your local one. Not on the phone; they're busy people. Walk into the pharmacy. They like people. There's a high likelihood they're going to walk back from their compounding room and talk to you because they like it. You ask them this: “You're receiving a lot of prescriptions, and I have a need for hormones. I would like to go to someone that you really feel confident in. Who in our community—can you give me a list of three that you really like?” We're seeing the quality of the process, and they're able to identify who really knows what they're doing and who doesn't.
Dr. Daved Rosensweet 35:20
You could do that for your community or you could go online to our organization because we've trained providers all over the United States. But that's the main thing for women that I think matters. Find someone you really like because you're on a long journey. Just ask me as a man: When will I stop taking my testosterone? When I can't get the cap off.
Dr. Jill 35:43
The same with me for hormones.
I love the suggestion to go to the compounding pharmacy because we have a very special relationship—you and I, any of us who are in this realm—with our compounding pharmacies because we can't do what we do without the experts who help make this possible to create formulations that really work. So I love that you said that.
Dr. Jill 36:02
So, you are teaching. I always say I like to teach the teachers and influence the influencers, and you're doing the same thing. Tell us about: Where can people find you? Where can they find the courses? What are you up to now? Just share a little bit about where we can find your work.
Dr. Daved Rosensweet 36:31
You can go to drr@iobim.com or go to iobim.com—Institute of Bioidentical Medicine is what it stands for—and you'll encounter a lot of information and a lot of different avenues and pathways and also a connector because we've trained so many that very often we have a provider that's working out of your state that you could connect with.
Dr. Daved Rosensweet 36:48
I love the providers that go through our training. There's a lot to it. It's rigorous. We mentor them also. We do grand rounds every week. Our medical team is there to answer their immediate questions when they're in a tough case and they can't figure out the next step. I know every single one of these providers we train. They're a good group. They're the functional medicine group, which is a good group of doctors, nurses, and nurse practitioners.
Dr. Jill 37:20
Yes. If you're driving, don't stop the car; you can find this in the show notes wherever you're listening. I will be sure to put the links to your websites and to your programs.
Dr. Rosensweet, as always, this time goes so quickly and it has been an absolute joy to get to know you better and to hear your heart in medicine in helping women and men through this transition. I really love that you've been at this for such a long time. You're really at the forefront of the next generation. I think you and I both want to change the face of medicine in a positive way, so I get so excited about aligning with people like you. Thank you again for coming on the show. It has been so much fun.
Dr. Daved Rosensweet 38:00
Thank you, Jill. It's such an honor to be [inaudible]. I know who you are and I know what you've been doing, and I've been very touched by your whole life and story and your brilliance as a professional. So thank you for having me.
Dr. Jill 38:17
Aw, thank you. That deeply touches me as well.
And if you're out there listening, thank you so much for tuning in to another episode of Resiliency Radio. As you know, you can find all the transcripts, all the links, and past episodes at JillCarnahan.com or anywhere you listen to podcasts. Dr. Rosensweet, thank you again from the bottom of my heart for the work that you're doing. And I hope to see you soon in person.
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