Loading summary
Transcript108 lines
- [00:04]
A
Welcome to the youe Are Not Broken podcast. I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality. Enjoy the show.
- [00:18]
B
We spoke last time and I think a few people were interested about the lack of libido. But it's a difficult discussion to have for anybody, I think, and especially, I don't know whether it's, especially my generation, we were not brought up to speak about anything like that. Could you start off by saying what libido is, why it changes, that sort of thing?
- [00:43]
C
Yeah. And thank you for acknowledging that because I think so many people feel broken just because they think they should be able to talk about it. Not understanding that there's so much shame in our education on this. What I got in America in the 90s was don't get pregnant and don't get a disease. Never were we taught to desire sex, that sex can be pleasurable, that it's an amazing connection between yourself and other humans. Like we're not given that positivity language to begin with. We're taught never to desire it because those are, what do we call those women? We call them bad names. Right. So we're socialized to not desire it and then we find ourselves not desiring it and then we feel like we're broken. And so the topics, I love the topic because it's so complex in what your parents tell you. Did they show you what a beautiful sexual relationship could be? Did they tell you that your body is okay to touch? Right. So it's like parents, education, your first relationship, they didn't know anything. But we carry that with us, Right? Like, oh, my 18 year old boyfriend told me, blah, blah, blah. So it's like all of this past history ties in to how we view sexuality. Wonderfully complex. But you have to bring it up. You can't just have an expert be like, we've got some medications for libido. Right. Like you've got to understand your thoughts about it. Because I think so many people, they do so much better just understanding, like, oh, I was never taught that this was like a beautiful, loving, amazing thing. Let's work on that. So that's like my background, but you
- [02:22]
B
work on that and then nothing happens.
- [02:25]
C
And then nothing happens. So libido, libido was I think coined or really talked about first by Freud. And Freud said libido was kind of like an innate drive, like hunger, like thirst. And many people disagree with that. They say in some bodies it is, but not in all bodies. Especially in bodies that are in long term relationships. Because our brain loves novelty. And the definition of a long relationship, as far as like the dopamine sex, the spontaneous desire brain is about 6 to 12 months. So here we are. Yeah, so here we are. And you know, I was like, remember how it used to be? It's like, because it was novel, our brain loves novel. But then you kind of get used to this person that you're with. And so Esther Perel is, you know, the most famous person who says within a long term relationship, you have to cultivate novelty and knowledge of that person at the same time. Because boredom and like routine doesn't spark sexual desire. That's another thing to think about of like, are you just bored or do you have low libido?
- [03:31]
B
Bit of a checklist going on here.
- [03:34]
C
Yeah. So for somebody to come in and just say, I have low libido, it could be so many different things. And I think people just want to jump on hormones. But if you jump on hormones, you miss all the other pieces. And hormones are amazing tools. And hormones do help with libido, but they're not. They won't fix a relationship. They won't help you not be bored. You know, they won't reverse your Catholic upbringing on what religion says about women who have sex. Right? So it's like sex is so complex, we can't oversimplify it without explaining things. And then thinking, think about like Hollywood music. How do we get portrayed that desire is. It's always spontaneous. You should always be hot, you should always seek it out. That's one type of desire. That's called spontaneous desire. Many people have spontaneous desire, but many people don't. The other type of desire is responsive desire. So you respond to something sexual going on, your partner behaving a certain way, you respond to it and really understanding that of like, you know what? I never want to exercise. But when I go to the gym and I start working out, I love it. That's what a responsive sexual desire is like. I do not spontaneously ever want to eat vegetables. I just don't. But I know I want. I know I want vegetables in my life. And then when I am eating them, I'm very happy I'm eating them. I'm like, I should eat vegetables more often. Okay.
- [05:03]
B
Just like vegetables.
- [05:05]
C
Vegetables are exercise. So for people to be like, I should always want to want. It's more complicated than that. There are people who say, I did always want to want. I love my partner, we have a fantastic relationship. But now sex is just like muted or. I'm kind of actually disgusted by it now. But nothing else has changed. I've just gotten a little bit older. Then you start thinking like, okay, she wants to want. What are our tools in our toolbox to help her do that? That's where we talk about hormones and that's where we talk about the non hormonal medications.
- [05:41]
B
Okay, so where do we start with that?
- [05:44]
C
The first thing I start with is what else is going on in her life, right? Is she having menopausal perimenopausal symptoms? Is she sleeping? Is she having hot flashes? Is if she's having mood changes. Because desire doesn't exist in a vacuum, right? So, like, if she doesn't feel well, she's not going to have desire. Like, desire and sex are extra as far as our bodies prioritizing, like being healthy, right? So you got to. The healthier you are, the more sex kind of comes easily.
- [06:14]
B
But that's from a woman's point of view. I mean, a man presumably can be all of those things and still want
- [06:20]
C
sex, or he might not. Like, you know, the stereotype, the gender stereotype is that men always want it. And. But that's not true. And a lot of men feel very broken because they have responsive desire and they feel like the definition of manhood is kind of stereotypically wrapped up in spontaneous desire. And a lot of men don't identify like that. So men can have responsive desire or low desire. Also, the sex therapists, some sex therapists will say it's about 50, 50 split in what they see. Some people will say it's like one third men have low desire, 2/3 women have low desire. But to think it's only a female problem of low desire, no. So if she's having menopausal symptoms, we'll treat those with hormones first, if she's open to that. Because if you can get her sleeping, get her feeling well, her body feels more like her own, right? I feel more like myself. It can be a lot easier to have a great sex life when those things are corrected. Estrogen helps libido, testosterone helps libido. And we've put these hormones in a box, like testosterone's for libido, estrogens for hot flashes. I'm like, maybe, but I've got plenty. I just saw a woman this week, she came back, just put her on estrogen, and she's like, people are starting to look pretty good again, right? So. So hormones can definitely help libido. They're not. They're not Perfect for everybody. I kind of hate the stereotype that testosterone's only for libido. Testosterone is great for lots of other things. And estrogen is also great for libido.
- [07:49]
B
Right. And I had put it all into the hormone box, which is why I said to you, at what age is it likely to start? Which is so bad, really.
- [08:03]
C
If you look at the data, it's the perimenopausal window. So perimenopause within 5 to 10 years of the menopause end of periods. And they're the most distressed by it. We don't know why they're the most distressed by it. But low libido, if you don't have a sex drive and it doesn't bother you, there's nothing to fix. One of the really medical definitions is it has to be low desire, but bothered by it. We're not going around telling everybody they need to want to have sex. Right. So you got to be kind of clear of like, is this. Is this what you want? Because if you don't, you're not broken. We know testosterone starts going down late 20s, right. So testosterone kind of starts going down way before that last period. And people don't think about that. As far as, like, you can be having periods, but start having low libido or low desire because your hormones are changing. We don't hang our hat on that last period very much.
- [08:56]
B
Would that have been back in the caveman era, where you would have had your children by your late twenties and therefore you wouldn't need to add a sex.
- [09:08]
C
Yeah, I mean, I think it's very challenging when we try to interpret what humans were doing a hundred thousand years ago to what we should be doing now. We live in concrete buildings, we have air conditioning. You live in Dubai. Like, humans couldn't have done that. Right. So, like, for us to take sex and try to keep it making sense is, like, it's not fair to modern humans, it's not fair to the cavemen.
- [09:30]
B
Right.
- [09:31]
C
And in all fairness, you were dead by 40.
- [09:34]
B
And you have said recently, we have never been this age before. And I say that to my daughter when she's giving me a hard time. I said, I've never been a mummy this age before. I don't know what to do.
- [09:46]
C
Oh, I love that. That's so beautiful. Somebody did research on, like, the era, this was British research, looking at, like, average lifespan back in the 1400s, 1600s, and they only measured the rich men, the, like, aristocratic men, because they were the only people worth keeping records for.
- [10:06]
B
Right.
- [10:07]
C
So these were like the wealthiest, the best taken care of people in society. Average age 42 at death. Now there's some outliers, you know, Oh, I remember my grandpa lived to blah, blah, blah, blah. There's some people that lived older, but average age. We were not having a discussion about libido when we were 45. You know, the whole natural thing. One in eight women died in childbirth, naturally. So to me, like, to ever go back to be like, why should we? Blah, blah. Because didn't we. It's like, it doesn't, it doesn't make sense anymore. You know, we have dental care and we don't want to get rid of dental care just because the cavemen didn't have dental care.
- [10:45]
B
We do not.
- [10:48]
C
We do not.
- [10:49]
B
Right. Okay, so. So I've come to you. I'm 60 and I have no desire whatsoever.
- [10:58]
C
Okay, what else I'm going to like, to me, I'm like, I want to know. I want to know your story, right? How's your relationship? How are you sleeping? How's your stress life? How stressed are you?
- [11:09]
B
Pretty good.
- [11:10]
C
I'm not pretty good.
- [11:11]
B
I'm pretty.
- [11:12]
C
Because all of those things, if you just throw a med on a bad relationship and a stressed woman who's juggling way too much, you're not going to get anywhere, Right? So to me, I'm like, you got to take care of the simple basics and make sure she understands sex. The other thing I ask you is, do you have sex worth desiring? Super important, right? We think all these people are having amazing sex and just not desiring it. That's not the case. Sex is for the other person. The other person gets the pleasure. She's just there as her, as her married duty, and then she wants to desire mushy broccoli. It's like, you can't desire mushy broccoli. We have sex is great. Once we get going, it's good. I just never think about it. I drag my feet to there. But like, it's a good time when we get there. First of all, I want to make sure she knows responsive desire. We don't have to treat responsive desire. It's normal. But if she wants to want, we have tools for that.
- [12:10]
B
Perfect.
- [12:11]
C
But it's a lot, right? I. I never want somebody to be like, Casperson just thinks I should go on meds of like, it's wonderfully complex. There are meds, but we gotta like, get to them first. Make sure, make sure that. Make sure the garden looks good before we want to Bring in a new tree. Then I talk about making me blush. I wonder about your hormones. You're 60. When was menopause? Are you having any hot flashes? Are you already on hormones post menopause?
- [12:38]
B
I've been on HRT for, until I, since I was about 50.
- [12:42]
C
Perfect. And then I would say, are you interested in testosterone?
- [12:46]
B
I'm on test.
- [12:47]
C
I have that on testosterone. The other thing I would do with testosterone then I was, I would say let's check your levels because I want to know are you, are you at a good testosterone level? Where I can we start seeing desire with it or not? So I adjust that. And then in America, and I know that you don't have this yet, there are two medications, medications that are FDA approved for low desire. One is a pill that we take every night. It's called Addi or Flibanserin. The tagline for it is the little pink pill. The side effects are sleeping better. A lot of people like that. And a little bit of weight loss. Some people like that. Usually I say give it six weeks to three months to know if it's working. Take it before bed. Insurance is iffy on covering it at this point, which they should cover it. But cash is about 150 bucks a month. So that's fine for some people. That's not okay for some people as far as that medication, but very safe. Doesn't work in everybody but in the people it works in, they're like, oh my gosh, I have my sex life back. This is fantastic.
- [13:54]
B
What is a good range of testosterone? What are the levels for testosterone?
- [13:59]
C
My answer is an American based lab value. It's going to be different in the uk. It's going to be different in different countries. So I always want to say that when I throw out a number it has to do with our lab values. I see women get the most benefit around like 60 to 80, 60 to 90. Now that's going to be read as high by our labs. Our labs say high for women is above 35. I disagree with that. And the lab values I think are very narrow. And I don't see the benefit of testosterone that low. So to me I'm like, are you absorbing? Are you at a good range? Those are things I look at, right?
- [14:38]
B
Somebody tried addi and had to stop. It totally messed with my mood. That didn't help. Desire.
- [14:43]
C
You can take half dose. So that is an option if you want to do it. But yeah, it doesn't work for everybody. It works roughly about 60% of people.
- [14:52]
B
Oh wow.
- [14:54]
C
Is that different from a truche trosh? I'm sure it's a French word for something. It's a compounded medication you usually put in your cheek to like dissolve a medication. I like the compounded cream a lot. This question I think is about testosterone. So I don't put testosterone in my mouth. I'm not fully convinced, like I haven't seen enough data that the oral troch doesn't go through any first pass metabolism. And oral testosterone is really hard on the liver. Unless there is a one brand name of testosterone called Kaisertrex that is oral, that is safe for the liver. But otherwise we're very cautious about testosterone going through the liver. It's just not good for it. That's why transdermal cream, gels, injections, pellets for some people are safer because it doesn't go through the liver.
- [15:43]
B
Right. Okay. And the pink pill, we're not worried about that?
- [15:47]
C
No, we're not worried about that.
- [15:49]
B
So you're gonna put me on the pink pill maybe half to start off with four, six to eight weeks and see if that makes a difference.
- [15:57]
C
Yeah. And some people will say it takes up to three months. Give it some time. I make everybody read my book and listen to my podcast because they need to have the biopsychosocial understanding of sex. They need to work on priority. If you want great sex in your life, you have to prioritize it. It's like, I want a healthy body, but I don't want to work out. Right. And so to me, I'm like, sex doesn't exist in a vacuum. There's a great book, Magnificent Sex by Peggy Klein Palatz. Fantastic book. She basically researched all of these people who like, raised their hand and they were like, she's like, who has great sex? And these people were like, I have great sex. And she's like, great, let's research you. So she researched all of them and she's like, they prioritize it. They're amazing. Communicators have novelty. It's not the same old thing all the time. Right. But in none of the research did any of these people say, I have spontaneous desire for sex. So I think a lot of, a lot of people, their stereotypes, like, if I only desired sex, I would have a great sex life. It's like, maybe, but there's a lot of people with great sex lives who, like, they have skills, Right? They have like, skills that give them a great sex life.
- [17:07]
B
Yeah.
- [17:08]
C
Even if we do pills or medication, which. Which I'm fine with it's. Worth understanding those skills.
- [17:14]
B
And you are not allowed to write the word S E X on Instagram, are you? What do you call it? Sexy S E gg Stupid Instagram. Is that what you do?
- [17:27]
C
I haven't gotten kicked off at Instagram yet, but I know people who have like sex educators. This is not pornographic. This is not anything. It's like people who want to educate people about sex because we're in the dark and when we're in the dark we suffer. And so I know I was talking to somebody from Instagram a while ago and I'm like, do you know that this is happening? And they're like, it is. So I haven't gotten kicked off yet for talking about sex. Maybe I have more protection because I'm a physician. I mean the other. Just to. Just to be fair and discuss the other medication for low libido, which is vilistius or brimalanitide. Expensive. It's about $200 a month. It is a self injecting, on demand medication. Side effect is nausea for a decent amount of people. So personally I don't use it as much as certainly hormones and addi. I'm using more. But the Vile C is another approved medication for low libido. I want to be fair to everybody and say. Say what all the medications are.
- [18:34]
B
When you say it's on demand medication, is it like it's Wednesday night?
- [18:39]
C
Yes. It's like, hey, maybe we're going to be in the bedroom in an hour. So. So it's interesting. Demand. I think it's about an hour before sexual activity. It's kind of like Viagra. Right. When do you take, when do the men take Viagra? An hour before.
- [18:54]
B
Wow. I get my hormones from my gynecologist, which I'm very lucky to have here. They cost a flipping fortune. I mean, it's ridiculous. Every month.
- [19:06]
C
How much do they cost?
- [19:07]
B
A couple of hundred pounds, I think. Something, I mean it's, it's a lot.
- [19:13]
C
Can you go back? Why don't you go back to the UK and get some?
- [19:17]
B
Yes, but then you have to be with a doctor and it's really difficult to get doctor's appointments now. And it's, it's not, it's a crazy.
- [19:25]
C
I mean, my opinion is like women shouldn't have to mortgage their house to take hormones that their body naturally made. I think it's atrocious and they shouldn't
- [19:33]
B
have to make a choice of whether they take them or not because they can't afford them.
- [19:37]
C
Exactly. Because we Know that women who are on hormones actually use less healthcare in the future. So it's like.
- [19:45]
B
Yes, because they're looking after their bone health, their brain health, their heart health. Yes, that makes so much sense.
- [19:51]
C
Yeah, totally. Somebody said can you get the book in Australia? Yes, you should be able to get it on Australian Amazon for pre order right now. If you can't, I want to know about it because it should be up on Amazon in Australia right now.
- [20:04]
B
Mexico. Oh, Siagra. Is that what you say? Is that one the injection?
- [20:12]
C
No, I think there's talking about Viagra there. Guys can get sierra. I think they mean Viagra. Yeah, you can get over the counter. Oh yeah, women take Viagra. So Viagra. So this is how. Let's talk about how Viagra works because it's interesting. So Viagra is a vasodilator. It dilates blood vessels. So if this is the. If this is the blood vessel to your penis and you take Viagra, it dilates the blood vessels, you have better blood flow. Blood flow is good for arousal and erections. Women have the same body parts as men do. We call them different names, they're different sizes or different locations, but it's the same, it's just rearranged differently. So we also vasodilate when we take Viagra. But when a man sees an erection, it usually triggers desire in him. They're pretty closely related. When a woman gets blood flow in her pelvis, she doesn't always have desire because of it. They're kind of two separate things. You can have blood flow without desire, desire without blood flow for anybody who's had desire but is not getting well lubricated. Right. So it's just a little more tricky to give a woman a Viagra pill. She's going to vasodilate. It's going to. It doesn't mean she's going to be interested in sex. So Viagra is a blood flow medication. It's not a desire medication. But for a lot of men it is a desire medication because he sees the erection and he's like yeah, but they're coming out. You can get this compounded now, but they're actually going to come out with an actual FDA approved pharmaceutical I believe. I don't know the timeline, but it's a topical or cream Viagra that goes directly on vulva and clitoris for blood flow. And that seems to work better than taking a pill and waiting for it to get all the way down there. They're doing studies on it right now and you can Currently compound it. You know, if you, if you go to a sex med physician and talk about usually it's like, hey, desire or an arousal issue you can get. It's in the generic of Viagra for anybody who's interested is called sildenafil. So it's a sildenafil cream. Off the top of my head, I don't remember the concentration of it. But if you go to a sex med doc, they'll know, right?
- [22:28]
B
I mean, how many are there of you out there? Is it easy for women, men to find doctors who can, who are interested in helping?
- [22:38]
C
No, it's very, very hard. I wish I could say it was easy, but America has about 70, 70 million midlife women. America has about one physician for every roughly 25,000 menopausal women. Like somebody who's trained right in menopause. So that's just for hor that's like hormones and menopause, let alone the sex med part of it. There's very few. And so I mean I came from, I'm a urologist, so female urologist, trained in sex med, who understands hormones. There's probably five of us because I'm friends with all of us. Very, very rare. But the more we talk, right. Which is why I do things like this, the more because my belief is we're not going to change this by educating the doctors. They're too busy. They're too busy. They're not going to go do specialized training on hormones and sex X med. But if I can get enough women to go in and start saying, hey, I'm really interested in X, Y and Z and teach them how to talk to doctors and teach them how to advocate for themselves. That's how the doctors will start changing. They'll be like all these women coming in asking about hormones and their desire and blah, blah. It's like then they're gonna start changing. So I'm really doing this from a bottom up instead of a top down approach.
- [24:03]
B
But you're reaching more people.
- [24:05]
C
That is, it's incredibly important.
- [24:07]
B
Thanks to all of these women who are people who are joining us today. I'm really, I'm proud that they're staying on and listening, knowing that there's something that they do. What do you do if you have very little sensation?
- [24:20]
C
Good question. So it's hard to find somebody who's trained in a female genital examination that was looked over in medical training. Right. But so the first thing I'm going to look at is what's her body look like? Does she Have a skin condition that's covering up her clitoris, making it harder to have an orgasm. A common one would be lichen sclerosis. Another thing I'm interested in is, does her clitoris look atrophic? Does she need some hormones? Right? Does she just need more blood flow? The other thing I'm going to look at is something called clitoral phymosis, which is where the skin over the clitoris is kind of adherent so it can't come back. And that can have trouble with arousal and orgasm. Other things, neurologic things, diabetes, that can all affect arousal. Hormones is a big thing. And then the other going back to sex ed. So many women are having penetrative intimacy that doesn't include the clitoris. So maybe they've never had an orgasm or they rarely have an orgasm. Because our sex education is so bad. Nobody ever told anybody the body parts that are important for females pleasure. And so always just going back to be like, how are you trying to have an orgasm? Because for 70% of women, just putting something in their vagina doesn't give them an orgasm. And then they say, I don't like sex. And we're like, right, yeah, it's the sex you're having, which you thought was what the sex you should be having is, but it's not serving you. That's just what Hollywood portrays. We have to talk about estrogen cream and estrogen in the vagina and vulva. We haven't talked about that yet.
- [26:01]
B
Okay, we'll do that one next. Because this is that point which might have got you. I'm 67, never done HRT. I've not had sex with my poor husband for 6 years as it's too painful for me that I think you
- [26:14]
C
incorporate all day, every day. Women are not taught about menopause. Women just think menopause is hot flashes. Many women think if I didn't have hot flashes, I didn't go through menopause. Right? Like our education is so bad. So when, when you say, oh, pain with sex is a consequence of low hormones, which is what happens in midlife, their head explodes because they've never heard that before. How can this possibly be related to not having periods anymore? Right? So I always have to go back and be like, let's talk about what menopause actually is, which is a profound loss of hormones that work everywhere in your body. So very simple fix. And to me, for somebody who hasn't had sex in six years, maybe simple is oversimplifying it, but I would care I'd care about what is her vaginal estrogen? Can I get her on that? Is. Is her skin healthy enough? Because I don't want to force her into doing anything. And. But then also just getting back into the sexual world, right? Like prioritizing pleasure. You haven't put sex in your schedule for six years. You got to carve out some time for intimacy now. And that's really where the sex therapist can come in to be like, how do we get you if you haven't run a marathon in six years? And then I give you a pair of shoes and I'm like, hey, you should be able to run a marathon now. That's not how it worked, right? So it's like, I don't want to just be like, here's a pair of shoes. Go. Go for it. Of like, there might be pelvic muscle tightness. There might be some skin conditions. There might be, you know, the psychological barrier of you guys not having been active. He might have erectile dysfunction, right? So it's like getting back into it and trying it in a very supportive, healthy way. So you're not like, I tried it once, it didn't work. I guess I can't have sex.
- [28:08]
B
It's going to be hard for her to start this conversation. I mean, I can't even imagine starting that conversation with my husband after six years. Would you have them both visiting you together so that you can try and help her broach it?
- [28:26]
C
I think ideally, but sometimes women just come in by themselves because they want to get checked out and they want to do their part. You know, they're fine. They've got a great relationship with their. With their partner. They just need some hormones, right? But then there's some people, they've kind of got this avoidant thing happening, and that's where it's like, okay. And it's interesting because I'll see men for. Because I'm a urologist. I take care of men. I'll see them for Viagra. And I'm like, what's your plan with this Viagra? Like, who do you. Do you want to share this. Do you want to share this Viagra with anybody in a bedroom? And they're like, oh, yeah, my wife. And I'm like, have you told her you're here to get Viagra to hopefully have sex? And they're like, no, I haven't told her that. And it's been five years since they've had sex. And I'm like, you need to talk. It's easier said than Done. But you can start it with, this is so hard for me. This is so awkward for me. But I love you and this means a lot. Like, you don't have to be good at it. You don't have to be good at talking about sex. I would say nobody is good at talking about sex unless they got that role model for them in their family, which some people did, or they have training in how to talk about sex. Because our default is to not talk about this.
- [29:43]
B
Absolutely. I have spoken to gynecologists who have said that they would start somebody in their 60s or on HRT. Not everyone will do it, but some will.
- [29:56]
C
Oh yeah. Especially if you're healthy.
- [29:59]
B
Right.
- [29:59]
C
And remember, and this is Americans guidelines, but our menopause guidelines, they don't say you can't have it after 60. They just say the lowest risk is to start early. But people interpret that to say you can't have it when you're older. That's not what it says in America. The issuish website. International Society for the Study of women's Sexual Health. Excellent. Find a provider. Because the ishwish doctors and nurse practitioners and PAs, they are comfortable with sex and they're comfortable with hormones. So that's like a nice Venn diagram of like find. Find those people.
- [30:34]
B
Oh my gosh. Viagra makes sex too long sometimes. Don't need that. And how does it affect men's orgasm?
- [30:43]
C
Yeah, so Viagra doesn't work on the orgasm pathway, but if it helps you facilitate good sex, it might help you have an orgasm.
- [30:51]
B
Right.
- [30:51]
C
Here's something interesting. So remember we talked about the little pink pill? Addy? 10% of people who take that are men. Why? Because it helps their desire and orgasm as well. We all have the same brains, just rearranged in different parts. But if desire and orgasm are so important to men that they will literally take a pink pill that's marketed to women because it helps them. That I just think it says a lot.
- [31:18]
B
Yeah, yeah. Really does. I'm gonna have to try and get my hands on this thing. If you start before 60, do you then stop after 60 or continue? I'm gonna stay on HRT for as long as it benefits me. If that means until I die, then is that correct?
- [31:36]
C
That's correct. There's no age where you have to stop hormones. I saw a woman very recently, she was like early 70s, and she said, you know, I have a friend and my friend's 82 and my friend's been on hormones for decades and I kind of want to Be like my friend. Like, I see what she's. She's like playing tennis out and active, you know, and she's like, can I be on? Is it too late? And she's incredibly healthy person. Right? Heart, Heart's healthy, everything's healthy. And it's like, yeah, you could start hormones, you know, this one 60 year old does not look like another 60 year old. Right. We've all got our unique health challenges, but to say that there's an age to stop or start, it's way oversimplified.
- [32:20]
B
Right. Okay, let's quickly get onto the vaginal estrogen, please.
- [32:25]
C
Very important people need to know this. It's just for the genitals and the bladder. Works really great on the bladder because the bladder and the vagina share a wall. So very low dose, incredibly safe. Literally everybody can take it. I like using it. This is how I think, why wait for pain with sex and overactive leaky bladder if you can prevent it? So I like to think of vaginal estrogen as a preventative medicine. Maybe start when you're 55, maybe start when you're 50. Just something to think about. But it's so safe and it makes no sense to me that if 50 to 80% of women will have genital urinary syndrome of menopause, pain with sex, dryness, overactive bladder, recurrent UTIs. If it's that common, why aren't we trying to prevent it?
- [33:15]
B
If you're using vaginal estrogen, you don't use the gel or you use both the estradiol.
- [33:21]
C
Oh, you mean systemic estradiol? Yeah, you can do use both. Systemic estradiol is very low dose.
- [33:31]
B
Right.
- [33:32]
C
You have so much more estrogen in your body when you're in your 20s and when you are pregnant, like we're not giving you a lot of estrogen.
- [33:41]
B
Okay.
- [33:41]
C
And so. And so a lot of people who are on systemic estrogen still need vaginal estrogen because the systemic estrogen is just not enough to really treat those tissues. And some people put it on their
- [33:54]
B
face and neck and it's amazing.
- [33:56]
C
It is.
- [33:56]
B
Why is that?
- [33:58]
C
Because it's estrogen. Estrogen is very good for skin. It increases blood flow, it increases collagen, it increases the thickness of the dermis. So it's just beautiful skin.
- [34:10]
B
Do you put the vaginal estrogen on at nighttime? Is there a time?
- [34:15]
C
Yeah, I like it at night. So you can get it in tabs, creams, and a ring called estring. Estring is awesome because it's just plug and play. You leave it in there for three months. But it's expensive. The cream is the cheapest in America out of all of these. I like the cream because I like to get it on vulva, clitoris, the external structures, because it's skin care and it keeps those structures intact. Women don't know that their labia minora goes away with menopause because you don't have any estrogen. So those are sexual structures, and they also protect the urethra and the vagina from irritation, probably infections. So I like to do it at night because then you just go to sleep and it's not super goopy or messy.
- [35:02]
B
What do you say to people who say hrt can't be good because some cancer patients go on hormone blockers?
- [35:09]
C
Great question. So food, cancer likes food. That doesn't mean that all people shouldn't eat or that food is bad. It just means that if you have cancer, it likes food. So we take the food away from the cancer, but we don't take food away from all the humans. That does not mean estrogen caused the cancer. We know that estrogen at this point does not cause breast cancer. But people can't. If you don't give them that analogy, they have trouble understanding, why do you get food if they don't get food? Because they have a tumor that we're treating.
- [35:47]
B
That's why. Okay, and then can they go back on it after, if you're out the other side of the cancer?
- [35:54]
C
It's a wonderful question. The dogma says no. The experts say it depends. And probably if you're cured, you've done your treatment, and then it depends upon how bad was it. So breast cancer is incredibly complex with many different types and stages, and you can't just do a broad brush on everybody. But more and more women are going on hormones and after breast cancer treatment, because what's the number one killer of women who've had breast cancer part. And these women say. They say, well, if estrogen didn't cause my cancer, and now I have all these other risks of osteoporosis, heart disease, my brain, I want the opportunity to take care of the rest of my body. And. And we have. Good. We need more studies, but we have studies that say, you know what? This is not increasing your risk of recurrence more than if you didn't take hormones.
- [36:56]
B
Right. We could talk about this all night, But I think you've. It's the best topic that you have a day of work ahead of you. Thank you so much. Still more questions. But As I said, you've got to go. Thank you for talking to us about intimacy and helping so many people. You are awesome. Follow this amazing doctor and buy the book. I'll be tagging it.
- [37:21]
C
Thank you for having me.
- [37:23]
B
Thank you very much. Have a great day.
- [37:25]
C
Bye Bye bye.
- [37:27]
A
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 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, dental 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.