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Podcast Host (Midlife Crisis)
Today's episode is supported by what Should I Do with My Money? An original podcast from Morgan Stanley. Let's be honest, money can make people feel insecure. That's why I love this podcast.
Interviewer / Co-host
It takes the fear out of talking.
Podcast Host (Midlife Crisis)
About money by letting you listen in on real, unfiltered conversations between people asking big financial questions and the advisors who help them figure it out. It's smart, it's emotional, and it just might make you feel braver about your own money story. I just listened to the episode about the price tag of parenthood on what should I do with my Money? And it hit me hard. Every parent I know is doing the same math. How do we give our kids the best without burning ourselves out? This conversation lays it all out. It's smart, it's relatable, and it reminds us that financial planning is part of caregiving. Definitely worth a listen. Search for what Should I Do with My Money in your podcast player. We'll also include a link in the show notes. Thank you to what Should I Do With My Money? And Morgan Stanley for their support.
Reshma Sajani
There's one thing that all people on earth have in common. We move through the world in a human body. Bodies ache. They bleed, they desire, they hold the stories of our lives. International Planned Parenthood Federation, or ippf, is sharing some of those stories from around the world. Read them now at ippf.org/everybody Lemonada. Welcome to my so Called Midlife, a podcast where we figure out how to.
Interviewer / Co-host
Stop just getting through it and start actually living it.
Reshma Sajani
I'm Reshma Sajani.
Interviewer / Co-host
All right, so I'm just going to come out and say this out of the gate.
Reshma Sajani
Everything you know and everything I thought I knew about libido and sex in midlife is wrong. Maybe that's not a surprise to some of y', all, but the messaging that.
Interviewer / Co-host
I've heard for most of my life.
Reshma Sajani
Is as you age, women's libido drops.
Interviewer / Co-host
The desire for sex goes away, and.
Reshma Sajani
The only way to keep a healthy sex life is to schedule it and.
Interviewer / Co-host
Just not talk about it.
Reshma Sajani
Whether it's fun or not fun, here's the good news. I learned it doesn't have to be like this. I Talked to urologist Dr. Kelly Casperson, who has literally dedicated the last eight years of her practice to women's sexual wellness. And you know what her main message was? You're not broken. You can have good sex. In fact, you can have the best sex of your life. In midlife, Dr. Caspersen realized that while she's often able to fix pain or dryness for women she wasn't able to fix. They're lacking sex in their lives. So after years of studying what she wasn't taught in school, she realized that libido is just more than biology. It's gotta do with what's happening in our heads and the social aspect of our lives. Dr. Caspersen, set the record straight for me. Like, you actually don't have to have sex a certain number of times a month. Sex is not dead. It and over after you turn 35, that men don't have to be the ones that dominate in bed. That libido is complicated for everyone. She taught me that it's okay for women to have sex and desire and.
Interviewer / Co-host
For us to talk about it and.
Reshma Sajani
Not be ashamed of it. If you don't like the sex you're having, guess what? It's time to have a conversation with your partner. So if you're struggling to figure out how to have good sex in midlife, this is the conversation for you. I want you to listen to it and literally share it with every woman you know. Let's get into it.
Dr. Kelly Casperson
Thanks for finding me. Thanks, Tamsyn.
Interviewer / Co-host
I know I stalked you. I was like, oh, yay, Perfect. I need to talk to this incredible woman.
Dr. Kelly Casperson
Awesome.
Interviewer / Co-host
My sister and I were nerding out about you yesterday because I sent her one of your videos. She's a gynecologist.
Dr. Kelly Casperson
Oh, awesome.
Interviewer / Co-host
Yeah, so.
Reshma Sajani
And a doctor.
Interviewer / Co-host
You know, doctors love talk about doctors.
Dr. Kelly Casperson
Doctors love doctors.
Interviewer / Co-host
We talk a lot, Dr. Caspersen, about the midlife mindset and how it is, like, literally different for everyone. Where do you land? What's your midlife mindset?
Dr. Kelly Casperson
Oh, God, anything's possible. Yeah.
Interviewer / Co-host
Like, best time of your life or medium time of your life?
Dr. Kelly Casperson
Best time. And, like, I know it, and I know that it's going to be fleeting, right? Like, I know enough to be, like, at some point, I won't be this young, this healthy. My kids at home, all the things, right? So, like, I know how precious it is, which makes it all the more special.
Interviewer / Co-host
It's almost like when I was listening to you, it's like the way people talk about their, like, life in their 30s. Like, I gotta, like, I was. I was seeing.
Dr. Kelly Casperson
I was in surgical residency in my 30s. There was no best of, best of times happening.
Interviewer / Co-host
So I. I'm just thinking about, like, I think on Instagram, I saw, like, a note that Kim Kardashian wrote to herself, and it was basically like she had note she wrote to herself in her twenties and she was like, remember, never look this good and to be kind to yourself. And it's kind of like what you're saying right now about your 50s, which is pretty damn cool.
Dr. Kelly Casperson
Yeah. Well, you know, we live in this, like, society that says we're never supposed to age and, you know, but it's like, inevitably we all do. We all will get sick at some point. We all will have loss. Not to be a downer at the beginning of your talk, but it's like knowing there's something very spiritual in that, like, knowing that this is fleeting and precious. So choose wisely.
Podcast Host (Midlife Crisis)
Mm.
Interviewer / Co-host
I. I feel. I was thinking about that the other day. I was playing tennis with my son, and, you know, I'm about to turn 50. He's, like, nine. He's kicking my ass, by the way.
Reshma Sajani
But I'm like, wow. Like, I'm so grateful to be able.
Interviewer / Co-host
To be on the court with my son and play right now.
Dr. Kelly Casperson
Yeah.
Interviewer / Co-host
And to move and to at least make him run for it a little bit.
Dr. Kelly Casperson
Is there for, like, another couple of years.
Interviewer / Co-host
Yeah. If even. Is there anything you've done in your 50s that's, like, been a game changer?
Dr. Kelly Casperson
Well, I'm. I'm in my 40s.
Interviewer / Co-host
Oh, sorry. I'm, like, aging you.
Dr. Kelly Casperson
I'd have to manifest if I was to talk about my 50s right now. Game change. Oh, God. Well, I just quit my job.
Sponsor Voice / Ad Reader
Yay.
Dr. Kelly Casperson
That's pretty big.
Interviewer / Co-host
That's amazing.
Dr. Kelly Casperson
I know. I'm on my second. Second book. Manuscript just went in, so. Yeah, no, the 40s are amazing. Like, you. I got to a point. I hope everybody gets to this point, but I got to a point where you're like, the rules are all made up, and you can do whatever you want to do. And, like, once you. Once you truly believe that, watch out, your life can change.
Reshma Sajani
So, like, that's.
Interviewer / Co-host
That's interesting because you're a doctor, and, like, I think, like, I know this about my sister.
Reshma Sajani
Right.
Interviewer / Co-host
It's like, that identity is, like, something that's really important and to kind of let go of.
Dr. Kelly Casperson
Very important. It's very important.
Interviewer / Co-host
So how'd you do that?
Dr. Kelly Casperson
Well, realizing the hospital is not going to love me back.
Podcast Host (Midlife Crisis)
Tell me more.
Dr. Kelly Casperson
I wasn't a doctor in the 90s and the 80s and all the, like, precious good times that the old people say it was. But it's like, they current medical system, they will take and take and take and take and take until you get sick and have to quit because you're sick. And for me, I was like, I want to quit before I get sick. I want to quit because I'm ready for something bigger. And with the education I do now, with the podcast and the writing and the speaking and all of that, I'm like, it is pointless for me to be in the emergency department at 2 in the morning anymore. Like, it doesn't fulfill me. I. But the problem is you never get taught. Like, do you get taught this growing up? Like, you're gonna get really, really good at something and it's okay to quit that?
Interviewer / Co-host
No, you don't get taught that.
Dr. Kelly Casperson
You do not get taught that. And so like, so for me it was like, but you're really good at it. Right? Like, that was the hardest thing. More than like. Cause I'm like, I'm a mom, I'm a writer, I'm a podcaster, I'm a woman. I'm a. Like, I've got all. You've got all these labels, but at the end of the day, you are you. Right? So like, Dr. Wasn't the only thing I was hanging on to. And I'll always be a doctor.
Interviewer / Co-host
Yeah, right.
Dr. Kelly Casperson
I don't have to take Medicare to prove that. So it was the, it was the, I'm really good at this and giving it up that was the biggest problem. Because like, where's your context for learning how to do that?
Interviewer / Co-host
You don't.
Reshma Sajani
I wrote a book called Brave Not.
Interviewer / Co-host
Perfect, and it was in the context of girls and young women, but it's, it's actually the opposite. It's why women stay longer in jobs. Like, men are actually constantly quitting and growing, and that's why their promotion rates are much higher. Whereas for us, we get stuck. And we often get stuck because we're good at our job, not because we're happy. And we get confused between being good at something and being happy with something. And that's the thing that we have to actually unlearn and ask fundamentally different questions.
Dr. Kelly Casperson
I love this. I'm glad this isn't just a me problem. I feel so much better now.
Interviewer / Co-host
It's not a problem. It's actually a you. It's a lesson. Like, and I'm so glad we're starting this podcast with you sharing that, that it oftentimes when you do get good at something, it's when you're supposed to quit.
Dr. Kelly Casperson
Yeah. Because now, right, like, doctors don't get told that. That's for sure.
Interviewer / Co-host
No, no, I think my sister. I totally see that. My sister's life. Okay, so you're a board certified urologist, you study conditions and diseases that affect the urinary tracts and reproductive organs in people. For a while, you focus on pelvic health, but then about six or seven years ago, you started focusing on the sexual health and women's sexual wellness.
Sponsor Voice / Ad Reader
Why?
Interviewer / Co-host
What happened?
Dr. Kelly Casperson
It was like the intersection of, like, several different things. Probably three things. Number one, it was a seven year itch. So I was told in residency by a very wise attending, watch out for the seven year itch. Whether it's your marriage, your job, whatever it is, it. It's real. And so I was like, oh, crap, it's. I'm seven years in. Is this why I'm so bored? I was like, recurrent urinary tract infections over and over saying the same thing. Over, over. Like, what was the point of all this training? Is this all there is? Am I going to do this until I decide to retire? Like, it was kind. It was a seven year inch. It was just like, you know, this existential crisis of like, hey, I have an amazingly well paid indoor job and I'm unsatisfied.
Podcast Host (Midlife Crisis)
Right?
Dr. Kelly Casperson
And so I had actually treated a woman for a long time for bladder cancer, done a very large surgery, cured her of her bladder cancer, and got to really know her, like, loved her. And so she was cured. She would just come in, we do our checkups, blah, blah, blah. And one day she was crying about her sexless marriage, and I was like, handing her the box of Kleenex. And then the lightning strikes your brain and the lightning's like, you don't know how to help her. And I was. And so then I went back to, like, my training, and we were trained, like, women were difficult. They're complicated. We'll never figure them out. And don't worry, because the gynecologists are taking care of them. Wow. Like, that was what I was told. And so at that point I was like, is that true? Is that real? Do we not know anything? Are the gynecologists taking care of female sexual issues? Because, you know the urologists are the bosses of Viagra, right?
Interviewer / Co-host
Yeah.
Dr. Kelly Casperson
Viagra has been on the market since 1998. So I'm like, who's taking care of the people who are supposed to be sleeping with the people that we're giving Viagra to, Right?
Interviewer / Co-host
So it's like, who's. Who is talking to the women? I was listening to one of your podcasts and you said when a man would come in and say, I need Viagra, sometimes he would bring his partner, but no one would turn to her and be like, do you want him to have that Viagra? Like, what's happening in for you? Is sex pleasurable? Are you in pain? Like, what's happening with your libido? Like, no one asked women the same questions. And so you're telling me. Because you weren't taught that you were supposed to, because that was the work. That was like, the terrain of the gynecologist.
Dr. Kelly Casperson
Gynecologists are taking care of them. And, I mean, I don't blame the urologist, because it's like, do you take care of the patient in front of you? Right? But now that I'm wiser and smarter and an expert and. And I understand how many women are having incredibly mediocre sex, right? So a guy comes in for Viagra, and I'm like, what's your plan? And he's like, I don't know. And I'm like, so you're here for a Viagra prescription, and you don't know what your plan for a harder penis is? And he's like, I haven't talked to my wife about it. We haven't had sex in eight years. And I'm like, do you think walking into the bedroom with a hard dick tonight is gonna solve all your problems? Like, it's like. It's so funny to me. It's a tragic story for them. But, like, to me, I'm like, oh, my God, he has no idea. He thinks this is the answer, right? And so now I do ask. And I. I thought, like, some guys didn't. Wouldn't have. 90 to 95% of guys have not talked to their partner that they were going to go get Viagra that day.
Interviewer / Co-host
And what they thought about it. So this light bulb goes off, and you're like. So do you start then asking women who come to your practice, like, what's going on with their sex life or what happens next?
Dr. Kelly Casperson
No, because I didn't know anything, so I had to learn everything first. So I'm like, you know, started reading the book, started reading the journals, started just, like, going to the conferences. Like, really started understanding, like, arousal, desire, genital urinary syndrome of menopause, or orgasmic inequality. Like, vagina is not the organ of orgasm. The clitoris is Right. Like, all of this, just all of the things. And then about a year into that, you know, then I started talking to people and helping them out and, like, just saying, like, hey, I care. And a voice in my head was like, you need to talk. And I'm like, that's really annoying. But the voice would be there like you need to talk, you need to talk. And I really liked podcasts and so I'm like, okay, I'll start podcasts. So five years ago I started a podcast and the voice got quiet.
Interviewer / Co-host
Mmm.
Reshma Sajani
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Podcast Host (Midlife Crisis)
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Interviewer / Co-host
It takes the fear out of talking.
Podcast Host (Midlife Crisis)
About money by letting you listen in on real, unfiltered conversations between people asking big financial questions and the advisors who help them figure it out. It's smart, it's emotional, and it just might make you feel braver about your own money story. I just listened to the episode about the price tag of parenthood on what Should I Do with my Money? And it hit me hard. Every parent I know is doing the same math. How do we give our kids the best without burning ourselves out? This conversation lays it all out. It's smart, it's relatable, and it reminds us that financial planning is part of caregiving. Definitely worth a listen. Search for what Should I Do with My Money? In your podcast player. We'll also include a link in the show Notes. Thank you to what Should I Do with My Money? And Morgan Stanley for their support.
Reshma Sajani
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Interviewer / Co-host
Entertainment are taken care of.
Reshma Sajani
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Interviewer / Co-host
Book now and use code midlife for.
Reshma Sajani
$250 off new reservations.
Interviewer / Co-host
I think a lot of women don't know, so I want you to tell me the basics. I want you tell our community the basics. Let's start with what is a libido?
Dr. Kelly Casperson
Libido traditionally means sex drive. Freud kind of coined the term. It's. It's described as this is a really awesome word. Appetitive. Appetitive means appetite. Like right? So Freud described libido as an appetitive thing like hunger, thirst, sleep. The only difference is if you don't have those three things, you want them more. If you don't have sex, you don't. Often some people will be like I do but sleep. Most people won't want it more the less you have it. So it's not an appetitive drive. In many people But Hollywood portrays sex as spontaneous desire. We kind of get taught that sex is spontaneous desire. There's a lot of spontaneous desire happening when our hormones are through the roof in teenage years. New relationships to the brain. The brain thinks a new relationship ends around 6 to 12 months. So. And what that means is like, you know the person, you know how they're like, you just, you get habituated.
Interviewer / Co-host
So that's. Is that your brain? When you're like married to someone for seven years and you're no longer really have desire, is that your brain saying, okay, that's why?
Dr. Kelly Casperson
Yeah, I bet if you put yourself in the right context, you would have desire for something. It just might not be the thing you know, you know everything about. That's just the way the brain works. But people don't know this because we didn't get any sex education. We got a disease and pregnancy prevention plan, if you were lucky.
Interviewer / Co-host
So when women are coming to you and they're saying, I don't have desire or it's painful, what is going on? So if everyone's, if people are listening, like what is going on for many of them, if they're sitting and they're having kind of a mediocre to no sex life.
Dr. Kelly Casperson
Yeah, Well, I mean, first of all, libido is very complicated. Desire is complicated. Humans are complicated. Right? So sex is biopsychosocial, meaning it's biologic. It can be your hormones, it can be your body. Do you have a sore back? You know you're not going to desire sex if you're, Are you a shift worker and you've got, have you have a newborn at home? Right. So it's like what's going on with your body affects it and then your relationship and then society. What does society say about women who like sex? We give them bad names, don't we? So here we are not supposed to want sex until you get married. Then you're supposed to want it all the time. And so you're broken no matter what.
Interviewer / Co-host
Got it.
Dr. Kelly Casperson
Right. So that's society also not serving us. So biopsychosocial. But, you know, common. There's, I mean, there's lots of common things. Common women have responsive sexual desire. What that means is when you're at your job, you're not thinking about getting laid. But if you put yourself in a sexual context, things are looking good. You're nice and relaxed. Maybe you've got a nice full tummy, whatever, you're like, oh, maybe sex. Or maybe you start into the act and then you like it. Or maybe you have a great act and then afterwards, that's where your desire is. It's like, oh, my God, I love that. Isn't that so good? I forget about that. Let's do that again sometime soon. You're desiring it after it happened, right? So this whole, like, stereotypical dogma that desire must come first or sex doesn't happen is completely wrong and only explains like a narrow amount of people.
Interviewer / Co-host
What about women in midlife? Do hormones. Does our aging change that?
Dr. Kelly Casperson
It can. It can. For, for a lot of people in midlife, sex is now freedom. You don't have to worry about getting pregnant, right? Kids might be out of the house. So you have a lot more time on your hands. You give a lot less Fs about anything, and you're more there to be like, I want to connect, I want to feel good. So it's this myth that the best sex is in your 20s. There's, you know, there's this great book called Magnificent Sex by Peggy Klein Platz. And like, these are not young people. Like people are having the best sex of their lives. 50s, 60s, 70s. And again, it's a. What does society tell us? Society tells us that only certain people are allowed to have sex. So we don'. Have in our mind that the 70 year olds are having a really great time. Now they might need Viagra. They certainly. I hope they're on vaginal estrogen, right? I hope they're using lube. So we might have to help ourselves out because our bodies do change, but they're. The myth that older people aren't sexually active is a myth.
Interviewer / Co-host
Have you seen Baby Girl?
Dr. Kelly Casperson
I haven't seen it yet.
Interviewer / Co-host
Okay, so I won't ruin it for you, but I want to just throw it up because I saw it last week with my girlfriends and it opened up this entire conversation about sex and desire, right? So in the movie, Nicole Kidman has an affair with an intern. And her kind of fantasy, I hope I'm ruining it for you, but I have to ask you this question. Okay, so her fantasy, right, is to be dominated, right? She has some BDSM fantasies. And the movie kind of portrays it as something that she's always been ashamed of and she kind of should be ashamed of. And so I thought that was interesting, right? This idea that a woman over 50 having desire, that there's something wrong with that, that there's something to be ashamed of. And I think the other thing that the movie sparked for many women was that, wow, like, we don't talk to each Other about sex. Like, even though most women are probably struggling with their libido or discomfort, or maybe they have a bigger sexual appetite, their partner, they think they're the only one.
Podcast Host (Midlife Crisis)
Right.
Interviewer / Co-host
It's not a conversation that we're having out and open. Even with our best friends.
Dr. Kelly Casperson
Even with your sexual partner.
Interviewer / Co-host
Even with your sexual partner. And maybe it's not even gendered. Right. Because men are doing the same thing. What is that about?
Dr. Kelly Casperson
It's just so shameful. I mean, we know we traditionally in America, it's better than some countries, but it's a pretty puritanical place. You know, there's this big fear that if we teach people about sex, then like, you know, the 17 year olds are going to go crazy and the data doesn't actually support that. But we don't get sex education. We don't get the tools. We don't know how to communicate about hard things. Right. Like, we don't get taught how to talk about it. And I would say a large amount of people's sexual issues in midlife is because you've been limping along and, and then you're kind of doing like the repetitive Tuesday night buttered noodles meal. And then at some point you're just like, ugh, Right. And so people just need to learn how to talk about it. Like my, you know, my book again is, it's called you are not broken. Stop shooting all over your sex life. Because we just take all these shoulds, right? You shouldn't have fantasies. If you have fantasies, it shouldn't be bdsm. If you're a powerful, high powered woman, you shouldn't want to be dominated. Those are all wrong.
Reshma Sajani
Yeah, that feels like the social and.
Interviewer / Co-host
The psychological parts that you've been, you were talking about, like, how do we change that as a culture?
Dr. Kelly Casperson
Start talking, you know, have people like me on your podcast. Right? Yeah, it's like, because the, the, the funny thing is as soon as you like, make it safe to talk about, everybody wants to talk about it, right? Like it's, it's in everybody's life. Our society uses it to sell hamburgers and cars, right? Like sex is literally everywhere. Sex is everywhere.
Interviewer / Co-host
Well, I think the problem with women or at this age or actually at any age is I would say after marriage is like, you don't want to talk about it because you think that you're not having enough and that then your friends will judge you right there. It's that same kind of comparison issue. And you don't want to be like, oh, if we're only having sex once a month. That there's something broken about my marriage. I think there's all that judgment piece is big too huge.
Dr. Kelly Casperson
And the again the myth that a you should be having sex a certain amount of times. Like who made that up? Right? And, and yeah. Is it not quality versus quantity for many people? So yeah, like it's, you know we were talking about earlier is like you get to a point where you realize it's all made up, my friend.
Podcast Host (Midlife Crisis)
Wow.
Interviewer / Co-host
It's all a con. And is it really just made up for women or for men too?
Dr. Kelly Casperson
No, Men. Men are also suffering in our shame filled silent society. Their stereotypes include are not limited to, but include that they should dominate. That their penis should always be hard and be without fail and never go soft. That their sexual desire should be higher than their female partner's sexual desire. That they should want sex all the time. Right. Those are all mess that are again are untrue and really make men feel not manly. Right. Because they're comparing it like this is the definition of a man.
Interviewer / Co-host
Right.
Dr. Kelly Casperson
And they don't feel like they live up to that. And then you realize like, no, that's all made up too.
Podcast Host (Midlife Crisis)
That's made up.
Interviewer / Co-host
You're being con too.
Dr. Kelly Casperson
Yeah, that's some people some time in your life. But not all people for all the time in their life.
Reshma Sajani
Foreign.
Julia Louis Dreyfus
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Dr. Kelly Casperson
But I'm not alone.
Julia Louis Dreyfus
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Sponsor Voice / Ad Reader
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Dr. Kelly Casperson
In the world of public health, every.
Sponsor Voice / Ad Reader
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Reshma Sajani
Foreign.
Interviewer / Co-host
So what advice do you have for women who are trying in their midlife to improve their sex life? Like, what's the first? What's 1, 2, 3? What are the first three steps?
Dr. Kelly Casperson
Lube? Communicate. My book, like, my book is Saved Marriages. It's ended one marriage because it was it. And I say, I say it jokingly because it was a man mant me. He's like, thank you for your book. It ended my marriage. And I'm like, what? And he's like, I realized that I was worthy of love and I wasn't going to get it where I was. And it was like the most beautiful thing.
Reshma Sajani
Wow.
Dr. Kelly Casperson
So I do my disclaimer is the book, to my knowledge, has ended one relationship. But it's, it's helped. I mean, everybody's like, we just didn't get sex education.
Interviewer / Co-host
No, we did.
Dr. Kelly Casperson
How to communicate about it, how to prioritize your pleasure. People are like, I don't desire sex. And I'm like, do you, do you like the sex you're having? And they're like, no, I could take it or leave it. And I'm like, so you're beating yourself up about not desiring mushy broccoli, right? Like, you gotta change the mushy broccoli.
Interviewer / Co-host
It's so true.
Reshma Sajani
I want to talk about hormones.
Interviewer / Co-host
One of the interviews I was listening to with you, Kelly, you said, you know, the mistake that we made was gendering hormones, that right now any man walking down the street in New York City probably has more progesterone than me right now at like 49. Like, what did you mean by that about gendering hormones?
Dr. Kelly Casperson
Well, when they discovered. So, you know, we had to discover these things. So we discovered them and we discovered estrogen first in ovaries and we discovered testosterone first in testicles. Those are the other things in our bodies make these hormones. But those organs, like really make a lot of these hormones. And so we discovered them and was like, oh, male and female, boom, there it is, right? And then we keep forgetting, like we've, we've been giving women testosterone since the 1940s, right? Like men have more estrogen in their body than a post menopausal woman. If you take a man and you block his estrogen, his libido goes down. Estrogen is incredibly important for a man's sex drive. So it's like we keep forgetting all of these things. Like, we want it easy, we want it black and white, we want, do we want testosterone to work for everybody's libido? And it doesn't. But in engendering things, we, we, we keep the conversation too simple.
Interviewer / Co-host
So what are the basics, right? Because again, I think there's a perception.
Reshma Sajani
I had a perception, right, that we.
Interviewer / Co-host
Have three hormones, but we have hundreds of hormones.
Reshma Sajani
If you were going to.
Dr. Kelly Casperson
Hundreds of hormones. Vitamin D is a hormone in our body, right? Like we have hundreds of hormones. I, as far as the sex hormones, and I hate the term sex hormones because it takes away the fact that it helps your bones, your muscles, your brain, your heart, all the things. But they call them sex hormones again, because we discovered them in testicles and ovaries, right? But 3, 4 if you want to count DHEA, which is more of an adrenal hormone, but three commercially available products that we can purchase and use. And so we kind of dumb it down to 3. Testosterone, estrogen and progesterone.
Reshma Sajani
And every person has different levels of.
Interviewer / Co-host
Each of those hormones, right? Every person's different.
Dr. Kelly Casperson
Well, on any, on any given day, I mean, you have, you have in one month, if you're menstruating, you have like 30 different days of different hormone levels.
Interviewer / Co-host
So then what happens in perimenopause for people? So people at a certain age, what happens?
Dr. Kelly Casperson
Yeah, so perimenopause is like the big, the big black box that like you're, it's, you're hard pressed to find doctors who like, believe that it's real. And it's like, I don't care what you believe. It's real. It's like saying puberty is not real is like, puberty is a time that the, the gonads start producing more hormones and like get online and your periods are wonky and your moods are crazy and your skin's nuts and it's like this crazy fluctuating. Getting online, right? Then you stay online for a while. But I mean, by that is a regular period. And then perimenopause, Perry, just means surrounding. So usually means the time before menopause. There's no test for it, so you don't really know. Except for, like, age is a decent ballpark. It can be late 30s, certainly in your 40s. You're in perimenopause whether you feel anything or not. But the ovary is sputtering in its ability to put out eggs.
Podcast Host (Midlife Crisis)
Okay?
Dr. Kelly Casperson
And so in. In sputtering, it wants to slam more hormones in to try to get an egg out. And that's why, you know, you lose your fertility early 40s, it's very hard to get pregnant, right? So we're losing our fertility, but you still have periods for years afterwards, Right. People are like, I'm 54. I'm still having periods. But it's like, you couldn't have gotten pregnant even five years ago. But in perimenopause, you can spit out periods, but they aren't always associated with an egg release or ovulation. So that's why they're wonky, they're spaced out, they're super heavy, they're super light. Is because that. That ovary spitting out an egg in the period, it's starting to become. It's starting to go offline. And that's why the hormone spikes super high, super low. And that's why a lot of the experts are like, don't check your labs on Tuesday and think that that's how you are. That's just how you are on Tuesday.
Reshma Sajani
So then how are you supposed to.
Interviewer / Co-host
Know what, like, if you're doing hrt, Like, I'm taking testosterone right now. It's really improved. I mean, I was like, a bitch on wheels. Took some testosterone. It's game changer, right?
Reshma Sajani
Cause I was like, why am I.
Interviewer / Co-host
So mad all the fucking time? Like, what?
Reshma Sajani
Like.
Interviewer / Co-host
And it really helped me.
Dr. Kelly Casperson
I'm really glad that you bring that up, because going of a woman going to a doctor and saying, I'm mad. We are not going to admit that women are not. And I have a story about that. A woman came in with bladder leakage. Started around bladder leakage, and she was like, you know, in late 40s, I was. So I. And I ask everybody about hormones now, because I'm Kelly Casperson, and I'm like, you know, what's going on? And she's like, oh, yeah, really hot flashes, night sweats, blah, blah, blah. So I threw on an estrogen patch, saw her back, fixed her bladder leakage. And I'm like, oh, how's the estrogen patch going? And she's like, I have to thank you, you fixed my rage. But she would have never come in and said, I have rage. And to the average person, if you go in and you tell your doctor you have rage, are they going to think about hormones as the first thing? I would guess I would wager some good money that they would not.
Podcast Host (Midlife Crisis)
Yeah.
Dr. Kelly Casperson
And so hormones are incredibly important. That's why I hate that they're called sex hormones because these are brain neurochemicals.
Reshma Sajani
So when you said that, like we're.
Interviewer / Co-host
Fluctuating all the time and how do.
Podcast Host (Midlife Crisis)
You know which hormone to take and how much?
Dr. Kelly Casperson
Again, everybody's different. And that's why you have to see it, see an expert for your own thing. But stereotypically, testosterone starts declining in women after your 20s. It's a much more linear decline. We don't know why, but there's no cliff that, you know, you don't fall off a cliff at menopause with your testosterone. So slow decline. Um, and then progesterone tends to go down before estrogen does. And so the perimenopause experts will usually start with progesterone and testosterone. Cuz especially in perimenopause, if you're having those high spikes again, trying to push out the egg, your estering can go really high sometimes. It's called a loop cycle. Breast tenderness, moodiness, stuff like that. So you tend not to start with estrogen in perimenopause. But I just talked to a woman, I'm like, what's bothering you? You know, and if she tells me what's bothering her, I can usually decide what I want to start first.
Interviewer / Co-host
Now, why hasn't the FDA approved testosterone for women? Because like, I got some, but I had to find a way.
Dr. Kelly Casperson
Yeah, yeah, yeah. This is, this is one of the other big pushes is in changing the world is an FDA approved female testosterone. It's going to come. I think it's, I think it's three years away. Again, this is like my gut. So the Women's Health Initiative was the big study that scared the whole world and said that estrogen causes cancer and estrogen. Just to follow up on that, if anybody's living under a rock, estrogen doesn't cause cancer. Women's Health Initiative, all has been walked back, but the damage was done. The genie went up, genie went out of the bottle. Couldn't get it back in still 22 years later, we still haven't fully gotten it back in the bottle. That was 2002. Women's testosterone product went up to the FDA right after that, like, 04 or something like that. And so when they pushed to get it done, it was like too soon. Hormones could not be trusted. And so they said, we don't have enough safety data. Now, just as a thought experiment, what if we gave you 10 times the dose of any drug, but let's say it's testosterone? What if we gave you 10 times the dose because you asked for it and then we followed you for 50 years and you didn't die sooner? We have decades of trans male data. Decades of trans. The, the UK published a 50 year study looking at trans men. This is 10 times the female testosterone dose. There's not any other drug where we could be like, we've got 10 times the safety data for five decades. That's how safe testosterone is.
Interviewer / Co-host
But do you think the reason why the FDA is holding back approval is because we've gendered these hormones and we feel like that, that, that is supposed.
Podcast Host (Midlife Crisis)
To be for men.
Interviewer / Co-host
Why would we have to approve that for women?
Dr. Kelly Casperson
Yeah, I mean, listen, the FDA shouldn't be stupid. I, again, I didn't learn this in med school, many people didn't. But women have four times the amount of testosterone than estrogen in their body.
Interviewer / Co-host
And I don't think people, I don't think people know that.
Dr. Kelly Casperson
People don't know that. So, yeah, we gendered it. We said this because this is the pink one and this is the blue one. But it's like the FDA is not dumb. I, I don't think it's because the FDA doesn't know that testosterone is not in women's bodies. It's because the bar for safety for women is much higher than the bar for safety for men. Why? Testosterone got approved for men with six months safety data. Viagra got approved for men with, I'm pretty sure, six months safety data. We've got multiple year safety data in women and testosterone and we've got efficacy data and we still don't have a product. So, number one, the bar for our safety is so much higher that nobody gets anything because it might hurt one person. And we don't think that way in men.
Interviewer / Co-host
Do you think it's better because they want to control us?
Reshma Sajani
I don't know.
Interviewer / Co-host
Part of me feels like you just want me to feel like in a raging. Right, like, so it's like, it's like something like 15 of women above 50 have left their Jobs because of menopause systems. It's huge.
Dr. Kelly Casperson
I have heard, I have heard from a friend that somebody within the FDA said, what do we need a bunch of horny women walking around for? So there is that attitude embedded in.
Interviewer / Co-host
Exactly, yeah.
Dr. Kelly Casperson
And then the other problem is testosterone is a natural occurring hormone that is very cheap.
Reshma Sajani
Right.
Dr. Kelly Casperson
Testosterone's cheap. In order to get 5 year safety data to do that study to go to the FDA and then only be able to sell it for pennies, that's not a business plan for anybody. So, yeah, we. Oh. The other problem with testosterone, real quick is that it is a DEA Class 3 medication. It is categorized like ketamine and Tylenol with codeine because of the Anti Doping act passed by Congress in 1990 because of the Olympic doping scandals of the 80s. So with the other thing we've done with testosterone is we've made people feel it's very safe. It must be addictive if it's scheduled like ketamine is.
Podcast Host (Midlife Crisis)
Right.
Dr. Kelly Casperson
But that limits our access to getting it and perpetuates the myth that it's dangerous.
Interviewer / Co-host
So how do women get testosterone right now?
Dr. Kelly Casperson
Good question. You can get. Everything's off label in America. Australia has an approved female testosterone dose. It's called Androfem. It's coming to the UK and South Africa as well. So it exists in countries where you can actually get this. By the way, testosterone's over the counter in Mexico. You can buy it at the airport. Remember, going back to. Everything's made up, my friends. You can get it in pellets, you can get it injected. You can use a male dose and just dose 1/10. You can compound a cream.
Interviewer / Co-host
I have a cream. That's what I.
Dr. Kelly Casperson
My practice. Compounded cream. Easy to dose, hard to get, too high of a dose. Cheap. Idiot proof.
Interviewer / Co-host
Yeah, idiot proof me.
Dr. Kelly Casperson
Yeah, it's nice.
Interviewer / Co-host
I do think that what I, I'll, I will say it like I'm. I was a little nervous, right. So I'm not doing the dosage I'm supposed to. I'm doing a little bit less. But I notice that when I do it, I feel it's literally my husband's like, what happened to you today? Like, I am a different person.
Dr. Kelly Casperson
The hormones are important. So you give women testosterone and they come back and you check their levels and you make sure they're not having side effects. The things they say. And it's this quality of life, it's this feeling like myself. It's this stuff you can't measure. It's the My glasses on my face don't feel as heavy. I actually like people. Again, humans are attractive.
Interviewer / Co-host
I don't, like, lose my at the slightest, like, thing.
Dr. Kelly Casperson
I don't lose my somebody, somebody. One of the women told me, you know that part in the wizard of Oz where it goes from black and white to Technicolor?
Interviewer / Co-host
Yes.
Dr. Kelly Casperson
That's my brain on testosterone.
Interviewer / Co-host
What's the most powerful information you've learned that you think a woman needs to change her midlife experience?
Dr. Kelly Casperson
Oh, orgasms are easy if you know how to have them.
Interviewer / Co-host
Ah, tell us more, Kelly.
Dr. Kelly Casperson
Well, it's, you know, especially again, if you look at the heteronormative when. When partnered with a male, she. She will take longer to orgasm, but when she masturbates, she takes just as long as a man takes to masturbate. But society says they're difficult, they're challenging, they're hard. Like, you know, society put all this on, like, oh, it must be very hard. And it's like, well, yeah, if you rub a guy's scrotum, it might be harder for him to have an orgasm. Meaning if you put something in a woman's vagina, it might be hard to orgasm, but if you focus on the organ of pleasure, which is the clitoris, it's actually pretty easy. Given what a woman needs to be successful to orgasm is her own body knowledge combined with her sharing that knowledge with her partner and that combo is orgasmic success for women.
Interviewer / Co-host
So how do we change the lack of information about women's health?
Dr. Kelly Casperson
Like, things like your podcast, like podcasts are incredibly powerful podcasts, books, speaking to senators, writing to the fda. Like, it's grassroots. If I think of it, think of the AIDS epidemic, because this is how I remain optimistic. AIDS epidemic was devastating and nothing was really happening. Who changed it? The patients and the patients advocates changed AIDS health care for everybody. Same with it for, like, wait, for the doctors. Are you kidding me? They see 30 people a day.
Interviewer / Co-host
Yeah, they're exhausted.
Dr. Kelly Casperson
They're exhausted. They aren't curious. They're just trying to urinate once in their. In their day. Right. And so it's like, it. It's not going to come down from them. It's going to come from the people. And, and doctors will change because they'll say, God damn it, I had six women in my office this week asking me for. For hormones. I should probably figure out what this is about. That's how it changes it. The ship is turned by the ocean, not the ship.
Interviewer / Co-host
All right, well, you are the best. You are like my my favorite find of 2025.
Dr. Kelly Casperson
Well thanks for friends for sharing everybody.
Interviewer / Co-host
This was so awesome. Yeah, and just keep sending us all the amazing things that you're doing so we can just lift it up and share it with the community. But thank you so much Dr. Casperson.
Dr. Kelly Casperson
Oh thank you. Thanks for your amazing podcast.
Interviewer / Co-host
This was great.
Reshma Sajani
Doctor Caspersen is a urologist, podcast host and author. Her book and podcast are both called.
Podcast Host (Midlife Crisis)
You Are Not Broken.
Reshma Sajani
If you want more advice and information from Dr. Kasper Asperson, I highly recommend checking both of them out. Thanks so much for listening to my so Called Midlife. If you haven't yet, now's a great time to subscribe to Lemonada Premium. You'll get bonus content from episodes like this one where Dr. Caspersen and I talk about why hormones are so helpful for women outside of just libido. Check it out on Apple Podcasts and see you next time. Next week. I'm your host Reshma Sajani. Our producer is Claire Jones. Our Associate producer is Isaura Acevez. This series is sound designed by Ivan Kurayev. Ivan also composed our theme music and performed it with Ryan Jewell and Karen Waltock. Our senior Supervising Producer is Kristin Lepore and our Senior producer is Chrissy Pease. Our VP of New Content is Rachel Neal. Special thanks to our development team, Oha Lopez, Jamila Zara Williams and Alex McGowan. Executive producers include me, Reshma Sajani, Stephanie Whittles Wax, and Jessica Cordova Kramer. Series consulting and production support from Katie Cordova. Help others find our show by leaving a rating and writing a review and let us know how you're doing in Midlife. You can submit your story to be included in this show@speakpipe.com midlife follow my so Called Midlife wherever you get your podcasts or listen ad free on Amazon.
Interviewer / Co-host
Music with your prime membership.
Reshma Sajani
Thanks so much for listening. See you next week. Bye.
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Story Pirates is the number one podcast for kids and families in the world and the newest addition to the Lemonada Media Network. We take stories written by real kids and turn them into into sketch comedy and songs featuring professional actors, famous guests and original music. So get ready to light up your kids imaginations with a show that you will also enjoy. The Story Pirates Podcast new season coming November 6th.
My So-Called Midlife with Reshma Saujani
Episode Title: Revisit: You’re Not Broken, Your Sex Education Was Just Bad with Kelly Casperson
Date: November 26, 2025
Host: Reshma Saujani (Lemonada Media)
Guest: Dr. Kelly Casperson (Urologist, Podcast Host, Author of "You Are Not Broken")
This candid and empowering episode takes on myths and shame around women's sexuality, especially in midlife. Host Reshma Saujani brings on Dr. Kelly Casperson—urologist, author, and sexual wellness advocate—to debunk persistent cultural and medical narratives about libido, sex, hormones, and gender. Together, they explore why so many women feel “broken” about their changing desires and bodies, and what can be done to reclaim sexual satisfaction and self-confidence at any age.
“You're not broken. You can have good sex. In fact, you can have the best sex of your life in midlife.”
– Reshma Sajani summarizing Dr. Casperson’s message (02:13)
“The rules are all made up, and you can do whatever you want to do. Once you truly believe that, watch out: your life can change.”
– Dr. Kelly Casperson (06:19)
“We didn’t get any sex education. We got a disease and pregnancy prevention plan, if you were lucky.”
– Dr. Kelly Casperson (19:48)
“In perimenopause, if you’re having those high spikes again… your estrogen can go really high sometimes... So you tend not to start with estrogen in perimenopause.”
– Dr. Kelly Casperson (36:27)
“We’ve got multiple year safety data in women and testosterone and we still don’t have a product… The bar for safety for women is much higher than for men.”
– Dr. Kelly Casperson (39:26)
This episode is a lively, irreverent, and truth-telling journey through topics many women (and men) have been taught to avoid. Dr. Kelly Casperson’s expertise and enthusiasm empower women to shed shame, communicate openly, challenge outdated rules, and embrace midlife sexuality as something to be celebrated—not feared or silenced. Reshma Sajani’s honest curiosity and vulnerability make the conversation relatable and actionable.
If you’re grappling with midlife dissatisfaction, taboo feelings about sex, or questions about hormones and health, this is an episode to listen to—and share with the women in your life.