Nelson Vergel
Founder, ExcelMale.com
Transcript:
Hello, everybody, Nelson Vergel, here founder of ExcelMale.com and DiscountedLabs.com. I'm very honored today to have, Dr. Rosensweet. He's been in the field for 50+ years. I don't know how you look that young doctor. He has been treating women, postmenopausal, premenopausal women for a long time since 1971. So, you've been through all kinds of changes in the field and obviously enough time to learn things even by trial and error. So, a very high honor, thank you for accepting to be interviewed. Let me just explain to everybody why two men are speaking about women and HRT, and hormonal treatments and all that. That's the first question I get sometimes.
And the fact is obviously we're men, and my website is ExcelMale, which is basically male oriented, and it's been around for 11 years or so. But many of the men on my site who get hormonal treatment, testosterone, thyroid, et cetera, kept asking me Nelson, I feel much better on my treatment obviously, but I need to help my lady and, is there any information out there? When are you going to start reaching out to doctors in that field? So that's why we're here. I've been looking for such doctor for a while, Dr. Rosensweet, has been kind enough to agree to maybe do a series of these videos. Not only for my guys that are really, really interested in trying to get some information to their ladies who are usually busy taking care of entire family or kids and all that.
So, thank you so much. Dr. Rosensweet, has been obvious, like I said, a doctor for 52 years and in holistic practice since 1971. He's got two websites for those of you that want to contact him. One for physicians, he's doing some trainings for physicians who are interested in the HRT field and the website for that is menopausemethod.com, menopausemethod.com, and one for patients that is actually brand new, kind of revamped and fancy and beautiful, with a lot of training also videos is called, iwonderdoctor.com. That's a pretty smart, I wonder doctor, iwonderdoctor.com. So, I'm going to stop here, I'm going to just let you doctor speak a little bit about your background and what drives you to do this for so long. Welcome.
Dr. Rosensweet:
Thank you, Nelson. And I just like to pause and say, I'm here for a special reason, because every so often a being comes along where I feel a special alignment and you are one of those people.
Nelson Vergel:
Oh, thank you.
Dr. Rosensweet:
So, it's an honor to be here too and all that you've accomplished in this world. Oh, my God.
Nelson Vergel:
Thank you.
Dr. Rosensweet:
And how did I get here? I have always felt like my career has been divinely guided and it has many different elements to it. And I started out delivering babies at home and then wanting to write about health. And then as my patients got older, the women who I was delivering, or I was part of the delivery, the women deliver the babies, and women became of menopausal age. And so, I never really planned it out, but right out of the gate, I started to see that it could make such an enormous difference, that here you have these empowered women who are living dynamic lives and peaking in their own intelligence and ability to affect the world and they fall off a cliff, so many of them.
Dr. Rosensweet:
They lose their energy, they lose their sleep, they lose their libido, their vaginas, their bladders. And I saw if you could restore hormones, the most powerful biochemicals in our body, you could make such a difference. And so that's really, if there was any rationale that really was interesting to me because people with chronic illness, it's going to be a slow go. And it can be so dependent on what they choose day after day or not so much this. So anyway, I'm here.
Nelson Vergel:
Yeah. And the thing is that most doctors don't learn much about this in school, even endocrinology, or right? So that's that, we're still struggling, especially after all the stigma associated with WHI study, which we're trying to obviously clarify in the past few years. But it is... I've seen on like and the male world where obviously testosterone is becoming a lot stronger when it comes to physician education. I see, I feel it, I see it in my female friends, in my family, in my... Even guys that I talk to, there's a lot of struggle and a lot of pain associated with the fact that they can access treatment or even an assessment or a doctor that is willing to treat them holistically.
Nelson Vergel:
So, I do have to say the challenges are there and you obviously, you're a pioneer. And hopefully with your training program for physicians, you can make a dent in this struggling a field that changes people's lives. So why don't we start first with general aspects? I mean, we're only going to be speaking for 30 minutes today. We're going to keep this short, so we obviously don't want to ramble, but when a woman... What usually... What is typical patient, female patient that reaches out to you and how do they do that?
Dr. Rosensweet:
Well, for many of them they've noticed very dramatic changes. Like for one thing, they've noticed changes they can't sleep, they're waking up in the middle of the night, their mind is racing and they're awake for a couple hours for reasons. And you lose a couple of nights sleep and it really captures your attention. Or they've been careful about their health, their diet, their exercise, and all of a sudden, they're gaining weight. And they cannot get it off and it really bothers them, they have mood issues, they have libido issues, cognitive issues. These are all strong symptoms. 75% of women who go into menopause have strong symptoms. 25% don't have symptoms, they wonder what's wrong with everyone else. They still are having the deep underlying problems of loss of bone, loss of muscles, loss of vagina, loss of bladder, canes, walkers, wheelchairs, assisted living, they're still having the same problems.
Nelson Vergel:
So, when you say, I'm sorry, I'm going to have to specify, loss of vagina. Meaning vaginal dryness, when you say loss of vagina, you can be more specific.
Dr. Rosensweet:
Thank you. The health of the vaginal tissue is very dependent on adequate levels of estrogen. And when a woman goes into menopause and she's not having periods, her estrogen is tanked. And so, the vagina starts drying up and getting very thin and frail, and that can irritate the opening to the bladder, and lead to chronic bladder infections or even cough incontinence, incontinence loss of urine. And any woman who still has an active sexual life and is interested in it, is very difficult. Lubrication will work for a little while, but that dry vagina becomes very painful to intercourse. So, relationships get affected, love of oneself and love of one's passion and one spouse. That's what I meant, I'm sorry, that was an over dramatic statement.
Nelson Vergel:
Oh no, it's all right. It's just one more word to describe it. So, when they reach out to you, what is the next step? What is the assessment? What kind of beyond a physical exam and even testing or not testing hormone levels?
Dr. Rosensweet:
Well, we do everything these days and I have for the last 10 years by telemedicine. They still retain a relationship with a gynecologist or their family doctor to do annual exams and to handle physical needs. But all the menopause can easily, beautifully be practiced by telemedicine. It took me a long time to figure it out, but it does. And the very first thing they meet up with is a very extensive questionnaire that I've designed myself over the years. And we spend the first visitor's two hours. We spend a great deal of time first of all learning about the woman because women are individual and if you don't catch it, if you don't get their individual needs and preferences, and if you don't dive in, [inaudible 00:08:48] know their medical history. Well, that's my tradition, we dive way into understanding them.
Dr. Rosensweet:
We do a certain of blood tests for thyroid and for this thing called sex hormone binding globulin, but it does not help. In fact, it hurts to test a woman in perimenopause or menopause to test them for hormones. Interesting statement, but you're going to get inaccurate results, I've learned this the hard way. When a woman's ovary function starts declining, her brain and pituitary gland says, wait a minute, you can't let these ovaries go. And it puts out a stimulating hormone at higher levels than it ever did. But it can't keep it up so the levels decline, but then it puts out another, stimulate, fall, stimulate, fall. So, you could test someone on a day where they were stimulated and it could look like they had excessive levels of hormones. And yet they were having hot flashes every night, which tells me they're really low.
Dr. Rosensweet:
There's no value in testing a woman in the perimenopause or menopause. We test 100% of the women once we go through a process to determine what their optimal dose is. Then we test their hormone levels absolutely because I've been very rigorous to go into the medical literature and define what's too little and what's too much. We need a certain amount of estrogen to do the things that a woman's body needs, but we don't want too much, or will overstimulate breast glandular tissue, for example, and put a woman at risk for that. So, we really have an optimal zone that we aim for, but there's no use testing them. In the beginning, you test the menopausal woman, you learn her hormones are low. Oh, great, I got to spend $280 in my hormones as well. I already knew that.
Dr. Rosensweet:
So that's part of the assessment, and then we start them off on a program to... They usually have significant symptoms, so we start them on low doses and we gradually increase those doses and watch those symptoms go away, and they feel better. And then sometimes in a rather, anywhere from one to three months, they feel really good and they're very grateful. And it's that point we test 100% of the women with the 24-hour urine hormone test. And interestingly enough, even though they feel better, that's not reliable. 50% of the women by my own study who say they feel good, are when dosage is too low to protect their bodies over the long run. And 25% are when dosage is too high to put them at risk for breast glandular cell proliferation. That means cellular division, that means mitosis. We don't want any mitosis happening in a 50-year-old man or woman. No more mitosis of that type.
Nelson Vergel:
Yeah. So, you basically go by symptoms for the first what? Few weeks then, to adjust any dosages of estrogen. And you're starting usually with a combination of estrogen and progesterone is that how it goes?
Dr. Rosensweet:
Well, we do them independently.
Nelson Vergel:
Mm-hmm (affirmative).
Dr. Rosensweet:
You start out with a special estrogen called bias and a progesterone in bottles, in organic oils. You start with those two, although sometimes I'll start with four. When a woman has obvious muscle loss, loss of libido, we'll start with a steady dose of testosterone and DHEA because I've tested some thousands of women, I can tell you, their testosterone and DHEA is too low. They may need it as much as we men need testosterone. So, I start them with a low steady dose of testosterone, and then we'll have them start low on the bias and progesterone and gradually increase until they get, for example, oh, my hot flashes are not as bad. Oh, my mood is better, I'm not depressed, I'm not anxious.
Nelson Vergel:
And that titration can take anywhere from what? Two months, three months?
Dr. Rosensweet:
Some women start feeling this as early as a week into it. Some of them it can take up to four months, usually two to three months just like you said, is a fairly average, their highest hormone levels were when they were 20 and they've been declining ever since. And then they really declined at menopause so the receptor sites have gone to sleep, we go gradual because if you go faster, you make mistakes.
Nelson Vergel:
Yeah. And how about this notion from, I guess, other doctors, because I just read your book and by the way, I didn't mention your book, which is free for download. That was very generous of you by the way, and it is on the... I have it on my... By the way guys, I have it... Or to ladies, I'm sorry, I haven't mentioned a very important resource, which is my Facebook group for women called Women's Health and HRT, just keyword it and search it on the Facebook, Women's Health and HRT. And Dr. Rosensweet, has a free book called Happy Healthy Hormones, over 200 pages. I read it this week, oh, my God, so many details. I mean, I'm an engineer and I thought I was pretty good with at least male hormones. And I have to say, it's pretty amazing that you're being so generous in giving this work for free for a download.
Nelson Vergel:
So, it's called Happy Healthy Hormones: How to Thrive in Menopause. You can download it from menopausemethod.com or you can join my Women's Health and HRT group on Facebook. And I recommend it even for those of you that may not be too much into reading medical stuff, because you do give a lot of good details here on titration, all that. I would say any woman that has the time to glance through this work that you have put together, at least you will get educated to have a pretty, a good, educated discussion with your doctor. And especially if your doctor is Dr. Rosensweet.
Nelson Vergel:
So, let's continue, I'm so sorry, just have to do that before I forget and before people click away. So, I was going to ask that question about youthful hormone levels and in the male world obviously, that's a concept that is very popular, bring in your testosterone back to youthful hormone levels. So, I've read in your book that for menopausal women, you are not really too keen to do that. Can you explain?
Dr. Rosensweet:
Yes. For one thing, for all the things that a woman really wants, she does not need to return to her 20s. She does not need those levels. And the issue is this, that if at a certain level of estrogen, you start reforming the endometrial lining and you may continue to menstruate, and at a certain level of estrogen youthful levels, this will happen. You do what a woman does every single cycle. She prepares for breastfeeding, every single menstrual cycle. She builds new cells, new breast glandular cells through cell division. If she gets pregnant, she continues to get breast enlargement in preparation for lactation. If she does not get pregnant, those cells are taken away by a process called apoptosis. And I feel it's risky to put a 50-year-old woman in general, through monthly mitosis and cell division to get breast glandular cells to proliferate.
Dr. Rosensweet:
And that's what we're at risk about and this has been written about in the medical literature. Plus, she doesn't need that much, that's the interesting thing. If a young woman, the range for what young women like is right, this would be the lowest of the young women, this would be the highest of the young women, this would include all young women who are regularly menstruating. Menopausal women need this much just below that range. And I've defined that out of the medical literature, because there's been medical studies that have said, well, how much does it take to protect the vagina? How much does it take to prevent bone loss? Now, some women do need a little more, it's rare, but there are some women who've lost cognitive function that it's important that we give a trial of robust estrogen doses. So, you never say never, this whole field is all about individualization.
Nelson Vergel:
Yeah. And that's a... I'm glad to hear that because some cookie cutter does not work, cookie cutter mythology that I see out there not only for men, but also for women, obviously we're all different in our way that we respond. Also, wanted to talk about something else that caught my eye because I've been reading a lot about HRT in women for the past five years, trying to make some sense of it. Since I get so many questions on my male side, the oil-based formulations of hormones compared to just the cream based or even alcohol gel base or even oral basis.
Nelson Vergel:
That was also something that struck me as different in your approach. Can you tell us a little bit more about the oil-based formulations? And why even though there is suspension that need to be shaken up and used twice a day by droplets, which concerns me, concerns me about what we call adherence and compliance long-term. Because all of us men we have to inject testosterone if maybe twice a week, once a week, and still, that could lead to what we call needle fatigue, or even long-term adherence and we call it adherence issues, where people just get tired of doing it every day. And we are reminded when we stop, why we used to do it all the time because we start feeling bad again. But anyways, the oil-based formulations a little bit on that please.
Dr. Rosensweet:
Well, just one side, I did put in the chat the actual link where people can download the book for free. And I did send you an email right now about with the link.
Nelson Vergel:
Yeah. menopausemethod.com/book.
Dr. Rosensweet:
Yes.
Nelson Vergel:
Thank you.
Dr. Rosensweet:
Well, this was by accident. 25 years ago, I started treating women and tenured and 15 years ago, the pharmacy sent a woman's prescription to my office by mistake and I had never seen a hormone jar. I was fascinated then I opened up the jar of estrogen and out came this strong odor. And I wanted to know what that odor was. And just as inside, estrogen and testosterone, it's imperative for women. For safety to apply estrogen and testosterone to the skin, for example, there's no men out there taking oral testosterone nor is there any oral testosterone anymore because it's dangerous for the liver. And estrogen has its own problems when taken orally like women who took the birth control pill, a certain number of them got thrombophlebitis and pulmonary embolus clots in the veins of their legs and their lungs. There are reasons why you take estrogen topically rather than orally.
Dr. Rosensweet:
And so, I opened up the jar, this odor is very strong and I investigated what is that? And I learned that number one, hormones are very poorly soluble, even in strong solvents and it takes really strong solvents to get them into solution. And you want them in solution if you're going to deliver the exact dose every time. And so, it turns out that in a jar or a topic like wherever people are using 99 plus percent is actually the solvent, and less than 1% is the hormone for women. And that concerned me because I did the math and I was asking women to apply a quart of this stuff every year for the rest of their life.
Dr. Rosensweet:
And meanwhile, I'm a holistic doctor and I'm asking them to detoxify and get rid of all their toxins. And I'm asking them to apply toxins to their skin. So, I've been an organic guy, all my adult life. And my son and I went and invented, we patented in organic oil mix. And yes, you do have to shake the bottle that much, but we've tested it and it works perfectly. And we deliver it in drops to the skin and its certified organic oils mix, rather than solvents that are potentially toxic. That's why we did that.
Nelson Vergel:
But you are not opposed to the cream based compounded cream [inaudible 00:21:51].
Dr. Rosensweet:
There's so much better than other options. And yet at the same time, I'm always looking for, what's the healthiest thing I can do? And what's the healthiest thing I can do for my patients? That does matter to me, I've dealt with a lot of toxicity. We get ill for a lot of reasons and there's a lot of moving parts and one of them is toxicity and I know that. I've asked many, many patients to detoxify and clean up their houses of everything that is obnoxious, that could hurt them, that they could breathe or rub on their skin or wash their clothes with because I know the effect. And so, I love what we do and creams and gels are the next best.
Nelson Vergel:
And orally, you do prescribe for instance, DHEA or even progesterone, right?
Dr. Rosensweet:
Well, I always start with the oils and sometimes to get enough progesterone into a woman, we need to do it orally. A lot of women do well just on the topical progesterone, but a lot of women, especially those who are having very significant sleep issues that we cannot abate with the topical, we'll go to oral because oral progesterone is safe. It doesn't cause adverse effects. Yes, I like oral DHEA, but I still prefer the oil, so we do a combination for women of testosterone and DHEA. So, on the same oil and I'm very happy with that. Makes it easier, makes it less expensive. But I do, in the past I definitely prescribe primarily oral DHEA, I take oral DHEA.
Nelson Vergel:
You as a man, obviously. And so, tell me, is there any chance, because I see that in the testosterone world, where most guys probably feel much better once they normalize or increase their testosterone levels from being low, but some don't feel that great. They actually feel worse. Any women out there you have seen where HRT just does not work? Any of those rare cases maybe?
Dr. Rosensweet:
Well, yes or before I'll conclude that it won't work, I really like to investigate as closely as I can because there's reasons why things don't work. And sometimes if you just put your shoulder to the wheel and keep on trying to figure it out, we figure it out. There's been two cases over 25 years, that I was not able to solve. I wanted more time, but they didn't want more time. They wanted to go on their way.
Nelson Vergel:
Yeah, that's a problem.
Dr. Rosensweet:
But there's always reasons. Sometimes those reasons bleed into life. I mean, I'll give you an example, as a woman feels really bad and part of why she feels really bad is her marriage is falling apart, and then there's this real trouble there. And we go to make them feel better with hormones, but nature doesn't allow it. Nature does not want to take away a woman feeling bad because the purpose of feeling bad is have the patient ask, "What's going on here?" And the problem is you got to come up with the real answer and with some of these issues that come up around midlife, it's not just, I'm low in hormones. And sometimes you solve those deeper issues and all of a sudden, the hormones work beautifully. So, nature is stronger than our better living through biochemistry.
Nelson Vergel:
Yes, I completely agree, it's almost like the white elephant, the elephant in the room, in my world where guys are chasing after their numbers, their blood values testosterone. They blame everything on estradiol, which obviously men need estradiol also. Everything on estradiol and they never answered questions about, well, how's your life at home or at work? How's your stress level? How do you sleep? Whatever, so everybody is chasing their numbers instead of really looking seriously at the factors in their lives that are depleting them of energy, of libido, of cognitive function, which obviously is... So, I see it every day. It's very frustrating when you're trying to help somebody, but they don't want to see, they don't want to deal with that part of... Especially in the male world, we don't want to deal with what's obvious and we want a hormone to change our life, and our positive attitude and be starts and take care of everybody and do the right thing.
Nelson Vergel:
So, it's a hard job, sometimes a lot of babysitting, a lot of... And you're not a psychiatrist or a psychologist, but we have sometimes had to play. One used to help people access the right treatment. Something before we go, I will do a few of these by reading your book, just we can have maybe, I don't know, 100 more of these, some lectures or interviews because there's so much to talk about. But I wanted to talk about... And this concerns me a lot because obviously I have a mother, she's 84. A lot of cognitive issues and issues that are showing up, they're kind of scaring me as mama's boy. The older woman, the three men of the older woman, over 75 let's say cognitive dysfunction, all the usual aging related issues. How do we treat? How do we deal? How do we assess that population?
Dr. Rosensweet:
Never too late. I first started treating my mother-in-law when she was 86. She'd fallen and fractured her hip and her humerus and her clavicle. Three months of rehab because she had gotten weakened muscles. So, I started treating her with hormones including testosterone. And we actually have a video of her sitting on a low soft couch with her arms like this, standing straight up without using her hands many months later. And I also treated my own mother and for a while for stalled, some of the difficult things that were going out for her.
Dr. Rosensweet:
There's special caution with the elderly. They need a special evaluation, especially around coronary artery disease and whether there's possible potential for clots there. But we even went so far as to develop an oil combination that was all in one bottle, because cognitively it's usually the most that they can handle, we put all the hormones in one bottle. I never combine hormones except for testosterone and DHEA for reasons, but in them we put six hormones in there. And they only have to do it once a day and I say, it's never too late. And you'll be surprised, I mean, what happened with my mother-in-law was really dramatic.
Nelson Vergel:
Yeah. I'm excited about that. I just... And this is from my own perspective because I do see a push back, like for instance, geriatrics or the primary care doctor, if you ever mentioned hormones, so how do you get around that? And I know that's a long discussion that we should not probably have today. But when you are about to start treatment on an older woman, that obviously has all the symptoms, especially cognitive. That really, really scares me as a son of a mother that has been very strong, very... Just take-charge kind of person. And obviously there is a discussion at the primary care office or geriatrics so we say, "Hey, my mom is going to start this hormone treatment." There's almost 100% chance that there'll be a pushback that I'm going to have to explain, or even write, I don't know, sign a waiver or something. Can you... I know that's an emotional kind of a tricky question to ask somebody like you, but how do you deal with that?
Dr. Rosensweet:
No, it's a question I deal with all the time. And I think at this time in human history, we have to take a certain amount of this process into our own hands, accept that the primary care doctor serves a very important function, some more than others. The specialists serve a very important function, some more than others, but as far as hormones go, we have to come into our own heart and mind what is the right thing? And do the right thing. And so, like my patients are afraid to go to their gynecologist. They say, "Listen, do whatever you'd like, if the gynecologist would like to talk to me, I'd be honored to do that. It never happens, I never get the call or you don't have to say anything, you can say I have a hormone doctor and they're taking care of it."
Nelson Vergel:
Yeah. Okay.
Dr. Rosensweet:
And you find someone who really cares about hormones, is really knowledgeable about hormones, is really excellent at it and you don't have to have the communication. I refer patients to doctors all the time. I don't need the doctors to communicate to me what they did and what they're doing. I like to see a diagnosis, but if I trust the doctor, I just want them to do their thing. That's their specialty.
Nelson Vergel:
I get it, thanks a lot doctor.
Dr. Rosensweet:
So, 80 years analogy, but it's sort of like this egregious thing called don't ask, don't tell.
Nelson Vergel:
Which I know of very well, but anyways-
Dr. Rosensweet:
Yes, so [inaudible 00:31:29] time, but it was a transitional time.
Nelson Vergel:
Well, and people use it in many aspects of their lives. So, I appreciate your time, we have reached the 30-minute mark, which I wanted to keep it under 30. We will have a few of these hopefully whoever is watching will think it's useful. It's an introductory interview, obviously we didn't get into huge details, more philosophical. So once again if you want to get a hold of Dr. Rosensweet, go to, iwonderdoctor.com. Physicians or even patients can go to menopausemethod.com. The book is there too, /book, download that book it's free. [inaudible 00:32:16] you don't even ask for an email, you just download it.
Nelson Vergel:
And even if you're not detail, great glance through it, because it will give you a lot of perspective on how the doctor actually treats women in his 50 year or so experience. So, we appreciate your doctor, Happy New Year. We'll be talking to you in a few weeks again. I'll be digging for more topics in the Facebook group called Women's Health and HRT. So, find me there, and you [inaudible 00:32:48] well. And thanks a lot for your time doc.
Dr. Rosensweet:
Thank you, Nelson.
Nelson Vergel:
You take care, okay.
