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- [00:01]
A
Hey everybody, welcome back to the you are not broken podcast. Today is an awesome episode. But before we get started, I want to let you know that my book, you are not Stop shooting all over your sex Life is being republished September 10th. It's currently available for pre order on Barnes and Noble and Amazon. And if you're an organization, you can get bulk orders are available. Porchlight Books is one website to go for bulk orders for this. So check it out. It's going to reach a bigger audience. It's going international this time. It did so well that I'm just honored that I got to republish it with a bigger platform and get it out to you guys. So if you pre order as a thank you to that or if you've already pre ordered and you have your receipt number, which you can just go on Amazon and look at your orders to get it, pretty soon you can go onto the website and put in your receipt order to show proof that you pre ordered it. And then I'm gonna do two live webinars, one in July and one in August where all my pre order people can come hang out for me with me probably for like an hour on a zoom and talk about intimacy, menopause, coaching, sex life, sex ed, all of the above. Get your questions answered and hopefully just have a really good time getting excited about this book coming out. In addition, I'm going to be doing two nights for the book launch in September in Chicago that corresponds with the Menopause Society's meeting. That's going to be roughly the September like 11th through the 14th timeline. And then we'll be headed to New York City to do some promotion for that afterwards. Kind of like the September 14th through 18th. I'll be in New York City. So stay tuned. Follow me on Instagram for all of the lives on on where I'm going to be in Chicago and New York. I'm flirting. I'm heavily flirting. I'm heavily petting with LA after New York, but sometimes I just need to, I need to mellow out. So we'll see if LA happens after New York City or if I'm just going to go home and lay on the couch. So this is a cool episode that is. So check out me interviewing Dr. Maria Yolok on episode 266 where we talk about health tech. It's a great episode. It's not that far back and Revolutionizing Vulva Care where I interviewed Dr. Yoloko on that and then she interviewed me for her podcast and that's what this episode is she's kind enough to give me the audio so I can share it with you. It's actually a. I don't know if vulnerable is the right word, but it's like this is getting into, like, the soul of why I do what I do. I. It's decently vulnerable account of why I picked urology. And I talk a lot about medical gaslighting. I talk about the advocacy that women really have to do for themselves because medicine, we'll just say, hasn't quite caught up to helping women out. So Dr. Yoloko's podcast, again, for anybody who wants to check it out, is called Salvaging Sex. That's a newer podcast out there talking all about sex ed, sex advocacy, health advocacy, and the sexual health world. And I hope you'll help support her by checking that out too. All right, without further ado, welcome to the you are not broken podcast. Welcome to the you are not broken podcast. 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.
- [03:30]
B
Hello and welcome to Salvaging Sex. Today's guest, I'm so happy and so honored to have her here. It's Dr. Kelly Hasperson.
- [03:38]
A
Thanks for having me.
- [03:40]
B
Oh, my gosh. So excited to have you. Okay, so, Kelly, tell us what, Where, Wait, tell us. Let's start from the beginning. Tell us about your background. Where are you born? Where did you grow up? When did you decide to become a urologist? And how did you even find that track?
- [03:59]
A
Yeah, so I grew up on the shores of Lake Superior, Duluth, Minnesota, oldest of three. And I was, I was always the smart kid. I loved reading, like, I loved thinking about stuff. And I remember I was sitting in my car, in my mom's car, I think, in high school. And I was thinking, I was talking about, like, dabbling, kind of being in. No physicians in the family. Right. And she's like, if you want to do that, you decide. You decide you want to do that and then you commit to it. It was something like that.
- [04:30]
B
Yeah.
- [04:30]
A
And. And I was like, o, okay, that's how you become a doctor then. Right? And so, so that's what I did. Amazing mentor at the University of Minnesota. And I met with him and his name's going to come to me. And he was a urologist. And I was like, I'm kind of thinking of like, ER OB or urology. Right. I kind of like ran through it with him and I was like, the miracle of delivering babies. But two in the morning and then the er, like working at a level one trauma center. How much awesome dopamine is that? But there's usually one in every state. And then you're dealing with like, sinus infections and domestic abuse and, and only you can only see the path backwards, right. Of like, fast forward. I became a urologist. I've been doing it for a while and I. Now I understand urology protected my soul, right?
- [05:22]
B
Yeah.
- [05:22]
A
Like, to be able to stay in medicine because the OB and seeing, you know, seeing the, the trauma, the stories, the child abuse, the, the issues that create babies, right? Like the drug babies born. Like, my soul, it would not have stayed protected. And same with the emergency department, right? Like society's ills day in and day out. And so now, now I understand urology to be like, I needed my soul protected. I would have burnt out and quit medicine a lot earlier. Because people don't know this. Doctors are not taught how to process trauma. We are not taught how to take care of ourselves. Like, we are thrust into a system of, you be the savior and you can't save everything and you're not given any resources to deal with you not being able to save, which you thought you were going to be able to do. Right? And so, like, there's so much, you know, trauma in becoming a physician. And I think urology really protected me so that I could stay, stay in this game to where I am now.
- [06:31]
B
Yeah.
- [06:32]
A
So fast forward that. Loved, loved training, loved urology. I love the instant gratification of it. Like, because you showed up today. So, like, this kidney stone's gone, the cancer is cured, and now you have your bladder strained, right? Like, tons of instant gratification was sexy as hell. And then I was seven years in private practice and I was bored, like, monotonous, recurrent uti. What the hell am I doing with my. I went through all of this training to just tell people to drink more water, pee more frequently, and use vaginal estrogen. Right? Like, what am I doing with my life? And, and it'll just, it'll just keep coming until you decide to retire. Right? And I had a, I had a attending in residency who had all the residents over one night. And he said two things. Number one, your most expensive investment is your. Is your relationship and your marriage. So choose wisely and, and work on it.
- [07:28]
B
Right?
- [07:29]
A
And his second piece of advice was, watch out for the seven year itch. And he's like, whether it's your job or your relationship at seven years, shit happens, right? Yeah. You get bored, you Get. It gets mundane. You get like, you get destruct, whatever happens. And I was like, oh, my God, I'm seven years in. This is the seven year itch, right? And I, like, I. I had. I knew it. I was kind of primed for it. And like, at that moment, the universe was like, you're ready. And I, you know, I truly think the teacher shows up when the student's ready, you know? And I had this patient that I had treated for bladder cancer, cured her invasive bladder cancer back in the beginning of the. Of the world when I was doing cystectomies in private practice. And she came in and she was crying, and it was about her sexless marriage. And the unique thing about that, besides it being seven years, was that I was very bonded with her. This wasn't some stranger who. I was like, what's her problem and why is this important? Right? Like, I was very bonded with this person, and I was like, handing her the box of Kleenex, and I'm like, I don't know how to help. Like, that was the moment where I was like, does anybody know how to help people with sexual health? Because I was told in residency, number one, do a fellowship so you don't have to deal with women. But I was also told, you know, women are complicated. They're difficult, they're challenging. I was told, we will never figure out women's sexual health. This is. This is to like, this is what I was told in residency. Like, you know the kings of Viagra, right?
- [09:03]
B
Yeah.
- [09:03]
A
In urology. And so I was like, at that moment, I was like, is it true that we don't know?
- [09:09]
B
Yeah.
- [09:10]
A
That's when I started reading all the books, went to my first Ishwish lecture conference, and was like, the gynecologist I went to med school with was there. And I was like, I'm like, what are you doing here? And she's like, we didn't learn this either. And I was like, oh, so the gynecologists don't know how to help women with this either. Got it. Read all the books. And I had this voice inside of my head, and this voice was like, you need to talk. And this voice was annoying. Like, somebody's talking to you voice. Annoying, right. And I love podcasts. And I was like, but I don't know enough. I had learned by then that there was one fellowship for female sexual med, and I didn't even know it existed and didn't do that, do that fellowship. So I'm like, I didn't do A fellowship. So I'm not qualified enough. And I was waiting for permission, and I had a couple of people in my head that I thought were the people who would call me and give me permission. Was getting out of the shower one day and, you know, lightning struck again and was like, the permission you need is your own.
- [10:11]
B
Oh, yes, I know, I know.
- [10:14]
A
It's such a good start. And so. So I started the podcast four years and four months ago. It's like, top 10 in medicine, top 50 in alpha health and fitness. Now, like, and through the podcast. Oh, by the way, the voice goes away when you do what it wants because it's actually your future self calling you forward. For anybody who has the Voice and doesn't know who it is, that's your future self. So she got quiet and started getting into hormones then, because people are like, well, you know, so I wrote the book, started the podcast, and then women are like, but you know what happens with menopause? You know what happens to your sex life with menopause? And I'm like, no. Like, I'm staring down the barrel at it. I'm in my mid-40s. What's going to happen? Right? And they're like, well, estrogen kills people and it causes cancer, and then your sex life goes to shit and blah, blah, blah. And then it was same thing. Is it. Is that true? Right. So started doing the research, and I'm like, oh, my God. People are scared of, like, the oral medroxy progesterone, where the placebo arm was flawed from the WHI in 2002, and we moved zero forward.
- [11:20]
B
Yeah.
- [11:21]
A
And so that the podcast really started talking a lot more about midlife hormones, menopause, why are we scared? And then it's the incredible of, like, you mean we've got cheap and effective medications with decades of safety data that nobody uses, and it decreases mortality. Like, the pharmacologic holy grail is something that decreases mortality. Statins don't even do that for women. Baby aspirin doesn't do that.
- [11:53]
B
Yes.
- [11:53]
A
High blood pressure meds don't do that.
- [11:56]
B
Yes.
- [11:58]
A
We've got hormones. And so really, like I sit now in the Venn diagram of sex med hormones and then testosterone, specifically testosterone for women, because that's, to me, I'm like, why? Testosterone makes estrogen. It's actually wrong that ovaries make estrogen. Ovaries make testosterone, which makes estrogen. Right. So that's been very fun. That's my. That's my current favorite thing is females and testosterone. Because libido is a mood, by the way. So if testosterone improves libido, AKA changes your mood, how come you say it doesn't work on your brain? Yeah, testosterone is fascinating to me. Absolutely fascinating. Social, culturally, for all the different reasons. Oh, and I did a TED talk in the middle of that about adults not having any sex ed and why that's like wrecking our relationships there. Boom. Hope that wasn't too long.
- [13:01]
B
So many things from that. Holy. I loved everything you said. Let's see. I took some notes and so I'm gonna. There's just so many things I want to circle back to is I totally resonate with urology. Saved my sou. I. I feel like I was still, like, disillusioned by the system always. I always just have been, but I think I was. I did not realize how much of a privilege it was to be a urologist, to have resources, funding, have a training model that not only thinks about disease states, but also quality of life after said disease treatment, have access to research and industry and this kind of idea of, well, if we don't know, let's do a trial and figure it out, you know, like this instead of just like, oh, this is how it's always been done. And there's still definitely, like dogma and tradition in urology, but it was always kind of a little bit more of a spirit of innovation. And I think that training model is really what helped you to see how things are once you started doing women's health. Once you were like, wait a second, why, why did, why did it, why actually is it like this? You know, because I, you. We are so hyper focused on specifically the quality of life of men and how easy it is and how evidence based it is, and, you know, how we have insurance and, and coverage and all these things. And then you get over to the women's health side of things and looking at the quality of life, and it's just not even addressed. It's not even addressed. And then the patients are then blamed and said they're difficult when all they're asking for is a quality of life. Their difficulty is really our ignorance of the medical system. And we were not. I was not privy to this until I did Goldstein's fellowship. And I think I called this training, learning about female sexual health, learning about menopause, a superpower, because it makes you just a better, well rounded clinician and physician and, and, and carer. And I just love that you then took that knowledge, listen to that voice in the back of your head, kind of voldemort type, like, persistent for sure. And then said, I'm going to speak up on this. I'm going to start speaking up and seeking out and educating the masses. And I also love what you said about waiting for permission. I think so many people are scared to speak up, are scared to do big, brave things because we're always waiting for someone to say it's okay. And you said this. I'm giving myself permission. And look at where you're at today, right? Like, just, just night and day, like one of the leaders in this space when it comes to speaking on and speaking up about menopause and sexual health and how it interacts and intersects. Like, that is just so, so, so, so, so, so amazing.
- [16:23]
A
Yeah, I. I mean, I actually, I started out MD, PhD. Like, I was that nerdy, right? And then I was like, oh, my God, I hate microscopes. I hate grant writing. Like, this is not. And I, like, really want to get out and help people, right? So it was like, not okay. And, you know, I think in the medical system, academic, you know, world we grew up in, research was put on a pedestal, right? And you'll still hear this. We need more research. We need more research. You know, Dr. Biden, right now, we need more research. And to me, in this role of, of medical translator, right? Like, my superpower is explaining complex things simply so people understand. And I'm like, we need more translation. We need the doctors that practice in this country to know the research. That JAMA article that came out like, last year saying it takes 17 years for, like, solid, good data to actually trickle down to the people. I'm like, my women can't wait another 17 years for more data. We need start using what we have now. And really, that role of translator, which was never talked about in our training paradigm of like, you do the research and that's how you help people. It's like your research will stay behind a paywall, honey.
- [17:40]
B
Yes.
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A
Unless there are people that will then take it out and say, why aren't we doing this? Why aren't we doing this?
- [17:48]
B
Yeah.
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A
So to me, like, I'm full on you know, come into. Of like, there still hardly exists the job of the translator. But I see that now. That's my job with the podcast and the books and the TED Talk is like, to tr. We've got some data, we're good. We're gonna die waiting for more, and it's going to be behind a paywall anyways, unless you have people who will speak it.
- [18:12]
B
Yeah, that is. That was always Something I found so interesting. We'd have journal clubs, you know, every month or so and we look at the newest article and blah, blah, blah, talk about it. And then I was like, guys, did we write this for us or did we write this for the patients? Like, these are, these are things for the patients. Why aren't we talking about science communication and how important it is to then, like, I, I'm a big believer that research is advocacy. And, and, and if we are not then doing the work to then tell people about the research that was already done or has been done, like, we're failing. We're failing the population and leaving them kind of prime for these like, charlatans, for these, like, snake charmers, for these, like, misinformation. If we're just staying in our ivory tower in our little ecosystem, having our journal clubs and then not dispelling this information to the people that are going to be affected or treated or their clinical care could potentially be changed or helped by this information. Like, what are we doing? Why are we.
- [19:27]
A
Yeah, I mean, like on a boots on the ground. Is that's your taxpayer dollars funding that research?
- [19:34]
B
Oh, yes.
- [19:35]
A
What is it doing behind a paywall?
- [19:37]
B
Yes, yes, yes, yes, yes. And then we have a critical mass of like, you know, 2020, where people are like, well, I don't trust the physicians because they're not the people. They've been talking to me this entire time. I trust this guy in his mom's basement who is telling me to do this. And like, he, I formed a relationship with him, period. Like, I'm going to trust them over the physicians that have ignored me for all this time.
- [20:05]
A
Yeah, I think a really good current example of this is the. Is birth control. And because what I'm seeing is a lot of people trusting these people who don't have your best interest, or maybe there's a political interest or whatever else, but they're telling you, don't be on your birth control because of X, Y and Z. And then the doctors are like, that's not true, or blah, blah, blah. And I'm like, but the distrust. Doctors never told women there was any side effects to this stuff.
- [20:34]
B
That's the tea. Oh my God, I could talk about this all day. It's like birth. The birth control conversation is such a nuanced one. It does a lot of good. And also it has side effects. And when those side effects happen for my listeners, medically, it can potentially cause painful sex, feelings of recurrent UTIs, dysuria, pain with urination, depression, depression like, it can cause recurrent yeast infections because it changes your hormones and your body is very dependent on hormones. And so when you're getting a prescription for oral birth control or any of these birth controls, oral has the most side effects. It's, it should be a shared decision making of, hey, these are, this is why we're doing this. And this is the potential complications that those conversations aren't happening. And then when the patient comes back with pelvic pain now, or recurrent UTIs or recurrent vaginal infections or all these other symptoms, we're then gaslighting them and saying, now that's weird, and then going on their way. I equate what is happening with birth control and the side effects that are happening with birth control to like, being started on a blood thinner like warfarin, which, you know, that blood thinners help to. For our listeners that are non medical, if you have a blood clot, it helps to thin your blood to like, essentially help to disintegrate that, that clot and also to prevent things like strokes, heart attack, all the things that the clot could potentially cause. So that means if your blood is thin, you're going to bleed more. So what's happening with a lot of my, the people on birth control is the set. It's a quote, equivalent to being on warfarin, getting a cut and then going to the emergency room because you can't stop bleeding. And then everyone at the emergency room is like, that's so weird that you're bleeding so much. I don't know what's wrong with you. Maybe you should drink some wine and you hate your partner. Like, it's like, that is what I equate. Like, there's no way that anyone would get a prescription for warfarin without you're going to bleed. Bleeding is a complication. Bleeding, bleeding, bleeding. Why aren't we having that same discussion around, you know, the potential side effects of birth control? Because I think if we were actually having real conversations about it, people would still probably take it because it's what we have so far.
- [23:05]
A
Birth control is amazing. It's changed. It's changed the world.
- [23:08]
B
Exactly.
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A
But when you play with hormones, there are side effects.
- [23:12]
B
Yes.
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A
And, and because physicians don't tell women about the side effects, I think they're more liable to, like, listen to the people who are telling them how bad it is because they're like, you know, it's, it's an honor to care for people. These conversations are long. The doctor patient relationship is sacred, and it's being eroded. You can't, you can't have these pros and con conversations in a 10 minute visit.
- [23:36]
B
No, no. And that is, that is such a, like how. I mean, and this is not a question that I anticipate that you just fixed it, but like how do we reimagine a world? How do we maintain good quality health care with health systems that are promoting bad care? Right? Like how do we as physicians even, even address that? You know, and how, how, what are, what is, what's been your experience with this and what has been like some, some, some of your thoughts on it?
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A
I mean I joke around. I'm like, I worked really hard to be really lazy in clinic now, but it's because like I wrote a book, I have a YouTube channel, I have 261 podcast episodes. Right? So like to me I'm like, listen, I put it out there. Maybe you didn't know that before you came to see me in clinic, but now you know, it go out get the. Because the educated patient, what do you, whatever you want to call it, educated human patient, consumer person of the world, the more educated you are. And I'm not telling everybody to go to medical school, but if you don't know where your, what a urethra is, if you don't know what a vulva is, you cannot have the in depth conversation that you think you want with your doctor. Right?
- [24:57]
B
Yeah.
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A
If you come in, you already know the FDA approved medications for low desire in women. You come in and you already know that transdermal estrogen does not increase your risk of breast cancer. You come in and you're already educated, which is info you're going to get from listening to my podcast.
- [25:11]
B
Right.
- [25:12]
A
You the of the level of conversation that you can have is elevated beyond compare.
- [25:19]
B
Yes, yes, yes, yes. I just stroll so strongly believe in that and hence why I'm creating a whole company around this idea of an educated patient as a powerful patient. But it also helps the doctor. You know, one of the constant questions I get is like, well what if the, the doctor doesn't believe the patient? And I'm like, well one, it's evidence based stuff. So that's on them for not being up to date on the evidence, but also to a doctor should in theory. I anticipate a lot of doctors also being like, oh thank God I don't have to explain what the clitoris is or where the clitoris is or where like hormones and like, and like I spent some every time I was in clinic and I was in Clinic a lot. When I would have a scribe or a medical student with me, by the end of the day, they're like, doctor, you know, I could do what you do. And I was like, yeah, you could, because we just talked about the same goddamn thing 30 times. Like, you're 100% correct. By this time, you've actually completed this day of clinic. Was a fellow, a whole fellowship. Right, because we're saying the same thing. And this is not just in Sex Med. This is also in my. You're our urogynecology fellows. You know, a lot of those women and people with bulbas are having crazy changes in their anatomy. Like, I don't know, I think it's strange that the bladder can just fall out of the body or like, your vagina can just fall out of your body. So I totally can get why that person in their office is terrified and wants all the information, but for them, they're just like, yes, your. Your organs can fall out. Yes, there are options. Yes, these are the options. How much better would it be? How much of a better clinical experience for doctors if the patient was like, oh, yeah, no, I already. Already knew about the options, and I'd like to talk to you about them instead of the doctor being like, this is your uterus, this is your vagina. Sometimes they come out, you know, like these, like, really rudimentary things. It just leads to faster care, more, higher level of care. And. And it's kind of the best way to at least work within a system that's not giving patients the adequate amount of time to get high level care. So I love that. I think that's a. That's a great, great, great, great answer.
- [27:42]
A
And not everybody wants to be a podcaster or wants to write books or blah, blah, blah, but it's really like, find the resources that you think are reputable. Refer your patients to them, put them on your website, have them read them before they show up. Like, there's so many different things you can do to get to that. Like, how many doctors have reached out to me and they're like, because of your podcast. A patient came in, she wanted V. She knew it was safe. Like, like, everybody's day is better.
- [28:06]
B
Yeah, yeah.
- [28:08]
A
With an educated person.
- [28:10]
B
Absolutely. I mean, I've talked to you about the amount of people that I've met just in the most random situations. And menopause comes up and they're like, oh, I Learned that from Dr. Kelly Casperson. And I'm like, I know her. And they literally lose their shit. They're like, you know her. I was like, yeah, she's a, She's a real person and like in real places. So your, Your work. I, I can attest to how your work has empowered people to know themselves, know their bodies, and also know their options out there and not be gaslit. Because that medical gaslighting around women's health is so rampant. And I know statistics, statistics are like 76% of women or pet men presenting people in the healthcare system have experienced some sort of medical gaslighting. And I would not be surprised if that number is higher. And it is arming them to protect themselves from like, like, no, estrogen's dangerous. It's like, what. What study where the whi. Did you not read the sub analysis or update yourself? No. So that's amazing. Speaking of communications, you then wrote a book, Walk us through that process. Because that is writing a paper is one thing, and I find that very difficult and stressful. And I. But I love it. The end result. Now you wrote like 70 papers, right?
- [29:43]
A
Yeah, yeah, yeah. Listen to me. I'm like, I'm like, I dropped out of a PhD program because I hate grant writing. And then I'm like, I'm on my. I'm working on my second book now.
- [29:50]
B
Now. Yeah, like, walk us through that process. And you know, how you came up with the idea for the book and then your process of getting it out into the world and, and, and what was the, what was the thing that you were the most proud of once it was out?
- [30:08]
A
Oh, man. I'll start with that. When women tell me they cry and when women tell me they laugh. Like, I've gotten both from the book, so that's how good it is. But you'll laugh and cry, but, you know, oh, when they say they share it with their husband, when they say they gave it to their adult sons, when they say they bought it for, you know, baby showers, like, whatever. When people say how it affects them and what they've done because of it, that's. That's dopamine that you can't get enough of. Yeah. So, I mean, I created it because I read. Like I said, lightning struck. I didn't know how to help somebody, and I wanted to question the belief that nobody knew anything. So just started reading, reading, reading. I'm a voracious reader and just started reading it. I'm like, okay, sex books, we'll call them sex ed books for lack of better. They come in two flavors. One flavor is there's a stiletto and fishnet stockings on the COVID And it's all about how to, how to be the sexiest, you know, desired thing ever. That's one genre. And the other genre is I have a PhD. So let's not have any margins in this book. Let's make the font 10 point and let's write to a level that you don't really understand what they're saying because it's like a dissertation, right?
- [31:28]
B
Yeah, Yep.
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A
And so, and so I'm like, that's what we got. I'm going to write this sex ed book that I want to read. Yeah, you can finish it in a weekend. We're talking less than 250 pages, right? So it needs to be short, it needs to have humor, it needs to be written in a way you can read. Needs to be like practical.
- [31:53]
B
Right?
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A
Like, yeah, the average woman is not going to go out and buy 5 inch stilettos and fishnet stockings. And if she does, God bless her. But I guarantee you that's not actually the solution to society telling you that your body is gross. Your body image issues, the heteronormative gender bias that's in your relations. Right. And the fact that your vulva is changing and your boyfriend at age 18 told you to never use loop. Right. So it's like buy 12 vibrators if you want, but it's not gonna get you too far because we gotta, we gotta uncover this biopsychosocial, you know?
- [32:32]
B
Yeah.
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A
So that was the book. It did incredibly well. I was basically like, I don't know the publishing industry, but I don't really want to get to know it. It seems like a beast and you gotta get agents and you gotta like, do stuff. And. And so I self published it. It did very well. Then Hachette books called, basically called me because they found me on the Internet and they're like, can we buy your book and will you write another one?
- [32:56]
B
Amazing.
- [32:58]
A
Yeah, I did it totally backwards because they're like, will you write another book about sex? And I'm like, well, sure, but I kind of think my next book is going to be about menopause and hormones.
- [33:08]
B
Yeah.
- [33:08]
A
And they're like, oh, okay, write that. And I'm like, oh, apparently you just tell publishers what you want to write and they agree to it.
- [33:16]
B
Love it.
- [33:16]
A
Right. And then I was like, I should probably get an agent. So I. So I did, but so I, I'm very backwards. But like the book that I'm currently writing is coming out strong for hormones. Man, I'm sick of these books that are like, well, we need again, we need more research. We don't really know. Like, I'm sick of the soft midlife hormone books. Like, I'm basically like, you know, as much as they give the book Feminine Forever, which had its issues but was very pro estrogen and women taking, taking medications of like, I will give you the information, you make the decision. I'm not here to say everybody needs to be on hormones, but women need a freaking book that is gonna have their back when they're like, we have never lived this long on a global scale ever before. We're newbies, we're literally bloodletting with leeches on figuring out longevity at this point. And I truly believe hormones are part of that.
- [34:23]
B
Oh, absolutely. If you've ever seen someone on hormones versus someone not on hormones, like, you can, you can, you know, I tell,
- [34:31]
A
I tell people this. I'm like, you see enough 80 year olds in clinic, you get pretty damn good at who's coming in on hormones and who's not.
- [34:37]
B
Yeah, I'm like, I'm glad that I'm
- [34:39]
A
not the only one. I'm like, I don't like enough. You know, you get the 80 year old coming in and sneakers and a hoodie, finishing pickleball, gonna go pick up her grandson and take him out to dinner. You're not curious that she's on testosterone, estrogen and progesterone?
- [34:54]
B
Yeah, you've. There's a, it's, it's a, it's, it's a secret to vitality. And in a way that men have been very privy to. And we are urologists, we prescribe them to them. Right. And we've never once been questioned. Like, we have very strict guidelines. We have all the things. It's never once been. Do men even deserve this? It's. Well, as soon as they start having symptoms and they're bothered by it, here's an option for them and they can choose or pick and choose if they want. And then all I feel like all, all the urologists in the space, all the sex med people, all we're asking for is equality, right? In, in, in the clinical experience. Because the, the current thing that we experience way too much is I went to my doctor, they told me and I wanted to figure out what I could do about menopause. And they said, nothing. Here's an antidepressant. When there's all these options for them that are safe when done safely, ineffective, and like, not only improve your quality life, improve your overall health, and yet your doctor that is uneducated in Menopause and has their own biases and is truly going off of feelings over facts is gatekeeping this information and even this ability for you to even have access to it. Look that. Like that, like that just got so annoying.
- [36:24]
A
This is why we're friends. Because I feel normal.
- [36:28]
B
It's just wild.
- [36:29]
A
It's very normalizing for me. I mean, I agree. It's. This is an Equality issue 10 times out of 10 for me.
- [36:36]
B
Yeah.
- [36:37]
A
And women have the very unfortunate problem of having to prove that their suffering is enough in the eyes of their doctor. Men do not have that bar to cross.
- [36:48]
B
Yes, we are. We are just straight up, like, no, Is your number low? Perfect. Here you go. Like, is your number low and are you bothered? Great.
- [36:56]
A
Like, if men had a drug that decreased their chance of dying by 30% between the ages of 50 and 60, in addition to decreasing the risk of heart disease and cardiovascular events by up to 50% between the ages of 50 and 60, they would all be on this drug.
- [37:13]
B
It's.
- [37:13]
A
It's called estrogen.
- [37:15]
B
Yeah. It's so fascinating, the mentality, right? Like, even when you talk to the naysayers about this, they're like, it's just. There's just not enough information, blah, blah, blah. And I'm like, step back. You have to understand that because of the poor funding in research and there's just no one. Like, there has not been the ability to even garner information. It's not like. It's not like the people that say there's not enough. There's like, the research is dangerous. It's like, well, there's not enough research. And also, you don't have the adequate funding in women's health to then do the research. So what is the research that is already available and it's actually overwhelmingly positive pro hormones. But then let's take a step back and think about things. And I think the testost like, the way that I think about it or the way that why things are so different is when I still remember I was like, suggesting that we do intrarosa. Like, as part of my. Like, I had a clinical algorithm. Introsa, very important for vulvar health. Estrogen and testosterone, very important for your vulvar health. And I had this clinical pathway and I wanted the whole clinic to adopt it because I was. I became the UTI and chronic pelvic pain person. I was like, fine, I'm happy to do that because it's actually pretty straightforward for me. And also then we have to do a clinical protocol all across the board, right? Like, that's just what I need for these if I'm going to take on these patients. Like, please do my clinical protocol. I had a gynecologist be like, testosterone, that's too dangerous. Like, literally started honing in on me. And I was like, ma', am, there's, like, there's a lot of studies that actually show how safe intrarosa is and how it's effective against UTIs, recurrent UTIs, and like, vaginal pain. But it was again, this. Feelings over facts. Like, that her. She felt that women shouldn't get testosterone, but the facts actually demonstrated that it's super important. Right. And, and that kind of like, one, we're not. We're. We're. We're going for feelings over facts, one, and then two, there's this kind of also this accepted mentality outside of urology, when it comes to women of, well, did you die, though? There's not really like this, like, or did you. Was your quality of life good? Because it. It speaks to that argument of, well, estrogen is just dangerous. It's dangerous. It's dangerous. We shouldn't give it to anyone. It's like, okay, well, that's. That's way too far over there. And they're like, well, back in the day, we used to give it to everyone. And then there was complications and the whi. Blah, blah. And I was like, well, why isn't there a happy medium? Why isn't. Like, we have with testosterone, we have a range of testosterone that we know is safe. And so why don't you all start figuring out what the safe ranges of estrogen could potentially be? Right? Like, but instead, it's just. It's an all or nothing type of thing. We either they give all the hormones and we don't check or see how safe it is, or we give them nothing. Because if you're giving people hormones without doing it safely, which I think you should be checking hormones for safety, and then they have a bad outcome. It's just already. It's then confirming your bias that hormones are dangerous, and then you just say, no hormones. I can't imagine a land where we give testosterone without checking labs. Like, that's just wild to me. Yeah. And yet that's what our current guidelines are. So even if you can finally get to hormones, the guidelines aren't even protecting you in a way that makes sense to me.
- [41:09]
A
Yeah. There's a. I don't know if you. You saw the Atlantic article that Rachel Gross just did this week?
- [41:14]
B
Yes. Yes.
- [41:14]
A
Yeah, it's awesome. I was quoted in it basically saying, like, listen, transcare has it figured out. They care about quality of life in your sexual health. They're comfortable with it. It's part of the conversation. The amount of women who responded on my Instagram saying they get their menopause hormones from trans clinics because they feel safer, they feel the cares better, they feel they don't have to explain themselves.
- [41:37]
B
Yes.
- [41:37]
A
I was like, wow, that was super fascinating. And my second point is people are like, how do we know that testosterone is safe in women? And I'm like, because we've been giving 10 times the dose to the women who want to be live as men for trans care and they're not dying.
- [41:59]
B
Yeah.
- [42:00]
A
So I'm like, you guys, we've got like high dose studies, high dose studies on women. They're thriving, they're happy for it, they're doing great. So physiologic dosing at one tenth that dose is very safe. But it's like, it's like logic goes out the freaking window.
- [42:24]
B
It absolutely does. And that is the most frustrating thing when it comes to, to this work is that you're constantly. Because just goes to show that there's a cultural phenomenon that when you choose to decide to take care of women, you're going to also have to combat the, the dogma. You're going to have to combat a lot of, a lot of internalized sexism that is ingrained in medicine. Right.
- [42:56]
A
I mean, I see this in surgery too. And this is when I started realizing our safety bar for women under the veil of protection is very different than the safety bar for men. Example, women got some mesh for the pelvis, for the prolapse and for stress incontinence, they pulled slings in addition to prolapse mesh off the market in multiple countries, therefore leaving many leaky ladies with absolutely nothing to help them.
- [43:26]
B
Yep.
- [43:27]
A
We put penile implants in men who want to have erections. Horrific side effects from this. When it goes bad, they erode through the tip of their penis. They've got horrible skin infections. We haven't pulled that from any country.
- [43:43]
B
Not a single one. Not one. Can't even one. Not a single one.
- [43:47]
A
Because we want to protect air quotes, protect the women. We end up causing more women more harm.
- [43:54]
B
Which is so funny because, you know, it's. Again, again speaks to the, that paternalism. But a lot of the. I, I'm a strong believer that if they were to actually do trials where they actually first gave vaginal estrogen or vaginal DHEA and then Implanted mesh, we would not have seen that high erosion.
- [44:19]
A
100. The amount of mesh erosion that I see in women who aren't on vaginal estrogen.
- [44:25]
B
It's. It's like without.
- [44:28]
A
To take care of the mesh afterwards.
- [44:30]
B
Yes. You have to first make sure that it's a. Surgical principles. Right. It's so interesting how surgical principles kind of go out the window when it comes to. When we start talking about sexual health and women's sexual health in a. If I am a. If I'm in a surgeon implanting a foreign device, we know that we want to have healthy tissues to. Before you're inputting any sort of foreign device in, like, that is the. In a perfect world, if you could have perfect tissues, you're going to have a higher rate of like mesh device, tape. Right. No extrusion, no erosion. None of the things. The beauty of the vulva is that you can't have perfect healthy tissues. But so many, because of our poor, overwhelming understanding of and training in female sexual health and understanding how important vulvar health is and how to maintain the vulva. Like team, you can have the Same vulva at 20, at 100, there's no reason other than medical neglect. Like, and so if they had been doing good science and, and doing good surgical practices by optimizing the surgical tissue before then implanting a foreign object, you would have had like this. This conversation would have never happened. And this is what happens in women's health time and time again. They are, they are doing practices that doesn't actually take into consideration their physiology. And then when they have poor outcomes, they're like, ah, this is what this, it just, it just feeds your confirmation bias that, like, this is what happens when you decide to care about women's health. That's why we shouldn't do it. They should just suffer. But they're alive, so. Right.
- [46:21]
A
No, exactly. Yeah. I actually just heard this story. A patient just told me this. So a couple years ago, I did a gynecologist, did a hysterectomy. I came in to do the sling. And the patient told. The patient was told by another gynecologist that I'm the one who should do the sling. Right. So she had to tell her gynecologist, I don't want you to do the sling. I want Casperson to come in and do the sling. And the gynecologist said, well, you know, she's going to make you go on vaginal estrogen then. And I'm like, and what did I do? And the Patient's like, you made me go on vaginal estrogen after my sleep. And I'm like, yeah, because I'm in the right on that one. Yeah, 100%.
- [47:00]
B
As a scientist, as a surgeon, you want healthy tissues to help optimize healing, period. I don't want to hear any conversations otherwise. Like, I was in the. The Augs. It was a. It was a professional society, and they were creating a task force for sexual health. And they, you know, the group of gynecologists said, oh, we are not doing a great job. Let's bring in our colleagues that are in sexual health to help us create a research task force. And one of the things I talked about was the importance of vaginal hormones involve our health and surgical outcomes. And one of the surgeons was really like, why do we need healthy tissues? I was like, why are you a surgeon? Like, what are we talking about? This is wild to me that we as surgeons are being like, if there was a way that we could optimize the tissue before, during surgery and ensure patient. The best patient outcomes possible, that's easy, safe, effective. Why would you not take that? Why would you not do that for the patient?
- [48:05]
A
It.
- [48:06]
B
There's a. There's a cognitive dissonance when it comes to taking care of women that I truly do not understand. And I'm so glad that I have my urology colleagues and there's amazing gynecologists that also get this and see this and are speaking up about this. We need so many more people. And so I just, yeah, the despair.
- [48:25]
A
I mean, the stories go on and on. I had this woman who was seeing a primary care physician in town for her. Her menopausal hormones. Every time she wanted to change a dose, the physician made her stop her hormones for three months, recheck her hormones, and then start her on a new dose. This is a post menopausal person who doesn't make any hormones. And so I'm like, so every. Every three months when you haven't been on hormones, what are your labs? And she's like, yeah, I have low hormones. And I'm like, yeah, because. Because you're postmenopausal and you don't. And she's like, I'm miserable because she makes me stop the hormones for three months before I can start my new doses. And I'm like, if a man was on testosterone and we wanted to change the dose, do we make them stop the dose for three months before we give them a different dose? No, no, it is. It is one Step underneath the covers to hold up what we do to women, to men, and to say, does it make sense?
- [49:18]
B
Yes, that is it. Like, and I think this is our superpower is to be able to say, like, because if you're trained and that's all you know, that's all you know, versus if someone comes in and says, hey, this actually could be better. And this is how I think this is. This is why we are so vocal. This is why we think we say so much. You can't, like, turn on anything without hearing one of us saying something. But there's a reason, you know, we. We. Once you know better, you have to do better. It's very much see something, say something. And. And we are seeing these experiences in our clinic and speaking up and seeking out and trying to change a system and get everyone riled up like they should be, right? Like, we sh. Every single human being with a vulva and anyone that loves or knows anyone or is important that has a vulva should also be advocating for these things. All doctors should be advocating for these things. Like, if I were a neurologist and actually truly knew how much better my life would be if my patient was taking estrogen and I could prevent things like Alzheimer's, I would also be advocating heavily, but because in a cardiologist, I could actually be saving myself, you know, an emergent cath because my patient was actually taking estrogen and was protecting their heart. Amazing, right? Like, but these doctors, they're just like, oh, it's women's health, so it's not important to us. We don't need to know. And it's like, no, we all need to know. And I. And I just am so thankful that I get to share a space with you of people that are speaking up and speaking out and actually bringing the evidence to people directly in an easy way that is helping them advocate for themselves. So. Oh, thank you.
- [51:06]
A
Yeah, I get. I got a lot of inspiration because, you know, people ask me, how do we change? How do we educate all the doctors? How do we blah, blah, blah. And I'm like, we. We try, but that's not how we change the world. We are not going to change the world. Doctors are busy. They can't go learn all this all the time.
- [51:23]
B
Right?
- [51:24]
A
They're not going to do it on their own. They're not going to have the lightning strike their brain. Like, I got the lightning to strike my brain. I get a lot of inspiration from the AIDS epidemic and stand up community because people were suffering, people were dying. They didn't see the medical community moving fast enough. They didn't see access to this medication coming from top down. And so they started to speak up. Yeah, that's, that's how the HIV epidemic changed.
- [51:56]
B
Yes.
- [51:57]
A
Be like they demanded it. And I get a lot of inspiration from that, specifically with the menopause movement and the hormone movement to be like, listen, you know what changes a doctor. 200 women showing up to that office one at a time saying, I want vaginal estrogen. It's time for me to go on estrogen. I've read that the studies are safe. Let's. This is a paper for how I think we should start testosterone. Can we just try it and I'll come back in three months and let you know how I'm doing. Yeah, that's how this has changed. We cannot wait for the top to change it for the people. The people are going to come in. And that's my advocacy of why I will keep podcasting, why I will keep writing the books. Because at the end of the day, nobody cares more about your health than you. You've got to go advocate for it.
- [52:44]
B
Yes. I love it. I absolutely love it. I co. Sign it. It's something I deeply, deeply agree with. This is going to. That. That movement of the act of movement was Act Up.
- [53:00]
A
Stand up. Yep. Act up.
- [53:02]
B
Truly inspirational. Right. Like it was. It was a time you got to see the power of patient advocacy. It was so much coordination, so much work, so much death, dying and suffering had to happen before that. And I just, I get chilled when I think about that, that grassroots movement creating so much down this, down the line change. And I, and I, I want that for women. I want 50% of the population to also kind of stand up and understand that they're not getting remotely the right standard of care. And a lot of them. And we can reimagine a world where their health care actually takes into consideration how their body works and also takes into consideration their quality of life. Like, why aren't we advocating for these things? And I'm so, so, so, so glad that you are here today to talk about this. And, and it's just so nice to know that, you know, we're not in this fight alone. And I, and also, I hope patients, and not patients, but users, customers, patients, all the things people, as they're interacting with the healthcare system, understand that it is deeply flawed and understand that they are powerful beyond belief. And. Yeah, and in a perfect, like, yes, in a perfect world, we snap our fingers and we. It'd be Better but it's, that's just not how the system works. So. Yeah. So thank you, thank you, thank you so much for being here. Where can people follow you? Support, subscribe, do all the things, all this, all the stuff, all the stuff.
- [54:48]
A
Podcast is called you are not broken. Website is kellycaspersonmd.com book is called you're not, you're not broken. Stop shoulding all over your sex life. Currently not available but pre order coming back out re released September 2024. And I hang out on Instagram. It's my fave. So Instagram. Instagram is Kelly CaspersonMD Excellent.
- [55:11]
B
And then if there is one thing that you could tell the listeners that they, you wish that they knew about their health or at their, or going through the healthcare system, what would that be?
- [55:25]
A
That doctors are people too. But they're, they're stressed, they're strained. They really do want to care for people learning how to communicate well. And I, I, I always apologize, like I'm sorry that the burdens on the woman to go get educated like I'm. But the world isn't perfect and it's what you can do. And although menopause is not a disease, things happen when your hormones change and diseases happen more commonly because of it.
- [55:54]
B
Yes.
- [55:54]
A
And, and I think the lack of education of like that, that the world just thinks menopause is a hot flash completely blows over what the profound change is actually happening in your body. Yeah. So just to really educate women of like, listen, it's, it's on us to, to change this and to realize we are brand new at learning how to live 30 years post menopause. We are brand new at it, so why not try to figure it out? Like be profoundly curious. The lack of curiosity is astounding to me of like, let me figure it out. You don't realize what feeling good feels like until you feel good and then you're like, yeah, it's real good.
- [56:41]
B
Yeah.
- [56:42]
A
As much as you can to say, you know, you're in charge of this amazing spaceship that you have to be on this earth for with try to take care of it.
- [56:50]
B
Yeah, I love it. I absolutely. That's fantastic advice. And Kelly, thank you again for being here and sharing such nuggets of wisdom. Loved having you.
- [57:04]
A
Thank you. Thank you for listening to this week's episode of youf 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. 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 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 and 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.