The Tamsen Show — Episode Summary

Podcast: The Tamsen Show
Host: Tamsen Fadal
Episode: The Testosterone Doctor: The Truth About Women’s Libido
Air Date: October 15, 2025
Guests: Dr. Kelly Casperson (urologist, sex expert, author of "The Menopause Moment"), Dr. Isabelle Raymond (Nutrafol)

Episode Overview

This episode explores the complexities of women’s libido, hormonal changes during midlife, and the truth about testosterone for women. Emmy-winning journalist Tamsen Fadal sits down with Dr. Kelly Casperson, one of the nation’s leading urologists and a prominent voice in women’s sexual health, to answer real and spicy listener questions about libido, sex after menopause, hormone therapies, and busting myths about midlife sexuality. The second segment features Dr. Isabelle Raymond focusing on hair loss and hormone shifts during perimenopause. Throughout, the tone is frank, empathetic, and empowering, aiming to destigmatize private health issues and provide actionable advice.

Main Discussion Points and Insights

1. The Role of Hormones in Female Libido (02:18, 12:57)

• How Hormones Affect Libido:
  • Estrogen and testosterone regulate neurotransmitters in the brain; libido is deeply connected to mood and dopamine pathways.

    "Libido is a mood. Moods come from our brain. So this is a brain change. So when estrogen and testosterone go down, the dopamine pathways that drive libido also don't work as well." — Dr. Casperson [02:18], [12:57]

• Complexity of Libido:
  • Libido is not just about hormones; stress, sleep, relationships, and mindset all play roles.

    "Libido is really biopsychosocial. It's all of the things... Are you having orgasmic equality in your relationship? What kind of sex ed did you get? That all affects libido." — Dr. Casperson [13:37]

2. Breaking Myths and Sex Ed for Adults

• Sex Shouldn’t Be a Chore:
  • Viewing sex as a "should" leads to low enjoyment and libido.

    "Never expect a good libido or healthy enjoyment of sex to come from a chore." — Dr. Casperson [23:06]

• The Myth of Spontaneous Desire:
  • Waiting passively for desire is a myth; prioritization, communication, and scheduling are part of healthy sexual relationships.

    "Just sit there and wait for desire to spontaneously blow in the window... that's not how it works." — Dr. Casperson [15:35]

3. GSM: Genitourinary Syndrome of Menopause (11:41)

• What is GSM:
  • GSM refers to a constellation of symptoms (recurrent UTIs, urgency, pain) resulting from decreased hormones—"vaginal atrophy" and formerly even called "senile vagina."
  • Vaginal estrogen is the mainstay treatment and is safe and effective.

4. Conversations With Healthcare Providers (17:14)

• Barriers to Care:
  • Many doctors (and even therapists) are not trained to talk about sex. There is a cultural and medical bias that sexual health is secondary, especially for women.

    "Most doctors aren't trained in sex. I could write a book on the shit that doctors tell women about sex." — Dr. Casperson [17:38]

• Actionable Advice:
  • Start with sex therapists, pelvic floor physical therapists, or specifically seek out providers with menopause and sexual health expertise.

5. Testosterone for Women: Science & Access (36:18)

• Current State of Testosterone Therapy:
  • No FDA-approved, female-dosed testosterone exists in the U.S., forcing women to "microdose" men's products or use compounded versions.

    "A man would take this entire tube in one day. The female dose is to make this tube last ten days." — Dr. Casperson [37:49]

  • Other countries (UK, Australia, South Africa, New Zealand) have approved options.
  • Dr. Casperson advocates for FDA approval for “hypogonadism” (low hormones), not just for libido, to facilitate insurance coverage and remove stigma. [40:59]
• Pellets and Side Effects:
  • Testosterone pellets can lead to excessively high ("male-level") testosterone in women, causing side effects and are not ideal for everyone.

    "Nowhere in nature does a woman have the testosterone that they're getting when they receive a pellet." — Dr. Casperson [44:33]

  • Monitoring for side effects and checking labs is important, but how the patient feels is paramount.

6. Vaginal Estrogen: Options & Effects (47:12)

• Forms and Effectiveness:
  • Creams, tablets, and rings differ mainly by price and ease of targeting the vulva; creams are Dr. Casperson’s favorite for targeting tissue and affordability.
  • Six to eight weeks is typically needed for tissue improvement; stopping therapy reverses the benefit, but it’s never "too late" to start even in later decades.

7. Sexual Health: Lubes, Pain, and Communication

• Lubes:
  • Silicone and oil-based lubes are better for aging, sensitive skin; water-based can be cold and sticky [26:38].
  • Check for allergies or friction if experiencing irritation.
• Pain and Pelvic Floor Therapy:
  • Pelvic pain or pain with sex is never normal—seek a pelvic floor therapist early.
• Orgasm Concerns:
  • Worries about leaking urine during orgasm are common and can be addressed with therapy and mindset work.

    "Sex is a big pelvic floor contraction, and you are, like, not in your brain. You are relaxed, letting pleasure happen." — Dr. Casperson [34:05]

8. Libido, Relationships, and Mindset (51:06, 53:12)

• Communication in Long-Term Partnerships:
  • After decades, the spark can fade. Open, blame-free dialogue, prioritizing connection, "putting the party on the schedule," and troubleshooting arousal or pleasure issues are encouraged.

    "You can love your partner, but not like them. And if you don't like them, you don't want to have sex with them." — Dr. Casperson [51:06]

• Men Seeking to Support Partners:
  • Approach with curiosity and no blame; recognize the broader context and stress in women’s lives.

9. Hair Loss & Perimenopause Segment (57:11–end)

With Dr. Isabelle Raymond, Nutrafol

• Why Hair Changes in Perimenopause:
  • Estrogen receptors in hair mean hair is highly hormone-sensitive; thinning, texture changes, and shedding are common.
  • 50% of women report hair thinning at this stage, often without prior knowledge or warning.
• Research and Solutions:
  • Nutrafol has developed and clinically studied supplements specifically for menopausal women.
  • Dermatologists specializing in hair loss (findable at menopause.org) can help assess if the cause is hormonal or otherwise.
  • Hair health is a vital sign, not just vanity — slow results (3–6 months) are normal, and consistency matters.

Notable Quotes & Memorable Moments

• On hormone research and misinformation:

  "The 2002 Women's Health Initiative study basically scared women into thinking that something their body naturally makes is trying to kill them." — Dr. Casperson [08:19]

• Refuting cultural shame:

  "When it comes to sex, we have been taught to whisper about it. Well, not today." — Tamsen Fadal [03:20]

• On women outliving their ovaries:

  "Nobody knows that we outlive our ovary function. And that's actually what menopause is." — Dr. Casperson [09:11]

• On mindset and pleasure:

  "You don't have to have a partner to experience the amazing pleasure that your body can give you." — Dr. Casperson [13:53]

• Advice for women feeling unseen:

  "Respect your understanding of what's happening to you and knowing that it is true...trust that voice, even though you might have to fight for it." — Dr. Raymond [67:19]

Key Timestamps

• [02:18]: Hormonal modulation of libido explained by Dr. Casperson
• [11:41]: GSM, its prevalence, and history of terminology
• [17:14]: Navigating tough conversations with doctors and seeking sex-positive professionals
• [23:06]: Dispelling the “should” in sexual frequency and chore mentality
• [36:18]: FDA, testosterone therapy for women, global differences in access
• [44:33]: Testoterone pellet use, risks, and side effects
• [47:12]: Forms of vaginal estrogen and their impact
• [51:06]: Relationship longevity and sexual intimacy challenges
• [57:11]: Dr. Isabelle Raymond on perimenopause and hair loss
• [67:19]: Empowerment around hair loss and self-advocacy

Resources, Tips & Takeaways

• Hormones: Hormones are vital not only to sexual health but to overall well-being. Don’t fear them — advocate for real information.
• Communication: Open, judgment-free dialogue with partners and practitioners is essential for thriving sexual and relational health in midlife.
• Provider Search: For menopause-specific care, visit menopause.org to find trained clinicians.
• Supplements & Hair: Early, evidence-based interventions for hair health (like Nutrafol) can help, but results take time.
• You’re not alone: Sexual concerns and body changes are common. You're entitled to compassionate, informed care.

Episode Tone and Final Thoughts

The conversation is candid, relatable, and optimistic, directly addressing stigmatized topics and equipping women to reclaim their health, pleasure, and confidence at any life stage. Dr. Casperson’s evidence-based, no-nonsense approach, and Dr. Raymond’s personal and scientific insights, underscore the show’s mission: You are not broken, you are not alone, and you deserve knowledge, agency, and joy.

For further reading:

• Dr. Kelly Casperson, "The Menopause Moment"
• themenopausesociety.org — Provider directories and education
• Nutrafol studies on hair and menopause

Follow The Tamsen Show for future episodes and resources.