← The Tamsen Show
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- [00:00]
A
AI had the time of my life A I never felt this way before. From building timelines to assigning the right people, and even spotting risks across dozens of projects, Monday Sidekick knows your business, thinks ahead and takes action. One click on the star and consider it done. And I owe it all to you. Try Monday Sidekick AI you'll love to use on Monday.com this show is sponsored by Eight Sleep. Let's talk about hot flashes. Can we? And how I finally got my nights back. Before I found eight sleep, I was waking up, I don't know, three or four times a night, drenched in sweat, exhausted the next day and completely drained by noon. Menopause was wrecking my sleep. Then I started using the pod 5. I'm telling you, it changed everything. The pod cools my side of the bed without touching. Ira's my husband and and it actually cools before a hot flash wakes me up. I even use hot flash mode. Some nights when I feel it coming on, I just tap the bed and the pod instantly kicks into cooling mode. It's wild. Here's the thing. This isn't a gimmick. It's clinically shown to reduce hot flashes by over 50%. I have tried everything. Supplements, cooling fans, even ice packs. This really works. I sleep through the night and I wake up rested. If you're going through menopause or just struggling with night sweats, you have to try this. You don't need to just deal with hot flashes. This is what finally worked for me. Head over to 8sleep.com tamsin and use code TAMSIN to get $350 off your Pod 5 Ultra. The best part is that you still get 30 days to try it at home and return it if you don't like it. But I'm confident you will love it. Trust me, your body will thank you for this investment in better sleep shipping to many countries worldwide. See details@eightsleep.com this is a testosterone gel.
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1%. A man would take this entire tube in one day. The female dose is to make this tube last 10 days. There's no other medication where we're like, hey, figure out the dosing on your own.
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A
Dr. Kelly Casperson is a leading urologist, sex expert, and one of the loudest voices pushing for women to finally have FDA approved testosterone in the U.S. can you explain exactly what goes on with our hormones that impacts our libido?
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B
Estrogen and testosterone modulate our neurotransmitters in our brain. And libido is a mood. Mood 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. And then libido is also very complicated. It's not just hormones. You're overworking. You haven't managed your stress. You're not exercising. You're sleeping really poorly. You hate your partner.
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A
I think I've heard all the. I'm sure you have. I've heard all those things.
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B
I'll see women, they'll be like, I got on testosterone, and I still don't have a libido. Like, testosterone's a part of it, but it's not all of it.
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A
Today, she's answering your spiciest questions. It's been months since I've had sex with my husband. How often are we actually supposed to be doing it? Are there natural ways to get my sex drive back? Sometimes I get these sharp pains during sex, even when I'm totally turned on. Should I be worried my husband has Viagra? Is there anything like that for women? I saw on social that our vagina disappears as we age. Wtf Is that true?
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B
I don't think a lot of women know this.
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A
When it comes to sex. We have been taught to whisper about it.
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Right?
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A
Well, not today. I asked you guys to send me some of your questions, totally anonymous, and, boy, did you deliver in a big way. You went there in all sorts of ways. So we decided we're gonna do something a little bit differently today. I'm asking your questions, and a leading menopause expert is going to answer them. We got to as many as we could get to, and we'll keep going. We'll figure it all out. But my friend and one of the top urologists in the country, Dr. Kelly Casperson, is here with her new the Menopause Moment. This is the book that every woman in midlife needs on her nightstand. It's gonna show you how to get your energy back, how to feel like yourself again if you're feeling a little bit off, and finally understand what is really happening in your body. She covers all of it in the Menopause Moment. Today she's here on the Tamsen show to take on the questions you have been dying to ask. And you did. This episode is the sex ed we should have all really had as adults. And by the way, if you love the conversations and you want more of them, leave us a review. It really helps. Thank you so much. Let's keep this movement going, and let's go ahead and get into your questions, into all of it. Kelly, with you, nothing is off limits. Ever.
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B
That's right. Thanks for having me.
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A
Yeah.
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B
It's so good to see you.
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A
So let's start with the book. Your new book is called the Menopause Moment. Why'd you write it? And what do you want people to take away from it?
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B
So this is book number two. And in book number one, which is the adult sex ed book called you'd Are Not Broken, I have a menopause chapter in it. And at that point when I was writing that, I was like, like, should I put this in here? Are people not going to read it if I put this in here? And then I put it in there? Because I was like, people need to know what's coming, right? Even if we want to teach sex ed, when you're 23, you need to know what's happening with your body. And that chapter, people kept saying, I'm so glad that was in there. I had no idea what was happening. And I got a lot of really good feedback from that chapter. So when the publishers came back and they're like, will you write another book about sex? I was like, I kind of want to write a book about menopause. And they were like, yes, write that. And so, like, I'm wrecked as far as book publishing goes. Cause I'm like, I just told them what I wanted to write about, and they said yes. And so this one has sex chapters in it. So it's kind of inverse from the first book. But I'm like, now we know enough about menopause. And the other thing is, like, people say we don't have enough research. And I agree. We need more women's research. I always say yes when we say we need more research. But I think what people don't realize is how much we already have. And let's not forget the hard work that's already been done about what's beneficial for our bodies. And so I really wanted one place to put the studies that we already have. So when people think like, oh, we don't have anything, that's not true.
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A
I'm really glad you did that. And you're right about that, because we do say that over and over, and then we kind of, you know, just believe it. But the truth is, and you've shown that in the book, that there are actually studies out there, a lot of studies that we need to be looking toward when we're asking for information or trying to figure things out. So let's go back to your story, because you are a top Urologist in this country. One of very few women urologists. Is that correct?
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B
10% of urologists in America are female. So there's about a thousand of us now.
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A
It's incredible.
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B
It's a tight club.
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A
It is a very tight club. Was there a patient or was there a story or an incident that made you say, I have got to go deeper into women's sexual health.
- [06:28]
B
Yeah. So seven years into my career, you get good at your career. You kind of know what you're doing. You're like, why am I doing this? It's the like seven year itch. And so I think the universe knew I was ready for something new. And so delivered in front of me was a patient that I loved dearly. I'd actually treated her for cancer. And now I see her once a year. How are you? Scans are good. Everything's great. But that year she was crying in my office. And the reason she was crying was because of her sexless marriage. And so I'm handing her the box of Kleenex and realizing I don't know how to help her. And everything from my training came up in that visit. Women are difficult. We'll never figure them out. And don't worry, the gynecologists are taking care of them anyways.
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A
And that's what your training taught you?
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B
That's what my training taught me. And so I just started questioning all that. Are women too complicated? Will we never figure them out? Is there no data? And are the gynecologists taking care of their sex lives? Because here I'm the urologist. We're best known for Viagra. Right. 90% of men are heterosexual. So the ultimate billion dollar question is, who's taking care of the women who are supposed to be sleeping with the men that people like me are giving Viagra to?
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A
Well, like to be in the office going, oh, my goodness, not realizing all those years, of all the people that you've treated over time, and to have this woman in here come in and really open your eyes to.
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B
To everything.
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A
It's really been a whole new chapter for you in a lot of ways.
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B
And I mean, I always joke that sex got me into menopause, literally and figuratively, because as I learned about female sexual health and female sexual function and the domains, you know, arousal, desire, lubrication, orgasm, what role do hormones play and what happens when those hormones go away? And so the question that kept coming back was, but, you know, what happens to your sex life during menopause? And people kept asking it enough that I'm Like, I don't know, what's the data say? And so started peeling back the layers of the onion on, like, what happened happens when the hormones go down. Oh, hormones are actually really important and really vital. Why are we so afraid of them?
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A
Yeah.
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B
So then peeling back that onion of the. The media misinformation from. For any listener that doesn't know, the 2002 Women's Health Initiative study that basically scared women into thinking that something their body naturally makes is trying to kill them.
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A
Yeah. We've talked about it a lot on this show, and I think every time I talk about it and. And somebody is. Is here, I. I just go back to it. And I can't believe how long ago that was now, but still, how that is so fresh in minds and they don't even realize.
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B
Yeah, yeah. It's like ether or the zeitgeist. Right. Because if you ask a woman, if you say, well, why do you think that hormones cause cancer? Why they can't say. People won't say, oh, the 2002 Women's Health Initiative, it's. It's just permeated through the culture enough that they're like, I don't know. It just does.
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A
I want to address women that still feel so unprepared for midlife and so blindsided. Why do you think that happens, man?
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B
I think it's the culmination of, like, there wasn't any solutions for a while. We live in a society that literally sells you things with the belief of you should not age, which flies in the face of anything that lives on planet Earth. Right. So like, we live in such a society that is, like, shrouded in. Don't age, fear, age. And then pregnancy happens, whether you choose to become a mom or not. We all know puberty happens. Nobody knows that we outlive our ovary function. And that's actually what menopause is. Even though the definition of menopause is one year, no natural periods. That's just a consequence of us living longer than the ovary functions.
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A
And who else on earth outlives their ovaries?
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B
Any animal that lives in captivity, actually. So it's a myth. You know, I hear, I get so irritated now because of the research for the book is like, only humans and four whales have menopause. A couple of things about that. First of all, most mammals don't menstruate. They resorb their uterine lining. So it is true, not many mammals menstruate. But if you take a mammal and you put them in Captivity. For example, there is a harbor seal in a Oregon zoo right now that's 49 years old. In the wild, these animals live about 18 years. Right. So what we're doing is you got a good water supply, you've got food, you've got shelter. We can treat infections, we can treat tumors. You're not going to die in childbirth. We're literally in captivity. And that is preserved along all animal span. So if you take fruit flies and you put them in captivity and you provide all those things, they live longer than their reproductive potential. Same with mice, same with yeast, same with monkeys, same with. Same with the harbor seal.
- [10:48]
A
All the stuff that you've learned since looking into this.
- [10:51]
B
So, I mean, the funny part is I was like, I'm going to name my book Aging in Captivity because I wanted to. I wanted, I think, the menopause moment. If I'm not an. I'm not an editor, Kelly. But the publishers didn't like my title, but my fans love that title. And, you know, Amazon search terms the menopause moment works better. Yeah, but I wanted. It was a nod to Esther Perel. Right. But it's like, we need to realize because everybody will say, oh, menopause is natural.
- [11:16]
A
Yeah, I know.
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B
Living to 84 as a society on a global scale, we've never done it before. It's actually not natural. So I really wanted to, and I put all that in my book to really be like, let's stop thinking that, like, we're these unique things that we must, you know, go through it. And that what that means is suffer through it. Yeah, right. It's like, no, no, no. We're aging in captivity. We get to make a choice to try to age as well as we can.
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A
There's a term gsm, and I want to talk about that in particular, because I think it's something that a lot of women hear and might not necessarily understand, where it fits into everything.
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B
Yeah. So GSM is a mouthful when you spell it out. It's genital urinary syndrome of menopause. Syndrome in medicine means a constellation of things. And then genital urinary means the sexual structures and the bladder, urethra structures. So genitals and urinary syndrome of menopause, prior to that, it was called vaginal atrophy. Nobody likes terrible words. People don't like that. Plus it doesn't include the bladder stuff. And then prior to that, in the 1980s, in medical literature, it was called the senile vagina.
- [12:18]
A
What? Yeah, I don't think I knew that.
- [12:20]
B
I know.
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A
I didn't know that.
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B
Yeah. What is it? 50 to 80% of people will be affected by GSM. You can be affected before your periods end. That's why the period is a stupid, arbitrary thing. Like, as your hormones go down, you can have these symptoms. Recurrent urinary tract infections, getting up at night to pee, urinary urgency, bladder leakage, pain with sex, burning with urination. All of that is this constellation of genital urinary syndrome of menopause. It happens because our hormones go low, so it's treated by putting hormones back.
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A
I know. It's complicated. Can you explain exactly what goes on with our hormones that impacts our libido?
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B
So estrogen and testosterone modulate our neurotransmitters in our brain. And libido is a mood. Right. 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.
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A
Right.
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B
And then libido is also very complicated. It's not just hormones. So you're overworking, you haven't managed your stress, you're not exercising, you're sleeping really poorly, you hate your partner.
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A
Right.
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B
Like all of these things.
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A
I think I've heard all the.
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B
I'm sure you have.
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A
I've heard all those things coming from.
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B
But it's important to cover it because people will, you know, they'll get back on hormones, and they'll be like, oh, I still don't have a libido.
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Yeah.
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B
And it's like. Because libido is really biopsychosocial.
- [13:37]
A
Yeah.
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B
It's all of the things, like, what. What kind of sex ed did you get? Right. Are you having orgasmic equality in your relationship? So all of that affects libido. Because I'll see women, they'll be like, I got on testosterone, and I still don't have a libido. Like, testosterone's a part of it, but it's not all of it.
- [13:52]
A
How does mindset play a role?
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B
Well, if you were trained that sex is dirty, that you're not allowed to touch yourself, that you need to prioritize your partner's pleasure instead of yours, Right. There's all these negative beliefs around sex if sex is a chore. Right. So if you're thinking all of these things about sex, I can make your pelvis perfect, I can make sure your vaginal estrogen's on point, we can do your testosterone. But if you're still like, what's the point? Of sex. It's just for my partner, like, all those negative beliefs. And that's where the education comes in to be like, the. This is for you to enjoy the pleasure that your body can give you. And in an amazing world, you get to share that with a partner. Right. You don't have to have a partner to experience the amazing pleasure that your body can give you. But really, reframing sex is like, this is a joy. This is adult play. Because most people weren't taught that. Right. It's a spousely duty. For a lot of people.
- [14:42]
A
We were taught it was purposeful. You know, there's a reason that you're having sex. Right. And I think that you're the first person that really explained this to me in a way where I went, oh, I get why we think, like, because you said Hollywood's like, oh, you fall into bed and you're sweating, and all of a sudden, the soap operas in Hollywood make like, sex is this easy thing, and it just naturally happens. And if it doesn't, you're screwed up and something's wrong with you and it's your fault. And I think you're the first person that really explained that.
- [15:11]
B
That is how we think about ourselves. Yeah. That's our sex ed, Right?
- [15:13]
A
That's crazy.
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B
Yeah. Sex ed is Hollywood. Sex ed is porn. Sex ed is any negative beliefs that's coming from your family or your church or your education. So it's like, we got a sex education. It might not have been a very positive one.
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A
What is the biggest myth about. And you hear a lot of stories, but what's the biggest myth about sex or hormones that you're hoping that women in midlife will unlearn, that you should.
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B
Just sit there and wait for desire to spontaneously blow in the window. And then when that happens, you can have great sex.
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A
So, meaning, like, I'm turned on now. I'm gonna go have sex.
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B
Yeah. Like, oh, I actually want it. I'm gonna go have it. Like, a spontaneous desire that a lot of people have. And when you. When I see so many women, they're like, oh, if I only had desire for sex. I'm like, why don't you just go have some great sex? And it blows their mind because they think, like, this has to. This has to be a green light of desiring it. Before you go of amazing sex, there's an amazing book by Dr. Peggy Klein Platt. She's a PhD and she researched people who have amazing sex. She was like, raise your hand if you have amazing sex. Great. Can we talk. Right? So she put this whole book together. Nowhere do these people say, spontaneous desire for sex is why I'm awesome at sex. They're like, I prioritize time to be sexual. I can troubleshoot. I'm okay with failing. I'm a great communicator. I prioritize pleasure. And you're like, nowhere do they say, it's just because I dig, you know, I desire sex all the time. That's why I'm great at this.
- [16:34]
A
I think people sometimes are shocked if someone's been married a long time, and they're like, oh, yeah, we have sex every week or every twice a week. People are shocked by that. Is there a how often we should be having sex? Answer.
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B
No, There is a what works for the relationship? Answer.
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A
Okay.
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B
But not what all humans should do.
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A
Well, no. I mean, obviously it's not like two times or you're not. But I'm just wondering if there's like, hey, that's a health. We consider that healthy or not healthy. No, I guess not. Because every relationship's different.
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B
Every relationship's different.
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A
Yeah.
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B
Yeah.
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A
And whether or not you have a partner is different. I'm excited about the Q A. And by the way, full disclosure.
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B
You're like, let's get there.
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A
When I told you, I told you we're gonna do this, you're like, bring it on. And I said, are you sure? Because there's going to be a lot of questions.
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B
I love Q and A. It's like, my favorite thing.
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A
I think it's so important. I think it's also really important, before we go into it, is I don't know that a lot of women know how to walk into a doctor's office and say, hey, I have. I'm not having sex with my partner. Or I don't. I don't feel comfortable having it, or it's painful. Can you just give somebody who's listening that sentence, that script, if it. If it's two sentences of how to approach that conversation and who to approach it with.
- [17:39]
B
That's a really hard conversation because most doctors aren't trained in sex. And so I could write a book on, like, the shit that doctors tell women about sex. Whether it's like, just deal with the pain. Go get another husband. Recently, very recently, a top cancer center told a woman to use Crisco.
- [17:57]
A
What?
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B
Yeah. And I'm like, we don't even bake with Crisco anymore.
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A
How does that happen? How does that happen?
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B
Well, in medicine, again, medicine has a culture, right? And the culture of medicine is that sex is for reproduction. So dismissing any sort of pleasure thing, like, I didn't dissect the clitoris when I was, you know, a beginning med student, because it's. There's no point of a clitoris when it's only about reproduction, which I disagree. It's nice that the woman's turned on and likes your partner and all the good signs, but, like, we didn't even dissect the clitoris. And that's an anatomic body part solely designed for pleasure. So there's that. And it's a very, you know, patriarchal. Man teaches a man, teaches a man, teaches a man. So there's not a lot of, like, let's talk about the women happening. So I think it's a hard question to answer because it's like, how do I set a woman up to go into where she might fail because the doctor didn't get a good sex edit.
- [18:48]
A
I know. That's the. That's the confusing part.
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B
That's really hard. I would say sex therapists are a great place to start. Doctors are. And I'm over generalizing, but they're your go to for vaginal estrogen, for gsm, for hormones, but for, like, sexual health issues. Sometimes you don't need a medical doctor for that. Like, sex therapists are worth their weight in gold. They're sex coaches. There's amazing people that don't need to, like, prescribe medications that are trained to deal with sexual. But here's the other crazy thing, and this is what my sex therapists say. Marriage therapists also didn't get trained to talk about sex.
- [19:21]
A
I know. I mean, you've got people going to couple therapy, couples therapy, for years, but no one ever brought up menopause or perimenopause or lack of libido or sex. Or sex.
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B
Yeah, that's what's so crazy. So I met. I met one recently. She was like, well, I was a marriage therapist, but we need to address sex issues. And I didn't get trained that marriage therapy. And I'm like, that marriage is like a sexual union, like, amongst other things. So, yeah, a sex therapist.
- [19:44]
A
So a sex therapist. Okay. I. I mean, I. I want to give women that kind of answer because I don't know that when you're in the doctor's office, someone's coming and looking down at a chart, and they're looking.
- [19:53]
B
Up at you, and you're naked except for a guy.
- [19:56]
A
And then they're like, okay, well, you know, are you feeling okay? And you're like, oh yeah, sex hurts and I don't feel like having it. And, and, and yeah, I don't know what part of that conversation you know when you bring that up. Some people might be fine bringing that up, but not everybody is gonna be.
- [20:09]
B
So yeah, the other people that are really good and trained in sex and pelvic structures is our pelvic floor physical therapists.
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A
Okay?
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B
So they're amazing people and they're pretty good at knowing, hey, you've got gsm, you've got some thinning of the tissues. Why don't you go ask your doctor for some vaginal estrogen? So to me I'm like, we gotta get the doctors more trained, but they're already very busy. But low hanging fruit is if every doctor listening can realize that vaginal estrogen is incredibly safe, incredibly effective and to.
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A
Help with painful sex.
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B
Painful sex. And to prevent painful sex, to decrease urinary tract infections, to help bladder issues. Right. If you've got bladder issues, you don't really feel like having sex.
- [20:46]
A
No.
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B
Right. So it's really treating the whole pelvis so that it's optimized.
- [20:53]
C
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C
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- [21:22]
A
Questions I get from women is what can I do about thinning hair? Whether it's from stress hormones or just this stage of life, I hear it all the time. And I get it because when your hair starts changing, it can really affect how you feel. There are so many products out there and it's hard to know which ones are actually going to do anything. That's exactly why I gave Nutrafol a closer look. It's not just hype, it's physician formulated, clinically tested and even recommended by dermatologists. You can feel great about what you're putting into your body. Since Nutrafol hair growth supplements are backed by peer reviewed studies and NSF content certified, the gold standard in third party certification for supplements, Nutrafol is the number one dermatologist recommended hair growth supplement brand trusted by over one and a half million people. Adding Nutrafol into your daily routine is simple purchase Online, no prescription required. Automated deliveries and free shipping keep you on track. Plus, a Nutrafol subscription can save you up to 20%. You'll have access to free one to one naturopathic doctor consults to support you on your hair growth journey and a headspace meditation membership is included. See Thicker, stronger, faster growing hair with less shedding in just three to six months with Nutrafol. For a limited time, Nutrafol is offering our listeners $10 off your first month subscription and free shipping. When you go to nutrafol.com and enter the promo code TAMSEN10. Find out why Nutrafol is a best selling hair growth supplement brand@nutrafol.com spelled n u t R A F O l promo code TAMSEN10. That's nutrafol.com promo code TAMSEN10. It's been months since I've had sex with my husband. How often are we actually supposed to be doing it? I feel guilty all the time.
- [23:07]
B
Okay. So that's very, very common. But the way she's asking it is kind of like it sounds like it's going to be a chore for her. And to say you should do it this amount of time because this is what the marital contract says, is like, it's very should. And never expect a good libido or healthy enjoyment of sex to come from a chore. Right. So that would be the first thing of, like, what does sex mean to you? What does sex mean to your partner? Can we just talk about sex in this relationship first? Cause I guarantee you, if it's been months, they probably haven't talked about it. So to skip the talking part and going straight to the, like three times a month as a prescription, it's not gonna work. It's gonna backfire.
- [23:44]
A
Where do you do the talking part? You're making coffee in the morning, you're sitting down, both of you looking at your phone.
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B
Yep.
- [23:49]
A
You know? Or you're having dinner out. Where do you. How do you.
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B
I mean, those are all great places. Cause like, make it casual, you know, like if you're a cat, not in the bedroom, not naked after a failed orgasm attempt or a failed, like a penis, that doesn't work. Like, that's a bad time. Walking is very safe.
- [24:04]
A
Right. It's like, you're gonna be in a lot of bedrooms this week, Kelly.
- [24:07]
B
I know. Oh. I mean, you can use me. I always say use me as an excuse. Like, I was listening to this podcast, I was reading this book, and it turns out that it's very common for people to, you know, lose interest in sex in midlife. And I am interested in figuring out how we can make our sex life better. Would you like to help me with that? Right. And what we're saying there is let's partner. Don't do a. You never. You always. I never. You like those absolutes and like making it one person's problem. Like sex in a relationship is a relationship issue, not a her fault, his fault, et cetera, et cetera.
- [24:40]
A
Do certain positions really make it easier to orgasm or is that just something in magazines?
- [24:44]
B
It is true. So different positions put different forces or pressure on different body parts. Right. So some people might notice that the anterior or front side of the vaginal wall, because that's where the clitoris is, that might be more arousing or, you know, doggy style is. Might be more arousing for the male. Right. So all the different positions just hit things in different angles, and that's why it's fun to experiment. There's some very cool pillows out there. If I could, I'm going to think of a name of a cool pillow. What is it called? There's an amazing sex pillow that is made by Tabu T A B U. They make an amazing sex pillow.
- [25:19]
A
Oh, Taboo does vibrators and a sex.
- [25:22]
B
Oh, yeah.
- [25:22]
C
Okay.
- [25:23]
B
So they have a pillow.
- [25:23]
A
We'll put Taboo in the.
- [25:24]
B
Yeah. You know, when you think of sex pillow, I don't know if you think of sex pillow.
- [25:27]
A
I don't even know what a sex pillow is.
- [25:28]
B
So sex pillow is a good.
- [25:30]
A
Crestron.
- [25:31]
B
Right. Like, what's a sex pillow? So a sex pillow traditionally is like a black velour foam triangle wedge.
- [25:37]
A
Okay. Okay. I do know what it is.
- [25:39]
B
Yeah. So it's like, you know, it's a little kind of X rated. And like, where are you going to put that in your house? House.
- [25:43]
A
I don't know.
- [25:43]
B
Right. Like, you had a closet to hide. Black foam wedge. Right. So what Taboo did is they made it like, it comes in a very nice kind of thing that you would just have a throw pillow in your bedroom. You wouldn't know. That's great. People wouldn't know that that's a sex pillow unless they also have one.
- [26:01]
A
Okay.
- [26:01]
B
Right.
- [26:01]
A
All right.
- [26:02]
B
And so it's just.
- [26:02]
A
It'll have to start gifting them to people.
- [26:04]
B
Yeah. Oh, it's a great. It's like a wedding gift. That's great. Or like a retirement gift now that you have more time. But so what it does is it changes the angles of the pelvis.
- [26:14]
A
Okay.
- [26:14]
B
Right. So the angle is tilted up. It's great for people with like, lower back pain.
- [26:18]
A
So a better position is.
- [26:19]
B
Different positions. Yeah.
- [26:20]
A
Oh, no, a better position is what?
- [26:22]
B
Whatever works for you, man. Like, you know, some people are like, hey, I love doggy style. Some people are like, hey, I love, you know, I'm on the bed, he's standing like, okay. Lots of different things. There is no, like, best one because we're all built differently.
- [26:34]
A
There are so many lubes out there. Is there actually one that works better for women in our 40s and 50s? 50s.
- [26:38]
B
Great question. So lubes in general come in three forms. Water based, oil based, silicone based, and then they do hybrids of like, combos of all of those. So in as we get older, our skin can get thinner and it can get more dry. The silicone and oil based are really nice because your skin isn't sucking in a water based, like a, like a water based face cream. Right. You're going to absorb it really quickly, especially if you have dry skin. Also, water based lubes can be cold. I, I don't know about you, but I do not have desire for sex when I'm cold. No, I don't put something cold on my private parts.
- [27:10]
A
No.
- [27:10]
B
Water based tends to be cold.
- [27:11]
A
That's like starting back over at square one.
- [27:13]
B
Yeah. I mean, some people think ice cubes are sexy, but like, that's not my job.
- [27:15]
A
No.
- [27:15]
B
Yeah, water based. And it also tends to be what they call tacky or sticky and it's just kind of an unpleasant, unsexy thing. But condoms, water based, that's your go to silicone. Stays on the skin, it doesn't get absorbed.
- [27:29]
A
Okay.
- [27:29]
B
So it will stay lubricious for a lot longer. And you know, uber lube, I always plug uber lube because they're amazing and there's no, there's no smells, there's no tastes. It's very natural. Triathletes use it under their armpits and groin.
- [27:42]
A
Yeah.
- [27:42]
B
Very, very slippery if you use it in a shower because there's water and it's very slippery. But for skin that's dry and you want the slipperiness to stay there for a while. Uber lube or a silicone lube. And then oil based lubes, they're warm, they're not cold. You just don't use them with condoms because it can break down what the condom is made out of. But oil based lube's also longer lasting. Try if you have really expensive, nice sheets that you're very attached to. Maybe sample a little Bit on the side of the, you know, under the sheets so you know you're not going to wreck your sheets with an oil based lube.
- [28:13]
A
Sometimes after sex I get super itchy and irritated. Even when we use lube. What is going on?
- [28:18]
B
Could be friction, right? Is there, is there shaven hair or anything that's more frictiony? Something to think about. You could be irritated. Are you irritated by the lube? You know, are you irritated by the friction? If it self resolves by itself. Itself, I would think more just an irritation. But if you're itchy for a long time afterwards, then I'm like, is there some other allergy? There's very rare allergies to sperm or sensitivities to the makeup of sperm and in male semen, but that's pretty rare. So I would see if it's bothersome enough. I would see somebody who's trained in sexual health. But otherwise if it's just a little bit irritating and it resolves, it's probably fine.
- [28:54]
A
I've heard that working out can boost libido. Is that true and are there workouts that can actually help more than others?
- [29:00]
B
Yes. So that is true. Working out increases endorphins, feel good, also helps body image, also helps cardiovascular fitness, also helps your strength. And sex at the end of the day is a physical activity.
- [29:12]
A
Right.
- [29:12]
B
So the more fit you are, the more you can sustain long term sexual health. There's actually a paper that showed the more a woman exercises, the more sexual health she has. Meaning less pain, more desire, like all the sexual health markers up to a certain point, when you get to your over exercisers, the ones that are doing it kind of pathologically or two month much, they actually have less sexual health. They have worse sexual health domains, probably because they're exhausted, they're drained. They're not, they're tapped out. They're tapped out. So it's like exercise up to a healthy point, but over exercising. Then back to the baseline of, of issues with sexual health.
- [29:47]
A
I think that's interesting.
- [29:48]
B
I know. And then as far as as types, I don't think there's one over the other. I mean yoga is fantastic for like being embodied in mindfulness, cardiovascular health. Great for endorphins and cardiovascular fitness. Weights. That's sexy as hell. Right. You feel, you feel strong, you feel confident. Right. So it's like it's all good.
- [30:08]
A
I always think yoga because I feel like I get to know my body again when I'm on that mat.
- [30:11]
B
Yeah.
- [30:12]
A
If you don't have me looking at my body. I can see it. I don't usually do that. Usually I'm like, get up in the morning, put my workout clothes on. But yoga, I feel like I connect with myself again.
- [30:21]
B
Yoga's. Yeah, I think yoga's the. A great. I don't say trick, but like, for people who are like, I can't get out of my head or I can't turn off from the day, right? Because a big myth is like, you should just be ready to go for sex whenever. And it's like, dude, do you see what you did with your day? Like, you're not in the relaxed, parasympathetic, accepting state that's really great for sex. Yoga can help get you there.
- [30:44]
A
Are there natural ways to get my sex drive back? I don't always want to jump to medication.
- [30:50]
B
So I would say communication with your partner, prioritizing, having good sex, right? That's incredibly important. So if you're eating chef Boyardee SpaghettiOs for dinner every single night, then people are like, why don't you love Italian food? And you're like, cause my Italian food comes in a can and it's cold, right? It's the same thing. Meanwhile, this guy's having like a five star Italian meal, right? He's like, I love Italian food. And so prioritizing sex worth having.
- [31:17]
A
Prioritizing sex, like, hey, you know, we're not gonna like eat a big meal, go to bed, watch tv. There's like nothing sexy about any of those things. Is it like going in, shutting the lights off, having conversation, relaxing. Is that advertising?
- [31:32]
B
Make sure you're enjoying the experience. Yeah, right, because that's how, that's how dopamine works, right? Dopamine goes up because you're, you're headed towards something that's pleasurable or rewarding. And if sex isn't pleasurable or rewarding for you, don't expect your brain to desire it.
- [31:46]
A
Sometimes I get these sharp pains during sex, even when I'm totally turned on. Should I be worried?
- [31:51]
B
I would be worried. I'd say pain that's uncomfortable is never normal. So that going back to that pelvic health physical therapist, because they're going to be able to target that and there's pain in so many different locations. Is it pain on entrance? Is it the vulva? Is it pain deep around the cervix? Have you had surgery? Is it around the scar? Right. So there's a lot of different things to investigate when we investigate pain with intimacy. A great place to start is that well trained pelvic floor physical therapist.
- [32:16]
A
Yeah, Pelvic floor comes up over and over again. And we've had a pelvic floor therapist on. On the show before we did.
- [32:22]
B
Yeah, she's amazing.
- [32:23]
A
Yeah, Sarah's great.
- [32:24]
B
It's amazing.
- [32:25]
A
It really is. And I just didn't know very much about it. And would you say that somebody should be looking at that before they're dealing with any kind of problems just to be aware of it, or is this when you need it?
- [32:36]
B
No, I mean, I think, you know, we're all busy. To say you need to go to see a pelvic floor therapist just to check things out. It's like, I think it's in the. If it's not broken, don't fix it.
- [32:44]
A
Okay.
- [32:45]
B
And if something is a hint of being broken, like, oh, my gosh, my bladder just leaked. That hasn't happened in a while. Like, don't wait seven years.
- [32:52]
A
Okay?
- [32:52]
B
Right. Like, nip it in the bud. Small problems are easier to fix than big problems.
- [32:57]
A
Okay. I get close to orgasm, and then I panic. I'm going to pee.
- [33:00]
B
Yep.
- [33:01]
A
How do I get past that?
- [33:01]
B
Yeah. So I would dig into that to be like, do you ever actually pee? Or is it just a panic about peeing? Like, do we just work on the. On the brain and saying, you know what, we can relax. We've never actually leaked before. We probably won't this time. Or have you leaked in the past and now it's kind of wrecking the sex pleasure because you're worried about leaking again? So pelvic floor physical therapist to say, why are we leaking with orgasm? But it's actually pretty. I don't say pretty common, but in my world, like, I see that a lot. Or leaking of urine with orgasm, which they can sometimes fix. And sometimes they say, you know what? It's a big pelvic floor contraction. Make sure your bladder's empty, but be okay with a little bit of urine when you have sex.
- [33:40]
A
Okay.
- [33:41]
B
I mean, that's the other big thing is, like, it's okay.
- [33:43]
A
Right?
- [33:44]
B
Right. You might not think it's okay, but, like, get it checked out. Take care of any issues that you can. And then at the end of the day, like, you know, some people think, like, if sex isn't a mess, they're not having fun. Fun.
- [33:53]
A
Right.
- [33:53]
B
So I. And I don't mean that to downplay anybody's symptoms. See somebody and get it checked out, but sex is a. Is a big pelvic floor contraction, and you are, like, not in your brain. You are relaxed, letting Pleasure happen.
- [34:05]
A
Shouldn't be in your brain.
- [34:06]
B
Right, Exactly. So it's like sometimes you just kind of let things. Let things go. And sometimes it's a little messy.
- [34:11]
A
Okay, next question. I'm in my 30s, but preparing for perimenopause, which I always thought, those millennials, they're so good. Those millennials are so good. I was not thinking about this at that age. Is there something I could do now so I don't lose my libido?
- [34:24]
B
So just prioritize your health. You know, that's number one. Is like metabolic health. If your fitness. That you're prioritizing sex worth having pleasurable sex. And when the time comes and you might notice that hormones are changing or you're having symptoms, stay on top of it.
- [34:37]
A
Okay, so the next question is. I saw on social that our vagina disappears as we age. Wtf? Is that true?
- [34:44]
B
So the first thing to know is your vagina is the tube on the inside. The vagina is where the tampons go and where the babies come out of. What disappears. So the tube of the vagina doesn't go away, but what disappears is the outside tissues, and that's called the vulva.
- [34:58]
A
Okay.
- [34:59]
B
So the vulva is the clitoris, the labia majora, the labia minora. And the clitoris and the labia minora are adult structures because of hormones. So what happens in midlife is that your hormones go down to the point where. And I don't think a lot of women know this, or men that post menopause. When you're done reproducing, your estrogen is lower than that of a man's.
- [35:21]
A
If you're not doing.
- [35:22]
B
If you're not taking a hormone replacement therapy. Yeah. Like, people do not realize that because they don't know men have estrogen. And then they realize, whoa, I must really have a low amount of estrogen if he has more than me. Right. So when the estrogen and the testosterone go down, the labia can resorb or disappear. And that's where the question came from. The clitoris can shrink, the clitoris can atrophy. Arousal can become more difficult because blood flow also goes away way.
- [35:46]
A
And this is where vaginal estrogen comes into play.
- [35:48]
B
Correct.
- [35:48]
A
Which is separate from estrogen. If someone's putting their patch on, that is not your vaginal estrogen.
- [35:54]
B
Correct. So vaginal estrogen or vaginal dhea, they can come in multiple different forms, and that's local or pelvic dosing of hormones. I think it's skin care down there.
- [36:03]
A
Okay.
- [36:04]
B
That's all it is. And what I mean by that is it goes on your skin. It doesn't actually go inside your body. If I drew your blood, I wouldn't know you were on vaginal estrogen.
- [36:13]
A
Right.
- [36:13]
B
Whereas systemic hormones. Systemic means full body. If I drew your blood levels, I would know that you were on those.
- [36:19]
A
Let's go into hormones and treatment because you talk a lot about testosterone. You were recently on Capitol Hill at an FDA meeting talking about testosterone. And what were you talking about there?
- [36:31]
B
We were tasked by the FDA as experts to bring to the FDA what they could do to help the American people. So a lot of us were talking about the importance of correcting and removing the boxed warning on vaginal estrogen. Just for your listeners, there's a boxed warning on vaginal estrogen that says it causes lots of scary medical conditions and it simply is not true. So a lot of us were there saying that's the lowest hanging fruit. Fda, that's your job. Take that warning off.
- [36:56]
A
And that is not. That's vaginal estrogen.
- [36:58]
B
It's only vaginal estrogen only. So I came as a representative of the American women to say, listen, American women need a female dose testosterone product. Because right now we're bootlegging, bootstrapping, microdosing men's doses, taking high dose pellets. We're trying to figure it out, but we don't have a safe female dose testosterone product. Four other countries do currently. The uk, South Africa, Australia and New Zealand.
- [37:22]
A
Are those relatively new?
- [37:23]
B
New Zealand's new, but the UK's had it for a while, Australia's had it for a while, and I think South Africa was like a year or two ago.
- [37:30]
A
So right now, when a woman wants to take testosterone, she has to do what I do, which is take a tenth of a man's dose. Correct. And figure out how much to put on her hand and where to put it. Or compounded.
- [37:42]
B
Yep.
- [37:43]
A
And then is there another option too now?
- [37:45]
B
Yep. So you can microdose a male tube. I brought that. I brought that.
- [37:47]
A
Just for a while. Yeah. Can we show that? Can we show the amount?
- [37:49]
B
This is a testosterone gel, 1%, which is. This is. A man would take this entire tube in one day. The female dose is to make this tube last ten days.
- [38:00]
A
Okay.
- [38:01]
B
So. Well, that's hard to do. You have to kind of learn. And women can figure this out, right?
- [38:06]
A
Yeah.
- [38:06]
B
But there's no other medication where we're like, hey, figure out the doping on your own. Right, right. Like, it's very. That's Very, very non standardized pharmaceuticals.
- [38:14]
A
Yes.
- [38:14]
B
So this, that would be. This is a 50. Yeah. 50 milligram tube. So over 10 days you're going to be taking 5 milligrams a day and.
- [38:23]
A
5 milligrams a day. How? My doctor explained it to me. But I want you to explain it is basically the top of a pencil eraser. Is that right? That's about that dose. Yeah.
- [38:32]
B
And then you can see, you know, today, whatever today is the first of the month. Can you. Is it. Are you dosing it appropriately to make it last 10 days? Days. And if you're like, oh, there's still a ton left in this tube, you got to start taking a little bit more out of it.
- [38:43]
A
And where should you put it on you. Where's the best way if you're going to use a gel?
- [38:48]
B
So lateral thigh is kind of the most common place. Why? Because the side. A side effect is hair growth at application site. So forearm might not be a place where you want to have that. Right. Same with face. And lateral thigh tends to have less hair follicles than on here, on your.
- [39:04]
A
Sides of your thigh. Okay.
- [39:05]
B
And the inner thigh has more hair follicles, so you might just have more hair growth. But at the end of the day, if you don't care about hair growth, who cares? And if you do care about hair growth and you shave, who cares? Right. So it doesn't really matter.
- [39:17]
A
Don't put it on your chin.
- [39:18]
B
Don't put it on your chin. Yeah. Or your. Or your elbows. Okay. So that's kind of the standardized. So I said, fda, we want a female dose testosterone product. We want this FDA approved for hypogonadism, which means low hormones. That's what men have testosterone dosed for. I want a quality in that. Because what's happened with these other countries is it's approved for libido. Remember, libido's a mood. It's in the brain. Happens because of low hormones. Right. But what happens when you get an FDA approved medication for libido? Two things. Number one, insurance doesn't cover it because they have sexual health riders and they say we don't cover sexual health. Cause that's not real health. Not. Not true. But that's what insurance does. So if we get an FDA approved for low libido or hypoactive sexual desire disorder, we'll have insurance coverage issues. That's not helping anybody. And, and this is what happens in Australia. A woman either has to lie to her doctor and say, I want this for libido but she wants it to try it for something else so she has to lie to get it. Or when she says, I do want this for libido, there's doctors over there who say you can't have it because you're not married.
- [40:21]
A
Well, you know, I was sent to a sex therapist when I asked for it. Did you know that? Did I ever tell you that?
- [40:25]
B
I didn't know that? Yeah, but you're not the first person. And that's the same with Addie.
- [40:29]
A
I didn't even understand what was going on.
- [40:30]
B
It was the same with Addie and flibanserin that in some insurances are like, you must fail sex therapy first. And we're like, do you make a man fail sex therapy? Sex therapy for Viagra? Do you make a man fail sex therapy for testosterone? No.
- [40:41]
A
I couldn't believe it. I didn't even know what was happening. And I went through and I did it and then I was like, halfway through, I'm like, what the hell am I doing?
- [40:47]
B
Do we make people fail?
- [40:48]
A
What the hell am I. Why am I.
- [40:49]
B
Do we make people fail therapy to get an antidepressant? Yeah. No, like, it's insanity.
- [40:54]
A
It is insanity.
- [40:55]
B
Sex therapy is awesome. You shouldn't have to fail it to try a medication.
- [41:00]
A
No, mine was, you need to talk to a sex therapist, Explain to them why you want testosterone.
- [41:06]
B
Stop it.
- [41:07]
A
Yes, that's what I'm saying. I was, I was at. Yeah, so.
- [41:10]
B
So you can see why I do not want this FDA approved for low libido. It needs to be FDA approved for low hormones.
- [41:17]
A
Low hormones. I understand what you're saying. Which is not for low libido. Okay. Yes.
- [41:20]
B
So that's what men have it approved for.
- [41:22]
A
If I want to try testosterone, who do I go to? Will my OBGYN prescribe it or do I need someone else?
- [41:27]
B
So this is the first thing I say is just call the office because the receptionist should know if the provider. Providers provide female dose testosterone or not. Don't take a day off of work, find parking, pay your copay to go in there for them to be like, we don't do this right. So do your a little bit of legwork ahead of time. If you have a friend who you know is on it, hey, who do you get it from? That can be useful. Some of the telehealth companies do testosterone. Not all, because again, testosterone is dea restricted in this country, which is a whole separate podcast. But. And then the other thing is, not only OB GYNs are the ones who can do this. Primary care. Doctors do it, psychiatrists do it. Like a lot of people do it.
- [42:01]
A
Endocrinologists.
- [42:02]
B
Yeah, totally. And I mean, I think a big harmful thing that we've done is we've brainwashed women into thinking that only ob gyns take care of your entire body. Right. Why did we put them in charge of hormones? Right.
- [42:14]
A
So.
- [42:14]
B
And there's 28,000 OB GYNs in the country, maybe, maybe 40,000 OB GYNs, and they're busy doing other things. So I hear it over and over and over again. It's like women want to go to their. I'm like, why was it 50% of the population shouldn't have to go to like one type of doctor for all of their issues? It's like brainwashing that we did, I.
- [42:33]
A
Think, when we were younger. But you know when you're going to get. When you get your period and then that's when you start. And then you know you're going to start your pap smears. And then at that point you're like, that's the. That's the girl doctor. That's the doctor for my woman part. Like, that's literally what I think we think in our head. I never thought about it.
- [42:47]
B
I can't handle 50% of the population. That's unfair.
- [42:50]
A
Yeah. A mochi moment from Sadie who writes, I'm not crying. You're crying. This is what I said during my.
- [43:01]
C
First appointment with my physician at me Mochi.
- [43:03]
A
Because I didn't have to convince him I needed a GLP one. He understood and I felt supported, not judged. I came for the weight loss and.
- [43:11]
C
Stayed for the empathy. Thanks, Sadie.
- [43:14]
A
I'm Mayra Amit, founder of Mochi Health. To find your mochi moment, visit joinmochi.com Sadie is a Mochi member, compensated for her story. This episode is brought to you by Progressive Insurance. Fiscally responsible financial geniuses, monetary magicians. These are things people say about drivers who switch their car insurance to Progressive and save hundreds. Visit progressive.com to see if you could save Progressive Casualty Insurance Company and affiliates. Potential savings will vary. Not available in all states or situations. This is a conversation. You and I have sat on panels for a long time and this conversation always comes up and there's like one side that groans and another side that cheers. My doctor put me on testosterone pellets, but now I keep seeing online they're not good. What's the real story?
- [44:07]
B
Testosterone pellets have been around for a long time for men. They are FDA approved and covered by insurance. So that's, I just say that to be like it's not some weird thing, right? It's a legitimate option for men. What happens in the female community again, Cause we do not have our own FDA approved proper dosing of female testosterone. And what gives pellets a bad name is women are, are supraphysiologically dosed on them. So they'll.
- [44:33]
A
So what does that mean?
- [44:34]
B
That means that nowhere in nature does a woman have the testosterone that they're getting when they receive a pellet.
- [44:39]
A
So you get a pellet and your testosterone and estrogen and what else?
- [44:44]
B
It depends upon what's in the pellet. Some people pellet estrogen, but what we're talking about here is the testosterone. So normal, and this is American values, but roughly a normal female testosterone value. It's under 100, 100, fair. Just very large round numbers. Under 100 and a pellet. We've seen people with pellets of these are male levels. They're coming in with levels of 600, 400. So it gives all pellet people a bad name. And this is what I tell people because I'm in the middle of the camp, right? Like I don't think we should ban them. And I think some women do benefit from higher testosterone levels, but it shouldn't be the only option on the menu. If, if a doctor only does pellets and they don't know about the other ways, that's a one trick pony. And then you get side effects with testosterone when the higher of a dose you do. So watch out for side effects and realize that side effects can happen slowly over time.
- [45:36]
A
Side effects, hair growth, voice change, voice change, hair falling out can be.
- [45:40]
B
But it's more because you shocked your system with a drastic hormone change than the dose of the hormone. I mean there's a lot of men, yeah, there's a lot of men with really high testosterone and they have hair, Right. So it's not this, it's not a absolute that's going to happen.
- [45:54]
A
If you start seeing some of those symptoms, you should go see your doctor and you should get your levels checked. Correct. How often should you get your levels checked? If you were on testosterone, get it.
- [46:04]
B
Checked at a baseline just to kind of know where you are, get it checked about two months afterwards to make sure you're absorbing it. But what we care more than lab values is your symptoms. How are you feeling? Are you seeing benefit? Are you experiencing side effects? Because we know that labs, if you checked my testosterone lab four times today, it Would give you four different results.
- [46:22]
A
Oh, interesting.
- [46:23]
B
Okay, so it's like people rely on labs, like their goal or like, that's the. The profit of telling you what to do is like. No, we have to. We use it as a tool to interpret how you're doing. But it isn't like the end all, be all. One more thing about pellets. I tell women hormones. Our goal is for you to be on hormones for like 40 years. So is the most expensive, the most invasive and the highest dose option what you want to do for a 40 year plan? And that gets people thinking like, oh, maybe pellets aren't what I want to do forever.
- [46:51]
A
Yeah.
- [46:51]
B
It's 40 years of a little button decision.
- [46:53]
C
Right.
- [46:54]
B
And it's expensive.
- [46:55]
A
Yeah.
- [46:56]
B
So pellets are good for a small subset, But I don't think it's where women should start necessarily. I mean, I joke and I have an Oprah Daly article on it is like, you have to earn your pellet.
- [47:06]
A
What's better for vaginal estrogen? The cream, the tablet, or the ring? And why would a doctor choose one over the other?
- [47:12]
B
So they all have different prices. Right. So the doctor might choose based upon price. Again, 40 year plan. Right. We don't want something that's $800. I have a cream bias because I like targeting the vulva, the clitoris, I the vulva, to get the hormones. And the. Especially the vaginal tab isn't always high enough dose. I mean, I see women where they're, they're on the tab, but they have horrific atrophy and GSM in the genital. It's just not enough. Right. So lots of the good news is we have lots of different options.
- [47:39]
A
Yep.
- [47:40]
B
And it's not one size fits all. So again, my favorite is the cream because it's the cheapest and I can target the vulva with it.
- [47:47]
A
Next question. If I start vaginal estrogen, how long before things actually feel normal again down there?
- [47:52]
B
68 weeks.
- [47:53]
A
Six to eight weeks?
- [47:54]
B
Yeah. You're literally rebuilding healthier skin. It does take a while.
- [47:59]
A
Six to eight weeks. I think that's a, that's a nice amount of time. I don't think that that's not six months.
- [48:03]
B
It's not bad. It's better than hair growth.
- [48:05]
A
If I stop using vaginal estrogen, do I lose everything I gained? Do things just go back to being thin and dry if I stop?
- [48:11]
B
Yes. And the underlying reason is because you have low hormones after you've outlived your ovarian function. So if you give Your hormones back. Great. Vulva likes to be an adult vulva again. But you take that away, goes back to your low hormone state.
- [48:25]
A
Okay, I'm 50 and I've never used vaginal estrogen. Is it too late for me to start?
- [48:30]
B
No.
- [48:31]
A
How old?
- [48:32]
B
There's no age at which you're too late to start.
- [48:34]
A
70.
- [48:35]
B
Start it.
- [48:36]
A
Really?
- [48:37]
B
Yeah. Vaginal estrogen, anybody can start it.
- [48:39]
A
And it's really important because it also helps prevent things like UTIs. Is that, is that a correct way to say that?
- [48:47]
B
Okay, yeah. To me I'm like, get your 93 year old aunt on this stuff. If she has recurrent UTIs, it will decrease her UTIs by 50 to 60%. Nothing is more effective. And very recent data shows that for women with recurrent UTIs, the ones who are on vaginal estrogen, decreased risk of hospitalization, sepsis and death from uti.
- [49:06]
A
My husband has Viagra. Is there anything like that for women?
- [49:11]
B
Yes.
- [49:12]
A
What do we have? Let's go.
- [49:13]
B
So Viagra works by increasing blood flow. It's a blood flow drug. It's actually a failed blood pressure medication. A blood flow drug. Vaginal estrogen improves blood flow. You can actually get female dosed Viagra. So some people take it orally. Doesn't work in everybody. And it works more for blood flow issues. Right. It works for a man, it works for erection, but it doesn't work for his desire.
- [49:35]
A
Right, right.
- [49:36]
B
Separate. Two separate things. People think of like sex is sex. It's like there's actually lots of different pieces going on. So if a woman has an arous issues, like, I would love to have sex, I'm into this idea, let's do it. But like, I just cannot get aroused. I can't get turned on. It takes forever to have an orgasm. That might be more of an arousal disorder than a desire disorder. So blood flow medications to increase blood flow to the genitals can help that.
- [50:03]
A
And what are those medications?
- [50:04]
B
Viagra. And you can get it compounded in women?
- [50:07]
A
Yeah. Okay.
- [50:08]
B
So you can take oral. There's a lot of different types of Viagra. Now Viagra is the brand name as Sildenafil, but there's a lot of different types because for men, we, we need to have 10 different products for their erections. Right. So there's a lot of them.
- [50:19]
A
Do oysters and chocolate and foods that are supposed to turn us on actually work?
- [50:23]
B
Yeah, I mean, do you remember reading that in like Cosmopolitan when you were like 23? Right. And then you're like, I'm 23. Oysters are expensive. I'm not super into seafood. What's a woman to do? I know. If it works for you, fantastic.
- [50:36]
A
Yeah.
- [50:36]
B
And to me, I'm like, dude, if you're eating oysters, you're probably in a nice restaurant, you're probably pretty relaxed.
- [50:42]
A
You don't think it's oysters?
- [50:43]
B
No. I mean, no. Yeah. No.
- [50:46]
A
I mean, I guess if you're dripping chocolate all over yourself or off over.
- [50:49]
B
Somebody and, you know, I'm sure there's people who are like, have oyster fetishes and it is the oysters.
- [50:54]
C
But.
- [50:55]
B
But most modern sex birds are telling you to go shuck some.
- [50:58]
A
Okay.
- [50:58]
B
To get. To get a good sex.
- [50:59]
A
We can put that to rest. I've been with my partner for 30 years. I love him, but the spark is gone. Gone. How do we get it back?
- [51:06]
B
I heard this important thing from a sex therapist very recently. And they're like, 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. And so there's always that piece of like, do or do you want to be connected in a sexual way with this person?
- [51:20]
A
What if you do and you still just don't feel anything?
- [51:22]
B
Yeah. Well, then you say when you get to the party, like, if I said, you know what? Don't wait for spontaneous desire to come around. We know you don't need that to have a great sex life. We talked about that. When you go to the party, do you love the party?
- [51:33]
A
Party.
- [51:33]
B
And if a woman says, no, I don't actually like being at the party, then I'll say, okay, is this an arousal problem? Is it a pain problem? Is it an orgasmic inequality problem? Why don't you like the party? Let's tackle that. And if she says, once I go to the party, I freaking love the party. I have a great time. I just forget that I like the party. Like, great, Then remember you like the party. Or put the party on the schedule.
- [51:55]
A
And the party sucks.
- [51:56]
B
The party sucks.
- [51:57]
A
Okay.
- [51:57]
B
If anybody wasn't tracking. But. But it works. So, you know, a big myth is that we shouldn't have to schedule. Good sex isn't scheduled sex. Right. All sex therapists disagree with that. That's an absolute. But you know, the only people who would disagree with that is, like, at 2:00pm on Sunday, I must have sex with you. Yeah, don't make it that.
- [52:19]
A
Yeah, that's.
- [52:20]
B
That, that's the.
- [52:21]
A
That's.
- [52:21]
B
That's a thumbs down. But if you're like, hey, I want to have a sexual relationship. I need to prioritize time. Time to have sex. I mean, if you think about it, 150 years ago, was there anything better than sex besides, like, whiskey?
- [52:34]
A
No, no.
- [52:35]
B
Like, the light. There was no electricity. It got dark. There was nothing to do. Now we have, like, ice cream and Netflix and, like, theater, and it's like our dopamine is being given to us in so many easier ways.
- [52:47]
A
Yeah. Oh, sex. I forgot about that.
- [52:49]
B
Yeah. You want to go do some physical activity with a partner at the same time? Like, sex is actually a little bit of work compared to what we have available to us now for dope.
- [52:57]
A
Okay. This is from a guy, and I want to ask it because I'm sure there are a lot of guys that ask this question. My wife's sex drive has dropped, and I don't know how to bring it up without making her feel badly. What's the right way to start that conversation?
- [53:13]
B
With love and curiosity. No blame. No blame in this game. Understand that what happens to women is we are living longer than our ovarian hormone production, and hormones are important. Important not to everybody's sex life, but it is important. And also, what's on her plate, Right? Is there anything you can take off of her plate? Is she, like, completely packed and then has to schedule sex in when she's exhausted? Right. So what's your scenario of sex in your life, and is it being prioritized? So safety, love, communication. Do it when you're on a walk where she doesn't feel backed into a corner and be like, hey, you know what I really like? Like, I like having sex with you. I would really like us to try to prioritize that. Can you think of any way that I could help you with that? You know, is there anything and even you can have. Another thing to start with is, like, just talking about sex.
- [54:06]
A
Right.
- [54:06]
B
Just talking about it. Because if you've. If you spend 30 years never talking about sex.
- [54:11]
A
Yeah.
- [54:11]
B
And now your sex life has a problem, and you don't know how to talk about it.
- [54:15]
A
Right.
- [54:15]
B
So it's like, dude, talk about it when it's good.
- [54:17]
A
Talk about it when it's good. That's so. It's so true. All right. Will my sex drive ever actually come back or is it gone forever? Good.
- [54:23]
B
Oh, well, sex drive is very complex. Right. Like, are you working 80 hours a week and raising three kids under the age of five right now? Right. So are you breastfeeding? Did you just have a vaginal delivery? Right. So there Might be something going on in your life that absolutely is affecting your sex drive, because you got a lot of stuff going on right now. Are your hormones down? Are you having hot flashes? Are you not sleeping? Right? So sex life, I think the big myth is like, this. Sex life exists in a bubble of, like, no, no. What's going on with your life? And is there anything that you can say, well, this too shall pass. Right? You won't be breastfeeding and have young kids forever, or is there a health condition that we have to take care of? But desire is not this separate thing that isn't tied in with what's going on in your life. So that's what I would say. To say to that person is like, you've got to examine where you are before we can say, like, oh, it'll absolutely come back. But I have to say this. Many, many, many people, it's gone. For whatever reason, they change something. They learn more about sex. They learn more about how their body works. They learn how to have more amazing or whatever it might be, and they're like, oh, yeah, sex is great. Like, the big myth is, like, when you're 70, you don't have great sex. And I talked to a woman literally yesterday. She's been married for 50 years. She's 71, 72. And her and her partner were like, they're just at their house, right? Nothing special. They're like, let's just pretend that this is a hotel, a fancy hotel, and let's not do any chores today, and let's not wash any dishes, and let's just have sex multiple times and sit outside and drink coffee and, like, pretend we're at a hotel.
- [55:48]
A
Is that what they do?
- [55:48]
B
I love that that's what they did.
- [55:50]
A
That was my next question. It was people in their 50s, but you're saying 70s, so I love it. Kelly, thank you. I could do this for you for. With you for a very long time. We'll have you back.
- [55:58]
B
Thank you.
- [55:58]
A
Again and again, all of you out there, I hope you're walking away with the same feeling. It's why the conversations like this matter. And I want you to know you don't have to go through this alone, because we are here to talk about it. If you want to go deeper with Kelly, Dr. Caspersen's book, the Menopause Moment, is out now. And if this sparks some more questions, send them my way. We're going to keep this conversation going, because the more we talk about this, I promise you, the better it gets for all of us. If you love this episode, leave us a review. It helps other women find us and join the movement. I'll see you in the next episode. So, one more thing. One of my most asked questions from you all is about hair. And if you're listening right now and you've noticed maybe more hair in the shower drain or your part looks a little bit wider than it used to, I want you to know you're not alone in this because hair is a huge part of how we see ourselves. And when it comes to changes, in midlife especially, it can feel like a loss of identity. And I felt it too. My hair got so dry, especially in perimenopause and brittle, that I did the big chop. And that's why I wanted to have this conversation today. I'm talking to Dr. Isabelle Raymond from Nutrafol, who leads a global medical and clinical affairs. She is not only a scientist, but she's going through it herself and going to help us understand what's really happening with our hormones and what we can do about it. So it's so good to have you here talking about this very important topic.
- [57:12]
C
Well, thank you for me having. Having me.
- [57:13]
A
Let's jump into it because I think that this is something that we don't even realize how hair loss is so tied to our identity and it really changes our hair changes in perimenopause, right?
- [57:25]
C
It does. It does. Because if you go back to thinking about what goes on through menopause, we have estrogen receptors throughout our all our organs, and that includes hair. So hair is going to be affected. It's just not something that we think about because we don't think hair is going to be one of those organs that's affected.
- [57:40]
A
No, we think about hot flashes. We think about all the things that we've been talking about. So what do you actually see? What do you often see at this stage with women?
- [57:49]
C
So we have done some research from our own consumers and patients and realizing that about 50% of women will complain of hair thinning at this stage of their lives. And we know that aging is a factor here, but really there's a slope that happens during perimenopause that is absolutely related to the hormonal change.
- [58:05]
A
I have always seen hair in the drain. And then all of a sudden I was seeing more and more. And it was, for me, it was brittle, dry, and like, I could see it just, you know, it just wasn't growing the way it would before. And so it's. I've really had to focus on that. There's there's no question about it. When I look at my before and now, pictures are very different. What's normal when it comes to hair loss?
- [58:25]
C
I hate to use the word normal because I think we all have, you know, we are all born with our own hair follicles that we're not going to grow anymore.
- [58:30]
A
Okay.
- [58:31]
C
So it's like you, it's not a thing that you're going to be growing more hair, so you have to take care of the follicles that you have. And so as you go through changes of perimenopause, your growth phase of hair is also going to change. So how long you're in that growth phase, the antigen phase is going to start shortening. The texture of your hair is going to change because of the less, you know, sebaceous glands, et cetera, that are really kind of feeding that hair. And so not only is it growing slower, it's maybe in more of the shedding phase, but also the texture changes, which means that you do wind up cutting it off.
- [59:00]
A
I see it over and over and you know, I hear a lot of women say like, all of a sudden I've got, got like clump of hair in the shower and I didn't used to have that.
- [59:07]
C
No, exactly. And so there's a couple of factors that are related to debt. A, it's always important to speak to a dermatologist because they are the ones who see hair loss and hair thinning and they will know, be able to see if it's due to something else.
- [59:19]
A
Right.
- [59:19]
C
I don't want to say perimenopause is the only reason why this is going to happen to you. So getting, you know, really the, the help you need to see. Is there another medical condition affecting my hair is super important. And then, you know, yes. Realizing that, that this, a lot of hair in your shower can be so devastating. It happens to a lot of women post pregnancy.
- [59:38]
B
Right.
- [59:38]
C
And I think we talk about that. A lot of women are aware of the fact that when I'm going to give birth, chances are I will lose some of my hair, because during pregnancy you remain in the antigen phase a lot longer. And so all of a sudden now, because of the loss of estrogen, the rapid loss of estrogen, you suddenly now are in that telogen phase where you're shedding all the hair you were supposed to shed over the nine months. So that is devastating. So we are expecting that. But when it happens during perimenopause, I didn't even know about it and you know, why am I a scientist who does not know about hair thinning during perimenopause and these changes? And so when you start looking at the research and understanding that roller coaster of, you know, dips and estrogen and testosterone and progesterone, you start understanding that your hair is going through that ride with it. And depending on, you know, your own antigen phase and your hair texture, it will. Will be affected a lot more than we think.
- [60:30]
A
So let's talk about your personal. Because I think we all have these personal experiences of, wait, what is going on now? My hair. What did you do? What happened to you when you were going through that? Because I didn't even know I was in perimenopause. And I was, you know, I had really dark hair and really light floors and those. You know, I would walk around, I'm like, what is happening to my hair? Thinking it was stress, and it very well could have been. But what happened to.
- [60:53]
C
To you? I think all of us very similarly at this age. We no one talk. Talked to us about this. You know, they don't talk about pregnancy very much. You get an idea. But when it comes to premenopause, it is silence. No one mentions it. Every people are women. I don't know if there's an embarrassment or a shame about it because I never. I knew it was. I thought it was a moment. I couldn't even define it. I didn't know what menopause was. And again, I have a PhD in biomedical science. I'm a neuroscience by training. I have worked in cardiology, in neurology, in all of these different phases. And I not once was menopause ever brought up. And so when I was, you know, in my early 40s, I was at a conference and I feel like I hit a wall. And some of my lovely colleagues, women dermatologists, just looked at me and they knew because they were, you know, 10 years older, they knew. But for me, it was very much the physical, the emotional, the anxiety, the rise of all those things. And so I've had. My journey has been a lot more physically draining. Insomnia has been very hard. And then add insult to injury, here I am joining this company working on hair thinning. And we had a study on menopausal women looking at their hair. And I said, why would hair change during menopause? Again, clueless. I cannot believe I'm clueless at this point. And then looking at the cameras, because we're all on zoom at that point during the pandemic and realizing that, oh, oh, my God, this is happening to me. And it took me studying it to realize that it was happening. And I said, if I'm. I cannot be the only one, I cannot be this well educated and not know about this. So I think that we really wanted to bring this to people's attention.
- [62:24]
A
And I think you have to be really sympathetic then to women that, you know, we didn't know. I mean, we didn't know a lot of things that were going on, and we're just now talking about it. You talked about the study, so I want to get back to those. Because you've done a number of different studies from what I understand. Correct. But then, you know, you're also talking about moving the conversation forward. So along with talking about hair loss or changes, you all published the menopause edit, which I was excited to be a part of.
- [62:50]
C
Thank you.
- [62:51]
A
But you really write in an incredible introduction to who you are and to why it's so important. So let's go into why this is so important for us to be having this conversation. Not just the studies, not just how we find solutions, but really the conversation.
- [63:07]
C
Yes. No, thank you. And this menopause edit is the brand did a wonderful job at gathering experts, because what I love about this brand is they have been talking about conversations on hair loss and thinning for women. And I think as women, men can have this conversation. It's well accepted for a man to. Again, I know it's not easy for them to go through this, but a man can shave his head and go on with his life and make that decision, and it is well accepted in society. Women having hair issues is incredibly embarrassing. And they were not able to have a conversation with their physicians. So I think what I've loved about Nutrafol is really being able to have these awkward, awkward conversations about hair thinning and then expanding that to menopause. Because I think it's again, one of those things that a. We're talking about a change that happens in women that we don't want to talk about. So creating those opportunities to speak about it and make it. Okay.
- [63:57]
A
So let's talk about the studies that you did. Because Nutrafol started a certain way and now you've really got a focus on women and women in menopause. And I love it.
- [64:05]
C
Yes, I love that. And I think it's having women who are deciding what studies that we're doing is very helpful.
- [64:10]
B
This is what I mean.
- [64:10]
C
It's very helpful. You know, when the company started 10 years ago, they had A formula for men and a formula for women. What was important, that is because they know that the root causes, this integrative approach that we're looking at, the root causes, are going to be very similar between men and women, but men need a little more hormonal support because of just the biological sex. But then women in their 40s started getting the men's version because there was that additional hormonal support that dermatologists were recognizing was important as women were going through perimenopause. So they taught us, hey, we're giving this to women. And so instead of just deciding that we'll just give the men's version to women, we've formulated a specific product meant for menopausal women, really addressing not only the hair root causes, but also any other root cause, increasing in terms of stress, in terms of metabolism, lifestyle, all these things actually geared to women and not just extrapolating from what would be good for men. So already there not realizing, I think, that we were doing the first and only at this point, menopausal study in hair thinning with a supplement was huge. And I was at the Menopause Society meeting presenting this abstract, and we had a press release, and I was like, why is this so important? Because it is. And I didn't realize how important it was. And from there, we really opened the door to this conversation, and not only because we did a study in menopausal women, because the endpoints are women driven, the results are women driven. And what that does is it focuses, feeds the conversation that you as a woman, are worth being studied.
- [65:42]
B
Yeah.
- [65:42]
C
And you see yourselves in our results. And then you know that it's easier to have that conversation with your physician because a company decided to study it.
- [65:51]
A
Well, two shout outs there. Themopausesociety.org, obviously, they are educating physicians all the time. And so it's exciting to hear that this is all part of that conversation. And for anybody who doesn't know what the Menopause Society is, they really do an incredible job of that. And if you're looking for a doctor that has a special in menopause, they have a patient provider directory there that you can go to themenopausesociety.org or menopause.org.
- [66:17]
C
Correct menopause.org and again, you don't have to. You don't have to. These doctors are trained in menopause specifically for menopause, and they can help you. So you don't have to have that conversation to explain to them why you need the help. They're already trained for it.
- [66:28]
B
Yeah.
- [66:28]
A
So menopause.org there. And then one of the doctors who has been on The Tamsen show, Dr. Dora Stay, is an incredible dermatologist in New York City. My dermatologist. But she has done a lot and talks a lot about hair, hair loss, dry, brittle hair, and just how important it is to pay attention to what's going on in your body.
- [66:46]
C
Yes. And she's actually one of the dermatologists that we've worked with that I've known for a very long time, who's not only been a help in terms of working with the brand, but also as a friend helping me go through menopause.
- [66:58]
A
What is one thing you wish every woman out there knew about hair thinning or hair loss? They could just understand what's going on. So if they're listening to this and saying, oh gosh, I'm going to be going into perimenopause, what can they know before the pause to help themselves? Are there other things that they can focus on? Is it lack of stress and however we can do that? Is it sleep? Is it food? What is it?
- [67:20]
C
I mean, I think to me the most important thing is knowing. There's a theoretical knowledge and then how it applies to you. You know, and I go back to you had a guest, Jane Morgan, Dr. Jane Morgan, talk. She's a cardiologist and she knows, she knew the symptoms and she didn't recognize them in herself. And that just really hit me because, you know, as scientists, we see, or I see customers and subjects, and I hear it, but when it happens to you, it's very different. I think we are very good at gaslighting ourselves that it's fine, it's okay. So I think respect your understanding of what's happening to you and knowing that it is true, if you're seeing a change, if you're feeling a change, if you're feeling something's not right, whether it's related to your hair, whether it's related to your health, do something about it and trust that voice, even though you might have to fight for it. And hair is just one of those things that it's very subtle. Right. You know, you're in your hair growth phase for a long time. So the changes that are happening, if they're hormonal or stress or metabolism, it takes three to six months to see growth of hair, to see results. But it also takes that long to be able to see changes, because it's not over unless you have this huge Telogen effluvium. But even telogen effluvium, what is that? Telogen effluvium is a condition where it's really. So you have this stressful event and then three to six months later you start shedding. Okay, so that is that big shed that's shedding that we see postpartum, but also can be due to a big stressful event, surgery and things like that. But because it's not directly timely related to it, we also, we always wonder, what did I do now? When is something that happened three months ago to you? Because again, it takes time for the hair to get out of the anagen phase into that telogen phase.
- [68:59]
A
So the anagen phase is a growing phase?
- [69:01]
C
Yes.
- [69:01]
A
And the telogen. Telogen, yes, Telogen phase is the one where three to six months after some type of event. You could see that if you start taking a product like Nutrafol, how soon can you see the results? And what do those results look like? Is that new hair growth? Is that stronger hair? Is it is hair that feels healthier?
- [69:20]
C
Yes and yes and yes.
- [69:21]
A
Yes.
- [69:22]
C
So like any product for hair growth, hair takes again, because of the nature of how the hair grows. Nothing is going to grow your hair overnight night. No, it's not. And you are again born with the follicles that you have. So you're not going to grow any new follicles. You may have dormant hair that you can awaken if you will with, you know, either topicals, lasers. There's a lot of modalities now that exist, and I believe that we should always think about the entire picture of it in terms of a treatment phase, but in terms of a supplement. You really want to look at what are the other root causes that can affect, that are not treated by conventional medicine. Right. So we know that stress is going to affect your hair. When you know that metabolism, when you know, lifestyle, all of these things, if you can address them internally, you are going to give your hair follicles the best shot at growing. It's still going to be the same three to six months, because that is how long it takes.
- [70:11]
A
If someone is listening right now and feels overwhelmed by all the changes going on in their body and their appearance, what is the best place to start?
- [70:21]
C
Oh, my goodness. Well, I think you.
- [70:26]
B
Thank you. I know I'm not even a science, but.
- [70:29]
C
No, but I think just being. Being aware, I think, you know, five years ago, none of us were having this conversation. I think that the, the amount of knowledge and information that is now available to the public is huge. So I think women have a lot more resources today than they did even, even five years ago. So going through, you know, the documentary or going online to themenopause.org there's a lot of social media, you know, physicians who have a mission. I mean, I've never seen social. Many smart, brilliant women getting together to help other women. And so I feel super privileged to be part of this, to be able to share that information and so find someone that you see even on social, that you, they have resources for you. And in terms of hair, they'll also. Everyone's talking about hair right now. I know always because it's so important, because it makes us feel it's our identity. And though as we go through all these changes during perimenopause, you're like, can I just hold onto one of them? Can I please just hold onto this? Don't change this one, don't change this one.
- [71:26]
A
I want women to stop thinking it's just vanity. Don't you like about hair? I think sometimes women are ashamed to say, like that's a problem. But I think it's okay to talk. They should be talking about this.
- [71:37]
C
It should be. Because also when you think about hair is a reflection of your health, just like your skin. So we take care of our skin, we wash our face, we put moisturizer, we put sunscreen, we brush our teeth. Hair should. Why is hair different?
- [71:49]
A
I don't know.
- [71:50]
C
Why?
- [71:50]
A
I don't know.
- [71:51]
C
All of a sudden, hair, vanity thing, when it's, it's a health thing. It is. And it should be showing you something that internally may not be functioning as well as it did before.
- [71:59]
A
Well, and I think that's so important. And I'm, I'm glad that you're at the helm of, of a company like Nutrafol to really get out there and really talk about evidence based solutions. Because I think that that's what all women are looking for right now. Is this something you would take if you, if you want to just strengthen your hair too and you want to be proactive when it comes to going into perimenopause?
- [72:18]
C
Yes. So again, we, the way the company was founded, really to address hair thinning from within whatever stage you are in your life. So we have different formulations for younger women, vegan women, postpartum women and postmenopolis. Menopausal, postmenopausal. And so I think it's never too early to start taking care of your hair because again, it is, it is biology. And they're organs and you want to take care of them because you're not growing anymore. Once they're gone, they're gone. I think that's the first message I want people to know, as you like anything else, you put your sunscreen on, take care of your hair. Secondly, in terms of looking at studies, it's important to be able to choose products that have been studied in you so you can see yourself and also the different methodologies that were used. So it's very easy to provide a questionnaire to somebody and say, do you feel like your hair grew? It's another thing to actually do phototrichograms, to count the hairs, to do placebo controlled trials, trials to look at hair under a microscope to see if it has, if the diameter has changed and all of these things we have done. So to go back to your answer, I know I said a lot of things, but it does grow stronger because we have a study that we just submitted to the American EADV in Paris. We were just coming back from there where we showed that the root of the hair, once we pull it out, having taken Nutrafol for three and six months, there was an increase in the diameter. So that's one of the first studies that's shown that. So again, we keep increasing the amounts of studies we do to be able to give data to women to make sure that if they are gonna spend their time and energy on something that they can know what to expect.
- [74:02]
A
Wonderful. Dr. Aman, thank you so much.
- [74:05]
C
Thank you.
- [74:05]
A
It's such a pleasure.
- [74:06]
C
Oh, it was nice to see you.
- [74:07]
A
I appreciate you. Appreciate you.
- [74:08]
C
Thanks.
- [74:09]
A
Hey everybody, I want you to know today's episode was sponsored by Midi Health. If you're ready to feel your best and write that second act script, visit joinmitty.com today to book your personalized insurance covered virtual visit. That's joinmitte.com the care that women deserve.