Kim Vopni (00:02.022)
Thank you for joining me, Dr. Rosensweet. I have, as I was saying offline, I recommend your work and your books and direct people to your community often. And it's a real honor and pleasure to have you today chatting all about hormones with my audience. So thank you so much for joining me.
Daved Rosensweet M.D. (00:19.616)
Yes, it's my honor.
Kim Vopni (00:22.034)
Can you start out just telling us a little bit, you have a very extensive bio, but just a little, who are you? What brought you into this world of bioidentical hormone therapy, specifically in women's health? And then we'll go from there with a list of questions that I have.
Daved Rosensweet M.D. (00:40.202)
I always loved medicine and in 1968 as a senior medical student, I started exploring what eventually became functional medicine or holistic medicine and was in private practice and about 33 years ago, Deborah, a patient of mine, who I knew really well, she was in her mid 40s, she came storming into my office before office hours, pounded her fist on my desk.
And said you gotta help me. I'm telling you I am going crazy and don't think you know me I thought I didn't know her. She was so brilliant. She had retired in her mid-40s think about what it takes to do that And You know the divine guidance of life and medicine I had been speaking to John Lee Medical doctor who pioneered progesterone a couple weeks before that
Kim Vopni (01:13.051)
You
Kim Vopni (01:19.216)
Yeah, wow.
Daved Rosensweet M.D. (01:34.54)
And I gave her some progesterone and three weeks later, she wrote me a letter saying, my God, I can't believe this stuff. I'm totally myself again. And that was very dramatic and very rewarding. She was so relieved to see results like that.
Kim Vopni (01:52.647)
Mm-hmm.
Daved Rosensweet M.D. (01:54.008)
But I never totally guided my career. Before I knew it, she referred a lot of her friends. And it suited me great because I love biochemistry. love. And I decided to really just zero in on it. There was a lot to learn. And so I started to specialize in it. And that's how I got there, Deborah.
Kim Vopni (01:59.952)
haha
Kim Vopni (02:16.177)
Debra started it all. Thank you, Debra. So you've seen the whole evolution of hormone therapy, women's health initiative, the aftermath of that, and now the sort of resurgence of hormone therapy. I remember my mom going through her menopause transition.
struggling went on hormone therapy at the time that would have been she didn't have a uterus so she would have been just taking the conjugated equine estrogen absolutely helped her however it was around the time of the women's health initiative and so she struggled with should I stay on this should I not she was a nurse she worked in the medical field she had a lot of doctors saying what's being presented in the media is not accurate so she was
She stayed on it for a period of time, but she still battled with this decision of, this safer? Is this actually causing me harm? Then I saw the, you know, I was sort of out of that world for a while. She, she, I think she, well, she still struggles to some extent, but when I started to focus in women's health, I started to recognize the importance of learning about hormones.
At the time I was starting to learn the terms bioidentical, which many of the kind of standard allopathic people were considering just a marketing term. But this is what you have worked in this bioidentical space really for the entire time. So where does the term, I guess, can you talk a little bit about the evolution of hormone therapy and was it?
Was it in the beginning bioidentical and then the pharmaceutical came in and then we had this resurgence or what was the history there with regards to this quote unquote marketing term of bioidentical hormone therapy?
Daved Rosensweet M.D. (04:09.006)
It began bioidentical. About a thousand years ago, we learned that the Chinese had set up these outhouses for young women and young men and collected their urine individually and dried it out and fed the powder that residual to the aristocracy. because in the urine, there are actual hormones.
Kim Vopni (04:32.965)
So interesting.
Daved Rosensweet M.D. (04:39.118)
And then update to the early 20th century, they even did an experiment to do pregnant women's urine. Why pregnant women? Because it was rich in hormones, richer than ever before. But it wasn't practical or I don't know exactly why they gave that up. But they then, they decided to try and extract the hormones from pregnant mare urine, horse.
Kim Vopni (04:51.488)
huh.
Daved Rosensweet M.D. (05:08.846)
large animal, lots of urine, lots of hormones, and it became the most popular and profitable drug of all time up to the early 2000s. 40 % of American women were on premarin, pregnant, mare, urine-derived hormones, 50 % of which were unique to the horse. They never seen by a female, human female.
Kim Vopni (05:09.041)
Mm-hmm.
Kim Vopni (05:22.575)
Daved Rosensweet M.D. (05:38.862)
And yeah, 40 million American women. And then along comes 2002, where there was the false reporting of a medical study, a really poorly designed medical study, the Women's Health Initiative. But it exploded in the press.
and at the foundation of it was if women are taking hormones they're at risk for breast cancer. Totally false. That was not what was in the actual study. In fact, the women who took Premarin alone were shown in that study by to be at less risk for breast cancer.
And the women who took Prem Pro, this was combining Premarin with an artificial progesterone called a progestin, which is a funky molecule. They had a 1.26 or what was stated in the paper, statistically insignificant increase in risk. That was the facts of the study in 2002, but the press somehow got a hold of it and scared
women and physicians all over the planet. I'm sorry, was 18 million women, 40 % of those women in menopause in the United States. That 18 million dropped below 2 million overnight, scared women, very deleterious side effects to those women who lost those hormones. And if I could pause and give you...
what I now know to be the best science around risk, because I think your audience, some might still be concerned, and here is the science. Human beings were all at risk for thousands of diagnoses. We're at risk for hundreds of cancers. As a male, I have an increased relative risk for prostate cancer, and there's new reasons for that. That wasn't true when I was in medical school.
Kim Vopni (07:34.13)
Please.
Kim Vopni (07:56.332)
really?
Daved Rosensweet M.D. (07:56.982)
Yeah, and women are now have an increased relative risk relative to other cancers for the development of breast cancer. Again, that wasn't true when I was in medical school. We might ask the question, what happened? And given that we're all at risk, here's the actual science. Women who are on hormones are at less risk
Kim Vopni (08:12.825)
Yes.
Daved Rosensweet M.D. (08:25.87)
for breast cancer, heart attack, and stroke than women who are not on hormones. And to take it one step further, women who have had breast cancer and had that breast cancer properly treated, they happen to have an increased risk of recurrence than a woman has developing breast cancer brand new.
However, if those women who have had breast cancer and had it properly treated are treated with hormones, they turn out to be at less risk for recurrence than women who are not getting treated. That totally blurs the story around receptor sites, which is not accurate. So that's the science, less risk. That's the main thing many of your audience by now
Kim Vopni (09:03.897)
and less risk of dying as well.
Kim Vopni (09:08.901)
Right.
Daved Rosensweet M.D. (09:16.14)
may know this, but if there's a few stragglers out there who haven't heard the updated science, I wanted to mention it. I never wrote a prescription for Premarin. I had the great privilege of knowing Dr. Jonathan Wright, who suggests that we use bioident. Why not use the same molecule? He knew it was out there. In the 80s, he knew that the pure molecule, the same molecule,
Kim Vopni (09:20.091)
Mm-hmm.
Daved Rosensweet M.D. (09:43.951)
that's being produced by a female ovary was available. He knew that they were using part of it for the birth control pill. So he asked a compounding pharmacist, who's a compounding pharmacist? Well, up until recently, every pharmacist that have ever been were compounding pharmacists. They used to take stuff, mix it together, put it in pills and elixirs and suppositories. Everyone was a compounding pharmacist. That's changed.
Kim Vopni (10:05.808)
Yeah.
Kim Vopni (10:10.331)
Mm-hmm.
Daved Rosensweet M.D. (10:14.508)
But his local compounding pharmacist, he reached out and he found the pure estradiol, estriol, progesterone, same molecule. It's derived from plant sources. It was done so in 1940s. They found a precursor in plants. How different are we than plants? There some differences.
Kim Vopni (10:40.547)
You
Daved Rosensweet M.D. (10:42.222)
And the pure hormones, the pure molecule, same that the woman's ovary produced, became available in 1980s. And so I started in the early 90s. I went right to it. It seemed made sense to me. And yes, my only experiences with the bioidenticals, it's the same molecule. And there's a lot more details that have been learned about, well, how do get it right for each individual woman? Well, that's a whole story unto itself.
Kim Vopni (10:56.411)
Mm-hmm, mm-hmm.
Kim Vopni (11:01.296)
Yeah.
Daved Rosensweet M.D. (11:12.482)
But did that pretty much answer your question, which I've now lost in the background of what was that original question that you asked?
Kim Vopni (11:15.259)
Mm-hmm.
Kim Vopni (11:18.681)
Yeah, yeah, I do the same thing. I love the tangents though. The tangents are I think where the gold is. But I, it's funny, I often say the same thing where the original hormones were bioidentical, the original pharmacy was compounding, and it came to a point where both of which were considered woo-woo or marketing terms or what have you. And really it's just fundamentally where they began. was the...
Daved Rosensweet M.D. (11:22.359)
Hmm.
Kim Vopni (11:48.345)
It was the origins of those.
Daved Rosensweet M.D. (11:48.974)
There's an important reason why this happened. Pharmaceutical manufacturers started taking over modern medicine from 1950 on, roughly speaking. And the profits in manufacturing pharmaceutical medications are huge. And just for one example, when Premarin and Prempro were the most
Kim Vopni (12:02.577)
Mm-hmm.
Daved Rosensweet M.D. (12:16.046)
popular and profitable drugs of all time, like I mentioned. Then their market share disappeared overnight. And into that void, some women went, wait a minute, we need these hormones. And so there was a gradual return and a lot of the women gravitated to those who were saying, let's do bioidenticals, holistic doctors, functional medicine doctors and nurse practitioners.
Kim Vopni (12:19.877)
Mm-hmm.
Mm-hmm.
Kim Vopni (12:30.905)
huh.
Kim Vopni (12:44.582)
Mm-hmm.
Daved Rosensweet M.D. (12:45.634)
And a study was done in 2016 in which there was a return of women to about 6 million women were back on hormones. 18 million in 2002, 6 million in 2017. And over half of them were on compounded bioidenticals. That means the pharmaceutical manufacturers had lost that much market share. So it's no accident that incomes to the marketing world
Kim Vopni (13:05.392)
Interesting.
Kim Vopni (13:10.319)
Mm-hmm.
Daved Rosensweet M.D. (13:16.11)
this false information. Why? Because who got what kind of pharmacists are compounding pharmacists? They're the most interested. They have the most sophisticated analytical machines. They're not just counting out pills. They're formulating stuff. They're the they're the ones that and so I know a lot of them. I'm a member of the Alliance for Pharmacy Combounders and I met a lot of them. They're beautiful people.
Kim Vopni (13:24.047)
Yeah.
Daved Rosensweet M.D. (13:46.25)
Overall wonderful group of the most interested scholastically interested patient centered of all the pharmacists that are out there the rest of them bless their hearts. They're tired. They're overworked. They're working for huge corporations. They're counting pills. They're typing out and stapling packages. I don't know if you've ever seen one do this. So I love
Kim Vopni (13:47.173)
Mm-hmm.
Kim Vopni (13:52.838)
Mm-hmm.
Kim Vopni (14:07.633)
Yeah.
Daved Rosensweet M.D. (14:14.158)
You know, we're all human, none of us have got it all together yet, but the compounders are the best of the best of the best.
Kim Vopni (14:20.945)
Yeah, yeah, I would agree with you. when, right now we are, at least in my community, the majority of people are somewhere between, you know, they've reached their menopause and say 75-ish. That's the majority. Of course, there are some that are older, there are some that are a little bit younger, but generally it's in that kind of, they're just transitioning or have been in...
postmenopause now for several years and there are some of them who have been informed and are using hormone therapy. There's, I would say, a bigger group where they were part of the fear, the scare, the generation where you can't use it, it's dangerous, you're gonna get breast cancer. you can't because you have a history of breast cancer. And now they're starting to learn. Some of them feel anger and resentment because they feel like they've missed that window. But I guess there's two parts to this question.
When somebody is starting out, and I guess the second part of the question is, is it ever too late? So when somebody is starting out, how do they determine which hormones they should, quote unquote, replace? And what testing would somebody go through? Is testing necessary? Because I sort of say, well, if you're postmenopause, we know you will be deficient in your hormones. So is there a?
Is there reason to test or would we treat and then test once they have started? That's sort of a convoluted question, but I guess how would somebody know where to start from a testing perspective if they need it and is it ever too late to start?
Daved Rosensweet M.D. (15:57.29)
well, just to give you an idea, I started treating my mother and mother-in-law when they would let me. They wouldn't, didn't want me to get near women's matters, but things got rough for them in their eighties, late eighties. And both of them let me treat them to some advantage. and I always, what we teach is, boy, whenever you can think about it.
Kim Vopni (16:07.961)
Yeah.
Mm-hmm.
Kim Vopni (16:20.154)
Mm-hmm.
Kim Vopni (16:26.673)
Mm-hmm.
Daved Rosensweet M.D. (16:28.358)
And having said that, is it easier to start with a woman whose ovaries are just starting to get irregular? Yeah, it's a lot easier and a lot more good can be done. It's not as easy to retrieve functions like the brain or the bones or the muscles once you've lost them. So, but we say whatever age. Now,
Kim Vopni (16:37.477)
Mm-hmm. Mm-hmm.
Right.
Kim Vopni (16:51.078)
Right.
Kim Vopni (16:54.715)
Right.
Daved Rosensweet M.D. (16:56.418)
There are certain unusual risks if a woman's been without hormones for quite a while. Because, like for example, estrogen is so protective to the arteries. And the, for example, every so often in medicine you hear he was 40 years old, he had a heart attack on the tennis court, never sick a day in his life. You never hear that about women. They don't do that.
their incidence of coronary artery disease is much lower than men. But it equalizes by the age of 60. And why that's so is a woman loses her estrogen, which is so protective to arteries. So when a woman intercepts hormones, let's say she's 10 years with no hormones because she got scared, there's a certain small number of those women who are at special risk for coronary artery issues.
Kim Vopni (17:38.065)
Mm-hmm.
Daved Rosensweet M.D. (17:52.918)
in the hands of someone who loves this field and knows what they're doing, so we say, what? So we evaluate your coronary arteries if we need to. This can be done in a very sophisticated way. And it's always risk benefit. Sometimes you can learn so much about someone that you wouldn't have to put them through what you need to evaluate, but there's certain risks. But everything else outside of that one additional risk,
If they happen to have a blood clot in the coronary, it doesn't matter what age you do it. It's just a lot easier when it's younger.
Kim Vopni (18:31.153)
Is that risk with the coronary artery? Is that the same even if it's transdermal?
Daved Rosensweet M.D. (18:39.171)
Yes.
Kim Vopni (18:40.384)
it is, okay, I didn't know that.
Daved Rosensweet M.D. (18:41.57)
Well, I shouldn't say that. The risk is, is if let's take a 70 year old woman who's been 10 years with zero hormones.
Kim Vopni (18:50.928)
Yes.
Daved Rosensweet M.D. (18:53.486)
65 year old woman who's 10 years into menopause, no hormones. A certain percentage of those women have lost the protection of estrogen to the coronary arteries and the coronary arteries are vulnerable to arteriosclerosis.
And when you look at an arteriosclerotic artery on the inside, it's like barnacles on a boat. It's very rough surface. And the big problem becomes that rough surface can provoke a clot really easily. Whereas a smooth surface does not provoke a clot, a rough surface can. So there's some women walking out around there, they're not common, but they actually have a clot in a coronary.
And if you give those women estrogen, there's a risk that that clot will break loose and that will cause a heart attack.
Kim Vopni (19:52.133)
And what's the reason for that? What would the introduction of how, what's the mechanism that the estrogen would?
Daved Rosensweet M.D. (19:57.452)
We believe it has to do with a special function, wonderful function of estrogen in a young woman. It produces a dilating factor called nitrous oxide.
Kim Vopni (20:08.913)
Mm-hmm.
Daved Rosensweet M.D. (20:11.042)
that dilates that vessel. And if you dilate, you shake loose that clot, you can break it loose. It has to do with the breaking up of the clot. The oddest thing about it, it is so rare. I have colleagues that have been doing this work as long as I have. when we first learned about this just a couple of years ago, we thought of all the women we had treated and we never ran into this.
Kim Vopni (20:15.831)
Mm. Mm.
Daved Rosensweet M.D. (20:37.172)
And my friend who's a pharmacist in Dallas, I have a very privileged demographic, some of the most health motivated, intelligent women on the planet earth. He was on the front lines in Dallas where he had hundreds of diabetic patients, obese patients. They are really at risk for arteriosclerosis big time. And he just shuttered and we chuckled.
how lucky we were, especially him, to have never had this complication. So I don't want to overblow it. But when you go to a physician or nurse practitioner who really is doing a good job, they're going to take a medical history and they're going to start asking you questions that are going to lead to the healthier coronaries. And they're going to leave them alone if everything is fine. But if this particular risk is there, they're going to tell you, inform consent.
This is what you face. This is what I think we should do about it, even though the risk is really rare. It's your choice.
Kim Vopni (21:42.226)
Could that person, if we're introducing estrogen, so let's say we've established that there could be a risk or we're concerned that maybe there is a risk there, would titrating the dose change anything? So rather than starting with the standardized dose, starting with a much smaller dose as a sort of gradual introduction, would that change any of that risk mitigated at all?
Daved Rosensweet M.D. (22:06.83)
I really like where you're going there. I don't know any science on that. That would certainly be an optimal way to go. Not make that artery or that clot vulnerable all at once.
Kim Vopni (22:20.465)
Mm-hmm.
Daved Rosensweet M.D. (22:23.756)
This is so rare that you don't find out. You have to really search to find this possible complication, but we'd like to cover all bases. So the original question was, what age do you say it's okay? And we say, however old you are. Whenever you come to us and you're inspired and we'll just take the appropriate steps with your particular situation.
Kim Vopni (22:41.414)
Yep.
Kim Vopni (22:50.726)
Right. And then testing wise, if somebody was no longer cycling, would they need to have testing to start?
Daved Rosensweet M.D. (22:56.046)
Yeah, well I thought they did because I did a lot of testing when I first started out working with menopausal women and I had the privilege of knowing about the 24 hour urine hormone test. So I did it three times with women who didn't have periods and I learned very quickly that what did I just do?
I gave them the privilege of paying $340 for me to tell them that their hormones were low. Well, their praises stopped. Of course they were super low. So we suggest exactly what you were suggesting. Don't test a woman in the beginning. Don't test a woman in the beginning for her hormones. Don't test your hormones.
Kim Vopni (23:33.874)
Great.
Daved Rosensweet M.D. (23:51.456)
If she doesn't have a period, you're going to learn nothing. You're going to learn, your hormone levels are low. Okay, brilliant. If she's in perimenopause, that means she's still having periods. This is perilous to test her hormone levels. Because as the ovary starts declining, her brain realizes this, and pituitary and hypothalamus realize this, and they try to remedy the declining hormone, BATE.
Kim Vopni (23:57.331)
Right.
Daved Rosensweet M.D. (24:21.502)
the brain and they try and remedy it by pushing out some very strong ovary stimulating hormones to try and wake that ovary up. It's going to sleep and when that push comes out there's a burst of hormones in the perimenopause. Higher than a woman often has ever had in her life but it's momentary because the ovaries don't have the full capacity to keep going at that rate.
Kim Vopni (24:45.116)
Mm-hmm.
Daved Rosensweet M.D. (24:51.502)
So you get, instead of these nice smooth menstrual curves with hormone output, you get erratic up and down, higher, lower. And if you test on the wrong day, you're doing blood tests, you're doing 24 hour urines. And how did I know this? Cause I did this. So I'm sitting in front of a woman in the perimenopause that I just asked to pay, in those days it was 280 or something.
And she's looking at a report and it says high estrogens. Meanwhile, she's having nightly hot flashes. Tells me for sure she's low on estrogen. And I say to her, well, I'd like to treat you with estrogen. And I don't think I've ever seen a look like this from a patient in my life. Like, I'm a doctor and I'm handing her a test that says she's high in estrogens. I'm suggesting we caught her on the wrong day the rest of the month.
Mostly she was low enough to produce high flashes. So that's why I never test hormone levels. We test 100 % of the women in our practice. 100%. But we wait to the two to four month mark when a woman has dialed in an optimal hormone program and says to us, these are the magic words, oh my god, I'm myself again. I feel really good. We really found these dosages. Thank you so much.
Kim Vopni (25:51.856)
Right.
Kim Vopni (26:14.684)
Mm-hmm.
Daved Rosensweet M.D. (26:19.746)
That's when we test hormone levels. There are some blood tests I like to get in the beginning with women. I like to test their thyroid routinely because there's so many women midlife that have gotten slightly or significantly low thyroid levels and we need to bring that in as well. And I like to test this thing called SHBG or sex hormone binding globulin because there's a certain percentage of women that go into menopause, they've got an elevated sex hormone binding.
Kim Vopni (26:27.91)
Mm-hmm.
Daved Rosensweet M.D. (26:50.002)
And we need a baseline because a few of those women are going to have a more difficult time. It got elevated because they went on the birth control pill. It's a natural protective mechanism. The birth control pill has hormones in it.
Kim Vopni (27:04.306)
Mm-hmm.
Daved Rosensweet M.D. (27:06.222)
You put hormones in a young woman whose levels are already high and they go too high and her body can protect her from the too high. So it binds them up with sex hormone binding globulin. So a lot of women entering the menopause, they have an elevated sex hormone binding globulin. I just want to know what the baseline is. I never say anything like, oh my God, I never say anything. I just say, I don't think we're going to have to deal with this. But if we do, we've got the baseline.
Kim Vopni (27:35.398)
Right.
Daved Rosensweet M.D. (27:35.992)
to explain a woman that's having challenges in the dose determination, dose titration. Why should she be having challenges? She shouldn't really be having that many challenges. An elevated sex hormone binding glogon above baseline is one of the things that can do it. But it's not guaranteed to do it. No, a lot of women go into menopause, they have the elevated sex hormone binding glogon, we go ahead and treat it and it never becomes a fact.
Kim Vopni (28:04.627)
Do you treat with estrogen, progesterone and testosterone?
Daved Rosensweet M.D. (28:12.587)
Absolutely.
Kim Vopni (28:13.917)
for everybody.
Daved Rosensweet M.D. (28:15.798)
Sooner or later, every single woman absolutely. The ovaries produce a couple of estrogens. We're very selective. We choose two of them, esterol and estradiol. Progesterone, gosh, galore, it's wonderful. The ovary produces testosterone. A young woman's ovary produces more testosterone than it produces the most potent of the estrogens, estradiol.
Kim Vopni (28:20.061)
Mm-hmm.
Kim Vopni (28:33.028)
You
Daved Rosensweet M.D. (28:45.698)
Testosterone is not a male hormone, it's a human hormone. Women absolutely need it, and every single woman with maybe one exception, in 33 years I've seen one exception, by three years into menopause, every woman has got low testosterone.
These days, most women who go into the perimenopause in my practice are low in testosterone already. That didn't used to be the case when I started out. I'm seeing it almost universally now. It's very easy to detect. And I'm glad you brought this up because testosterone is so important. You need testosterone to keep your muscles. You need to exercise, you betcha.
but you need testosterone. when you, like I used to live in, is this okay that I'm going into this level of DTM?
Kim Vopni (29:40.179)
Please, yes, keep going.
Daved Rosensweet M.D. (29:42.638)
I used to live in Florida for 20 years and I used to walk the beaches and even though there's so many elderly folks in Florida, there's not many elderly people on the beaches. And when they are walking the beaches, you see this phenomena called very thin lower extremities. They've lost their muscle. And in 1968, as a medical student,
Kim Vopni (30:04.85)
Mm-hmm.
Daved Rosensweet M.D. (30:10.606)
We had a gerontologist lecture to us in the hospital, a noon lecture in the hospital, and I was a gerontologist. I'm a young guy. don't want to annoy these older people. Arrogant young guy that I was. But what do I remember from medical school? A lot of stuff. But I remember with this gerontologist, he said, you you're senior medical students. You know thousands of diagnoses. Let me tell you what's really happening to older people.
Kim Vopni (30:18.554)
You
Daved Rosensweet M.D. (30:39.406)
They're losing their muscles called sarcopenia. They're losing their bones called osteopenia and osteoporosis. They can't stand with stability. They're moving from canes to walkers to wheelchairs because they've lost their muscle and they fall on their osteoporotic bones and they die. Along with loss of cognition,
This is what gets 80 % of women into assisted living facilities and nursing homes. You want to do something for old people? Help them with their muscles and their bones and their brain.
Kim Vopni (31:23.61)
and their balance and their pelvic floor.
Daved Rosensweet M.D. (31:25.932)
Yes, right. Well, part of the pelvic floor issue is there's a major muscle holding up that pelvis, holding up the uterus and the bladder. It's called the levator anii. Major important muscle. That gets sarcopenia too and that flops. And you're talking about exercise and that's great. But without the, why is there adult diapers? When you go into a grocery store, if you do anymore, there's
Kim Vopni (31:36.785)
Mm-hmm.
Kim Vopni (31:41.538)
Exactly.
Daved Rosensweet M.D. (31:55.726)
I did it because of my mother. I was amazed at how much grocery store real estate was taken up by adult diapers.
Kim Vopni (32:00.115)
You
Kim Vopni (32:07.548)
Yeah, yeah, it's shocking and it's getting bigger.
Daved Rosensweet M.D. (32:11.244)
Yeah, so that pelvic floor prolapse is a, there's several causes to it, but one of them is the loss of the muscle that holds it up. So testosterone, why am I laying around on this? Because people really need to know this. This is a crucial part of proper treatment of women.
Kim Vopni (32:21.606)
Yeah.
Kim Vopni (32:32.186)
With testosterone delivery, so there, well, with any, let's carry on the testosterone for a moment. There's a lot of clinics popping up that are doing testosterone pellet therapy. There, I personally use a testosterone cream.
Right now, I'm in Canada, but even in the United States, there is no FDA or Health Canada approved testosterone. So you need to find a doctor who's willing to prescribe testosterone in the first place. Right now, if you're working with an allopathic doctor, you can say low libido, but it's so much more than low libido. But from a delivery mode perspective, what is preferred? What would be ideal? I've heard...
two sides of the story with regards to pellets. There are some people who love them. Some providers love them. Some people love them. Other people find that they're concerned because you put it in and you can't necessarily, if it's not the right dose, you can't really do anything about it. So is titrating up with a cream better or are there other modes of delivery that I'm not aware of? And sorry, on that, would vaginal testosterone...
be favored because of the absorption through the tissues in the vagina.
Daved Rosensweet M.D. (33:48.984)
You've been around the block in this field. You ask in the big ones. As far as ovarian hormones go, I have very strong opinions. I'm opinionated.
Kim Vopni (33:50.834)
You
Kim Vopni (34:04.412)
Tell me your opinions, I wanna hear them.
Daved Rosensweet M.D. (34:07.086)
Topical in almost all instances is by far the way to go.
Injections?
They work, but the proper way to do injections would be daily.
Kim Vopni (34:23.1)
Mm-hmm.
Daved Rosensweet M.D. (34:24.694)
Like in men's treatment, when it started out, they were injecting men once a month. Well, how'd they get it to last a month? Well, they didn't pretty much, but they had to shoot in a tremendously high dose to last a whole month. And then it ran out. So daily needles, will you show me how many people are real excited about daily needles? Plus it's too fast. You inject something into a muscle or under the skin.
Kim Vopni (34:35.441)
Right.
Kim Vopni (34:46.586)
Yeah.
Daved Rosensweet M.D. (34:52.384)
It's absorbed too fast. This is the body doesn't work like that. It doesn't throw out a whole day supply in one second. Pellets are very similar. They go in, they last for three months or six months. You got to shoot a lot of pellet in there to get it to last that long. And yeah, there's a lot of people who like it because super physiologic people can get high on
Kim Vopni (35:01.074)
rate.
Daved Rosensweet M.D. (35:22.336)
on high doses. It usually doesn't last. It doesn't have sustain to it in that they might like pellets for half a year or a year. I think in the hands of an expert pellet person I've only heard of a couple, you could probably do a decent job, but overall I'm very much opposed to pellets. It's so non-physiologic. And like you said, once you stick a dose in there, did you hit it right?
Kim Vopni (35:23.569)
Mm-hmm.
Daved Rosensweet M.D. (35:52.0)
Whoa, the range of, mean, individualization is the key to doing great work in menopause. Like for example, we know our numbers. We know that in my practice that women range in the strength of bias they need anywhere from 0.9 to 4.8 milligrams of estradiol equivalent. Whoa, that's quite an increase. That's five times the lower. And all these women can be doing great on any one of those doses there.
Kim Vopni (36:15.582)
huh.
Daved Rosensweet M.D. (36:21.486)
But that's a huge range. Well, it's not a problem clinically. We just titrate the women to their optimal place and then we test them. Well, that range has got to exist in Pelletville too. And yet you got to hit it right and you can't take those out. So once they're in there, they're in there for three months. lot of pellet failures out there. I testified in front of the National Academy of Sciences in 2019 where they were examining.
Kim Vopni (36:22.983)
Mm-hmm.
Kim Vopni (36:34.353)
Mm-hmm.
Kim Vopni (36:38.333)
Right?
Daved Rosensweet M.D. (36:49.55)
shall I say trying to punish compounded bioidenticals. And pellets were number one on their list. They felt like they had reason to attack them and they did. So I'm not trying to hurt anybody's business but I really want good medicine and I want to protect compounded bioidenticals and we're vulnerable there because of the science aspect of pellets.
So let's go back to topical, because it's great. Topical is great. you do daily or twice daily application of estrogen, for example, is best. And you start with low doses and like you know, you gradually increase until you alleviate symptoms and then you test. it's a beautiful process. And the delivery is very, it's slower.
to absorb through the skin. So it's more mellow. So it's more like the body behaves. And yeah, I love topical. My favorite is, well, here's what happened. About 15 years ago, and I'd been treating women for quite a while by then, but I'd never seen a hormone. I I wrote a prescription to my pharmacist and he shipped it directly to the women. And then one day a woman's bias shows up in my office, a jar, white cosmetic jar.
and I was about 10 years into it and I had never seen a hormone. And I cracked the seal on her prescription and I'm capped at an outcome, the strong odor. And we did some investigating and we realized that steroid hormones are very poorly soluble in order to get them up in the solution. So that when you click a toppy click or you spoon something out, you're getting the same dose every time. They have to be solution.
Kim Vopni (38:16.179)
Hahaha
You
Kim Vopni (38:40.285)
Mm-hmm.
Daved Rosensweet M.D. (38:42.542)
You have to use strong solvents and over 99 % of what's in a jar is strong solvent. And here I am a holistic doc and I've been detoxifying people for decades and I did the math and I'm asking women to apply a quart a year of this strong solvent for 10, 20, 30, 40 years. So.
Kim Vopni (39:03.026)
Mm-hmm.
Daved Rosensweet M.D. (39:07.244)
That was very disturbing and it really triggered us into a lot of research, a lot of investigation. We developed an organic oil base. So these are my beloved hormones. They come in an organic oil base. And they're not a solution, they're suspension, so you have to shake the bottle before you use it every time. Certified organic oil. Topical. That's the state of the art.
There's room for oral progesterone. That's a subject unto itself.
Kim Vopni (39:41.992)
Before we go there, hang on one second, I wanna just come back to testosterone. Does it matter where on the body you put your cream? And when you were talking about the ranges of estrogen even, and there's ranges for everybody with every hormone, so what are the ranges you see from a testosterone perspective? is there, like I really had to push my doctor to even get me up to four milligrams.
allopathic minded, still considering other research that it was going to cause damage to my heart and what have you. But yeah. So what are the ranges that you see most favorable for women and where on the body should they be putting the topical cream?
Daved Rosensweet M.D. (40:26.786)
And that was false information about the damage to the heart. Heart's a muscle. There are studies of testosterone helping people in congestive heart failure. These topical hormones, they'll absorb from anywhere. But there's a difference. I mean, the soles of the feet are not going to be as good of an absorptive surface as the soft forearms, for example.
Kim Vopni (40:29.831)
Yeah. Yeah.
Kim Vopni (40:36.31)
huh.
Kim Vopni (40:52.531)
Daved Rosensweet M.D. (40:54.142)
And the way we like to do it is we like women to apply the bias to the soft forearm.
Kim Vopni (41:00.211)
meaning it's the estriol and estradiol just for those that aren't okay yep
Daved Rosensweet M.D. (41:03.32)
That's right, yes. We like women to apply the progesterone to their inner thighs, and we like women to apply the testosterone to their lower abdomen.
that's above the pelvic crease there, not in the pubic hair area, because you can get hair growth there, but in that area. But there's nothing magical about those. We like it. We do think it's most beneficial to not apply different hormones to the same spot.
Kim Vopni (41:19.923)
Mm-hmm.
Kim Vopni (41:23.635)
Mm-hmm.
Kim Vopni (41:36.295)
Right.
Daved Rosensweet M.D. (41:37.71)
It's easier to, and then sometimes you've got to rotate. I'm some women who apply to the forearms. can do that their whole life. Other women after a while, they get something called dermal fatigue. They get saturated skin and subcutaneous fat. We haven't switched like to the posterior deltoid, lateral deltoid area. So sometimes you need to rotate. Women taught me this. What the French knew is women said, I always save a little biased.
Kim Vopni (41:54.653)
Mm-hmm.
Daved Rosensweet M.D. (42:07.35)
on my hand for final application to my face and neck and back of the hands, because it's so good for the skin. Well, the French knew this. They were sticking estrogen in their expensive French skin creams and not listing it as an ingredient back when I started out. And they were getting magical, wonderful results from it. Yeah, vagina.
Kim Vopni (42:24.796)
Interesting.
Daved Rosensweet M.D. (42:34.415)
You know, applying estrogen to the vagina for a woman who's not having penetrative sex?
is fine. It's a good absorptive surface. It's probably a better absorptive surface than the skin. But if she's having penetrative intercourse, it lingers in the vagina. How do we know that? We had a 38-year-old woman in premature menopause. If I get too detailed here, you please interrupt me.
Kim Vopni (43:03.037)
No, keep going.
Daved Rosensweet M.D. (43:05.694)
She really loved her husband and they had an active intimate life and she developed what happens when you lose your estrogen you get vaginal atrophy. She was having pain in intercourse, extremely common. So what we did is we did our standard bias for the arms.
Kim Vopni (43:18.675)
Mm-hmm.
Daved Rosensweet M.D. (43:27.502)
forearms to bring her general body level up, but rather waiting till that eventually repaired the vagina, which would go a long way to doing so, just getting her general body level of estrogen up. We had her for a couple months apply some intravaginally, because that accelerated the restoration of the vaginal mucosa. So at about the three month mark when she said, I found my doses of miracle, I feel great.
Kim Vopni (43:28.307)
Mm-hmm.
Kim Vopni (43:36.658)
Mm-hmm.
Kim Vopni (43:50.205)
Mm-hmm.
Daved Rosensweet M.D. (43:57.39)
And I said, well, great, now's the time we do a 24 hour urine hormone test on you.
And she said, don't you think I should stop the intravaginal estrogen before collecting the urine? Won't the urine collect what I've got in the vagina, which doesn't represent what's in my body? Scientific bent that she had. And I went, oh yeah, that's right. That's a good idea. And I called the lab and asked how long should she omit her intravaginal? And the laboratory director who was brilliant said 48 hours.
Kim Vopni (44:12.999)
Mm-hmm. Mm-hmm.
Daved Rosensweet M.D. (44:34.446)
And she being the scientist that she is, she's elected 60 hours. And there was a tremendous amount of esterol contaminating the urine. The vagina had held on to that. It was still not fully absorbed from the vagina. So it interferes with the 24 hour urine hormone test. That's one thing, intravaginal. If you're having penetrative intercourse, you're passing that on to your partner there.
Kim Vopni (44:54.867)
Mm-hmm. Mm-hmm.
Daved Rosensweet M.D. (45:03.822)
So, and I say why bother? Because yeah, if there is vaginal atrophy in the beginning, you can do intravaginal and just time it in of course for a couple of days later or something. And we often do that when the dryness is really a challenge. But most of the time it's handled by just applying it to your forearm.
Kim Vopni (45:04.093)
So.
Kim Vopni (45:16.285)
Mm-hmm.
Kim Vopni (45:29.523)
Okay, so that was one of the questions I had for you because I'm on the vaginal estrogen train and I very much promote it and do say away from intercourse. it's ideally just before you go to bed. I mean, I'm making an assumption here. I don't know how many women in my community are having daily.
insert of sex with their partner. So potentially there are multiple days in between, but keeping it away from the act of insert of sex with a male partner. But I haven't
Daved Rosensweet M.D. (46:06.456)
But what we saw with this young woman is it was 60 hours, it was still there abundantly. So that's.
Kim Vopni (46:11.601)
Yeah, yeah. So have you seen like I because the the argument I hear is well, it's not being absorbed systemically, but you're saying it's hanging out in the vagina. So it's not going to.
Daved Rosensweet M.D. (46:26.124)
No, no, it is being absorbed systemically. yes, definitely. And beautifully. And that's a great thing. Vaginal application will absorb. But I say why do that when it also absorbs beautifully from the skin?
Kim Vopni (46:29.563)
It is, okay.
Kim Vopni (46:35.047)
the vaginal estrogen.
Kim Vopni (46:44.883)
I haven't seen, well, I don't treat people, but I haven't heard people tell me that just the systemic estrogen being enough for some people. And so is there...
Daved Rosensweet M.D. (46:57.176)
sooner or later it is. But to jump start the healing, which is very important, we do recommend a month or two, like I used to prescribe the bias for the forearm, and I would give an 80 gram tube with a tampon-like insertor of Estriol.
Kim Vopni (46:59.291)
It is, okay, so it's about the...
Yep.
Kim Vopni (47:18.493)
Mm-hmm.
Daved Rosensweet M.D. (47:20.206)
for a woman to use for the first couple months. And I never had to refill that tube. Because at a certain point her vagina had healed to the point that the systemic estrogen sustained the health of the vagina.
Kim Vopni (47:23.048)
Mm-hmm.
Kim Vopni (47:37.031)
Right.
Daved Rosensweet M.D. (47:38.574)
I mean think about it, your ovaries are putting out, a young woman's ovaries are putting hormones systemically, they're not putting them intra-vaginally. And it's very healthy.
Kim Vopni (47:45.428)
Yeah, yeah, that's a good point. And in the vagina, as I understand, there are there are receptors, alpha, beta receptors, estradiol receptors. So most vaginal estrogen formulations of the standardized, so FDA Health Canada would be estradiol based. But I think there's benefit of having estradiol, which is,
you're talking about Biesna, you are talking about it systemically. So perhaps the systemic Estriol is something that's also helping the vagina more so than just Estradil. Would you say that's true?
Daved Rosensweet M.D. (48:27.342)
I don't know. I only know working with biased. And you know, although I've never written a prescription for Premarin, women who are on oral Premarin, they did so much better than the women who didn't. And the main thing they were missing was the testosterone. So all these hormones, given reasonably, they do a good job. And we're working on Canada.
Kim Vopni (48:32.593)
Yeah, yeah.
Kim Vopni (48:45.747)
Mm.
Kim Vopni (48:52.082)
Right.
Daved Rosensweet M.D. (48:55.022)
And we have a pharmacist in Toronto that's dispensing in our organic well. Yeah. Yeah. The way he ships to all the provinces. Yeah.
Kim Vopni (48:59.462)
really? amazing. Okay I'm in Vancouver so I'll find somebody here.
Kim Vopni (49:07.626)
interesting. Can you share the name?
Daved Rosensweet M.D. (49:10.818)
Yeah, I can. If you'll, you have my email address and email Katie and we'll get you the name. And any, any Canadian licensed physician or nurse practitioner can prescribe through this pharmacy. One of our partners lives in Kelowna, BC. So we had to give them hormones and my nieces are all living in Toronto and Vancouver. So they're all very, we to get this done.
Kim Vopni (49:14.151)
Yes.
Kim Vopni (49:17.509)
Okay, that would be great.
Kim Vopni (49:24.955)
Okay.
Yep. Yep.
Kim Vopni (49:37.87)
interesting. Okay, that's good to know. Okay, we're I've kept you way over time, but I just kind of want to wrap things up with you were you were heading into oral progesterone. And then I just want to ask the one question of why why have you always been biased as like the two together as opposed to just estriol or just estradiol?
Daved Rosensweet M.D. (50:05.462)
It came from a study that was done in the late 1960s. There was an oncologist at the University of Nebraska who wondered if hormones had anything to do with women developing breast cancer. And he did 24-hour urines because they were occurring back then. And he learned that young women had more esterol than they had the sum of estradiol plus estrone.
Kim Vopni (50:33.959)
Hm. Hm hm.
Daved Rosensweet M.D. (50:34.562)
He did the study and he saw women with breast cancer very often had less Estrel by quite a bit than they had Estradilin and Estrone. And he proposed that Estrel could be beneficial. And this was picked up by Dr. Jonathan Wright, who was just South of you in Seattle. And he wrote about it and he encouraged his company pharmacist to get to start with biased.
Kim Vopni (50:55.88)
Mm-hmm.
Daved Rosensweet M.D. (51:05.261)
And to replicate a young woman's picture, copying nature, as Dr. Wright always used to say, it took an 80 % estriol and 20 % estradiol. And in the 1990s, the estrogen receptor sites were discovered. And there's two major ones. There's the proliferative one.
Kim Vopni (51:08.872)
Mm-hmm.
Kim Vopni (51:13.106)
Mm-hmm.
Daved Rosensweet M.D. (51:35.278)
estrogen receptor site alpha that when it's stimulated you get proliferation, get proliferation of a uterine lining, you get growth, you get preparation every single menstrual cycle for breastfeeding. Women's breasts get fuller, they're getting more cells, they're getting more glandular cells there as the beginning of possibly getting pregnant. If they don't get pregnant everything disappears, it's a deproliferation.
Women can feel their breasts get smaller somewhere in the course of their cycle. They've lost cells and the proliferation is primarily inspired through the interaction of hormones with estrogen receptor site alpha and the main Interactor with that is estradiol
And the deproliferation is guided by, inspired by interaction with estrogen receptor site beta. And the main inspiration for beta is estero.
I repeated this study in 2010. We've prepared it for publication actually. Same thing, have just a much, young healthy women scrupulously identified 18 to 29 have just as much Estriol as they have the sum of Estrone and Estradil. So I figured copy nature and that receptor site information, that was very impressive. So really trying to do the healthiest thing possible.
Kim Vopni (53:09.16)
Mm-hmm.
Daved Rosensweet M.D. (53:09.804)
Do what nature said up there.
Kim Vopni (53:12.805)
If I think of the bone research, most of that is, and most of the delivery is suggesting estradiol be the most protective for bones. Does estradiol have protective effect for bones as well?
Daved Rosensweet M.D. (53:27.638)
Is that true? Well, you're getting estradiol in biased. In fact, the potency of the estradiol that's in there is more potent than the estriol that's in there. Even though there's more estriol, the potency is there. But there's estrogen receptor site betas in bone and brain. They're everywhere.
Kim Vopni (53:34.311)
Yeah. Yeah.
Kim Vopni (53:41.607)
Hmm. Mm-hmm. Mm-hmm.
Daved Rosensweet M.D. (53:52.302)
So we just favor copying nature we really respect. And I spelled this out in a free book that you could give to your audience. It's Happy Healthy Hormones. You could give them the PDF copy of it. Katie can give you a link to it. And I describe this in detail while we favor bias.
Kim Vopni (54:09.605)
Mm-hmm. Yeah, that would be great. Thank you. Any final things you want to wrap up? We're going to provide people with that book. Where can people find you and learn more? And one, I guess more for people looking for somebody like you. So they don't live in your area. How do they find a good practitioner? Do you train people? And yeah, OK.
Daved Rosensweet M.D. (54:33.826)
Yeah. It's the main way I spend my professional day is training and mentoring physicians and nurse practitioners. And we have them in many States, all over the United States. And we even have a new thing where we've got 50 state license telemedicine people. Yeah. And we're working on Canada. desperately need a provider in Canada. We just need one, you know, just for starters.
Kim Vopni (54:41.659)
Okay, thank you. Amazing.
Kim Vopni (54:50.957)
wow.
Kim Vopni (54:55.293)
Good luck. Yeah.
Hehe.
Daved Rosensweet M.D. (55:02.86)
care greatly about Canada. It saved my brother during the Vietnam War. He lives in Canada now to this day and he evaded the draft in 1968.
Kim Vopni (55:04.391)
Mm-hmm. Mm-hmm. wow.
Kim Vopni (55:12.434)
Yeah.
Kim Vopni (55:15.973)
Wow. So can they find people on your website? Okay.
Daved Rosensweet M.D. (55:20.022)
Yeah, well they can contact Katie at iobim.org, iobim.org, then go to our website, which is bright.live, v-r-i-t-e dot live, L-I-V-E.
Kim Vopni (55:26.098)
Mm-hmm.
Kim Vopni (55:37.895)
Perfect. Amazing.
Daved Rosensweet M.D. (55:38.776)
Yeah. And in the book, you, if you contact Katie and you get a link to the book, there's our contact information is there. And for women who are not finding, you know, another way to do it is you can go to your local compounding pharmacist. There's 7,500 of them in the United States. And I suggest that the woman actually walk into the pharmacist.
Kim Vopni (55:45.863)
Perfect.
Kim Vopni (55:58.151)
Mm-hmm.
Daved Rosensweet M.D. (56:03.566)
because they're busy people, but if they see an actual patient, they'll walk, they'll, they'll be delighted to talk to you rather than trying to do it on the phone and say, you're prescribing to women all over this province here. Who do you think is the best provider? Who, who do you think knows the most? Cause they do know who knows the most is they're dealing with their prescriptions and they care a lot about it. they, so that's one great resource or ask your friends.
Kim Vopni (56:09.009)
Mm-hmm. Right.
Kim Vopni (56:17.159)
He was the practitioner.
Kim Vopni (56:22.833)
Yeah. Yeah.
Kim Vopni (56:33.617)
Yeah, that's perfect.
Daved Rosensweet M.D. (56:33.934)
There's a lot of women like you're identifiable as you're on hormones. I know that you didn't have to tell me you're on hormones So go out and spot the women that look really good In their 60s and 50s and ask them. How'd you get these? How'd you get these? Because the networking is also a great resource
Kim Vopni (56:46.611)
Yeah.
Yep. Yeah.
Kim Vopni (56:59.429)
Yeah, yeah. This was such a fascinating conversation. I so appreciate the work that you have done, the pioneering work and also that you are still continuing to train other people because it is so needed. And I really, really appreciate you sharing your knowledge with us today. Thank you so much.
Daved Rosensweet M.D. (57:17.314)
And it was an honor to do this with you. Together, it's a team sport and you're getting this information out there is how we do it. We're doing it together.
Kim Vopni (57:21.939)
Yeah.
Kim Vopni (57:27.059)
Yeah, yeah, yeah. And now everybody listening can go and tell others and so on and so on.
