Estrogen, Testosterone, and Menopause, OH MY

Summary

Healthful with Norah O’Donnell

Episode Summary: "Estrogen, Testosterone, and Menopause, OH MY"

Published: August 12, 2026

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Main Theme & Purpose

This episode focuses on the realities of perimenopause, menopause, and hormonal changes in women, challenging pervasive misinformation and stigma. Dr. Rachel Rubin—a urologist and sexual health expert—joins the show to explain what really happens in women’s bodies during this transition, why medical education and care have long been lacking, the outsized impact on women’s health and quality of life, and how treatments like hormone replacement therapy (HRT) and vaginal estrogen can be empowering tools, not causes for shame or secrecy. The conversation is frank, lively, practical, and determined to dismantle taboos, with personal insights from host Norah O’Donnell and memorable anecdotes—and more than a few laughs—along the way.

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Key Discussion Points & Insights

1. Menopause: What Actually Happens

• "Menopause is a castration event, whether we like it or not." - Dr. Rachel Rubin [00:00]
  • The term "castration event" signals that menopause represents the abrupt shutdown of ovarian hormone production: estrogen, progesterone, testosterone.
  • This process is universal for women who reach midlife, normally between ages 45 and 55.
• Hormonal withdrawal affects every part of the body—not just reproductive organs but the brain, heart, bones, skin, and urinary tract.
  • "Your sleep goes to your memory. Your mood changes...There are hormonal reasons for all of it." - Dr. Rubin [00:09]
• Menopause isn’t only about hot flashes. It can cause:
  • Brain fog, mood shifts, musculoskeletal pain, dry eyes, dry skin, urinary issues, sexual changes (orgasmic intensity, lubrication), and more.
  • Even impacts like "labia minora resorption" (loss/shrinkage of inner vulvar folds) are real but little known [19:22].
  • Weight gain at midlife, especially around the stomach, is a frequent but often misunderstood result [08:21].
• Estrogen receptors exist throughout a woman’s body:
  • "Estrogen receptors in your brain. They're everywhere, right?" - Sam [06:22]
  • Hormonal withdrawal disrupts many systems, far beyond reproduction.

2. Medical Misinformation & Neglect

• Less than 7% of those training in gynecology/family practice receive menopause training [03:53].
  • Medical curricula often entirely omit menopause care.
  • Most doctors are not equipped to screen for, discuss, or manage menopause.
• Historically, both society and medicine treated menopause as taboo, invisible, or a minor hygiene issue—perpetuating ignorance and stigma.
  • "Menopause has the worst PR campaign in the history of the universe..." - Dr. Rubin [05:07]
• Journalists, social media, and celebrities have recently driven awareness.
  • Outrage and advocacy are changing the conversation—but medical training is lagging behind.
  • "Women aren’t getting good healthcare...if wealthy women don’t know, what about the rest of the population?" - Dr. Rubin [17:55]

3. Hormone Replacement Therapy (HRT): Myths, Science, & Practice

• The risks of not going on hormone therapy—osteoporosis, increased likelihood of fractures, cognitive decline—are often understated.
  • "If you fall and break a hip, there's a high likelihood of dying or not being able to get back to the life you wanted." - Dr. Rubin [11:28]
• Vaginal estrogen is vastly underutilized, despite strong evidence for preventing urinary tract infections, sepsis, and improving comfort for older women—even 70s, 80s, and beyond.
  • Only about 9% of eligible Medicare patients receive it [14:37].
  • "Everybody should be offered and given the chance at vaginal hormones. And at any age." - Dr. Rubin [12:54]
• Personal anecdote: A cruise-ruining UTI could likely have been prevented with vaginal estrogen [15:15].
• Hormonal treatments can be simple, safe, and affordable, but myths persist due to past studies and regulatory hurdles.

Common Myths Debunked — “Mythbusting” [46:12]:

• Menopause symptoms are just something women have to deal with: False
• The only symptom is hot flashes: False
• Estrogen patches cause weight gain: No definitive evidence
• HRT is only for five years: Definitely false
  • "How long can you be on it?" "Till death do you possibly." - Dr. Rubin [46:49]

4. Sexual Health and Society

• Hormonal changes affect libido, arousal, and orgasm for many women, yet sexual health is rarely discussed in medical settings.
• Vaginal atrophy and changes in genital appearance and function are medical realities (labia minora resorption) but are never explained to women [19:22].
  • Viral reactions on TikTok and even celebrities (Kim Kardashian) were "in shock" to learn this [25:52].
• Menopause-related sexual symptoms are sometimes misdiagnosed (e.g., Halle Berry mistakenly diagnosed with herpes) [18:02].
• Dr. Rubin’s "pro-Viagra" stance: believes both men and women can benefit from improved sexual function [72:21].

5. Testosterone: Not Just a Male Hormone

• Women actually make more testosterone than estrogen; it's vital for libido, arousal, and even pelvic muscle function [27:12].
• Testosterone is FDA-approved for post-menopausal women in other countries but not in the US, making access harder [28:14].
  • Many women benefit from off-label testosterone therapy for mood, sexual function, and even muscle mass.
  • Treatment is much lower dose than men—e.g., a "tube" of topical gel lasts 10 days for women, just one day for men [31:22].
  • "My job is to get you to try to feel as much like yourself as possible." - Dr. Rubin [34:05]

6. Perimenopause: Hormonal Chaos

• The hormonal transitions in perimenopause can feel like mental health crises, with sleep, cognition, and mood changes—sometimes misattributed to stress, psychiatric illness, or aging [50:20].
  • "It's hormonal chaos...I just don’t feel like myself." - Dr. Rubin [50:44]
• Unaddressed, these symptoms can drive women out of the workforce, damage relationships, and reduce quality of life [59:17].

7. Wider Impact: Work, Relationships, and Gender Equity

• Unmanaged menopause drives experienced, talented women out of the workforce at their peak [59:17].
• Marital disruptions: Many divorces occur during perimenopause/menopause, often misunderstood as personal or relational, rather than biological in origin [60:25].
  • "If men were castrated between 40 and 60, there’d be a lot of issues too." - Dr. Rubin [60:40]
  • Men’s health also suffers when they’re disconnected—healthy relationships benefit both partners.

8. Medications and Side Effects

• SSRIs/antidepressants and GLP-1 drugs for weight loss can both have significant impacts on sexual health, including libido and orgasm [37:13, 41:44].
  • "Every medicine we put into our body can have potential side effects." - Dr. Rubin [37:33]
• Supplements are largely unregulated. Dr. Rubin doesn’t recommend them over evidence-based medicine [71:09].

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Notable Quotes & Memorable Moments

• "Menopause is a castration event, whether we like it or not." - Dr. Rachel Rubin [00:00]
• "I hate when women suffer when they don't have to." - Dr. Rachel Rubin [00:50]
• "Menopause has the worst PR campaign in the history of the universe." - Dr. Rachel Rubin [05:07]
• On vaginal estrogen underuse:
  "We could save Medicare between $6 and $22 billion a year if women were given vaginal estrogen." - Dr. Rubin [14:44]
• On celebrity awareness:
  "If Dolly Parton is not on vaginal estrogen...I just can’t live life knowing she isn’t getting good advice." - Dr. Rubin [16:00] "Kim Kardashian wants to know if this is true..." - Dr. Rubin [25:52]
• "Who is not pro Viagra? I think Viagra should be in the water." - Dr. Rubin [72:21]
• On the need for education:
  "My mission right now is to teach doctors how to write prescriptions...because they never learned." [53:34]
• "If you want to leave the workforce, leave—but if it’s because of a biological reason, it breaks my heart because we have tools and options to help you." - Dr. Rubin [59:17]
• "Women are amazing. Women do so much. They just need the health care they deserve." - Sam [69:47]

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Key Personal Moments & Practical Takeaways

Norah O’Donnell’s Regimen [62:19–63:59]

• Estrogen patch (0.5mg)
• 100mg progesterone at night (“a game changer” for sleep)
• Testosterone as a pea-sized topical amount (“prescribed by Dr. Rubin”)
• Vaginal estrogen tablet (“like a tampon once a week”)
• Occasional use of prescribed estrogen cream—sometimes on her face (shared candidly, with both amusement and recognition this practice lacks official dermatological endorsement, but some supporting data exists) [63:43–64:52]

Real-World Advice

• If your doctor dismisses concerns about menopause symptoms, seek a provider with menopause expertise (menopause.org and isswsh.org are good resources) [58:14].
• Perimenopause/menopause can coincide with career peaks; don’t accept suffering or withdrawal as inevitable [59:17].
• More research and funding are needed to increase options and understanding for women [55:22].

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Timestamps for Important Segments

• 00:00~00:50 – Opening on menopause as a “castration event”; intro to hormone impact
• 03:32 – Why menopause is neglected in medical training and research
• 05:07 – “Worst PR campaign in the history of the universe” for menopause
• 08:21 – Discussion on menopause, weight gain, and societal gaslighting
• 11:11 – Risks of not using HRT (dementia, osteoporosis, UTIs)
• 14:37–15:15 – Economics and quality of life impacts of vaginal estrogen
• 17:55–18:02 – Even rich/famous women suffer due to lack of medical knowledge
• 19:22 – Labia minora resorption: viral TikTok moment
• 27:12–28:14 – Testosterone for women: importance and regulatory hurdles
• 46:12–47:04 – Mythbusting menopause and HRT
• 50:20–52:52 – Perimenopause as “hormonal chaos” and psychosocial impacts
• 59:17 – Impact on work and relationships
• 62:19–65:10 – Norah O’Donnell’s personal regimen and experience
• 71:09–73:08 – Supplements, sexual medicine, and advocacy for Viagra

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Conclusion

This frank, informative episode tackles menopause with science, humor, radical transparency, and empathy. Dr. Rachel Rubin insists that suffering and confusion around menopause are avoidable with proper knowledge, tools, and advocacy. Listeners are equipped with insight, practical next steps, and the encouragement to demand better care—and not only for themselves, but for all women.

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Want more?
Find a menopause-informed physician via menopause.org or a sexual health specialist at isswsh.org. Demand more from your providers—education may be lagging, but change is coming.

Transcript

[Dr. Rachel Rubin]

Menopause is a castration event, whether we like it or not.

[Sam]

Dr. Rubin, I'm so glad you're here to talk about perimenopause, menopause, sexual health.

[Dr. Rachel Rubin]

Perimenopause is hormonal chaos. Your sleep goes to your memory. Your mood changes. There are things that happen to every single woman, and the truth is there are hormonal reasons for all of it. My job is to get you to try to feel as much like yourself as possible. Who is not pro Viagra? I think Viagra should be in the water.

[Sam]

They said to me, you're aging in reverse. And I didn't want to tell them that I'm putting vaginal cream on my face.

[Dr. Rachel Rubin]

I'm not mad about it. I'll get hate for this because people are still pushing the narrative of, like, stop scaring women.

[Sam]

I'm going like this because I'm trying to, like, hold the steam in my head.

[Dr. Rachel Rubin]

It is natural, but so is it losing your eyesight. So are hemorrhoids.

[Sam]

So we can fix those things now.

[Dr. Rachel Rubin]

We have technology. We have biology to help you not suffer. And I hate. I hate when women suffer when they don't have to.

[Narrator/Announcer]

This show is sponsored by UnitedHealth Group. We know women live longer than men, but did you know they spend 25% more of their lives in poor health? How can that be? Well, it's that women's care is often treated as isolated moments instead of a lifelong experience. That's why UnitedHealth Group is working to reshape women's health with a more connected approach to care, supporting women through every stage of life, from adolescence to menopause and every moment in between. This year, UnitedHealth Group was the first to expand coverage for doula care nationwide, helping more women access personalized support before, during, and after birth and through community partnerships and in home care. UnitedHealth Group is helping women with the greatest needs detect and prevent diseases like cancer and heart disease earlier. Because women's health is more than any single diagnosis or moment in time. It's about care that follows women throughout their lives.

[Sam]

Doctor Rubin. Rachel, I'm so glad you're here to talk about perimenopause, menopause, sexual health. Everywhere else we go in this conversation. You are also my doctor, and we've had these conversations in the past, but I'm glad you're going to be able to share so much of what you know with our audience. Good to have you.

[Dr. Rachel Rubin]

Thank you so much for having me. What an absolute honor.

[Sam]

So I think first, the Question is, why is there still so much misinformation when it comes to menopause?

[Dr. Rachel Rubin]

Yeah, I mean, it seems like everybody's algorithm, at least my algorithm right now, everything is about menopause. And if you ask my husband, we have to stop saying that menopause is not being talked about, because it is being talked about a lot more. And he gets very annoyed about that. But the truth is, is this is kind of new for everybody. It's almost like we're all waking up from a nap and. And sort of realizing, like, oh, we never really talked about this before. I think it's because of a few things. One. One being. I have a theory, actually, and. And hopefully you don't take offense to this. I think it's because of all you journalists that are going through perimenopause and menopause, and you're kind of pissed off and you're kind of like, why I don't. I. You're starting to not feel like yourself, and you have access to the world's leading experts, and you don't always have the answers. And so it. It. I have found that it is because journalists have started ask, and then you have this groundswell of social media and doctors getting onto social media and being loud. And I think that has exploded. So we're seeing more books, more podcasts, more news articles, legitimate news articles. And so it's gotten really popular, I

[Sam]

also think, because it's a symptom of the lack of research and care in women's health generally, and because all women go through menopause. And it's like, how is this never been talked about and not taught in medical school? And so that causes, I think, a lot of the outrage and anger, as it should.

[Dr. Rachel Rubin]

It's an actual nightmare. The data is very clear that less than 7% of anyone training in gynecology, internal medicine, family practice, get any training whatsoever in menopause. And so if you have nobody in the medical schools who know how to teach it, like, it's not going to get taught if it's not part of the curriculum. And it's not really part of the curriculum for anybody. And so we have to change this. Like, we have a solvable problem, but we actually have to have people and human beings try to solve it.

[Sam]

For me, it was. It started a while ago, I would say probably my late 40s now. I was commuting back and forth from New York to Washington, and I felt like someone was in my head flipping a switch. Like, flipping it. Something just went, oh, my Gosh, something just happened to me, and my doctor chalked it up to being tired and having three young kids and working really hard. But now looking back, I see it was probably something else. And one of the things that's so interesting to me, and I want to talk about what chemically happens and biologically happens in the body, because you've described it as a castration of hormones. Explain that.

[Dr. Rachel Rubin]

Yeah, a lot of people don't like that I say it, so it just makes me say it more. Me, too. That's why I brought it up.

[Sam]

Because you know why? It makes you listen.

[Dr. Rachel Rubin]

It makes you listen. Menopause is a castration event. Whether we like it or not, whether it's natural or not, whether it's supposed to happen or not, we are outliving our ovaries. The ovarian function turns off for 100% of women who are old enough to experience it, and the average age is 45 to 55. So we think of menopause as old people. It's not. You are no longer old when you're 45 to 55, but it is a castration event, which will affect you. It will cause symptoms, and it will be different for everybody. How severe the symptoms are, how much you want to put up with the symptoms. But there are things that happen to every single woman.

[Sam]

What gets castrated.

[Dr. Rachel Rubin]

So your ovarian function is no longer making estrogen, progesterone, testosterone. You're not making the hormones that you were during your reproductive years. And that has consequences because you have hormone receptors throughout your entire body. So it's not just hot flashes and night sweats. So I've been quoted as. Menopause has the worst PR campaign in the history of the universe because it's not just hot flashes, which are a nuisance. Hot flashes are actually quite dangerous for your health. Not only that, your sleep goes to your, your memory, your mood changes your brain.

[Sam]

Estrogen receptors in your brain. They're everywhere, right?

[Dr. Rachel Rubin]

So you get, you get brain fog. You get the. Oh, my gosh, I swear, I, I, I know the name. Oh, this is a book. I forgot the name of this thing. You kind of have word zaps. I call them. You. As I said, your sleep isn't great. People get musculoskeletal symptoms. People get itchy ears and dry eyes. They get urinary tract infections with sex, their orgasm changes. Women aren't walking around thinking, huh, you know, my orgasm used to be more powerful, and now it's just kind of a blip. It can happen or some people say I need a device or it's not happening anymore and they just assume it's aging. And the truth is there are hormonal reasons for all of it.

[Sam]

And what's the difference with men then? Their hormones though are more of kind of. They fall off too, right?

[Dr. Rachel Rubin]

Yeah. So men experience, and not every man experiences this. This is sort of a natural decline in testosterone, but an age related decline. But even that isn't really true. But men don't really get to castrate levels. I always say. I love this gas tank analogy Often use is women, their gas tank is zero. Men, they kind of live in like a half a tank and maybe if they get to a quarter of the tank, they can go to their doctor, they get some testosterone and they go back to half to three quarters tank and they feel great.

[Sam]

Women.

[Dr. Rachel Rubin]

I just got back from lecturing 2,000 primary care clinicians about how to prescribe hormone therapy and why they shouldn't be afraid of it. And one of the things that I say is what other organ do we let fail entirely before we help? Right? Your kidneys do not completely shut off before we start treating you and then eventually put you on dialysis. Your liver doesn't fail completely before you get on the transplant list. And yet your ovaries are failing completely. They're failing for about 10 years before they fail completely. And you are during this time. And doctors are saying, oh, you have to wait 12 months of complete empty before we intervene and you have to be bothered enough. And oh, by the way, we forgot to teach doctors how to treat you.

[Sam]

I also think that the word castration, while as difficult as that may be for some people to hear it is this wake up call, as you point out. But there's so many changes because of the multiple estrogen receptors throughout the body and other hormone receptors and almost every cell in your body correct things like weight gain all of the sudden. And I have, you know, seen it in myself and I've seen it in friends, all of the sudden, you know, maybe in the 50s, everyone starts to get a little bit their, their weight changes, that it's a lot around the stomach area. Why is that?

[Dr. Rachel Rubin]

Yeah, so again we see an increase in visceral fat, we see a change in your ability to lose weight. All the stuff that used to work doesn't necessarily work anymore. And this isn't being studied to the level that we need it to be studied and hopefully that' changing. But again, it's one of a very common complaints that we have. And unfortunately our Answer is always work harder, eat better, do more exercise. Right. Just try harder. And it doesn't work for a lot of people. And I think, meaning, like, if you

[Sam]

go to the doctor and say, you know, all of a sudden I haven't been feeling the same and I'm putting on all this weight that a lot of us were being gaslit in the back and just saying, well, you need to be working out more and not eating as much and stop drinking wine,

[Dr. Rachel Rubin]

blah, blah, I think. So when I spoke to these primary care clinicians, this woman came up to me. She was in her 70s, lovely, older primary care clinician doctor she came up to, she said, I've been telling people to exercise as my only option for all these years. And your lecture just taught me that maybe there's some other stuff I should be considering. This is an MD doctor. Her mind was completely changed, but she had. She was able to come and tell me that and to say, like, hey, all I've been telling patients is just exercise more. But she said, me, I've been exercising and I still have osteoporosis.

[Narrator/Announcer]

Right.

[Dr. Rachel Rubin]

And so she realizes that maybe that advice isn't the best.

[Sam]

You bring up a really important point, which is, and I want to get into, what are the types of hormone replacement therapy? But if you don't go on hormone replacement therapy, what are some of the outcomes that may happen that are really deleterious to your health?

[Dr. Rachel Rubin]

Yeah, People love to talk about, ooh, the risks of hormone therapy. Hormone therapy is dangerous, but what do we flip that? What are the risks of not going on hormone therapy? So some of the. There are the unknown risks of not going on hormone therapy. Listen, we're all going to die, every single one of us. Right? Like, that's where we're all going. And so the real question is, how are we going to live?

[Sam]

What is about improving our health span?

[Narrator/Announcer]

Yeah.

[Dr. Rachel Rubin]

What do we want life to be like? My grandmother was 90 in the nursing home. She had quite a long life. She took no medications, but she had osteoporosis and dementia. She did not know who any of us were for the last 10 years of her life. And she didn't have much quality of life. So we really have to ask ourselves, what do we want the years to look like?

[Sam]

You think if your grandmother had been on hormone replacement therapy, the end of her years would have been different potentially?

[Dr. Rachel Rubin]

Right. It would prevent osteoporosis. Right. I think the dementia data. We have a long way to go for our full understanding of that. But for the Osteoporosis data. Absolutely. My grandfather hugged her and she broke all of her ribs.

[Narrator/Announcer]

Right.

[Dr. Rachel Rubin]

I think all of us want to be able to withstand a hug as we get older. But the truth is, what are the risks of not going on hormone therapy? And so osteoporosis, if you fall and break a hip, you are very high likelihood of dying or not being able to get back to the life that you wanted to live. So bone density is really, really important. And the thing that I talk a lot about and care so much about is the genital and the urinary symptoms that happen without hormones. And we know that hormones prevent urinary tract infections, local hormones prevent urinary tract infections. So you don't even need high doses of them. And they're safe for everybody to take. And so that 70 year olds, 80 year olds, 90 year olds and beyond. Right. Are, are going to urgent care. They're going to, they're going into the ICU with urosepsis, which we can prevent using hormones.

[Sam]

This is such an important point and having talked to you a lot, I know how passionately you feel about this. So I would say, generally speaking, correct me if I'm wrong, that for most people, when they go on hormone replacement therapy, they're taking a systemic estrogen. Right. Either through a patch or a pillow. Right. Please correct me if I'm wrong. I'm not the doctor. A progesterone, which they normally take at night, a progesterone pill, they could, that will help them sleep. You are then saying there should be additional things on top of that. I think those are the basics that like a lot of my friends are on. But you say there should be more than that, including vaginal estrogen. Why?

[Dr. Rachel Rubin]

Yeah, so not everyone may choose to take a whole body estrogen or a whole body progesterone, but everybody should be offered and given the chance at vaginal hormones. And at any age, everybody. Why? Because no one wants to die of a urinary tract infection. Everyone wants to wear pants. Everyone wants to sit and get through their movie without having to urinate. Everyone wants to sleep through the night without having to get up to pee. And so the. What happens to the genitals and the urinary tract if they do not have hormones? They get dry, they get thin, they get irritated. It's like a plant needing water. Right. A plant needs water to be fully healthy, to be robust. And that's what happens to the genitals in the urinary tract. And so actually hormones keep the tissue acidic so it can fight infection. And so we talk a lot about microbiome these days, right? And the most important thing for your vaginal microbiome is to keep an acidic environment with hormones. And it turns out if you micro dose hormones, you can do a very small amount, very low dose into the vagina. It fixes the microbiome of the urinary tract and can prevent urinary tract infections by more than half. And data shows we can prevent sepsis hospitalizations, even death in, in anyone, recurrent urinary tract infections. And so it is the thing I talk about at nauseam because it is so easy to do. It should be covered by your insurance. It should be inexpensive. If it's not covered by your insurance, it's an easy prescription to write. We wrote guidelines to support this. It's supported by the American Urologic association. And yet my colleagues publish that less than 9% of Medicare patients who have a diagnosis and should get this prescription are getting it.

[Sam]

You mean less than 1 in 10 older women are on vaginal estrogen. And you think if they were, it could save their lives?

[Dr. Rachel Rubin]

We published that we could save Medicare between 6 and $22 billion a year if women were given vaginal estrogen. And that's a conservative estimate. Why? Because not only are those are the costs for going to urgent care, for the prescriptions, for the Euro sepsis, ICU admissions, for the hospitalizations, but what about the missed work days? What about the you can't go on your vacation? I had a patient just a couple weeks ago. She got a UTI on a cruise. Ruined her cruise.

[Narrator/Announcer]

Right.

[Dr. Rachel Rubin]

It was miserable. She got antibiotics from the cruise doctor and she didn't get better. She came home and then she couldn't go on her trip to Europe because she wasn't better from this infection. And so the, the lost cost to that family was huge. But also just her quality of life, she was miserable. And she actually had to drive from, you know, New York City to D.C. to see me because nobody would help this woman.

[Sam]

Julie, my producer, would be very upset because she loves cruising. So she would say, this is definitely a travesty. This is definitely a travesty. The other thing is there have been celebrities and very prominent women who are in their 70s and 80s that you worry are at risk because they're not on vaginal estrogen.

[Dr. Rachel Rubin]

Well, so what Nora's not telling you is that I text Nora regularly because I am very worried about certain people not being on vaginal estrogen, number one being Dolly Parton. So if Dolly Parton is not on vaginal estrogen. Estrogen. I will not. I will not. I just can't live life knowing if she's not getting good advice.

[Sam]

So people will say, wait, what a minute. Why is Dr. Rachel Rubin talking about Dolly Parton and vaginal estrogen?

[Dr. Rachel Rubin]

Because Dolly Parton has publicly talked about being sick with kidney stones. She's talked about being sick and having a hard time getting her health back. And that's why it's been difficult for her to go on tour and go back into her entertainment, which she is literally a national treasure, as we all know. And so what my urology brain does is says, we have guidelines by the American Neurologic association for the genitourinary syndrome of menopause that we must help Dolly Parton's microbiome. And the best thing she can do is put a tiny tablet twice a week. It's 10 micrograms of estradiol twice a week vaginally, can prevent urinary tract infections and hospitalizations. And so if Dolly Parton's been hospitalized, then that's not going to prevent her kidney stones, but for her healing from her kidney stone surgeries and things like that. And so I'm not Dolly Parton's doctor, but I know that people like you who interview everybody in the world, that you have access to these people. So I constantly bug Nora and I say, like, hey, can you just make sure she's getting good medical advice? Because unfortunately, and just so you know,

[Sam]

I don't know Dolly Parton well enough to give her that advice. But I do think this is.

[Dr. Rachel Rubin]

Not yet.

[Sam]

But this is an important conversation to share, because here is the expert on this. A urologist who has studied this, has done the research, and you want to raise this as a national emergency, but

[Dr. Rachel Rubin]

you have to understand that the rich ladies are not getting good medical care here. Right.

[Sam]

Some of whom are your patients.

[Dr. Rachel Rubin]

Are my patients. And. And so the. The people who have the most resources are not getting good information because we forgot to teach doctors how to do this and why.

[Sam]

But if wealthy women are not getting this care, what about the rest of the population?

[Dr. Rachel Rubin]

Correct. It's horrible. I say it's the. The most equitable thing in the world because no one's getting good hair. Listen, Oprah had to have hot flashes for. Or.

[Narrator/Announcer]

Sorry.

[Dr. Rachel Rubin]

She had heart palpitations. She says this publicly. Again, not my patient. But, you know, call me Oprah. I'm happy to help, but. But the. The truth is, is Oprah had heart palpitations, and nobody could figure it out. She figured it out herself. Herself. Halle Berry publicly said that she was diagnosed with herpes right. When she actually had genitourinary syndrome of menopause. Halle Berry literally doesn't look like she's in menopause, but she is. And so no, her doctor did not know that vaginal hormones was going to save her and help her genital symptoms. And they said, oh, this must be herpes. It wasn't herpes. And thank God for people like Halle Berry who publicly talk about this. And, and all the celebrities were really starting to talk about this because I think it' really important. Right. Naomi Watts writes a whole book about menopause. And so it makes it realize that it is, it is young hot people who are having these symptoms. Amy Schumer has been very vocal about this. And so it's really important that we understand that there are really. We should be talking about this in our 40s, we definitely should be talking about it in our 50s. But even Dolly Parton in her 80s should be talking about this because vaginal hormones can save her from urinary tract infections.

[Sam]

Now this is the thing that people may freak out about, that you actually lose a body part during menopause.

[Dr. Rachel Rubin]

Yeah. So we went very viral last year. I did a podcast that's not nearly as popular as this podcast. And congratulations, you're amazing. I did a very low key podcast with a friend of mine and I talked about how in menopause, the labia minora, those inner wings of the vulva, they actually resorb in menopause. So they, they can reabsorb. They reabsorb? Yeah, they resorb where they reabsorb and they, they shrivel up and kind of disappear. Now not everybody's does that and not everybody's goes away completely. But it is medical fact that part of this syndrome, this, this genitourinary syndrome of menopause, they start to go away.

[Sam]

Okay, how do you stop that from happening?

[Dr. Rachel Rubin]

We actually don't know.

[Sam]

So science has the vaginal estrogen doesn't help.

[Dr. Rachel Rubin]

We don't know. No one's ever studied it. Literally no one's ever studied it.

[Sam]

Science has completely to get on that. Dr. Rubin.

[Dr. Rachel Rubin]

Listen, if you all want to fund my non profit that I have, please. Because we need to do research and things people care about. The NIH is not going to be giving a big grant about labia minor research. But my little tiny little, we will. Well happy we can get you some

[Sam]

shirts say save the labia menorah.

[Dr. Rachel Rubin]

I'm on it. Need swag. We need all the things, but we need, we need to do research on this like science hasn't studied. Is it estrogen, is it progesterone, is it testosterone? What hormone is involved with the labia minor?

[Sam]

I love the story that you opened up your own sexual medicine practice because people told you it wouldn't work.

[Dr. Rachel Rubin]

Yeah, so when I came out of my fellowship training, and by the way, when I, when I graduated, there was one fellowship in the entire country that even acknowledged women's sexual health. That was in 2016. Today, in 2026, 10 years later, there are three. Really two that just started about two years ago. So we have no training in women's sexual health. I did the only fellowship in the country at the time.

[Sam]

You're the pioneer.

[Dr. Rachel Rubin]

We by mentor, I would say is the pioneer. Irwin Goldstein, a man who actually invented Viagra, essentially was the pioneer because he started the field of women's sexual health. And I am lucky enough to have trained under him. And so when I came out of my fellowship and wanted to get a job, the academic centers, they said, ooh, what you do is weird and you're not going to make us enough money fast enough. So I went to the big urology practices and they, they even handed me a contract and then they took it away because the private equity firm said, ooh, you're not going to make us enough money fast enough. You actually want to spend time talking to people that doesn't make money. You're not going to be doing enough surgeries. Like that is not going to be a financially viable way to have a business. And so I had to start my own business, right? I had to start my own business. And unfortunately, like a high priced lawyer or a plastic surgeon or a dentist, I take, I don't take insurance because my model is about spending time with, because your sexual health, your quality of life, you understanding your body takes time.

[Sam]

And now you clinic is thriving.

[Dr. Rachel Rubin]

And now we have a very long wait list. We have four doctors. We are doing, we're bringing in another one. We're doing great because people invest in time spent and they invest in their health care. To be fair, we don't do life and death medicine. We're not an emergency room. Plastic surgeons also do not often take insurance. Like there are models of health care where it's very difficult to get insurance companies to care about what's going on with you. And truly we, we do everything we can to get your insurance to pay for medic patients, to pay for the things that you need, but the time spent with your doctor, you deserve more than 10 minutes talking about your sexual health and understanding what's going on with you. Puberty hits and the whole body morphs and changes. The labia grow, the clitoris grows, The. The area becomes pink. It becomes lubricated. You can put tampons in. You can have sex. Babies can happen. And so the. The whole genitalia, just like the breast tissue, are hormone sensitive. And so they transform. And guess what? What? Just like you feel the receptors, then when you go into menopause, you lose those hormone. Like, right. The hormones are leaving your body. And so everything sort of shrinks and, and, and can become.

[Sam]

Now, when people are saying, I'm uncomfortable hearing this, or talking about very uncomfortable people. Well, but no, no, no, not me. I'm saying I'm. If someone at home is saying, I'm uncomfortable hearing this, I say, no, this is your body. This is your health.

[Dr. Rachel Rubin]

I have a really good analogy that I've started to use with people. So you never show up to the doctor and say that you have face pain. Okay, we have, like 10 doctors for the face because you would never go to the dentist with eye pain. You would never go to the dermatologist if you needed an ear, nose, and throat doctor. We go to, like, 10 different doctors for anything that goes wrong with our face. We've got plastic surgeons, we've got neurosurgeons. We've got all these people, yet no one knows what's going on with their genitals. They don't even have the language. Everyone calls it a vagina when they mean the vulva. They don't know where their clitoris is. They don't know that they have labia, let alone that they shrivel up and disappear in menopause. And so when women do not have language or access to their own body parts. And what happens when you go to the doctor? Okay, they have a sheet, and it's like their mechanics looking under the hood. You know, sort of like, let's get in and get out and get out of here as quickly as possible, because this is weird and gross. That's essentially what they're telling you. They don't teach you anything. They don't show you anything. And so where do you learn? Learn, Right. You expect your partner to know your buttons and know what's going on, because they don't get a lesson either. And so when do we give women access to their own body parts? And so. But they change. Like, these body parts are Changing, which is why sex changes in menopause, urinary health changes in menopause. You leak more, you itch more, you feel uncomfortable more. But, but, but women don't have the words, so they just say down there, or they just sit and suffer. And I hate, I hate when women suffer when they don't have to. It's one thing when we don't have the answers because medicine hasn't decided not to study women for 30 years. But, but, but when we have the answers and vaginal hormones, vaginal estrogen is like the thing. We have answers. We, it's been safe, we've known for decades. It's not expensive. The fact that women aren't being offered it is to me a nightmare.

[Sam]

And to me, this is so much about learning about this and removing if there's shame or secrecy around is all about women and men living better, healthier and happier lives. It's as simple as that.

[Dr. Rachel Rubin]

It's so simple. If you give people information about how their bodies work, they get to decide what they do.

[Sam]

Everybody's interested in it. They may be being, oh, I'm uncomfortable hearing this conversation. But everybody actually is totally into it and being like, I need to know more. Including. I mean, you've had big time celebrities ask about, is this really true that the labia minora disappears?

[Dr. Rachel Rubin]

Yeah. So when this went viral, so I did this little podcast, talked about the Labyrinth. Nora. It went so viral on Tick Tock, which I'm not even on, by the way, people were doing reaction videos of being in shock that their labia disappear and nobody told them. And it went so viral that I got a text from a, a celebrity who said, kim Kardashian wants to know if this TR is true. And I said, well. And the celebrity said, well, if Dr. Rachel says it's true, then it must be true. So I think, think the truth is, is that women don't know this. Women are furious about this because they're like, why didn't anyone tell me? Right? I'm smart, I'm educated, I can learn, I can take it. Why aren't doctors Let me. And the truth is, health care for women is really not optimal right now. If you're going to the doctor once a year with your legs up in stirrups for a pap smear, like, that's not health care to me. Like, it doesn't. You need, you need to actually sit down and talk with someone and have conversations about your particular health.

[Narrator/Announcer]

Right.

[Dr. Rachel Rubin]

And what's going on with you?

[Sam]

Back to the Conversation, too. Rounding up hormone replacement therapy. We talked about systemic estrogen, we talked about progesterone, we talked about vaginal estrogen. What about testosterone?

[Dr. Rachel Rubin]

Yeah. So testosterone is this thing that everyone is like, we're talking about a lot more, right?

[Sam]

Well, everyone says testosterone is a male hormone. Is it?

[Dr. Rachel Rubin]

Yeah. So testosterone is a human hormone. The ovaries make testosterone, the testicles make testosterone. Everyone goes, really?

[Sam]

There's testosterone in women?

[Dr. Rachel Rubin]

Yeah. So actually, fun fact, there's more testosterone. Women make more testosterone than they make estrogen. In fact, you even need testosterone to even form estrogen in the ovary. It goes through that pathway. And so we forgot to teach everybody this. We forgot to teach doctors this. And so there's global consensus, actually, that testosterone helps with low libido in menopause and perimenopause. And so the problem is we do not have a product in the United States that is FDA approved for women for testosterone, which is a huge product.

[Sam]

But by the way, and you could probably speak to this, this is just based on my anecdotal evidence, but I would say that most very wealthy billionaire men who have access to the best health care are all on testosterone, as are their partners.

[Dr. Rachel Rubin]

Yeah, that's true.

[Sam]

Why?

[Dr. Rachel Rubin]

Well, when men's testosterone gets low now, men don't get to castrate levels unless they have metastatic prostate cancer. Men, they get a bit low, say their testosterone is lower than 300 or 350, and they're feeling tired, they have erectile dysfunction, they're feeling low libido. If you give testosterone to those men, they feel much better. Most of them feel much better. They get in better mood, they get a bone better bone density, they get better sexual health. Their libido goes up, they just feel

[Sam]

more like their muscles get a little bigger working out.

[Dr. Rachel Rubin]

Muscles get a little bit bigger working out. And so they did a big study about testosterone, five year study. They gave it to old men with bad hearts. And it showed that it wasn't that serious. It actually helped them. It didn't really hurt them. It wasn't very dangerous. Now, the problem is testosterone for everybody is a controlled substance. So it is. You need a DEA license. And it is like you are prescribing opioids, actually. So it's. We're really advocating to the FDA to change this because it makes no sense. It's based on the doping scandals of the 1990s and some bodybuilders that went a little too far with anabolic steroids. And so many of us are really advocating to the FDA to change this ruling because it's hard for women to access testosterone.

[Sam]

What would testosterone do for a woman?

[Dr. Rachel Rubin]

Yeah. So we have global consensus that testosterone works for libido for women. But I will tell you, my patients tell me it helps with a lot more. It is the thing I see so many patients come back and say, oh, I just feel more like me. And the data shows it doesn't just help libido, but it helps arousal. It helps orgasm. I have patients who tell me it helps with their mild stress incontinence because the urethra, the tubia p through, has testosterone receptors in it. The pelvic floor is full of testosterone. Your biceps have testosterone. You know, so when you're lifting weights, you actually can maintain more muscle mass. Now, the problem is, is because we don't have a product in the United States, there is limited research in it. And by the way, it's been studied. Five years of data went into it, and it showed that it was effective and that it was safe. But because this was done around the time that the Women's Health initiative came out and the warning labels on estrogen products were placed, the FDA was too afraid to approve these products. And so they actually did not approve them. So we have had 20 years of. Of no products and no companies trying to. To. To launch a product, even though testosterone is approved for women in Australia, New Zealand, South Africa, and England. And so we're really in England. Yeah, and England. And so we're trying really hard to get some of those companies to say, hey, maybe if you come to the U.S. maybe we could have a different conversation with the FDA. Now, now that the warning labels on hormone therapy products have been lifted, and

[Sam]

I've never talked about this publicly before, but I use testosterone.

[Dr. Rachel Rubin]

Tell me more.

[Sam]

Prescribed by Dr. Rubin.

[Dr. Rachel Rubin]

Tell me more.

[Sam]

But it is a. It is normally in a tube that is prescribed for men. And that tube does explain how you say women should use.

[Dr. Rachel Rubin]

Yeah. So women make about one tenth the amount of testosterone as a man. So if you say men, the 300 to a thousand is sort of normal male testosterone, then 10 times less is like 30 to 100. So we kind of live. That's kind of the. The range that we look for. But that. That being said, man may use an

[Sam]

entire tube or half a tube on their chest.

[Dr. Rachel Rubin]

So a generic little tube of testosterone, a man would use the whole tube every single day. But my female patients need to make that tube last about 10 days. And so it's not that serious. It feels serious. But it's not that serious. They say, nora, take a blob, put it on your hand, rub it on your leg, wash your hands, and move on with your day. It's not that hard. And I always tell patients it takes a while to kick in. For many of my patients, I would say it takes, like, four to six months for you to. To, like, notice that it works. And I literally had a neighbor the other day. She ran up to me. I was walking my kids to school, walking home. She ran up to me with her dog, and she said, Dr. Ruben, I said, oh, good morning. She said, guess what? The testosterone kicked in. I said, oh, that's great. How long did it take? She goes, five months. I feel amazing. And guess what I said? What? She said, I quit my job because I'm starting my own thing. Right? She had this, like, strength about her. She felt great in her own body. She felt like she had the strength to launch her own, you know, consulting business, which is so exciting.

[Sam]

So that's why I'm starting this podcast. It was the testosterone. I'm just kidding.

[Dr. Rachel Rubin]

So what did you. What did you learn? Like. Like, when did you notice. Did you notice that it helped? And what did you notice that it helped with?

[Sam]

That there wasn't like, an altar. There wasn't like an aha moment for me. But. But I definitely think you notice it over time.

[Dr. Rachel Rubin]

But it's.

[Sam]

It's in concert, I think, with the other hormones, for sure.

[Dr. Rachel Rubin]

I often do it. You know, listen, it's. It. You can just take testosterone, and I think that is an option in perimenopause when you still have a lot of estrogen around. And I do think if you are over 60 and you're afraid of estrogen, though, I don't know that you absolutely should be. It is an option to just do testosterone. We have lots of patients who just use it for their libido.

[Narrator/Announcer]

I'll.

[Dr. Rachel Rubin]

I. I'll never forget this patient in our second 70s who was seeing me for low libido. We gave her a testosterone prescription after, you know, discussing all the risks and benefits. And, you know, at three months, we did a call. She said, you know, I don't really notice anything. I said, just give it. You know, give it four to six months. I swear. And so then we did a call at six months, and I'll never forget it. She looked at me and she goes, it's working. And it wasn't what was so interesting about the stories. It wasn't working for her to have more sex with her part Partner.

[Narrator/Announcer]

Right.

[Dr. Rachel Rubin]

There were lots of issues around that, but she had this desire to like, get her device out and have a good time and have an orgasm and like, enjoy herself. Like, like, how old is this person? She was in her 70s and she felt her own sort of desire back. And that was so spectacularly meaningful for her. Now that's what I love about my job, because my job is not to tell you what kind of sex to have or what kind of sex to want, but my job is to get you, you to try to feel as much like yourself as possible. And I think that's really important because so many people are, you know, oh, you know, women shouldn't want to want, like, as you get older, it's okay to not want these things, but if you want them, then there are tools in our toolbox to help you.

[Sam]

Yeah, I'm glad you're bringing that up because I do think, and I want to address this again as someone who grew up Catholic, but I had a family who was doctors, so these conversations were not often limit. But certainly as a Catholic, there is this shroud. And I'm sure other people of other religions do, is like, you don't talk about sex. Yeah. But why is talking about sex and having a healthy sexual life so important to having just a full, happy life?

[Dr. Rachel Rubin]

Yeah. So if you're Catholic, you believe in family, you believe in love, you believe in connection and, and not getting divorced and like enjoying each other. Right. Like, those are the things that everybody sort of loves and believe. Like this, this idea of the more we understand the human body and the biology which is not anti religion, the more you understand what you can do to optimize your own health and longevity and wellness. And when you feel good, when you feel good in your body, when you feel good in your. With your own health, that makes your connections that much better, that much easier. Your love, your. And so this idea that you have to get old and that sex is no longer part of the equation and it's just not in the cards for you. I push back on that because. Because sex can look a lot of different ways. Connection and intimacy can look a lot of different ways. And when you don't talk about it, you ignore it. And I think it brings people farther and farther apart when the goal is to bring people together. And so I'm a urologist. I take care of men, I take care of women. I love helping both sides of the couple because a lot of biology can happen that brings people farther apart. And by not talking about it, it doesn't help the situation, actually, I joke. I. I talk about sex like it's high blood pressure and diabetes. Because when you understand diabetes, understand what you need to do, you can live a better life. You can be healthier. You can. You can, you know, feel great. And so the more people understand their sexual health and the biology surrounding that, the better they can sort of live their lives.

[Narrator/Announcer]

This show is sponsored by UnitedHealth Group. We know women live longer than men, but did you know they spend 25% more of their lives in pornography?

[Dr. Rachel Rubin]

Health.

[Narrator/Announcer]

How can that be? Well, it's that women's care is often treated as isolated moments instead of a lifelong experience. That's why United Health Group is working to reshape women's health with a more connected approach to care, supporting women through every stage of life, from adolescence to menopause and every moment in between. This year, UnitedHealth Group was the first to expand coverage for doula care nationwide, helping more women access personalized support before, during, and after birth. And through community partnerships and in home care, UnitedHealth Group is helping women with the greatest needs detect and prevent diseases like cancer and heart disease earlier. Because women's health is more than any single diagnosis or moment in time. It's about care that follows women throughout their lives.

[Sam]

Let's about talk about sex and SSRIs, because you've been identified as someone who's part of the menopausy, but you're a urologist and a sexual health medicine specialist, and a lot of young people have asked that question about. And a lot of people are on antidepressants. How does that affect sexual health?

[Dr. Rachel Rubin]

Yeah, I just want to be very clear. This is a very important area of research and very important conversations that are very polarizing in the world right now. And as a urologist who takes care of sexual health problems, every medicine that we put into our body can have potential side effects. Right. The FDA is not there to approve drugs to say they have no side effects. Their job is to say, do the benefits seem to outweigh the risks? And the risks are different for different people. And we are not that good at understanding the human body. And everyone's body metabolizes different. Everyone's genetic code is slightly different. And we are only just beginning to understand the different things, the different ways people metabolize different medications. And so antidepressants are a very not one thing. There's many different types of them. They can be extremely helpful for some people, but there is a lot of side effects that can happen that can be quite harmful for your sexual health. And so antidepressants we do see have significant sexual side effects in some people, not all people. And those could be erectile dysfunction. They could be low libido, they could be muted or delayed orgasm. They could be absent orgasm. Orgasm. And we see even more than sexual side effects for some people. They'll describe what we call sort of genital numbness. And, and what, what women and men will describe is, it's like, you're touching my elbow. I can feel that you're touching my elbow, but there's nothing sexual about you touching my elbow. And they lose that arousal response, that joyful connection. And it's a word we use often is anhedonia, sort of a lack of pleasure. And it's hard to make that better. And so our, our toolbox of how to fix it is limited. We have some success with some people, but it's not a one size fits all.

[Sam]

Is this a big area of research you're seeing now on around this?

[Dr. Rachel Rubin]

I wish I could tell you that there was a lot of research going into this. You have to understand the area discussion for sure. It's a big area of discussion by the patients. There are some researchers. We actually just gathered a group of these researchers together in Detroit. And it was actually quite beautiful. It was. It was a room full of researchers throughout the entire world. There were people from Australia, there were people from Italy, there were people from Portugal. And we all got in a room together to talk about SSR induced sexual dysfunction, finasteride. Induced sexual dysfunction.

[Sam]

And oh, that's finasteride.

[Dr. Rachel Rubin]

That's for the hair loss.

[Sam]

And that's not minoxidil, is it?

[Dr. Rachel Rubin]

It's not minoxidil. It's different than minoxidil and accutane Induced sexual dysfunction. And these researchers were looking at it from mouse models to genetic. Genetic issues to spine issues to neuros neuroscience issues. And it was so incredible to watch. No drug company sponsored it. In fact, the drug companies don't love that we're all meeting, right?

[Narrator/Announcer]

No.

[Dr. Rachel Rubin]

Well, because the drug companies that studied all these drugs, they. They want to make their drugs look as good as possible. So sometimes some of the science side effects get a little bit pushed under the rug. And they don't get marketed as loudly as. And they don't want their drugs to be dangerous. They want their drugs to only be good. But all drugs can have side effects. Every drug out there. The truth is many people need and rely on antidepressants to help them with very serious Problems. And so, but we have to also validate the fact that there can be side effects and that we don't teach psychiatrists much about sexual health and we don't teach primary care doctors much about sexual health. And that becomes a problem problem when your patient is getting these drugs from telemedicine companies or from doctors that don't know anything about sexual health. So they're not giving true informed consent necessarily. And I think that's where a lot of the problem lies.

[Sam]

So we need, it's worth asking your doctor about if you're taking an SSRI or if you're considering taking one is have that discussion.

[Narrator/Announcer]

Yeah.

[Dr. Rachel Rubin]

And, and the problem is your doctor may not have all the answers. And that can be very scary too. We live at a time where we are learning things, but we don't have all the answers. And we, we want to have all the answers. We wish we had all the answers, but we don't.

[Sam]

What about GLP1s OIC WeGovi Zepbound and sexual health?

[Dr. Rachel Rubin]

This is super, a super interesting area of research and we started doing studies on this because we anecdotally. Right. We have. I'm a sex doctor, so patients come to me with sexual problems. So once all these drugs started getting prescribed for diabetes and obesity, patients would come to, to me and some would say, Dr. Reuben, I have never been more comfortable in my body. I feel great. I have no interest in sex whatsoever. Or the man would come to me and say, oh, I feel great, everything's good. I can't orgasm. It takes me forever to have an orgasm and I'm so frustrated by it. So it got us thinking. We sent out a survey to thousands of people on social media to say, hey, you take GLP1s. What, what, what's happening? We found about a 10 to 15% of people, people sort of said that they had some kind of sexual challenge with the GLP1. But here's where it gets kind of interesting. We published not too long ago a case study of a woman who had a devastating medical problem. She had persistent genital arousal disorder where she felt like she was on the verge of orgasm 24 hours a day. It's a suicide inducing medical problem that we have had lots of suicides in the community for. It is often we don't know. It's different causes for different people. People sometimes spine pathology, sometimes you took a medication that it was a side effect. But, but women and men sort of feel this, this uncomfortable feeling 24 hours a day. Devastating. This woman took a GLP1, she took tirzepatide for her weight gain and she couldn't leave the house because she was so uncomfortable and miserable. She gained a lot of weight, so her doctor gave her a GLP one that was indicated for her weight. And her persistent general arousal went away. It went away. It was gone. A week later, her shot was due to do again. Her symptoms came back. She did the next shot, her symptoms went away.

[Sam]

And that's a very rare, a very rare case. But for most, how would you say from, for, I mean, millions of people are now on GLP1s for weight loss. Does that benefit your sexual health? Are there, does it not?

[Dr. Rachel Rubin]

I think for some, I think what we're seeing in the literature is that for some people it can affect their, their sexual health. So low libido, delayed orgasm. We do see some people with anhedonia, that word again, of that lack of pleasure. So you're not hungry for food. You may also not be hungry for sex, just like they're saying you're not as hungry for shopping or gambling or drinking. And so where the brain centers of dopamine and joy live and some of these sort of, I need sugar. Right. Like there may be some connection to, you may not want sex, sex as much. And so there is a potential for, you know, boosting dopamine in other ways.

[Narrator/Announcer]

Right.

[Dr. Rachel Rubin]

We have FDA approved medications to help with libido. We have hormones that can boost testosterone that we know work for libido. And so for a lot of my patients, we're seeing, we're, we're, we're playing with this. If you do find that you have side effects, we are using other things to help boost dopamine and sexual health. So I don't think it's a one size fits all. I don't think everybody who takes a GLP one has sexual side effects. In fact, some, some people have never felt better. And so, but if it's, if you are experiencing, I think their main point is if you have any changes or frustrations with your sexual health, there should be a medical provider who can like, help you. And there aren't enough of us.

[Sam]

I mean, it's an interesting Discussion because in 2026, there are so many drugs that can help us, whether they're the weight loss drugs, SSRIs, hormone replacement. I mean, we could go on, but there are, as you pointed out, there are some side effects for all of these drugs and they're part of the conversation you should have with your doctor. Yeah.

[Dr. Rachel Rubin]

The challenge is finding you know, one thing I think is we forgot to teach doctors about hormone therapy. And we don't teach doctors anything really about sexual medicine. And so your doctor's never going to bring it up. Most of your doctors are never going to bring it up. And so when you bring it up with them, if they dismiss you, if they minimize, if they say it's all in your head, you have to know

[Sam]

that, like, is that called gaslighting? Is that what they. That means?

[Dr. Rachel Rubin]

It is, but I, I think it's not. While it. I don't think your doctor is an intentionally being a jerk, I think that it is very hard. We doctors don't know everything. I've made a career off of being like, oh, we don't have any data. We don't know this. We, we. But doctors have a hard time, you know, especially when patients come in and say, hey, I saw Dr. Rubin on Instagram say there's a drug for low libido. They have two options there. They can say, oh, that's so interesting. Let me watch the video with you. Oh, let me go live. Learned something. Or they could say, Dr. Google only I know everything. You don't know everything. And I wish doctors didn't choose that option so much, but they do sometimes.

[Sam]

Now it's myth busting. True or false? Menopause symptoms are just something women need to deal with.

[Dr. Rachel Rubin]

False.

[Sam]

The only symptom of menopause is hot flashes.

[Dr. Rachel Rubin]

False.

[Sam]

Estrogen patches cause weight gain.

[Dr. Rachel Rubin]

No. No definitive evidence. But if it happens for you, then it's real.

[Sam]

Hormone therapy for menopause is affordable.

[Dr. Rachel Rubin]

Yes.

[Sam]

Sex after 50 is supposed to hurt.

[Dr. Rachel Rubin]

No. False.

[Sam]

If you're 60, it's too late to start hormone therapy.

[Dr. Rachel Rubin]

False.

[Sam]

You can only be on HRT for 5 years.

[Dr. Rachel Rubin]

Definitely false.

[Sam]

How long can you be on it?

[Dr. Rachel Rubin]

Till death. Do you possibly.

[Sam]

Doctors spend less than a day learning about menopause in medical school?

[Dr. Rachel Rubin]

True.

[Sam]

Is that the biggest travesty of all time? Yes, one of the biggest. Yeah, one of the biggest.

[Dr. Rachel Rubin]

One of many.

[Sam]

Let's talk about hormone replacement therapy and Alzheimer's dementia. Could it help prevent those in women, for instance, if you're on hormone replacement therapy?

[Dr. Rachel Rubin]

Listen, I just got back from a phenomenal conference at the Cleveland Clinic with Maria Shriver and the Alzheimer's foundation that were really just focused on what can we do to solve this problem. It is a huge problem. And women are so much more likely to get Alzheimer's than men. Women don't even realize that they're so much more likely to get Alzheimer's than men. And the research is we is. Is more robust than it ever has been before. There are people, really smart people, and a lot more money that is going into figuring out this problem.

[Sam]

The challenge with Alzheimer's problem, why do more women. Why do more women have Alzheimer's and dementia?

[Dr. Rachel Rubin]

And how can we prevent it? Right? What is the way to prevent it? How can we treat it? If you get it, you know, so there are a lot of smart eyeballs looking at this and the thought process being, well, women make more estrogen than men. Is it a hormonal cause? Right. Women become castrate, men don't. And so is it that loss of estrogen that increases your risk for Alzheimer's? And there. The problem with this research is it takes so many years for to. To. To do a trial and actually see the changes and see the differences and the ways that we. The way that we study, study it has evolved as well. And so again, I'm a urologist. I can't begin to tell you that I am an expert in brain health, but I do think early. I think one of the things that has been really burned into my own brain is that Alzheimer's is not a disease of an old woman. It's actually a disease of people in their 40s and 50s, meaning it develops that age. But you're symptomatic. It's like gsm. It's like the genitourinary stuff, symptoms.

[Sam]

I know you're being careful talking as a doctor, but do you personally believe there's a relationship between menopause, the castration of all those hormones, and the increased risk of Alzheimer's and dementia for women?

[Dr. Rachel Rubin]

So as a urologist who's so curious about hormones and is kind of obsessed with this concept, how could it not, right? Like your brain is full of estrogen receptors. Lisa Moscone has proven that at 65, the estrogen receptor density increases. Increases. It increases because your brain is so hungry for estrogen, it creates more receptors to take every morsel it can find weight, right? Your fat cells make estrogen, which is, I think, why people gain weight in menopause, because they need to feed the brain. The brain needs estrogen to, like, fuel it. And men are walking around with estrogens of 25 and testosterone's of 500, and their brains are getting coated in all of these hormones. And so how could it not? So I think of it like if. If in perimenopause. I actually think this is happening in perimenopause, because what's happening is Your hormones go high, then they go low, then they go high, then they go low. And I think your brain is glitching. Like, I think the inflammation that happens in that moment of, like, it's high, it's low, it's high, it's low. I think your receptors are like, what the. Is going on. Right. And so how could it. That's your personal theory, personal sort of thought process there. And so, again, I am guideline driven. I don't have. Have patients coming to me saying, Dr. Rubin, I want hormones for dementia prevention. They're coming to me because they have hot flashes, night sweats, they're not sleeping, they don't feel like themselves. Do I think earlier hormone therapy is beneficial for their brain? My money's on yes.

[Sam]

And to put a finer point on that, too, because you brought it up, which was this ekg, like in hormones, that happens in perimenopause, which is so important because so many women say, like, what the heck happened to me? 45, 5, 50. And a lot of women go on antidepressants, then a lot of women end up getting divorced. Lots of issues happening because of this ekg. They call it something chaos, right?

[Dr. Rachel Rubin]

What are the.

[Sam]

What do they call it? The.

[Dr. Rachel Rubin]

It's hormonal chaos. It's hormonal chaos.

[Sam]

And explain biologically essentially what's happening. It's also, a lot of women in their 40s also end up having twins, too, because your body's going. And it's just spurting out eggs, too.

[Dr. Rachel Rubin]

Don't have those whoopsie babies if you don't want them. So hormonal K is perimenopause. Menopause is hormonal chaos. Right? So here's sort of what happens to your point of the ekg, right? In a normally reproducing person, your. Your estrogen shouldn't go to zero. Maybe your floor is 50, maybe your ceiling is 150. When you're pregnant, by the way, 3,000. Higher. Many thousands. Right. You have a very high hormone level. But when you're in menopause, it goes to zero. And perimenopause can be zero, then it can go to th.000, then it goes zero and. And it. It goes chaotically because your ovaries are sort of having a temper tantrum because they're almost done and they're sort of fighting their last fight and they are causing chaos while they're doing it. They don't leave the building quietly. And so for some people, that is incredibly symptomatic. One of My favorite diagnosis code. A paper was written called nflm. Not feeling like myself. I just don't feel like me. Something has changed. My sleep has changed. My irritability has changed. I had a patient just the other day. She said, Dr. Rubin. She was in her mid-40s. She said, Dr. Reuben, for half the month, I want to divorce my husband and I want to punch him in the face. I hate him so much. And the other half of the month, I love him to death, and it's been great. And like, this is what per. Menopause is doing to me.

[Narrator/Announcer]

Right? Like.

[Dr. Rachel Rubin]

Like, there is hor. But no, don't blame it on hormones. If your husband's a jerk, he's a jerk. But like. But like, the truth is there are hormonal changes that are happening, and I'm so fascinated by that. Of, like, where is. Like, you don't feel like yourself now? There is some steadiness, but this is

[Sam]

like, such an aha moment. And that's why I think talking about this is so incredibly important, because I think that there are so many in talking to my girlfriends is. There are so many people that have said out loud, I think I'm going crazy. I think I'm actually going crazy, or someone in my family is driving me crazy or work is driving me crazy. But in fact, there is a significant, significant biological event happening in their body that is about to end in a castration.

[Dr. Rachel Rubin]

Dr. Rubin would say castration event. And. And no. And, like, I'll. I'm gonna get, like, I'll get hate for this because people are still pushing the narrative of, like, stop scaring women. This is natural aging. Like, menopause is normal.

[Sam]

People are saying that. That you're scaring women.

[Dr. Rachel Rubin]

Yeah, people don't. Like when we talk about perimenopause. Like, there is still this idea that,

[Sam]

like, what are you scaring about? What's the story?

[Dr. Rachel Rubin]

Scare. They don't like that because this is natural. This is. This is by. This is natural form of aging. Not every woman needs hormones. And I'm not suggesting every woman needs hormones.

[Sam]

Okay, well, it's a good question. Why isn't it natural? It is natural.

[Dr. Rachel Rubin]

It is natural. But so is it losing your eyesight. So are hemorrhoids. So are like, so.

[Sam]

So we can fix those things.

[Dr. Rachel Rubin]

We have technology. We have biology to help you not suffer.

[Sam]

So are cavities too. You can fix that stuff.

[Dr. Rachel Rubin]

So many women are suffering, and we aren't even giving them the information. You have to understand My. My mission right now, now is to teach doctors how to write prescriptions. To teach nurse practitioners to teach people how to write prescriptions because they never learned. So we can be all fired up, we can be all excited and we want everyone to go to their doctor and talk about this. They're going to be turned away because their doctor doesn't know how to do it.

[Narrator/Announcer]

You don't.

[Dr. Rachel Rubin]

Dr. Doesn't just magically know how to write prescriptions. Someone has to teach them, someone has to mentor them, they have to see cases, they have to take courses, they have to learn about it. But it's not in medical school, it's not in residency. And like so this year at the American College of Obstetrics and Gynecology, acog, the OBGYN conference for the first year that like there were menopause courses and there was standing room only. There was, there was like people were in like extra space watching it on TV because people, women are coming in every day asking for help. But unfortunately there hasn't been anyone answering that call.

[Sam]

I'm going like this because I'm trying to like hold the steam in my head that's like coming out of my head. Cause I'm just like, I'm like, I'm like this is the root of all evil. Like the lack of attention on women's sexual health and then the lack of. I mean we're in 2026 and I feel like we're literally on the just the beginning of learning about this that we're. Because not to. But you're teaching everybody about this that doesn't know about it kind of prescribing everyone who by the way every woman is a different size and is a different biological makeup about the same thing. And we're going to be. You're the doctor. But my view is we're going to be 10 years from now we're going to have multiple different kinds of doses treatments for women finally. Because we're just at the teeny tiny beginning of this. Am I wrong saying that?

[Dr. Rachel Rubin]

I think it's hopeful and I agree with you. I think what I tell my patients every day.

[Sam]

Why isn't there like so much money flowing into this whole thing field? Because it's half the population and it's. We're literally like right here the beginning of just to me which is, I mean they're estrogen pass patch shortages which

[Dr. Rachel Rubin]

is a huge problem and is not just because more women want estrogen. It's because there is a monopoly on these, you know, these, these like pharmacy benefit managers and these are Generic drugs. So they don't make them any money and so they don't produce enough of them. And so it's this like crazy thing

[Sam]

that like they're pretty expensive for generic drugs.

[Dr. Rachel Rubin]

It's not profitable enough. Like they're just not making enough of them. There's like three of them. There's like three companies. It makes no sense. Like we, we need more industry, we need more companies in this. But, but not everybody agrees with us in this idea of like people are okay with the status quo and are

[Sam]

not really what's preventing this revolution in women's health.

[Dr. Rachel Rubin]

I think it's a lack of education on the medicine side. So I think your primary care doctor doesn't know enough about this. Your gynecologist doesn't know enough about this. So whose responsibility is it to write hormone prescriptions? I would argue, argue it's everyone who takes care of women.

[Sam]

And why isn't Big Pharma also found this to be a profitable.

[Dr. Rachel Rubin]

Because they're generic, because they're generic drugs now. Okay, so there's no money in it for them or they don't see the money in it for them. And so they're finding other new ways nor non hormonal things to help women. Why not just use hormones? It doesn't make any sense. So I think it's going to change it. So let me just say that now that the FDA removed the warning labels on hormone therapy. So for everyone listening in 2025, for 20 years, all hormone products, regardless of type, dose and ways to do it, every hormone therapy product had a big box warning label that said causes stroke, blood clots, heart attacks, probable dementia. None of that was true. And all of that was based on a study from the early 2000s that studied a pill version, one pill, one dose of a synthetic fake estrogen progestin combination. It had nothing to do with progesterone or natural estrogen or testosterone. Like it didn't. Or vaginal hormones. It hadn't, didn't have to do. But all products sort of got this warning label. Well, in 2025 the FDA announced that they were removing that warning label which is so excellent and I think is going, is going to spark a lot more interest in this. I've seen more interest, we've seen more interest in the ob GYN conferences. I've been lecturing to primary care clinicians. I, I lectured 3,500 a couple weeks ago. I, I lectured 2,000 just yesterday. And it is electric. They're learning about this of sort of like what are you afraid of? Doctors don't want to hurt you. And no one taught them that hormones were actually quite safe. And so they don't know the toolbox, they don't know how to do this.

[Sam]

So if you're sitting and if you are listening to this and thinking, I've got to do something about this, who should you go to? Your general practitioner, your ob GYN who can help?

[Dr. Rachel Rubin]

Yeah. So I would find someone who actually has an interest in hormone therapy and menopause. The Menopause Society. Menopause.org is a great website to find someone who took a test and has interest in menopause. That doesn't mean they know everything, but that's a great place to start. You could also go to a website called iss wsh.org or isish, the women's sexual Health Society. They have find a provider as well. And so those are people who know hormones and sexual health a little bit. Those are two great places. There are television, telemedicine companies that have really gotten into this space. So if there is no one in your area, that is also an option, some of which take your insurance and you can meet with somebody online.

[Sam]

You know, the effects of not treating perimenopause and menopause can really affect a woman's life. And we know from the data that this, you know, this change in life, perimenopause and menopause happens at just about the same time that a woman, woman is, you know, starting to begin to reach the peak of her career. And then so many women say they want to drop out of and do drop out of the workplace.

[Dr. Rachel Rubin]

Yeah, we see it all the time. And it. Women are leaving because they don't want to be bad at their job. They can't remember words, they can't get things done that they say, wow, I used to be able to handle this level of stress and I just can't handle it anymore. And that is because of the hormone fluctuation and then the hormone crash that happens. And so women are leaving and I think it's a trap tragedy. If you want to leave, of course, leave it your own free will. But you're leaving because it's because there's a biological reason that to me breaks my heart because we have tools and options to help you. And I do think women are at the height of their careers. They have the most institutional knowledge, they have the most like, that's my God complex. I believe when I can keep strong women in high places. I think we change the whole world and so for me, I want to be that sort of person behind the scenes. Means that is. That's why I'm so nosy with everybody. Like. Like, I'm always like, okay, what dose is she on? But is that high enough? Are we doing this? Is she on this? Is she. Like, this is why, like, I want Dolly Parton around for as long as humanly possible. And I know that I have a tool that can get her there.

[Sam]

You think treating perimenopause and menopause is the way to change the world?

[Dr. Rachel Rubin]

I actually do. I also think it's the way we keep people married and happy together. Like, when do people.

[Sam]

I totally agree.

[Dr. Rachel Rubin]

When do people get divorced between 40 and 60? That's when Perry Menabas is. Menopause is happening. People are getting divorced every single day. Like, a lot of people are getting divorced.

[Sam]

And so for. Husbands are saying, yeah, my wife doesn't want to have sex with me anymore. It's not because they're sick of them.

[Narrator/Announcer]

It's.

[Sam]

They're going through a change.

[Dr. Rachel Rubin]

It's literally, if we cut men's balls off between 40 and 60 and castrated men between 40 and 60, they would also have a lot of changes and issues that happen. And so the more we can educate men about what's actually happening, the better. And there are solutions. There are biological solutions to help these people. And so the I. I do think. And everyone's talking about longevity and the bro sphere and manosphere and all the. The bro science stuff. The bros need to give a crap about menopause because men who are single, divorced, or widowed have terrible health outcomes. Men need to be connected. They need to be partnered. They want to be, like, among community women.

[Sam]

Men need women.

[Dr. Rachel Rubin]

Well, women will live forever because they all are friends and they love each other and they'll just hang out all the time. Time. Men get lonely. They get isolated. They get like, I'm watching. You know, my mom died a year and a half ago. Like, my dad. Like, watching my dad just sit at home and be lonely. Devastating. Now that he's dating again, it's the most beautiful thing in the world because he's connected. Men who are single, divorced, and widowed have terrible health outcomes. How do we keep people partnered? If they are partnered is like, like, like, we need everyone's healthy. We need everyone feeling good. And. And so men should care about women's hormonal health. They should care about perimenopause and menopause. They should demand research and funding and, like, a lot more science. Like, we need A lot more science and then everybody wins.

[Sam]

This part of the episode now is when Dr. Rachel Rubin turns the tables.

[Narrator/Announcer]

Turning the Tables is sponsored by UnitedHealth Group working to close the women's health gap.

[Dr. Rachel Rubin]

Do you want to talk more about your personal story at all? Because I do think people would be.

[Sam]

What's my personal story?

[Dr. Rachel Rubin]

Like your hormone regimen. Like people want to know what you're taking.

[Sam]

Well, I've never talked about this before, but I take testosterone prescribed by you and I use a pea size amount I put on the back of my calf as you told me to do. You know, I do it every night or every morning when I remember. And I think it's made a huge difference. And you know, a lot of my friends, I've taken a picture of what I take because there's such a lack of information out there. I mean, thank goodness to you and Dr. Mary Claire Haver and Kelly Casperson and so many other great doctors out there are sharing what they know on Instagram. But you know, I take an estrogen patch.

[Dr. Rachel Rubin]

What dose?

[Sam]

I don't know. 0.5, I think that's right. Does that sound right? 0.5, 0.5. 100 milligrams of progesterone at night, which is a game changer, changer. That helps you sleep at night. And so many of my friends have said it helps you sleep at night. It's fantastic. I also take magnesium glycinate at night, which I think helps me sleep. That's a muscle, helps with muscles. I work out a lot. That helps. That's not hormone replacement therapy. That's just a supplement. Vaginal estrogen.

[Dr. Rachel Rubin]

How do you do it? Is it a tablet?

[Sam]

I take the tablet. It's like a tampon once a week. Yeah.

[Dr. Rachel Rubin]

You put it. Yeah. So you put this tablet in there and it's.

[Sam]

And then I put. Going to say something that really might be. You know, I did get prescribed the estrogen vaginal cream, but I put it on my face.

[Dr. Rachel Rubin]

It's a popular thing to do. So here's the deal.

[Sam]

Not all the time, but I think

[Dr. Rachel Rubin]

it helps with the wrinkles. I put it on my face, too.

[Sam]

I mean, a couple people did say during White House Correspondents Dinner, they said to me, you're aging in reverse. And I didn't want to tell them that I'm putting vaginal cream on my face.

[Dr. Rachel Rubin]

Yeah. So it's very popular right now. The truth is estrogen cream, estradiol cream. Right. The reason it helps, it's skin care for your, you know, down there. It also can be skin care for your face. Now, again, you're on progesterone to protect your uterus, meaning if you use unopposed estrogen. If you use estrogen and not progesterone, you do over time can increase your risk of uterine cancer. But you're on progesterone to protect your uterus from developing an overgrowth of cells. And so for you to add a little pea size amount of estrogen on your face to help with moisture, to help with wrinkles, it sounds like it's been very beneficial for, for you.

[Sam]

Yeah, I don't use it all the time, but you know, when you're feeling a little older or wrinkly or I start the regimen back up again.

[Dr. Rachel Rubin]

I'm not mad about it. And we really do need more dermatologists. Right. To.

[Sam]

You know, my dermatologist said there's no science behind it.

[Dr. Rachel Rubin]

There is science. There is science. There's between.

[Sam]

On using it on the face.

[Dr. Rachel Rubin]

Yes. There's data. Just because she doesn't read the data doesn't mean that there's no data.

[Sam]

Don't send me the data because I'm

[Dr. Rachel Rubin]

going to show it to her. Happy to. Yeah. So I think that's so brave of you to talk about this because people are nosy. People want to know, you know, listen, you know, you're very casual in a T shirt, but my goodness, you look so hot.

[Sam]

Thank you. But my shirt says when women support women, great things happen and look how great you're doing. Yeah. And I am trying to support other women by sharing what I think can change people's lives. I've just, I'm in that age zone. I've seen so many of my friends suffer with frozen shoulder, you know, having severe mood changes, the inability to sleep at night, you know, divorce, separation, unexplained weight gain. Even though they're incredible athletes who work out all of the time. So I just see it. I see my friends in some ways suffering and then their doctors tell them that they don't need anything.

[Dr. Rachel Rubin]

Can you tell people what. Because you are very good at lifestyle. Right. You eat very well. I watch your exercise videos on Instagram. I'm addicted to them and very jealous. How do you have time? Time, because how do you have time for all of this? Because you have a podcast, you're on TV all the time, you've got kids you like. Like, how do you do it? And what did. You were doing it before hormone therapy and then you after hormone therapy. Can you tell people like what that, what that changed in you now that you're sleeping and, you know, what else you learned about hormone therapy?

[Sam]

I mean, I only think just one of the benefits of being a journalist is being naturally curious, being surrounded by a naturally curious team. So I seek out the best people in every everything. So getting advice from people, I think has made my life healthier. So whether it's the best doctors out there who can prescribe me the best care, you know, the best trainer, who not only, I think teaches mobility and strength and has, since I've been working out with Kira Stokes for more than 10 years, has been talking about the importance of building muscle for the more than. Well, it's probably almost 15 years I've been working out with her. But even with her, it's just. Even if it's only 30 minutes at a time or even if I get on the treadmill for 15 minutes, I just say it's better than nothing. So, I mean, it's a lot messier behind the scenes. But I do believe that food is medicine, and I do believe that food can heal the body. Not in replacing hormone replacement therapy or other types of drugs, but I do believe you can change a lot about your life by what you eat. And I kind of live by that model.

[Dr. Rachel Rubin]

So I think it's really important. Nobody is out here saying, just take hormones, it fixes everything. Of course, the lifestyle changes are important. You had done lifestyle, great lifestyle before hormones, and you're continuing to have a great lifestyle, good lifestyle choices on hormones. What do you find was the most beneficial thing did. Was it that you had better sleep? Was it that your brain felt better? Was it that your mood was better? Like, what did you notice the most about, like, hey, I like this, and I want to keep refilling these prescriptions.

[Sam]

Well, I think the first time I noticed it, and I was, you know, anchoring in New York in the morning show, and I had three young kids and was traveling back and forth between Washington and New York on weekends. And I was in the airport and I called my doctor then at the time and just said, I feel like it's in the movie, like inside out. And I feel like someone is just flipping a switch. So for me, it was emotional meaning I felt this emotional wave coming over me like that something was turning off of a switch for me. But I think in using estrogen, progesterone, testosterone, vaginal estrogen, in addition to all the other stuff I did, one helps me sleep better, certainly helps my mood. I think it's helped my skin In a lot of ways, I think people don't realize how much collagen loss you have. So I think it's all of those things. I don't have musculoskeletal issues. I mean, definitely at 52, even on all those things, you start to have musculoskeletal issues that are just part of aging. But I think it has improved with those things. Does that sound.

[Dr. Rachel Rubin]

Am I. I think it's amazing, and I think sharing it is really. I think that's part of why we.

[Sam]

Sharing is caring so successful. That's what we said growing up.

[Dr. Rachel Rubin]

To many people, like, they don't know that you're really a human. Right? You're, you, you're just like, you're so, like, I don't know, you look perfect, you sound perfect. You're so smart. It doesn't seem fair to us regular people out there and to know that there is biolo and there is, you know, the exercise and the eating. Right. And that you invest in you. I think for a lot of people, I think it's gonna be really important for them to hear that people who look like you don't always feel perfect and that there are things that you can do to help to, like, improve the quality of your life.

[Sam]

I do believe that women caring for themselves, their mental and their physical health is about changing the whole dynamic and allowing women and helping women rule the world.

[Dr. Rachel Rubin]

I couldn't agree more.

[Sam]

Like, women are amazing.

[Dr. Rachel Rubin]

They're amazing.

[Sam]

Women are amazing. Women do so much. Women care for their families. They bring home the bacon, they fry it up in a pan, and they just need the healthcare that they deserve.

[Dr. Rachel Rubin]

Yeah. And they need good. They need a team around them to support them, and it's okay to ask for help. And I think one thing I, as a doctor, like, it can be very intimidating to take. Take care of a celebrity. Right. Because I, I, I've seen you on TV for a very long time, and there is that ability to just have that human connection and to say, hey, I'd like to help take care of you and to sort of see you as a human being who has medical issues. And I'd like to, again, you know, to be able to explain things in a way that makes sense to you and to convince you that, like, there is, like, sort of medical things that can be helpful. And you were very receptive to that. And I think that speaks loudly. And I think all women need to hear that, like, just because you're the height of your field or you're the best at what you do, finding other people who are knowledgeable about things that you might not know about. And don't put your head in the sand. Don't think that yoga and deep breathing and meditation is going to fix everything. Like there is a lot of biology and science that we do know about women. Even though we have a lot more to learn, there's a lot that we do know and that you don't always, always have to feel badly or suffer. There's a lot of times an option to help you.

[Sam]

What do you think about some of these companies that are now providing perimenopause supplements?

[Dr. Rachel Rubin]

Yeah, so my take on supplements, you'll actually never hear me talk about supplements fully. And it's really because supplements aren't fully regulated by the fda. And so we don't even know if, if you have a bottle and it says that this is what's in it, there's actually no one looking in that bottle, bottle and making sure that's what's actually in it.

[Sam]

And so you mean I can buy something by a reputable company and we don't know what's in it? It's testing.

[Dr. Rachel Rubin]

There have been studies that have looked at that. And it's not always what it says it is in the full amount. And so we have enough challenges with the FDA having medications that are fully safe, although it's the, you know that they have a lot more oversight and testing. And so it's just not my space. It's not my expertise. There are no supplements that are absolutely magical in my line of work that actually are better than. Than the hormones and the medications that I have to offer. So I'm not a big supplement person. That being said, vitamin D can help a lot of people. Fiber can help a lot of people. We know, you know, we, we know that cranberry supplements can help prevent urinary tract infections, but nowhere near the amount as vaginal hormones can prevent urinary tract infection. So when people ask me what supplements can help my erectile function, how about eating right, sleeping well, and using Viagra? Like, those are really good things to help.

[Sam]

You're pro Viagra.

[Dr. Rachel Rubin]

I'm very pro Viagra. Who wouldn't be pro? Who is not pro Viagra? I think Viagra should be in the water, right? Everybody should have some. It helps female arousal as well, by the way. It's just most women have low libido and hormonal issues and, and hormonal problems in their genitals. So they don't respond to the Viagra as much. But if you fix all those things and give a woman Viagra, it works great to increase blood flow to her clitoris, just like it increases blood flow to the pen. So it can work very well. And we know that Viagra can help men's cardiovascular issues. And so the. Why aren't we studying that in women? Like, we've. We've published on this? Why aren't we studying PD5 inhibitors for women's cardiovascular health, please? Because they're generic drugs, and they don't make anybody any money. And so nobody wants to study it. And we don't have NIH funding anymore for anything. So it's a challenge.

[Sam]

Thank you, Rachel.

[Dr. Rachel Rubin]

Thank you, Sam.