This is a question I discuss with every patient as they age.
Dr. Rosensweet and I sat down for a candid conversation about bioidentical hormones.
Are they right for you? I hope everyone will watch this video and think for themselves.
Unknown Speaker 0:02
Dr. Rosensweet. Thank you for joining me today, I wanted to talk to you about the most common questions that my patients are giving me about hormone replacement therapy. And they're gonna be listening to this, and I wanted to record it with you. Because they asked me a very predictable sequence of questions about this. And I turn to you for my hormone questions. Because while you know, you're not as famous as somebody like Dr. Oz, in the national and integrative medicine world, you are, as far as I'm concerned, the hormone doctor, particularly for women's hormones, but I mean, by no means do you lack expertise in men's hormones. And so we need to talk about the realities of this because I think, and where I start, I want to start this conversation is pretty simple. Despite everything that people have heard about bioidentical hormones. The reality in our profession is that I don't know a single anti aging doctor who's come down against bioidentical hormones. And I talked to one after another after another, at conferences on the conference floor, behind closed doors and zoom meetings like this. You know, in the hallway, wherever it may meet them, their mothers are on it, their fathers are on it, they're on it, their wives are on it. I will admit, behind closed doors that if I am dating a woman who says that she's really resistant to this, I'm like, I can't deal with her getting older while I stay young. And that might sound extreme. But the reality is that you and I have both seen this up close and personal. We've seen people become little and old and miserable and demented. Sometimes very rapidly, because they lack youthful levels of hormones. And then we've seen other patients just defy the aging process. I don't know what you'd say. But I would say that I've seen people slow down the aging process by 60 80%. With the judicious use of bioidentical hormones. What are your thoughts on that?
Unknown Speaker 2:12
fun to be with you Leon? Well, useful levels. One thing is we don't have to replenish youthful levels. In most but not all instances. Sometimes we really got to go for it, especially when cognition is at stake. But 30 years of doing this, let's start with me. I wouldn't there be a test and a few other tools. Right. And you know, it's a dramatic thing. It always has been. The Chinese knew about replenishing hormones, even permanent prempro, the pharmaceutical industry's big derivations from horse urine, and, and combined with Provera Li. But you know, the women who are on that, they did so much better and 40% of American women were on and you could see the difference. And any one of us who were in treating women, we can see the difference immediately. The main thing is, it goes so deep into I was talking to a provider, and we were asking, what percentage of elderly do we see in assisted living facilities and nursing homes? What's that? Why are they there, and we're both guessing in the 80s are 90%, because they lose their muscle without the androgens, they lose their bones, it's almost guaranteed, they're gonna get osteoporosis, a lot of them fall and fracture their hip, they lose the protection that estrogens have for the arteries. So they're far more vulnerable to heart attack and stroke. There, and that's why they're there. And, and you mentioned cognition, of course. So many of the elderly in nursing homes assisted living, are have severe to very severe cognitive issues. A few of them don't, but they can't walk. They downstairs, they can't burn.
Unknown Speaker 4:12
It's only a matter of time until they have cognitive issues. And what I found when I worked as a hospitalist and I was regularly on call for the local nursing home was that I could always get grandma through another UTI, pneumonia, mild stroke, mild heart attack, but I was returning her to a quality of life that was very poor. And that's being kind. And I look back and I think how many of these people have dementia or are wheelchair bound or have this chronic disease XYZ? Simply because their hormones were imbalanced at some point. And for me, this became very personal in the last year my mother, I don't know if I told you this But my mother had a very terrible car accident. She mistook the gas pedal for the brake at the top of a seven year 100 foot drop in California, and she sent her Audi SUV rocketing over the cliff. And she fell 70 or 100 feet. And this is the kind of thing that most people would just say, Well, you know, your mother made a mistake. Well, why do people make mistakes? Why is that not surprising for 78 year old woman to do, but you'd be shocked if a 28 year old woman did it for hormone levels declined. And if there's one mistake I've made, and I'm assuming that my mother's doctor, although, you know, tell her that she won't stop asking me questions. I wish I one of the biggest mistakes I think I've made is I didn't say Mom, you've got to get on biochemical hormones, you've got to stay on them. Because she gave me one of the most common objections that I hear from women, which is I don't want to have a period again. I had a period for 3040 years. It was a pain. I don't want it anymore. I look at the pain of that. And then I compare that to the 10 out of 1010 pain my mother was in when she was in the hospital because from that car wreck, she had a sacral fracture T 12 compression fracture, she could barely move. She was bed bound for a period of three months, had to wear a brace had to be rolled on her side to get the brace on was in excruciating pain all the time. Waking up in the middle of the night on opiate pain medications. Why did she have the fractures, whereas a young healthy person might have walked away from the crash, she had her bones break, because you has worse bone density because she doesn't have the bioidenticals on board. As she's gone through this process, I've watched her muscle mass just disappear. Yeah, he's barely able to do very mild workouts with my strength and conditioning coach. And I look back on this. And I think all of this was preventable. I could have if I pushed her to stand by identical hormones that are appropriate doses, I could have gotten her to if she had happy accident at all. And let's say perhaps that the bioidenticals could have prevented it. can't know that. But I hypothesize that it may be the case, I could have set her up to weather this terrible
Unknown Speaker 7:17
episode. It's so personal, if you don't mind me interrupting you there. The it's so personal when I had my own story with my own mother, who wouldn't let me be your doctor. And it was a little late. But two things that you brought up. One was when we go to these functional medicine conferences. And for example, I have colleagues that I've known for decades and decades, women and men that are experts in hormones, and you immediately noticed the huge difference in how they look how they think how they talk, their exercise programs, they're doing great. And, you know, number one fear that you mentioned, fear of getting a period back in 95%. We don't aim for that. We know that young women various to the amount of hormones, they need to be fertile regularly menstruating. And they vary. Some are at the low and some are at the high end. But they can there's a range there. What we learned about hormones in menopause is we come in right below that range. That that is going to serve 95% of the people protect their vagina, protect their bones. We know the science on this. Right. And some people who have cognitive declines gotta go a little more robust. But most women are served to not not get their period back. Because if you're getting your period back, you're doing too much proliferation of uterine tissue not so bad, but breast glandular tissue that can lead to breast density. So that's you don't have to fear getting that period back. Because 95% of the patients that I treat that period doesn't come back. Yeah, we're falling shy of those dosages. The other number one concern that I bumped into over the years is that whether women language it or not, they have a fear of risk for breast cancer, because of the false reporting of a study that injured the world population, the actual medical sciences, that women who are on hormones are at less risk for breast cancer, heart attack and stroke. Then women who are not treated right and accordingly for men, men who already have adequate testosterone levels is the science are at less risk for prostate cancer than men who do not have sufficient testosterone.
Unknown Speaker 9:46
Yes, I was just looking at the studies on this showing that for Morgentaler and his colleagues, his book actually have over there that even when they treated men who have prostate cancer with testosterone, it did not make progress. State Cancer worse.
Unknown Speaker 10:02
Use me. Yeah, genius in our field.
Unknown Speaker 10:06
Also real, I mean Maverick, it takes courage to fly in the face of what a lot of your colleagues say.
Unknown Speaker 10:13
But when you sit and listen to him, he sounds his traditional.
Unknown Speaker 10:17
And yes, Tina, right,
Unknown Speaker 10:20
based as one could ever desire, right? As a professor at Princeton or Harvard or some urology no less. Yeah, no. But the the science and I can't emphasize enough that women who are treated with hormones are less risk than women who are untreated, even women who have had breast cancer, and had the breast cancer properly treated. There have, they have an increased risk of recurrence of that breast cancer than a woman who's never had breast cancer as in getting it. But their recurrence rate is lessened if they're treated with hormones than if they're not treated. That's the science I covered in my book. And yeah, we're all at risk. There are exceptions. We're all at risk for 1000s of diagnoses you and I know it we're all at risk for cancer, but treated with hormones is less risk for breast cancer, heart attack, stroke, this is humongous to reduce the reduction to reduce the risk for those.
Unknown Speaker 11:22
I know, not to mention that there are so many things that have a higher risk carrying, or for things like breast cancer, that women are not being counseled on increasing your iodine intake with something like seaweed, which is a very simple dietary introduction, the iodine will reduce your risk of breast cancer maintaining a normal vitamin D. Mean staying indoors as a as a risk factor for cancer that's equivalent to smoking. So is shiftwork working at night. So there's all these things I share with people about how to reduce their risk of disease and cancer. And when I look at even the studies that were published that did report the risks, which as we've discussed, are not good studies and should not be relied upon. There, the risk change is not, it's not even comparable to the reduction risk you get with all these other things. And so I you know, it's it's so frustrating that there's so much noise and confusion out there about hormones, because to those of us who are living in this anti aging and Regenerative Medicine world, there is no debate, there is no question. We all check our hormone levels, even those of us, you know, at 34, I'm not exactly at risk of low testosterone. But we're all checking them. We're all monitoring them. And I don't know a single anti aging doctor over the age of 4045. And I mean, it's not like I don't have enough contacts in this field, who's not on TRT, or who's not at least making sure this this dosterone is normal. And that goes for their wives. As I said earlier, one of the things I wanted to ask you is, have you seen a change or an effect on autoimmune illnesses or perhaps a worsening of autoimmune illnesses with hormone replacement, as many of my patients have autoimmune disorders.
Unknown Speaker 13:13
I don't have enough experience to be able to comment. With great expertise on this. The immune system can go off and be hyper or less responsive than we want it to be. And what does a healthy immune system like it likes health, it likes in order to have health, you've got to have hormonal balance, the immune system tends to behave a lot better. When there is adequate hormones. The strongest thing that I've ever been aware of, is like the a woman with multiple sclerosis. What's well known is, if she is they quite often get recurrences and have actual symptomatic illness, but they're much less likely to do so if they're pregnant, where their hormone levels are super high. And that's been used to advantage. For example, women with MS have been treated with estriol, one of the three estrogens to reduce the autoimmune nature of multiple sclerosis. So there's, you increase the house, you normalize things, and I can't think of a reason can you have why it would tend to be more reactive, some more active?
Unknown Speaker 14:30
I've never, never seen or heard anyone reporting changes in autoimmune severity with bioidentical hormones. And of course,
Unknown Speaker 14:40
one thing I have seen is a lot of women arrive at their first consultation with pain, aches and pains and sometimes it's thought to be autoimmune issues and you know, they get worked out for arthritis. Autoimmune arthritis is a Sometimes that pain is very severe. The strongest example I had was a 55 year old woman who was on Oxycontin, from multiple joint pain. Yeah, she was a high end real estate agent in Naples, Florida. And I'm sitting there that first interview going, oh my god, do I want to take out an oxy gun?
Unknown Speaker 15:21
For those who don't know, octagon is a very strong and highly addictive opiate.
Unknown Speaker 15:27
But I thought, gee, she sounds so rational, I'm going to do it, I'm going to risk it. And three weeks later, I show up in the parking lot of our local health food store, and she runs up to me. And she said, Oh, my God, I feel so much better. And my pains gone and I dropped the Oxycontin. He dropped it cold. She was taking the oxycontin for pain, joint pain, Anna. Now this doesn't prove autoimmunity. But I never felt inclined to do the workup at that time. Because as we instruct, you know, you can have a long list of symptoms in a midlife person, go after the hormones first and see what's left before you do these extensive medical workups. You'd be surprised how much stuff disappears, including pain syndromes.
Unknown Speaker 16:15
Yeah, no, I mean, I see that absolutely all the time. And that's one of the things about, then that's why I think there's so much controversy about hormones is that they're really bad. For the medical industrial complex. I mean, the number of symptoms that you will look at being caused by lack of appropriate levels of estrogen, testosterone, and progesterone. This is something that we counsel men on intensively because many of them don't realize they need an appropriate testosterone to estrogen ratio. And it's not just max out your tea, which is what the sort of mainstream narrative is in this world. But if you don't have this appropriate balance, you'll just have this litany of problems that like you said, Just go away. And what happens with all these problems, you end up with an SSRI for your depression, you end up with men end up on Viagra for their erectile dysfunction. You end up on IVs, you know, pills for your irritable bowel syndrome, you end up on this and that. And the other thing for all these different symptoms that once you treat with the hormones can go away overnight.
Unknown Speaker 17:23
And of course, there are legitimate other diagnoses that aren't going to respond to hormones. But if so, there's such a good probability that you're going to alleviate so much symptoms and suffering in a middle aged person or older by the hormones. So just start there. See what see what you got left.
Unknown Speaker 17:43
Right. Exactly. And that I think is the is the is the toughest thing is that and what do you think about how the narrative that hormones can be dangerous? I mean, how did that horse get out of the barn? And what do you say to people who are who are still resistant after your, your initial counseling, based on their concerns about risk?
Unknown Speaker 18:05
You know, it's one of the biggest, intense errors I've ever seen in my whole career. That people on hormones in prior to 2002 40% of American women in menopause, Ron Premarin and prempro body that that's 18 million women. And they were enjoying it. We're getting great results. And along comes the publication of this study calls the Women's Health Initiative. It was very large, it was 16,000 subjects and 16,000 controls. And that was Miss reported. And it was stopped early. Because there was two arms of the study one they were treated with Premarin harsh urine derived estrogens. And they were showing they have less of a relative risk of getting cancer than someone who was untreated. 0.791 is no risk one way or the other, no less, no more 0.79. But the prempro arm was stopped, because it reported 1.26 increase relative risk, which they stated in the original study was statistically insignificant. And you and I know in medicine, that statistically insignificant means don't draw any conclusion, folks, and don't take any action. It's statistically insignificant. But that's not what the press got to hold off. And who knows what misogynistic energy exists in this in the consciousness of this planet, but erupted?
Unknown Speaker 19:40
I have to point out I don't think it's misogynistic because men got the wrong end of the stick on testosterone with prostate cancer in the same decade.
Unknown Speaker 19:49
Right on, right on.
Unknown Speaker 19:52
It's almost it's almost just sadistic.
Unknown Speaker 19:55
It's crazy. It's really wildly crazy, especially when you look at the origins of the state. and who is funding it. But before going there, the 18 million dropped to the very low millions overnight. And the health consequences of that was monumental. But they continue this study by following up the original patients. And in 2017, the original study committee published in their original journal, that after 18 years of follow up, there was no increased risk of breast cancer. That was known right at the outset with by 2006. It was that was known but it wasn't published. But hardly anyone's heard of this. Even physicians, a very small percentage of the physicians have heard of this. But when physicians heard this, they got scared. They didn't want to hurt their patients put them at greater risk. And when women heard this, they just dropped it thinking that they could go through menopause naturally. And what was false information? Well, we studied it right out of the gate, and saw Wait a minute, this is physically insignificant. This is not compounded by identicals. There's European literature that shows that they're safe, we continue to do it, then that study was retracted, then an oncologist of the highest class, I run blooming came out with a book. He's a breast cancer specialist called estrogen matters. So for anyone who's still concerned, and you really want the science, Dr. Blooming goes into the details, showing that it was false. And of course, the study committee admitted it was false still, but that it scared everybody. Yes, false information. There's not even intuitive with that's, you know, that fear was out there.
Unknown Speaker 21:48
It is. Yeah. And I want to talk about one of the words that you use there, you said, women thought they could go through menopause naturally, I think this word natural is a very sticky word. Because what's interesting about is that people will say, Well, I just want to be natural and just go through menopause naturally, which, you know, to a clinician has taken care of, for most of his career in the hospital, women who are on the other side of menopause and who are suffering all the consequences of aging is a little bit like saying I want to go through a life threatening car accident gracefully. I understand this just desire for a natural process. But in my career as a clinician hoping to give my patients the greatest quality of life, even over the greatest quantity of life. Most of my patients endorse that they would rather have better quality over quantity, although there's obviously you know, let's just say a nuanced conversation to be had there. But once the with that out of the way, right, this idea of of quality over quantity, the bioidentical hormones are the gateway to that. And people have this resistance, I think many times in the natural health world to doing something that they perceive as being fundamentally unnatural, which is supplementing with their exogenous hormones. But I've just found as a clinician, that the upside and the benefit of bioidentical hormones is so profound, and the consequences of of kicking the can of BioIdentical Hormone Replacement down the road. so ugly that I simply can't counsel anyone any other way. And the relatively minor inconvenience of once yearly, typically, urinary hormone lab testing, every other year, every six months, or whatever routine bloodwork to look at other blood markers, which we do in our practice, and the occasional referral for women's health exam, or men's health exam with a urologist is, I mean, so worth the trouble in the investment as to be. It almost shocks me that what we're talking about is something that only a very small proportion of clinicians are doing, and that patients often are hesitant to engage in or skeptical of. And I wonder, how did how did we become such a minority in medicine? And how is something that's so profoundly beneficial, not more mainstream?
Unknown Speaker 24:17
Wow. Well, first, I'd like to say you stated it so elegantly. And it's another example of a doctor's iView because people are 40 years old, and I'm going to go through menopause naturally, and they haven't spent 1000 hours in a hospital taking care of the elderly. They haven't dealt with severe debilitating illness. They haven't walked through nursing homes, through assisted living facilities,
Unknown Speaker 24:46
and even the experiences they've had with family members aging. Those family members didn't tell them about their incontinence, about their memory lapses about their embarrassing physical ailments. They hit all that. So I think there's a lot in the women in particular, and men as well. They burry it from their family members, but they can fight about it to us.
Unknown Speaker 25:12
Yeah, that's right. That's our job. That's right. And how many couples have you spoken to where the husband can't get an erection anymore, and the marriage or the woman is got so much pain on intercourse, that there's their intimate life is, you know, the stories go on and on. And I've always been blessed. Consider it a blessing that we get this wide view from inside the womb till all ages. So someone might have a theory, well, I'd like to go through menopause natural. But boy, when the rubber hits the road, you may change your mind. And what's natural, I mean, natural for the last couple 100,000 years is there was no such thing as menopause. 99% of the folks were passing, we're leaving Earth. And that's,
Unknown Speaker 25:56
and I tell them that, you know, it would be natural for me to allow you to die in your next urinary tract infection or pneumonia of sepsis.
Unknown Speaker 26:04
Yeah. And people accept hygiene, they think that's a remarkable people except good nutrition, because it's made a dramatic difference in people except advances and efforts that have been made to improve one's consciousness when awareness, sensitivity, ability to relate, communicate and stuff. But I think it arose out of repelling what was not so good in our culture. And you know, so I want to go the natural route. And not us not an actual living experience of the consequences until it's too late. Often, it's not too late.
Unknown Speaker 26:44
I think that on that point, you know, my strength coach and conditioning coach, Jim is a is a former former power lifter. And what people will do with hormones can be very unnatural. Yeah, people have been turned off by that, and I want you to, we're not going to turn your husband into some roid rage machine. And if you're a lady, we're not going to, you know, make you very masculine, like a female bodybuilding might be, we use and that's where the word natural, so sticky, because we use naturally occurring quantities of hormones, in appropriate doses to achieve levels that are not only natural, but are designed based on extensive research and study. And I mean, 10s of 1000s of patients. And we have a whole mean, you have a whole network and all Institute where you are on the cutting edge of this with lots of practitioners sharing their experiences, we know very well how to dose these so that people get natural, healthy levels and feel and look and perform and live at their best without any of these negative side effects.
Unknown Speaker 27:52
Right. That's the whole goal, not too much, not too little, just the right amount. And the studies are there, we know exactly how much estrogen it takes to preserve the bones or replenish the bones if you had bone loss, right, we know what that amount is, we know the level it takes to protect the vagina. And we that's what we aim for is that wonderful, beneficial spot. But we're not trying to restore youth or we're not trying to restore periods, you don't have to, you can get so many great benefits from lesser than youthful levels.
Unknown Speaker 28:26
And I have to say that I think a lot of people out there in the natural health community will give people the impression that they can prevent things like osteoporosis, and muscle loss and the aging process in general by eating healthy, taking the right herbs, doing this doing that biohacking.
Unknown Speaker 28:50
Let's be real. That's right,
Unknown Speaker 28:52
these things are a side show to the main event hormones, and we just can't replace them. I would love it. If I could put people on supplements and vitamins and minerals and get the same results. It's not possible. And no one should waste their time thinking, Oh, I'm going to get great results and prevent osteoporosis and this now the other thing just by taking vitamin D and mag and calcium and strontium and this not elegant, it is not going to work. And it's it's so powerful become such a proponent of biochemical hormones, having come to it initially very much as someone who who wanted to be and I view it as my responsibility to be very skeptical of anything that anyone is trying to get me to do for my patients because there's so much bad medicine out there. But this is I can't find way around the fact that I end up recommending bioidenticals to all my patients. Yeah.
Unknown Speaker 29:51
The other thing you mentioned was our profession. And you know, things are changing very, very rapidly. I'm when I started out what did we know? Injectable B 12 is good, thyroids good. We're just getting a hint about the hormone since a long time ago. And functional medicine
Unknown Speaker 30:13
is you're on TRT.
Unknown Speaker 30:16
But I'm I'm not, I feel good. I think I'm 80 and 80, I'm 80. I'm about to turn 81 I didn't realize what was there wasn't a word functional medicine, the word holistic hadn't been done, there were people interested in health. And what I've seen is an explosion. I mean, I just came back from an event that was 5000, functional medicine, holistic medicine doctors at a three day conference. And I was so moved, I thought, the way that this is catching on. And you know, our traditional colleagues are picking up on a two. For one thing, all you got to do is talk to a traditional colleague who's sort of open minded. And soon as they know that I'm into hormones, they got a lot of questions. A lot of interest, they want to know, for themselves, so many of them are not having erections and not and then having vaginal atrophy.
Unknown Speaker 31:19
One of the things I point out to patients, I say, look, all due respect for my colleagues, the men have a 1.5 for increased risk of suicide, and the female physicians have a 2.27 fold increased risk of suicide. These are not emotionally or physically healthy people. And they can be very effective if you're bleeding out, or you're in need of surgery, or you're dying of sepsis. But these people don't know how to be healthy, let alone expand your life.
Unknown Speaker 31:53
Well, I have deep deep gratitude for what they do do well, of course, and you know, who knows why. Consciousness resists good stuff, you know. But it's, it's, it's yielding. I mean, there are millions and millions there's like in 2016, there were they did a count there was 6 million women had returned to hormone therapy after dropping down to a million, and over half of them over 3 million run compounded bioidentical hormones. Now, now, five years later, six years later, I can't imagine that but that hasn't doubled and the number of providers like I'm, I'm involved in teaching and you know, this year, I'm going to two or three or four, to teach at conferences to train physicians in bioidentical hormones. So, it's a rising tide. And so it is becoming so much more popular and you know, it will have its day people will get it.
Unknown Speaker 33:00
I agree. Any closing thoughts? I mean, I think we've really covered it pretty well.
Unknown Speaker 33:08
Well, it's, it's an honor to be here with you, Leland, I, I see the gifts you have, or I suspect the gifts you have. And it's just such a pleasure to be working with you and know what your what you're doing for the people of this that are in your care and I feel a warm spot in my heart for the great work we're doing.
Unknown Speaker 33:33
Thank you. It's great to be here with you too. Thank you for taking me on as your student. And if you're watching this and you have questions for me, contact me reach out to me. I may sit down with Dr. Rosen sweet again and cover those questions. We'll see if they're, they're good enough that I'll post links to articles and things explaining answers to those questions.
Transcribed by https://otter.ai
Should you use bioidentical hormones?