My guest today is Dr. Todd Dorfman, a board certified emergency physician who’s also trained and certified in age management medicine. He founded Cedalion Health to spend more time and resources with his patients. His specialties include customized health programs, supplement programs under physicians’ care, nutritional and fitness guidance, and hormone replacement therapy.
Today, Dr. Dorfman shares common signs and signals that may indicate our hormones are off. That can occur even in our early adult years.
Dr. Dorfman shares his thoughts on approaching our hormone health and which first steps to take when exploring hormone adjustments & treatments. I like Dr. Dorfman’s step-by-step approach to hormone management and being conservative with solutions. We dive deep into the best ways to balance hormones, how stress can wreak havoc on our hormones, and what are some everyday hormone disruptors and estrogen mimickers to watch out for. Enjoy.
Listen to the episode here:
- Hormone Talk [00:03:35]
- Age Management Medicine [00:04:48]
- The Circadian Rhythm and Working Night Shifts [00:09:47]
- Hormonal Health of the Youth [00:15:03]
- Disruptors to Hormonal Health [00:18:24]
- Epigenetics and Cardiovascular Disease [00:23:03]
- Data-Driven Diagnosis [00:26:18]
- Cortisol Formulation and Management [00:31:57]
- Food as a Disruptor [00:38:15]
- Menopause [00:41:36]
- Importance of B12 [00:43:27]
- On Birth Control [00:45:36]
- Hormone Supplementation [00:48:19]
- Relationships of Hormones [00:54:28]
- Estrogen and Cognitive Intelligence [00:57:02]
- Hormone Myths [01:00:13]
- Dairy vs. Non-dairy [01:02:53]
- Struggles in the Daily Lifestyle [01:04:36]
- Rebalance [01:08:03]
- “Falling Off a Hormone Cliff” [01:09:35]
Why Hormonal Health is Important, Signs Your Imbalanced & Natural Tools to Manage with Certified Emergency Physician Dr. Todd Dorfman
“95% of this stuff, my advice would be proper sleep, proper exercise, and proper nutrition. If that’s a three-legged stool, per se, if you have two of those legs, it doesn’t work that well. If you have one leg, it’s a wobbly stool in a way. In those things, the legs are attached. You can’t have terrible sleep and expect to have reasonable exercise results. There are studies that show that for people who have bad sleep, night shift workers are a great example, they tend to have poor diets and tend to put on more percent body fats. The majority of this stuff, if addressed early and if people are given the tools, it’s totally in their grasp to alter their course moving forward.”
“Not enough people are looking. It’s not common for you to go to a doc and get a big hormone panel like I might do because, in the end, it’s not often part of a yearly screening or anything like that. In a lot of ways, it’s incredibly important for health moving forward for longevity and health span. It’s incredibly important for preventing disease and yet not enough people are looking for it.”
My guest is Dr. Todd Dorfman. We’re talking all about hormones. Dr. Dorfman has an interesting background, he’s a board-certified emergency physician who is also trained and certified in age management medicine. He worked for a long time in charge of the emergency medical service in Boulder County and then has since opened up his own practice where he helps people either increase their preventative health. It’s all about that proactive stance, it’s using those three pillars. We hear it all the time, it’s sleep, movement, and food. It’s how this can disrupt or support our hormone system.
What I appreciate about Dr. Dorfman is he has a conservative approach, he’s going to look at your blood work and then talk about your lifestyle first, the things that we’re in control of. Also, maybe some supplements that would support the ways that you’re feeling or want to feel, and then take steps from there. He’s not a guy who’s going to put a bunch of pellets in your glutes and say, “Have a great day.” Also, how we’re also unique.
There might come a time that we need to do something a little more aggressive. He shares what supplements he does like, the best ways to balance your hormone, and what are some of the big hormone disruptors. That’s another thing that’s important. We live in a time when our air, our water, the stress, and all of these things can disrupt our health. What are the things that we are in charge of? Let’s drill down on those, worry about those, and let’s acknowledge that these other things exist. What are you going to do about it? He keeps things simple and thorough. I hope you enjoy the show.
Dr. Dorfman, welcome to the show.
Thank you for having me.
This field that you’re in is some of our audience’s favorite. Whether people are young and thinking, “Maybe I want to be as strong as possible or have children too. I’m trying not to fall off the hormone cliff.” People love to talk about hormones.
There are a couple of contributing factors. The aging population in general and as we get older, we all have hormone imbalances that are addressable but a lot of people tend not to address them until it’s too late. That’s why younger people need to start to think about it earlier because there are several things that we can do through exercise, foods, and natural techniques before it potentially, way down the road, comes to needing to do a medical type of hormone replacement.
Maybe we can progress through age, natural, and then to some of the more intense options that are available. First of all, you studied age management medicine.
Yes. Isn’t that a ridiculous title? Conceptually, what it is and what I tell people is it’s about the concept of healthspan versus lifespan. We want to employ preventative techniques. Whether it be cardiovascular prevention or hormone rebalancing, whether it has to do with mitigating risk factors that you might have genetically, you can’t pick your parents and those things.
It’s about addressing disease processes earlier and not allowing those to affect aging. We don’t want a bunch of ill people sitting around taking a bunch of medicine because I can keep them alive. We want people who are vibrant and enjoying their life. That’s the key to this. That’s what age management medicine means.
Why were you interested in that? You’re ahead and now in the sweet spot. Did something happen to you or a situation that you thought, “This is what I want to go into.”
There are two things, Gabby. One is my traditional training as an emergency physician and trauma physician and I did that for twenty-some years. It became evident early on in my career as we were treating people, for example, with heart attacks who were pretty young in age, and as we were dealing with more and more diabetes complications and obesity complications. All of these things, it became obvious that a lot of these things can be prevented.
[bctt tweet=”I can tell you that year after year and study after study, the best diet is still a diet that is more Mediterranean-ish if you will.”]
Sometimes our healthcare system isn’t set up to perfectly prevent those things. I opened this independent practice and I started as a consultant helping people with difficult medical problems and helping people with disease prevention. Over the years, it morphed into a full-time private practice doing exactly this hormone-type management, tons of preventative cardiovascular strategies, and dealing with difficult disease processes to give people a nice health span to make them feel as good as they can feel with the cards that they are dealt.
I don’t want to oversimplify things but the more I have these conversations, it feels like 80% of the deal is in our hands, it is in lifestyle. Is that consistent when you see people maybe through lifestyle and not just genetics? Obviously, there are epigenetics so I might have stuff in my background but through lifestyle, I have the opportunity to override that or turn those switches off.
Is that pretty consistent with what you see? There’s so much chemistry that it’s almost like once we start on the not-great side of it like a stressful job and not a great lifestyle, it’s almost like our chemistry gets off and then that’s how everything unwinds. People don’t realize that 80%-ish of some of the things that you’re going to see to try to help people either get healthy or feel better is usually back to lifestyle.
That’s 100% true. I was joking a little bit before we came onto the podcast because I reviewed some of the concepts or things that we might talk about and I was joking, I said, “95% of this stuff, my advice would be proper sleep, proper exercise, and proper nutrition. If that’s a three-legged stool, per se, if you have two of those legs, it doesn’t work that well. If you have one leg, it’s a wobbly stool in a way.
In those things, the legs are attached. You can’t have terrible sleep and expect to have reasonable exercise results. There are studies that show that for people who have bad sleep, night shift workers are a great example, they tend to have poor diets and tend to put on more percent body fats. You’re 100% correct. The majority of this stuff, if addressed early and if people are given the tools, it’s in their grasp to alter their course moving forward.
If someone is reading and they do have to work at night, they can’t control that, how do we help them with their circadian rhythm and all of that? What do you do? It’s like, “I’m a fireman and we get called and picked up.” What are the things? It’s obviously doing movement and eating well but how would you approach that? We don’t live in a perfect world so how would someone manage that?
It’s a complicated problem. The real deep down honest answer is that we haven’t found the perfect way to manage that. If you look at studies comparing even lifespan and disease risk in lifetime night shift, third shift workers, versus people that work during the day, people that work at night have significantly lower lifespans and higher disease risks. We haven’t found a perfect way but some of the ways that we can mitigate that risk are the things that we talked about.
You still keep good sleep hygiene even though your sleep is at a different time. You have these hormonal surges that are incredibly dependent upon a set circadian rhythm, a 24-hour clock. There are even studies done on cells in pancreatic cancer, for example. Part of what happens in pancreatic cancer is the cell’s 24-hour circadian rhythm gets thrown out of whack. Whether that’s from cancer or the cause of cancer, I have no idea. The point is there is an effect on all cells in the body with the circadian rhythm.
There are certain supplements that can help with sleep. Things like ashwagandha, melatonin, and magnesium supplements can help with sleep. GABA, which is a receptor-type supplement, can help with relaxation and sleep. It’s all about good sleep because when you sleep, you rebalance your hormones and secret certain hormones like growth hormones only at night. Also, you have a surge of your cortisol in the morning, which helps set your sleep-wake cycle again. Sleep is the key. Anything that we can do to help these people get regular sleep, uninterrupted sleep, we try and do.
You’re the perfect person to ask. I heard that melatonin is made through eyeballs. Is this right?
That’s why looking through light or looking at sunlight in the morning sets the body. Can you tell me the connection now? I need clarity if I’m going to talk about it at a dinner party or something.
Let me tell you about melatonin. Melatonin is secreted from the pineal gland in your brain. It’s not secreted from your eyeballs if that’s what you’re saying.
The eyeball stimulates production, is that right?
Yes, that’s part of the circadian rhythm. If you look at data on sleep and people that sleep well and then you speak to sleep experts, one of the keys to setting this melatonin cycle is with the cortisol cycle, which is also important. First thing in the morning, within the first probably 15 or 20 minutes when you wake up, you have your surge of cortisol.
These studies were done in Norway where there’s no light so they used artificial light to stimulate people versus the group they didn’t stimulate. Studies show that if you can go out right away, whether you have your coffee in your hand or you don’t have your coffee in your hand, that is one of the prime ways to start to reset your circadian 24-hour clock.
That then leads to the secretion of melatonin several hours later, about 10 or 12 hours later. There’s a small secretion of melatonin and then a couple of hours after that is a big secretion of melatonin and that’s how your body naturally sets it. You’re right, it does have to do with the sun but it’s the sun right when you wake up. It’s most important, the first fifteen minutes or so.
Is it safe to say that if we live in a gray area or it’s a winter month, we can still go outside and look toward where the light is and we can at least get some benefit?
Absolutely. You don’t wear your sunglasses or whatever it is. I live in Boulder, Colorado and it has 300-some sunny days a year so I get a lot of sun and it’s usually available. This was even done with artificial lights in some of these Scandinavian countries.
Let’s start with younger people first. Of course, we want to keep it dialed in. They maybe haven’t started a family yet. It never occurs to us. For most of us, things occur to us when we’re not feeling great. When things are running smoothly, what would be a baseline conversation about it? Is it once a year, go in, get your blood work done, and check things out? You probably saw that book, Count Down. There are so many other things now impacting people’s overall hormonal health whether it’s in the foods, the environment, or our stress. We live in a more unnatural way. What would you say to a younger person to stay on top of it?
The first thing I would say is that if you’re talking specifically about hormones as opposed to maybe heart disease, heart disease may start much earlier to have some people who would have some concerns potentially. Maybe even in their late teens or 20s, there may be some signs of heart disease. Hormonal issues or hormonal deficiencies, we call them hormonal imbalances. The reason that’s important is it’s not the total value of each hormone, estrogen, progesterone, testosterone, or whatever, it’s the ratio or the balance between those that are important.
For women, it’s usually a few years around menopause, a few years before menopause, and what we call the perimenopausal period, that’s when they tend to get fluctuations in their hormones that frequently need to be addressed. There is male menopause, which is called andropause as the technical name. It starts to slowly dwindle around age 35-ish to ballpark. It’s a much slower process than women so it dwindles down a little bit from the mid-30s, whereas women have, let’s say, 4, 5, or 6 years where all the hormones go haywire, and then they don’t secrete ’em anymore.
The time to check in is around those times regarding hormones. Maybe one of the best ways to check in is to go through a checklist of what hormone imbalances or deficiencies cause. Frequently, with testosterone, for example, in both men and women, people think about libido, sexual function, muscle endurance, and muscle recovery. Strength overall and fatigue is worsened, for example. Sometimes later into the hormone course, people get what they refer to as night sweats but they can be hot and cold flashes so to speak and it can be during the day or at night. It happens in men too. None of these things are isolated to women.
Insomnia is a big thing. Women can start to develop mood swings and so could men but it’s always blamed on women, I don’t know why. It is a man and a woman thing with hormone imbalance to get mood swings. There’s a checklist of clinical symptoms if you will that you would want to speak to your doctor about if it hits home with any of those things I mentioned.
Maybe we can then go look at some of these disruptors. Also, when we talk about lifestyle, people don’t realize our food, light, and all kinds of things like stress that impact. Maybe what are the things that we can be completely in charge of and be aware of that can disrupt our hormones? Let’s start with food. I have three daughters and it was always that thing of, “How do we give them the foods that, all of a sudden, they’re not going through puberty at 10 and trying to keep things at bay?” Maybe we could start there.
The big picture on foods or let’s call it nutrition at this point, one of the things that are super confusing for my patients and probably for most people is, are any of these different diets or nutritional plans worthwhile or not? I can tell you that year after year and study after study, the best diet is still a diet that is more Mediterranean-ish if you will. It’s not any processed foods or carbohydrates. No fried foods and soft drinks.
You mentioned your daughters, it’s a big deal. In high school, it’s a big deal to drink a lot of diet soft drinks so that they don’t put on weight and all these things are issues. Enriched flour, processed vegetable oil, soy products, or any of those things can alter hormone balance. There are different data on this but organic foods don’t have harmful bovine growth hormones or steroids or antibiotics. The tricky thing about what I’m saying is that it’s probably a little more costly to eat this way. You have to shop at a nice store and buy healthful foods but that’s the key.
As I mentioned the three-legged stool concept, lots of these things are tied together. If your nutrition is poor and then you start to put on percent body fat, for example, that’s another hormone disruptor. The more percent body fat, the more estrogen secretion, and the more it’s out of balance with other hormones. You can see how these things have to go hand in hand.
I always made nothing taboo with the kids because it’s also obnoxious. My husband and I are relatively healthy but we’re not obsessive and it’s also part of our life. I almost created a strategy where it’s like, “In the house, this is what we’re eating. Out in the world, I’m not going to make anything taboo.” You find with most kids, their palate gets used to what their family gives them. When they become teenagers, they love a drive-through but I don’t think it’s not habitual.
I would encourage people that if you can show them a good example, they have a tendency to come back to it. They do weird stuff for a couple of years but I feel like they come back to it the minute they want to have their skin look good or whatever. You mentioned diet soda or all these chips and things with a lot of unusual ingredients. Besides weight, let’s say someone stays slender, this can wreak a little bit of havoc on your microbiome and maybe some inflammation. This too can throw your system out of whack.
You’re right on the mark. Let’s go back. I keep going back to cardiovascular disease. One of the reasons that I keep going back to it is it’s the number one killer of people in the world, heart attacks and strokes. Probably 70% of people succumb to those vascular issues. If you were to speak to a cardiologist or preventative cardiologist, some of the foods that you mentioned would be 100% off the list. French fries are probably number one off the list. Depending on the type of oil they’re in, they can also cause other hormone abnormalities. They cause you to secrete more insulin, which is a hormone. They throw off your gut biome. Your gut biome is tied into several other things.
There are even studies that show it’s tied to Alzheimer’s disease, which is becoming more and more of an issue as we move forward. You’re right, you can set the precedent for your kids and I tried to do that. I have three boys, they’re a little older. They’re all healthful eaters because we were healthful eaters as kids. I didn’t go to school and take away the birthday cake.
That becomes a thing, believe me. Dr. Dorfman, before we move on from it, you mentioned that for young people, even in their teens, the cardiovascular situation could even show up sooner. How does that show up in such a young person? Genetics?
You mentioned the word before, epigenetics. To me, that’s a combination of what genes you were born with. You can’t pick your parents, you have a set of genes, and it all goes from there. If you decide to be a chain smoker and drink alcohol all day and never exercise and eat french fries, you will be a different person than if you eat healthfully, exercise, and start as a teenager with these lifestyle changes as they’re generally referred to. Good sleep habits, good exercise habits, and good nutritional habits, that’s what I’m referring to. You can start those things early on and prevent a tremendous amount of disease moving forward even if your parents and grandparents all have terrible heart disease, for example.
I’m sure you’ve seen this. You have three sons. There’s a time period when they are in adolescence when it’s natural that their clock gets set later, they want to stay up later, and sleep longer. It’s the comfort of knowing where we’re trying to end up. There are these moments in time when our kids will go through these periods and as parents, we go, “What’s wrong with them?” There are parts of that too that are pretty natural.
[bctt tweet=”Think of your hormone system a little bit like an assembly line, you can only produce so many things at a certain time.”]
There are some school districts probably in California also that start the time back a little bit. I don’t know how that is for parents. My kids are past that. Ultimately, that’s the right thing to do. If you look at their sleep-wake cycles in those teenage years and when they’re starting their initial hormone secretions, that’s the time when sleep is even more important. Generally speaking, they don’t like to get up that early and it’s probably more healthy if they don’t but that’s how it rolls.
Our system isn’t set up that way.
Who’s coming to see you? You have the preventative side and then you have people who are not feeling great and they’re dealing with probably some serious issues. Let’s say your patients come in and they’re more on the preventative or increasing health side, they’re being proactive, and maybe they’re at a time with the hormones and they’re starting to pack their bags a little bit or things are changing. You take a look at the three lifestyle things.
Do you know how people get so nutty and obsessive and maybe they’re overtraining and putting a weird amount of stress on their system that way that’s also impacting their health? I’m curious because sometimes when people get a little older and they start to freak out about getting older because it’s strange, I’m there, they maybe go overboard. Have you seen also even where it’s like, “You need to train less.” Let’s go to the sharp end of the sick. Let’s say someone comes in and it’s too intense, what would you say to them?
This ties into your initial question also. The first thing I have to do with something like that is to get some data on them. I do run a big panel and I call it my baseline panel. If you were coming to me as a new patient, I would run my female baseline panel. It looks at a number of data points and a large section of it is hormones, the hormones that are secreted from your brain like a follicle-stimulating hormone. It looks at your thyroid hormone and your cortisol levels, which are from your adrenal gland function.
It looks at your estrogen, progesterone, and testosterone. It looks at your insulin. I’m looking at a number of hormones to pick that section of the lab panel out. I’m also looking at your kidney, liver function, electrolytes, blood counts, all those other things, and lipids. I sit down in my practice behind the scenes and at the same time, you will have filled out a questionnaire and that questionnaire includes, “Are you having any symptoms or not?”
It includes a training schedule and a nutritional or dietary schedule. I say, “What are you putting in your mouth all day long for the next five days?” I sit behind the scenes and I come up with this big analysis and I sit down with the patient and that’s where we start to pick it apart. In Boulder, Colorado, as you probably know, it’s the mecca of people working out.
No one here admits they have any illnesses and everyone is biking, swimming, and running all day long. I have a lot of people that overtrain. Something you might not know, this is a great example and there are studies regarding this, is that endurance athletes have a higher risk of cardiovascular disease. They have higher levels of calcifications. We don’t know if it necessarily leads to more deaths yet but they have more vascular disease.
I’m careful with all my patients even if they come in and say, “There’s someone of your athletic caliber and they are 20 or 30 years older. Trust me, they are working out as hard and they’re trying to feel like they felt when they were 20.” I see that a lot. We have to make adjustments. Sometimes those adjustments are simple lifestyle changes. You sent me your fitness tracker information and your heart rate is not ever going down to a baseline. Your heart rate variation is too high.
I usually get help because there are also a lot of expert training people here. I usually refer them to someone who I trust to help guide them a little bit. I do some preventative cardiovascular testing and I come up with a whole package to say, “How can we most mitigate risk moving forward?” A lot of times, that has to do with a supplement program.
As you mentioned earlier, before I throw prescription medicines at people, frequently, I’m using natural type products, fish oils for hormone imbalance and also for cardiovascular protection. Sometimes I’ll use things like vitamin D3 and vitamin B12. Vitamin D3, by the way, is one of the precursors or ingredients to make estrogen and progesterone. DHEA is another ingredient to make testosterone. I check all of those levels and things and I come up with a plan. We talk about sleep, for sure, and then we keep checking in on the plan and moving forward.
I love that idea. The thing is once people get dialed in, the supplementation, for me, is usually after you get, “Am I sleeping? Am I moving enough? Am I eating better than I’m not?” That’s then when that stuff can support you. That is how I met you. I myself have been taking a brand. I appreciate it, first of all, because when I can take something that has no downside, for me, that’s a nice start.
I met you through a brand called Rebalance. I took the supplement for quite a few months before I worked with them. What I appreciated was if you say to me, “There are these fifteen herbs and they’re going to be great for cortisol management,” I’m not going to be able to pull it. Maybe you could even break down the intention and the goal and the formulations for the morning, the evening, and the sleep.
The Dream Catcher.
What I love about this is that it was created out of a need. The founder’s wife was going through this process, they themselves. Let’s talk about cortisol because people are not sure, it’s like, “I need it low.” No, you want it high in the morning. When you want to go out and kick ass and get it done and do all the hard stuff, you want to do that when that’s high and you’re in the right frame of mind and you’re ready to go. Maybe you could talk about the thinking behind the formulation and the management of cortisol and so how that would impact us hormonally.
I’d be happy to. The Rebalance Health System is a series of three lozenges for lack of a better term, and that’s an important piece right off the bat because the difference in how you give people medicines is important. You can inject, into their muscle, subcutaneous fat, you can give intravenous medicines, you can give pills, of course, and all of these different delivery methods if you will.
We’ve done some studies on the lozenge delivery method and it significantly increases the absorption and maintains the level of the products much better than, in the studies, the leading competitors that we checked. That’s because your stomach acid has a lot to do with absorption. Certain things can’t survive well in your stomach acid. A good example that will hit home with people is vitamin B12. As we get older, it is hard to absorb vitamin B12. You have these hormones in your stomach and with the acid in your stomach, you can’t absorb it.
When you give a lozenge a sublingual B12, it gets the same blood levels as if I was giving you an injection every two weeks or a month. The delivery system is super important. That’s the first thing that went into the Rebalance Health System. Throughout the day, on a 24-hour circadian clock, the design is to lower cortisol levels to appropriate levels thereby allowing other hormones to be secreted properly.
Think of your hormone system a little bit like an assembly line, you can only produce so many things at a certain time. If you’re overproducing one type of hormone and in this case it’s cortisol, your body does not have the opportunity to produce other hormones or produce them in the correct ratios. The Rebalance System starts in the morning, it’s an Energize-type product and it is a combination of several different herbs and natural products which work together to help start to control your cortisol levels throughout the day.
When you wake up in the morning, the first 20 or 15 minutes, you get a huge surge of cortisol and it’s super important. You don’t want to maintain that huge surge of cortisol the whole day, that is not what you want. This Energized product gets you going in the morning and then starts to tamper down the levels throughout the day.
In the late afternoon or early evening, the second product is called Relax, and that further lowers the cortisol levels because you want low cortisol levels by the time you go to sleep. It gives your body a chance to produce more hormones and to rebalance throughout the night. The third lozenge is called Dream Catcher. For obvious reasons, it helps with sleep. The three products in the system, I like to describe them in reverse.
People need to focus more on the sleep part and what happens at night to help rebalance their hormones. If you think about the Dream Catcher as almost the number one product, you take that at night, it helps you sleep, and it helps you maintain sleep. It has things like ashwagandha and melatonin in it that are proven to help with sleep and the appropriate stages of sleep. Your hormones get secreted, growth hormones only at night, other hormones get rebalanced, and then you wake up and you start that process again. That’s what the Rebalance system is about.
That’s a smart way to look at it, which is backing into sleep first and then saying, “How do I back out and do everything right to make that happen?” Don’t have caffeine too late in the day, all the things that we can do to. I have never been a great sleeper and that’s what I have also appreciated about the product, it has helped me wind down and get into that better state easier. I find it helpful and I also appreciate it because I am a believer that if certain things have been around for a long time, there’s probably a reason.
I’m with you on that, you’re right.
These ingredients are old. I appreciate that it was like, “Here it is.” I do drink coffee in the morning so I use the morning one after my coffee, especially if I’m on the go because it is minty. You have to let it happen though.
I want to go back to things that can disrupt our hormones. There are things that are out of our control like the air, the water, the plastics, and it goes on and on, and people get overwhelmed with that. At times, that makes them almost not do anything. If someone was going to come to you and you said, “In the times that you can do the best that you can, where would you say some of the major landmines are?”
Let’s take it from the big picture and move it down a little more microscopically. One of the things that you asked me about before in terms of hormone disruptors is food. Food is a key hormone disruptor, it might increase percent body fat, throws off the microbiome of your gut, and all sorts of other potential problems. We mentioned sleep. These are the big-picture things. Food and sleep are major hormone disruptors. Percent body fat versus lean body mass, a higher percent body fat is a huge hormone disruptor. Those are the things that, from my standpoint, are fixable things, those are things that we can address.
We were talking about the Rebalance System, the studies show that as we control the cortisol, we get a boost in testosterone and we get a boost of estradiol to the point where several women who were having menopausal symptoms have stated that they are not having those anymore. We’re in the process of doing further testing. With a combination of appropriate supplementation, appropriate nutrition, appropriate exercise, and appropriate sleep, we can tick off several of the big hormone-disrupting factors.
You mentioned that there are these other things, there are dioxins in the water and there’s lead, arsenic, BPA, Bisphenol A, and different things that they’re taking and removing. I’m sure there are a bunch more chemicals. Those aren’t the low-hanging fruit. Sometimes you’re exposed to that because of where you live or sometimes where you work. The bottom line is the control of all hormone disruptors, we can do a lot about.
With young people, it’s like saying, “Let’s get in that preventative mode. Maybe get your blood work done, take a look under the hood, and get an indication.” As you get older, are we saying that in 35 or 40, start to get your blood work done once a year to see? There’s also something interesting where if you make a lifestyle change and you see a drastic shift in your health, good or bad, it’s an interesting thing to be able to catch it quickly or continue on if it’s a good change.
Let’s go back 100 years. Do you think menopause was meant to kick your ass the way it seems to be kicking people’s asses now as much? Do you think it was that brutal for people who have a simpler life, harder granted? You weren’t navigating some of the landmines that we have in modern life. With menopause, if we survived that long, do you think it was something you went through more naturally than we are now?
I do. Maybe because 100 years ago, they were tougher and didn’t complain. Who knows? There’s always that component. You hit the nail on the head, which is their options for food back then did not include all of these processed foods and all of these chemicals in our dairy. A lot of what you’re referring to as hormone disruptors were not present, they weren’t available, and it wasn’t an option. They also spent a lot less time sitting behind a desk all day, for example. There was much more manual labor. They had much less obesity.
The average male or female, back then, if you look at their weight, was much slimmer from a body mass index standpoint. That played into it also. Maybe the stress was less. We talked about cortisol before. Emotional stress in addition to physiologic stress like if you get sick, cortisol needs to go up to help you heal. Emotional stress keeps cortisol up all the time. It’s almost like your cortisol system is burning out the rest of you. In that sense, you’re not producing appropriate hormones. They probably had less stress in a lot of ways back then, less to worry about, and it probably was less of an issue. That’s my best guess.
They didn’t have a lot of snacks and 700 types of drinks in the fridge.
You need a separate fridge in the garage for the beverage selection.
Before we move on, I want to ask, do you have a B12 lozenge that you have found that you like and that has high quality and good absorption if people are interested in trying to find one?
Absolutely. B12 is a super important supplement because as we get older, it affects several things. One of the things that it affects is your neurologic system. It can help people with balance issues and it can help people, who are athletic, get older. The second thing I would mention is that almost everyone, I guarantee you, has a low B12 level unless they’re supplementing properly if they’re over the age of 40 because you don’t absorb it well even if you eat beautiful green leafy vegetables and all those things.
The other thing about it is that it’s one of the essential nutrients for hormone balance. B vitamins in general, B6, B12, and biotin are important for hormone balance. They’re also water soluble so you can’t take too much, and you can’t overdose on them. There are a couple of different supplement companies that are well-vetted. There’s one called Douglas Laboratories that has a good sublingual B12. Pure Encapsulations is another one that’s quite good. I only care about if it’s a pure product or not.
I like to give people a few options because they’ll read this and then they’ll go try to look for something and nobody ever knows, like, “Is this good? Is that good?” Thank you for that. Can we go back quickly and talk about birth control? Young women get put on it and a lot of times, they’ll say, “This is going to help your cycle.” The doctors will put them on to help their cycle. Is there any greater disruptor than birth control? What would we do as an alternative if we have a young adult daughter who’s off to the races and has a boyfriend and whatever? It’s a conundrum at that point for a lot of people.
The first thing is to understand that the birth control pills, what you’re talking about, they’re generally hormone pills and most of them are estradiol and progesterone, they’re an estrogen and progesterone combination. Some of them are pure progesterone, there are a few different variations. In general, what they’re doing is creating a ratio of hormones in your body, which is faking your body out as if you’re pregnant, that’s the bottom line. You don’t ovulate and you don’t have any eggs to be fertilized.
There are studies and women are on these for years and years. Most of these are synthetic hormone products. If you’re asking me what I would do if I had a daughter or how I recommended my patients if it’s for birth control purposes, there are probably some better options like IUDs or other types of methods.
[bctt tweet=”It’s not the total value of each hormone, estrogen, progesterone, testosterone, or whatever, it’s the ratio or the balance between those that are important.”]
Hormone methods, in the long run, can tend to cause a problem after 15 or 20 years on hormones and that used to be common. If you’re asking me if would I recommend hormones to regulate a cycle, for example, because it was inconvenient or something and had nothing to do with protection from becoming pregnant, I would a hundred percent stay away from synthetic hormones.
There are natural ways to do that, you have to look at the percent body fat, you have to look at the nutrition, and you have to look at the hormone disruptors. You have to then consider using supplementation like the Rebalance System to potentially help them rebalance estrogen, progesterone, and testosterone. The long and the short of it is each case would have to be taken separately but it’s not my go-to, for sure.
I come to you, I’m middle-aged, and I’m saying, “I’m trying to continue to increase my quality of life, my energy.” You do my blood work, I’m a male or a female, and it looks like it would be a good idea to supplement. I’m at a certain age where that’s what’s happening. What are the options that you like? I know everyone is different. People will say, “Do I do the pellets? Do I do the cream?” Where do you tend to move where it seems feels good to you or that, in your practice, works for you that you like?
What you’re asking about is prescription-based hormone replacement therapy in a way. The first thing I do, based on that big lab panel that I referenced earlier, I determine where the levels are and how far out of a range I want them in. Remember also that the range is different for you and it’s different for you at age 75 and it’s different for you at age 20. In the end, what we have to do is make an appropriate lab range for where your hormones should be. It’s not always the lab range that’s in the general lab. I don’t want to name labs but whatever lab you go to. What we do is pick that point.
The next thing I do is say, “What’s the safest way we can do it?” We’re always talking about a cost-benefit analysis. It’s like what you’re talking about with your kids before, the benefit of teaching them how to eat properly, the cost is if you don’t track them when they’re out, they might have soda and fast food but that’s okay because 95% of the time, they’re eating well. I make cost-benefit analyses and the first thing I start with is a natural type of treatment. We would start with supplementation almost always unless something was wacky.
I mentioned the Rebalance Health System before, that’s a good place to start. There are other specific things that I would hone in on. Some of the vitamins I mentioned that are important for hormone imbalance would be vitamin D3, vitamin B6, Omega fish oils, DHEA, and vitamin C. I would work there. I then would see how they’re doing, we will change some lifestyle things, and I check in with them frequently like every 2 or 3 months. We repeat parts of the blood panel to see what we’ve affected and we check in with them clinically, “How are you doing? Do you feel better? Do you not?”
Eventually, I might need to work up to prescription hormone replacement. I usually do what’s called bioidentical hormone replacement. My hormone replacement strategy is with plant-based hormones. For example, my testosterone is made from either yams or peanuts and the same with estradiol so we get plant-based. In the delivery method where the rebalance is a lozenge, our delivery method for some of the hormones is frequently creams, and that’s been shown to decrease some of the risks with estrogen like blood clots and other things.
I use the safest possible modalities and then I target a specific blood level. I don’t just slap a cream on you and say, “Have a nice day. Come back in a year.” We then check the blood levels again. We see how you’re feeling until we hone in on the right place for you to be. Everyone’s a little bit different but we hone in on that. That’s where I start with bioidentical creams. Rarely, if ever, do I go to synthetic hormones or birth control-type pills or anything unless there’s something unusual.
What about peptides? Do you ever use any peptides that help kick certain parts of the body in gear a little bit that will produce some of those hormones?
Yes, there are certain peptides that will help to stimulate, for example, human growth hormone. Sermorelin is a peptide that helps to promote that. I do use those if needed. Another one is HCG, human chorionic gonadotropin, you can give that to someone to help stimulate testosterone production in the testes, for example, as opposed to giving them testosterone.
It gets more and more complicated and I do use peptides if needed but you have to do it step-wise because everything you add, every layer increases potential risk or a potential side effect. I’m pretty conservative. It only takes a few months to get it sorted out perfectly and sometimes a few weeks. It’s not like you come in, this dose one size fits all, and have a nice day, that’s not how this hormone stuff can be done.
That’s why I wanted to bring it up because people have to realize that you can’t go straight to a certain destination. You have to take all the steps, check yourself, and check how your body responds. It is such a symphony of things. Quickly, testosterone. We joke, it’s like, “Testosterone.” If you say that word, it’s like saying naked or sex.
Women, as we get older, should also be positively concerned with testosterone for ourselves as well, it’s a great hormone. I was listening to something and I would love to get your take on it and it was with Robert Sapolsky and he was talking about how people are like, “Testosterone makes you aggressive.” He’s like, “It is a much more nuanced hormone than that and that it is an amplifier of things.” It’s not necessarily like, “You’re going to be bold and aggressive.”
The case he was talking about was the Rhesus monkey study where they had five monkeys and they gave it to the number three in line and didn’t become more aggressive to 1 and 2 but he did to 4 and 5. People don’t understand what the subtle or nuanced hormone testosterone is. You talked about how everything is all in relationship to the other. It’s also in relationship to estrogen and progesterone and that libido isn’t just about testosterone.
Right on the mark. Part of this testosterone rage thing comes from old-school steroid rage. This is like in the days of the gym guys who would shoot 80 gallons of testosterone, I don’t even know how much, and they’re monstrous people. Those people had a reputation for being irritable, to say the least. It developed this bad name.
I agree with what you’re saying now, completely. We’re using subtle amounts and more importantly, I’m using targeted amounts. I am targeting a specific range in the blood. I’ve never had one patient or a patient’s wife or patient’s husband or anyone call me and say, “I am going crazy. I’m yelling and screaming at everyone. I’m raging.” It never has happened to me. I’ve been doing this for twenty-some years now.
What people notice, in fact, is the opposite. Testosterone tends to, as we call it in the literature, improve their sense of well-being. If you can take some that make you a little less depressed, something that can help your body composition, you lose and percent body fat, you feel better in the gym, it’s true, you can have some better libido with it along with the other hormones.
For example, estrogen is important for women for libido and sexual function and those things. It’s hitting the sweet spot, Gabby. It’s not overshooting the mark and that’s the key to doing it scientifically. You’re right, it doesn’t have to be like that. It’s a big miss in hormone replacement therapy to not consider testosterone in women, it’s at about 10% of the total dose in men. It’s super important for many of the same reasons and it helps women feel better while they’re doing exercise and feel less stressed.
I appreciate you saying that because sometimes we get bucketed like estrogen. Speaking of that, conversely, I would love to ask you, there has been information out there saying that estrogen can help you with your cognitive intelligence, are there times that men want to take a look at that as well? I had heard a little bit about it but I wanted to talk about it a little bit more.
The way that sometimes I explain it to people is the opposite whereas this concept of “brain fog” or lack of cognition or difficulty concentrating are some of the symptoms that you might look for if you’re estrogen or estradiol, which is one type of estrogen level, are too low. If someone comes to me with those symptoms like a female, I do give consider doing natural ways to boost estradiol and decrease cortisol to help with the other hormones. If it comes to it, they get a bioidentical estradiol cream of some sort. With men, it’s interesting.
I’d love to hear that conversation that Big Joe comes in and you’re like, “You need a little estrogen.”
The good news is I don’t have to have that conversation because they all want more testosterone. As I normalize testosterone, there’s a natural enzyme called aromatase that converts testosterone to estradiol. They naturally get some more estradiol and it does help with brain fog. I let that estrogen level run higher in patients who, for example, have some early Alzheimer’s changes or some short-term memory changes. There’s even data about progesterone in men and some data on prostate cancer protection and other things. The big picture is we share hormones. Men produce the same hormones as women just at different levels than women tend to produce.
Is it possible to do the supplementation of testosterone and not get bald or impact hair?
Absolutely. It’s simple. It comes down to knowing the science. The reason the men have balding problems or, for example, women start to grow a mustache if they’re on too much testosterone or something, that all has to do with a hormone called DHT, dihydrotestosterone. In my hormone panel, that’s one of the hormones I measure to make sure that you’re not bumping your DHT up too high if you’re on a replacement of testosterone. DHT only causes large prostates and hair in women and no hair in men and all the bad stuff. We watch all that.
What I am hearing though is still being conservative even within this pursuit and realizing that everyone is different. It’s never too early to keep knowing where your own levels are at. Is there an ultimate myth or mistake you see in men, women, or individuals doing that? Over and over, they come to your office and the myth is there is something that you go, “This is one of the most common mistakes people are making.”
One of the most common mistakes people make, honestly, that affects all this stuff has to do with nutrition and sleep and that’s tied into, in a lot of cases, too much alcohol consumption, which can mess up your sleep and can also mess up your hormones and increase percent body fat. It decreases your ability to turn down cookies, cakes, and candies. It disinhibits you and all those things. I would have, high on the list, too much alcohol leading to poor sleep, etc.
I would also say that people don’t start early enough to address hormone issues. We mentioned people in their 20s and 30s may not have symptoms yet but it doesn’t mean it’s not a good time to use a system like the Rebalance system, for example, to help control stress levels, help control cortisol levels, and help improve your sleep.
Moving forward, your hormone system remains more in balance. It’s a preventative strategy as opposed to you coming to me and saying, “I’m way overweight. I can’t lift two pounds. I’m breathing heavily walking up the stairs.” We then have a lot of work to do. People your daughter’s age are saying, “We should start to regulate this stuff,” or my kid’s age in their 20s.
Nobody loves the alcohol comment.
I hate to say it though, it’s a real sleep disruptor and a real hormone disruptor.
It’s everywhere and it’s part of people’s rituals, it’s amazing to me. Finishing this up, quickly, you mentioned soy. We have whole raw butter and milk when we can get it but otherwise, we don’t have too much dairy. Because our milk isn’t good, it’s pasteurized or homogenized, a lot of people are saying, “Alternative.” Remember how amazing soy milk and everybody was like, “Soy milk.” Where would you direct people if they go, “I don’t eat dairy,” or for their kids? The problem is I see a lot of the non-dairy. I don’t even know why we need to drink it as adults. Do you still eat cereal? We shouldn’t eat cereal either.
That’s a perfect comment. I don’t think there’s any evidence anywhere that says we should be drinking a glass of milk each day.
We know we shouldn’t be eating cereals so I guess it’s game over. We’re not telling you what to do. Let’s say that they want to have something other than milk and it’s not soy, where would you say, “Head that way.”
This is an opportunity for me to say that people do not drink enough water. The first thing I would say in a facetious way is whenever you think about milk or whatever, think about having a glass of water or something. Having said that, you have to be careful about some of these milk substitutes or whatever, a lot of them are too high in sugar and too high in fat so you have to watch those. Almond milk products that are non-unsweetened are quite good. Oat milk products are quite good. It has to do with reading the label again and not getting into that high sugar. If I use the term glycemic index, it means how rapidly your blood sugar is spiked. You don’t want to keep spiking your blood sugar all day.
Wrapping it up, Dr. Dorfman, you have a lot of answers, and you have a lot of information. I’m always curious about the people who know where their hurdles are and how they put systems in place to manage that. I would imagine, for you, it’s probably stress and sleep because you’re probably a busy guy. I’m curious.
I struggle with all of the same things that everyone else does, I’m sure. I’m fortunate that I live in Boulder because there’s a lot of peer pressure to look fit and be healthy. I have no choice, that’s how it rolls. Having said that, you’re right, I like to have wine once in a while and those things. I have to manage alcohol like everyone else and make sure it’s not an abundance and not too frequent. I have to manage sleep, which is probably one of my biggest hurdles.
It’s interesting that when I first started taking the Rebalance Health system, that is the number one, by far, thing that helped me the most. I use a sleep-tracking device, which is good for people. That was something I meant to mention. Some of these tracking devices for exercise and sleep do help people focus on fixing problems. I started to use the Rebalaned System and then my sleep got much deeper so I spent more time in deep sleep and I stopped waking up in the middle of the night. That was a huge thing. I have to do all the other stuff, I can’t use my computer before bed, and all that stuff.
[bctt tweet=”I keep going back to cardiovascular disease. One of the reasons that I keep going back to it is it’s the number one killer of people in the world, heart attacks, and strokes.”]
Fortunately, I grew up loving exercise. This was a parent thing, my dad exercised every day of his life even though it was not the era where people did that. I’ve enjoyed playing sports and exercising my whole life. It’s a fun part of my life so that’s not a struggle. With the nutrition stuff, I love to cook so I tend to buy or my wife buys healthful foods and we try not to have a bunch of processed stuff around. If we do have a glass of wine, I don’t start eating potato chips.
Do you have any decompressing practice at all or is it just you use exercise to blow it?
I do have a couple of decompressing practices but it has a lot to do with hiking and exercise and being outdoors. In our beautiful mountains, I do a lot of cross-country skate skiing. 30 minutes away from me is a 10,000-foot beautiful snow skate skiing. That’s not just exercising but it’s relaxing and good for my brain. My phone is off because I don’t get reception up there. Everything seems to settle down for me. It’s a combination of exercise and outdoor time and other things I like doing like cooking, being with my family, and those things.
Dr. Dorfman, I’m glad I got to meet you and learn more about the thinking behind Rebalance. For people who were reading this and are curious about the product, I do giveaways a couple of times a month of the product. There is a formulation for males and females. That is also important because we are different and have different hormones. People can go to RebalanceHealth.com if they want to learn more or follow me. They’re kind and supporting me and want to give it away to have people try it. Do you do telemedicine or anything like that?
Absolutely. I have a private practice and I’m available if you want to consult for a half hour or an hour or if you want me to manage everything. I have patients all across the country. The key to this stepwise approach and even if a patient doesn’t want to go to their doc or doesn’t want to, for example, spend money on lab draws and those things, it’s starting with appropriate supplementation. I mentioned some of the different vitamins, D, C, and B, and the Rebalance System, those are good ways to get started. I’d be more than happy to help anyone that wants help.
Can you direct people exactly where they can find you?
Sure. It’s Dorfman and I can be contacted through CedalionHeath.com and Rebalance Health, those would be my two best contacts.
I have one last question and it occurred to me, it’s probably selfish. Let’s say someone’s pretty healthy and they’ve paid attention to their blood work, is it safe to say that the chances of them falling off a hormone cliff when they turn middle-aged are pretty slim? Do you ever see it?
I see it because there are many reasons for “falling off a hormone cliff.” In other words, you can do everything right in terms of exercise, nutrition, sleep, and those things, and it’s likely that you still may need some either natural supplementation to help with hormones as you get older or even eventually some level of hormone replacement therapy.
The key to your question though, Gabby, is that not enough people are looking. It’s not common for you to go to a doc and get a big hormone panel as I might do because, in the end, it’s not often part of a yearly screening or anything like that. In a lot of ways, it’s incredibly important for health moving forward for longevity and health span. It’s incredibly important for preventing disease and yet not enough people are looking for it, at least at this juncture.
What would be one reason someone would fall off a hormone cliff?
For example, let’s pick stress, too much cortisol. It’s a type of thing where it slowly builds and slowly builds and people don’t even realize how much stress and how crazy their cortisol levels are and therefore throwing off the other hormones. That could be a cliff in that sense. Someone could have other medical-type issues where their ovaries aren’t responding to any of the signals from the brain or the brain isn’t sending any signals to the ovaries, in your case, or testes in men, or whatever.
Dr. Dorfman, thank you for your time. I appreciate the work that you’re doing. I appreciate the work that Rebalance is doing because I’m not a great sleeper. I call it mind-grind in the middle of the night. I don’t think that’s unique if people are trying to do their best. I even know better and I have seen not only an improvement but an improvement in that back end part of the conversation. Thank you for joining me.
It’s been a real pleasure. Thank you so much.
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About Dr. Todd Dorfman
Dr. Dorfman specializes in preventive and proactive care for his patients and is an emergency medicine physician in Boulder, Colorado affiliated with Boulder Community Health-Foothills Hospital. He received his medical degree from University at Buffalo School of Medicine in 1994. Owner and Medical Director of Cedalion Health, he is a board-certified emergency physician, trained and certified in Age Management Medicine. Dr. Dorfman has practiced in Boulder, CO since 1999, founding Cedalion Health in 2002. He has been in charge of the Emergency Medical Service (EMS) in Boulder County as well as serving as the Associate Trauma Medical Director at Boulder County’s premier Trauma Center. His specialties include Customized Executive Health Programs, Physician Prescribed Supplement Programs, Acute Disease Medical Consultation, Nutritional and Fitness Guidance, and Hormone Replacement Therapy.