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The Neuro Experience
Why Testosterone is the Missing Link in Women’s Health | ft. Dr. Kelly Casperson
01:20:13
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- [00:00]
A
We have these two waves that are going to crash. We have this millennial wave that says we don't want to suffer, we don't want the glucose metabolism to go bad, we don't want our bones to thin, we don't want to be headed towards dementia. And you've got the big wave of the medical system saying we'll treat you when you're suffering.
- [00:14]
B
Exactly.
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A
And it's like those two waves are going to hit each other.
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B
And I hope it does.
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A
And we're here for it.
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B
Joining me today is Dr. Kelly Kasperson. You are the woman who I think has normalized testosterone for women.
- [00:24]
A
I hope I have. We have a lot of work to do.
- [00:26]
B
For nearly a century, testosterone has been studied, prescribed and celebrated as the hormone that keeps men strong, sharp and vital.
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A
Urologists technically, stereotypically take care of the men, forgetting that 50% of the humans also have pelvises.
- [00:40]
B
Yet when women lose testosterone, something that happens to every single woman if she lives long enough, we're told it's just about sex drive.
- [00:48]
A
Libido does not exist in isolation in our life or in our body. To pigeonhole testosterone, to say it works in this 1 square centimeter of the brain where the libido is, is actually insane. And understanding the brain very well and not understanding what libido is, which is a mood and motivation. I want to speak on behalf of the American women.
- [01:06]
B
Why?
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A
Because they're voiceless and they're suffering. And I think people in power don't know.
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B
This is a political failure that has harmed millions upon millions of women's brains, bodies and futures.
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A
The level of risk that's acceptable between the genders is different.
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B
So you would say that there's a lot of discrimination then?
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A
I think so.
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B
The world isn't built for, for females to thrive. We're denied access to safe FDA approved treatments, forced into microdose male products, pay cash for pellets or simply go without.
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A
When I went to the fda, I said do not get this indicated for low sex drive. I want it indicated for the exact same reason that men have it indicated for, which is hypogonadism, which means low hormones.
- [01:48]
B
This is not medicine, this is negligence. But what's a marker of health in women? Is it libido related?
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A
I don't think we have enough data.
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B
It's infuriating.
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A
It's madness.
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B
I'm Louisa Nicola and this is the neuro experience. Dr. Kelly Kasperson, welcome to the show.
- [02:04]
A
Thanks for having me.
- [02:04]
B
You're a board certified urologist, You're a New York Times bestselling author of two books, one which has just gone out, which I am absolutely obsessed with.
- [02:14]
A
Thank you.
- [02:15]
B
And not just that. You. You are the woman who I think has normalized testosterone for women.
- [02:21]
A
I hope I have. We have a lot of work to do.
- [02:22]
B
We have a lot of work to do. So we've got this huge menopause moment right now. Many people are speaking about it. There's books coming out. There's this group called the menopausy, and we've got a lot of friends involved in that. But I think. What's the missing link? You know, we hear a lot about estrogen progesterone, and we've heard a lot about it on the podcast. We haven't heard a lot about testosterone. So let me just first ask urology. What is that?
- [02:48]
A
So urology is a surgical subspecialty of the genital urinary organs. So kidneys, bladder, scrotum, penis, urethra, vulva. And I got into it. Urologists technically stereotypically take care of the men, forgetting that 50% of the humans also have pelvises that have genital urinary structures. But we're kind of the classic Viagra, male testosterone experts. Viagra was approved in 1998. It's been around forever. We have about 12 testosterone products on the market currently for men. So I really came into this menopause, first of all, because of my obsession with female sexual health, because I had a patient that changed my life because she was crying in the, in the clinic because of her sexless marriage. And I realized I didn't know how to help her. And so I did a deep dive into female sexual health. Really kind of talk a lot about adult sex ed, right? Like, we all got, if we were lucky, a disease and pregnancy prevention plan, but not adult sex ed. Of how do you do this long term, possibly with a long term partner. So Deep Dove started the podcast, did the first book, and I always joke that sex got me into menopause. And the reason is everybody kept saying, well, you know what happens to your sex life with menopause? And I'm like, I don't. So I just kept peeling the layers of that onion. And I'm very comfortable with men taking testosterone, trans men taking testosterone. So this idea of just replacing what the ovaries naturally made in women, it's 1/10 the dose. That doesn't scare me. Right? And I see the insane gender bias because I'm a urologist, I take care of the men. So if A man comes in and for whatever reason, he needs his testicles removed for cancer, it would be malpractice to not give him testosterone back. After we removed the gonads that produced testosterone. To the best of our knowledge, the UK has better data than America. After a woman has her ovaries removed.
- [04:37]
B
Hysterectomy.
- [04:38]
A
Hysterectomy. With the ovaries removed, about 5% get hormone replacement therapy. And I didn't know this in medical school either. The ovaries make testosterone. It's part of the cholesterol pathway of which you make estradiol. You can't make estradiol without making testosterone. Nobody knows that we gender biased these hormones. We said the man has testosterone, the female has estradiol, end of story. And in fact, men have estradiol, women have testosterone, they're just in different amounts.
- [05:06]
B
And don't women have. What's the. We've got way more testosterone than estrogen.
- [05:11]
A
Four times.
- [05:11]
B
Four times as much. Yeah, that's. This is. Okay. This, this episode is going to be wild to me and I'm so excited to get into this with you. So let's first start about why something that you just mentioned. FDA approved. So if women live long enough, they're going to go through menopause, which is the loss of all of these hormones, including testosterone. Men have had an FDA approved Testosterone for almost 90 years.
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A
Probably. Yeah.
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B
Women in 2025 still don't have a single FDA approved dose in the United States. Obviously that doesn't feel like nuance. It actually feels like some sort of scary story.
- [05:47]
A
Yeah, I mean, it's gender bias. Gender bias 101. Combined with the fact that these hormones are naturally occurring and not patentable, therefore they're generic, they're cheap. It's hard for a company to make a ton of money off of these. Right. You'd have to kind of patent the delivery device or something like that. So not a lot of motivation to come out with a product. But male testosterone got approved with six month safety data. Viagra got approved with six month safety data. We've been giving women Testosterone for about 80 years at this point. But there was a patch that went up for approval and it had over four years safety data and did not get approved. The unfortunate thing about that is it went up for approval right after the WHI hit. So for people who don't know, that was the landmark study that was misinterpreted by the media and caused basically a massive scare about the risks of hormone therapy, which have been completely Walked back at this point. But it was an unfortunate. We have tons of safety data. But it went up right after that big scare.
- [06:43]
B
The WHI was not. It was just. It was synthetic estrogen and progesterone. There was no involvement of testosterone around that time. And now we know that we have bioidentical hormones, estradiol.
- [06:56]
A
So. Yeah. So the who, you're exactly right. It was one dose of an oral synthetic medication which we don't even use anymore with hrt. But when people say hrt, they assume and they think estrogen. Right. So we're kind of trying to rebrand it like pet therapy. Pet for progesterone, estrogen, testosterone. Because it just makes. It opens up the conversation. Especially when a woman's like, I was told I can't take hormones. It's like hormones is actually a massive tent.
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B
Right.
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A
There's so many things under there. And kind of reframing that estrogen gets the spotlight. But that's not all of hormone therapy options.
- [07:30]
B
Yeah. It's the sex differences that exist also in neurology. And we know that with dementia and Alzheimer's disease, which we'll get to. But let's actually talk about hormones. I think they're so misunderstood. I mean, you know, medical specialties are so interesting because you go into endocrinology, you go into urology, you go into ob, but you have to know across the board everything. You have to kind of become board certified in five specialties. Right. Just to look after a woman. So I describe hormones as kids because they never go anywhere without something else.
- [08:02]
C
Right.
- [08:02]
B
So if you're going to. Unless it's sex hormone binding globulin, you know, like you mentioned, if you're going to raise testosterone, it's going to aromatize and go into estrogen. So let's just talk about testosterone for women. Like where is it released? You said in the ovaries.
- [08:17]
A
Yeah, ovaries. And there's some testosterone metabolites that come from the adrenal glands, but by and large it's ovaries. But we do have some adrenal production and then we do have some end organ tissue conversion. So it's kind of all over, but the ovary is the lion's share. And I just want to go back to this because I think this is a common myth that if I give you testosterone, it's going to convert to estrogen and that's why it's working or that's why it might be unsafe. That is not true. In multiple studies, they actually give Women testosterone, they check their estradiol and testosterone. Testosterone goes up, estradiol stays the same. And that's important. Right. We have four times the amount of testosterone than estradiol naturally. It doesn't all convert to estrogen. They've also done interesting studies where they give women testosterone, but they're on aromatase inhibitors, the breast cancer. Right. So they on purpose can't convert to estradiol and their symptoms get better, thus disproving that the only reason you're feeling better on testosterone is because we're just converting to estradiol, and that's how it's working. It's not true. We have testosterone receptors everywhere. And those women felt better because of the testosterone.
- [09:21]
B
What's not clear to me is when you look at, let's just say, optimization, right? You want to go natural first and you think about optimization. Even for a man of testosterone. We're thinking sunlight, sleep, stress less and muscle mass or. Or resistance training.
- [09:38]
A
And don't drink alcohol.
- [09:39]
B
Yes, evidently. So naturally, as we get older, we obviously going to lose testosterone, but we can also see low testosterone. You know, you and I were speaking offline about testosterone being a receptor hormone. So I'm not in perimenopause yet, but I had a low testosterone reading. But then I think I went back and I was freaking out. I think I went back like two months later, and then it was higher. I was less stressed. But when I got it tested, I was stressed. I was flying to Australia. It was winter in New York City. So what's not clear to me is let's just say a woman 35 years old, and let's just even say 45 years old. How do you know if her testosterone is low because of perimenopause or just because she's stressed?
- [10:20]
A
It could be either. You know, science and medicine, we don't have. It'd be great to have a test to be like, you're 80% stressed, 20%, you know, low ovarian function. That would be ideal. We don't have that. Right. So it's really holistically looking at her. What's your life like? Right. And we see this a lot. You know, men in testosterone are just so much farther ahead than women, but we can use them to say, what are we doing over here? And thinking about how we can use that with women. So a guy comes in, he can't lose the weight, he can't put on muscles, he's exhausted. He hits a wall at 3pm you check his testosterone, and it's low. Well, you could say the same for a woman, right? And you're like, well, let's optimize all these things. Stop drinking, you know, start sleeping regularly, get your circadian rhythms back. But what we find is a guy, you just raise the testosterone a little bit with some medications, and he's like, I finally can get to the gym. I finally do feel like eating right. I finally do feel like. So it's like you don't have to do. You don't have to exhaust one option before starting another option. And it often get. Kind of gets the guy off the ground enough where he then is motivated to do the lifestyle changes. So it's really a newer way of thinking of, like, exhaust all the natural lifestyle changes first. Of like, no, let's do it all at the same time, because ultimately we want you to feel better.
- [11:33]
B
Okay, so testosterone in the ovaries, it's released at puberty, I guess. And then what role does it play?
- [11:41]
A
Yeah.
- [11:42]
B
So in women, specifically.
- [11:43]
A
So going back to what do hormones do? Right. I love the kids analogy. I say when I explain what hormones do, they're bricks. You need bricks to build a house. It's not a home. Other things create the home, right? Your social environment, your sleep, your food, your exercise, your lifestyle, that creates your home. But bricks build the house. If the bricks are falling down, it's hard to have a home. Right. So they're foundational. They simply help cells be healthy. Their mitochondrial importance. Right. And so in thinking of how society stereotypes testosterone, right, it's just for muscle or it's just for libido. That's not how cells work. It's not how the bodies work. We have testosterone receptors everywhere. It helps mitochondria function, it helps glial cells be healthy, which takes care of the neurons. Right. So it's like foundational to the functioning of your body, and receptors are everywhere.
- [12:35]
B
So you could say then this is a neurohormone.
- [12:37]
A
100%. Most. Most menopause experts are trying to get away from actually using the word menopause or sex. Certainly sex hormones is a horrible thing to call these things because then sex is extra. You're not reproducing anymore like, oh, that's just for sex. Of, like. No. It was discovered in rooster testicles and bull ovaries. And that's why it's called. They're called sex hormones, but they really are neuro hormones.
- [13:01]
B
Exactly. It's so ridiculous. And what I, you know, what I find fascinating that, you know, the number one predictor of health in Men is morning erections, right? Well, I mean, I don't know if that is that, is that.
- [13:11]
A
No, I, Yeah, I would say it's very true that erections are a marker of health.
- [13:15]
B
A marker of health. Not the one. Yeah, but what's a marker of health in women? Is it libido related?
- [13:20]
A
I don't think we have enough data. Right. And libido is so complex, right? That's, that's the problem with kind of stacking testosterone as libido of like you can have a normal testosterone and not want to have sex because your environment's awful, right. You're stressed or you're in a fight with your partner and you know. Right. So it's so complex. But clitoris get erections, Right. We're not oftentimes aware of them. Right. They're not as obvious as a male erection, but it's blood flow, Right? What's erection? It's blood flow. So for a female, it's also blood flow.
- [13:50]
B
Okay, so let's talk now. Now that we know that, what's the, what are some of the signs that a woman has low testosterone? Because in a man, as you mentioned, you raise the testosterone. And I'm guessing that what's 300 nanograms per deciliter is the, the low end of testosterone in men for the lab values. Lab values.
- [14:10]
A
Lab values. But normal doesn't mean optimal, especially in male testosterone. Well, female. Any testosterone lab. So male. And this is, these are American numbers. You know, the UK and Australia would have to convert. In America, we use nanograms per deciliter. So in men it's about 300 to 900. That is a very wide window. But that's what's considered normal. Right. So if a man can talk to a patient this week, her husband's 51, came in with a testosterone of 303. Doctor said that's normal. I'm not going to give you any testosterone. Insurance won't cover it because you have normal lab values. But 303 is the lowest 2% of all men. Right. So yes, it's normal in a lab value, but you're the lowest 2% of all men's testosterone. Right. And when you think of it that way, you can kind of back off because I think so many people, they just like take a lab value as God or like, you know the word, and it's like, no, you have to use that in combination of knowing the actual ranges. Lowest 2%, and he's symptomatic. You know, he hits a wall at 3pm he is gaining fat, he can't hang on to muscle, he has no sex drive. So it's symptoms plus lab values. And there is actually something in men also called age adjusted testosterone. So that's what I told her. She's like, what do I need to do to go to my doctor to get testosterone is you need to say age adjusted because that was kind of bumps up, especially as the man is younger, that a 70 year old is going to naturally have a lower testosterone than a 50 year old.
- [15:38]
B
And so the men feel lethargic, maybe gaining weight. But for a female, what's she feeling? Is she feeling the same things?
- [15:44]
A
Yeah. Tired, lack of motivation, low libido, feeling like, you know, I'm working really hard in the gym and I'm not seeing any gains.
- [15:53]
B
Not attracted to my husband.
- [15:54]
A
Not attracted. He's a great person. I love him very much and empirically he's very attractive. I just don't want to sleep with him. Yeah, yeah. And we have a great relationship. I just don't want to sleep with him. Right. So like checking all the other boxes that affect libido. But the problem with it because the hormones work, work in the whole body. Right. So low hormones, they're kind of very generic symptoms. Like how many things can cause low energy. Right. Like probably 50 things. Right. So there isn't this like one thing where you're like, that's testosterone. It's all complex. But medicines really try to, to make things binary and put things in boxes and it's like it's a human. We're not all that, you know, we can't be put in boxes. So I'd say symptoms combined with lab values.
- [16:35]
C
Yeah.
- [16:36]
A
But even in women the lab values, like you know, some labs, normal for a woman is a.
- [16:41]
B
That's interesting because I told you, I went and mine was low and it was 11.
- [16:46]
A
Yeah.
- [16:47]
B
And I looked up the values of a 35 year old woman and it was like I needed to be up at around. What was it, 30, 40. I freaked out.
- [16:55]
C
I was like, what is going on?
- [16:57]
B
But then I also started combining dhea. The precursor. Is that the precursor? I was doing around, I was doing a high dose, actually 75. I haven't tested since.
- [17:10]
A
Yeah, yeah. So DHEA, like I wish it was easy, clean and we have better data, but we don't. Some people it'll raise their hormones, some people it doesn't. Tends to work better in younger women because you actually have the functioning ovaries to convert things less, less beneficial the older you Get. So what I say about oral DHEA supplements is start low. Side effects would be like greasy skin, acne. It's very safe. So we could say it's a safe supplement. It might not help everybody.
- [17:39]
C
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- [18:48]
B
Guys.
- [18:48]
C
One of the biggest shifts I've made for sustained focus has been switching to ketone iq. I never was a believer in exogenous ketones until I really did the research on brain fuel for women in midlife. Now let me tell you something. Women in midlife experience a drop in their brain energy metabolism by at least 30%. Now, the main energy fuel source for your brain is glucose, but when we are depleted, it switches to ketones. And if we don't have enough ketones in our body, the brain literally starts to eat itself. When I found that out, I started pumping myself with exogenous ketones from ketone iq because ketones can actually cross the blood brain barrier, which directly fuels the neurons. Not to mention that it really helps with mitochondrial health and reduces oxidative stress. Ketone IQ is my favorite one. I'm currently having the apple flavor. I put it in the fridge, I chill it, and then I either sip it throughout the day or I have it all at once. So if you want to try Ketone IQ, you can just go to ketone.com neuro to receive 30% off your order or just input neuro@checkout ketone.com.
- [20:10]
B
Now we know. So a female, maybe she's, she's going through this transition. She's feeling frustrated. You also mentioned something to me which I found interesting. You've had a woman who. You've dosed her with testosterone and her rage went away.
- [20:23]
A
Yeah.
- [20:23]
B
So anger, rage. I mean, how do you know if it's towards your husband, your boss, or is it just low testosterone? That's so interesting.
- [20:31]
A
You know, if you look at the testosterone researchers, what they will say is, testosterone makes you more of who you are. So you'll see a lot. You'll put people on testosterone. They're like, I'm more loving. I'm a better partner. I'm getting more stuff done. You know, I'm more creative. And then you put other people on testosterone, and they're like, I'm more. I'm angry. So I had a woman very recently, and she's like, I'm getting angry on testosterone. What's up? And I'm like, well, check your levels. Make sure they're not too high, because too high of any hormone can cause mood issues. Right. So let's make sure it's not too high. But if it's not too high and you're angry, maybe you're actually angry about something. And it's just the emotions actually can happen now. And she's like, well, yeah, I actually hate my job. And me and my husband are. We have a horrific relationship and we need therapy. And I'm like, anger's a normal, healthy emotion. And it sounds like you should be feeling that. Right. And she was kind of this like, oh, okay. Because when she had low hormones, she was kind of more like just kind of living in the crap.
- [21:28]
B
Yeah.
- [21:29]
A
And now she's on testosterone, and she's like, I'm seeing the crap, and I'm angry about it.
- [21:33]
B
Oh, my God.
- [21:33]
A
Right? So, yeah, it's like, that's what's so fascinating about hormones, is, again, you get the stereotype that testosterone's for rage, but it's actually like, rage is normal in some. It's like, actually making her feel again. And a lot of people will say the opposite of like, I'm happier. I just like, life is brighter.
- [21:50]
B
Yeah.
- [21:50]
A
We know that giving women testosterone helps with anxiety. It helps with depression. There's an amazing study out of Luis Newsom's clinic in the UK this year about being able to de prescribe SSRIs by putting people on estrogen and testosterone. And the biggest gain in getting women off of SSRIs was adding testosterone.
- [22:09]
B
That is unbelievable.
- [22:10]
A
How do you.
- [22:11]
B
How do you feel about vitamin D in conjunction with testosterone? Because I know that they're doing early studies now of being able to replace SSRIs with high dose vitamin D as well.
- [22:22]
A
Very cool. Yeah, yeah. I mean, vitamin. It's so. But I think the most interesting thing about vitamin D is we have so many studies saying low is correlated with depression and bone issue, like maybe some cancers. Like, it's crazy that low is not good for you. And then like medical societies will come up with statements and be like, don't check your vitamin D. Insurance doesn't cover vitamin D. And it's like this big clash of like, how can you say that we shouldn't look when low vitamin D is associated with all of these health conditions. So I get a, I get a vitamin D on all of my patients.
- [22:54]
B
Yeah. And that's also involved in the cholesterol pathway as well that you mentioned.
- [22:58]
A
Yeah. I don't know exactly where vitamin D comes in, but in the, in the testosterone to estrogen pathway, vitamin D is not right there, but yeah, it is. It is. I mean, that's the crazy thing is it is a hormone. We just don't think of vitamin D as a hormone.
- [23:10]
B
Okay, so. So let's now talk about some of the myths. Right. Because if you mention testosterone to my mother, 70 years old, she's going to think it's this injectable steroid that men use to get big and we want to destigmatize that. So first myth is testosterone is only for sex drive, Right?
- [23:32]
A
Yeah. I think that echo chamber is getting stronger. And, and fortunately, and unfortunately, Australia has a female dose testosterone, which we've got here, by the way, ladies and gentlemen.
- [23:43]
B
It's called, It's Androfem. Testosterone 1% 10 milligrams. Each mil of cream contains 10 milligrams of testosterone.
- [23:51]
A
There it is.
- [23:52]
B
Learn America.
- [23:53]
A
I know there's. So there's four countries that have Androfem now. South Africa, New Zealand, Australia and the uk. Yes, it's very exciting.
- [23:59]
B
You mentioned something though, and I really want to go down if. Can you tell me how to get prescribed this in Australia?
- [24:06]
A
So if you're in Australia, that is indicated or your FDA approved for hypoactive sexual desire disorder or low libido, Low sex.
- [24:13]
B
Yeah.
- [24:13]
A
Slow sex drive and getting into what your initial question was, what's libido? Libido is a mood, libido is a motivation. So those are both things are true. Right. I just did a talk where there's a group of 100 women and I said, how many people in this room are on testosterone? This is a very educated group. 70% of women raise their hands. So I'm like, this is not all, this is not American representation. 70% raised their hands.
- [24:37]
B
That's great.
- [24:37]
A
Oh, it was incredible. And I said, keep your hand up. If testosterone helps you with something other than mood, all the hands stayed up. Women know like, libido does not exist in isolation in our life or in our body. And so to pigeonhole testosterone, to say it works in this 1 square centimeter of the brain where the libido is, right? Libido is multiple brain pathways, right? It's the dopamine pathway. And so to say it's just for libido is actually insane. And not understanding the brain very well and not understanding what libido is, which is a mood and motivation, right? But the problem, so here's, this is what I tell people. The problem with Australia is it's indicated for low libido. So what are women doing? Number one, they're lying to their doctor to say, I want this for low libido because they want to try it for something else, right? But they have to say it's for sex, which is absolutely insane. And if a woman says, I do want this for libido, I do have low libido. I've had women message me, multiple women saying, in Australia when they go to their doctor and say, I want this for low libido, the doctor says no, because they are not married.
- [25:39]
B
I mean, that's just disgusting.
- [25:41]
A
It's awful. And so to me, you know, and when I went to the FDA to make my FDA requests for a testosterone here, I said, do not get this indicated for low sex drive. I want it indicated for the exact same reason that men have it indicated for, which is hypogonadism, which means low hormones. Because two problems. Number one, we'll have to lie to our doctor. Number two, doctors aren't good at talking about, about sex, right? So they're going to say stupid stuff like you're not married so you don't get this. And then number three, in America, our health insurance, often the private health insurance, often has exclusionary riders on sexual health deeming sexual health not worthy of being covered. So what is the point of getting an FDA approved product if insurance won't cover it anyways?
- [26:22]
B
It's so interesting. It's like, you know, let's just play it out here as a little story. 50 year old female goes into the doctor, into her GP in Australia and says, I'm suffering from low mood depressive like symptoms and I Have no sex drive. Can I get some testosterone? GP says, of course. Are you married? Female says, no, I'm not. Well, then we can't give you any testosterone.
- [26:44]
A
Yeah. It's insane. And I know we don't want you.
- [26:45]
B
To have sex outside of marriage.
- [26:47]
A
Yeah. That's not what. I'm sure there are great doctors in Australia. Australia is prescribing this stuff. But it's those horror stories that come back to me, which exist, which exist everywhere, which exist everywhere, say, we cannot have that in America. I don't. Those same barriers. I don't want that in Australia.
- [27:02]
B
So obviously my family lives there. I've got a lot of friends who I tell them, and family members. I'm like, you're going. You are imperimental.
- [27:10]
C
48 year old.
- [27:11]
B
She's like, yeah, but I've went to my doctor and my hormones are fine. And I'm like, you are gaining weight. Clearly, I can see it. You, you're changing. You're telling me your mood is. They've got all the symptoms, but just because two points on their progesterone estrogen, maybe they're aligned. Maybe they're in a ratio of 1 to 1. Which, by the way, if they were to do it over a series of like one week, they'd all be different.
- [27:35]
A
Yeah, exactly.
- [27:36]
B
They're not being put into that perimenopause bucket. And then we're still going to deprive them of hormones, which is. My mother missed that boat, obviously, because she was affected by the Women's Health Initiative.
- [27:48]
A
Yep.
- [27:49]
B
And guess what? My mom now has osteoporosis. Her T score was minus 2 on her bone density DEXA scan, which. And now she's got Pralia injection once a month.
- [28:00]
A
Yeah. Which is expensive and not without side effects. That's the thing is, like, what's the alternative to hormones? Other medications which are often more expensive and have their own side effects.
- [28:10]
B
Myth number two, testosterone will masculinize me. Facial hair, deep voice, and I'll lose my femininity.
- [28:17]
A
It's great, great myth. So women often ask me, like, will you turn me in? Will this turn me into a man? And I say, only if you ask me to.
- [28:24]
B
Literally. Because it's a steroid.
- [28:25]
A
Yeah. Well, yeah, if you give behind high doses or it's like any medication, too high of a dose, you get more side effects. Right. Because what women don't know when they ask that question is that ovaries make testosterone. And what they don't know is that female dosing is 1/10 the male dose. Right. So you have to. There's a lot of education that goes. If you, if you Google testosterone, it says the male sex hormone. Right. You have to like get down to two or three paragraphs on Google to actually be like, all genders make testosterone. Right. It's like, that should be much higher up in the Google search. So you have to explain to women, ovaries make testosterone. Ovaries help your cells be healthy. We only give female doses to females unless they ask if they want to transition to men. And that's the fascinating thing, and I brought that to the FDA, is what other medication do we have? 50 year safety data at 10 times the dose? Nothing. But trans men willingly are like, we'd like the male dose. They've been doing it for decades. We've got published 30 year and 50 year safety data. They don't die any faster or more frequently because we've given them high testosterone.
- [29:29]
B
I always thought that testosterone competed with estrogen because don't they indicate women if they're on testosterone and they want to conceive to get off testosterone?
- [29:38]
A
No. So testosterone, synthetic testosterone. So different medication, Right. Synthetic testosterone can be fetal toxic. That's why testosterone has category X as a medication. But testosterone is actually used in fertility clinics. Testosterone is necessary.
- [29:56]
B
Synthetic testosterone. Testosterone.
- [29:57]
A
No. Natural testosterone.
- [29:58]
C
Yeah.
- [29:58]
A
So the synthetic testosterone is why that is fetal toxicity. But natural testosterone that your ovaries make. Testosterone helps follicles form and be healthy.
- [30:07]
B
Correct? That's this.
- [30:09]
A
Yeah. Well, I mean, just in your body, what is testosterone? Testosterone in your body is pro fertility, correct?
- [30:15]
B
Yes. Right.
- [30:15]
A
And so the natural testosterone is often used in women in infertility clinics if they need to boost their fertility. So it's not the only thing that fertility clinics use. But that blew my mind. I'm like, your ovaries and that just testosterone that your ovaries make are pro fertility. They help the egg and the follicle be healthy.
- [30:33]
B
Correct. And that's interesting because you also shared that trans men taking high doses of testosterone can still fall pregnant.
- [30:41]
A
Yeah, yeah. I mean, ideally, people say, hey, we don't know, we don't have great tests on this. Maybe stop your hormones. They don't all do that though. But there's, I mean, there's so little data, it's untested. But for the, for the average person to be like, testosterone's not that scary. You know, we have, have so much safety data.
- [30:57]
B
So now when you get your blood test done, you'll see something called total testosterone and free testosterone. So total is the total amount of testosterone floating around in your body, but the free is the one that's available.
- [31:09]
A
To you for use. Yeah.
- [31:11]
B
Okay. What if I have an A normal free can that exist?
- [31:17]
C
Normal, free, low.
- [31:18]
A
Low.
- [31:18]
B
Like what, What's.
- [31:19]
A
Yeah, it can all exist because. Because the, the total testosterone and free testosterone are just two windows into what's actually happening. I mean, this is so complex and we don't have tests for all of this. How much sex hormone binding globulin do you have? We can test for that, but how responsive are your receptors? Right. How many keg repeats do you have on the end of the testosterone receptor? How easily does your testosterone get into your brain? We know from cadaver studies that brain testosterone levels, we can't tell them by your serum. Testosterone, testosterone, they're not correlated. Right. So there's so much more than just these blood tests. And I always go back to, like, how does a woman feel? How does the woman feel? Because I think there's a group in medicine where they just want to dial you in to get you on this, like, balance beam of a certain lab. And it's like, but how do you feel? Right. If you have. If you're having side effects, but you have low of one of the. I'm not going to keep pushing your testosterone up. Right. And if you checked my testosterone level four times today, I would give you four different lab values.
- [32:16]
B
Yeah.
- [32:17]
A
Right. So people who hang their hat on what's the most important and what number does it actually need to be? I'm like, you're losing the forest and the trees here of like, how does she feel? Is she getting side effects? Use that along with the lab tests to help you adjust.
- [32:30]
B
And in your book, your new book, do you provide an analysis of everything, like, the best thing, like estrogen, progesterone, and testosterone as the cocktail of hormones to take in this period?
- [32:41]
A
Yeah. I mean, I never say, like, this is the best because I think, you know, we're not all Toyotas. And what is the best for you is not the best for Susie. Right. So to say that this is the best and women are like, I can't have the best. It's fraught with, like, compare and despair. But I will say this is the current gold standard. Right? The current gold standard is a transdermal estradiol patch. Current gold standard. So gold standard means, like, by and large, we drive Toyotas. But some people need Jeeps and some people need an suv and some people need the minivan. Right. There's different options for people and just.
- [33:13]
B
Like with estrogen, how you have to be mindful. Maybe if you've, if you've had breast cancer, is it the same? Is there any contraindications with testosterone?
- [33:24]
A
A contraindication with testosterone would be already having high testosterone. We don't want to give you more. So that's why.
- [33:30]
B
Maybe polycystic.
- [33:31]
A
Yeah. Like pcos. And some people just run high and.
- [33:34]
B
Yeah.
- [33:35]
A
And they're happy. It's like, don't give her more abnormal bleeding, undiagnosed or untreated cancer. Like there's some contraindications, but it's pretty rare. Testosterone looks like it's breast protective. And this is actually pellet data. So this is higher dose testosterone data. But in women who were on it versus women who weren't on it, there's about a 30% decrease risk of getting breast cancer. That is an insane decrease risk. I'm like, where's the super bowl ad for literally?
- [34:03]
B
Why is that not front page news?
- [34:05]
A
Why is it not front page news? Yeah, absolutely. So, so the fear of testosterone and breast cancer, it's more like testosterone. Testosterone's likely breast protective. And now we are more and more especially even women who are on aromatase inhibitors because we know you're not going to convert any. We know that in you, you're not going to convert all your testosterone to estradiol. But if you're taking an aromatase inhibitor, you're not converting any of it to estradiol. Right. So these women on aromatase inhibitors, they have significant side effects like this. These medications are not zero as far as how they're affecting your quality of life. And so there is a subset of breast cancer survivors on active treatment with aromatase inhibitors receiving testosterone. It helps their mot musculoskeletal aches and pains, it can help them sleep, it can help hot flashes. Like it helps. And we know zero is converting to estradiol.
- [34:52]
B
Yeah, it's a bi directional, like you mentioned. Take testosterone, get to the motivated, get to the gym. The gym heals, brings more muscle mass. And it's like this, this flow on flow effect. Right?
- [35:02]
A
Yeah.
- [35:03]
B
I have to bring this up. I'd be remiss if I didn't. Did you hear the. I don't know who shared this about. At women getting divorces during menopause. The divorce rate.
- [35:13]
A
Yeah.
- [35:14]
B
Is this is interesting because it could be testosterone related.
- [35:17]
A
It's so, it's so interesting. And you. So this is, this is looking at, you know, gray divorce. We call them gray divorces or midlife Divorces. So it's your classic, like, you're in perimenopause or menopause. You know, you've been married for a while, but all of a sudden you're like. And he's like, I didn't change. You know, she changed. And it's really, how can we support couples to help them get through things? And I think this is. It's so great because it's changing so fast, is the mental health people, the marriage counselor people, the sex therapist people, they're all learning that hormones are important, which is fantastic because it's like, if sex is painful, you don't want to have sex. Right? Sex is an important part of a partner relationship. You got married to be in a sexual relationship, Right. And never is any of this ever to blame the world woman. It is to say, we need to support the woman. We need to support the team. And it's interesting, you know, people, this. This is all like, tongue and cheek stuff of, like, what HRT means. HRT means. Can mean hormone replacement therapy. It can also mean husband replacement therapy. And so they're like, you know, do I need my menopause treated, or do I actually need a divorce? Some people truly do need to end a bad relationship. But so many people are like, maybe I wouldn't have gotten divorced had I been on hormones. Like, they feel so much better now. And you hear horrible, tragic stories about relationships, you know, fell apart because of untreated menopause. And I have a friend who's a divorce lawyer. I tell this story all the time, but she's like, I'm pulling couples out of the end of the river. Like, it's. By the time you get to a divorce lawyer, bad things have already happened. She's like, I can't repair it. I'm not there to repair it. But she's like, by and large, I think untreated menopause is a huge reason and I would argue low testosterone in men too, right? Which is just not as common. Low testosterone in men's about 20% of men. Whereas hormones us outliving our ovary hormone production will be 100% of women.
- [37:09]
C
Everybody's talking about longevity. Everyone's talking about how do we power the mitochondria in our cells. Now we know that mitochondria lose efficiency as we get older. And this is where mito pure comes in. Mitopure gummies from timeline are the best way right now that I am them fueling my mitochondria. And I'll tell you why Mito Pure is powered by something called urolithin A and that is a clinically proven compound that recharges your mitochondria so your cells can generate more energy. I used to take their pills, the urolithin a timeline pills. Now I'm taking their gummies because they taste good and they actually have been certified to show that they have urolithin A in them. They're vegan, they're NSF certified and they are backed by over a decade clinical research. So it is longevity. But at a cellular level the best part about urolithin A in my opinion is that it can help your muscles recover. And I really feel it. So if you want to try this, go to timeline.com neuro you'll get 20% off timeline.com neuro to get 20% off the mitopure gummies. I used to eat honey, drink honey. But I never thought that honey was more than just honey, if you know what I mean. Until I tried manukura. This is not just your average honey or your average sweetener. It's a nutrient rich superfood straight from New Zealand. This type of honey which you can have in your coffee, in your smoothie, I have it in sachets, is creamy, it's rich and it's packed with mgo. MGO is a powerful antibacterial compound that supports gut health, immunity and even brain function. And let me tell you guys, we're moving into the winter here. It's now getting really cold in New York City. So I know that flu season is upon us. So one spoonful in the morning is like starting the day with nature's cleanest energy source. The best part, every batch is third party tested and you can trace it back to the exact hive using their QR system. I love that because it's like full transparency if you want to be having honey. If you want to give your kids honey, you need to be giving them Manukora. Head over to manukora.com neuro you will save up to 31 plus 25 in free gifts with the starter kit. Manukora.com neuro we're going to get to.
- [39:51]
B
My favorite part which is the science of testosterone in the brain. But before we go, do you testified at the FDA quite recently recently alongside our dear friend Dr. Vonder Wright, but also my idol, one of Dr. Roberta Brinton. Yay. Can you tell me a bit about that? Why did you, why did you do that?
- [40:11]
A
Well, I got invited which is very nice.
- [40:14]
B
They forced me to.
- [40:14]
A
No, they didn't force me to. I want to speak. I want to speak on behalf of the American women. I mean, to me, I'm like, why? Because they're voiceless and they're suffering. And I think people in power don't know. And I feel like because of my podcast and because of my Instagram, I have a door that's open to see the suffering on a level that most people, you don't see it. Right. You know, I, I joke, but it's like most doctors, we think we're doing a good job. Like, ask the average doctor, I think we're doing a good job. I thought, I thought I was doing a good job. I got on Instagram about six years ago now and the door opened to hearing all the stories of like, I'm on my fifth doctor. My doctor told me this insurance won't cover that. Of like, oh my gosh, we all think we're doing such a good job and people are suffering like I've never experienced. And so to me I'm like, the FDA doesn't know. They don't have the door open.
- [41:04]
B
Right.
- [41:04]
A
You can email the fda. And I encourage people to email the FDA because they want to know what they can do is like email the FDA to get equality in our hormone production and coverage in this country. There's horrific inequality going on. So I do want. The world won't change just because I showed up. The world will change because millions and thousands of women actually speak up for their health care and their coverage. So the low hanging fruit of the FDA was to get the boxed warning off of vaginal estrogen after the whi. Big scary boxed warning went on. All estrodiol products, no matter the dose, no matter the route, no matter the formulation and what we know. A friend published this study that if a woman's lucky enough to get a tube of vaginal estrogen, which is basically just skin skin care, it helps recurrent UTIs, overactive bladder, pain with sex. If she's atrophy, atrophy, if she's lucky enough to get a prescription from a physician, 30% will still not use it because of the boxed warning, which is completely inaccurate.
- [42:01]
B
It's a psychological. It's like when you see the, the warning on a cigarette box and you see babies and like there's, there's black arms. I don't know what they're like here, but I know that that's what it's like in Australia. It's horrific.
- [42:11]
A
Yeah, rightfully so. Yep.
- [42:13]
B
And got that exact same label.
- [42:15]
A
It's from the government. So you assume that it's true. Yeah, I mean, that's like this sowing distrust, right? Of like, hey, guys, you eat. And this is why I tell my patients of like, because I now I'll tell them about it. I'm like, you know, if you read labels, you're gonna read that it says blood clot, heart disease, probable dementia, not possible, probable dementia, liver failure, you know, all these things. And like, no, you get to choose. And I'm sorry, I'm putting you in this position. You have to choose to believe me. Who' the sex med hormone expert or your government? And they're like, we choose to. To believe you. And I'm like, well, thank you very much, but if I didn't say that up front, they're going to believe that boxed warning too. And then they're like, the doctor is trying to kill me. Or often this happens. The husband will read that and say, comfortable sex is not worth it. Let's just not have sex because I don't want you to have these side effects.
- [43:05]
B
I can't imagine a man saying that.
- [43:06]
A
That. Well, men don't. Most men don't want to hurt women. Right.
- [43:09]
C
And.
- [43:09]
A
And they. Most men want their woman to stay around for a while. Of course. Right. And so they're like this, honey, it's okay. It's not wor. Right.
- [43:17]
B
So where are we at now?
- [43:19]
A
So we went to the FDA in July of 2025, and we don't know. They haven't come out and said anything yet. We're still waiting.
- [43:27]
B
What are some of their reasons as to. As to why not to remove the blacks the box label and to not make testosterone FDA approved?
- [43:36]
A
That's a great question. I think it's just inertia at this point with the box labeling. Like, you just need to make a decision. They made a decision to put it on without. Without any input from the pharmaceutical companies. They can just make the opinion to take it off. And there's precedent in this because the male testosterone box label said heart disease is a risk. So they did a study. This is the Traverse study. It came out like two or three years ago, basically saying no men on placebo and men on testosterone have no change in risk of heart disease. So the FDA took that part off of the box warning straight away. Straight away. Away. Well, not actually. They had to be reminded, like, remember you told us to do a study and we did a study. So here's the study. Could you remember to take this off? And they're like, oh, sure. They took it off. So there's precedent. You can remove things. And we have, we have studies on over 50,000 women with vaginal estrogen. Vaginal estrogen safe in breast cancer survivors. Like it is not proven to increase any of those things. There's plenty of studies, multi year studies. People have been taking vaginal estrogen since like the nineteen nineteen seventies. Right. This is not a new medication. So inertia. You know, the FDA may be being distracted by some other things right now.
- [44:47]
C
Yeah.
- [44:47]
A
But I hope they can get around to helping the American, American women. 50 to 90% of women will suffer from GSM or genital urinary syndrome of menopause. So this isn't some rare autosomal recessive disease. This is like the common human will experience this.
- [45:01]
B
Utis.
- [45:02]
A
Utis.
- [45:03]
B
Yeah. It's really interesting because you look at where the, all the money is being shuttled into, into right now. When we look at vaccines, which we've got millions of data points on kids and now we've got millions of data points on females and we're still not choosing to just do that one thing. So I can imagine how upsetting that is as a physician.
- [45:24]
A
Well, yeah. And you look at the bias and you're like, dude, Viagra got approved with six month safety data. Right. Like we're appropriate stuff. That was 1998. Exactly. But it was considered a very important drug at the time and it became the bestselling pharmaceutical pharmaceutical ever.
- [45:38]
B
Yeah.
- [45:38]
A
Like that's how big it went. And we're like, some men had heart attacks when they had sex for the first time after Viagra and they actually put out a news article to be like, don't worry, it's not the Viagra that caused the heart attack. It was the sexual activity that was enabled because of the Viagra. But I'm like, had a woman taken a medication for her sex drive and she had a heart attack and died. They'd be like, get this medication away from all women. Like the level of risk that's acceptable between the genders is, is different.
- [46:04]
B
So you would say that there's a lot of discrimination then?
- [46:07]
A
I think so, yeah. Yeah.
- [46:08]
B
It's like they, the world isn't built for females to thrive.
- [46:11]
A
Listen, I wasn't there, but somebody at the fda, a this is a while ago, was quoted as saying, what do we need a bunch of horny women walking around for? There's a huge, huge, huge, huge. I mean there's Viagra and its cousins, there's probably 10 different products. Testosterone, which helps low libido in men, 10 to 12 different products. Women have two FDA approved products for hypoactive sexual desire disorder and no, just other testosterone product. But 90% of men are heterosexual. Who's helping the people who are supposed to be sleeping with those people that I'm giving testosterone and viacre to?
- [46:42]
B
It's infuriating.
- [46:43]
A
It's madness.
- [46:44]
B
It's madness. Just to be clear, the you're doing so when you prescribe testosterone now for females, it's off label.
- [46:50]
A
Correct. But we do lots of things that are off label. Most of obstetrics and gynecology and pediatrics are all off label.
- [46:55]
B
Oh, 100%.
- [46:56]
A
Right. And so I want to always clear that up for people like can't do that. It's off label. Is like minoxidil for hair loss is off label. Like lots of things are off label. Depression for a lot of. Not depression. Other reasons we give women SSRIs are off label. Right. So just a lot of birth control use is actually off label. So when people use that as a reason not to try testosterone to help a woman's quality of life, it's a big double standard because it's like, well, you better not prescribe anything else off label then if that's the reason you're using. To not give women testosterone.
- [47:28]
C
Yeah.
- [47:28]
B
I mean look, you can look through all the specialties, right? And you can look at all the nuances to it and it can just drive you mad. There's so much in neurology as well. We'll go to that. And then I want to talk about actually the different types of testosterone. I know that there's cream, there's injectable forms, there's so many different things. But one of the most profound things that you've ever said is that testosterone is a neurohormone. So it fuels the mitochondria, nerve cell function, blood flow, dopamine. In other words, it powers the brain. It's literally fuel for the brain. What have you seen? And I know that you brought up this really great study in one of your of your long form YouTube podcasts where you looked at a study that showed the correlation between low testosterone and Alzheimer's disease. And I really want to talk about that. Because Alzheimer's disease, the most prominent form of dementia, affects 2/3 of women. Well, 2/3 of Alzheimer's disease patients, I should say, are female. And we used to think that that was just because women live longer. But we now have substantial evidence to suggest that hormones play a role too. Now I have Harped on on this podcast for years. The podcast has been alive since 2016 about estrogen receptors in the brain. We're seeing these wonderful meta analyses of hormone replacement therapy and enhancement in cognitive performance. And it helps with cognitive decline. It may help offset everything as it relates to cognitive decline.
- [48:56]
A
Roberta Britton's paper with the Humana database, like we should be mention that quick because like to me, I'm like, why was that not front page news?
- [49:04]
B
Exactly.
- [49:04]
A
I reread it when she was at the f. When she was. I got to sit next to her at the fda. And I'm like, you wrote the Humana insurance database paper?
- [49:11]
C
Yep.
- [49:12]
A
And like that is such an important paper. So it was looking at almost a million women looking at. This is not a randomized placebo controlled trial, but it was a massive amount of women looking at women on estrogen replacement therapy. So just to be clear, this is not testosterone estrogen versus not being on hormone replacement therapy. Statistically significant decreased risk of all cause, dementia, Alzheimer's dementia, ALS or Lou Gehrig's disease, multiple sclerosis and Parkinson's. That's insane.
- [49:39]
B
Yeah.
- [49:39]
A
And here we are spending billions of dollars on treatment, right? And especially for Alzheimer's, no good treatment, horrifically expensive, significant risk of side effects such as brain swelling. Right? So here we are, we're trying to get at again, we're trying to pull people out of the downstream of the river. We really need to switch medicine into being, being like prevention. Because you know, this is what I tell patients. I'm like, listen, on the tragic day that you or a loved one are diagnosed with dementia, on that tragic day, understand it started 20 years beforehand, right? That's what we have to get people to think about. And what's 20 years before the average onset of Alzheimer's? The day of menopause, basically. Right? And so I think we're getting stronger and stronger about saying estrogen. And now I think the next step is to look at testosterone. We know low testosterone in men is correlated with both depression and dementia. We have cadaver studies in both genders saying people, the cadavers with higher testosterone levels. And again, doesn't correlate with serum. Right. Something else is happening. Higher testosterone doses in the brain lower risk of dementia. So like we're getting in the. I don't say the haters, but the critics of this say, well, we don't have a 20 year randomized placebo controlled controlled trial. And I'm like, damn straight we don't. That's a multi billion dollar Study.
- [51:00]
B
Yeah, literally.
- [51:00]
A
Right. And are you going to wait another 20 years for that to happen? And by the way, nobody's really doing research in America right now.
- [51:06]
C
Unless you.
- [51:07]
B
Lisa Moscone, she just got given 50 million.
- [51:09]
A
Yes, she did. From private, private sources now, which I think is the new wave of actually getting some answers to the questions that we have so that the. So the haters are like, we don't have a 20 year randomized placebo controlled trial. Like, nope, we don't. And we're not going to have one. So we need to use what we have. We need to use male data to be like, dude, brains aren't that different. Right. Neuroprotective in men, neuroprotective in women. You know, rat studies, the cellular studies, glial health studies, myelin sheath studies. Like, we. You put all of this together and you're like, once you know the data, you're like, testosterone is neuroprotective. Yeah. But you can't come out of the gate and say, testosterone will prevent dementia. You know, you've got to build that case. Because people are. Aren't where we are in our knowledge base. They don't even know testosterone's in a female body.
- [51:57]
B
Yeah, Right.
- [51:58]
A
So, like, that's where we're starting.
- [52:00]
B
Trust me. Like, I get asked wild questions in my DMs, and I think, okay, we're there. I'm here talking about receptors on Instagram. We're really. Yeah, we've got to start at a low level. Interestingly enough, I've got some things to say about where it targets. Like, testosterone isn't floating around aimlessly. Brain imaging. Actually, one of the things that you've pointed out and postpartum, postmortem work show dense testosterone receptors in the hippocampus, prefrontal cortex, and the amygdala. And these are all tied to executive functions. Memory, mood, all of that.
- [52:31]
C
So, of course, let's talk about skincare. I think skincare doesn't get enough attention, because skincare can really mean the difference between what the toxins you're putting in your body and the nutrients you are.
- [52:46]
B
Putting in your body.
- [52:47]
C
Now, I have switched all of my skincare to Jones Road Beauty because. Because I've stripped back to the essentials. I love their daily moisturizer. I have to tell you guys, this moisturizer, it feels so light when I put it on. And I know that I'm putting something real. I've looked into their products, I've looked at the manufacturers, and I have to tell you that all of their products are built on real dermatological science. Hydration and bathroom barrier support are the two non negotiables for healthy resilient skin. And that's what Jones Road Beauty really delivers. And they do it really cleanly and beautifully. So if you want to get a cool gloss with your first purchase@jonesrowbeauty.com just go to that website, use code Neuro and you will get your purchase. So jonesroadbeauty.com code neuro for a free cool gloss with your first purchase purchase. Over the years we've seen every fad diet come and go. But the real danger isn't the diets, it's what happens afterwards. Doctors call it weight cycling. Losing and regaining weight over and over again, which can increase your risk of heart attack, stroke and metabolic disease. And who likes to be skinny fat and then fat and then skinny fat? Really? Here's why that's dangerous. Every time you drop 10 pounds and then gain it back, you stress your organs and increase your risk of diabetes, liver damage, heart, heart disease, even stroke. That's where lean comes in. It's not a prescription supplement developed by doctors. It's not a GLP1 injectable lean from Brickhouse Nutrition helps in three key ways. It supports healthy blood sugar, reduces cravings and helps your body convert fat into energy so you can lose weight at a steady pace and keep it off. So if you've ever been frustrated by the cycle, this is your tool to break free. Go to takelean.com and use code neuro for 20% off. That's takelean.com code neuro.
- [54:53]
B
Roberta Brinton actually said something. We've got to bring her in here. She's in Arizona. She said something that shocked you, which was a female's brain literally eats itself during menopause if you don't replace it with hormone replacement therapy. And you wanted to know the mechanism there or the pathophysiology and I'm to going to tell you so during, obviously during the the loss. So estrogen in the brain does multiple things. One of them is it helps with glucose metabolism. What do we see in women at the onset of menopause? We see a reduction in brain glucose metabolism of 20 to 30%. So when the brain cells don't have glucose to operate to function, glucose is the main primary fuel source for the brain. What does that it do? Well, it doesn't sit there in a starved state because neurons are smart, right? And they're hungry. So it says how can I feed myself and I don't have any available ketones right now. So it makes its own ketones by using the fat in the brain. Where's the fat in the brain? Covering the myelin sheath. Oligodendrocytes. So it metabolizes the oligodendrocytes from the myelin sheath to create ketones, to use the ketones as fuel, effectively, literally.
- [56:11]
C
I know.
- [56:12]
B
Eating away at the myelin sheath. As a neurophysiologist, I've scanned, I've done EEG scans. I've done thousands upon thousands. I've also done EMGs. We do EMGs when we suspect somebody has multiple sclerosis. And what we see is conduction block, right? And we're going, okay, you've got complete conduction block. Maybe you've got low conduction velocity indicative of multiple sclerosis. Is it that, or is it just menopause and your brain is literally just eating itself?
- [56:40]
A
It's. Yeah, it's crazy. And I think this story is so worth it telling because I think people. It'll be entertaining for people and educational. So I'm sitting next to Vonda Wright and Dr. Britton at the FDA, right? And Britain does. We all do amazing presentations. It's free online. Go to the FDA, YouTube, you can watch all of it. It's basic education for everybody to watch that video. So Roberta Britton gives her speech. And so I was talking to Vonda and I are really good friends. I was talking to her afterwards, and I'm like, did I hear this crazy correctly that Dr. Britton said, after menopause, when estrogen goes down, the brain can't utilize glucose, so the brain eats itself? Did I get that right? And Vonda's like, yeah, that's what I heard too. And I'm like, you realize if I said that on the Internet, I would break it, and I would be like, this crazy person, right? So then I see you yesterday, and I'm like, clear this up for me. I'm like, this is what I heard. And you're like, yep. And I'm like, oh, my God. Like, people like, we're all like, I'm kind of hiding saying it. Like, it's such a incredibly powerful statement to, I think, wake people up and especially the medical system. Again, these myths of, like, you need to be symptomatic enough. It's only for moderate to severe symptoms. There is a bar of which suffering must occur for you to receive help. Right. That flies in the face of you can't feel glucose metabolism changing. You cannot feel that. So what do we do when we have these two huge chasms. And I think the other important thing is the millennials. I said this quote yesterday of Gen X will be the last generation to suffer. And the millennials are like, hell, yeah, that's absolutely right. We don't wanna suffer. We see you guys now, we know what's going on. And I'm like, we have these two waves that are gonna crash. We have this millennial wave that says, we don't wanna suffer. We don't want the glucose metabolism to go bad, we don't want our bones to thin. We don't wanna be headed towards dementia. And you've got the big wave of the medical system saying, we'll treat you when you're suffering.
- [58:36]
B
Exactly.
- [58:36]
A
And it's like those two waves are going to hit each other, and I hope it does. And we're here for it.
- [58:40]
B
And we're here for it on that. Okay? I am doing a meta analysis right now, and if anyone knows anything about it, it's excruciating. Basically, you get all of the. It's a statistical analysis of all of the available evidence. And your. My brain fries when I'm looking at my screen. I'm like, am I seeing it correctly? But so it's what I believe. And there's no data on this, by the way. I believe we need to be attacking hormone replacement therapy, therapy in a way where we're looking at genes as well. Now, when it comes to Alzheimer's disease, there are three genes, okay? There's presenilin 1, presenilin 2, app, and dementia. If you've got these three, then you know there's predisposition of getting early onset dementia. But when it comes to the risk factors of Alzheimer's disease, we've got the apolipoprotein e, you've got e2, e3, e4. And e4 is the strongest risk factor of getting this disease. If you've got one allele or two at your risk tenfold. Did you know that it actually is. It is so insane when you look at the data in women that going through menopause plus having just one allele of ApoE4, your brain glucose metabolism isn't disrupted by 30%, it actually goes up to 50%. So this is an even stronger indication that we need to be talking about hrt, testosterone and estrogen for women who have this gene, everything goes away. So imagine. And by the way, just to make you a little more mad, male counterparts, exact. The same, exact same age could also have one allele women are affected 100%.
- [60:20]
A
More than men because we're having multiple hits.
- [60:23]
B
Multiple hits. But also because there is data to show that because men don't go through andropause until what age.
- [60:30]
A
Different for everybody.
- [60:31]
B
Different for everybody. But they do have, they do, they are aromatizing estrogen and they do have testosterone available in the brain to protect them. So even if they do have one allele of ApoE4, they're still neuroprotective and women aren't. So it's not just the fact that a female is going through menopause. She's also at the mercy of this genetic risk factor which is, is like destabilizing lipids in the brain as well.
- [60:58]
A
Yeah. And I think we should bring up for people because I learned this yesterday from you is you can just get an APOB blood. It's a blood test.
- [61:05]
B
APO A4. Yes.
- [61:06]
A
APOE 4 is blood test simple that you can just get at a quest pharmacy just to see, see what your risk factor is. Yeah. I think when we're looking again at precision medicine, realizing that the APO4E4 allele people are probably should have a stronger recommendation towards seriously consider hormone therapy to give you as much you can't change your gene, but you can modify the health of your body and hormones is one way to do it. So I think especially with the, the preventative dementia data and the, the way that hormones affect the brain like I'm like we should be telling those women hey, strongly consider hormone therapy because you have multiple hits to your brain. Otherwise.
- [61:46]
B
Yeah, I've got to a early data study but it's very limited. But it suggests that testosterone interacts with the ApoE4 allele. In this study they showed that ApoE4 carriers with high testosterone levels had slower hippocampal atrophy than those with low testosterone. The sample was small, under 100 women, far from definitive. But it was female. Yeah. It was female.
- [62:09]
A
It was female. Yeah. I'm telling you, we put together all the data we have because we're never going to get that 20 year randomized placebo control. But if you put together all of the pieces, testosterone is dementia prevention.
- [62:21]
B
It actually is the same with. I'm very on the bandwagon of statins are great because what we see with Apoe 4 carriers is we know that, okay. We know that you don't metabolize lipids well in the brain. So we need to keep Your LDL and APOB LDL below 60. When people hear that, you know you've got your carnivores out there, you've got your Don Saladinos saying that's ludicrous. It's like. But all of the studies, all of the studies, when it comes to dementia and cholesterol, LDL specifically, we want them to below 60 and that's why statins are favorable. And we had to go through. I, I put this out on Instagram and it went viral because I said dementia, statins don't cause dementia. And we've still got this huge, this huge.
- [63:06]
A
Do people think statins cause dementia?
- [63:08]
B
Oh, yeah, it's huge.
- [63:08]
C
They do.
- [63:09]
B
It's, it's definitely a massive.
- [63:11]
A
That's a thing.
- [63:12]
C
Yeah.
- [63:12]
B
Do you know the amount of my friends say to me, hey, Louisa, like my mom has to be put on stands, but we're super scared that she's going to get.
- [63:19]
A
Where did that come from?
- [63:20]
C
Exactly.
- [63:20]
B
You tell me. So I put it out there on Instagram. But I'm telling you there was about two and a half thousand comments, half from men saying, you need to go and read, you need to go back to school. I'm like, I stated all the studies as well. So I don't know where this came from. And it's ridiculous. Ridiculous. I've cross referenced this with many neurologists who also believe the same. But then there's also a lot of general practitioners who still say if you take any form of statin, you may get, I don't know, may get joint pain and it raises your risk of getting Alzheimer's disease.
- [63:54]
A
Whoa. Interesting. There's a very small, and correct me if I'm wrong, but there is a very small risk of increased risk of diabetes. Yes, but it's very small.
- [64:02]
B
Oh my gosh, it's so small.
- [64:04]
A
Yeah. And I would suggest, suggest, you know, and again, why don't hormones get super bowl ads? Is always like my go to statement of like, if there was, if there was a medication that decreased your risk of converting to diabetes, if you had pre diabetes by 30%, it would have a Super bowl ad. That's estrogen. They've done the studies and this was in perimenopausal women. So perimenopausal pre diabetics estrogen patch versus placebo for one year, 30% decreased risk of becoming diabetic at the end of that year. If you were on the estrogen, estrogen.
- [64:31]
B
Patch, do you think that is just because of the metabolism and mitochondria?
- [64:35]
A
Yeah, well, insulin, insulin metabolism, like estrogen modulates that.
- [64:38]
B
Yeah. And people don't realize that we like. That's what's happening in the brain as well.
- [64:43]
A
Right. Well, we've labeled these things sex hormones. Like, it all comes back to this lack of body knowledge. People do not know what their hormones do in their bodies.
- [64:51]
B
And I love how you spoke about testosterone's relationship to blood flow because the. The brain is the most vascular, rich organ in the entire body. Right. The first things to go in the brain when it comes to, you know, we've got the capillaries, we've got the veins, we've got the arteries. The capillaries are the first things to go during a hypertensive state or in those fluctuations in blood pressure, which, by the way, is literally one. What, what, what's. I know the gold standard is 120 over 80, but anything above that, like 125, you're even at risk.
- [65:19]
A
Yeah. You've got problems. And that's why. That's why erections are so nice to you, because that's. That's blood flow and that's blood flow in small vessels. Right. And they actually have done a study where they take women and they put women on testosterone because they have low testosterone. Right. And then they took an ultrasound probe and they put it on their clitoral artery. Increased clitoral blood flow being on testosterone, which is, again, let's go back just to pound the point that testosterone is not just for libido. Clitoral blood flow is arousal.
- [65:46]
B
Yes.
- [65:46]
A
It's a different domain of sexual health. Right. So the people who hound that it's only for libido. I'm like, you don't understand. Like, it's all domains of sexual. Sexual health that testosterone helps with, including, like, body image and positivity towards being sexual. Like, it's not just libido, but it also increases blood flow.
- [66:02]
C
Yeah.
- [66:02]
B
And people ask, well, why is exercise good for the brain? Why is it, like the number one mixer for. For dementia? Well, blood flow.
- [66:09]
A
Well, there's studies that are showing people on Viagra and Cialis, which are the erection medications, which work by improving blood flow, have less risk of dementia.
- [66:17]
B
Vasodilation.
- [66:18]
A
Vasodilation, brain blood flow.
- [66:20]
B
Exactly.
- [66:21]
A
It's very cool.
- [66:22]
C
Blood flow.
- [66:22]
B
Yeah, that's what I mean. And increased blood flow, you're getting oxygen and nutrients to the brain. I mean, I am. So if anyone, you know, you know how you're packing for a holiday and you're preparing or maybe you packing. To me, I am so ready. I've got so much information. I am. I've got a backpack Ready to go. As soon as I hit my 40s or whatever happens, I am ready to go. I've got all my physicians in place. I know what's happening. Yeah, I'm excited. I'm trying to get a lot of women because people think, you know, well, I talk about Alzheimer's disease, I study it. It's my whole life. It's not sexy because women in their 20s and 30s are like, it's not going to affect me.
- [66:59]
A
Right.
- [66:59]
B
I'm not 70. Yeah, it's affecting you now.
- [67:02]
A
And I think the older women, especially if you have dementia, they're not the advocates, right? Like, they're silent, they're forgotten. And it's like when I have a woman and she's 50 and she's thinking about hormones, this is the question I ask her. Who do you want to be when you're sitting 73? What do you want to be doing? Where, what, what physical activities do you want to be doing? Right? Because you get her thinking about herself and to be like, you want to love on her, you want to love on that 73 year old. Like, to me, I'm like, I'm incredibly proud with how hard 20 year old Kelly worked. Right. Like, I love how I set my life up for myself. Like, good job. And it's like when you're 73, you love that you set yourself up to be traveling to Italy or getting off the ground with your grandkids or writing your third cookbook, whatever it might be of. Be insanely proud of that life that you created. And it starts now.
- [67:53]
B
Oh, I love that so much because it is a 20 year gap to intervene. I keep telling people, Alzheimer's disease is once you get that diagnosis, there is no going back. It is like getting a diagnosis of end stage cancer, Stage four cancer.
- [68:06]
A
Totally. You know the other crazy thing, I did a substack about this. Like last month, there was actually two. Two papers that I found. I didn't go any further digging, but these are randomized placebo controlled trials. Estradiol patch versus four placebo in women who've already been diagnosed with dementia. They didn't get cured, but they got better. Compared to placebo, cognitive symptoms improved. Why is that not a Super bowl ad? Why is we're spending billions of dollars to try to cure this disease and we're staring at great data that why aren't we using it to improve quality of life? I think looking at testosterone and estrogen in the frail elderly population is horrifically understated, studied, horrifically understanding.
- [68:48]
B
Yeah. And we can definitely help that. I want to talk about the different forms of testosterone and estrogen you mentioned. I know the most. The gold standard is an estrogen patch. Yes.
- [68:58]
A
Yeah. Or transdermal estrogen. Transdermal, which you can also get with a gel or, you know, a cream or a vaginal ring with the. There's different doses, but transdermal just means through the skin.
- [69:08]
B
Yeah.
- [69:08]
A
And why that's important is it's decreased risk compared to oral. Now oral still very low risk, but it does get metabolized through the liver and can increase clotting factors slightly. I'm not saying don't do it. Lots of people do like their oral estrad. But I'd say gold standard is transdermal in whatever form you want to take it.
- [69:26]
B
Okay. And testosterone, how many forms are there?
- [69:30]
A
So options with testosterone? We can do a cream in America. You have to compound it. But the Androfam in those four countries is also a cream. So you get.
- [69:39]
B
What does compounded mean?
- [69:40]
A
Compounded means it's specialty pharmacy that makes it just for you.
- [69:43]
B
Okay.
- [69:44]
A
So they can take a cream, they can take testosterone, they can put the testosterone in the cream. And this is your testosterone cream. So not FDA approved because think of a compounding pharmacy as like bespoke. Right now the sad thing in America is we've got 80 million women over the age of 40. Majority of them will have low testosterone. They don't all need expensive bespoke testosterone. They need a standardized, cheaper option. Right. So bespoke tends to be more expensive. Insurance doesn't cover compounding pharmacies and you need to have a physician who knows how to write for it versus like androfen.
- [70:13]
B
Yeah.
- [70:14]
A
Right. So there's a lot of. It's clunky in America right now to get female dose testosterone. So by and large, it's one tenth the male dose. You can get it via a compounded cream. You can use a male product, Testum or testosterone 1%. It's a 50 milligram tube. You divide that in 10, so it's 5 milligrams a day. Those are the transdermal options for women. You can inject it, you can pellet it. You can. There's an oral formulation that again is a man transformulation. It's oral and you just dose it much lower. But that's kind of a newer one. You just can take a pill. And what's interesting about that medication is if you just go to a compounding pharmacy with oral testosterone, if you process oral testosterone through the liver, it can be liver toxic. So by and large we say don't do that. That's why I'm nervous about. A lot of people do troches. Right. Which is compounded, but it's like sublingual. I do not think there's enough data to say that this is safe and it's not going through your hepatic metabolism. Also very few short half life. So to properly do it, it's likely multiple doses a day and a lot of women aren't doing that. So it's popular in the compounding world. There is not enough data for me to say safety and efficacy with that. But trochee is an option that some people use and they like. Okay, so we got creams, we've got gels, we've got injections, we've got oral, we've got troches and we've got pellets.
- [71:37]
B
What do you prescribe the most of transdermal?
- [71:39]
A
Either the compounded cream or the male dose. And microdose it, it's just easy.
- [71:44]
B
You put it on the inside of your thighs.
- [71:45]
A
Yeah. Inside or outside.
- [71:46]
B
And it works well in conjunction with progesterone, estrogen.
- [71:49]
A
Yeah. And the other, the other nice thing about transdermal is you get a nice therapeutic level, but it's very hard to give you a super therapeutic level, meaning a testosterone of 300, 400. Because you'll see we've got some good pellet data. Like there's two, two camps, right? We should ban the pellets. And pellets are the best things in sliced bread. I in the middle. It's the most expensive option, it's the most invasive option and it's the highest dose option.
- [72:14]
B
I invasive compared to an injectable.
- [72:17]
A
Well, it's a little incision to put a pellet in, in your thigh.
- [72:19]
B
Okay.
- [72:20]
A
Right. So that's 40. So when I look at women, I'm like, this is a 40 year plan. Ideally you're going to want to be doing this for a while. Is the most expensive, the highest dose and the most invasive, your 40 year plan? And they're usually like, huh, okay, maybe not.
- [72:32]
B
Right.
- [72:32]
A
And a lot of people who do pellets don't know that it can come in a trip cheaper form a more low dose formulation. So I spend a lot of time actually depelling people. Meaning, oh man, I love the pellet. But then it wears off. Right. Because it's a high peak and then a slow decline. Or they're like, this is really expensive. Is this the plan? Or like, what if I just want a lower dose. So I spend a lot of time kind of depelling women because they don't know all these options are available. Traditional medicine does not have an FDA approved product. So you have to go usually outside of traditional medicine or find a doctor within traditional medicine who knows how to properly dose it.
- [73:10]
B
I mean, you're. You're a busy woman. All right, why did you decide to do another book actually? Tell us about your book.
- [73:16]
A
Yeah. Okay, so the current book right now is called the menopause moment. And it's all about the science and the hormones and the lifestyle for longevity. Right? Because I think of reputation that a lot of the menopause experts get is like, you just want everybody to be on hormones. And we're like, hormones are the bricks. Yeah, but that's not a house, right? Hormones own. They help the body function. But you still need all the other things.
- [73:36]
B
Don't need to put it in.
- [73:37]
A
And in the first book, which is all about female adult sex education called you are not broken, stop shoulding all over your sex life, where I just basically debunk a whole bunch of myths that Hollywood and porn teach you about sex. But I have a menopause chapter in that book. And I actually was like, do I put this in there? Are people not going to read it if I put this in there? Like, because I want 23 year olds to get sex ed too, right? Are they not going to read this? And I'm like, everybody needs to know what's happening. This is 50% of the population. You know about pregnancy, you know about puberty. You need to know about ovarian decline in midlife. So I put that chapter in that book and I got a lot of feedback that, oh my God, that chapter just explained everything to me. Now I know what's actually happening. Thank you so much for the menopause chapter. So the publisher came and they're like, will you write another sex book? And I'm like, yes. But I think my next book is I want to write it about menopause. And they're like, great, write it about menopause. And the gist of the book is, I'm not gonna tell you what to do. I don't want you to do something. Cause Dr. Casperson told you or Dr. X, Y and Z told you. I want you to understand what's going on in your body, understand what the options are, and make the decision on your behalf. Cause that's an empowered woman. That's not a woman who's like, I'm Doing this. Cause somebody else said so. It's a woman who's like, now I know the data. And I'm pretty good. I'm a pretty good medical translator, right? So it's like, here's the science. What does it. It mean for you? Here's the science. Why is this good and bad? What does it mean for you? So I just received an Instagram message from somebody who was wanting to do this whole menopause thing naturally, right? And we can debunk the myth of natural. Yeah, we can debunk the myth of natural next. But she's like, I read your book. I'm thinking about things differently now. Thank you. Oh, because again, you can't feel your bones thinning. You can't feel your glucose metabolism changing, right? This whole thing of, like, if you choose to go through midlife unsupported and unsupporting your ovarian whole hormones, there's consequences to that, and you gotta know what those are. Now you make the best decision, because.
- [75:30]
B
It'S not just about hot flashes. No, it's so much more than that.
- [75:34]
A
No, it is like, you know, the whole, like, it's about your period ending in hot flashes. No, no, those are symptoms because of the underlying hormone changes. That's not actually the thing. That's the consequence of the thing. So it's like, to bring women one step back to be like, this is what's happening. Because of that, the thermal regulatory center of your brain gets all whack and your hormones are so low that you don't have periods anymore.
- [75:58]
B
Jesus Christ.
- [75:59]
C
I'm.
- [75:59]
B
So your book, your book is phenomenal. And it actually really is suited for anybody. You don't have to be a physician.
- [76:05]
C
To read this or a PhD.
- [76:07]
B
It is.
- [76:08]
A
Yep.
- [76:08]
B
Let's play this out. If tomorrow the FDA approved a safe, low dose testosterone patch for women, what would change in America?
- [76:16]
A
I would hope I would get on Oprah. I know, right? I'm like, oh, I've been doing this for a while. It's just gonna normalize it. Like, it's gonna normalize that this is a hormone that is in all bodies and is in a certain dose in females, and that it's legitimate, the best that we have. And this is hard data to get because people get compounded and people use pellets and nobody's tracking all of that. But to the expert's best ability, both in the UK and in America, currently, as many women are on testosterone as. As men are. Easy math. Only 20% of men have low testosterone Less than that actually get treated. 100% of women will have low testosterone. You know, I was talking to a pharma person yesterday and they're like, we're doing market research. Blah. I'm like, I've done the market research. I've been talking to women for, for years at this point. Stop doing market research. Get a product out there, normalize this conversation. And to me, I'm like, I want as many products as the men have. Look at the disparity. 20% over here, 100 over here. Hypogonadal. Like we need 10 products. We need a cream, we need a vaginal ring, we need an injectable, we need an oral pill. Right. So to me, I'm like, let's get one to normalize it and then let's get many so that we actually have options.
- [77:28]
B
Do you know how long, in my opinion, women have been misrepresented for testosterone?
- [77:34]
A
No, for all of this.
- [77:36]
B
In terms of, I would say in terms of Alzheimer's disease and hormones. Give a year. Like in your, your instance.
- [77:43]
A
Well, we've been giving women testosterone since 1943.
- [77:47]
B
It traces back to 1901. The first ever woman diagnosed or the first ever human diagnosed with Alzheimer's disease by eloise Alzheimer.
- [77:55]
A
By Dr. Alzheimer. Yeah, yeah.
- [77:56]
B
Augusta deity. She was 52 years old.
- [77:59]
A
There it is.
- [78:00]
B
Went to her doctor complaining of I'm not myself. There's. This was in Monich in Germany. She said, I just don't feel like myself. Her husband said, she's going to going crazy. You know what they did? They sent her into a psychiatric ward.
- [78:13]
A
Yeah. They did that for decades.
- [78:15]
B
Yep. And that was 1901. If it wasn't for Eloise Alzheimer who looked at her and he was a resident 37 year old neurologist at the time. If he didn't really study her and they did like brain slices and really saw that she had a brain full of amyloid and tau, that her psychiatric symptoms were just the underlying cause of Alzheimer's disease. She actually, it was extremely accelerated because back in the then they had, you know, there was no antibiotics, she had infections. She didn't die of Alzheimer's disease. She died of other complications, obviously.
- [78:48]
A
Probably mistreatment. Yeah.
- [78:51]
B
And they literally put her in this asylum, closed the windows, closed the doors, no sunlight. She just started to forget pain. He kept diary entries and I'm actually flying to Germany. It's my dream to actually. Because they've got them on display and just to have a look at all of that. It's really interesting they've got all of the diary entries from Dr. Alzheimer who detailed today. She didn't know who I was. And you see the progression. It's like that. It's a clear state like. And it was still ignored. So I believe in my opinion that women have been ignored since 1901.
- [79:22]
A
That's a wild story.
- [79:23]
C
Yeah.
- [79:24]
B
Dr. Kelly Casperson, thank you so much for coming onto the Neuro Experience podcast. We're going to put your book below and I can't wait to see you on Oprah one day.
- [79:32]
A
Thanks for having me.
- [79:46]
B
And Doug here We have the Limu Emu in its natural habitat helping people customize their car insurance and save hundreds with Liberty Mutual. Fascinating. It's accompanied by his natural allies Doug. Limu is that guy with the binoculars watching us. Cut the camera. They see us. Only pay for what you need@libertymutual.com.
- [80:11]
A
Savings very unwritten by Liberty Mutual Insurance Company affiliates.
- [80:13]
B
Excludes Massachusetts.