Testosterone and Menopause: What Every Woman Should Know

Summary

Episode Summary: Testosterone and Menopause: What Every Woman Should Know

Podcast: The Tamsen Show
Host: Tamsen Fadal
Guest: Dr. Kelly Casperson, MD
Release Date: June 18, 2025

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1. Introduction to Testosterone in Women's Health

In this enlightening episode of The Tamsen Show, host Tamsen Fadal engages in a profound conversation with Dr. Kelly Casperson, a board-certified urologist, hormone expert, and author of the podcast You Are Not Broken. The discussion centers on the critical yet often misunderstood role of testosterone in women's health, particularly during menopause.

2. Dr. Kelly Casperson's Background and Journey [00:56 - 04:38]

Dr. Casperson shares her unique path into urology—a field with relatively few female practitioners. She explains her initial attraction to urology due to the immediate, tangible impact it has on patients' lives, offering "instant gratification" by resolving issues like kidney stones or bladder tumors. However, after seven years in private practice, Dr. Casperson experienced a "seven-year itch," feeling unfulfilled and seeking deeper meaning in her work. This led her to focus on female sexual health and hormone function after a patient expressed distress over her sexless marriage. This pivotal moment motivated Dr. Casperson to explore and educate about female hormones, resulting in her book and podcast aimed at addressing the informational void affecting millions of women over 40.

Notable Quote:
Dr. Casperson: "It was one woman and one story that hit you so hard. And I think that happens because during this time, we're all sort of, you know, in that same place, rediscovering ourselves in a lot of ways." [04:15]

3. Understanding Testosterone and Hormones [05:44 - 07:24]

Tamsen introduces the topic by dispelling the common misconception that testosterone is solely a male hormone. She emphasizes that testosterone is actually the dominant sex hormone in women, contrary to the widespread belief that estrogen holds that position. Testosterone operates as a neurohormone, influencing not just sexual health but also cognitive functions.

Notable Quote:
Tamsen Fadal: "Hormones aren't gendered, right? But we, you know, for better, better, for worse, probably for worse, we said estrogen's for women, testosterone's for men." [05:44]

4. Testosterone vs. Estrogen: Myths and Facts [07:31 - 10:44]

The conversation delves deeper into the biochemical roles of testosterone and estrogen. Tamsen explains that cholesterol serves as the precursor for both hormones, highlighting their interconnected pathways. She corrects the myth that testosterone levels drop precipitously during menopause, noting that while testosterone peaks in the 20s and gradually declines, it may even increase in some women after age 70.

Notable Quotes:
Tamsen Fadal: "Testosterone is actually women's dominant sex hormone. It is wrong when people say estrogen is our main hormone, our Main hormone is testosterone." [07:18]
Dr. Casperson: "So wait, we have more test. We actually have more testosterone than we do estrogen, Is that right?" [07:23]
Tamsen Fadal: "That's correct, yes." [07:24]

5. Current Options for Testosterone Therapy in Women [10:44 - 21:15]

The discussion shifts to available testosterone therapies for women. Currently, the U.S. lacks FDA-approved testosterone products specifically for women, leading to off-label use of male formulations at significantly lower doses. Tamsen outlines the three main options women use today:

1. Microdosed Androgen Gels: Such as AndroGel or Testum, diluted to one-tenth the standard male dose.
2. Compounded Testosterone Creams: Typically starting at around 5 milligrams, offering affordability.
3. Testosterone Pellets: Implanted subcutaneously, these provide a high-dose, long-acting option but come with increased risks and costs.

Notable Quotes:
Tamsen Fadal: "Most common things that we're using now, I'd say are three things. Number one, we take a male product... it's very small amount of gel, pretty cheap. Second option is we compound a testosterone cream... and the third option is pellets." [22:01]
Dr. Casperson: "I had pellets initially... felt great, and then three months later, I felt like crap." [23:37]

6. Challenges and Misconceptions in Hormone Therapy [21:15 - 28:14]

Tamsen addresses the significant regulatory and educational barriers hindering the development of female-specific testosterone treatments. Despite decades of use and extensive safety data, the FDA has delayed approval, often citing the need for more breast safety data. This regulatory inertia stems partly from historical gender biases in medicine.

Notable Quotes:
Tamsen Fadal: "In America, our FDA approves medications... We've had a female testosterone go in front of the FDA twice already to the tune of a billion dollars and five years of safety data." [21:15]
Dr. Casperson: "Status quo is women using poorly dosed male products." [26:52]

7. The Role of Testosterone in Libido and Sexual Health [28:14 - 32:00]

The duo explores how testosterone influences libido. Tamsen explains that testosterone enhances neurotransmitter activity, particularly dopamine, which is crucial for the reward pathways associated with sexual desire. However, libido is multifaceted, influenced by factors like relationship quality, stress levels, and overall well-being. Therefore, testosterone therapy alone may not resolve all issues related to low libido.

Notable Quotes:
Tamsen Fadal: "Sex is incredibly complex. Testosterone can help, but libido is not just about hormones." [28:27]
Dr. Casperson: "Libido is incredibly complex. Testosterone increases dopamine pathways, but if sex is a chore, testosterone won't make you desire it." [28:52]

8. Genital Urinary Syndrome of Menopause (GSM) [38:07 - 40:25]

GSM encompasses a range of symptoms resulting from decreased hormones during menopause, such as vaginal dryness, urinary urgency, and recurrent urinary tract infections (UTIs). Tamsen emphasizes the lifesaving role of vaginal estrogen in reducing the risk of severe UTIs and other pelvic complications. Despite its safety and efficacy, less than 4% of eligible women utilize hormone therapy for GSM.

Notable Quotes:
Tamsen Fadal: "GSM stands for genital urinary syndrome of menopause... It can lead to severe complications like sepsis and death from recurrent UTIs." [38:21]
Dr. Casperson: "UTIs are so deadly and so dangerous, and they increase with age." [39:35]

9. Safe Use of Vaginal Estrogen [36:42 - 37:57]

Vaginal estrogen is highlighted as a safe and effective treatment for most women experiencing GSM. Tamsen dispels fears surrounding breast cancer, citing extensive studies that affirm its safety for breast cancer survivors and the general population. She urges women to consult with their oncologists if undergoing cancer treatment but reassures that vaginal estrogen is suitable for 99.9% of women.

Notable Quotes:
Tamsen Fadal: "There's no asterisk: 99.9% of people can be on vaginal estrogen." [36:50]
Dr. Casperson: "GSM is increasing due to ignorance about hormonal changes post-menopause." [38:21]

10. Recommendations for Women Feeling Disconnected [44:13 - 46:44]

For women who feel disconnected from themselves, experience low libido, or suffer from GSM, Tamsen advises starting with education. She recommends resources such as her podcast, books, and online sex education courses to empower women with knowledge. Additionally, she suggests seeking out specialized healthcare providers trained in women's sexual health and hormone therapy.

Notable Quotes:
Tamsen Fadal: "Education, I think is number one and understanding that libido. There are treatment options, but a lot of things for libido aren't medication." [44:13]
Tamsen Fadal: "International Society for the Study of Women's sexual health is the Venn diagram of sex and hormones." [45:44]

11. Future Directions and Regulatory Challenges [46:31 - 47:11]

Tamsen discusses the need to deregulate testosterone, which is currently classified as a DEA Schedule III drug, severely limiting its accessibility for women. She criticizes the lingering stigma from past athletic doping scandals, emphasizing that testosterone is a naturally occurring hormone essential for women's health. Deregulating it would pave the way for more accessible and appropriately dosed female testosterone therapies.

Notable Quotes:
Tamsen Fadal: "We need to deregulate testosterone. It's a hormone our body naturally makes, yet it's heavily restricted." [46:31]
Dr. Casperson: "We're gonna get this conversation finally and it's a big deal." [46:39]

12. Closing Remarks and Upcoming Book [47:11 - 48:00]

The episode concludes with a preview of Tamsen's upcoming second book, The Menopause Moment: How Hormone Science and Mindset Create Optimal Longevity, set to release in September. She underscores the importance of integrating hormone science with mental well-being to enhance longevity and quality of life during and after menopause.

Notable Quotes:
Tamsen Fadal: "This book is like the 201 to the amazing 101 books that my friends have already written." [47:11]
Dr. Casperson: "I cannot wait to have you back on to talk about it." [47:40]

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Key Takeaways:

• Testosterone is the Dominant Hormone in Women: Contrary to popular belief, testosterone plays a crucial role in women's health, influencing libido, muscle mass, and overall well-being.
• Current Therapy Options are Limited and Off-Label: Women often rely on microdosed male testosterone gels, compounded creams, or high-dose pellets due to the absence of FDA-approved female-specific testosterone products.
• Education is Empowering: Understanding hormonal changes and available therapies is essential for women navigating perimenopause and menopause.
• Safety and Efficacy of Vaginal Estrogen: Extensive research supports the safe use of vaginal estrogen for treating GSM, benefiting nearly all women except those with specific contraindications.
• Regulatory Barriers Persist: The classification of testosterone as a DEA Schedule III drug hinders the development and accessibility of appropriate hormone therapies for women.
• Comprehensive Approach to Libido: Low libido is multifaceted, requiring a combination of hormonal therapy, relationship dynamics, and personal well-being considerations.

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Additional Resources:

• Dr. Kelly Casperson's Website: KellyCaspersonMD.com
• International Society for the Study of Women's Sexual Health: ishwish.org
• Tamsen Fadal's Podcast and Books: Available on thetamsenshow.com

For those seeking to deepen their understanding of hormone therapy and its impact on women's health, this episode serves as an essential guide, bridging the gap between medical expertise and personal empowerment.

Transcript

[Tamsen Fadal]

Breaking up is never easy. But saying goodbye to your old clunky work tools, well, that's easy. Just repeat after me.

[Dr. Kelly Casperson]

It's not me, it's definitely you, you rigid, unfriendly software.

[Tamsen Fadal]

It's time to freshen things up with Monday.com the first work platform you'll love to use. With stunning dashboards, customizable templates, and built in AI that actually works.

[Dr. Kelly Casperson]

Switching to a new work platform has.

[Tamsen Fadal]

Never felt this good.

[Dr. Kelly Casperson]

So move on to Monday.com. this episode is brought to you by Progressive Insurance. Do you ever find yourself playing the budgeting game? Well, with a name your price tool from Progressive, you can find options that fit your budget and potentially lower your bills. Try [e-mail] Progressive Casualty Insurance Company and affiliates Price and coverage match limited by state law. Not available in all states. When Halle Berry said on this show that she uses testosterone, the comments blew up things like, isn't that for men? Wait, should I be taking that? When I was writing how to Menopause, I learned testosterone is not just a male hormone, it's a human one.

[Tamsen Fadal]

Testosterone is actually women's dominant sex hormone. But people don't know that.

[Dr. Kelly Casperson]

My low testosterone was impacting my libido in a big way and it's led me to start taking it myself. Today I'm joined by My dear friend, Dr. Kelly Casperson, a board certified urologist, hormone expert, and author of the book and podcast by the same name. You are not broken.

[Tamsen Fadal]

It all boils down to we did not get a good sex education.

[Dr. Kelly Casperson]

If you're feeling confused or you're feeling overwhelmed, we're going to get you some answers that you're looking for.

[Tamsen Fadal]

Feeling like yourself is one of the most important things we can do to help people in medicine.

[Dr. Kelly Casperson]

It's not about fixing you, it's about informing you on all of it.

[Tamsen Fadal]

This conversation is going to freaking explode.

[Dr. Kelly Casperson]

So let's get into it. Dr. Kelly Casperson, it is so good to see you my friend.

[Tamsen Fadal]

Thanks for having me on.

[Dr. Kelly Casperson]

Yeah, I always look forward to our conversations because I feel like I, I walk away with new things to implement. So I feel like our audience is definitely going to do that today. I to start at the beginning though, with your story because I've always been fascinated by it. Urology is what you decided to go into and major in. Why urology? Because I know there are just a handful of female urologists in the country.

[Tamsen Fadal]

Yeah. So right now there's about a thousand female urologists that are board certified in the United States of America out of about 10,000 urologists. So it's still, it's a for the fact that every human has a pelvis. It's still a very small specialty. So for people who don't know, urology is basically the surgery and the medicine of the genital urinary organs, which includes the kidneys, the ureter, the bladder, the prostate, the scrotum, the external genitalias, testicles in men. And I fell in love with it because of the people. I mean, the urologist, very smart, very funny. They love instant gratification. I love knowing that because I showed up today, your kidney stone was gone, your bladder tumor was gone, you could pee again. It just very amazing, instant gratification where a lot of medicine is, well, you know, maybe try to smoke less or, you know, exercise a little bit more. Let's adjust this dose. And it just wasn't that, like, really sexy because I showed up at work today, somebody's life got changed for the better. So that was what the people and the instant gratification is what made me gravitate towards it. And then about seven years into private practice, you know, just like you, you get really good at what you're doing and then you're like, is, is this all there is? Is there, is there more? You know, I'm kind of bored. I trained my whole life and I'm bored. Which is, you know, a privilege to be able to say I'm like super bored at urology now. But the universe, I think, knew that I was at the seven year itch and basically delivered the next path for my life. And that was in the form of a patient who was, I was very bonded with and she was crying because of her sexless marriage. And it hit me like a ton of bricks. I was like, I don't know how to help her. I don't know if the gynecologist know how to help her. Does anybody know how to help her? And went down this amazing path of female sexual health, female sexual function. What's the role of hormones? Then you just dig into why is everybody afraid of hormones? What was this WHI thing? And it's just my curiosity, basically created this new career for me, started a podcast, wrote a book, have the second book coming out. Because I was like, it's not enough just to know all this information and, and just see people in clinic, right? There's 80 million women over the age of 40 and nobody, by and large, rounding up, nobody has this information.

[Dr. Kelly Casperson]

Isn't it fascinating? I don't think I knew the part about Instant gratification or knowing why you went into the field. Because when you and I met, it was maybe it's five years, four or five years ago. Four years ago, maybe. And I think we both went down the same rabbit hole. We were probably just side by side in that rabbit hole trying to figure out exactly, you know, what was going on with women in this age group. But that one story, it's. It's so fascinating to me. And I always remember you telling me that is it was one woman and one story that hit you so hard. And I think that happens because during this time, we're all sort of, you know, in that same place, rediscovering ourselves in a lot of ways. So you went into women's sexual health and sexual health, and along the way, there's been a lot of questions to answer, but the big one, I feel like, is testosterone for you and sex and really being educated about it. So we get a lot of questions on the show about testosterone, and I really want to go deep with you on it. So women leave here understanding what it is that we have it and, you know, what can change if you decide that's a path you want to take.

[Tamsen Fadal]

Yeah, I mean, we really gendered the hormones. One of my sayings is, like, hormones aren't gendered, right? But we, you know, for better, better, for worse, probably for worse, we said, estrogen's for women, testosterone's for men. We discovered estrogen in cow ovaries, and we discovered testosterone in rooster testicles. Like, we've never been more nuanced ever since then. So we gender these. These hormones. And what are hormones? Hormones are chemical messengers in our body that travel to other places in our body that tell our cells how to function and how to communicate. They actually help the health of our cells, our mitochondria, like the lining of nerves. Right. So to even call these hormones sex hormones is very dismissive because most of us aren't reproducing for our entire life.

[Dr. Kelly Casperson]

And.

[Tamsen Fadal]

And it kind of makes them extra, right? Like, oh, it's just about sexual health. That's not life or death. But really, these are neurohormones. And when you dig into the whole sexual function, like libido, I'm always like, where's your libido? It's in your brain, right? Oh, okay. It's in your brain. And so these hormones work in your brain as well as other places. And so testosterone is actually women's dominant sex hormone. It is wrong when people say estrogen is our main hormone, our Main hormone is testosterone. And if you convert, if you were to a normal cycling woman, not a post menopause woman, if you convert her testosterone, which is measured in deciliters, it's like deciliters, and then estrogen's measured in something else. And if you do the math, you will see that testosterone is higher than estrogen in your average woman.

[Dr. Kelly Casperson]

So wait, we have more test. We actually have more testosterone than we do estrogen, Is that right?

[Tamsen Fadal]

That's correct, yes.

[Dr. Kelly Casperson]

So that's what. So let's go back a little bit. So let's talk about what is testosterone, first of all, and why women need it.

[Tamsen Fadal]

Yeah. So testosterone is considered a neuro or steroid. And steroid just means the way the carbons are arranged in rings. Steroid itself has gotten a very bad reputation for bodybuilders and overdosing. All steroid means is what it looks like. Right. So vitamin D is a steroid and a hormone and cholesterol. Right. And so cholesterol is the steroid pathway. Cholesterol will lead to progesterone, to testosterone, to estrogen. And you can't make estrogen in your body without it coming from testosterone.

[Dr. Kelly Casperson]

See, I don't think, or think I even wrong that I don't. I don't think I realized that's how closely aligned it is.

[Tamsen Fadal]

I went to med school. I didn't know that.

[Dr. Kelly Casperson]

Okay, good. I feel. I feel better. You made me feel a little bit better.

[Tamsen Fadal]

Don't feel bad.

[Dr. Kelly Casperson]

Okay.

[Tamsen Fadal]

So I think a lot of menopause experts don't know that.

[Dr. Kelly Casperson]

Well, I think it's very confusing because when we talk about hrt, we talk about estrogen and progesterone. Right. And then testosterone. Third thing that maybe you might want.

[Tamsen Fadal]

To do again, it's extra instead of like, it's the dominant hormone. We were at this talk together in Dallas, which was awesome.

[Dr. Kelly Casperson]

Yes.

[Tamsen Fadal]

But every time, this is like what makes me cringe so much when somebody's like, I can't take hormones because of X, Y and Z, which. Number one, that's usually wrong. But number two, what about testosterone? What about progesterone? Like, when they say they can't take hormones, what they mean is estrogen. And it drives me nuts because I'm like, that's one type of hormone.

[Dr. Kelly Casperson]

But. But because you can usually always take the other one. So let. So let's help women understand that. So if women think. If we think we can't take hormones, let's. Let's go back and say, you know, why. Why it's been so confusing and perhaps why testosterone could be an option.

[Tamsen Fadal]

Yeah. So I think the biggest reason to not be able to take estrogen, which is what people mean when they say, my doctor said I couldn't take hormones, which again, is not true, because most everybody can take vaginal estrogen. Right, Right. So again, it gets like, it gets nuanced and it's like, no, most people can take some type of hormone.

[Dr. Kelly Casperson]

Okay.

[Tamsen Fadal]

It just might not be oral estrogen. Right. So what a lot of people mean is that they're not allowed to take oral estrogen because of going through the liver. So people with a stroke or a recent heart attack or blood clot risk. Also, anybody being currently treated with breast cancer, we are liberalizing the survivors pretty fast. Like, even talk to me in three years, it's going to be different than it is now. So even, like, that's turning from a red light to a yellow light. Treated breast cancer.

[Dr. Kelly Casperson]

Meaning. Meaning somebody that went. Went through breast cancer and is now in remission might be able to take some type of hormone therapy.

[Tamsen Fadal]

I know many people who have been cured from breast cancer who are on hormone therapy, including transdermal estradiol. And so, again, things that make me cringe. But, you know, we exist in the world of Instagram and it's hard to be nuanced, which is why podcasts are so awesome.

[Dr. Kelly Casperson]

Yes. We're going to clean up misinformation.

[Tamsen Fadal]

Yeah. The other big myth, I think, about testosterone is that people think it falls off a cliff with menopause, just like your estrogen does. That's not true. Our testosterone's the highest in our 20s and then has a slow decline. Actually, in some people after age 70, it tends to go up again. We have no idea why that is.

[Dr. Kelly Casperson]

Wow.

[Tamsen Fadal]

Looks like it's heart protective.

[Dr. Kelly Casperson]

However.

[Tamsen Fadal]

However, again, testosterone works everywhere in our bodies. So it is a myth that testosterone falls off a cliff with menopause. I think we're going to. Again, what are we going to see if you talk to me in three years from now, we're going to see more and more perimenopause people be treated with testosterone because there isn't anything to do with your periods or normal that has anything that tells you what your testosterone is. And I think as we expand the conversation into treating perimenopause, the role of testosterone is going to get greater. This is the other thing. New Zealand just got their FDA approved Androfem. So now we have Australia, New Zealand, South Africa. It's available what we call off label so the government doesn't cover it. But it is available as a female product in the UK now. So that's four countries.

[Dr. Kelly Casperson]

It is not available as a female product in the U.S. correct. @.

[Tamsen Fadal]

@ this time.

[Dr. Kelly Casperson]

At this time.

[Tamsen Fadal]

But it is coming. The people who know know that it is coming. And I'm like, this conversation that we're having right now is going to freaking explode. Three to four years. Because once we get the FDA approved dosing for women and the data we have in both the UK and America, it looks like women are taking as much testosterone as men are.

[Dr. Kelly Casperson]

Wow.

[Tamsen Fadal]

But men have 20 products and women have zero.

[Dr. Kelly Casperson]

So a woman walks into the, you know, the, the gynecologist or doctor let's say is in perimenopause. How. How does she know whether or not one. She needs testosterone and, and what it's going to be, what it's going to be good for? How does she know her levels? Is that a blood test? There's.

[Tamsen Fadal]

Yep. So that's a blood test. You have to make sure it is a blood test that can detect female ranges because again, women have about 10% of a male testosterone level.

[Dr. Kelly Casperson]

Okay.

[Tamsen Fadal]

So not all tests are sensitive enough to detect those lower levels.

[Dr. Kelly Casperson]

Okay.

[Tamsen Fadal]

So you need the mass spectrometry test or it'll say testosterone comma female and ms, which means mass spectrometry, testosterone comma.

[Dr. Kelly Casperson]

Females is easier to remember. So you need this testosterone comma female test.

[Tamsen Fadal]

Yeah, it's just that the other one isn't good at detecting levels under, under 100 and most women have testosterone underneath 100. And again, I'm using America lab values here. So there, this is not a red light, green light. Meaning there isn't a level where you're like, she needs it, she doesn't. That doesn't exist.

[Dr. Kelly Casperson]

Okay.

[Tamsen Fadal]

This is really a trial and error. Meaning I just don't feel like myself. I have lower energy. I cannot. I'm going to the gym. I just can't see the gains. I like sex with my partner. It's a great time, but I could take it or leave it. I just don't have that drive. That's what's so tricky about testosterone is there's not an absolute number indication and there isn't an abs. These are all kind of soft things like.

[Dr. Kelly Casperson]

Well, all of them, all hormones are pretty soft.

[Tamsen Fadal]

Right.

[Dr. Kelly Casperson]

Especially in the, in the perimenopause time because it's really symptom based. So if you are dealing with certain type of symptoms, most likely in perimenopause. Right. Irregular periods, you got weight gain, you're not feeling good, you got mood swings. And now on top of that, more of that soft area is the low libido. And like, you're not seeing any kind of gains at the gym. Is that right for testosterone?

[Tamsen Fadal]

Yeah. Testosterone's really good for lean body mass.

[Dr. Kelly Casperson]

Yeah.

[Tamsen Fadal]

Right. And so it helps, it helps in that arena. But I think these soft outcome, soft indications, like not feeling like myself, which is huge. 60% of women in perimenopause, not feeling like myself. That's a thing that's well researched. But it's soft like your blood pressure. That's an absolute number. Right. I absolutely know I should give you a blood pressure medication because of your blood pressure. We don't. How do I know Tamsen doesn't feel like Tamsin felt Right three years ago? Right. So I can't measure that. But I would say feeling like yourself is one of the most important things we can do to help people in medicine. But completely blown over.

[Dr. Kelly Casperson]

How do we know if that's testosterone or that's a result of getting on, you know, what we would call, I guess, traditional hormone therapy of what we think of as estrogen and progesterone.

[Tamsen Fadal]

It is trial and error.

[Dr. Kelly Casperson]

Okay.

[Tamsen Fadal]

You know, you can try things that most experts tend to try one thing at a time, what we call stacking hormones, because we don't know what the side effects from and when you got a big win, what is it from? So add things, you know, every. Every two months, you can add things, adjust things. Another big myth I see with testosterone. People say this all the time on my Instagram. They'll be like, I'm on testosterone and my libido is not better. It's not a one to one. Right. Libido is incredibly complex. Like, you know, you're working 80 hours, your relationship's on the rocks, you don't feel safe at home, you know, you've got all this stress. A testosterone level increase is not going to make you horny again.

[Dr. Kelly Casperson]

No.

[Tamsen Fadal]

And so really breaking that down, for people to be like, libido's complex. Testosterone can help. But I mean, to tell you the truth, I have plenty of women we put on estrogen and they're like, I am good to go. I am loving sex again. So testosterone kind of gets stereotyped as the libido hormone. But estrogen also is lovely. And libido at the end of the day is incredibly complex.

[Dr. Kelly Casperson]

If somebody is going to the doctor and says, like, okay, I'm willing to, I Want to do hormones, Would you suggest they start with estrogen or progesterone and then layer on testosterone?

[Tamsen Fadal]

That's what most people do.

[Dr. Kelly Casperson]

Okay, but, but.

[Tamsen Fadal]

And in perimenopause, that might be different, because in perimenopause, estrogen can go very high, and you don't want to add more to more. So it's really, what are your goals? What are you hoping to get out of this? You know, are you having periods? Are you post menopause? Where are you?

[Dr. Kelly Casperson]

Right?

[Tamsen Fadal]

And so it's, you know, we don't have a cookbook of hormones. Most experts will say this is individualized medicine.

[Dr. Kelly Casperson]

Y what are your goals?

[Tamsen Fadal]

What are we. What are we hoping for? And, you know, I think we're the pendulum swinging back from, we never need to test hormones. It's like, nah, they can be useful, but you have to know what you're looking at and understand that they move all the time in perimenopause, especially estrogen. So we don't labs all the time to say, you need hormones. But they can be useful to say, where are we with this? With testosterone, the guidelines do suggest getting a baseline. I always joke. I'm like, I'm trying to find the mythical perimenopausal woman with high testosterone. I haven't found her yet.

[Dr. Kelly Casperson]

No.

[Tamsen Fadal]

But we check a baseline, and then we check in about six to eight weeks to see that she's moved that up by being on a testosterone product.

[Dr. Kelly Casperson]

Okay, so what do you say to a doctor if you think you need testosterone?

[Tamsen Fadal]

Until more people get educated on this, this is what I recommend. Make sure that they are comfortable doing this in the first place. Call the office, ask the receptionist, you know, see who your friends go to and love. Right? Because even endocrinologists, who are our hormone specialists, I would say the majority of them don't do sex hormones, right? But what I mean by sex hormones, estrogen, progesterone, testosterone. We've completely stopped caring about this after the whi to the fact that our hormone doctors in this country don't do it. The urologists are pretty savvy with it because we give 10 times the dose to men every day, right? So we're like, we know how beneficial testosterone is, and we're not scared of it because we give 10 times the dose every Tuesday, and they do fine. Also, the people. You know, I did an article. What was it? Not in maybe in the Atlantic a year or so ago. A lot of women are getting great menopause care at trans clinics because they understand the role of hormones in feeling like yourself. They're comfortable with it. And I hadn't known that that was kind of like an underground thing of like, oh yeah, that's where doctors actually care about hormones. We do have an international guideline. The Ishwish Society and multiple societies published I think 2019 a global consensus on the use of Testosterone Post menopause for libido. So that's a nice place to start. I think it's getting a little dated now that it's 2019. I think do believe they're going to redo that. In addition, most experts say there's nothing magical about a year with no periods with testosterone. So we can start offering it more in perimenopause, but you can bring in those guidelines to your doctor. But don't expect that the average doctor is going, we don't have an FDA approved product.

[Dr. Kelly Casperson]

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[Tamsen Fadal]

Yeah. So in America, our FDA approves medications, meaning we've got great data to say this is safe and it's effective. Better than placebo. Here's our basically stamp of approval, which is a very expensive process. We've had a female testosterone go in front of the FDA twice already to the tune of a billion dollars and five years of safety data. And the FDA just moved the stick on that again and said, nope, we need five more years of breast safety data on this. Keep in mind the men, an FDA approved testosterone with six months safety data. Viagra approved six months safety data.

[Dr. Kelly Casperson]

Why do we need this? Why do we need it?

[Tamsen Fadal]

So long I we've been giving women testosterone for 80 years. In addition, love the trans data. We give women 10 times the dose because they want to transition. We've been doing that for 50 years. We have 50 year safety data in the trans community. I don't know what other drug can you dose people 10 times the amount? We'll follow them for 50 years and say they don't have more cancer, heart disease or death.

[Dr. Kelly Casperson]

Yeah, I heard you say that at the conference.

[Tamsen Fadal]

That's the safety data that we have.

[Dr. Kelly Casperson]

Yeah, I heard you say that at the conference and I wasn't aware of that.

[Tamsen Fadal]

It's, I mean I love pulling it up because it's so stinking obvious like what burden of proof is needed at this point besides just gender bias and giving women safe access. So FDA keeps moving the needle on that. There are a couple of companies that are going to go forward again. So that's why I do believe in the next couple of years we will have one. And when we get a female dose, FDA approved testosterone product, it'll just normalize this conversation like it's going to explode. And so that's going to be very exciting. If that is in a pink box and costs $500 a month, we'll still use what we're using now.

[Dr. Kelly Casperson]

So what are we using now?

[Tamsen Fadal]

Most common things that we're using now, I'd say are three things. Number one, we take a male product, most commonly the androgel or testum, and we micro dose it to women. It's one tenth the dose. So it's a very small amount of gel, pretty cheap. Second option is we compound a testosterone cream, usually starting at around 5 milligrams, very cheap. I can get a 90 day supply for like 60 bucks at my compounding pharmacy. And the third option is pellets. And now if the FDA thinks that we're keeping women safe by not approving a normal dose amount, we're actually making them less safe because we're giving them the most expensive and the highest dose, which is a pellet.

[Dr. Kelly Casperson]

Kelly I had no idea. I had no understanding of pellets because I did them initially. I had no idea what I was doing. I did it one time I went to a doctor, they said, I said, I'm not feeling good, I'm not feeling. This is before I knew anything. And I felt great. And then three months later, I felt like crap. And I didn't know what had happened. And I was so scared that I had such a difference in how I felt. And now I've heard you talk about pellets quite often, but I really, I wanna stop for a second and talk about pellets because a lot of women, I've been traveling all over the country for my book and a lot of women are telling, they're coming up saying, like, I'm feeling great, my sex life is back, I'm doing pellets. And then I'll talk to somebody else that said, I did them, but I got too much testosterone. So can you explain them if there are pros and cons or just con?

[Tamsen Fadal]

Pellets are a drug delivery method that is implanted usually around the buttock, really small, like a piece of bird seed. It's the most expensive way to get hormones and it's the highest dose way to get hormones. And to me, especially if you're introducing yourself to hormones, that's not the best, that's not ideal, right? I always say you have to earn your pellet. What do I mean by that? Know that you tolerate hormones, you tolerate them at lower doses, that you work your way up to higher doses. And then. So who's the perfect pellet person? I tolerate hormones I actually feel better at higher doses. I'm not getting side effects. I have the money that I can do this for the next 40 years. And I like plug and play where I just have to think about this four time a year because it's a longer acting. There are two schools of there's like the pellet only people. Then there's the we should ban pellet people. To me I think it should be on the menu like it's your most expensive bottle of wine. That is not what everybody needs. It's not practical and it's the highest dose and what we know. Again let's use our wonderful trans data because we have takes a while to start seeing just higher level testosterone side effects. I don't give you a high dose, you look blood more burly tomorrow. It's slow. And in the women that continue to take the pellets I worry about their, their androgenic side effects over time. Sure, not everybody will get that. But that's what I worry about with higher dose is like eh, testosterone at 250 for a while. Do that for a couple years. There might be some things you might not like but you don't know that right away.

[Dr. Kelly Casperson]

So I did the compounding testosterone because I was nervous in full disc. I was very nervous despite everything. I knew, read, studied, research. Then I went to another doctor who said why are you spending the money on compound when you can do gel but you've just got to do like a. She put a circle in the middle of her hand and said like just like the top of an eraser and just do that much. So now I have the tubes that you're talking about which are you know, pretty generic. But I will say that like every once in a while I'm like is that too much? Is that too little? Is that too much? Because we're asking women to, I mean to measure.

[Tamsen Fadal]

That's what's so silly. So we're like hey, fda. FDA is like we don't have enough long term safety data and it could be unsafe. They're like oh, so you're happier with women poorly dosing a product that was in no way designed for them. Like no sense that we can't provide women with a safe effective dose. And that's, you know, that's what it is until we get an approved product.

[Dr. Kelly Casperson]

So if somebody decides yes, I'm going to do testosterone, they're going to want to know the real side effects, right? What are side effects that they're going to be afraid of? Anybody that I'VE spoken to says, I'm afraid that, you know, I don't want to be too muscular. I don't want to. I don't want my voice to change. I don't want to lose my hair. So let's talk about some of those real side effects.

[Tamsen Fadal]

Well, don't take. Don't take male doses.

[Dr. Kelly Casperson]

Yes, Male doses. Not. Not male testosterone. Male doses.

[Tamsen Fadal]

Male doses. So the, you know, one thing that comes up time and time again on Instagram, people do not understand dosing. They don't understand, like, it's a concept that, like, why would the average person understand that? Right? Because I got a thing today and somebody's like, well, if testosterone goes on the skin, but that's in your bloodstre, but estrogen goes in your vagina and that's not in your bloodstream. They both go on skin. And I'm like, it's not how it's delivered, it's the dosing of it. Right? And so many women, when they're like, I don't want to turn into a man, that's a dosing problem. Not again. Testosterone is way higher than estrogen pre menopause for women. But people don't know that. So you have to educate that first and say female doses, female dose testosterone. But again, it's weird because we don't have an FDA approved female dose. We do in Australia, New Zealand, South Africa and, you know, off label in the UK now. So you can actually go and get it appropriately dosed. And again, it's about one tenth the male dose.

[Dr. Kelly Casperson]

1/10 the male dose. All right, let's talk about how it helps with libido, because I know, I know that we said it's in the brain. I know estrogen will work for some women, but can you talk about how testosterone helps with libido?

[Tamsen Fadal]

Yeah. So basically, the sex hormones estrogen and testosterone help modulate our neurotransmitters. Neurotransmitters being serotonin, neurotransmitters being dopamine. So dopamine is a big neurotransmitter. In seeking out rewarding behavior, that's key. Sex has to be rewarding. I can't make you desire mushy broccoli, cold old chicken, mediocre sex.

[Dr. Kelly Casperson]

I hope none of that comes up together.

[Tamsen Fadal]

It must be a reward worth seeking out. Yes. And so many women when they're like, I wish I wanted sex, and I'm like, is sex good when you have it? Like, no. I'm like, I can't make you like something that's not rewarding. Right. So that's very important in the whole libido thing, is like dopamine works for things that are rewarding.

[Dr. Kelly Casperson]

Yes.

[Tamsen Fadal]

Right. Casinos, alcohol, sugar. Right. Feel good, Netflix and ice cream. Right? Like, that is all dopamine. And so what testosterone does is will increase through the dopamine pathways. You being like, you know what? Humans are more attractive now, right?

[Dr. Kelly Casperson]

And so.

[Tamsen Fadal]

So it works in the brain by increasing those reward pathways. But if you. If sex is painful, if you're just having sex for somebody else, if it's a chore, Right. If you're never having an orgasm, testosterone won't make you desire something that's mushy broccoli in the first place.

[Dr. Kelly Casperson]

All right, so I just learned this term I did not know. Hypoactive sexual desire disorder. Yep. Why didn't I know that?

[Tamsen Fadal]

Hsdd. Cause it's a mouthful.

[Dr. Kelly Casperson]

Okay, hsdd. What is it? Can you explain it?

[Tamsen Fadal]

It's basically the medical term for low libido.

[Dr. Kelly Casperson]

Okay.

[Tamsen Fadal]

That's like the. That's the distilled down answer to that.

[Dr. Kelly Casperson]

Is there a certain amount of time that your libido has to be low to decide you have low libido? Look, painful sex. We totally understand why there would be no interest in that. If you have just no desire. You look at, you just have like, I'd rather watch tv. I'd rather have a glass of wine. It didn't even occur to me. We haven't had sex for a year. Is that something different?

[Tamsen Fadal]

Yeah, yeah, yeah. And you'll. You know, the classic libido is so complex that you always have to suss it out. But if I was to give you the classic low libido person or HSD person, my relationship's awesome. My work life balance is pretty great. I'm sleeping wonderfully. I. I had. We had this great sex life. Like, we are. We are so attracted to each other. And now I could totally take it or leave. I still love them so much, but I could take it or leave it. Like, it doesn't excite me. Like something's changed. Right. It's not like I always thought sex was shameful. And I've never had an orgas. It's none of. Of that. It's. It was really great. I didn't really have to think about it. And now it's just kind of gray and blah. That's more of your hsdd because you're ruling out all the other things that it could be. Also medication side effects.

[Dr. Kelly Casperson]

Yes.

[Tamsen Fadal]

Really? Affect sex life. And many people will agree that we do not do a good job in informed consent of letting people. Because, again, sex is extra. Sex isn't important. Keep in mind. And many relationships end over it, right? But in the medical world, it's just extra. We don't care. And then people are like, man, I've, like, my orgasm's gone. And you're like, oh, yeah, no, that happens, like, 50% of the time on antidepressants. And other people are like, what?

[Dr. Kelly Casperson]

Nobody told them, well, sex is not extra. If you have Dr. Kelly Casperson as your doctor.

[Tamsen Fadal]

Sex is not extra.

[Dr. Kelly Casperson]

Sex is not extra. Everything.

[Tamsen Fadal]

Sex is not extra.

[Dr. Kelly Casperson]

So you.

[Tamsen Fadal]

It feels really good.

[Dr. Kelly Casperson]

You starred in the M Factor documentary and really, you know, talked about sex, talked about testosterone, had brought a patient in whose life changed. I mean, several patients. One said, I didn't feel like myself anymore. And then I, you know, I became a new person after, you know, I was put on testosterone. I felt like my old self coming back to me, didn't want to have sex. And so I want to go into the sex conversation because you talk about it all the time on your podcast, which I have loved to be on because I always just love. I love talking to you. You've talked about it in your first book, and now you've got another book coming out that we're gonna talk about shortly. But, you know, we have a very confused idea of what sex is supposed to be, and we think we failed at it. If it's not the Hollywood romance, according to you, and I think you painted such a great picture for me when you said that a while back, and I've repeated it so many times and attributed to you, because I think that we think sex is supposed to be one way and don't think that we have to work at it or that it is in our brain. We think that it's supposed to be, you know, what it was at 20 years.

[Tamsen Fadal]

Well, I mean, it all boils down to, we did not get a good sex education. And when you have a gap of knowledge, what do you do? You try to fill it in, right? Fill in the knowledge. Where are we filling this in from? We're filling it in from country music, Hollywood religion, our parents, our first romance. All shitty ways of getting sex education. Right. You know, possibly a disease and pregnancy prevention plan when you were in 8th grade that mostly made you afraid of it and taught you about ovaries, although it didn't teach you that ovaries make testosterone. I mean, where was the clitoris and the labia in any sort of sex education, Pleasure, right? Why do people have sex? It feels freaking good. And you're not taught that, right?

[Dr. Kelly Casperson]

We're not taught anything about our bodies. I mean, most of us have never looked at our bodies. Right?

[Tamsen Fadal]

The biggest show, if you want a reaction on Instagram with hormones, you tell women that their labia minora goes away. And it's like you're telling like you like to be again, not to say that sex is extra, but it's like, dude. Also osteoporosis, heart disease, dementia, like all these bad medical things, but the labia minora, like, dude, women care.

[Dr. Kelly Casperson]

Explain what that is. Explain what the labia minora is and, and why it goes away and how to stop it from going away.

[Tamsen Fadal]

Yeah, exactly. Labia minor is the inner lip. So non hair bearing genitalia. So the, the area with hair that's labia majora on the inside before you enter the vagina are these little, I hate the word flaps, but they're pieces of tissue that's labia minora. And they're incredibly responsive to hormones. They're there because you went through puberty and you had huge surges of testosterone and estrogen, perimenopause, birth control. Post menopause, these hormones are blocked in the pelvis. And so the hormone responsive tissues can resorb, go away, atrophy, whatever horrific words you want to use. But many women will say it's just, it takes a lot longer to get turned on, to get aroused. The clitoris has some skin that goes over it, kind of like a turtleneck that can become kind of stuck to the clitoris. We call it phimosis or adhesions, making orgasm a lot more challenging. Right. And to be fair, women are not examined. Like they come in complaining of this. They're told, oh, everything looks normal down there. And. Or they're just like, drink a glass of wine of like. There are anatomic biologic things that happen when hormones leave the body. We must get an education about this because every time women freak out about their labia minor on Instagram, I'm like, we didn't get a good sex ed. And what does the labia minora do? Number one, there's nerve endings, erectile tissue, incredibly responsive for arousal. It's how we feel pleasure. Also, it's protective to the inner workings of the urethra, helps it prevent it from having micro trauma. Maybe it helps recurrent UTIs. It's just a protective structure as well. So sexual and protective goes away. The Second, the next question is, can it come back with hormones? Probably. There's no studies on this. You think anybody's. You think the NIH is researching, like, getting your labia minora back after you weren't on hormones for a while?

[Dr. Kelly Casperson]

I mean, we got so many other things to focus on. That's probably the last thing on the list right now, right?

[Tamsen Fadal]

It's extra, right?

[Dr. Kelly Casperson]

It's extra.

[Tamsen Fadal]

Women really do care about it. Of course, you know, that's why the people like me, the female urologists who care a lot about gsm, we're like, why don't we just be starting vaginal estrogen around age 50 so we don't have to play catch up once you've suffered enough.

[Dr. Kelly Casperson]

All right, let's talk about the one hormone that pretty much every woman isn't. Is it safe to say every woman could take it or pretty much every woman can take it? Vaginal estrogen.

[Tamsen Fadal]

The biggest fear people have is breast cancer. And our breast cancer survivors, we have new GSM guidelines that say it's safe. Just let your oncology team know. If you're a rare condition being actively treated with hormone blockers. Still probably pretty safe, but, you know, you want your team to know, but we have Studies of over 55,000 breast cancer survivors looking at the safety of vaginal estrogen. This is not a. We don't have enough research. We have plenty of research. It just isn't getting out there. So to us, we're always saying there's not enough research. We have enough research. We have so much research. We have guidelines.

[Dr. Kelly Casperson]

Now explain what GSM is and then vaginal estrogen. And, you know, every woman can take it now, is that what we're saying?

[Tamsen Fadal]

Pretty much. There is a rare. Like, I would say every woman can take it. Asterisks. If you're being currently treated for breast cancer, check with your oncologist. Just let them know that you're on it. And then, number two, there's a rare, rare form of uterine sarcoma. Not endometrial cancer. Yes. Rare, rare, rare cancer that. I would say check with people.

[Dr. Kelly Casperson]

Okay.

[Tamsen Fadal]

But I would. 99.9% of people can be on vaginal estrogen. And we know in America right Now less than 4% of women who can be on hormones are on them. We have a lot of work to do.

[Dr. Kelly Casperson]

Isn't that unbelievable? I keep thinking that's going to go up. I keep thinking it's going to go up, and it hasn't gone anywhere. Gsm, explain what that is. Just so people know what it means and what you could be dealing with as a result.

[Tamsen Fadal]

Yeah, so GSM stands for genital urinary syndrome of menopause. Basically, it's the effects of the pelvis as a result of low hormones. This can happen in perimenopause. Again, there's nothing magical about a period. You can still have low hormones. Breastfeeding, birth control pills, all things that are low hormones in the pelvis. So trouble with sexual function, trouble getting aroused, trouble having orgasm, trouble being lubricated, bladder issues, urgency, frequency, getting up at night, urinary tract infections. An amazing abstract just came out at the Urology association, like, two weeks ago. Women with recurrent urinary tract infections who are on a vaginal estrogen versus who were off vaginal estrogen. The women who were on vaginal estrogen decreased risk of hospital admissions, decreased risk of sepsis. 70%. Decreased risk of death by recurrent urinary tract infections for taking vaginal estrogen. And this is like sunscreen and seat belt. It's so stinking safe. You should be able to get it pretty darn cheap. It's covered by insurance. And of all the things that can kill you in the pelvis, urinary tract infections can.

[Dr. Kelly Casperson]

Well, I was just going to say, UTIs are so deadly and so dangerous, and they. They increase with age. Correct. What is. What is the average age that we start seeing that increase?

[Tamsen Fadal]

I. I really start seeing GSM kick in five to eight years after menopause. And the problem is women don't know what menopause is.

[Dr. Kelly Casperson]

Yeah.

[Tamsen Fadal]

Yeah. They just think it's hot flashes and no periods. So they have no idea that what's happening now five years after their periods is a result of low hormones because they didn't know they had low hormones in the first place. But GSM is the gift that keeps on giving, meaning it's cumulative. The longer you go without hormones, the worse and worse it can get. And I see this. A lot of, like, women haven't been treated for, like, a decade. They stopped having sex eight years ago. They're on antibiotic after antibiotic, and they actually start the estrogen product. And it's stingy, and it's irritating to them because their skin is so destroyed, it's so thin, it's so sensitive that even the treatment hurts. It's like walking around with, like, raging sunburn. Right.

[Dr. Kelly Casperson]

So what do you need to do? You just keep pushing through it. If you're. If you're on vaginal estrogen, there's a.

[Tamsen Fadal]

There's different options. So you can get vaginal estrogen in a suppository form. In a ring form, you can get it compounded without the alcohol base in it to make it less stingy. There's a vaginal dhea, which is chef's kiss for the vulva. DHEA is a precursor hormone that in the cells of the pelvis convert to testosterone and estrogen. Estrogen. So it all ties in. Right. Remember, our bodies are responsive to testosterone everywhere, especially our genitals. We have, there's this amazing paper. They put women on testosterone and they actually measured the velocity of their clitoral artery before and after testosterone. Clitoral blood flow goes up when you're on testosterone. Shocking. Penis blood flow goes up when you're on testosterone. Right. So it's like our pelvic structures are responsive to testosterone. And people, you know, they'll, when they poo poo testosterone like it's just for libido. No. Testosterone helps every single domain of sexual function. Desire, arousal, orgasm, lubrication, distress from your sex life. Being off lowers distress from sex. So testosterone's way more important. And again, I think like buckle up because if you're part of this conversation with testosterone now, give it three years when we have an FDA approved product and it's just going to be, the conversation is going to be huge.

[Dr. Kelly Casperson]

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[Tamsen Fadal]

Yeah, it's a great question. Education, I think is number one and understanding that libido. There are treatment options, but a lot of things for libido aren't medication, right? Like how your, how your lifestyle is, you know, are you abusing drugs, are you sleeping? How's your work life balance? How's the relationship? Are you allowed to touch yourself? Is masturbation bad? What do you think about sex, right? Has it ever been about you and your pleasure? So there's so much personal growth in getting an adult sex education. So I'd say, you know my podcast, my book, I've got a sex ed course on my website of like just get educated on it because you're doing the heavy lifting that doctors can't do in the clinic anymore. Because let's be honest, unless you're doing a cash based clin, you got 10 minutes. No education happens in a 10 minute doctor patient visit. Plus you're too stressed. So get educated first and then be like, I think I might want to try hormones. My best resource is anybody who's been trained by Dr. Heather Hirsch is great. Anybody who's been trained by Dr. Rachel Rubin, great. International Society for the Study of Women's sexual health. Great. Why? Because those people are comfortable with sex and hormones. So, like, Ishwish is like the Venn diagram of sex and hormones. Not everybody who is menopause certified by the Menopause Society knows a darn thing about sex. And truthfully, they don't all know a darn thing about hormones, okay? So that certification is not a guarantee that that person knows how to prescribe. Ishwish is probably, by and large, dollar for dollar, the better bet. So go on theishwish.org, type in your zip code, find a provider near you.

[Dr. Kelly Casperson]

So there's a provider on there also the online.

[Tamsen Fadal]

I mean, the online companies. Right. So the online companies that are dedicated to perimenopause, menopause, because they've already done the work of, like, we do hormones here now. You're not wasting your visit going.

[Dr. Kelly Casperson]

Yeah, they're doing it every day.

[Tamsen Fadal]

The other big item that I'm part of and I want to see is we need to deregulate testosterone. What's that mean? It's a DEA regulation class three. So it is like ketamine, Tylenol with codeine. It is heavily restricted. Why? The doping scandals of the 80s, the athletes ruined it for us. Whether or not we get a female dose product or not, the athletes ruined it for the average person. We deregulate it because the online companies have big trouble accessing that because their doctors have to have a separate DEA license for every single state.

[Dr. Kelly Casperson]

Wow.

[Tamsen Fadal]

We deregulate a hormone that our body naturally makes.

[Dr. Kelly Casperson]

It's unbelievable. I feel like we. We have work to do, and then we have work to do. It just keeps layering on it.

[Tamsen Fadal]

There's a lot like. Yeah. You know, like, this isn't one hurdle. It's like a. It's like a track of hurdles.

[Dr. Kelly Casperson]

I know. I know. I. I keep going along. I'm like, we're gonna get this. Oh, wait, there's seven more things to do. But it's okay. Okay. Because we're having the conversation finally. So Nobody worry, because Dr. Kelly Casperson is gonna be back. You're gonna be back on in September because you have another new book coming out, which I'm book number two, so excited. The Menopause Moment. How Hormone Science and Mindset Create Optimal Longevity. Tell me real fast about this book, because I feel like.

[Tamsen Fadal]

So this book is like, you know, in college where you have the 101. Like, the 101 book. You wrote a 101. Mary Claire wrote a 101. Naomi Watts wrote the 101. We got the 101s. Women understand. This is the 201 of like you want all the data on prevention, bones heart. So we got two two chapters on sex, how to talk to men about it, how to talk to your doctor about it. So this is the 201 to the amazing 101 books that my friends have already written.

[Dr. Kelly Casperson]

I cannot wait. I cannot wait. I cannot wait to have you back on to talk about it and to see in person. Dr. Kelly, thank you so much. I appreciate.

[Tamsen Fadal]

Where can people find oh KellyCaspersonMD.com is the website you are not Broken is the podcast and then on Instagram I like to hang out at KellyCaspersonMD.

[Dr. Kelly Casperson]

All right. Thank you my friend. Good to see you.

[Tamsen Fadal]

Thanks for having me.

[Dr. Kelly Casperson]

Thank you so much to Dr. Kelly Casperson for the truth, the clarity and of course the work she is doing to change the conversation. Her book the Menopause Moment is out this September and available for pre order right now. If this episode spoke to you, share it with a friend. Leave a review please. It helps us get this podcast and all your questions answered and get more incredible guests like Dr. Kelly on I'm Tamsen Fadal. I'll see you next Wednesday. The Tamsen show is an original production by Authentic Wave executive producers Scott Weinberg, Kevin Bennett and Rebecca Grierson. Brand director Johanna Ofznick. Our line producer is Sabrina Sarre, editing by Zach Smith and Marquis Harris. The views and opinions and information shared by guests on the Tamsen show are their own and do not necessarily reflect the views of Tamsen Fadal or the production team. This podcast is for informational purposes only and is not a substitute for professional, medical, legal or financial advice. One of the things I talk about often is how our health journeys in midlife are anything but one size fits all. And yet so many weight loss plans. Totally ignore that. That's what first stood out to me about NOOM Weight NOOM builds personalized plans based on your biology, psychology and lifestyle. I'm noom's Menopause awareness advocate, so it's important for me to be able to recommend programs like NOOM when it comes to so many of the symptoms of menopause, especially since it's not a one size fits all time in our life. Stay focused on what's important to you with NOOM Psychology and biology based approach. Sign up for your trial [e-mail].