Loading summary
Transcript1 lines
- [00:01]
A
Hey friends. Welcome to episode 277 of the YOU are not broken podcast. I can't freaking believe we're on episode 277. It's incredible. Okay, so big news. Before I get started on this amazing, ask me anything that I did over on Instagram a while ago. Number one book coming out September 10th. Get it for yourself or your partner or your sister or your lover or your girlfriend. Americans do not get taught sex ed. We get taught disease and pregnancy prevention plans. So about a year ago I did a TEDx called why Adults need sex ed. And before that I had actually self published this book that I just wanted to freaking get out. And it did so well that Sheldon Press, a subsidiary of Hachette, bought the rights and they're republishing it September 10th. It's called you are not broken. Stop shoulding all over your sex life. You can pre order it on Amazon and Barnes and Noble and pre orders count in letting everybody know how important this book is. So if you wouldn't mind, go get a copy for yourself and for your friends. And I can't thank you enough for supporting me and supporting this education and supporting the thought that women's health matters and should be as equally as important as everybody else's health in accessing care and medications and therapy for sexual dysfunction and hormones for their bodies at all times of their life when medically appropriate to help people thrive. So there's my plug. I'm going to be in Chicago for the menopause conference. That is going to be September. Book launch September 10th, Chicago the 11th through the 14th. We're going to do a dinner and we're going to do a cocktail hour for book launch events. It's going to be the Thursday and the Friday of that week in September. So follow me on Instagram and make sure you're on my email list to learn more about that. But that is going to be September 12th and 13th in Chicago. I'm then going to New York City the 15th through the 19th and we'll be doing book events September 16th and 17th. Currently those are the plans. So come on, come all. And when there's signups for things like those nights, I will be posting those over on Instagram. So enjoy the AMA episode. I cover a whole bunch of stuff from exercise after prolapse to perimenopause hormones to lots of other things. So I hope you enjoy this episode and hopefully I'll see you soon in Chicago and New York. All right. Love ya. 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. Hey everybody, welcome back to the you are not broken podcast. I have not done an Instagram Q and A in a long time. So I actually posted on Stories a little bit ago to tell me your questions and I got like 15 times, a lot of questions. I took a bunch of screenshots because it's hard to do everything on phones and all the things. So anyways, I don't know how many questions, but it's a ton. So I poured myself a cup of coffee. I am recording live for a future podcast. I'm on Instagram right now and I'm gonna go through a bunch of questions while I drink coffee. Coffee and questions. I haven't done a live Q A in a while. So here we go. Starting off the top. How do I do strength training? I've had erectocele repair and can't lift weights. Who says you can't lift weights? Where'd that come from? Of course you can lift weights after prolapse repair. So I'm a urologist, a surgeon who does a lot of prolapse repair incontinence work. In addition to my side gig of this, I'm hosting this amazing podcast. So I feel like I am pretty expert at answering this question. If somebody told you that after your prolapse repair you can no longer lift weights that's detrimental to your whole body. See all the reasons that lifting weights is good for you. So when I do a prolapse repair, we have no lifting over 10 pounds for about four to six weeks. We want our sutures to heal. But then I send you to physical therapy because I always tell people I can make I fix bulges, but I don't make you stronger. So you've gotta go and get strong. Bulges are hernias, right? So we need our core to be strong, we need our pelvic floor to be strong. We need to learn how to lift by engaging our core and not pushing out through the hole in our pelvis, which is where prolapse comes from. So I disagree with you not lifting weights. Get an opinion on that. Get a physical therapist on that and start doing some strength training. But make sure that you are getting evaluated for the pelvic floor and core so that you cannot hurt your repair. I did have somebody blow out her rectastyle repair because she was bailing hay, like legit the round bales of hay. So it Happens recurrence of prolapse over a woman's lifetime, about 1 in 5 or 20%. That means 80% of people's prolapse doesn't come back. Okay, great question to the start of this podcast number. Next, any research on menopause effects on gastrointestinal health? How about after hrt? Yeah, super interesting question. So our gut microbiome is dependent on many things. One of those things is hormones. There is some data that when estrogen levels go down, that your microbiome does change. Tends to look more like a gut microbiome of a man. And that's one question of. Is that why women's risk for colorectal cancer goes up after menopause? Is that one reason that in the WHI study, that risk for colon cancer was decreased by 30% for people who were taking hormones? So, yes, there is some research on menopause effects on GI health. Also, just a lot of people who kind of notice increased bloating. You know, GI changes after menopause. There's some work looking at microbiome probiotics post menopause. You'll see that in the, in the menopause supplement world. I'm not fully convinced a lot of more data needs to happen, basically. But yes, your microbiome does change when your hormones change. You guys, everything changes after your hormones change. Don't think this is just hot flashes and no periods. Real quick, what do you think about PTNs for your urgency incontinence? PTNs stands for peripheral tibial nerve stimulation. It's basically like a acupuncture needle in the tibial nerve down by the ankle. I think it's time consuming, meaning you have to come in a lot to get these treatments. And I think that it doesn't work as well as Botox or sacral neuromodulation. That said, they're coming out with the new implantable ones and they're coming out with the new ones that you can just strap on and have at home. So if you don't have to go into the clinic every week for this, it's certainly less time consuming. So I don't hate on it. I think that there are better options currently, but the future looks good. Okay, are there optimal levels of hormones for women 60, 70, and 80? We do not have enough data to answer this. I cannot tell you that you should be at a level of 50 or 80 or 120. We don't know. We don't have data to say what is the best estrogen level for brain protection. We, we're like, hardly saying, and I think we're just starting to say that estrogen is dementia protective. When started early, within 10 years. Hormones do not treat dementia, they prevent dementia. But you've got to start on it early. And we don't have levels to say, this level is great for bones, this level is great for heart, this level is great for brain. Likely our body. What we can say is bones respond at a very low level of hormones. But what do we need for skin? What do we need for a systemic level so that you don't need additional vaginal estrogen? Lots and lots of questions. Okay, what are top arguments for my gyne to put me on testosterone? I'm 46 and perimenopausal. Top arguments. First of all, it shouldn't be an argument, but maybe you're not thinking about it in that sense. So because you want to. There's something called bodily autonomy, which I think is being chipped away. But when I trained in medicine, it was called patient doctor shared decision making. And that was all the rage. Somehow that's like, gotten to the sidelines where, like, we just have to do what the doctor says who have not been trained in testosterone or menopause for that matter. So I think the top argument is at 40, your testosterone levels are 50% what they were when they were 20. There are many studies looking at the multitude of benefits of testosterone in women. At women physiologic doses. We're not trying to turn anybody into a man or live like a man unless they choose that it's a much higher dose, 10 times the dose. But if you have to go in and you have to argue with a provider about being on any hormones or testosterone, maybe it's time to see another provider. When I see women, women who come to see me tend to be very educated because they know what I do. They know my podcast, they know my Instagram, they know my books. So they tend to come in and they're like, I want to be on testosterone. And I'm like, great. I already know that they're educated and they know the pros and cons of it and the safety of it. But if a woman comes in and she doesn't know anything about hormones, I'm not pushy. Like, I'm not going to push her on it. This is her personal decision. She doesn't have the education enough to say that she wants it. I'm not going to push her on it. I'm going to say how good hormones are, but it's her decision. So it's her decision to not go on hormones. It's her decision to go on hormones. Bodily autonomy. If I try transdermal or testosterone suppositories, will I also suffer from acne hair loss? Side effect of testosterone supplementation is greasier skin acne and some hair growth on the face. Most people who get within a physiologic or slightly above physiologic female dose don't complain of this too much to the point that they want to stop. I don't know what you mean. With testosterone suppositories, it's not really a thing. Maybe you're talking about pellets. So if you're talking about pellets, pellets tend to push you at a much higher testosterone level. So that's when we see kind of like the shock to the system where you're going to see top of hair loss. But with the physiologic ranges that I get with either transdermal gel or a compounded cream, I'm not seeing much in the way of bother of certainly hair loss. Haven't seen it. So dosing matters. Check your level, see where you're at. And I always say start low, adjust to it, see if you like it. See if you like your level at being 80. See if you like your level being at 50. Pellets are going to put you into 150, 200, 250, 300. Those are not physiologic female doses. And I do think some people do better at those doses, but I don't think that's where we should be starting. Women with testosterone, cystocele versus rectocele difference and treatments, please. Okay, great question. Cystocele is the anterior part of the vagina sagging down. Rectocele is the posterior part of the vagina sagging in. Go back to my podcast literally called Prolapse. You can find it on my website too. Spend over an hour to talking about the difference between all of those and treatment plan surgical, non surgical. So very common and very treatable. Pelvic floor physical therapy is your friend. Breast tenderness since starting estradiol gel six months ago. B ID levels still low. I don't know what bid level still low means. And you're 63. We tend to have you back off a little bit. You could try some progesterone and testosterone. So play with it. Make sure you're seeing an expert who can adjust all those things for you. 54 in full hysterectomy OBGYN won't prescribe me progesterone, but online doc service will. Why? Good question. So progesterone is mandatory if you have a uterus to protect the endometrial lining from unopposed estradiol supplementation. So a lot of people will think that if you don't have a uterus you don't need progesterone. But progesterone is great. It works in the brain, great for mood, it's wonderful for sleep. So it's becoming more common now to be air quotes allowed to be on progesterone if you don't have a uterus. And where did that come from? It came from the synthetic medroxyprogesterone acetate, thinking that it's probably the bully from the WHI in regards to adverse effects so that we don't use that medication anymore for incredibly rarely and for other things. So that's kind of where the like no, no, no, you can't have it if you don't have a uterus came from. Of like trying to keep people off the synthetic but micronized progesterone, very safe, quite beneficial and you can be on it if you've had a hysterectomy. You guys, not all gynecologists know these things. So what I'm saying is see a hormone specialist if you can. And if they tell you something that isn't resonating with what the hormone experts are saying, it's probably because they don't have up to date menopause training. Risk of blood clots from estrogen patch not any higher than your risk of blood clots from living. It's transdermal. It doesn't go through your liver, therefore it doesn't increase your clotting factors. We have multiple papers on this. Understand the physiology, that's how you get rid of search at what dose do I start with? Testosterone gel. So testosterone gel, I think what you mean is the androgel or testum which is the male dosed product in America. You're going to start at 1/10 the dose and you're going to recheck your levels 6ish weeks after just to see if you've moved the needle and how you're feeling. And then you can always go up or go down. So 1/10 the male dose. If you compound that in a cream, it's going to be 5 milligrams a day. 65. Never took hormones. Still having hot flashes, have osteo and a leaky heart valve. Can I take hormones? Probably. Probably See an expert. Best window to start for prevention of disease is within 10 years. So transdermal is going to be safest. But yeah, see a specialist. You guys. One of my top listened to podcast episodes is called the Boomer should be Pissed. And the myth that you can't be on hormones after age 60 is not true. They simply say the greatest benefit and the least amount of risks is when you start on hormones before your body's adapted to not being on hormones because of aging. So you're just, you're just less. I'm sorry, you're just less healthy the older you are. So like there can be more risk to things, but the risks of starting hormones in an older person is still very, very low. I literally could open up a clinic just treating boomers and hormones because they're such an underserved population. Love your show. You've given me knowledge to have better conversations with my doctors. That's not a question, but I love it. It's a compliment. Thank you. Does deep infiltrating endometriosis mean you can't take estrogen and menopause? No. I have many women who've been surgically treated for endometriosis and who are now on hormones don't. Testosterone and progesterone. But many, many. There's actually a paper on this looking at recurrence of endometriosis with hormone replacement estrogen. It's incredibly rare. I was just on a group chat with a bunch of people including many gynecologists, and they're like, they haven't seen it. So many, many happy, older and you guys pause for the cause of. Stop oversimplifying things. Endometriosis is not just because of estrogen. If that was true, everybody who had estrogen would have endometriosis. It's not that simple. Therefore there's something else going on which we need to figure out. But it doesn't mean you can't have estrogen afterwards. I've never known anyone to be tested for progesterone. Why is that? Fantastic question. With blood work, the range for progesterone when you're not like cycling or trying to get do IVF is really low and it's very hard to interpret. And we never treat to a level anyways. So if you're having symptoms of low progesterone, we just treat you. It's like an incredibly safe medication. Why it's not over the counter, I'm not sure. But that's why you'll see saliva, people checking progesterone then you get into the weeds with like estrogen progesterone ratios. That's not standard menopause care. It's pretty nichy. And most people say for the average woman that's not necessary. I would only get into that if they were still having symptoms after like standard trial of medication. So yeah, we don't usually check progesterone. If T is out as option for females, what can help with low T? Why is T out as an option for females? That. That question doesn't even make any sense. We don't have an FDA approved testosterone dose in this country. That doesn't mean women can't take testosterone. There's lots of things we do off label. Remember, remember, the FDA does not practice medicine. The FDA will say we don't practice medicine. They can approve medications for indications, so they play a very important role. But just because they don't have a product at a dose that works for you doesn't mean you can't use that prescription. Besides how I feel, what are lab levels do I use as a guide for HRT and dosing? Great question. I think this goes back to like, people think there's like a one size fits all and we just need to dial you in to like all 50 year olds should be here. That's not how this works. You guys, we are all amazing, beautiful snowflakes. I care about how you feel. How do you feel? I don't chase numbers. I'll use numbers. If I'm like, you know, you're on a really high dose. Let's just make sure this isn't like crazy high inside your body. So I'll look for that. I had one woman, she swore up and down that low estrogen was why she wasn't sleeping. And she was on a very large dose of estrogen. So I checked it and her estrogen level was like a thousand. And she's like, is that good? And I'm like, not if you're pregnant. Like that's like a pregnant dose. I was like, I don't want you to live at a thousand. I don't have data to say what living at a thousand all the time does, because humans don't do that. So I'll check labs kind of to prove like you're absorbing the product or whatever you're feeling is not because of that hormone being low. If you have blood clotting issues, what are your safe options? Transdermal. Transdermal. Transdermal. Transdermal. Has research been done to verify if estradiol applied to face causes pigmentation. In some people. It can make. So they're talking about low dose facial estriol or estradiol to improve collagen, skin texture, thickness, reduce wrinkles in some people, especially if they're prone to melasma or have melasma, which is like a darkening irregularity of the skin. That product can increase the melasma. So in those people, I'd say maybe it's just not worth it for you. But in the average person, I haven't seen that it causes melasma. People are just saying it makes my melasma worse. So you already are kind of prone to being sensitive to have that going on. Somebody says they have reflux with starting estrogen and oral progesterone. Two months in options. Yeah, I would play around with other administrations. Is it the progesterone? Is it the estrogen? Play around with it and that's where you're gonna see. Need to see an expert on like options for that. Too much for a general use podcast education. What options for testosterone? Pills, creams, injections. Also, my OB GYN says no. Okay. Remember, OB GYNs didn't get trained on progest on testosterone. Most of them still think it's a male hormone. They're not always the best people to go to testosterone. Lots of different options. Oral. Kaiserrex is a brand name. Oral picky with oral. No. Compounded, no. Anything like that. Even the methyl testosterone is a synthetic testosterone. I stay away from it. There was a JAMA article looking at increased rates of breast cancer. So I don't like the methyl testosterone. So that's synthetic testosterone. This testosterone I like is bioidentical cream gel. So cream is compounded. Gel is dosed one tenth the male dose. You can inject it. You can. There's no patches in America right now for it. And then pill would be something like Kaisertrex where it is safe for the liver. I don't like troches. Probably they're transdermal. I just haven't seen enough data on safety. And if any of that gets into the hepatic system. Troches is something that goes in your cheek. So also don't forget pellets. You can get testosterone pellets. Almost forgot about testosterone pellets. Okay, any tips on what to do during broken ankle healing as no exercise is allowed? Yes, good question. I just had this because I just had kind of a knee injury and we lose muscle fast. So the question is, can you be on a like a sit down recumbent Bike with the other leg? Can you move the other leg? Can you do some upper body? Can you be laying down, supported with bench press and do upper body? So lots of different questions on that, but I would say you just stopping cold turkey is going to be your greatest risk of muscle loss for sure. So I'd say do it. Don't do anything. Let your ankle heal for sure. Don't stress that. But see what else you can do for the rest of your rest of your body. More questions. This is a great question. Dr. Stops effective test to gel treatment because my blood level's at 2.2 nanomole per liter. Why stop? So if you go into the balance, it's like balance hormones. I think it's Louise Newsom's. I don't know. I just google testosterone unit conversion because America uses deciliters, not nanograms per liter. So I had to convert that. So what you're saying is your Testosterone's at like 62American units. That's perfectly great. I. Women are super happy at that level. It's not too high. And I'm sorry your doctor stopped you for that. I wouldn't have. I would have said, yay, a happy woman on testosterone. Is DHEA the same as testosterone or different? Okay. DHEA is a precursor hormone, dihydroandrostenedione, and it converts into both testosterone and estrogen. It's an oral supplement in America. It's a prescription in other countries. And the studies are mixed as far as oral goes to women. I find that prescription hormone replacement therapy works a lot better. It's rare that I see a woman who's like, I just took a DHEA supplement and I'm super happy. It's rare that that's enough to do much. So I tend to just go for estrogen, progesterone, testosterone, then mess with oral supplements. If you take an oral DHEA supplement and you're happy on it, great. It's probably safe. It's just that I don't think it's a legitimate treatment and it can't make up for using prescription grade. Here's a question. We all want prescription grade health skin care. Like, literally, people advertise that, like, prescription quality, prescription grade, blah, blah, blah. And like, people freak out about hormones. I'm like, it's prescription grade hormones standardized. It's good stuff. Now, DHEA in the vagina, which in America is a prescription, it's called Intrarosa or prasterone. It's expensive, but I love it. It is so good. It makes Beautiful, beautiful vulvas and vaginas. I hope that helped. It's not the same. Not the same as testosterone. All right, we're gonna keep answering some questions. You guys sent in such amazing questions. You talk about high levels of estrone. Estrone. Less common estrogen in the body. 17. Beta estradiol is the most common, which goes down after menopause. Estrone is. I don't have guidelines. I don't have the menopause society telling me this. This is my research. Probably the baddie in regards to inflammation. It's made by adipose tissue. We know adipose. Too much adipose tissue is just a baddie anyways. We don't know what to do as far as measuring that, trying to get that down. That's. I'm getting into the weeds here, and it's going to generate, like, more questions than I want to deal with from you guys. But I think. I think you guys can handle the fact that we don't know a lot of this stuff. Most people won't check estrone. So what do I say? Be as healthy as you can. Make sure you don't have too much adipose tissue, because that is adipose tissue can make its own estrogen and it makes estrone. And that might be the baddie in regards to breast cancer, but I'm not standing on a bunch of firm legs on this. It's kind of the fringy. Fringy. More research needs to be done. Part of things. Will you please talk about the outcomes of consenting to unwanted sex? Sometimes a byproduct of scheduling sex, hoping for responsive desire. Which fails. Fantastic question. I'm not sure we can really consent to unwanted sex. I'm not sure that's consent then, because part of consent is being willing to say yes, and then part of consent is being able to un consent at any time. The heteronormative world of sex is very linear. We start being intimate, and it must end in orgasm and penetration. Right? And think of that as just one theory of what sex is. And you gotta break yourself from that habit because literally Hollywood slams that paradigm down your throat. You are allowed to say, like, you know what? I'm just not in the mood today. Erections are allowed to get soft. Vaginas are allowed to get dry. You're allowed to get a charley horse in a cramp. Like, you're allowed to stop having sex. That's called agency. Just because you start things doesn't mean it has to end in any certain way. So most people are going to Say never, never do unwanted sex. You can schedule sex that's different than unwanted sex. If you schedule sex and it's unwanted, then you don't have to do it. Scheduling sex is really to set apart time for the experience of pleasure, for the experience of being close to somebody. It doesn't mean do things you don't want to do. And responsive desire doesn't always show up. Responsive desire isn't showing up. Give yourself an opportunity to, like, journal about that later or reflect on that. Was your mind too active? Are you stressed? Is your body in pain? Be curious as to why the response of desire was something painful. Did you not have enough clitoral stimulation? Did you penetrate too quickly? Be curious. Why? Because there will be an answer to that. And I think that is going to be part of your solution. Explain fsh. Follicle stimulating hormone. It is produced in the brain and it goes up in menopause because it's trying to get the ovaries to give some estrogen. And the ovaries don't give the estrogen, so the FSH stays up. I think there's. There's amazing research being done on kind of the chicken and egg of all of this. Is menopause starting in the ovary because the ovary is declining, or does menopause start in the brain and something in the brain triggers the ovary to stop producing hormones? We don't know. People who think they know don't know enough. How do you know when you're an expert, you know you're an expert when you know that we don't know. A lot of. Does all T just get converted to E and the benefit is felt because E ultimately goes up. Fantastic question. The answer is no. How do we know this? What if we did a study where we gave women testosterone and we blocked its conversion to estrogen? Oh, we've done that in breast cancer patients, breast cancer survivor patients. So they're on aromatase inhibitors which block the conversion to estrogen. Hot flashes got better, moods got better, Joint aches and pains got better, sleep got better. Estrogen remained undetectable. What does this mean? This means testosterone can help menopause symptoms. So, no, if anybody says, I don't want to give you testosterone because it's just going to convert to estrogen. Yeah, some of it will convert to estrogen, but that's not why testosterone's working. Testosterone's working because you have testosterone receptors everywhere. Because you have a body that has testosterone receptors everywhere. Because you have ovaries that make four times the Amount of testosterone compared to the amount of estrogen that you make. Nobody knows this. Welcome to my world. All right, if you're having issues with the estrogen patch, which is better, estrogen gel or spray? See what your insurance covers. Go cheap. First, HRT for people deemed high risk for stroke. Higher than normal blood pressure. Do what you can to get your blood pressure down. Blood pressure kills people. Transdermal. Pretty darn safe. See an expert who can calculate your cardiac risk factors. You need to optimize that. You guys, your health is not set in stone. You can do things to get healthier. Not all the time, but I think so many people, like, you're just stuck with this face tattoo of how your body is and you have no idea the power to modify that with your mindset, with your exercise, with your diet, with your sleep, with your stress. So to me, I'm like, optimize this stuff. Why are we sitting back, just saying, it is how it is? Like, get as healthy as you can. This is your only spaceship. Like, take care of your spaceship 49 with PCOS. I feel like I'm a forgotten person because I'm still having periods. Help. Well, because you are a forgotten person. It's called perimenopause. Some people don't even think it exists. Many people suffer profoundly in perimenopause and need help. See an expert. See a hormone specialist who's not afraid of pcos. See what your symptoms are. See how we can help you with progesterone. See how we can help you with some estrogen. See how we can help you with some non hormonal things. Is your insulin optimized? What's your fasting blood glucose? Are you exercising regularly? Are you sleeping? So don't ever think that I'm like, just into hormones. Hormones are amazing tools that I think are necessary for healthy body functions, but they don't exist in a bubble of otherwise neglecting your body. Why do so many health studies exclude women over 55? It's like, we older women don't matter. It's because older women don't matter. Like, legitimately, the money is going to pregnancy, fertility, abnormal bleeding, all the things. So you need to tell them you matter. Get loud. Write your congresspeople, Tell them you want more studies on older people. Tell them you want more studies on longevity. Tell them you want more studies on hormones. Get loud. You telling me, like, I can get a little bit loud for you, but get loud to the people who control the purse strings. Next time I'm going to ask you Guys to just give me sex stuff because it's like so hormones, but it's what you guys are interested in. Well, this is the best question. When are all the misogynists being replaced with real doctors that care about us? You guys, you may not know this medicine is a patriarchal craft. It was started by men. Women were excluded. Women have only been researched in regards to what their uterus does. We're literally trying to turn a big ship here. So, and here's my other theory. In the current health insurance driven world, doctors don't have time to care about you. They have 10 minutes, they've got 20 people after you. They need to write a note, they need to answer all the phone calls. Oh, and also they're on call. So the ER is calling. I know this because I am one. So it's very hard to find somebody who cares in 10 minutes. How do you care about somebody in 10 minutes? You don't care about somebody in 10 minutes. Right? So like, that's why getting somebody and like the doctor patient relationship is precious. And that's why it's worth going in every year just to touch base. Because that relationship is how you build caring. Let's see, what else treatment options for SSRI induced sexual dysfunction other than changing the antidepressant? You could change the antidepressant. You could come try to wean off the antidepressant. You could try adding Wellbutrin or Buspar to the antidepressant off label. But there are some studies. You can try Viagra. Oral women. Yes. You can try testosterone. You can try Flibanserin. You can try valise. What did I just give you? I just gave you like five different things you could try. So, yeah, completely common. I saw one paper, it's like 80% of people on SSRIs have sexual dysfunction. Like, if they don't tell you that when they're like, hey, antidepressants work about as well as placebo for about 80% of people who are on them. Plus they give you sexual dysfunction. You should have informed consent. Also, these things are really hard to get off of. So. And anytime anybody says this, we've gotta say, just like birth control. Birth control is good, but it has side effects. SSRIs can be good, but they have side effects. Okay, what do you do if your sex hormone binding globulin is high? Do you bother with hrt? Sex hormone binding globulin is a protein made by the liver that binds, as it says, hormones. So it's just Less free hormone to circulate and be active in the body? No, you can definitely be on hormones. It's just you might need more hormones to get the desired effect because you kind of gotta like push through the sex hormone binding globulin part to get enough that is gonna be free hormones. You just might need higher doses. Is it better to go to your GP or OB GYN to ask for hormones? Well, if either one of them says hormone specialist on their website, go to that one first. Being a certain type of doctor does not indicate knowledge in hormones. So I wouldn't say one versus the other on that one. Will using progesterone vaginally affect stress incontinence more than orally? No data on that. Is testosterone safe for those with slightly elevated liver enzymes? Stop drinking alcohol if you haven't already. Livers are precious transdermal transdermal. The limited data we have does not affect liver. But for, for me, I would just check your liver function tests a couple of weeks after starting testosterone and make sure you didn't bump anything up. But some people will say liver disease or cirrhosis is a contraindication to hormones. I don't think it's that black and white. Certainly liver failure is very different than slightly elevated liver enzymes. So I think everybody's going to be nuanced on that one. Does vaginal estrogen help with queefs? Mmm, very good. It can. Queefing can be. It's just air trapped in the vagina. So if you have more moisture in there, you might have less like room for air trapping because everything's more like touching and moisturized. So it's possible. Give it a try. Not FDA approved for queefs, but nothing ever is going to be FDA approved for queefs. I'm no longer prescribed vaginal hormones. Now I get systemic hrt. How do I convince her I need both? Tell her like 30 to 50% of people need to be on both. Systemic hormones for menopause is not a lot of hormones, you guys. Many people need vaginal hormones still because it's still so low dose. Tell her that. What are the side effects of too much testosterone? Acne, hair growth, hair loss, voice deepening, clitoral enlargement. You're gonna start seeing that at male levels, which you can see with some high dose pellets. But with the transdermal gels and creams, it's very hard on a standard dose to push a woman into a male level with that 47 on my third marina IUD, no period. Normal labs. How do I Prove perimenopause to doctor? Proved by math. Average age of menopause is 51. So perimenopause is within 8 to 10 years. So by definition, 47 is perimenopause. There's no blood test for perimenopause, you guys. So you just are in perimenopause because you're 47. If you're having symptoms treat you, periods are irrelevant. Periods are irrelevant. Lots of people have IUDs and hysterectomies and ablations. They don't have any periods to tell them anything. And periods are not a marker of it's time to start hormones. Or not. Like anybody who doesn't know that isn't a hormone expert. What's your opinion on surgically induced menopause in mid-30s with no hormones? This is not my opinion. This is multiple studies. Young women who have surgically induced menopause who aren't on hormones die younger, have worse heart disease, have more dementia. It's not good. See somebody about hormone options. Like, that's like as much as we're like, hey, do what you want in menopause with hormones. If you're young and surgically induced menopause experts say be on hormones until at least average age of menopause because you have higher risk of death, heart disease and dementia. We know that. How can I get testosterone? No one will prescribe it to me. Bring in the testosterone guidelines. International Society for the Study of Women's Sexual Health. It's on my link tree and Instagram. Print out the guidelines. It's free online. International guidelines for testosterone for low desire. Bring them in. Tell them you want to learn with you. Is testosterone pellet form safe for patients with hypercoagulable diseases? Yeah, I mean, I think transdermal is your safest and I always like to jump to pellets after you're good on transdermal because I don't like 0 to 300 where you can get super high dose and it's irreversible. So I never say go zero to testosterone pellet. I think we should go zero to testosterone gel or cream and then a pellet if you're somebody who thrives at a higher dose and doesn't want the daily application. So there is some nice plug and play with testosterone pellets. But yeah, from the data that we have, transdermal does not increase clot risk with testosterone. Thoughts on acupuncture therapy to help female sexual dysfunction? Yes. Won't hurt you Might help you got some data. Helps with stress, helps with calming the body, helps with all of the things. So female sexual dysfunction is not one thing, you guys, it's multiple things. So you can't be like oh, testosterone is going to help all of it. Acupuncture is going to help all of it. See an expert. But I don't think acupuncture is going to hurt hurt you. Thoughts on perimenopause and birth control pills? Good idea or not so good? Do you need to prevent pregnancy? Because then it's a good idea if you don't need to prevent pregnancy. You aren't partnered with somebody with sperm or your partner who has sperm has a vasectomy or you have had a hysterectomy. Right? There's many reasons that you do not need to protect yourself from pregnancy. Then don't use the synthetic, high high dose synthetic meds which are birth control pills. Use the bioidentical natural low dose hormones which are estradiol, progesterone, testosterone. Estradiol, progesterone, testosterone does not prevent pregnancy. So if you need to prevent yourself from getting pregnant, if you have sperm in your life, then birth control is what you need. IUD then you can take all the other hormones. Where in your body is the best place for absorption of testosterone Cream. I have not seen that study done. Most people do thighs because if you get hair growth, most people don't care because they shave and if they don't shave they don't care about hair growth anyways. So what else do we got? Who will prescribe me estring and testosterone as a HR positive breast cancer survivor hormone experts Will. I would many people who are experts will. There are many people who are breast cancer survivors who are on hormones. We've got some data to support that. Multiple studies. There's always a risk of recurrence. But from what we can tell hormones don't increase your risk of recurrence. So you just need to see somebody who is educated and knows what they're doing. What are my recommended lubes? I like silicone. I hate cold lubes. I hate sticky tacky lubes. I hate all the. Basically that's like most water based lubes. So get stuff without any coloring, flavoring, scent or taste unless you want some novelty. But I just think like less is better when it comes to added shit in your vulva. So silicone lubes. I love uber lube. They do make silicone water based hybrids which are kind of nice. Best of both worlds. I'm to the point in my life where I just don't give a shit about silicone and silicone toys like you do. You know, if you wreck your frickin silicone toy because you use too much silicone lube, you're using it a lot. Ask me how I know. I just like it. And I don't want to have multiple lubes for am I going to use a toy or not? I don't want to deal with that. Keep it simple. All right, last page of questions. You guys are amazing. Could topical estrogen be helpful in alleviating peripheral neuropathy pain? Yeah, I think it's worth a try. There's multiple studies looking at the hormone modulation of pain receptors. There's multiple studies saying women's pain pain scores go down when they're on hormones. So can I go as far as being like, you're going to be cured from peripheral neuropathy? No. But do I think estrogen also testosterone. Testosterone works quite well in decreasing pain. So yeah, I think why not try it? So you guys, that is it. I've done a ton of Q and a. That's like 40 minutes. I love you so much. Follow me on Instagram for more. And if you like these Q and A sessions where it's just me rambling, let me know because then I'll do more podcasts like this. So thank you much. Oh, yeah, look, somebody said my pain dropped with hrt. Yeah. All right, guys, I love you. Until next time. Thank you for listening to this week's episode of you are not Broken. If you want to dig deeper with me, sign up for my adult sex education masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. 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 in consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of Medicine, in case you were curious about that. And no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember, you are not broken.