279. Top Menopause Hormone Myths - Busted!

Summary

You Are Not Broken – Episode 279

Top Menopause Hormone Myths – Busted!

Date: August 25, 2024
Host: Dr. Kelly Casperson, MD
Guest: Dr. Naomi Potter (Menopause Specialist, UK)

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Episode Overview

Dr. Kelly Casperson hosts a dynamic conversation with UK menopause specialist Dr. Naomi Potter, busting common myths about menopause hormones. They tackle the most pervasive misconceptions around vaginal estrogen, hormone replacement therapy (HRT), testosterone, and women’s health advocacy, all with a science-based, relatable, and empowering tone. The episode aims to educate and dispel fear, while encouraging women to advocate for their own health.

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Key Discussion Points & Insights

1. Addressing Vaginal Estrogen Myths

[04:10 – 10:11]

• Scaring Women Away:

  • Both the US and UK require boxed warnings or scary leaflets about blood clots, heart disease, and cancers on all estrogen-containing products due to outdated data (Women's Health Initiative).

    “It says blood clot, heart disease, stroke, probable dementia... on a product that has not ever been shown to cause any of those things.”
    (Casperson, 04:20)

• Patient Reactions:

  • Many women are frightened into avoiding treatment because of these warnings, especially if clinicians don’t pre-warn them.

• Advocacy for Change:

  • Recent efforts (as of 2024) to convince the FDA to remove boxed warnings from vaginal estrogen are ongoing, with more data now supporting its safety.

    “We got so much more data since 2018 saying how safe it is.”
    (Casperson, 05:59)

• Benefits and Safety:

  • Vaginal estrogen is both safe and offers significant benefits, notably:
    • Reduces urinary tract infections (UTIs) by 50%
    • Can save significant healthcare costs and improve quality of life for older women

    “If everybody... over the age of 65... was just mailed a box of vaginal estrogen, it would save $1.2 billion a year in urinary tract infections alone.”
    (Casperson, 06:19)

• No ‘Too Old’ for Vaginal Estrogen:

  • Suitable for use at any age, with no "window of opportunity."

    “You can start your 91 year old mother on vaginal estrogen. Any age.”
    (Casperson, 07:09)

• Breast Cancer & Other Contraindications:

  • Generally safe even in women with a history of migraines or family history of breast cancer; oncologist consultation is courtesy, not always necessity.

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2. Prevention vs. Treatment Mindset

[09:46 – 10:38]

• The hosts compare cultural acceptance of preventive care in teeth and skin to the resistance found in vaginal and hormone care.

  “We floss our teeth... twice a day. We do stuff to protect our teeth... why aren’t we doing that with more things?”
  (Casperson, 10:00 & 10:36)

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3. Systemic Hormone Therapy (HRT): When, Who, and Why

[11:01 – 16:32]

• Systemic HRT Defined:

  • Distinction between local/topical and systemic hormone therapies.
  • In the UK, more women (approx. 15%) are on HRT compared to the US due to easier access and less stigma.

• Who Should Start HRT?

  • Textbook answer: when symptomatic ("when you’re symptomatic enough").
  • But new data support broader, possibly preventive usage within ten years of menopause for brain, bone, and heart health—even in women with few symptoms.

    “Should they be excluded from this amazing hormone because they’re not symptomatic?”
    (Casperson, 12:30)

• Public Perception and Education Gaps:

  • Despite growing evidence, public fear lingers, often reinforced by doctors still trained under outdated WHI (Women’s Health Initiative) fears.

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4. Breast Cancer & ‘Over-Medicalizing’ Women’s Midlife Health

[13:53 – 16:32]

• Risk Context:

  • Breast cancer is the headline-grabber, but risks are often exaggerated compared to actual data.
  • Comparisons are made: society doesn’t hesitate to prescribe antidepressants (even when rates are high and efficacy may be low for menopause symptoms).

• No Drug Reduces Mortality Like HRT:

  "There is no medication that decreases mortality except for hormones. If I’m wrong, somebody please tell me."
  (Casperson, 14:32)

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5. Turning the Tide — Who Drives Change?

[15:45 – 17:58]

• Both hosts agree: change will come from grassroots advocacy—educated women advocating for themselves—because most clinicians are too overwhelmed to initiate systemic shifts.

  “This is really a grassroots healthcare [movement]... we have the data. We just need women going in saying, ‘I want hormones for X, Y, and Z.’"
  (Casperson, 16:15)

• Media Influence and Backlash:

  • Media figures (e.g., Davina McCall, Halle Berry, Michelle Obama) are helping normalize conversations, but sometimes face accusations of fueling a "bandwagon effect."
  • Hostility toward increased HRT demand is often rooted in sexism and double standards.

    “When a man comes in and says he wants help with his erections and low libido, we don’t ask if he’s suffering enough.”
    (Casperson, 18:17)
    “Our tolerance for women suffering is greater than our tolerance for men suffering, you know, and until we believe women, women need to be believed.”
    (Casperson, 19:31)

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6. Testosterone: The Female Experience

[20:12 – 24:22]

• Barriers:

  • UK requires documented "distressingly low libido" post-estrogenization before prescribing testosterone.
  • Access to appropriate formulations (like Androfem) differs; UK has it, US generally does not.

    “Are you suffering enough to get a hormone that your body naturally makes but goes lower with age?”
    (Casperson, 20:51)

• Testosterone’s True Role:

  • Libido is not an isolated symptom; testosterone is a brain hormone influencing mood, energy, and function.

    “Libido is a mood. Mood is from the brain. Testosterone acts in the brain. Testosterone is a brain hormone...”
    (Casperson, 21:27)

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7. Access Disparities & the Cost of Care

[23:07 – 26:17]

• Comparing Costs:

  • Androfem in UK: ~£100 for three months (considered high by NHS standards).
  • UK’s over-the-counter vaginal estrogen (Gina) is seen as a breakthrough in the US, but considered expensive in the UK.

• Access Meant for the Privileged?

  • Disparities risk widening: “We’re going to start seeing more health disparities between the educated privileged and the people who don’t have that.”
    (Casperson, 25:37)

• Societal Impacts:

  • Keeping women healthy and in the workforce has broad, positive societal effects.

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8. The “Natural” Myth

[27:37 – 29:30]

• Challenging 'Natural':

  • Many women want to be 'natural,' but what’s truly natural in the modern context?
  • Living decades beyond menopause is not natural—enabled only by medicine, especially antibiotics.

    “Living to 95 is not natural... we’re only living that long because we have antibiotics and... trauma care.”
    (Casperson, 27:46)

• Antibiotics Changed Life Expectancy:

  “There’s a paper that says, on average, the average life is extended 26 years because of the invention of antibiotics.”
  (Casperson, 28:56)

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9. Empowerment Through Information

[29:48 – 30:42]

• Changing Mindsets:

  • Women often arrive with fear and fixed mindsets. Providing data, personalizing questions, and future-forward thinking helps them make more empowered decisions.

    “You give them the data and then... they make good decisions. They just don’t have the information. So that’s our job.”
    (Casperson, 29:48)

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Notable Quotes & Memorable Moments

• On Misleading Warnings:

  “It’s got these really strong warnings on a product that has not ever been shown to cause any of those things.”
  (Casperson, 04:20)

• On Societal Double Standards:

  “When a man comes in... we don’t ask him if he’s suffering enough.”
  (Casperson, 18:17)

• On Being 'Natural':

  “There’s, like, the stigma of doing it naturally is very interesting... Living to 95 is not natural.”
  (Casperson, 27:46)

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Timestamps for Important Segments

| Timestamp | Topic | |---------------|--------------------------------------------------------| | 04:10 | Vaginal estrogen scare tactics and FDA warnings | | 06:19 | Vaginal estrogen reduces UTIs, potential huge savings | | 07:09 | “Any age” candidacy for vaginal estrogen | | 09:07 | Breast cancer, contraindications, and prevention focus | | 11:01 | Local vs. systemic hormone therapy explained | | 12:30 | Preventative HRT, expanding indications | | 14:32 | “No drug decreases mortality except hormones” | | 16:15 | Grassroots advocacy: women driving change | | 18:17 | Sexism, double standards in treatment | | 20:51 | Testosterone guidelines: “are you suffering enough?” | | 21:27 | Testosterone is a brain hormone/mood booster | | 25:37 | Access, privilege, and health disparities | | 27:37 | The “natural” myth debunked | | 28:56 | Antibiotics extended life expectancy by 26 years | | 29:48 | Empowerment and changing mindsets |

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Tone & Takeaways

Mixing humor, science, and practical advice, Drs. Casperson and Potter advocate loudly for women’s autonomy, evidence-driven health choices, and equitable care. Their discussion cuts through fear and misinformation, delivering candid, up-to-date insights meant to empower women at any age to take charge of their menopausal and midlife journey.

Bottom line:

• Vaginal estrogen and HRT are safe and beneficial for most; outdated warnings cost women health and happiness.
• “Natural” aging myths don’t reflect today’s realities.
• Systemic change will come from informed, empowered women demanding better—together.

Transcript

[Dr. Kelly Casperson]

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[Podcast Host (Dr. Kelly Casperson)]

Welcome back to the you are not broken podcast, episode 279. This is a Instagram live I did with Dr. Naomi Potter, who is a brilliant menopause specialist in the uk and we talk about myths and misperceptions of hormones, specifically the myths and misperceptions around vaginal estrogen and testosterone and hormone replacement therapy in general. So we're here for some general education. Remember, this is not individual medical advice. Go see your own doctor or practitioner for, for your own needs. And if you want to come see me, I am opening the Casperson Clinic soft opening October, November, December of this year and then open officially in 2025. This is a micro practice where I dive deep. I want to know you and I want to spend a lot of time with you. So if you are interested in that sort of relationship with one of, I'd say five, maybe five female urologists, experts in sex, med and hormones in the country of America, probably four others. And I'm friends with them all. So come hang out with me. There's not a. There's not a lot of me's in the world, my friends. And we're going to go deep.

[Dr. Kelly Casperson]

So.

[Podcast Host (Dr. Kelly Casperson)]

Kellycaspersonmd.com and you can check out the clinic page and sign up for the emails to learn more. And I will see you in September in Chicago for the Menopause Society meeting, which I'm super excited about. Going to do some book events Thursday and Friday at the menopause meeting, um, and then fly my patootie to New York City on September 14th to have some book events on the 16th and 17th. If you're not on my email list or follow me on Instagram, that's where I will be announcing all of the tickets and where I'm going to be for all these amazing events for the re release of you are not broken. Stop shoulding all over your sex life. My amazing little gem of a book, teaching sex ed in a very funny, approachable, friendly, empowering way. I hope you pre order it. It's coming out soon, September 10th. I'm so proud to re release this to the bigger audience. You can pre order it in Canada, uk, Australia. If you're in a country and you can't see that you can pre order it, please message me because I can talk to people about that, but it is international. This is what's so cool about this release is it's going to be international. So I'm manifesting being flown to Australia to speak at the Sydney Opera House first quarter of 2025. So anybody who can make that happen, let me know. All right, you guys, I love you and I hope you enjoy this Q and A with me and Dr. Naomi Potter. 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.

[Dr. Naomi Potter]

So we thought we would just get on and talk about all of the things that patients or ladies worry about in terms of risk and in terms of can they, can't they, that kind of thing. So should we start with vaginal estrogen?

[Dr. Kelly Casperson]

It's a great place to start.

[Dr. Naomi Potter]

So in this country, and I'm assuming it's the same with you, it comes with a very scary leaflet on the inside. Do you have the same?

[Dr. Kelly Casperson]

Yeah, we have what we call the FDA boxed warning, which they put on after the Women's Health Initiative on anything that contains estrogen, no matter the dose, no matter the location of the product. So it says blood clot, heart disease, stroke, probable dementia. It's got these really strong warnings on a product that has not ever been shown to cause any of those things.

[Dr. Naomi Potter]

And that's the problem, isn't it? Because whatever medication it is that you buy or you're prescribed, it's an instinct to read the information leaflet, isn't it? And then if there's something like that in the box, what do you do? And I suspect that a lot of these boxes just end up inside people's bathroom cabinets, never to be used.

[Dr. Kelly Casperson]

Yeah, I mean, some people never read them and then some People read them with a magnifying glass and then don't use the product. Especially if the doctor doesn't ahead of time say, hey, if you are a person who reads labels, this is what it's going to say.

[Dr. Naomi Potter]

Yeah.

[Dr. Kelly Casperson]

A team that I'm part of, I couldn't be there, but a team that I'm part of met with the FDA in America last week to petition to take the boxed warning off of vaginal estrogen. So it's very exciting. The last petition to do that was like 2018, roughly, and it failed. The FDA said we don't have enough evidence. So last week was the next attempt to try to take that off of the box warning. And it's going to be a slow process, but they got the meeting.

[Dr. Naomi Potter]

Okay, well, that's a step in the right direction, isn't it?

[Dr. Kelly Casperson]

Yeah. And we do, we do believe otherwise we wouldn't be doing this, that we do have enough evidence to say it's safe. We're not just saying, like, oh, you're scaring people of, like, we've got so much more data since 2018 saying how safe it is.

[Dr. Naomi Potter]

Yeah. And it's not only safe, is it. It's got advantages.

[Dr. Kelly Casperson]

It decreases urinary tract infections by 50%. There's an interesting paper. Dr. Rachel Rubin did a paper, and she said if everybody in America on our national, basically health insurance over the age of 65, if everybody with a vagina was just mailed a box of vaginal estrogen, it would save 1.2 billion a year in urinary tract infections alone.

[Dr. Naomi Potter]

Wow. And then. And then even. And if you take cost out of it, if you think about, you know, the number of hospital days and the number of deaths in older women from urinary tract infections, I mean, you know, as a junior doctor, we used to see it all the time, little old ladies coming in with urinary tract infections. And some of them don't make it out, do they?

[Dr. Kelly Casperson]

Yeah. I mean, the worst case scenario is these things kill you, especially if you're frail, you know, and you don't have a lot of resiliency. And I think what's an exciting part of the conversation is we're starting to say, like, is frailty does that. Is it inevitable or are there things that we can do to not end up in the hospital with recurrent urinary tract infections when we're 82? And for people who don't know, you can be on vaginal estrogen at any age, you can start your 91 year old mother on vaginal estrogen. Any age to be on vaginal estrogen. There's no window of opportunity for it.

[Dr. Naomi Potter]

And isn't it amazing the difference in quality of life when you do start? Women who are much older on. Because it's just like a revelation, isn't it? It's not. It doesn't even take that long to work for them to see the benefits. And they're just like, why did I not do this all those years ago?

[Dr. Kelly Casperson]

It's noticeable, like, just the burning, the irritation, getting up at night to pee, all a lot of bladder things. I think urologists are getting better and better. But I joke, I'm like, I give out vaginal estrogen 15 times a day. You can't make it through my clinic without me giving you vaginal estrogen because it's so good for the bladder. Yeah.

[Dr. Naomi Potter]

So hopefully. So we've had a few questions here. So things like migraines with aura, or we just say migraines, you can use it. Migraines with aura, use it.

[Dr. Kelly Casperson]

Not a problem.

[Dr. Naomi Potter]

Family history of breast cancer, Not a problem. And breast cancer is. The one that everybody worries about, is nips. I don't know how you do it in the United States, but if we have a patient who's had breast cancer, then we liaise with their breast cancer team. But it's a kind of courtesy. We do it out of courtesy more than anything else. Because for most women, even if you've had breast cancer, using vaginal estrogen is safe and also it can be beneficial.

[Dr. Kelly Casperson]

Yeah, absolutely. I mean, I like to emphasize, like, all breast cancer is not created equal. Right. We call this disease one thing, and it's really like 25 different things. So it really, you know, depends upon how are you currently getting treatment. Okay, we're going to be telling your oncologist a little bit more that we're going to do this, but women are suffering. Most of these women aren't coming in wondering about preventative vaginal estrogen. The rest of us just want to start when we're 50, you know, which I think is a. Is. That's a conversation at least healthy women in the US are having. Because is it enough to treat disease once we have it, or should we really be talking about prevention?

[Dr. Naomi Potter]

In every other kind of aspect of medicine, we seem to be talking about prevention so much more, don't we? Like, even if it's. Even if it's not medicine, even if it's just that appearance, you start using skin moisturizers when you're 15, you know,

[Dr. Kelly Casperson]

we floss our teeth, like we do. We do a lot. Twice a day. We do stuff to like, to protect our teeth. You know, we don't think about brushing. Brushing our teeth as prevention.

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[Dr. Naomi Potter]

Whoever branded the whole kind of teeth brushing thing was onto a massive winner, weren't they? Whenever they. Because it's no different, is it? It's absolutely no different. You look at. Why are your teeth any different to anything else? It's just one part. And you think about the hours that we spend brushing our teeth in our lives.

[Dr. Kelly Casperson]

You go to. Well, at least in America, a standard is we go to the dentist twice a year just for cleaning and prevention.

[Dr. Naomi Potter]

Yeah.

[Dr. Kelly Casperson]

Why aren't we doing that with more things?

[Dr. Naomi Potter]

Yeah, we. Yeah, we should be. We should be doing it with vaginas, shouldn't we?

[Dr. Kelly Casperson]

Definitely.

[Dr. Naomi Potter]

Makes such sense. So tell me about the attitude in the States for starting hrt, continuing an hrt, stopping hrt, all of those kind of things.

[Dr. Kelly Casperson]

Yeah. So we're talking systemic now.

[Dr. Naomi Potter]

Yes.

[Dr. Kelly Casperson]

For everybody who's listening, we're shifting gears. So vaginal estrogen is considered local or topical. I also call it pelvic. Right. So it's not going in your body, goes in the vagina, vulva. Then systemic hormones is either a patch, sometimes oral creams, gels. The whole point is to actually get into your bloodstream, to actually get into the organs in your body. So that's. That's what we're talking about now, the tide shifting. I mean, I think the uk, I. I think the UK is ahead of us. And the data, the data supports that in the amount of women on hormones that the UK is higher, except for we can't. We do a lot of compounding of hormones in this country for various reasons and we can't count those number. So if we count as far as who's on prescriptions. So I wonder if we're more equal if you count all the compounded stuff that's happening.

[Dr. Naomi Potter]

Interesting. And so at what point do you start women on HRT if they want

[Dr. Kelly Casperson]

to use HRT when they're symptomatic? That's kind of the textbook answer. Yeah, the textbook answer is kind of when you're symptomatic enough, which I do a lot of reels on, of, like, what's suffering enough meaning. Right. But I think this is the natural progression of things, is as we become comfortable with the safety, as we become comfortable with the data on early use of hormones. There are some women who aren't symptomatic. Should they be excluded from this amazing Hormone because they're not symptomatic. Because if you look at brain data, bone data, heart data, all of its Support Starting within 10 years of natural menopause. But if you're not symptomatic, you don't get those good benefits. Like, it doesn't make sense to me.

[Dr. Naomi Potter]

And what's the fee? What's the kind of public feeling about being so say you are in that category. In the UK it's shifted. So over the last five years, you've got more women who want to be very, very proactive. And they're choosing to take, I mean, not all, but they're choosing to take HRT for the health benefits. Are people still scared? Are they still scared?

[Dr. Kelly Casperson]

Yeah. And I mean, I always have to realize, like, the bubble I function in is not the bubble of the world. Right. Because I'm like, doesn't everybody know yet? But a lot of people don't know. Their doctors got trained during the WHI scare. They don't know how to advocate. They're not in the healthcare system. They're not following us. Right. So I still think there's a lot of boots on the ground, education that has to happen. But for the people who are educated, they want to take it as a preventative medication. Very common. Once you get the education you want this.

[Dr. Naomi Potter]

Yeah, I think it is. Yeah, it's going to, it's going to take a while, isn't it? I mean, we still have. And I think you do too. We still have headlines, you know, HRT and the big one's breast cancer. Isn't it the worry about. About breast cancer risk. And if you show people the evidence about how safe HRT is, we then have the over medicalization argument. That's the kind of the comeback, which I find awful because is modern medicine over medicalizing everything or should we all.

[Dr. Kelly Casperson]

One might argue, yes.

[Dr. Naomi Potter]

What's the point in having to die anyway? Right?

[Podcast Host (Dr. Kelly Casperson)]

Yeah.

[Dr. Kelly Casperson]

I mean, it's interesting because it's like in America, 25% of midlife women are on an antidepressant and nobody's saying we're over medicalizing anybody with that. And I would argue one in four we're probably over medicalizing and, you know, the use of antidepressants. But we, it's like, it's amazing. What we don't think we're over medicalizing. And then we're like, oh, we got 7% of people on hormone therapy, which there is no drug that decreases mortality. Zero drugs. Aspirin doesn't. Statins don't Antidepressants don't. Blood pressure medications don't. There is no medication that decreases mortality except for hormones. If I'm wrong, somebody please tell me.

[Dr. Naomi Potter]

Yeah, I don't know that. I don't know those statistics, except that you are more likely to die if you are not using hrt. That's the, that's the statistic that we were, you know, we've always been taught, but it's still not a popular, it's still not a popular viewpoint. I don't know what our current rate of using and using antidepressants is, but I certainly know about all those women who are on antidepressants when they could be on hrt.

[Dr. Kelly Casperson]

Yeah, yeah, we're over. We're over medicalizing the wrong thing.

[Dr. Naomi Potter]

Yeah. How are we going to turn this around, Kelly?

[Dr. Kelly Casperson]

We do Instagram lives. This is what I think. At least Speaking from the U.S. our doctors are busy, they're strapped. They see 20 to 30 people a day. They are not going to go out, get the education and turn the boat on this. They're already tapped out. How we're going to change this is have the women go into the doctor, have the conversation, advocate for themselves. This is really a grassroots health care of turning things around because the healthcare system, we can't wait for them to do it. We have data. We just need women going in saying, I listened to these people, I've read these papers. I want hormones for X, Y and Z. I will follow up. I truly think this is coming from the women.

[Dr. Naomi Potter]

Yeah, it's a good point. I mean, we've seen that quite a lot here, I suppose sometimes again they turn it on the head. I mean, so I wrote a book with a lady called Davina McCall who's a TV presenter here. And some of my patients go to their doctors and say, oh, you know, I've read about, I've read about hrt. I really want to try it. I've got this, this is in this symptom and I think it might be really useful for me. And there's a backlash against the fact that it's been, that it is now in the kind of mass media and there's something called the Divina effect, which is to blame that those words, to blame for this big increase in demand for hrt. People jumping on the bandwagon and women have had, you know, have been through the menopause forever and why is it now such, such an issue? So all of those things. So it's so hard. I've watched the pendulum swing like Backwards and forwards and backwards and forwards. And then we had recently that the Lancet series, which in my opinion, were, you know, another step back. You know, look like things were being really quite progressive. And then bam, again, and our nice guidelines updated. It just feels like we are trying really hard to just present a balanced view of choice, letting women know that these are their options, and you make a little bit of headway, and then it's back again.

[Dr. Kelly Casperson]

I mean, a lot of this is sexism and misogyny. I have to think it is, because we've got so much papers, we've got women saying, I want to try it, and they're being told, no, I'm a urologist. When a man comes in and says he wants help with his erections and his low libido, we don't ask him if he's suffering enough.

[Dr. Naomi Potter]

Yeah.

[Dr. Kelly Casperson]

And not until you hold up the genders and say, are we treating these genders equally in health care. Do you realize the problem isn't the data. We've got the data. And another example, this might be more useful for the US people, but a while ago, like, 20 years ago, there was a guy running for the president. His name was Bob Dole. Bob Dole did a commercial for Viagra, publicly, erections running for president. Nobody's telling them we're over medicalizing erectile dysfunction. Nobody's saying, you know, they say the Bob Dole effect, but in a very positive way because it educated men to a medication that could be useful. So I'm like, I've got knowledge of men going out advocating for men, and it works well. So we just have to keep doing it.

[Dr. Naomi Potter]

God, that's fascinating, isn't it? And yet. Yeah, when. When Davina does it or when Lisa Snowden does it. And. And Halle Berry has talked about menopause recently, hasn't she?

[Dr. Kelly Casperson]

Yeah, Halle Berry, Naomi Watts. Oprah. Oprah, Michelle Obama. Like, people are speaking out, and it's wonderful.

[Dr. Naomi Potter]

And there is. There's support behind them. It's not them jumping on a bandwagon. And it's generally supported, is it?

[Dr. Kelly Casperson]

It's generally supported. But, I mean, our tolerance for women suffering is greater than our tolerance for men suffering, you know, and until we believe women, women need to be believed. I believe you when you say that you can't sleep. I believe you when you say you don't feel like yourself. I believe you when you say that sex is painful. Women need to be believed. And that's why. And it. It stinks that I have to tell women, like, go Get a second opinion, go get a third opinion, go pay private. You know, like it's, it's a burden because healthcare hasn't caught up to believing med women and using medications that are proven and safe and cheap.

[Dr. Naomi Potter]

Yeah, it's phenomenal, isn't it? What about testosterone?

[Dr. Kelly Casperson]

We love testosterone. I want to know about testosterone in the uk.

[Dr. Naomi Potter]

So it's kind of exhausting, really. So testosterone, don't you find?

[Dr. Kelly Casperson]

I'm sorry, not your question.

[Dr. Naomi Potter]

The kind of attitudes towards. The attitudes towards things like testosterone. So at the moment, the guidance is in the UK that you can start a woman on testosterone once she has been re. Estrogenized with estrogen and proving that she has a dysfunctional, stressingly low libido.

[Dr. Kelly Casperson]

So are you suffering enough. Are you suffering enough to get a hormone that your body naturally makes but goes lower with age?

[Dr. Naomi Potter]

Yeah. And so how you. One quantifies what, how, how distressing. How is distressingly low different to just low? I don't know, but that's. Yeah, that's where we are at the moment in terms of guidance. You are not supposed to prescribe for things like Mojo, feeling yourself, that missing piece that a lot of women describe. Cognitive function, strength, those kinds of things.

[Dr. Kelly Casperson]

Here's my big question. Sorry to interrupt. Libido is a mood. Mood is from the brain. Testosterone acts in the brain. So testosterone is a brain hormone. It helps with moods, libido being one of them. But any, Anybody who thinks that libido is this separate little exclusionary thing, it's a brain mood.

[Dr. Naomi Potter]

And that's how I. That's how. That's the conversation that I normally have with patients. Is that very, very unusual for somebody to just have a distressingly low libido in pure isolation? I've never seen that. I don't know whether you. You know, because everything's all. All mixed up together, isn't it? I mean, you're like, if you're feeling fantastic, you're likely to have a libido. That's great for you. If you're feeling terrible in every other sense, that your libido is likely to go hand in hand with that. So you can't. It's impossible to just kind of pick one, I think to pick one small factor. In isolation, we have the added complication of we can't get the female product on the. On our nhs, on our National Health Service. Different with you.

[Dr. Kelly Casperson]

We have no female product. Are you. Do you guys have androfen yet? Does endorphin. But it exists in the country.

[Dr. Naomi Potter]

Yes.

[Dr. Kelly Casperson]

We don't have. We don't have androfen. We don't have anything that's appropriately dosed for women.

[Dr. Naomi Potter]

Oh, I didn't know that.

[Dr. Kelly Casperson]

Cash or not cash.

[Dr. Naomi Potter]

Wow. So what do you.

[Dr. Kelly Casperson]

So that's where the comp. You have to compound it or you have to get a male product and micro dose it. But, yeah, yeah, Androfen's not here yet. Oh, right.

[Dr. Naomi Potter]

No, we've had that ever since I've been prescribing it. We've. We've had. We've had.

[Dr. Kelly Casperson]

Andrew, what's. What's cash for? Androfem? If you just wanted to pay private for a tube, what's it cost?

[Dr. Naomi Potter]

You know, it's a hundred. It's about a hundred pounds. And the tube lasts you about three months.

[Dr. Kelly Casperson]

All right, three months. That's. That's not bad.

[Dr. Naomi Potter]

We think here that's considered very expensive because we're used to having prescriptions on the NHS for, you know, for 10 pounds or 12 pounds a pop. So we're not used to paying anything for health care at all.

[Dr. Kelly Casperson]

Yep. But that was interesting because you guys have. What's it called, the tab, the vaginal estrogen tab that's over the counter now in the uk.

[Dr. Naomi Potter]

Gina, or Gina, I don't know how

[Dr. Kelly Casperson]

you're supposed to pronounce it, because from the US standpoint, we're like, it's amazing. It's over the counter. It's amazing. And then all the UK people are like, it's so expensive. And it's like, just like, you know, the. The perception of it. Because we're like, it's still expensive with insurance here. So over the counter would be awesome. Just because. Because then you get to avoid a doctor's office. Okay, okay.

[Dr. Naomi Potter]

Gosh, it's interesting, isn't it? We still have. We still have criteria about whether you can get it over the counter. So you have to be postmenopausal and over 50. And it still comes with the leaflet, you know, telling you, not basically telling you that you're putting yourself at risk if you. If you take it. So could you go to your GP and get some.

[Dr. Kelly Casperson]

But you're still paying like you. The cheapest vaginal estrogen is the cream, and the cheapest you can get, that's between 20 and $30 for a tube. It's not bad. I say if it prevents one urinary tract infection, it's paid for it.

[Dr. Naomi Potter]

I suppose it has, yeah. Wow, Kelly. I mean, we've got so far to go, haven't we? It's not. It's not very often that the UK kind of feels ahead in, in things, but I think we probably still are than the US in this. In this.

[Dr. Kelly Casperson]

Yeah. I mean, you've got over the counter vaginal estrogen, you have Androfem, so it's appropriately dosed testosterone. You have pretty cheap medications when you do get them, you know. Yeah. Which is nice. So, yeah, we've got a. We've got a ways to go, I think.

[Dr. Naomi Potter]

I think our HRT rate amongst kind of eligible women is about 15%.

[Dr. Kelly Casperson]

So, yeah, this is what I mean. The data's starting to show this, looking at the women who never stopped hormones is we're going to start seeing health disparities and we're going to start seeing more health disparities between the educated privileged and the people who, who don't have that. Because when you start on hormone therapy, you have a 50% decreased risk of heart disease, about a 30% decreased risk of dementia. If you want to believe Dr. Moscone's meta analysis, which I believe that one, we're probably saving marriages because of decreased pain with sex and sexual sleeping and all that stuff. So it's not going to go without. Notice the disparities.

[Dr. Naomi Potter]

We're keeping these women in work as well, aren't we?

[Dr. Kelly Casperson]

We're keeping these women in work. So to me, I'm like, this is no little thing to be like, consider hormone. This is a profound change to society potentially because we're keeping women functioning. You know, I go back to how do you want to age? When I talk to my women and I'm like, what do you want to be doing when you're 72 and actually get them to think 20 years down the road they're able to make a very good decision then, especially if they're seeing their mother age well or not well. Right, yeah. Of like, if you want to be out and exercising and curious about the world and having relationships, like, you need to feel well and there comes a point where your body just needs help and why aren't we helping our bodies live?

[Dr. Naomi Potter]

Well, I think it's culture, isn't it? I mean, I totally respect. There are some women that just don't, just don't want to use hrt. And you know, for some it can be such a hassle, can't it? I mean, we see cohort of women that no matter what you do, they have a side effect or they get bleeding or they, you know. But for the majority, I think it's fair to say for the Majority. It can be really, really beneficial.

[Dr. Kelly Casperson]

Yeah, totally. And to me, I'm like, you know, you probably have this where you are as well, but in our culture here, women really want to be natural, whatever the hell that means.

[Dr. Naomi Potter]

Right.

[Dr. Kelly Casperson]

Like, I live in a house and I have a car. Like, we're just not natural at this point. There's, like, the stigma of doing it naturally is very interesting in how that limits women from considering options because of what they think natural means. And I would say living to 95 is not natural. Like, yes, we've lived a couple years past menopause in the. In the back times, but now we're living 30, 40 years past menopause, which isn't natural. We're only living that long because we have antibiotics and, like, we're really good at trauma care, and we're decently good at, like, cardiac care. I know.

[Dr. Naomi Potter]

It's. So, yeah, I mean, I. I try and avoid kind of confrontation and argument with. In life, but particularly on social media, but when people argue with me about kind of what's natural and HRT is not natural, and women have been doing this forever and. Yeah. I mean, the biggest thing is antibiotics, isn't it? You know, what proportion of women who are 45 today would not be alive if they hadn't had antibiotics?

[Dr. Kelly Casperson]

There's a paper on that.

[Dr. Naomi Potter]

Oh, is there?

[Dr. Kelly Casperson]

Yeah. So they. I'm writing a book about. I'm writing a book, so. But there's a paper that says, on average, the average life is extended 26 years because of the invention of antibiotics.

[Dr. Naomi Potter]

Amazing. You know, you think about the number of times you have tonsillitis or a urinary tract infection. Just even. Just those two things.

[Dr. Kelly Casperson]

And then antibiotics, my friends, are not natural. You could argue if they kind of exist in nature, but, like, not how we've channeled them to fight infections.

[Dr. Naomi Potter]

Yeah. And neither is obstetric care, neither is diabetic care, Neither is arterial stents. Neither are, you know, none of. None of these things are shoes. Shoes, yes. Glasses.

[Dr. Kelly Casperson]

I know. So I. That. I mean, yeah, that's why I love the conversation so much, is because women come in with these fixed mindsets of, like, I'm afraid, I want to be natural, blah, blah, blah. And then you're like, what do you want to be doing when you're 72? How are you going to keep yourself healthy? And you give them the data and then they can. They make good decisions. They just don't have the information. So that's our. That's our job.

[Dr. Naomi Potter]

Yeah, well, we'll keep on. We'll keep on at it. Kelly.

[Dr. Kelly Casperson]

Yeah, I wouldn't. I mean, it's such a wonderful topic. I love it that I couldn't see me doing anything else.

[Dr. Naomi Potter]

No, me neither. I think it's a privilege, isn't it? And the ability to kind of turn people's lives around, being in a very straightforward way with. With absolute minimal risk is just.

[Dr. Kelly Casperson]

It's.

[Dr. Naomi Potter]

I think we have the best job, so. Yeah.

[Dr. Kelly Casperson]

Yeah, yeah, totally.

[Dr. Naomi Potter]

Kelly, thank you so much for joining me. I'm so glad we finally made it together. And I hope you didn't get up too early and.

[Dr. Kelly Casperson]

Nope.

[Dr. Naomi Potter]

Yeah, we must definitely do it again. So thank you.

[Dr. Kelly Casperson]

Very fun to chat with you. Thank you for the opportunity.

[Dr. Naomi Potter]

You too. And I'll see you soon.

[Dr. Kelly Casperson]

Sounds good. Bye, everybody.

[Dr. Naomi Potter]

Bye.

[Podcast Host (Dr. Kelly Casperson)]

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 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.