Key Timestamps

00:41 - Does Dr R recommend any solid alternatives to testosterone replacement therapy and/or DHEA supplementation when a perimenopausal woman has side effects? I have extremely low levels of both, but get agitated, irritable, greasy skin, and acne when I try to supplement with a very low dose of TRT cream or DHEA cream. I haven’t pushed past 2 weeks, so maybe I should stick it out? Thank you so much! 

06:47 - Dr. R provides the standard ranges he uses for testosterone in women 1.6 mg to 8.8 mg (or more)

7:51 - Dr. R talks about the pitfalls of testosterone pellets

11:45 - Can elevated DHT be a reason for “androgenic” symptoms when using testosterone replacement?

14:56 - What’s the best way to test DHT?

17:34 - Dr. addresses the order of declining hormones and why he almost never starts a woman on testosterone before starting estrogen

20:35 - Why do so many providers tell women they cannot have estrogen until they no longer have a period?

25:12 - Any specific risks in using sublingual Bi-est and testosterone vs topical? (Dr. uses the analogy of nitroglycerin tabs and rapid absorption)

33:10 - Dr. R reminds us that the reason for such a variety of practice approaches is the lack of specialization among providers

34:51 - When do symptoms indicate it’s time for vaginal estrogen? If there are no symptoms, when is the ideal time to start? Are there certain brands that are better than others?

39:38 - Dr. R reminds women using vaginal estrogen that if they are having intercourse, it can be transferred to their partner

45:53 - Why 24-hour urine testing is essential in women on HRT

48:50 - Can you explain Bi-Est vs Estradiol potency?  Is there an apples-to-apples comparison or a simple way for women to figure this out? ( I get this question about the patch, too ~ in terms of “What is equivalent dosing?”).

58: 55 - Dr. explains potency in “math” terms and shares some approximate equivalents (the patch to Bi-Est, etc).

// Notes about potency of Bi-Est compared to estradiol alone

A Bi-est 80:20 30 mg/ml preparation is equal to about 9.0 mg estradiol equivalent (mgeeq)  (80% of it is estriol and 20% estradiol, so it is less potent than estradiol 30 mg/ml).

Generally, with potency, we want 0.8 mg estradiol equivalent (mgeeq) and at the high end 4.8 mg estradiol equivalent (mgeeq)  (but could be higher depending on the woman) ~ average is 2.8 mg estradiol equivalent (mgeeq) 

// The patch conversion to Bi-est is not exact, but approximately:

0.025 mg patch = 0.8 mg estradiol equivalent (mgeeq) 

0.05 mg patch = 1.7 mg estradiol equivalent (mgeeq) 

0.1 mg patch= 3.4 mg estradiol equivalent (mgeeq) 

// About Dr. Rosensweet, MD

Dr. Rosensweet’s website:

https://www.davedrosensweetmd.com/

Institute of Bioidentical Medicine (IOBIM):

https://iobim.org/