278. Demystifying Testosterone in Women: Beyond Libido

Summary

Podcast Summary: You Are Not Broken, Ep. 278

Title: Demystifying Testosterone in Women: Beyond Libido
Air Date: August 18, 2024
Host: Dr. Kelly Casperson, MD
Guest: Carolyn Laboucher

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Episode Overview

This engaging episode features Dr. Kelly Casperson, urologist and sex medicine specialist, joining Carolyn Laboucher for a candid, science-backed conversation about testosterone in women—exploring its roles far beyond libido. The discussion aims to dispel myths, address dosing and side effects, and empower women to advocate for their wellbeing through better hormonal understanding.

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Key Discussion Points & Insights

1. Testosterone: The Underdog Hormone

• Dr. Casperson introduces testosterone as her “favorite hormone”, lamenting how it’s often overshadowed by estrogen in women’s health conversations.

  “Testosterone is this very kind of cool, quiet, badass... the underdog for women because there’s so many biases against it.” (05:56)

• She highlights surprising cognitive and motivational benefits reported by her patients—memory recall, curiosity, productivity—emphasizing that it’s “not just for libido.”

  “One woman was like, the German I learned as a child is coming back. This is a brain hormone.” (06:18)

2. Common Myths & Medical Bias

• Many women and even clinicians incorrectly believe testosterone is only for men, or that it’s dangerous for women.

  “I asked a doctor about testosterone for women. He laughed... ‘If you want a penis, take testosterone’—that’s shocking.” (07:44)

• Dr. Casperson explains that all bodies make testosterone, and women in their 30s have four times the testosterone as estrogen. The hormone declines linearly with age—well before menopause.

  “You can still have periods and have low hormones... That’s another myth.” (08:41)

3. Hormone Therapy After 65 & Medical Misinformation

• Misinterpretation of research guidelines has led to myths that hormone therapy cannot be started after age 60, which is not the case.

  “The guidelines say the safest window to start is earlier... but I have many women that I start on [HRT] at 72.” (10:21)

• Testosterone therapy is not contraindicated post-menopause and may provide benefits at any age.

4. The Role of the Urologist in Women’s Health

• Urologists like Dr. Casperson often see women for persistent genitourinary symptoms (UTIs, dryness, pain) that respond well to local estrogen and sometimes testosterone.

  “All of these things are menopause issues... I got into hormones because of seeing all these women suffering.” (12:12)

5. Biopsychosocial Nature of Sexual Desire

• Lowered libido in women is often pathologized as psychological, but biological factors like hormones are equally valid.

  “Men are allowed to have low testosterone, and we’re allowed to help them. Women... are allowed to have low desire because of a biologic reason.” (13:29)

• Dr. Casperson reiterates that pain, lack of lubrication, and hormonal changes all influence desire.

6. Addyi / Flibanserin—The “Female Viagra”

• The drug Addyi (flibanserin) is FDA approved for low desire in women, but rarely discussed or prescribed. It’s a daily pill that works in the brain and may improve sleep and mild weight loss.

  “Most women will describe it as subtle but welcome.” (16:42)

7. Testosterone Application, Dosing, and Side Effects

• Standard practice is to start with testing, use physiologic (low) doses, and monitor effects.

  “We dose for the female physiologic dose. We’re not trying to give you a higher dose, a man’s dose, or any other dose.” (01:14)

• Side effects (like chin hair) are usually mild and manageable; serious masculinizing side effects are rare at proper dosing.

  “When you play with hormones, sometimes there’s side effects... You don’t get all the wonderful things with zero hair growth.” (17:17)

8. Benefits Beyond Libido

• Research suggests testosterone may decrease breast cancer risk, improve bone and muscle health, support brain function, and potentially protect the heart.

  “There’s two papers where women on testosterone have a 50% decreased risk of breast cancer... bone, muscle, brain... cognitive benefits, heart protective.” (19:24–20:08)

9. Access and Product Issues

• No FDA-approved female testosterone products exist in the U.S.; women must use compounded or male-formulated versions, which complicates research and dosing.

• Pellets for testosterone delivery are discouraged due to high, sudden dosing.

  “Pellets take people from zero to Everest basecamp fast... a shock to the system.” (29:33)

10. Testing, Monitoring, and Personalization

• Dr. Casperson focuses on patient experiences and symptoms rather than lab numbers alone.

  “How do you feel? Are you happy where you are?... I don’t like to give people a range because people will obsess about it.” (25:18)

• DHEA is discussed as an alternative, but it is unregulated and generally less effective post-menopause.

11. Natural vs. Medicalized Aging

• Arguments against hormones based on “what’s natural” are challenged:

  “Dying after childbirth one in eight times is actually what natural is... we have no idea how to live to 95 and do it well.” (34:08-35:59)

12. Systemic Healthcare Bias

• The medical system is set up to treat (not prevent) disease, placing the burden on women to self-advocate.

  “It’s a burden on women that they have to go get a second opinion, advocate for themselves...” (36:33)

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Notable Quotes & Memorable Moments

• “Testosterone is my favorite hormone... It’s the underdog for women.” — Dr. Kelly Casperson (05:56)
• “One woman was like, the German I learned as a child is coming back. This is a brain hormone.” — Dr. Kelly Casperson (06:18)
• “Doctors did not get taught this. I did not get taught this in med school.” — Dr. Kelly Casperson (07:56)
• “We don’t diagnose low libido by a testosterone level... it’s a personal choice.” — Dr. Kelly Casperson (31:07)
• “If you take perimenopausal women and you put them on estrogen, it decreases the risk of getting diabetes at one year by 30%... If that was a drug, it would be a blockbuster.” (37:45)
• “You are not broken. Women think they’re broken...” — Dr. Kelly Casperson (36:03)

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Timestamps for Key Segments

• Hormone Introduction & Micropractice Announcement: 00:00 – 04:32
• Testosterone in Female Physiology & Myths: 05:49 – 09:35
• Age & Hormone Therapy After 65: 09:43 – 11:58
• Why See a Urologist? (UTIs, menopause & sex issues): 12:12 – 13:29
• Biopsychosocial Desire, Pain, and New Medications: 13:29 – 16:38
• Testosterone Dosing, Application, Side Effects: 16:50 – 18:54
• Benefits Beyond Libido: 19:21 – 20:44
• Testosterone Without HRT & Lifestyle Boosts: 20:44 – 22:12
• Pellets, DHEA, Safety, and Testing: 27:13 – 31:07
• Naturalism Myths, Longevity, and Medical System Bias: 32:48 – 37:45
• Diabetes Risk Reduction & Advocacy: 37:45 – 39:00

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Takeaways & Next Steps

• Testosterone is vital in women’s health—impacting cognition, muscle, bone, and mood—not just libido.
• Medical and societal myths block women’s access to evidence-based hormone therapy.
• Individualized care and education are essential. Women should feel empowered to advocate for their needs and seek practitioners with sex medicine expertise.
• Dr. Casperson recommends the International Society for the Study of Women’s Sexual Health (Ishwish.org) for finding knowledgeable providers.

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Resources Mentioned

• ISHWISH (International Society for the Study of Women’s Sexual Health): www.ishwish.org
• Dr. Kelly Casperson Clinic & Book Info: kellycaspersonmd.com

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For further learning and support:

• Listen to Dr. Casperson’s back catalog/“Boomers Should Be Pissed” episode
• Pre-order her book “You Are Not Broken” (September 10th release)
• Check eligibility and resources for HRT/testosterone through trusted medical providers

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Summary prepared for those seeking clarity, empowerment, and truth bombs on women’s hormones and midlife wellbeing.

Transcript

[Dr. Kelly Casperson]

Hey everybody, welcome to episode number 278 on the you are not broken podcast. This is a live Instagram live that I did with my new friend Carolyn laboucher. She is British based in Dubai and she's got a huge Instagram following. She's absolutely amazing and her interest is in thriving in midlife. So she asked me to come on to her Instagram to do a live about hormones and testosterone and it was so good I needed to share it with you all on the podcast. So as usual, you should know this is not individualized medical attention, right? This is for general education and entertainment purposes only. Please see your own specialist for your own individual needs for testosterone. The best people to find for female testosterone, that is a generalized find a find a provider practitioner would be the Ishwish website, International Society for the study of Women's sexual Health or ishwish.org you can go to find a provider. These people are cool because they sit in the Venn diagram of sex med and hormones. So they're pretty well versed in testosterone specifically for low libido or hypoactive sexual desire disorder, which is currently the most air quotes legitimate reason for a female to receive testosterone. But there are many other benefits. I see it all the time in my clinic. When women come back, the cognitive benefits are pretty darn impressive. Remember, testosterone is a hormone that is made in the adrenals, the ovaries and the testes, also made in the brain. And we have testosterone receptors everywhere. And also remember that libido is a mood. Mood comes from the brain, therefore testosterone works in the brain. So anybody who says testosterone is just for libido, I don't think understands the complexity of this power hormone. So and remember, when we dose for females, we dose for the female physiologic dose. We're not trying to give you a higher dose, a man's dose or any other dose. So see an expert. With that comes my announcement of I am opening a micro practice specializing in testosterone hormones and sex med soft openings last quarter 2024. Large. Large.

Was that a heart?

Opening January 2, 2025 it's going to be very small micro practice. I want a deep dive. I want to listen to women's stories deeply. I want at least an hour with you. I want to drink coffee with you. And to do that I need to create a very sacred special space that does not cowtow to insurance companies or hospitals or anybody telling me how to practice medicine. So check out kellycaspersonmd.com go to the clinic webpage sign up because I this is a micro practice. I am not going to see many people. And yes, currently you must come or be in Washington State to see me because that's where I live and this next chapter in my life is just as much serving me and being the doctor that I want to be as serving you. And to do that deeply, I actually don't need to get a lot of other state licenses because I don't want to see that many people. This is a micro practice so if you want to get in on the ground floor, get on that website because I'm not going to see 25 patients a day anymore. Just not going to happen. But there are other great companies I talk about a lot of them on here that can help you with your hormone needs. If you don't want to come see me, but Casperson Clinic is coming soon to a Washington state hopefully near you. All right, the Other Thing pre order the book you are not broken. Stop shooting all over your sex life to share with your friends, your lovers, your sisters, your neighbors, your girlfriends, your wives, your husbands, all the people who can benefit from adult sex ed since we never got any sex ed that included pleasure whatsoever or how to enjoy it in a long term monogamous relationship. So whether you're partnered or single, middle aged or younger than that, you will benefit from this book. Go pre order it. It comes out September 10th and I will talk to you soon. I hope you enjoy this conversation with me and Carolyn. See you soon. 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.

[Carolyn Laboucher]

Kelly, thank you so much for joining me. Love your hair by the way. Thank you. I tried to do you but this is all I got.

[Dr. Kelly Casperson]

Your hair's fabulous as it is.

[Carolyn Laboucher]

I'd also like to point out that everybody here in the resort, when they are new, they all have to wear this badge saying I'm still learning. And I thought I should wear it because I'm sure you are going to teach a lot today. Let's start Testosterone. It is a journey. Many women say, I'm not on it, I don't need it. I think I was put on, kind of scared me because I started getting whiskers and I thought that's the male thing so why am I doing it? Because it's a male thing. And you put it so well when you were talking about the Viagra. And Viagra has been given to all These men. And who are the men sleeping with? I never thought of it that way. So go forth.

[Dr. Kelly Casperson]

Well, testosterone is. It's my favorite hormone. I think estrogen gets all of the press.

[Carolyn Laboucher]

Yes.

[Dr. Kelly Casperson]

Gets completely ignored like an ugly stepsister. She's important, but she gets ignored. And then testosterone is this very kind of cool, quiet, badass. And so maybe that's why I like testosterone the best. But I like the underdog. And I think that testosterone is the underdog for women because there's so many biases against it. There's so many fears. And when I put women on testosterone and they come back, the stuff they tell me, like, one woman was like, the German I learned as a child is coming back. This is a brain hormone. People say, I'm more curious. My husband says, I'm asking more questions. Done around the house. Of course, libido is good. I actually see results in the gym. Like the things that women say when they come back using testosterone. It's not just libido. And I think we've put testosterone in a corner for women, and we've said it's only for libido. And so women who don't have partners or don't have trouble with libido, they're like, am I supposed to lie? Right? Because we've given it one thing. And then I challenge women to say this. I said, what's libido? Libido is a mood. Where do moods come from? Moods come from the brain. Okay, so what you're saying is testosterone improves moods in the brain. And they're like, oh, yes. It's not just for libido. So I love it. And you got to go back two steps, because women don't. Women, doctors, men, nobody knows. Testosterone is in all bodies. And when we are young and menstruating, having periods, let's pick our 30s. We actually have four times the testosterone in our body than estrogen. Whatever. Your hormones are, like, online.

[Carolyn Laboucher]

Oh, look at. Looking. Looking at this. Okay. I asked a doctor about testosterone for women. He laughs at me and said, if you want a penis, take testosterone. It's not for women. That's shocking.

[Dr. Kelly Casperson]

It's shocking. It's awful. But here's the thing. Doctors did not get taught this. I did not get taught this in medical school. I had to go learn when I started, when I started being very interested in female sexual health and female hormones. Ovaries make testosterone. Only through ovaries making testosterone do we then make estrogen. Testosterone comes first on the estrogen pathway from cholesterol. That's easy for anybody to find out. But if you think that testosterone is just for men, then you're not curious about it. Right? Right. Now, first of all, testosterone will not give you a penis. But if you take testosterone at male doses, which is 10 times a female dose, things change in your body. But women, it's really one tenth the dose. To get us kind of where we were functioning before menopause, perimenopause. And I think the other myth, if we're talking about myths of testosterone today, testosterone starts going down well before your periods start. So so many people think of menopause like a cliff, Right. Your periods end, and now we have no hormones over here, which is not true for really any of the hormones. But estrogen kind of does. This progesterone kind of goes down before the periods, but testosterone does, like a linear decline starting way over here. So certainly in your 30s, you're going to start to see a low testosterone, and you can still have periods and have low hormones. That's another myth that's out there because so many people will say, my doctor said I can't start any hormones until my periods are done.

[Carolyn Laboucher]

Yeah. And then other doctors will say, no, you've gone through menopause, you're post menopause. You don't need any hormones now.

[Dr. Kelly Casperson]

Well, you don't need glasses and you don't need hearing aids and you don't need a hip replacement, and we shouldn't take care of our teeth. Like, where does it stop? You know? And why is the bias just on ovaries?

[Carolyn Laboucher]

Yes, totally. So one of them, you said hormones past 65, which is fascinating also.

[Dr. Kelly Casperson]

Oh, that you can take hormones after 65.

[Carolyn Laboucher]

Well, I'm going to say I luckily have a doctor who says if they work for you, you keep taking them until you don't want to take them anymore. Yes, people do think that if they're post menopause, they. We didn't ever go on hrt. I'm post menopause now. It's too late. I don't need it now.

[Dr. Kelly Casperson]

So one of my podcasts, I have a podcast where I talk a lot about this. And one of my best listened to podcasts, still, it's old. It's called the boomers should be pissed. And the reason for that is when we scared everybody off of estrogen, we started figuring out, okay, well, who's the safest? Who can we start on estrogen? And the guidelines came out and they said it's safest to start it within 10 years after menopause roughly age 60 people took that statement to say, you can't have it after age 60. That's not what the guidelines say. The guidelines say the safest window to start is earlier, before your body's already suffered the changes because of chronic low hormones. So I have many women that I start on. There are 72. They're worried about their bones, you know, and so they're worried about their energy. So I see many women who are past that window because I'm an expert, because I understand the data. And yes, there may be a very slight increased risk starting it older. But if you're healthy, you're fit, your heart's healthy, and you use a transdermal estrogen product, it's incredibly safe. Incredibly safe. And I would say again, that statement had nothing to do with testosterone. So testosterone is not a contraindication either. And I think progesterone is also incredibly safe. I haven't seen any data to say these hormones aren't. It's the estrogen one that got misinterpreted because of that safety window.

[Carolyn Laboucher]

I'm having a real problem saying this today. A urologist. So I'm thinking, why would I come and see you? I didn't know. I thought that would just be if I had incontinence.

[Dr. Kelly Casperson]

Yes. So you would, you would come to see me for recurrent urinary tract infections, bladder leakage, pain with sex, burning with urination. All of these things are menopause issues. And so I connected the dots and I said, why is everybody coming to see me eight, after they've been suffering for eight years? These are all helped by vaginal estrogen, especially just local estrogen. Incredibly safe. You can start that at any age. You can start your 92 year old mother on vaginal estrogen. It's perfectly safe. And so I got into hormones, systemic hormones, because of seeing all these women coming in with menopause symptoms that they had. NEO was menopause because it was your blab. And their sex life because I care about women's sex life.

[Carolyn Laboucher]

Now also, I have been to see somebody about my sex life because, as you also mentioned, I feel sorry for my husband. I adore my husband. He's the kindest, sweetest, handsomest, everything but I just don't feel like it. But I wouldn't come and say a urologist. I have been to a therapist to talk about why I don't like it. That's what I did.

[Dr. Kelly Casperson]

Yeah.

[Carolyn Laboucher]

It didn't fix the problem.

[Dr. Kelly Casperson]

Right. I mean, that's what's so what's so wonderful about sexual desire? Wonderful and complicated, because sexual desire is biopsychosocial. And what that means is it could be talk therapy. We could be delving into body image issues. We could be delving into the marriage relationship. We could be delving into stress. Right. Like all of the psychosocial things that really affect our sex drive. But women are allowed to be biologic creatures, just like men are. Right. And I think that's another bias. Like, men are allowed to have low testosterone, and we're allowed to help them. Women are allowed to have low desire because of a biologic reason, and we're allowed to help them, but we just think all the women just need therapists. Yes, all that.

[Carolyn Laboucher]

Or we just say to each other, you know, girls sitting together, they say, I really don't want sex, sex night. And they all say, no, nor do I. And then the odd person will say, oh, my God, I have sex every night. And then you sort of get back in your shell and think, yes, I'm one of those people.

[Dr. Kelly Casperson]

Yeah. I mean, things I think of, number one, is their pain. If a woman's having pain with sex, she does not desire sex. You can't. You can't desire hitting your thumb with a hammer. So we always talk about pain. Is there any pain lubrication? Because perimenopause and post menopause is incredibly common because you have thinning of the tissue. We actually need estrogen and testosterone to have supple, lubricated, good collagen down in our tissues, in our vulva and vagina. So I'm always thinking about hormones and pain. And then we're thinking, is it the dopamine in America? It's coming to Europe, it's not in Australia. So this is not a worldwide availability. We have a medication now here called Addi or Flavanza.

[Carolyn Laboucher]

I've seen you talk about that.

[Dr. Kelly Casperson]

It was on people.com yesterday, which is. Which is a big website here. So I just did a reel on it. Been around for a long time. Five, six years, and nobody talks about it. It's rarely prescribed yet Viagra came out in 1997, and it's a blockbuster drug. Yeah, right. And it's like, if you're fixing all the erections, 90% of them want to be sleeping with a female. We have to help the woman.

[Carolyn Laboucher]

Yes, please.

[Dr. Kelly Casperson]

So, Addie, just real quick. It's FDA approved in America for low desire. It works on dopamine in the brain, once a day pill, and you can sleep as a side effect. But like good sleep. Because we know how sleep is an issue in perimenopause and menopause and then mild weight loss. So it's like the side effects aren't that bad for most people. Some people get cut.

[Carolyn Laboucher]

You say it's FDA approved. Is it available in other countries? Do we know? And is it the same name coming Europe?

[Dr. Kelly Casperson]

I don't have a timeline.

[Carolyn Laboucher]

Right. I'm gonna get. Get some of my shopping baskets.

[Dr. Kelly Casperson]

I don't know where it is in the uk okay.

[Carolyn Laboucher]

Why is that not. Why didn't we know about this before? That there was something that was going to. And is it something that I'm gonna take it for a week and then I'm suddenly gonna start wanting?

[Dr. Kelly Casperson]

Yeah, I mean, it's, it's an interesting. You're not gonna like, wake up home horny, but your interest is going to be.

[Carolyn Laboucher]

Ah.

[Dr. Kelly Casperson]

Most women will describe it as subtle but welcome.

[Carolyn Laboucher]

Okay. And is there testosterone? Sorry, go ahead.

[Dr. Kelly Casperson]

Testosterone helps libido too. Not for everybody.

[Carolyn Laboucher]

No, it doesn't do that for me. But it is a confidence giver. I think when in menopause, you begin to lose your confidence a little bit. But what about the blooming whiskers?

[Dr. Kelly Casperson]

Well, we have many, many ways to take care of hair on chin, my dear. We can tweezers, laser. We can pluck it, we can shave it, we can electrolyte it. All this stuff, testosterone promotes hair growth. It doesn't mean you're going to turn into a man. But my saying is when you play with hormones, sometimes there's side effects.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

And you don't get all the wonderful things of testosterone with zero hair growth. Some people, some people, I get a little bit. A little bit. They'll notice a little more acne than normal, but it tends to be pretty subtle. And some people say then it goes away. And then if it's a lot, I always check doses. If women are on way too high of a dose, I want to bring them down.

[Carolyn Laboucher]

Right. And also I'm putting it on the inside of my arm and then I get the odd longer hair on the inside of my arm or the inside of my thigh.

[Dr. Kelly Casperson]

Luckily, a lot of people will put.

[Carolyn Laboucher]

I can now see I didn't used to be able to see it.

[Dr. Kelly Casperson]

Yeah, yeah, exactly. That's so good. Yeah. A lot of women will put it on their legs because a lot of women will shave. And so they don't notice any hair growth on the legs.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

Because they shave.

[Carolyn Laboucher]

Now dose, I am using men's testosterone, which comes in a Little silver sachet. So you buy a box of X number of sachets and then I just squeeze out, well, probably half a nail. And then I use that. That's per day. Is. Does that sound all right? Do you start that and then check blood or how does it work?

[Dr. Kelly Casperson]

I always check blood beforehand and just to know where you are. And then I check in at about six weeks. But doing what you're doing, it's very hard to get too high of a dose.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

Most women just get a very nice physiologic dose where they're like. It's subtle, but I'm glad I'm on it. Some women will be like, I'm back, baby.

[Carolyn Laboucher]

Yes. Yeah, absolutely.

[Dr. Kelly Casperson]

Yeah. But a lot of women will be like, I feel more like myself again. It's a brain hormone. So feeling like yourself is very hard to study. But I would say one of the most important things we can do is to feel like yourself again.

[Carolyn Laboucher]

I'm sure that it gives your confidence back. We get the same benefits that men do naturally by taking it. I mean, we're not getting male benefits.

[Dr. Kelly Casperson]

No, you're not.

[Carolyn Laboucher]

Tell me the benefits, man.

[Dr. Kelly Casperson]

This. This sounds too good to be true, but there's about two papers on this. There's two papers where women on testosterone have a 50% decreased risk of breast cancer.

[Carolyn Laboucher]

Two papers.

[Dr. Kelly Casperson]

I. We're not researching that more. So that is.

[Carolyn Laboucher]

That's quite shocking.

[Dr. Kelly Casperson]

Shocking. Bone, health. Muscle. Muscle. Lean body, brain. We have dementia data in men. It has not been studied in women as much, but we've got some data to suggest that testosterone is heart protective. So to me, it's cognitive. There's a lot of cognitive benefits. Just women saying, like, I can think sharper, I have more interest in the world. So to me, I'm like, that cognitive benefit has to be great for dementia prevention. You need more studies. But it's so biased, we don't even believe it's in women's bodies. So it's very hard to do research on it. We don't have a female dosed product. That's very hard to do.

[Carolyn Laboucher]

Exactly. That's why I'm using men's stuff.

[Dr. Kelly Casperson]

Yeah. So women are pushed out to the sidelines of medicine to use a men's product to get a compounding dose. It's hard to research when we can't standard. We don't have a standardized dose. But I'd say for a business opportunity, 50% or 100% of women have low testosterone. Big market. Why aren't people jumping on board?

[Carolyn Laboucher]

Now one person saying, can I take testosterone if I'm not on hrt?

[Dr. Kelly Casperson]

Yeah. Again, this. I can't give medical advice on Instagram. You have to come see me. But how I think about it. If there's some reason that you can't be on estrogen or progesterone, which is very. A rare reason that you can't be on those things. Yeah, there's a lot of myths, but you can be on all of them for most people. But for, let's say, let's say a woman, she's got a reason that she can't be on estrogen, most likely she can still be on testosterone.

[Carolyn Laboucher]

So you would just say that alone? Yeah. Can we increase testosterone naturally?

[Dr. Kelly Casperson]

Good question. In the perimenopause, when you still have ovarian function, regular sleep, a clean diet, get rid of alcohol, marijuana, any drugs that are toxic to hormone producing organs. Smoking is horrible for the ovaries. Horrible. People who smoke go into menopause 10 years earlier. Wow. Yeah, it's dramatic. So any sort of smoking, stop it. Weightlifting and getting your body mass. Trying to get your body mass to more lean body mass than fat tissue, because fat tissue will convert your testosterone to estrogen. So you want more lean body mass. So yeah, you can, to a point. And then your ovaries are done. And then it just still do all of those things. But it's time for supplementation.

[Carolyn Laboucher]

Right. There are so many subjects that I want to talk to you about, but we must. I stay on the one. Stay focused. You are magical. And we need more of you.

[Dr. Kelly Casperson]

I was saying I love this topic. It's my favorite thing. Getting women to feel better is my drug. It's so awesome.

[Carolyn Laboucher]

We do need to do, I think a specific sex one at a later date, if that's all right. I need to talk to you about that. My husband is so grateful. So do you mind if I ask you some of the questions?

[Dr. Kelly Casperson]

Yeah, let's do it. That's fun.

[Carolyn Laboucher]

Okay. How do you test if your ovaries are done producing eggs?

[Dr. Kelly Casperson]

Oh, good question. So if you're. If you are done with periods naturally, that's a good sign that you don't have fertility left. But if you actually want to say, like, how many eggs do I have left? That's an infertility specialist question. And they can do blood work basically to make a gauge of how many eggs that you have left.

[Carolyn Laboucher]

Right. Okay. Still, I don't know why I wouldn't have. Why would go and see a urologist? It's just, it's so interesting.

[Dr. Kelly Casperson]

Clarify. Not all urologists have my interest.

[Carolyn Laboucher]

Right. And you are based where?

[Dr. Kelly Casperson]

I'm in Washington State, north of Seattle.

[Carolyn Laboucher]

Okay. One thing, I was getting my testosterone compounded and it was very expensive. So luckily my doctor said go and get men's version, which is the same as compounded.

[Dr. Kelly Casperson]

I mean, for the most part compounded is nice because they dose it properly. So usually you can just go.

[Carolyn Laboucher]

You do the pump.

[Dr. Kelly Casperson]

Nice. But yeah, I mean, I'd say they're mostly, for all intents and purposes, very similar.

[Carolyn Laboucher]

Right. And application, I do leg the other thing.

[Dr. Kelly Casperson]

So with any cream, hormones, cream, gel, hormones, there is a risk of transferring it to kids, other people, if you, if you hug them or touch them and stuff like that. So that's why a lot of you

[Carolyn Laboucher]

touching your husband, then

[Dr. Kelly Casperson]

how much he's got in his body. But with small kids, grandkids, stuff like that, to put on the inner thigh and then put on pants. So you're not going to transport to anybody.

[Carolyn Laboucher]

That's so interesting. No one has ever said that blood levels. What dose of blood level should you have when supplementing with testosterone?

[Dr. Kelly Casperson]

Good question. So it's hard to answer because the US numbers are different than the like than the Europe numbers and the Australian numbers.

[Carolyn Laboucher]

Is that because we're all.

[Dr. Kelly Casperson]

And the different. But we do it in deciliters. Deciliters per milliliter. You guys do it in nanomoles per liter. They're just different units.

[Carolyn Laboucher]

All right.

[Dr. Kelly Casperson]

But the other thing to say about that question is people get obsessed about numbers when you give them numbers. And if I say 62 is the right number, then people will obsess about how close to 62 they are. And that's not how I practice medicine. How I practice medicine is how do you feel? Are you happy where you are?

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

Do you have any signs? I check the number because I just want to know in the background that it's in the range that I, that I like. And I'm going to use that number with talking to you on if I think it should go up or down to try to dial in of like I need to get. Why isn't it. It was at 64 and now it's at 61. And it's like that's not how labs work.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

They fluctuate. So I don't like to give people a range because people will obsess about it.

[Carolyn Laboucher]

Right. Okay. I think that's very fair advice. Dhea, I took this and a lovely gynecologist lady said that she was Going to try it, because she had never tried it. So we both tried it at the same time. I didn't notice any difference at all.

[Dr. Kelly Casperson]

So DHEA in America, DHEA is over the counter.

[Carolyn Laboucher]

It's a supplement, which is where I got it.

[Dr. Kelly Casperson]

Yeah. Very easy to get, but it's unregulated. It comes in a bunch of different doses and you never can trust that what's on the label is in the product.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

That's how unregulated industry is. Just. So it's always. It's very hard for me to talk about something that I'm like, I don't know if your 10mg of DHEA has 10mg of DHEA in it.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

That aside, DHEA is a precursor hormone that actually converts into estrogen and testosterone, but it doesn't do it very well in most bodies. Meaning we need more data. But perimenopause probably gets a better benefit from it than postmenopause. Right. Because you need to convert a little bit more is one way of thinking about it. So it's very safe. It's not going to hurt. You start with a low dose, 5 milligrams, 10 milligrams. It comes in massive supplement doses in this country because men take it. To start with the low dose, I noticed oily skin and I had crazy sex dreams on it. And that's about it. Crazy sex dreams and oily skin. And I was like, I can take this or leave this.

[Carolyn Laboucher]

Okay. All right. And I don't remember any of those symptoms. My doctor is making noises about reducing my testosterone because she says they don't know if there is a cardio risk.

[Dr. Kelly Casperson]

Yeah, we do. There's a lot of papers on that.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

Can I be blunt? Just to make people think for a hot second. Okay. Do people take 10 times the dose to transition and live as males? Yes. There are transgender men.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

Have they been this for decades? Yes. Do we have papers studying them to see if they die? Yes. You can give a woman 10 times the dose so she can live as a man. And she does really great. We've got great studies on that. I do that point to, say, me giving you testosterone to get you to where you were in your 30s. We've got 10 times the dose safety data.

[Carolyn Laboucher]

Right. Good point. Love it.

[Dr. Kelly Casperson]

I just like people like, oh, my God, it could be so scary. And it's like, people take 10 times the dose on purpose. They're called trans men. We've got papers on them. They do great. You're gonna be fine. And if you have a heart rate like your heart risk is your heart risk based upon your genetic dial, blah, blah, blah. People are gonna have things happen to them. It's not because they're hor.

[Carolyn Laboucher]

Yeah, Pellets. I don't know anything about those.

[Dr. Kelly Casperson]

Yeah. So testosterone pellets are very high dose, very common in the US Again, why? Why are pellets common? Pellets are common because we don't have an approved female dose. Women are pushed to the sidelines of medicine to try to get this hormone. And what pellets do. This is my analogy. If you're at on the Mediterranean Ocean in Turkey and I fly you to Everest base Camp, you're gonna feel kind of crappy because it's too fast, too high, too fast. Right, right. So I want to take you from the Mediterranean Ocean to the Rocky Mountains in America. Right, right. I'm gonna give you a little bit of elevation, but you're not gonna feel bad on it. So pellets take people from zero to Everest base Camp fast. And that's where shock to the system. And a lot of people do poorly with that. So that's why I like the creams and the gels, because it's like, I want to get you physiologic. Do I think some women do better at higher doses? Yes, But I would get you there very slowly. A lot of experts will say if you're going to do pellets, get there slowly, it's the 0 to 300 that it goes very poorly for people.

[Carolyn Laboucher]

Right, okay. That's very sensible. What does testosterone do after surgical menopause?

[Dr. Kelly Casperson]

So ovaries make testosterone. Surgical menopause takes out the entire factory. So it tends to be a little more dramatic because you don't have the physiologic time of the ovaries slowing down. Right. And even after. After your period, stop. Your ovaries still make some testosterone. So I've seen a woman, she's been in menopause for 10 years, then she gets her ovaries removed, and she's like, this is awful. I can't get off the couch. I have no energy. I'm crying all the time. I'm foggy. And they're like, we don't know what's wrong with you. It's like, well, you took her little bit of testosterone out on Tuesday. And so some women, even after menopause, will notice a big change after their ovaries come out. And so, yeah, the thing about surgical menopause is that It's. It's fast, right? Because it puts it in the bucket.

[Carolyn Laboucher]

When do you advise testosterone is there? What lab results?

[Dr. Kelly Casperson]

It's how you feel. See, people are obsessed with labs because in. In our culture, our culture of being women, we want to be perfect, we want to be the best, we want to do it right. We want to follow the rules. Right? And I'm like, but how do you feel? How do you feel? What do you want to improve in your life? And then I can tell you if testosterone might help you or not. We don't diagnose low libido by a testosterone level. We don't check a testosterone level and say, now it's time to start. Like, that's not how it works. We're not cookie cutters. You know, is it the same, Is

[Carolyn Laboucher]

it like estrogen, that it's different today to tomorrow or this morning to this evening?

[Dr. Kelly Casperson]

If you did blood tests for perimenopause. Yeah, right. But post menopause, not postmenopause, some women will still make enough testosterone because the ovaries will still make Testosterone. But it's 50% the testosterone you had in your 30s, right? Hormones right now, they're not approved for prevention of disease. So nobody's going to say, oh, you should start at 47. Nobody's going to say that. Right? It may be some doctors who are going to say that, but, like, from, like, a medical perspective, there's no, like, you have to start or you should start. This is a personal choice at this point, and I don't see that changing. We're not going to say you need to do this to prevent whatever. Nobody's ever going to say that with hormones. This is a personal choice based upon a conversation with you and hopefully an educated doctor to hear what your goals are and to help you try them and adjust them and see if they are great for you.

[Carolyn Laboucher]

Do you think going back to human nature, sort of cavemen era we were not supposed to have. That is an argument that some women have. We've done our thing. We've had the babies. We now don't need to be independent or brave or any of those things.

[Dr. Kelly Casperson]

Here's the deal. Let's look at longevity data, because that's fun. Everybody remembers the one great aunt who lived long. But if you look at longevity data going back as far as we can document history, as long as people kept track of how people live, average age, and this is factoring in for infant mortality, to all the statistic nerds out there, average age, 45, 47. 52, maybe 54. And these were. What did we keep track of? We kept track of the wealthy men. So this is as good as it got. We have wealthy men longevity data. So, yeah, we're going to live probably four or five years past menopause, and then you're going to die. Why are we living longer? Sanitation, clean water, antibiotics, excellent trauma care.

[Carolyn Laboucher]

Right.

[Dr. Kelly Casperson]

Antibiotics alone, which I would argue people are like, only do what's natural. Antibiotics aren't natural. They're a medicine that we created to help people. Right. So the natural argument will piss me off. It's like, don't take. Don't floss then, because flossing is not natural. Or wear shoes. But we are at a time in our world where we are living longer than we've ever lived before. We have no idea how to live to 95 and do it well. We're like the first generation that's trying to figure that out. So to me, I'm like, you've got 40 years with low hormones. And hormones are messengers. It's all they are. They're not magical. They're messengers to cells, to help cells function. Well, if you're going to want to live unnaturally for 30 to 40 years, you might want to do some unnatural things like brushing your teeth, wearing glasses, getting eye surgery, taking hormones. But when people take hormones and they make them exceptional, right? Like, I want to be natural. Like, well, don't drive a car. We get very shitty on women and hormones and. And when I step back and I'm like, listen, we don't know how to get to 92 as a population with health, but we want to figure that out.

[Carolyn Laboucher]

Yes.

[Dr. Kelly Casperson]

And I think we're part of figuring out how to get to 92 with health, not with 10 prescription medications for broken bodies that we don't exercise, that we, you know, like, to me, I'm like, no, it's not natural. But dying after childbirth one in eight times is actually what natural is. And none of us are going to sign up for that.

[Carolyn Laboucher]

And talking about broken, that's your book. I am not broken.

[Dr. Kelly Casperson]

I'm not broken. You are not.

[Carolyn Laboucher]

You are not broken.

[Dr. Kelly Casperson]

Women think they're broken. And I just kept hearing it over and over when I started talking to them about their sex life because we didn't get education. And when you get women education, they can make smart decisions.

[Carolyn Laboucher]

That's what it's about. And also finding the right doctors, that is so hard, knowing which doctor to trust. And if you don't like the information, go and speak to Another one.

[Dr. Kelly Casperson]

It's a burden on women that they have to go get a second opinion, a third opinion, advocate for themselves. I can only speak for American America, but I know Europe's no better. I know Canada's probably worse. UK is probably a little bit ahead. But our medical system, it's designed to treat disease.

[Carolyn Laboucher]

Yes.

[Dr. Kelly Casperson]

It's not to prevent disease and be thriving and be healthy and to not get osteoporosis and to not get dementia and to not get diabetes. That's not how the medical system set up. Yeah. And when you understand that, you can understand. Oh, that's why I have to bring up the conversation about hormones. I have to bring up my sex life. I have to bring skin care, you know, because those are healthy things to, to, to manage and to keep healthy instead of like you're broken. And this is an interesting thing. If you take perimenopausal women and you put them on hormones, estrogen, estrogen, hormones is what they're talking about. It decreases the risk of getting diabetes at one year by 30%.

[Carolyn Laboucher]

Wow. Never heard that one.

[Dr. Kelly Casperson]

If that was a drug. If that was a drug, it would be a blockbuster drug. It would be on every guidelines. Any pre diabetic woman would be put on it.

[Carolyn Laboucher]

Yes.

[Dr. Kelly Casperson]

30, reduction in diabetes. Those save our country's million of dollars. Yeah. But they're not prioritized. And I think it's a great loss in society. Yeah. There's. In Canada, this is interesting. In Canada, birth controls free. Those birth control is free, but hormone replacement therapy is not free. So women will stay on their birth control because it's kind of like hormones. It's like synthetic hormones. They'll stay on them as long as they can because it's going to be expensive when they actually have to switch to what your body naturally makes.

[Carolyn Laboucher]

Yeah. Yeah. Well, I think we should love and leave you. I love every minute of this. Thank you so much for sharing. I do think we need to talk about the sex issue at some point. I'm sure we will upset some people, but if you would like to join us. And Kelly, if you would do that with me, I would love to do that. Thank you very, very much. And don't forget, everybody get the book. Thanks very, very much.

[Dr. Kelly Casperson]

Talk to you soon. Bye.

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 and 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.