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- [00:04]
A
Welcome to the youe 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. Hey, everybody. Welcome back to the you Are Not Broken podcast. I am so excited to have Dr. Jennifer Garrison on today. She is a researcher and assistant professor at the Buck Institute for Research on Aging, co founder and director of the Global Consortium for Reproductive Lung Longevity and Equality, which is her nonprofit, and a member of the Buck center for Reproductive Longevity and Equality, which is super interesting. Your goal is to create a network of scientists in academia and biotech, clinicians, policymakers and funders, and thought leaders and ambassadors from all over the world to promote a collaborative dialogue about women, aging and health that results in transformative interventions for women's health. Oh, my God. Thank you so much for joining us.
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B
Thank you.
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A
So we met at the Four Seasons in Austin at south by Southwest via a mutual friend. And then we just, like, fell in love talking about the ovary and menopause and the brain. And I'm like, having my mind blown at lunch because I'm like, what if menopause starts in the brain? You're like, yeah. And I'm like, oh, my God. I feel like somebody's actually speaking my language. So back up for all the people. How did you get to where you are now? What was, like, the undergrad? Why did you realize that nobody's looking at ovaries and why should we care?
- [01:31]
B
Oh, all the way back to my undergrad. Let's see. I was an undergrad at UC Berkeley in molecular cell biology about 1,000 years ago. And I knew I wanted to do science. I was really excited about immunology at the time. I wanted to cure aids. But then I started working in an immunology lab and realized that that actually wasn't for me at all, which is, I think, a pretty common trajectory for a lot of people. You don't know what you don't know, and it's great to try things out and to do different things. I did my PhD at UCSF in chemistry and chemical biology. So I really love chemistry. Deep in my heart of hearts, I'm a chemist at heart. UCSF was an amazing place to do my PhD, and I actually studied bioactive peptides during my PhD. Then when I moved to my postdoctoral studies, I wanted to do something different, like learn something completely new, something completely outside of what I was comfortable with. And I switched over to neuroscience. I moved to the Rockefeller University in Manhattan, and I worked for Corey Bargman on neural circuits and behavior. That was also fascinating. Steep learning curve. But again, I ended up weirdly focused on bioactive peptides. In this case, we were looking at the role of certain bioactive peptides in behavior. When I started my own research group at the Buck Institute almost a decade ago now, I was really fascinated with this idea that there's a part of your brain called the hypothalamus which is really controlling a lot of homeostatic systems in your body. So these are the things that keep everything within a certain set range to keep you alive. So things like energy and fluid homeostasis, body temperature regulation, circadian rhythms, and also reproductive function. And this part of the brain is super cool because it's really neurochemically diverse. There's just a lot of different. It's a part of the brain that just makes and uses a lot of different signaling molecules. And these neurons are controlling not just the physiology. So, like, for energy homeostasis, it's regulating how much energy. It's paying attention to how much energy you have, how many energy stores you have, and what you might need to do to keep those steady. But it's also then that those same neurons are controlling behavior for energy homeostasis. That means they're controlling food intake and feeding behavior. For circadian rhythms, they control sleep. They're not totally separated the cell population. They're somewhat overlapping. For example, some of the neurons that control reproductive function also control body temperature regulation. And so when you start to focus, actually all of the symptoms of being a female, everything related to female physiology through the lens of the brain, suddenly things start to make more sense. When you think about what happens during puberty, for example, or menstruation or childbirth or pregnancy or lactation or perimenopause, Suddenly when you start to think about this part of the brain and everything that happens there, like female physiology, becomes a lot more understandable. Long story, not short. I thought about this part of the brain as one of the most upstream places where we could focus our attention to try to find interventions that would hopefully impact aging. I'm here at the Buck Institute, which is an independent research institute that is wholly focused on understanding underlying mechanisms of aging. And the reason that we do that is not because we want to make people live forever, Rather, because your age is actually the number one risk factor for every disease in the modern world. So chronic diseases, so things like neurodegeneration and cancer. And there's a whole long list of things, your age is actually a much bigger risk factor than something like your cholesterol for cardiovascular disease. And so the idea is that if we can understand how aging works, we could exploit that knowledge to then intervene in multiple age related disorders at the same time. Our goal here is to extend health span, so to sort of square off the curve, so to speak, to extend the number of years that someone is healthy and free of those age related diseases. When I started my lab, I naively thought, well, I don't really care that much about the downstream consequences of aging. I feel like we've pretty well got that covered. I was much more interested in what is the most upstream thing that we can think about, where you could potentially intervene and impact all of those downstream pathways. For me, that was really these homeostatic circuits in the hypothalamus. The question was if there are changes in these brain circuits that impact physiology that might lead to aging, which isn't a crazy idea because there is an age related increase in inflammation, specifically in the hypothalamus with age. Like I said, this part of the brain is really neurochemically diverse. It's making and utilizing dozens, if not hundreds of these bioactive peptides. And I think of it as kind of like they're kind of like the brain's wi fi. So when I talk about neural circuits and signaling in the brain to somebody who's not a neuroscientist, they immediately picture a synapse like this picture. It's a physical connection between two neurons where there's like, you know, there's like little vesicles in this one and then they get released and they, you know, signal to little receptors in this one. That is not what we're talking about. That is actually signaling between two cells that are physically connected. Whereas what I'm talking about is more like wifi signaling. This is chemical signals that are released from one place in your body that travel over long distances and long timescales, and then are sensed in another place. It's a way for your brain to coordinate with distant tissues. This brain body connection, so to speak. The signaling happens in both directions. It's not just one way. It's actually coming back to the brain from distant sites as well. Bioactive peptides are so freaking awesome and interesting and we really don't spend enough time studying them because just in general, their inherent biology makes them difficult to study. My lab makes tools to study how bioactive peptide signaling changes with age. And, you know, with the idea that this might be a great place to try to think about interventions and then about five or six years ago, we started, you know, we had a project that led us to the reproductive system. And that is when I started thinking about ovaries for probably the first time in my life.
- [08:08]
A
I love it. So let's back up just for people's definitions, because they're people's definitions of menopause is when you don't have periods anymore. And I would argue that that's a sign of what's happening, and it's not actually what's happening. How would you def. If you're going to redefine what menopause is, how would you define that?
- [08:28]
B
Well, I mean, menopause has a very clear definition that I think we often conflate with lots of other things. Menopause is the day on which a woman has not had a period for 12 months. So it really is the cessation of menstruation. That's how we've defined it medically. But then, as a society and just in general, the conversation really takes menopause. They take that word and use it to mean a lot of different things. The end of menstruation, practically speaking, is certainly the end of fertility. You can't conceive a child without ovulation. But beyond the cessation of menstruation, it also happens to coincide with your ovaries. We're not stopping. I guess we're still trying to figure out what ovaries do after menopause because they're doing something, but they're essentially not producing all of the same chemical signals that they were before, and that has a lot of different downstream consequences. I'm not sure if I answered your question, though.
- [09:28]
A
Okay, got it. So. So many people. Let's clear up this myth. So many people say menopause happens, and we'll use the definition of no periods after a year. Menopause happens because the ovary runs out of eggs. That's not technically true. Right.
- [09:44]
B
There's a correlation there, very strong and very real correlation between the number of eggs and the quality of the eggs and the onset of the age at natural menopause. We should make that distinction, that we're talking about age at natural menopause, not a disorder or disease that would cause early menopause. That's absolutely true. But we don't know what's causal there. What we don't understand is what is causing your ovaries to age faster than the rest of your body, Practically speaking. Functionally speaking, ovaries in my body are aging at least two and a Half times the rate of the rest of the tissues in my body. Why is that? We have absolutely no idea. We don't know what's causing it, and we don't know what's driving it. What we do know is that age at natural menopause coincides with a drop below a certain threshold in terms of number of oocytes or primordial follicles left in the ovary. Be fearless in the sun with Blue Lizard Australian Sunscreen. Whether you're diving into ocean waves or simply chasing your kids around the backyard, Blue Lizard has you covered so you can enjoy every moment worry free. Designed for your whole family and free from fragrances, parabens and phthalates, Blue Lizard is your go to mineral sunscreen. Trusted by dermatologists, pediatricians and parents. Shop now on Amazon.com and be fearless in the sun with Blue Lizard Australian Sunscreen. So there's not, you know, we don't know whether it's causal. That's an area of open research. When I think about, and I don't like to use the words delaying menopause, when I think about extending ovarian function, the endocrine function of ovaries, you can separate ovarian function into at least two parts, and one part is very clear, and that is fertility. You need oocytes and you need ovulation to have an egg. You cannot make a baby without an egg. Very clear. That is what menstruation is set up to do. But then the other piece of it is that ovaries are producing many, many, many more signals. Not just the big three that we talk about. Estrogen, progesterone, testosterone. They're producing lots of other chemical signals, and they are sending messages to almost every tissue in a female body. They signal to heart and bone and liver and brain. We know something about that brain signaling, but they signal to your skin. They signal to almost every tissue in your body. Every one of those conversations is different. Each one has its own specific set of words and messages. But what's clear, and the reason this is clear, is only because we know what happens when they stop. What's clear is that those conversations between ovaries and your other tissues are promoting health. When ovaries malfunction or when they slow down in function or when they stop functioning, however you want to characterize it at any age, what it does is it uncovers a whole host of risk factors that are specific to you. Your biological age, your genetic background, your environmental predispositions, all those things. If ovaries aren't Working properly in a teenager, that can uncover all kinds of issues around puberty and menstruation. If they're not working properly in a woman in her 20s, that can uncover risk for things like PCOS or POI when they're not functioning properly or when they start to fluctuate in function in midlife, that can uncover all of the things that we refer to as symptoms of perimenopause. And when they have essentially stopped functioning the way that they were before, after menopause, that uncovers a whole host of other health risks like cardiovascular disease, osteoporosis, all the things that we're very familiar with. So menopause is not a disease. It's a time when your ovaries are not functioning the way they used to, and that uncovers all of these different health risks.
- [13:39]
A
Yeah. I don't know if people focus on this and it's important or it's not important, because I think it's just our bias on what we make things mean. But if we say menopause isn't a disease because it happens to everybody with ovaries, and it's simply that ovaries are one of the first organs to run out of function before your eyes do and your heart does and all the other things. But the thing. But you then can develop diseases because of lack of ovarian function.
- [14:06]
B
That's right.
- [14:07]
A
Is it fair to say it like that?
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B
Yeah. Yeah. So I like to. Yeah, exactly. So you're essentially uncovering risk for different diseases when your ovaries stop working, and then which diseases you're more susceptible to or disorders are gonna depend on who you are as an individual and how old you are.
- [14:22]
A
So one of the biggest things I've seen is smoking. Like, ovaries hate cigarettes. Like, on average, 10 years sooner. Menopause in smokers versus non smok. What are some other triggers for ovarian. We call it failure or, like, running out of lifespan on the ovaries. What can women do? What are some practical tips?
- [14:42]
B
Oh, gosh. Well, you know, I'm not a doctor. I mean, I'm a PhD. I'm a fake kind of a doctor, so I don't give medical advice. But so far, everything we know about aging and ovaries is reflected in aging in the rest of the body. So all of the advice that you hear from medical professionals about how to preserve function with age and other tissues also seems to extend to ovaries, diet and exercise, what you put into your body and how you take care of your muscles, especially for women, especially around midlife is probably those are the best things that we have right now, which isn't very satisfying. But that's the truth.
- [15:22]
A
I saw some people looking at melatonin, looking at dhea and then my other question is the role of alcohol on ovary function.
- [15:32]
B
Yeah. So I think more and more studies are coming out to show that alcohol is kind of a poison. You can make arguments about hormesis. Right. That just like a little bit of poison is good for getting your resiliency genes to kick in. And I think again there's going to be a lot of inter individual variation, like a lot of differences between individuals and how important those things are. For example, some populations have a much better, they're much more able to metabolize alcohol than others that might play into it. But I think for things like melatonin, DHEA really don't know the full extent of. We are in the dark ages when it comes to the science around ovarian function. We don't understand the most basic things about it. We don't understand all of this. We're just getting this first data on what all the cell types are in the ovary. Right. Like the very first omics data on like forget about aging in young people, what are all the different cell types? And then asking how those cell types change with age is like, you know, that's the cutting edge, the bleeding edge of the science right now. And so right now we're just trying to define things. We don't know what the full complement of chemical signals that the ovary produces are. We don't know if it's a chemical conversation. We don't know what all the words in that conversation are. That is active discovery science as part of what my lab works on. DHEA is one of those chemicals. How and when you might need it is going to be complicated. When you think about if you go search Google and you search ovarian cycle or menstrual cycle and you look at the images, you get a beautiful picture of estrogen, progesterone, lh, fsh, all of the symphony that we know about that's required for menstruation, you can have this beautiful graph over one cycle, which by the way is not usually 28 days, but whatever, let's not perpetuate that myth. But over one cycle and what you'll see is that there's two phases, the, the luteal phase and the follicular phase. And you'll see estrogen goes up, down and progesterone starts Low and it goes high. And all these five or six different lines that are changing in different ways at different times, just across a 20 some odd day cycle. That's just a snapshot of a few things. Imagine there's 100 things like that and that they're all going to be changing on different timescales and maybe not across a cycle, maybe across a year or maybe across a day, maybe there's fluctuations on a 24 hour cycle. And so we don't understand any of that. And until we understand that with some resolution, trying to look at someone and ask what's going wrong and what's changing at different ages and how could we potentially add something back that might help. Those are big open questions. And so I would definitely not take dhea, I would definitely not take melatonin until, until we have a better picture of what's happening.
- [18:46]
A
Yeah. Do we have any idea how many hormones, peptides the ovary actually makes? Because we simplify it into three things that are commercially available. But it's like saying that the colors are blue and red when there's actually a billion different colors out there.
- [19:00]
B
That's a good analogy and I think that's exactly right. And what I will say is that we know that estrogen is important. That's definitely one of the key words in this conversation. And we know that because if we give it back when it gone to very low levels that it can have these beneficial effects. But it's by no means the only thing. Stay tuned. We're working on it. Not just me, we're changing the name of our consortium to make it simpler. We're calling it productivehealth.org but we put together this global consortium about four and a half years ago. And our goal there was to really build out the research space around these questions like why do ovaries age faster than the rest of the body? What's causing that? And how can we think about how it's different between individuals? And how can we answer these questions that you're asking in a way that gives us real opportunity to provide women with menus of options for interventions and things that would help with extend ovarian function? And I'm talking about the endocrine health promoting impacts of ovarian function, not necessarily
- [20:10]
A
the fertility side, not just fertility. So at south by Southwest you were on a panel and remind me if you remember better what it was called. But basically my mind was blown because it was basically like is menopause? Will menopause be optional? And I was like, what? So it's so radical, I think. And I'm the one who's, like, more pro hormone than most. Like, I'm usually the radical in the room. And then these people on stage are like, maybe menopause will be optional for our daughters and our granddaughters. Who's having this conversation? How do we think we're going to do that? Tell me about the Is menopause optional world.
- [20:54]
B
Okay. The goal would be to give women to know enough about how female bodies work to give women at every age of adulthood a menu of options that would be useful to extend ovarian function. And my goal, our goal is, I don't say end menopause because that takes the conversation in a direction that's really. It's just a distraction because then people are like, oh, my God, we can't have women having babies when they're 70. And I'm like, oh, my God, that's not what I said. But so I prefer to say my goal is to sync up aging in ovaries with aging of the rest of a female body, like, full stop. That's the goal. Sync them up. Because right now, there's a real asynchrony between how a woman's body ages and how her ovaries age. So ideally, what will happen is that we'll do enough science and we'll spend enough time studying females that we will understand in some detail how ovaries work, what that chemical conversation is, what all of the words are in that chemical conversation, and how that changes with age, such that we could have available to women at any adult age a menu of possibilities that would allow them to preserve or extend their ovarian function to the end of their lives. Again, we're not talking about the fertility side. I actually think it would be very difficult. I'm not saying it's not possible. I'm just saying that it would be maybe more challenging to maintain menstruation, for example, past menopause. But the idea that we would be able to offer women options for keeping their ovaries healthy for longer, it's not science fiction. It really is just about doing the science. It's not radical. It's crazy, actually, that we haven't really spent any time thinking about this over the last hundred years.
- [22:47]
A
Do you think this is more like an optimism barometer? I guess. Are you optimistic that within your career we're going to have this figured out?
- [22:56]
B
I think some of it will happen within my career for sure. I mean, already I've been really pleasantly surprised to be Perfectly frank with the pace of discovery and the pace of progress over the last four years. When we started. So six years ago, we started a center here at Buck Healthy Aging and Women. And we changed the name of the center, changed the name of the consortium, to get rid of the word reproductive, which we could talk about in a minute. But when we started the center, it was meant to be like a physical thing here at the Buck Institute, where we would have a collaborative hub for researchers at Buck who work on aging and reproductive biologists to do this kind of synergistic work at the interface between longevity science and reproductive science. And what we realized right away was that even if we converted the entire Buck Institute into only working on ovarian aging, it wouldn't make a dent. Like, it just wouldn't be enough. The scope of the problem is just too big. And that's why we started this global consortium. Since we started four years ago, what we've been doing primarily is funding grants to scientists and clinicians all over the world to study this. Where there was not a field before, now there's a field. And we've given away grants to 49 scientists, $14.5 million. And we're going to continue giving away grants to seed this research field. And I have been. I mean, we just had the third international conference on Reproductive Aging, which we started. And to watch the progress from the first year to the second year now to the third year, to see not just how the field is growing, but how people who started projects a few years ago with seed money from us have really just done some transformative things. The first clinical trial has come out of work that started from a grant that we gave. First clinical trial looking at ovarian endpoints with, in this case, rapamycin at Columbia. We didn't fund that, but we funded the precursor to that, which gave them the data and the ability to apply for more funding to do this clinical trial. There have been just like, our knowledge is growing by leaps and bounds. So, yes, I'm pretty bullish on us figuring this stuff out. It's not rocket science, let's be honest. It's really actually not that challenging. It is just that we need to do the work.
- [25:17]
A
Tell me about what people are doing. I think it's in Europe where they're taking ovaries, parts of ovaries, freezing them and then putting them back in your arm or somewhere else to regain hormone function. What's currently happening. And that's for cancer treatment, right? Like to take your ovary out. So it doesn't get hit or is that more for fertility?
- [25:38]
B
I don't really know what they're using it for. So we don't know enough to say, like, what's going to work or what's not going to work. I'm pretty sure that's not going to be a widely applicable solution, but what that experiment does. So this experiment was originally, and I don't know which, which institutional review board approved this. I don't think. I don't think in today's day and age that it would have ever gotten through the regulatory agencies. But there was a classic experiment done on humans for women who are going through chemotherapy or radiation treatment for cancer. We know that that's going to kill all of the follicles in an ovary. Typically, what we would do is freeze eggs to preserve future fertility. For those women who are undergoing cancer treatment. Amazing. So glad that that happens. But for girls who are too young, who don't have any follicles to preserve, who haven't gone through puberty or who are too close to puberty, what they're going to need to have that cancer treatment. But how do you preserve their. Help preserve their future fertility? What they do is they actually take a piece of the ovary itself, slice it up and freeze it. Then years later, sometimes in some cases decades later, they've taken that frozen tissue and put it back any place that's vascularized. You said the arms doesn't have to necessarily be in the abdominal cavity. It could be in the back of the arm. You have a lot of blood vessels back here. Any place that's vascularized. And that that has been enough in some cases to not only restart that conversation between brain and ovaries so that ovulation can happen, but babies have been born that way. And so again, this is not a general solution. We're not going to ask women in their 20s to have an invasive surgery, preserve tissue for 20 to 40 years, and then have another invasive surgery. Certainly the numbers on this particular intervention are not where you would need them to be to even entertain that kind of craziness. But what it does tell you is that there is something, some signal that's coming from that tissue that is enough a circulating factor. I would argue it's probably a bioactive peptide, but who knows? Could be a lipid, could be all kinds of things. Could be a protein, but there's some signal that is coming from that tissue that is enough to restart a conversation there that is, is sufficient to restore function. And so that by itself tells me that, that there's a lot of, you know, I mean this is why we're pursuing the work that we are.
- [28:09]
A
Talk to me about peptides. First of all, just what the heck's a peptide? Because I see so many people marketing peptides that aren't FDA approved. You're getting them off the Internet, they're injecting these things they call peptides. Like peptides are the new like caramel latte macchiato of like health.
- [28:29]
B
Yeah, it makes me sick. Please don't inject peptides. Don't drink them, don't rub them on your skin maybe. I mean it's not going to hurt, probably in a skincare product. But yeah, it's the wild west and it's like many of these unregulated medical treatments. There's probably some kernel of truth at the base of it that has then been really co opted and maybe in some cases completely taken off the reservation. Kind of like stem cell, right? Stem cells do all kinds of really cool things and stem cell therapy is potentially going to be really amazing. But we're not there yet. And outside of a few indications where there have been really robust and rigorous clinical trials and thinking about joints and things like that, like osteoarthritis and those kinds of injuries, outside of a few instances, you probably shouldn't be injecting stem cells into yourself or having someone else do it. To be very clear, there are hundreds of bioactive peptides that your body produces endogenously, many of which are important for reproductive function. GnRH gonadotropin releasing hormone is a neuropeptide. Oxytocin is a bioactive peptide. Vasopressin bioactive peptides. GLP1 as it turns out, is a bioactive peptide. So is gyp. There's these peptides that people are more familiar with, but there's lots of other peptides. And as a class of signaling molecules they're all really distinct. But what's true among all of them is that they're often characterized or called neuropeptides. But that's a misnomer because they can be made and sensed by non neuronal tissue. Better to call them bioactive peptides. And what's really important to understand about this signaling is that it's complicated. There's the peptide itself which has to be made somewhere and it can be made usually in a lot of different places. But the peptide itself doesn't do anything. It can be released and it won't do anything unless it binds to a Target cell that has the appropriate receptor. It has to actually bind to something somewhere. You need those two components, peptide and receptor, and those can be expressed in different places. It's more complicated than just this one to oneness. One peptide might bind to multiple different receptors in different places. One receptor might sense multiple different peptides. It becomes this combinatorial thing. The really important thing to know about peptides is that the level of the peptide and also the timing and the location, all of those three things are really important for function. We can do experiments in a mouse where we, for example, just introduce peptide into the brain. We just dump a cannula into the ventricles and dump oxytocin in there. It can actually elicit repeatable behavioral phenotypes that have literally nothing to do with. With the endogenous function of the peptide. You can get spurious results because like I said, it's not just that you need the peptide and the receptor. The amount, the location and the timing all very important for function. When we're talking about peptide therapeutics, typically you're not going to have. It won't be the peptide itself that would be a therapeutic or an intervention rather, because again, timing, location, amount, really important. It would be more likely to be some kind of a small molecule drug that would modulate the receptor activity. So independence of the peptide, Trying to get something that would be beneficial and also not harmful by modulating levels of the peptide, that's like a fool's errand as far as I'm concerned. For most of these signaling systems, we don't understand them with enough resolution to be able to say you need, you know, you need to tickle this receptor on these cells at this time. It's a very complex system and we're just at the beginning of understanding these things.
- [32:42]
A
Yeah, and I think you bring up a good point of more is not always better. And oftentimes when we want to supplement, we just think more is better and you can cause harm.
- [32:51]
B
Oh, yeah. It's not a zero sum game. People think with supplements like it's either going to do nothing or it's going to be beneficial. But actually most of the time it's probably going to do harm and not be just neutral.
- [33:03]
A
Yeah, I feel like I need to go back to school. What's the difference between a peptide and a hormone?
- [33:09]
B
That's actually a really good question and very important to think about. No, that's really important, especially for your audience. The word hormone is a super generic term. It is literally any substance. So it could be A protein, a lipid, a peptide, a small molecule. Literally anything in your body that can signal over long distances and long distance in your body could be a centimeter. Right. But it can basically be signal between two cells or tissues that are not connected. And so a hormone can act locally, like between two. Signal between two distant brain regions could also signal between your brain and the rest of the body. Literally, that's all hormone means it's just a chemical message. Lots of different kinds of chemicals can be hormones that signals information over longer distances. That's it.
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A
So peptides can be hormones, peptides can be hormones. Not all hormones are peptides.
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B
Exactly. Not all hormones are peptides.
- [34:08]
A
Okay, got it.
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B
And so when we talk about hormones, when we use the word hormone in the context of female physiology, people always think about steroid hormones. Estrogen, progesterone, testosterone. And they're called steroids because they share a chemical scaffold that is literally called the steroid backbone. And they have different moieties decorating it. But that's why they're called steroids. That's just a drop in the ocean.
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A
Is steroid hormones a better term for estrogen, testosterone, progesterone than sex hormones?
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B
I mean, one is referring to this chemical scaffold that they're built on, and one is referring to the fact that they do tend to be important for different things related to, you know, biological
- [34:54]
A
sex, but they're important for the heart and the brain and the bones. And I think they get dismissed when we call them sex hormones.
- [35:01]
B
Ah, okay. Well, then by all means, call them steroid hormones.
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A
I'm trying to rebrand them.
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B
Okay.
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A
And then people are like, but steroids? I've heard physicians. And they're like, steroids are bad. And I'm like, vitamin D is a steroid. It just has to do with the carbon ring.
- [35:15]
B
Chemical structure.
- [35:16]
A
Yes, chemical structure. That's all. It doesn't mean it's addictive. It doesn't mean you're going to need higher doses down the road. It doesn't mean any of those things.
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B
Just like hormone is a generic term, stera just means literally the chemical backbone they're built on.
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A
Yeah. To me, I'm like, let's stop calling them sex hormone hormones. Some people call them neuro hormones because.
- [35:36]
B
Because I can get on board with that.
- [35:38]
A
Can you? Let's create a revolution. But like testosterone, progesterone, estrogen is important in the brain. And so some people call them neurohormones. Would that be incorrect? Because they do more than just the
- [35:51]
B
brain they do more than just the brain, but anything that signals to the brain could be called a neurohormone. It's all very, very imprecise language.
- [35:59]
A
I hope everybody else is enjoying. Like me just trying to define shit. Like episode 270, something where we just try to define things. Things.
- [36:09]
B
I'm cool with that. So steroid hormones and you have to stop calling them reproductive organs. Okay, we'll just shake on that.
- [36:16]
A
Yes, that's so important.
- [36:20]
B
This is my thing. Don't call them reproductive organs because it just, it lets people, it has allowed, I think, all of female health to be pigeonholed through the lens of fertility for the last hundred years. And it makes women's health small and like cast aside. They're more than reproductive organs. Call it an ovary.
- [36:40]
A
I mean, I think the surgeons. I don't want to pick on gynecologists, but the surgeons who take out ovaries are gynecologists, so I have to pick on them. But the dismissal of the ovary, of you don't need them anyways, anymore, of changing from a paradigm of dismissing an ovary to where you're talking about, which if I interpret it correctly, we don't even know how amazing this thing is right now, but it's doing shit that we don't even know yet. And it's like this, this whole like respect paradigm shift of what these walnut sized beans are in our abdomen.
- [37:16]
B
They're very small for the things that they. They're small but mighty. And yes, I think we have to reframe the narrative around women's health and focus it through the lens of ovarian function. If we're going to talk about healthy aging in women, we cannot talk about that without maintaining ovarian function. So yeah, totally. And I think just in general, it's probably a good idea to keep your organs unless there's a really good reason to get rid of them. And there are certainly instances where it would be appropriate to remove a whole organ like a uterus or your ovaries. But a lot of times I think what you're referring to is that there have been elective procedures to remove organs where maybe they shouldn't have. And the reason that we know I said earlier that we don't know what ovaries are doing after menopause, but that they're doing something. The reason we know that again is because of what happens when you take them out. If you take ovaries out of a postmenopausal woman, she will fare much Worse. Her health will be worse compared to someone who still has their ovaries while they're not doing what they were doing before. There's something happening and there's some protective effect of keeping ovaries past menopause. Just because we don't know what they're good for, it doesn't mean we should just rip them out.
- [38:33]
A
Yeah.
- [38:34]
B
Oh.
- [38:34]
A
I think the other thing that people don't understand is that just removing a uterus and keeping the ovaries in can be a hit to the ovaries because of compromised blood supply from the surgery. Not 100% of the time, but I think we tried to clean that up for a long time of like, it's just your uterus. But those women also can suffer ovarian decline as a result of just having surgery in the area.
- [38:59]
B
Yeah. I mean, this is the state of women's health. Right. Like, I personally know women who have had terrible struggles with endometriosis, horrible pain, you know, to the point where they were welcoming the idea of having their uterus removed, you know, to get rid of the pain diagnosis through surgery. Absolutely no treatment options. A lot of, like, suck it up and deal with it or let's take it out, you know, not a lot of nuance, not a lot of options. This is the state of women's health today, and that's the kind of stuff that we're trying to fix. It should be that women are presented with reasonable and varied options when they have a health problem. It should be that we can diagnose things like endometriosis without an invasive surgery. There's a whole universe of things that I think if they were impacting men the way that they impact women, we wouldn't be having this conversation.
- [39:56]
A
Totally. To wrap it up, do you have any final words or speaking moche on the, like, equality nature of this? Of, like, women live longer, but their health span is not longer. And really how we're trying to equal the playing field of, like, thriving while living. Not just living longer for the sake of living longer.
- [40:18]
B
Yeah. I mean, women do. In every country where it's been measured, women do live longer than men on average. There's a lot of different reasons for that that we won't go into, but a big one is risk taking and stupid behavior by men. But for whatever reason, women do live slightly longer than men on average. However, they spend a significantly longer portion of their lives in poor health. This is obviously for people who are lucky enough to live to old age that we're talking about women spend a significantly longer portion of their lives in poor health. And that is directly related to ovarian function. From my perspective, this is an equality independence of whether you want to have biological children. I think the fact that women undergo this decline in ovarian function in the middle of their lives. I'm talking about people who don't have any other underlying issues, that it truly impacts every aspect of your life. From the time you go through puberty, you are thinking about this ticking biological clock in the background when you make decisions about career, about education, about all of it. And men don't have to contend with any of this. And men don't have compromised health span because they have an organ system in their body that fails decades before their other organs. So yeah, it's an issue of equality, I would say.
- [41:37]
A
I love it. You are brilliant. I love how you think. Thank you for recording a podcast with me.
- [41:42]
B
You are brilliant too.
- [41:47]
A
I feel so basic. I'm like sometimes I just have to go basic like what the fuck is a hormone?
- [41:52]
B
Oh no, this is really important.
- [41:53]
A
But I'm like, if I'm confused by it, lord knows as 100% of the other people are.
- [41:59]
B
Yeah, sorry we were all over the place. But it's very fun talking to you. I would do that again too if you want to talk about other things.
- [42:05]
A
I love it. Thanks so much for joining us today. Yeah, 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 Masterclass 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.