271. What Every Couple Needs To Know About Women's Hormones

Summary

Podcast Summary: You Are Not Broken - Ep. 271: What Every Couple Needs To Know About Women’s Hormones
Featuring Dr. Kelly Casperson, MD and Amanda Louder, Sex and Marriage Coach
Released June 30, 2024

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Episode Overview

This episode is a crossover between Dr. Kelly Casperson’s "You Are Not Broken" and Amanda Louder’s "Sex for Saints," focusing on the critical topic of women's hormones—how they impact libido, sexual health, and the experience of perimenopause and menopause. The conversation explores widespread misinformation, the historical fear of hormone therapy, the nuances of hormone replacement, and practical advice for women and their partners. The discussion is science-based, compassionate, and peppered with humor, encouraging open communication and self-advocacy for better health outcomes.

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Key Discussion Points & Insights

How Dr. Casperson Entered Female Sexual Health (09:30–12:52)

• Personal Catalyst: Dr. Casperson’s journey began after realizing that medical training prioritized male sexual health while leaving a gap in female care, especially regarding urology and sexual function.
  • “[I] realized, I didn't know how to help her. And I was taught in training that women were difficult, they were challenging. Furthermore, they took too long in the doctor's office and it's best to just, you know, avoid that.” (10:16 – Dr. Casperson)
• Gender Bias: She highlights the medical field’s gender bias and insufficient education on female sexual health, even among gynecologists.

Perimenopause & Menopause Demystified (13:28–16:03)

• Defining Perimenopause: It’s not marked by a lab value or single event, but is roughly the 10 years before menopause (average at age 51). Women in their late 30s and 40s often lack awareness of what to expect.
• Fear Around Hormones: Widespread fear of hormone therapy is rooted in misinformation, often without people knowing the source of their concern.
  • “Nine out of ten of them cannot tell you why they're afraid. They just know to be afraid. It's literally a dogma that is not being challenged.” (16:13 – Dr. Casperson)

The Women's Health Initiative: Source of Hormone Fear (17:04–20:47)

• Flawed Study: The 2002 Women’s Health Initiative (WHI) study was based on women much older than typical hormone therapy patients and used hormone types rarely prescribed today.
• Media Panic: The media exaggerated findings about increased breast cancer risk, resulting in mass discontinuation of hormone therapy and fueling enduring fear.
  • “[T]here was a possibility of higher breast cancer risk. Not statistically significant. Media went nuts.” (18:54 – Dr. Casperson)
• Lasting Impact: Decades have passed without widespread updates or corrections in the medical community or public mindset.

Benefits of Hormone Therapy (21:20–23:47)

• Beyond Symptom Relief: Hormone therapy after menopause is linked with reduced heart disease, osteoporotic fractures, neurodegenerative disorders, mood disorders, diabetes, and even colon cancer.
• Estrogen in Perspective: Postmenopausal women often have lower estrogen levels than men of the same age, illustrating the hormonal shift’s scope.
  • “Your estrogen post menopause is lower than your male partner's estrogen.” (21:52 – Dr. Casperson)

Starting Hormones & Provider Selection (24:03–29:36)

• No One-Size-Fits-All: There’s no set age or rule for when to start hormones; it’s best determined with a knowledgeable provider. Birth control pills are often inappropriately prescribed in perimenopause instead of proper hormone therapy.
• Finding the Right Clinician: Look for someone willing to individualize care and engage in ongoing dialogue, not push “pellets or the highway.”
• Patient Advocacy: Dr. Casperson advises approaching providers with curiosity and a willingness to try options:
  • “The power move…say, I'm going to partner with you. We're just going to try and I promise I'll come back.” (28:18 – Dr. Casperson)

Vaginal Estrogen: Unsung Hero (30:03–34:43)

• Role & Safety: Critical for pelvic, bladder, and sexual health—prevents chronic UTIs, combats dryness, restores microbiome.
• Access Barriers: Insurance issues frequently inflate the cost; clever workarounds include GoodRx, Amazon Pharmacy, and Mark Cuban’s Cost Plus Drugs.
• Black Box Warning: The FDA’s warnings are outdated and overgeneralized, deterring both patients and providers.
  • “The black box warning says probable dementia, stroke, heart attack, cancer, et cetera… and if a woman doesn't know that that's actually wrong, she'll get her prescription…and then she'll think the doctor's trying to kill her.” (33:19 – Dr. Casperson)
• Eligibility: Virtually all women can benefit—those on active breast cancer treatment should consult their oncologist, but evidence supports safety.

Preventing & Reversing Sexual and Pelvic Changes (35:06–36:56)

• Prevailing Medical Attitudes: “Come to me when you have a problem” is outdated—preventative local estrogen can help avoid irreversible changes like clitoral atrophy.
• Personal Testimonies: Amanda shares chronic UTI relief with vaginal estrogen, underscoring the impact on quality of life.

Bioidentical Hormones: Buzzword or Science? (37:25–41:27)

• Marketing Myth: The term 'bioidentical' is often co-opted by expensive, non-insurance, compounded therapies, but insurance-covered, FDA-approved options are also bioidentical.
  • “Bioidentical means it's the exact same stuff as your body makes now…So if I test your blood and then I give you some bioidentical hormones…I can measure them because they're the same.” (39:43 – Dr. Casperson)
• Choose Smart, Not Expensive: “You’re just paying more for your bioidentical hormones because you’ve been hoodwinked into thinking it’s better.” (40:11)

Comprehensive Hormone Replacement (41:27–45:59)

• Which Hormones?: Estrogen, progesterone, and testosterone are all made in female bodies and may all play a role in health and sexual function—but dosages and combinations must be tailored.
• Pellets Debate: High-dose testosterone pellets can cause side effects; gradual titration is preferred.

Estrogen’s Direct Role in Libido (45:59–48:35)

• Surprising Science: Estrogen has a bigger influence on sexual desire than commonly thought—even in men. Sometimes estrogen alone can be enough for some women to regain libido.
• Addressing Symptoms: Hot flashes, mood changes, body image issues also affect libido—addressing these can restore sexual interest.

DHEA and Supplements (49:18–53:48)

• DHEA 101: Available over the counter in the US; can mildly raise estrogen/testosterone.
• Suppositories: Prescription DHEA (Intrarosa) can directly benefit vaginal health; off-label insertion of oral DHEA has been mentioned in some expert circles but lacks robust study.
• Supplement Skepticism: The supplement industry is unregulated—products may not match labels.

The Crucial Role of Communication (54:00–56:41)

• Between Partners: Men often understand even less than women about perimenopause/menopause; open dialog is vital.
  • “Assumptions are the termites of any long term relationship.” (56:05 – Dr. Casperson quoting Christine d'Angelo)
• Relational Impact: Clearly expressing and exploring what’s needed, expected, and changing, rather than suffering in silence, improves empathy and intimacy.

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Notable Quotes & Memorable Moments

• “Lack of education creates fear.” (15:21 – Dr. Casperson)
• “Doctors used to use leeches…Update the memos.” (16:24 – Dr. Casperson)
• “Why are we bothering treating all these men for their erectile dysfunction issues if nobody's addressing their partners?” (11:14 – Dr. Casperson)
• “What's the best? It's the wrong question. The question is, what should you try?” (43:12 – Dr. Casperson)
• “You can't go to an urgent care and expect somebody to put you on hormones. Right? No, it's a relationship.” (27:03 – Dr. Casperson)
• “Assumptions are the termites of any long term relationship.” (56:05 – Dr. Casperson quoting Christine d'Angelo)

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Key Timestamps for Major Sections

• 09:30 – Dr. Casperson’s path into female sexual health
• 13:28 – Perimenopause and menopause defined
• 17:04 – Fear of hormones and the WHI study
• 21:20 – Health benefits of hormone therapy
• 24:03 – When and how to start hormone therapy
• 30:03 – Chronic UTIs and the impact of vaginal estrogen
• 33:19 – FDA black box warning and advocacy tips
• 37:25 – Bioidentical hormones: marketing vs. science
• 41:27 – The complexity of hormone replacement regimens
• 45:59 – Estrogen’s underestimated role in libido
• 49:18 – DHEA supplements and vaginal suppositories
• 54:00 – The importance of communication with partners

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Actionable Takeaways

• Educate Yourself: Don’t accept medical dogma without question; search for current, science-backed information.
• Advocate in the Clinic: Ask for trials of estrogen, progesterone, or testosterone based on your symptoms—don’t settle for “it’s normal” or quick dismissals.
• Vaginal Estrogen: Consider for UTIs, dryness, and maintenance even before major symptoms arise.
• Check the Source: Not all ‘bioidentical’ or compounded hormones are better—insurance-approved medications are equally effective and far less expensive.
• Keep Communication Open: Share symptom changes, fears, and needs with both healthcare providers and partners; don’t let assumptions drive the relationship.

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In summary:
This episode delivers a compassionate, myth-busting, and practical guide to women's hormones in midlife, with specific attention to their impact on libido, sexual health, and relationship quality. Dr. Casperson and Amanda Louder empower women to seek better information, advocate for their needs, and create more open, supportive connections with both providers and partners.

Transcript

[Dr. Kelly Casperson]

Hey everybody, welcome back to the you

[Podcast Host (You Are Not Broken)]

are not broken podcast.

[Dr. Kelly Casperson]

I actually have a super cool treat today.

[Podcast Host (You Are Not Broken)]

I love promoting other people's podcasts, especially women podcasters. And this is Amanda Louder, who's a sex therapist and she's got an amazing podcast for Christian couples called Sex for Saints. And we had an awesome conversation about what every couple needs to know about women's hormones. So I wanted to share it with you guys too. And if you find yourself in the niche where you think Amanda's podcast would be awesome, please go over and support her with Sex for Saints. So this is episode episode what every couple needs to know about Women's hormones. We talk a lot about libido and how it's influenced by biological, psychological and social factors. We talked about perimenopause and post menopause that are stages of life that lack sufficient education and information for both women and their male partners. We talk about the fear surrounding hormone replacement therapy due to the Women's Health Initiative study that got published in 2002. We talk about vaginal estrogen and how beneficial it is for sexual health, particularly in addressing issues such as chronic urinary tract infections. Vaginal estrogen helps maintain vaginal health and reduces UTIs. And we talk about how that actually works. We talk about the FDA's boxed warning on estrogen products, which is outdated and does not differentiate between systemic and vaginal estrogen. Then we talk about how bioidentical hormones are the same as the hormones that are produced by our body and they can be obtained through insurance approved, FDA approved medication patients. Sometimes the term bioidentical is used as a marketing tool for vulnerable people. And then of course we talk about open and honest communication which is crucial in maintaining a strong and supportive relationship during perimenopause, menopause, and addressing issues related to sexual health. If you want more about intimacy, female sex ed and stuff you never got taught, please head over to Barnes and Noble or Amazon and pre order my book, you are not broken. Stop shoulding all over your sex life, which is funny, short, readable in a weekend, gives you the education you never got or wished you wished you had that your mom never gave you unless you were freaking lucky. I have women share this with their partners, with their kids, with their adult kids, with their older teenage kids. Basically getting a modern take on how our bodies work, how sex functions, how we can prioritize pleasure for all so that we all want to go to the party. All right guys, love you so much.

[Dr. Kelly Casperson]

Thanks for being here.

[Podcast Host (You Are Not Broken)]

This episode probably won't be up on YouTube because it's I don't have video from her podcast, but most of my podcast episodes now are gonna be up on YouTube. Kelly Casperson MD so head over there. Make sure to subscribe. You can watch the video. Apparently people like watching me talk.

[Dr. Kelly Casperson]

So if you don't just like listening,

[Podcast Host (You Are Not Broken)]

you like watching me talk. YouTube is now. We're finally getting YouTube up and and cooking so we've got 7000 subscribers already feeling pretty awesome. That off and enough of me.

[Dr. Kelly Casperson]

Let's go to the interview.

[Podcast Host (You Are Not Broken)]

Thanks so much. Welcome to the you are Not Broken podcast.

[Dr. Kelly Casperson]

I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality. Enjoy the show.

[Amanda Louder]

While this podcast isn't rated explicit, the

[Amanda Louder (Podcast Intro/Outro Voice)]

content may not be suitable for younger listeners.

[Amanda Louder]

Welcome to Sex for Saints, the Christian couple's guide to great sex. I am your host, certified sex and marriage coach, Amanda. This is episode 305, what every couple needs to know about Women's Hormones. An interview with Dr. Kelly Casperson.

[Amanda Louder (Podcast Intro/Outro Voice)]

Welcome to Sex for Saints, a podcast for Christian couples. My goal with this podcast is to help enlighten, educate and inspire you to understand yourself, your spouse and your sexuality better. I talk about sex in a way you probably haven't heard before. I'm bold, I'm direct, but I keep everything in line with my strong Christian values. Are you ready?

[Amanda Louder]

Let's go. Hello everyone. Welcome back to the podcast. So happy to be here with you today. I am so excited to share this interview with you. But before we get started, I just wanted to mention a couple of things. I am still running my promotion to get half off your first month of the Embrace youe Elite Society membership for if you use the the Code podcast in checkout that makes it just $24 and 50 cents for you to try out the membership for a month. You can cancel at any time. So it's really worth it for you to just see what this amazing membership is all about. And I think it will be of great benefit to all of you. In my opinion. Everyone needs coaching. Um, whether you're good in the sex department or not, you probably need it in some area of your life. And this is the perfect way to get some really inexpensive coaching because for that 24amonth or and then $49 a month after that you can get private semi private coaching and it is really beneficial. So highly recommend that you do that. Also, I'm still got some openings for couples coaching, probably not starting until March End of March, maybe April. But if you are wanting to do some couples coaching, you need to set up your consultation as soon as possible so we can get you started. So for more information about that, you can go to Amanda Louder.com couples if you want to sign up for the Embrace U Elite Society membership, you can go to embrace you.amandalauder.com and we will get you there. Okay, so this interview is going to be so amazing. I was just blown away. I'm so excited for you to hear this. A lot of times I get responses from women that they the reason that their libido is down or they're struggling with sex is because their hormones are off. And while I think that is sometimes the case, and we're going to talk about a lot of that in the interview, very much your sex drive, if you want to call it a drive, it's not really a drive, but just, you know, for simplicity's sake, or libido or whatever you want to. Your desire levels are really biopsychological, social. So we have to look at the biological component. Because, yeah, if your hormones are off, it can definitely affect things, but it's not going to just affect your libido. There's going to be other symptoms that you're having that will make it apparent to you. But if those are off, we definitely want to work on those. And then, you know, the psychological, like your mindset, your conditioning is really important and social. What's going on in your life and your relationship dynamics, those are all really important and play into the whole dynamic in the sexual relationship. So what we're focusing on in this interview is hormones and what that looks like for women, and especially women in perimenopause and menopause, like postmenopausal. And you may not think that you need this information right now if you're younger than that or if you've already gone through menopause, you absolutely do. We do not have a lot of education when it comes to what happens for women when we are perimenopausal, menopausal, and postmenopausal, we just don't have a lot of information. We have a lot of information about puberty.

[Amanda Louder (Podcast Intro/Outro Voice)]

Right.

[Amanda Louder]

And perimenopause is kind of the reverse of puberty. So we really need more information about this as women. I am. So it's so important to me to empower women in this area. And I have been learning a ton from Dr. Kelly Casperson, and I cannot wait for you to learn more from her too. Just so, you know, and she talks a little bit about this in the episode, but the average age for menopause in women is 51. Okay. And perimenopause can start 10, sometimes even 15 years before that. So if you're 36 or older, you absolutely need this information right now. If you're younger than 36, you still need this information because it is going to affect you eventually, I promise you. And so I really, really want to empower women to know more about their bodies and about their sexuality. And this is a missing piece. And, and so I'm really happy to bring you this episode. So here we go. I am so excited to have Dr. Kelly Casperson on the Sex for Science podcast today. Kelly is not only a fellow sex coach, but a board certified urologist. She has written an amazing book called you are not Broken and has an awesome podcast by the same name. I have been following her for quite a while and I've learned so much from her about female sexual health, especially when it comes to perimenopause and hormones. So welcome Dr. Kelly Casperson.

[Dr. Kelly Casperson]

Thanks for having me.

[Amanda Louder]

So happy to have you here. So I think it would be really helpful for my audience to hear a little background of how you, as a urologist, really got into the space of female sexual health.

[Dr. Kelly Casperson]

Yeah, it's a, it's a cool journey because everybody thinks like, we learn all we need to learn in training. Right.

[Amanda Louder]

And it's not really true. No.

[Dr. Kelly Casperson]

I was a urologist doing lots, I was doing lots of female urology. Prolapse, incontinence, you know, stuff like that. But I really had a patient change my life. She had some sexual health issues. And I realized, you know, urologists get trained in men and their body parts and their erections and all of their issues, and we just kind of always assumed the women were being taken care of by the gynecologist. That was my assumption.

[Dr. Kelly Casperson (Outro Voice)]

Yeah.

[Dr. Kelly Casperson]

And then I had this patient come into my office. She basically changed my life because I, I was very bonded with her and I realized I didn't know how to help her. And I was taught in training that women were difficult, they were challenging. Furthermore, they took too long in the doctor's office and it's best to just, you know, avoid that. And the more I researched on female sexual health, the more I realized there's decent research. It just doesn't trickle down. And certainly Hollywood doesn't help us, mainstream media doesn't help us. And you know, you ask any gynecologist who is worth their, their salt and Truth. And they're like, yeah, we don't really get trained either. Yeah. So it really became a gender bias issue to me in how we treat men and women very differently as far as what we think about their quality of life, what we think about if sex should be important to them. And it got to the point where I'm like, why are we bothering treating all these men for their erectile dysfunction issues if nobody's addressing their partners?

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

And then I really got into midlife and menopause and hormones because of sex. Because all of my. Mostly Instagram that did it for two reasons. Number one, Instagram kind of frowns upon us talking about sex and sex education, which is a huge barrier. They know how I feel about that. But really, so many people are interested in hormones. And it's just a kind of a safer thing to talk about on Instagram. You know, podcasts. That's why podcasts are so great.

[Amanda Louder]

Right?

[Dr. Kelly Casperson]

Because you can actually talk about sex on podcasts.

[Amanda Louder]

Yes.

[Dr. Kelly Casperson]

And not get. Not get blocked. So women are like, well, you know what happens because of menopause? And, well, you know what happens to your sex life because of menopause? And I'm like, I don't. And I'm staring down the barrel of this. Right. Like, maybe I should learn. Yeah. And so really from there drove into, like, is, is estrogen important? What about testosterone? What happens in perimenopause? Why don't people know what happens to their body? Which is insanely ridiculous, because we know what happens with puberty. Everybody, big heads up of puberty is coming. Nobody gets a head up that, like, puberty is basically reversing and stays that way. So I just really got into hormones. Why are we afraid of them? Is that fear based in science? You know, what's new since that fear based study came out 22 years ago. It's a fascinating topic and for me, I'll always have work because for me, this is equality. It is, you know, writing the gender bias or correcting the gender bias that's inherent in medicine. And it's a very fascinating topic and it's. It involves everybody. Like, this is everybody's health. Health. Yes.

[Amanda Louder]

Yes. Well, and that's why I love your work so much, because you're not only addressing some of the issues that other doctors aren't addressing, but you're also empowering other doctors to start learning and talking about it and so that more and more women can get the help that they need, which I think is so, so important. So I'm totally ready to Dive into this if you are. I'm so excited. So let's start with perimenopause. What is it? And what should we be on the lookout for when it comes to our health as women and specifically our sexual health?

[Dr. Kelly Casperson]

Yeah. I mean, it's incredibly important to start there because so many people, if we don't. If we don't define our words, it's hard for us to get on the same page with anything. Right.

[Podcast Host (You Are Not Broken)]

So.

[Amanda Louder]

Right.

[Dr. Kelly Casperson]

Menopause is a year without natural periods. Average age of menopause in America is 51. It's a difficult definition because so many people have IUDs or hysterectomies or, you know, whatever other reason that they don't have a natural period ending point. Right. But that's. That's what the medical establishment gives us for the definition of menopause. Perimenopause. It's not a laboratory value. It's not a year of your life. It's really just the years leading up to menopause. And by definition, they say about the 10 years leading up, or peri means surrounding.

[Amanda Louder (Podcast Intro/Outro Voice)]

Right.

[Dr. Kelly Casperson]

So surrounding menopause. And I actually saw a woman a couple weeks ago, and she was kind of obsessed about if she was in perimenopause or not. She was 43, and she's like, but am I in perimenopause? And my doctors won't do any tests to find out if I'm in perimenopause. And I'm like, what are you asking?

[Amanda Louder]

Right.

[Dr. Kelly Casperson]

What do you actually want to know by answering this question?

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

And she's like, I need to know if I can take hormones or not. And I'm like, that's a very different question. Different question in perimenopause. Right. So I mean, my advice to clinicians out there are doctors is, like, really understand what people are asking. And, yeah, you know, if you're asking the question, why does it matter? Right. And she was, like, obsessed about it. I'm like, listen, you're 43. That's within 10 years of the average age of 51. By definition, you're in perimenopause. Completely separate issue to if you. If hormones are right for you or not. Right. So I think just our lack of education and people's resistance. I don't want to be in perimenopause. It's like, well, honey, you're. You're living long. And her. She always said, there's only one alternative.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

And I'll, like, use it till the day I Die. It's like, it's just what it is, like puberty. Right. Like it's gonna happen if you live long enough. So it's not something to be afraid of. But lack of education creates fear year.

[Amanda Louder]

Absolutely. Well, I know I am fully in perimenopause. I'll be turning 45 this year. And so I am really. I mean, so much I've learned from you. I am trying to educate all of my peers as much as possible because, I mean, most of my peers, you know, about my same age and they're all in it too. And I know more information they do. So I'm telling all of them. And one of the things that they're so scared about is hormones. Right?

[Dr. Kelly Casperson]

Yeah, I know. It's.

[Podcast Host (You Are Not Broken)]

Well, it's.

[Dr. Kelly Casperson]

I mean, it's the interesting thing about fear of hormones too. And you can ask them this because if you want to be like a little sassy, you can be like, which

[Amanda Louder]

I love being sassy.

[Podcast Host (You Are Not Broken)]

Yeah.

[Dr. Kelly Casperson]

Right? Yeah. Nine out of ten of them cannot tell you why they're afraid. They just know to be afraid.

[Amanda Louder]

Right.

[Dr. Kelly Casperson]

It's like literally a dogma that is not being challenged.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Because I'm like, wait, you know, they're like, oh, my mom's sister's newspaper delivery man in the 1973 told her, Hormones, blah, blah, blah. It's like, dude, update your hardware. Yeah, we've got some new info. Like doctors used to use leeches. We don't, we don't do that. Update the memos.

[Amanda Louder]

Yes, but I think what. The reason they're so scared is from the Women's Health Initiative. From.

[Dr. Kelly Casperson]

They don't know that. That.

[Amanda Louder]

Yeah, they don't know that. I know that. But that's, but that's why this attitude of fear. So let's talk about that a little bit. What is, what was that? What did the. So where is all this fear coming from that they actually don't know where it's coming from?

[Dr. Kelly Casperson]

Yeah. So the Women's Health Initiative was a billion dollar study started in the 80s and 90s by the government. And this was like the feminists, like, wet dream, right? We're like, we're finally gonna study women on a very large scale to see. And the question specifically was, does giving women hormones post menopause decrease their risk of heart disease? That was like specifically the question because we had tons of studies showing that it did. This was basically going to prove it because we didn't have a randomized, controlled, placebo blinded study.

[Amanda Louder]

Right.

[Dr. Kelly Casperson]

Which in the medicine world is considered Creme daily. Yep. Except for the Women's Health Initiative, which is not the creme de la creme. So what they did is they randomized women, average age significantly post menopause. This is very important when you get down to who's. Who benefits the most from being on hormones. Right. The answer is not the people who've already been without hormones for 20 years. But what they did is they threw these older people with significant risk factors, smokers, overweight, on hormones and hormones that we don't even use anymore. So oral conjugated equine estrogens, synthetic progestin, so medications we don't even use anymore to women who are significantly older than the people who we think can benefit from the hormones. And they did show some adverse. Some adverse events the older you were as far as cardiovascular disease, stroke, heart attack. That's not why the. That's not why people are even afraid of hormones, though. What happened was before they even published the data, so doctors couldn't even go and read it for themselves to interpret, they went to the media and they said, we're stopping this study prematurely. Which is always a big, you know, attention getter.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Because we think in the estrogen progestin arm, you have to be on a progestin if you have a uterus when you take estrogen. So in the women with uteruses who are on combined estrogen progestin, there was a possibility of higher breast cancer risk. Not statistically significant. Media went nuts. And this was before social media, just mainstream media went nuts.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

70 to 80% of women in this country were taken off their hormones.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

We now know that the placebo arm. So they said, increased risk of breast cancer compared to placebo. These were not randomized to risk of breast cancer. And the placebo arm, actually, some of those women had previously been on estrogen, which decreases your risk of breast cancer. So compared to placebo, which was a flawed placebo arb, estrogen progestin wasn't even statistically significant, but looked like there might be higher breast cancer. Once you break that down and you realize, oh, my God, we're actually afraid of something that is a medication we don't use in women that we don't use them in in a placebo arm, that was flawed because they'd already been on a drug that decreases your risk of estrogen.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

That all of this fear was unfounded. I mean, it's pretty blockbuster story when you break it down.

[Amanda Louder]

Yeah. Yeah. And so many women who should have been on hormones are not on Hormones now because it's still not trickling down to the medical community at large. Correct?

[Dr. Kelly Casperson]

Well, we have two decades. So that was 2002. 2002. Now it's 2024. Right. So we have 22 years or two. Two decades of medical schools not teaching physicians of residencies, not teaching physicians of the mom passing it on to the daughter that the doctor said I couldn't be on hormones was unsafe.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Right. And so it's really going to be a, a culture shift. The good news is the culture shift is happening and I think, you know, it's, it's the educated women who have access who are going to be able to get on those hormones first. So again, there's a big disparity problem, right?

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

But you're going to start seeing health disparities between the women who are being proactive and the women who don't have access yet.

[Amanda Louder]

So what are those health disparities? Because I've heard you talk about like lower risk of heart disease. Correct?

[Dr. Kelly Casperson]

Yeah. And again, you know, I didn't even put this in the definition of menopause because this is not in the definition of menopause. Definition of menopause is no periods, no natural periods for one year. Right? Yeah, well, that's a problem because that doesn't actually tell you that. Oh, by the way, your estrogen, your progesterone and your testosterone are low. Low, Low. How low? Your estrogen post menopause is lower than your male partner's estrogen. Man. A man has about an estrogen level of 30 to 40.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

A woman post menopause has an estrogen level lower than a man's. And I point that out to be like, what's the big deal, Right? Well, estrogen is incredibly important in that man for his bone health, for his sexual desire, for his erections, for his heart health. Estrogen is important in all bodies. So what you see in women who take hormones after menopause, decreased risk of heart disease. We are thinking there's more and more data. Decreased risk of neurodegenerative disorders, Parkinson's, Alzheimer's, you know, any sort of neurologic issues. Decreased risk of musculoskeletal issues. Frozen shoulder. It's a huge problem. Nobody talks about that. Decreased risk of. But I guarantee you, your listeners have frozen shoulder right now and they have no idea the association to estrogen with this. It's literally called the 51 year old shoulder by like physical therapists, right? Yeah, yeah. Decreased risk of osteoporosis, significant. Decreased Risk of fracture, which nobody thinks about, but if you end up with a hip fracture in your old age, it is a horrific way to die.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Decreases of colon cancer, decreased risk of insulin resistance, decreased risk of diabetes. So many benefits. Also mood disorders, the rate of. The rate of depression, anxiety skyrockets. In our 40s, we. The tide is turning to say, hey, pay attention to hormones first. Before antidepressants, certainly. I would argue if you are on the natural bent of things, an antidepressant is much less natural than taking a hormone, which your body always made and just has less of. Natural now.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

I mean, the other goofy thing about hormones is, like, vitamin D is a hormone, insulin's a hormone. Thyroid's a hormone. You don't have anybody going around saying, we shouldn't get those people who are low in those three hormones back up to normal.

[Amanda Louder]

No one. Yeah.

[Dr. Kelly Casperson]

So we bias.

[Amanda Louder]

Yeah, we totally do. So if we're hitting perimenopause, you know, 41 is right. When should we be starting hormones?

[Dr. Kelly Casperson]

There's no. Yeah, it's a. It's a very interesting question, and I think the perimenopause question is kind of the. The newest question in this, because certainly, I mean, we're getting to the point where, like, menopause hormones, people are kind of getting comfortable, getting there. Okay. Perimenopause is the reverse puberty. Right. So it's kind of coming offline. Your hormones are fluctuating. That's why the periods are wonky. That's why your moods are wonky. That's why you'll have trouble sleeping, and then you won't have trouble sleeping. Right. Because we're kind of reverse puberty down to that, you know, below the man's estrogen level. So the question is, who, when, what hormones first, right? Give everybody a little bit of testosterone, because testosterone converts to estrogen. You know, that's a whole nother bag of worms. Okay. There's so many questions, and, I mean, I hate to frustrate all your listeners for not having it be easy, but it's like, that's why, really, a good relationship with a doctor who cares, who's not just trying to sell you one hormone product, by the way, people who are like, pellets are the highway. No, we can do this cheaply. We can get your insurance to cover this. You should not have to remortgage your house to be on hormones. But the United States Physician Task Services did make a statement saying, as a preventative medicine, in all people, we're not there we can't say, hey, everybody, just start hormones when you're 43. Like, we. We do not have that data. Certainly there are risks to taking any medications. They're very low with hormones. Yeah, but you're never going to get like, well, you're. You're 18. You can vote. Like, you're never going to get a. You're 43. You can start on hormones. It's really finding a provider who's knowledgeable, who can listen. Certainly me.

[Podcast Host (You Are Not Broken)]

I see.

[Dr. Kelly Casperson]

I put perimenopausal people on hormones all the time.

[Amanda Louder]

Yeah, well, that's a really good question. Yeah. There's like, how do we even find a provider? Because, I mean, I have people coming to me all the time. They're like, I talk to my ob gyn. Well, one, they're like, no, you know, this causes breast cancer. So then they won't. Right. Or they don't know enough about it, or they tell me I'm normal when I know that I. I'm not in. I might fit in the normal range, but I don't feel like my normal self.

[Dr. Kelly Casperson]

Yeah. Well, I think the other common thing, if I'm just going to stereotype, especially in the OB GYN world or even the Dr. World, is like, yeah, for a perimenopausal woman, is putting her on birth control pills first.

[Amanda Louder (Podcast Intro/Outro Voice)]

Yeah.

[Dr. Kelly Casperson]

Versus hormone replacement therapy, which. They're two very different things.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Now, I always say in perimenopause, you can still get pregnant. So if you have sperm in your life and you need to not get pregnant, you've gotta. You've got to figure that part.

[Amanda Louder]

You've got to address that. Y.

[Dr. Kelly Casperson]

Because if you just throw yourself on an estradiol patch, you could get pregnant. So there's like. As opposed to a. A full year without natural periods, you're basically not going to get pregnant anymore. Right?

[Amanda Louder]

Yeah. Yeah.

[Dr. Kelly Casperson]

So perimenopause has that unique other thing we got to figure out. And what do I say? And. Or birth control pills can help some people, but I certainly would say birth control pills, by and large, have more side effects than hormone replacement therapy does. They're a synthetic hormone. They're. They're made to mimic, but they're not exactly like, you know, hormones. So you got to be with, you know, somebody who can figure that out first and foremost. Do we have to figure out pregnancy? Okay, we don't. Okay, we can. You have a vasectomy in your life or you're, you know, not sexually active. Great. Let's just deal with putting you on some hormones? Yeah. I think it. Now it takes advocacy, it takes bringing in, you know, I think it takes a relationship. Like you can't go to an urgent care and expect somebody to put you on hormones. Right? No, it's a relationship. What I find helps is to say, hey, I've been reading a lot about this. I'm curious, can I just try xyz, whatever, some estrogen, progesterone for three months. I will come back, I will adjust the dose and if it doesn't work, I will stop. Like, that is the power move in the doctor's office. You say, I'm going to partner with you. We're just going to try and I promise I'll come back.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

That is a. That will. That will get you farther than like being antagonistic or why won't you. Or you know, or like not kind of can. Keeping the conversation going when somebody tells you no.

[Amanda Louder]

Yeah. Well. And so should they be asking their obgyn, should they find a urologist? Should they find just their general practitioner? I mean, I hear a lot that like functional medicine doctors do better at this, but a lot of that's not covered by insurance, so people are more reluctant to go there. What do you suggest?

[Dr. Kelly Casperson]

I mean, yes to all of that. Not all urologists. I mean, I'm kind of a unique urologist for some females of urologists. And I really got into hormones again because of gender bias. Right? Yeah.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

A man comes to my clinic with low testosterone and poor erections. I'm not telling him to drink a glass of wine and do yoga and that. He's just getting old and to deal with it. Right. Yeah. And once you see how treat men and women differently, I couldn't help but start helping the women the way we help the men.

[Podcast Host (You Are Not Broken)]

Yeah.

[Amanda Louder]

So many women get told like, like just deal with it. Deal with all these symptoms. This is just part of being a woman. And that's not true.

[Dr. Kelly Casperson]

No, it's not true.

[Amanda Louder]

And.

[Dr. Kelly Casperson]

And so what if it is? Dry eyes are part of life. We treat it.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Cavities are part of life. We treat them. Like it just doesn't. Painful childbirth is a thing. We treat it.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Like to me, I'm like, it just doesn't hold up to anywhere else.

[Amanda Louder (Podcast Intro/Outro Voice)]

In.

[Dr. Kelly Casperson]

In medicine, getting cancer is a natural part of life. Multiple. We've been getting cancer for years, as do other organisms. We don't say it's natural and just live with it.

[Amanda Louder (Podcast Intro/Outro Voice)]

Right.

[Dr. Kelly Casperson]

Like you can't. It just doesn't apply when you hold it to anything. Else.

[Amanda Louder]

It's so true. That's so true. So I. I have heard you talk about vaginal estrogen, and it literally changed my life. I have been having chronic UTIs for years, gone on multiple medications, you know, a daily antibiotic. I have not had a single one since I started vaginal estrogen. But I went to my urologist and she told me that I was too young. I was 43 at the time. And she told me, and she told me that I was too young and I had to advocate for myself. I said, no, this is what I want. I want you to put me on it. I will come back if it's not helping, but I want you to put me on it. So talk to me about vaginal estrogen and how important it is for women. Women?

[Dr. Kelly Casperson]

Yeah. I mean, sometimes I. I joke, but not really. Like, God put me on the earth to tell people to use vaginal estrogen. Like, God, I'm such a specific niche, because he seems to have really niched down on me. Yes, yes. So vaginal estrogen is amazing. It is local estrogen only. What that means is it's very different than systemic hormones. When you think of like pills and patches and things where you're all. Your body gets the estrogen. Estrogen. Vaginal estrogen is just for your pelvis. And it works great on the vulva in the vagina. It really helps the bladder out. And I tell people the bladder and the vagina share a wall. Right. So we're just putting the medicine in the vagina. That's why, that's how it's helping the bladder and most importantly, how it also helps reduce UTIs is it rebuilds your natural microbiome. So the vagina loves being acidic. Estrogen helps it be acidic. When it's acidic, it can promote lactobacillus, which helps make it acidic. And when you have an acidic environment, it. It acts as a. A massive infection preventer between the poop and the pee. Right. So really a healthy vagina really decreases the rate of urinary tract infections. In some countries it's over the counter, which is awesome, right?

[Amanda Louder]

Oh, wish it.

[Dr. Kelly Casperson]

What's that?

[Amanda Louder]

I wish it was that here.

[Dr. Kelly Casperson]

I know. I don't see that happening. Believe it?

[Amanda Louder]

Probably not.

[Dr. Kelly Casperson]

I'll be the first person to announce it. Yeah. The two big problems in the United States of America is cost. A lot of insurances are making money off of this. This product, generic, it's been around since the 70s or earlier. It should be no more than $20 a tube. Really quick three tips for that. Amazon Pharmacy, Mark Cuban's Cost Plus Drugs online pharmacy, and the Goodrx coupon. I went in to get my vaginal estrogen, and I think I have Blue Cross Blue Shield, you know, the generic big insurer. And they're like, that'll be $260.

[Amanda Louder]

Oh, really?

[Dr. Kelly Casperson]

Like who I am and how much vaginal estrogen I put through this place.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

And so I pulled up my app on my phone, pulled up the Goodrx coupon, made it that pharmacy, and it was $27. And they're like, oh, okay, here it is for $27. And you're like, women shouldn't have to know the loopholes to get, you know, affordable healthcare. But that's the way it is. So, number one, cost is a problem. Number two, the FDA put a black box warning on all estrogen products because of the whi, which we've now debunked.

[Podcast Host (You Are Not Broken)]

Right.

[Dr. Kelly Casperson]

And. And they don't care if it's vaginal estrogen or systemic estrogen. And the black box warning says probable dementia, stroke, heart attack, cancer, et cetera, et cetera. So if. If a woman doesn't know that that's actually wrong, she'll get her prescription from her doctor, and then she'll think the doctor's trying to kill her. Yep. We're actually petitioning the FDA to get the black box warning off. ACOG petitioned in 2018 and failed. We now believe we have more and more better data saying, this stuff is so safe, it does not cause all these problems. Yeah.

[Amanda Louder]

Is there anyone who shouldn't be on it?

[Dr. Kelly Casperson]

What's it.

[Amanda Louder]

Is there anyone that shouldn't be on it?

[Dr. Kelly Casperson]

No.

[Amanda Louder]

Okay.

[Dr. Kelly Casperson]

If you're currently being treated for breast cancer, get an okay from your oncologist. But most oncologists who know the modern data know that it's okay. So I'm not saying they can't. I'm just saying make sure every. Everybody on your team knows everything that you're. In case you have some weird case where you just can't. But we actually have the ACOG statement. You can get that online. American College of Obstetricians and Gynecologists. That says vaginal estrogen. Multiple studies showing safety in cured breast cancer. Active. Currently being treated breast cancer. Because these women have significant pelvic issues with the estrogen blockers.

[Amanda Louder]

Yes.

[Dr. Kelly Casperson]

Right. Pain with sex, burning when they pee, recurrent UTIs, severe pain, cracking skin. Like, you know, all these things where we say we. We can help, that we can do something about it.

[Amanda Louder]

Yeah. And the estrogen, the vaginal estrogen, correct me if I'm wrong, can also help with the dryness. Like, even clitoral atrophy.

[Dr. Kelly Casperson]

Yep.

[Amanda Louder]

Okay.

[Dr. Kelly Casperson]

Yeah. I mean, that's the big question, you know, like I was saying before, like, should we just start all per menopausal women on estrogen? Well, we don't have enough data to say we just give everybody this.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

But when it comes to vaginal estrogen, you know, we're. And this is how I like to think about medicine. Medicine in America.

[Podcast Host (You Are Not Broken)]

Right now.

[Dr. Kelly Casperson]

Come to me when you have a problem. Right, right. Like, what if I don't want to get clitoral atrophy? What if I don't want to wait for my orgasms to be a problem? What if I don't want to wait for burning, itching, dryness, your current UTIs. Right, right. Like, so to me, I'm like, I think if, if there's a preventative role of any hormone, it's really the local vaginal estrogen. I tell you, I'm not going to wait around to have a problem down there.

[Amanda Louder]

No.

[Dr. Kelly Casperson]

Is most of it reversible? Yes. But clitoral atrophy can be. Not only does it, it can cause pain. Right. But it can also diminished orgasm, diminished pleasure really can affect your relationship not only with yourself, but with your partner. And sometimes we do have to do a minor surgical procedure if you've got clitoral fibosis, which is where the skin over the clitoris becomes adherent and kind of COVID the clitoral head in order to get those tissues kind of exposed and healthy again. And I wish you, I wish I could tell you that happens in 75 year olds, but, you know, I just helped out a 52 year old with complete clitoral phymosis.

[Amanda Louder]

Yeah, yeah. Well, I, I reached out to you a few months ago with a follower of mine that had, she's my same age and she has had significant clitoral atrophy and she was devastated by it and who she could go to in her area. And you gave me a few names to pass on to her. I mean, she's 44, 45. Like it's happening in all different ages. It's not just happening when you're 75. So.

[Dr. Kelly Casperson]

Yeah, yeah. And, and I mean, shout out to my friend, Dr. Rachel Rubin, who's sex med in Washington, D.C. yes. Who's really starting to publish the papers on clitoral atrophy and, you know, license of clitoral adhesions, because it's not much in the medical literature. Right. I would argue that most physicians don't know how to examine a vulva, which just, if anybody doesn't know what that is. It's the external structures. Vagina is the tube that the tampon and the babies are in. The vulva is all the outside stuff.

[Amanda Louder]

Yes.

[Dr. Kelly Casperson]

Good, good.

[Amanda Louder]

So I recently saw a reel that you did from the sexual health conference in New York City where you said that bioidentical hormones is a marketing scheme. Tell me about that.

[Dr. Kelly Casperson]

Yeah, Mike. Dr. Talk about breaking the Internet on, like, things you wouldn't break the Internet on.

[Amanda Louder]

Right? Yeah.

[Dr. Kelly Casperson]

Yeah. So this is what happened. Like, it's really good for people to under. That's why I love podcasts. You can actually, like, explain yourself. Explain, you know, 82 seconds long because of the WHI. We said can. We said hormones are scary. And remember, those were the synthetic hormones that we used.

[Amanda Louder]

Right? Yeah.

[Dr. Kelly Casperson]

Which we don't even use anymore. But we said they were scary. We took all the hormones away. No, the. None of the doctors were prescribed anything and women were suffering. Suffering. So how did the people help the women who needed some help? They said, don't worry, come over here. I've got safer stuff. It's called bioidentical, by the way. Also, give me thousands of dollars for, you know, the pellets or the compounds or the blah, blah, blah. Because it's not the pharmaceutical industry, so it's safer. And I get it. I get it all. We were afraid women needed help. Help. This was the way to make everybody feel safe. But we haven't again, updated the hardware of, like, insurance covers. What. What's bioidentical mean? Bioidentical means it's the exact same stuff as your body makes now. It's made in a lab, in a pharmaceutical place, whether that's a compounding pharmacy or, you know, Abbott Pharmaceuticals. Like, it's not. People have this like, idyllic. Like, we take the yam from the organic garden and then we mash up the yam and then it's a plant based hormone. It's like you guys in your organic farming, like, no, this is pharmaceuticals on a massive grade. We don't have enough yams. Right. Like, it's. These are chemical compounds, but they're the exact same as what you make. Just like insulin is and thyroid is. Right. Okay, so. So going back to all of that, but bioidentical means exact is what your body makes. So if I test your blood and then I give you some bioidentical Hormones. And I test your blood. I can, I can test your blood will show that you put those in there because I can measure them because they're the same as what your body makes. That's all it means.

[Amanda Louder]

Okay, good to know.

[Dr. Kelly Casperson]

But people use it as a marketing term.

[Amanda Louder]

Right.

[Dr. Kelly Casperson]

And the thing, you know, I liked, which was on this reel of like, if I take two candy bars and I put natural on one of those candy bars, I can charge more money for that because it's a marketing tool and people somehow think that that's better.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

But it doesn't actually mean anything because natural doesn't mean anything in the food industry.

[Amanda Louder]

Right.

[Dr. Kelly Casperson]

It's literally just this word.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

And so that's what bioidentical is because it's like you can go to your traditional doctor and get insurance approved. Bioidentical hormones, because we use estradiol, by and large, hormones now are estradiol and micronized progesterone. By and large there are, you know, you can, we can get niche with it. But estradiol and micronized progesterone are bioidentical and they are cheap. Cheap, cheap, cheap, cheap. But the doctors, like, the average person isn't going around being like biodentic because we know it's a made up word. Like. Yeah, that's what everybody uses. Everybody uses bioidentical hormones. You're just paying more for your bioidentical hormones because you've been hoodwinked into thinking it's better.

[Amanda Louder]

Yeah. When it's actually what we're doing and not synthetic like it used to be.

[Dr. Kelly Casperson]

Nothing's. Yeah, no, you know what's synthetic? Like birth control is synthetic.

[Amanda Louder]

Yeah. Yeah.

[Dr. Kelly Casperson]

Right. How many people are on birth control? And I'm not dissing birth control. Birth control has literally changed the world.

[Amanda Louder]

Yes, it has.

[Dr. Kelly Casperson]

But, but we're also, we're also, you know, nose uppity about this when it comes to hormone replacement therapy. And we don't think twice about being on birth control for the most part because there's risks and there's benefits. But yeah, I mean, that's my whole thing is like, you guys, it's, it's safe, it's cheap.

[Amanda Louder]

Yeah. So do you think as women we need to go on like all the hormones? I mean, the estradiol, estrogen, progesterone and testosterone? Because I know a lot of women are going on just testosterone or a lot of women are scared to go on testosterone because they're afraid of side effects.

[Dr. Kelly Casperson]

Yep. Yeah. I mean, again, it's so hard to give a blanket statement.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

You know, and in all fairness to me or any expert who waffles on this answer is like, the true expert knows this is not a one size fits all. But what I can tell you is female bodies make estrogen, testosterone, and progesterone. They're all important, you might notice, benefit from some one or all of them. And this is really where, I mean, again, why healthcare is hurting us is like one 15 minute appointment a year is insufficient. Especially in perimenopause. When you're like, well, last fall I couldn't sleep, but now in March, I just feel exhausted and like a little, you know, sad and like, I'm not making gains in the gym. Right. Like, maybe we needed more progesterone in the fall. Now we need more testosterone because again, in perimenopause, things are changing, changing constantly.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

My wish on all of this is for women just to not be afraid. For women to understand you can try things and change things and for women to understand, we are not cookie cutters. What works well for your cousin and your friend down the street might not work well for you. And that's okay. I think so many women are just looking for the best. Like, how many Instagram things? Like, what's the best? What's the best? It's like, that's the wrong question. The question is, what, what should you try?

[Amanda Louder]

Yeah, what's the best for you is different for you.

[Dr. Kelly Casperson]

Yes. And until you try it, you're not going to know. And there's so many different doses and there's so many different routes of administration. And I'm not saying this to be complex. I'm saying this to get people to understand. Like, you don't know what your zone of genius is until you try something and you, you know, know, fiddle around with it.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

But then by and large, most of my women, they get on a plan, they're happy with it. They, they, they're like, no, I'm good. I don't want to adjust anything. And then you're fine. You know, it's just figuring out what, what you need. But if anybody says you just need a pellet or you just need these, if any, a big red flag is like truly oversimplifying this. Like, this is just what everybody needs. No, no, no. That's not how it works.

[Amanda Louder]

Well, and I've heard you talk about pellets and kind of anti pellet. Does that, does that sound correct? Maybe I'm just reading things into it.

[Dr. Kelly Casperson]

Yeah, I mean, the More and more I learn, and again, here I am being nuanced. Right. But it's like there are some women who I think do very well at a higher physiologic dose of testosterone, right. Which classic pellet you get. Estrogen pells you can get, but classically it's a testosterone pellet pellet. And these women, their blood levels are 200 to 300 on these pellets, which is like a low male value. Again, normally women have about one tenth the amount of testosterone that a man does. Yeah. So what I see with pellets is that women go for, I use the analogy of like, you're living at sea level. If I, if you live at sea level and I take you in a helicopter and I fly you up to Mount Everest, like, you're gonna pass out. Like, it's not comfortable for you at all. Yeah, that's where I see a lot of pellets. You movement are like, got pellets and. Oh my God. Right? And it's like, yeah, it was too much, too feather. Like my hair fell out. I'm like, yeah, you got out of a helicopter at Mount Everest. Like, it hurts everybody. Right? But some people like living it, you know, in Denver, right. It's like if you got to figure out what elevation is right for you, I think Pelosi pellets are good for some people. But even a lot of the pellet pros will say get there slowly. Right? Like, go live at Denver for a little bit before you decide Nepal's the right elevation for you. Right? Yeah, get there, get there slow. But again, it's hard to do in a 15 minute appointment once a year. It really does require a little bit more. But yeah, I mean, I think the other reason, and this isn't so much anti pellet, but it's like if anybody says there's just a one size fits all to everything, we shouldn't wonder why so many women give up on hormones.

[Amanda Louder]

Yeah, I know that you've talked about a little bit that estrogen actually plays a huge part in libido, so we tend to focus on testosterone. Like, if you're. If your libido is low, take some testosterone and that might help. Right. But estrogen plays a part in that as well. And, and from what I've heard you say, like, it's playing a bigger part than we. We thought it did.

[Dr. Kelly Casperson]

Yeah, yeah, 100%. I'm gonna, I'm gonna use a male study just as a, just, it's just a fascinating study and I think it really? It helps us understand how important estrogen is in libido. First of all, libido's complex, not everybody's libido is just a low hormone. It's relationship issues. It's. It's your body. You know, bio, psychological, social.

[Amanda Louder]

Yep.

[Amanda Louder (Podcast Intro/Outro Voice)]

Yes.

[Dr. Kelly Casperson]

Biopsychosocial. Are you sleeping? Do you have a kid that keeps you up all night? You know, like, libido is basically a canary in the coal mine of how your life is, by and large. But sometimes it's quite responsive to hormones. Right, so now. So now we'll talk about that. But, yeah, so there's this crazy study, and they took healthy younger men. They. They blocked their hormones by chemical with a medication. Blocked their hormones. They gave them back testosterone, but they blocked the conversion to estrogen. So testosterone makes estrogen.

[Amanda Louder]

Right.

[Dr. Kelly Casperson]

So we've got men with. They put back their testosterone, but they blocked their ability to make estrogen. These men had low sex desire, low sex drive, normal testosterone, going low desire, low libido because the estrogen was missing. I mean, so that's like a fascinating. First of all, what man would have signed up for that study? I don't. I don't know, but it just tells you, like, estrogen's important for all libidos, right?

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Even a. A little bit of estrogen in the men affected their libido. And so many women, I'll start them on estrogen and they'll come back and they'll be like, yep, I'm good. Like, this is great. Not even sure my partner wants me to have this much. Like, this is a different part of our relationship now. Yeah. And another thing that estrogen does, even if it's not directly affecting libido, is if you have hot flashes, if you have night sweats, if your body's changing and you're not happy with it, you know, body image issues, whatever. If you've got hormone changes that estrogen helps those things, then your libido can naturally come back because you're just feeling better.

[Amanda Louder]

Feeling better. That makes such a difference.

[Dr. Kelly Casperson]

The two, the two big. They looked at why. Why are women. If women stop having sex after menopause, what are the reasons for this? Right? And the two biggest reasons were availability of partner, which I always joke, I can't help you with that one. And then number two is vasomotor symptoms of menopause. Hot flashes, night sweats, anxiety, depression. Estrogen fixes those things. Oh. By and large, my libido came back. Right. So I think estrogen works in two ways. Number one, just fixing all the things that make you feel crummy. And then number two, for some people, there is a direct libido effect to it.

[Amanda Louder]

Awesome. Love hearing that. Talk to me a little bit about dhea.

[Dr. Kelly Casperson]

So DHEA is a pre. They call it a precursor hormone. It basically can make itself. It can turn into testosterone and estrogen. In America, DHEA is a supplement. What that means is you can buy it at Target, at, you know, any sort of supplement store, online, Amazon. You do not need a prescription for it. In other countries, it requires a prescription. All these countries and their hormone rules are all crazy and made up. By the way, testosterone's over the counter in Mexico. You can buy it at the airport.

[Amanda Louder]

Okay, good to know.

[Dr. Kelly Casperson]

Next time I go to Mexico, do that. I'm just telling you, all of our rules are made up and they're all different across the world. World, Right. Australia has a female testosterone dose. No other country in the world does. Right. So, like, everything's made up and it's crazy. But so in, in America, you do not need a prescription. The problem with the supplement industry in the United States of America, in case people don't know this, is it is unregulated. That means what's in the bottle might not match what's on the label. And this happens at least 30% of the time whenever you look at a study that said, hey, we saw what was on the label and we actually checked to see if that was in the bot. Most of the time it's not. So we've got a big trust issue.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Do you trust that this is actually what they say it is? Placebo effect is real, especially in sexual health. Yeah, but we know placebo. The placebo effect is real in regards to hot flashes. Give some people a placebo, their hot flashes get better. Right. The brain's amazingly interesting. So does DHEA work for some people it will. It can raise the estrogen and testosterone a little bit. I don't think you're going to get crazy high doses. You know, you're. I don't think you're going to be able to get male doses by taking oral dhea. So by and large, I say it's pretty darn safe and it'll probably help a little bit. It might not help, but I'm not a big. Like, you have to be on DHEA or don't be on dhea, but if you want to look at, like, who's it probably going to be most useful for? Probably perimenopause, because you still have the ability, you know, you still got ovary function, you got some hormones in there, you probably have ability to convert it a little bit more.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Than say a 70 year old who hasn't seen any hormones in a very long time.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

But I don't have good studies to show you on that.

[Amanda Louder]

Someone asked me about DHEA suppositories.

[Dr. Kelly Casperson]

Yeah. So DHEA in the vagina. There is actually a. A FDA approved pharmaceutical product. So again, now this is not over the counter. Okay. It's called Intra Rosa or Preston 6.5mg if I'm recalling correctly off the top of my head. It is an amazing product. We love it. And what it does is in the vagina, it will convert to estrogen and testosterone. The vulva and the vagina have androgen receptors. Testosterone is incredibly important for the function of the vulva and the vagina as well. So sometimes, especially if they're like, man, I'm really good with the estrogen. It's just, I'm still having atrophy. I still have all these issues. You can do a DHEA and get that androgen component kicking in and it just, it just is amazing sometimes what can happen down there. The problem with it being a pharmaceutical is it's expensive because it's brand new.

[Amanda Louder]

Okay.

[Dr. Kelly Casperson]

Now I. The things you break the Internet about. Right. Because I had it a world expert on my podcast and he's like, dude, just take an oral over the counter DHEA tab and put it in your vagina. Now, we don't have a lot of studies on that. Okay. Probably quite safe because if you think of something that's, you know, over the counter to swallow, Giant is not even swallowing.

[Amanda Louder]

Yeah. Right.

[Dr. Kelly Casperson]

So probably pretty safe. Definitely off label. I'm here to make people think.

[Amanda Louder]

Yeah. Yeah. I love it.

[Dr. Kelly Casperson]

I don't think it'll hurt you. I don't think it will kill you. Do I do it?

[Podcast Host (You Are Not Broken)]

No.

[Dr. Kelly Casperson]

For the aforementioned thing of. I have a strong suspicion of supplement industry anyways. Just because I know it's. I can't trust what's in the packaging. That truly is the power of an FDA approved prescription product is what it says it is. It is. And I think a lot of people don't know that about the supplement industry.

[Amanda Louder]

Yeah. Well, this has been so good. Thank you so much. Dr. Kelly, is there anything else you feel like we should talk about or mention before we end today?

[Dr. Kelly Casperson]

I think the role of communic communication. Communication with partners. Specifically. Specifically if you're partnered with somebody who doesn't go through menopause or perimenopause. Right, right.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

Of like, women didn't get an education on this. So by and large you can assume that the men got less.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

And what you're going through is real. What you're going through is valid. We don't know how to help everybody. But if you don't communicate that well, you're going to, you know, you're probably going to see a lot less compassion, more kind of like just deal with it. Right. Like, listen, if your partner's testicles shriveled up and went away by 51, would you want to know about that so you could help and be as supportive as you possibly could? Yeah.

[Amanda Louder]

Yeah.

[Dr. Kelly Casperson]

And that's inevitably what's happening to our ovaries. You just can't see our ovaries. So it's harder to know that it's, you know, air quote real. But it's very real and helps available. But I think people who communicate about this and kind of say, you know,

[Podcast Host (You Are Not Broken)]

what do you need?

[Dr. Kelly Casperson]

What do you need today? What's going on? How did it go when you went to your doctor and asked about this? That, you know, how do you want to age all of these things of like, that's going to be a better bond than people kind of not talking, being distant and feeling not connected over, over this part of life.

[Amanda Louder]

Yeah. I think that communication is so, so important. I feel like it's not talked about enough with women when, with perimenopause and menopause, let alone with our, you know, partners. And I feel like men don't talk a lot about when they have issues with erections and different things, like they don't want to and they don't communicate with their spouse. And then the spouse is going, why is our sex life like stopping? They don't understand. So there's total, you know, it goes back and forth between two, both of them, they're not communicating. And so that communication piece is definitely so, so important.

[Dr. Kelly Casperson]

Yeah. 100. I just interviewed this sex coach for my, for my podcast and she said assumptions are the termites of any long term relationship.

[Amanda Louder]

I love that.

[Dr. Kelly Casperson]

Christine d' Angelo's room. I'll give her, give the credit that quote. But it's like if you don't know why your husband's not sleeping with you anymore and it's be, let's say it's because of erectile dysfunction. Literally, women are going to be like, he's cheating. He thinks I'm unattractive. Like, all of your assumptions are freaking the worst case scenarios to you? Yeah.

[Amanda Louder]

Yes.

[Dr. Kelly Casperson]

Instead of like, dude, he's doesn't have confidence, he's like questioning what the definition of manhood is like.

[Amanda Louder]

Yes.

[Dr. Kelly Casperson]

He's got, you know, big stuff he's wrestling with and none of it is. He wants this to end and he's not attracted to you. And so. Yeah, communication can go so far.

[Amanda Louder]

Yes. Well, I feel like I need to have you back to talk about men's sexual health because I think you're the expert in that too, so.

[Dr. Kelly Casperson]

Yeah, no, I'm happy to. It's. They. Everybody needs to know about that too.

[Amanda Louder]

Absolutely. Thank you so much for being here.

[Dr. Kelly Casperson]

Yeah, thanks for having me.

[Amanda Louder]

Okay. Wasn't that amazing? So, so good. Was your mind just blown over and over and over? I think so much of this is just stuff we don't talk about and stuff we don't even talk about with our doctors and our doctors don't talk about with us. And so it's so, so important that we get this information and we learn this information and we share it with our peers. So if this was helpful for you, please share it with other women in your life. We all need this information. The good that she will be coming back to talk about men's sexual health. I'm really excited to bring that interview with you. That will be in a little while because she's kind of booked for a while, but we're going to talk about men's sexual health and erections and when men age out of erections and different things that affect men's sexual health. So if you have questions for her about men's sexual health, please send me an email AmandaAndOuder.com or send me a DM DM on Instagram with your questions so that I can make sure and get those answered in my next interview with her. Because she is just a wealth of information and I'm so, so grateful that she has been willing to come on and share that information with my audience. So thank you so, so much for being here and we'll see you next time. Bye. Bye. If you want to learn how to

[Amanda Louder (Podcast Intro/Outro Voice)]

apply what I teach you on this podcast, I want to invite you to work with me in my embrace you coaching programs. In my coaching programs, I teach you all of the skills and tools you need to have a better relationship with yourself, your spouse, and your sexuality. You also get weekly coaching to help you apply what you are learning in your own relationship. For more information, go to Amanda Louder.com and click get help in the menu to see my programs for both men and women. Like what you're hearing on this podcast. Make sure you hit subscribe so you don't miss a single episode. Don't forget to leave me review and share it with your friends.

[Dr. Kelly Casperson]

Thank you for listening to this week's

[Dr. Kelly Casperson (Outro Voice)]

episode of you Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types and how to talk to your doctor about sexual health concerns. Concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the Master Class class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor but not your doctor in this format and all of my platforms and guests including on this podcast are not giving individual medical advice or practicing medicine. See in Consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember you are not broken.