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Dr. Kelly Casperson
Welcome to the youe Are Not Broken podcast. I'm your host, Dr. Kelly Casperson, a
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board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality.
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Enjoy the show.
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Hey everybody. Welcome back to the youe Are Not Broken podcast. And it is a long time coming. Having done this podcast for four and a half years and not yet having on the amazing Dr. Luis Newsome. Thank you so much for being here and thank you for being my friend in this whole process.
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Dr. Louise Newson
Oh, do you know what? It's so exciting. I know you've very kindly been on my podcast and I've been really excited. I get excited quite a lot, but I was really excited when I looked in my diary yesterday and I was like, oh, I'm going to sing to Kelly.
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Dr. Kelly Casperson
We podcast so we can hang out and meet friends.
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Dr. Louise Newson
Yeah, totally, totally. I love doing my podcast. It's a great way of connecting with people and sharing knowledge, isn't it? You know, we didn't. You're younger than me, but I didn't grow up with podcasts. It's great. It's brilliant way of informing people.
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Dr. Kelly Casperson
Totally. So just to introduce you, for those who don't know, you're a physician, menopause specialist and a member of the UK government's Menopause Task Force. You're an award winning doctor, educator, author, committed to increasing awareness and knowledge of perimenopause and menopause. And you basically kickstarted the menopause revolution. Your clinic is in the uk. Your, you have a podcast, you're always, always advocating for women. And I'm so excited you're here.
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Dr. Louise Newson
Oh, thank you.
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Dr. Kelly Casperson
So tell us a little bit just about your journey. Quick like. Cause you did not go to medical school and get training in menopause. This was a passion that was found later on.
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Dr. Louise Newson
Yeah, isn't it? I mean, most things in life, I keep saying to my children, it's a journey. It's not that you'll never reach the destination or you might not. It's the journey. I've always been quite inquisitive. I'm like an annoying two year old that always keeps asking, but why? But why? So I had opportunity after three years at medical school to take a year out and do a pathology degree. So I did that, which was great because it really opened my mind to disease processes that occur in our body and also inflammation, which I'm sure we'll talk about in a bit throughout the body and what happens when our, our immune system doesn't work well. So that was Great. I got a first class honours degree, went back and did three years clinical medicine, got my degree with honours, which was brilliant. Wanted to do oncology, cancer medicine. Went off after first year of house jobs to New Zealand with my. I was going to say long suffering, but he is really husband who I met in fresh this week.
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Dr. Kelly Casperson
He's the urologist, he's above average, he's
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Dr. Louise Newson
a urologist, so I have to be careful what I say. But yeah, he's, he, he took a year out with me as well because he wanted to stay with me. So he did a pathology degree which he didn't enjoy as much as I did. But anyhow, I wanted to do oncology, so I did hospital medicine, lots of different specialties, did neurology, I did rheumatology as a gastroenterology, cancer job, of course, really enjoyed it, but it didn't quite feel like this is what I would do forever. And then I got my exams to be a member of the Royal College of Physicians and then I tried to find a role model and I don't know about you, Kelly, but it's really hard to find a female role model. But I think, yeah, she's got it, she's got children, she's got happy home, she's happy at work. I just couldn't find that person. And a lot of women less so now because people can work a bit more flexibly than in the late 1900s, in 1999, 2000, when I had just done these qualifications. But I just thought people are worn out, they're just bitter, they're resentful of patients and I never want to be resentful of my patients. I really enjoy it. It's a real privilege to be with and help people as part of our job. So then I thought, you know, I might become a general practitioner and be family medicine and just enjoy a whole aspect. And none of my family are medics at all, which is easier because I haven't got anyone to like live up to or anything. But I remember saying to my mum, I do you know what? I think I'm going to be a gp. And she went, oh, am I going to tell my family, my friends, like, you're only a gp? I was like, hang on, it's not only about being a gp, Mother, like, actually let me do what I want and I'll do it well. So I went into general practice and it made me really think about the person, you know, so much in medicine. It's about a disease, it's a label, bed number Four has got X condition, bed number six. It's about their discharge planning, not even thinking about what the home they live in or anything else. It's all about the disease and the treatment. And I really enjoyed that whole consultation, really loved it. And then I was fortunate to have my first daughter and then thought, I don't want to be full time as a GP because I want to be there for my daughter. I want to be at the harvest festivals and the concerts and the swimming galas and whatever. So I decided to very traditionally work part time so my husband could do his career full time, but it meant that I had a portfolio career. So I did a bit of general practice, a lot of writing, a lot of medical writing, but also not just medical writing for doctors, but for lay people as well. Which it sounds a bit weird, but, you know, I grew up when there wasn't an Internet, so you couldn't have Dr. Google, so you would just believe what your doctor told you. So actually my job, or lot of my work, was reading, literally reading the scientific evidence and translating it so that people could understand what raised blood pressure was, what migraine is, what erythrobiosis, all this, but using the evidence. So I did that for many, many years. And I worked for the Royal College of GPs a lot for many years too. And also when new guidelines came out, I would read the guideline, read all the evidence, summarize it and then give it back to the college and say, this is for busy doctors, they can just read the top level. And so in 2015, I was asked to do the menopause ones that come out first, Menopause and only menopause guidance from NICE over here in the uk, and I read it and I thought, you know what, I wrote about this in 2002 when I was doing some writing because I had a weekly column in a GP journal, I thought then there's no big deal, the WHI study, because it's the wrong type of HRT for the wrong women. And anyway, the results aren't that sensational. And I found out my old articles recently from 2002, just basically saying, well, this study, it doesn't mean much. But I wasn't in the space that I'm in now, so I never took women off hrt. I never didn't even realize that it was all over the press going, come off, come off hrt. It's terrible, terrible because I knew the evidence and I knew it wasn't that bad. But then when I read NICE guidance, which is fine, but it's still a bit conservative, if you like. It says there may not be an increased risk of heart disease, for example. And it's like, hang on, we've known for decades there's a reduced risk of heart disease with hrt. I thought, actually, this is quite disparaging for women. And it doesn't even list all the symptoms related to menopause. It's vasomotor symptoms. So flushes and sweatshirts. It does mention mood changes, but not much. And it mentions vaginal dryness. Great. But then it does mention osteoporosis. That's great. But did nothing else, really. And I thought, hang on, what's going on? This is a bit of a mess, really. And at the same time, I was 45, so I had some of my friends who were starting to be perimenopause and menopause at St. Louis. I've come out, I've got some medicine. I was like, oh, great, what is it? Oh, it's called citalopram. It's called venlafaxine.
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Dr. Kelly Casperson
What?
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Dr. Louise Newson
Why would you have an antidepressant? This is a hormone deficiency. It doesn't make sense. So then suddenly I put my head outside my GP practice and thought, hang on, this is awful. What is going on? And then I realized HRC prescribing, the fallen off a cliff, that people were experiencing all these symptoms. People were hemorrhaging from the workplace, people were not having any relationship, let alone any sexual relationship with their partners. I was thinking, hang on, this is awful. The injustice to women is terrible. So since that time, I've just plowed on through and opened a clinic, got the app, and the rest, as you say, is history. But I'm still driven every day like you are, because I know we text each other a lot about how has this been allowed to happen? And my job, I think a lot, is about choice, that we went into medicine to share decision making with our patients. So I don't actually mind what patients do as long as they are empowered and they're doing the right thing for them. And. And 50% of our population are having something happening to their bodies where 95% of them are not being allowed to have a choice. And I think that's really wrong.
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Dr. Kelly Casperson
Yeah, that's awesome. Thank you for sharing your story. I love it. Let's talk real quick about two words that come up and I think people argue about these cause they make them mean things. I want your opinion on the debate on calling menopause a disease and also the debate on calling it a hormone deficiency. There's, like, stupid arguments, but I want your opinion on those two words.
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Dr. Louise Newson
Yeah, and I don't think it is a debate, actually, but I'm happy to debate anything. If you look up the definition of disease, then it's something, a condition that affects an organ or parts of the body and affects their functioning. So I'm a menopausal woman. When I was perimenopausal, which you could say is also a disease, my organs were not working properly. And I can tell you firsthand, my brain wasn't working properly because I couldn't remember anything. I was miserable, I was moody, I was low, I was tearful, I was joyless, I was irritable. My husband can witness that. But I had muscle and joint pains and palpitations. So I had some problems. Disorder of my organs, which fulfills the definition of a disease. There's a whole debate, like, ethically, can a disease affect the majority of people? And that's where some of these politics get in the way, I suppose. But as a pathologist who studies disease, then that is a definition of disease, whether we like it or not. So, yes, I think it is a disease. I think any hormonal deficiency is a disease. Which means the second part of your question, the whole thing about menopause freaks me out. Why has it even been that word? Why is it about stopping periods? Like, I actually don't care about my periods. I'm 53 years old and I've had a hysterectomy. So therefore I could never have a period again and I could never have children again. But I'm being defined by my womb and my periods, because that's what menopause means. A year since your last period. So that doesn't make sense. So that's when you think, what is it? Well, it's about our hormone levels reducing and changing and fluctuating, because that fluctuation is actually, I think, more detrimental in our body than menopause because it's chaos in our brains and our bodies. Our bodies, like homeostasis, everything calm and even. We know that if we're hangry, we're hungry and angry, and our brain's just telling us we need to eat. But the same with hormones. We get these fluctuating levels in our brain and our heart, any of our systems. So the perimenopause, when hormone levels fluctuate, we're still having periods, can actually be more symptomatic. And I see that a lot in our clinic. But then they Also think about pms, pmdd, postnatal depression. These are hormonal fluctuations as well. So I think we should be thinking of it as a women's hormone insufficiency. So whi. Let's get rid of the WHI study and let's call it a women's hormone insufficiency. Let's not wait until those poor younger women with PMS or PMDD have their period, stopping like it's barbaric. So then if we think of it as an insufficiency rather than a deficiency, you're then more thinking about, right, which hormones are lowering? What can I do about that? Is there a way I can boost it through exercise, through nutrition, through whatever? Or should I just take some natural hormones, like if I was thyroid deficient or insufficient? Because otherwise people think about absolute numbers. And it then gets really. And there is this whole thing of obsessive. They do get obsessed. But the other thing is, you know, even when you read some work about the brain, then people say, well, the brain adapts with time and menopause. And of course it does. Our bodies are really good at adapting and using other hormones to sort of take over, if you like. So in the menopause, the body is more quiescent. Our brains don't work the same way without hormones, but they will function. And it is more of a period of calm for lots of people, not everybody. But you're forgetting this chaos that's happening, that is treatable. And the other thing really to add is if you're just thinking about the womb, you're forgetting that these hormones are neurosteroids, as in produced by the brain. They're made in the brain. So it's made in the brain because they're needed in the brain. And that's why this whole ovary brain divide, which has happened for centuries, needs to stop. So if we think of hormones not as our sexual hormones or gender hormones, whatever you call them, as our life hormones, as hormones that we need in our body, and then think about how they work in our body. Every single cell responds to these hormones, not just our womb, not just our ovaries, not our reproductive system, then we're changing the narrative which we need to do for future generations, because it's a mess. What we're doing at the minute, really keep talking about periods and fertility just doesn't make sense.
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Dr. Kelly Casperson
It's insane. One of the frustrations is a tangent on labeling hormones. But in America, at some point, we're gonna be looking at testosterone, getting FDA approved for A female dose. Again, we don't have that I know. Case coming first. And so I asked somebody who knows, and I said, tell me it's going to get approved for hypogonadism, because when you have a low hormone, you treat it with the hormone. Men's testosterone is indicated for hypogonadism. So for anybody listening, that means low hormones. Women's testosterone is going to get approved for low libido. It's missing the whole point that this hormone is naturally occurring in our body and is used everywhere in our body and that libido is a brain mood. So of course, testosterone's in the brain. Right. And it's infuriating the gender bias or sexism that's coming in what these hormones are approved for.
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Dr. Louise Newson
Yeah, I totally agree. And okay, we've got more research about testosterone in women when it's looking at libido. But who's decided that research? Like, why would you do research on a hormone that's biologically active, affecting every cell in our body and concentrating only on libido? That seems quite weird. And I know when I went to one of my first menopause, it was an International Menopause Society meeting in Prague many years ago now, and I just started taking testosterone myself. So I was quite evangelical because my world was in color again. I had my brain back. I was like, come on, you know that sun shining. Let's get out. This is really great. And there was a lovely Italian professor talking about testosterone. And I remember him very clearly because he was talking about his wife, and he'd been to the opera, and he was looking at his wife listening to the opera, and she had tears down her face of joy listening to the music and the story. And he said, I looked at her and I thought, that is testosterone working? And I. Because I'd just taken testosterone, I was nearly crying because I thought, yes, I get that. How you measure that in a study, Kelly, I have no idea. But actually, I came out and I said, this is really stupid. In hindsight, to two people that I was just sitting next to. I came out. Testosterone is amazing, isn't it? Do you take it? And you know what? They crossed their arms, they looked at me and said, I don't even know what you're talking about. Of course we don't need testosterone. And I thought, oh, gosh, I didn't realize it was quite so political. And then I go to another talk, and they're talking about how women have to be estrogenized fully before even thinking about testosterone. And I'm there thinking, well, there are three different hormones. Estradiol, progesterone, testosterone. They work differently, but they're all derived from cholesterol, as you know, and derived from progesterone. So they're all a family, aren't they, really, if you look at their structure? So thinking, why? Why is that? So there's me putting my hand up as a new girl on the block in front of mainly men in the audience, and I said, oh, could you just let me know? I can't quite work it out. Why do you need estrogen first? And so then, do you know what they say? Is it. Well, the studies have shown that women are more likely to have sex maybe once or twice more a week on testosterone. We wouldn't want it to be painful or the man to induce pain if they're not oestrogenized properly. So it's important they have estrogen throughout their vagina, then it won't be painful. And I just sat there and I was going to cry of despair then, not of joy, because I thought, really, is this what you're thinking about? They don't get it at all. And still no one's told me why you have to give estrogen first. And a lot of women we see who are younger are more testosterone deficient than estrogen deficient. So it's like, if you've got low thyroxine and you're also type 1 diabetes, do you go, oh, sorry, don't have your insulin yet. We'll start your thyroxine and then see how you get on it. It just doesn't make sense at all. But it's about controlling women.
- [17:29]
Dr. Kelly Casperson
I think even the guidelines for low libido for testosterone for low libido, which supports testosterone for low libido says, you know, an indication is postmenopausal low libido. And it's like, then you don't understand that testosterone starts going down in the 20s and it has nothing to do with your last period, nothing to do with your last period. And so it's like these artificial lines in the sand of, like, if you're 39, you can't have testosterone, but let me know when your period stops so you can have testosterone. It makes no sense.
- [17:59]
Dr. Louise Newson
But I was also reading a book, I've been reading a lot about history, as you know, about when testosterone was discovered and everything else, but actually they. They worked out quite early on that testosterone is very good for fertility, to improve fertility, to improve ovulation, and isn't that great? But why aren't we advancing that knowledge? It just seems so incongruous and so like prehistoric. It's not even going back to the 40s, it's just going backwards because Google
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Dr. Kelly Casperson
says it's the male sex hormone, which we know is wrong, but it's like it literally increases women's fertility. Like it is by definition everybody's sex hormone and brain hormone. Let's switch. We'll probably get into testosterone again in a bit, but I want to switch. We got to cover alcohol and the important research that you guys did. You did a survey on alcohol use in the menopause transition and it shows an increased use. This is a 2020, it was last year. You found that women are spending about 3,000 pounds on alcohol and over the counter medications in a year in a bid to cope with menopause related symptoms. Addiction is going up. Use to treat symptoms is going up. I'm very passionate about educating people on alcohol and that it causes cancer. And tell me what you found. Why did you do, why did you poll women about alcohol first of all? And then what did you find?
- [19:21]
Dr. Louise Newson
Well, firstly, as you probably know, I think beyond the box quite often. I'm always thinking and I'm also work a lot, some of it in public, some of it behind the scenes with people who are really disadvantaged and a lot of people who are socioeconomically disadvantaged drink more, do more drugs, everything else. And I'm always really interested in why, why they do it. Often it's to try and escape from their terrible lives. But we also know that a lot of women are tormented in their brain when they're perimenopausal or menopausal. So I did a survey. I did it last year for World Menopause Day because I wanted to have some interesting data really. So we put out a survey just through social media asking some quite basic questions. But the results were really sad but didn't surprise me because I speak to so many women who drink more to numb their symptoms. They think it will help them sleep, but they want to escape from how they're feeling. But I didn't expect to see the number of women who are starting class A drugs actually. So not just a bit of marijuana. And one lady. And there were free text comments and there were loads, there were hundreds and I have read them all. But one lady said I started using cocaine to escape from the cage of doom. I had no one else to talk to, nowhere to go, no one was listening to me. I know it was wrong and I've Only done it a few times. But I tell you, it was lovely to free my brain from the thoughts that I have and the emotions that have been really scaring me. Now I just thought, Gosh, we're 20, 23, we've got evidence based treatment in the form of safe hormones that she can't access. So she's going to class A drugs. Like the system is wrong, absolutely wrong. So it's really shocking. But it's not just drugs, it's not just alcohol, gambling as well. And there's a few reasons, as I'm sure you know, Kelly, why people do more addicts, addictive behavior sometimes because the symptoms, we know, the mental health symptoms are the most significant. But also our hormones, as I've said, they're neurosteroids, but they're neurotransmitters. So they affect the way the messages go to different areas of the brain, but they work with other neurotransmitters. So if you've got low estradiol in your brain, you're going to have low dopamine. And dopamine is like your reward hormone. You know, you tell me you've just done some exercise this morning. Usually you feel quite good after exercise because you get dopamine hit. But if your dopamine is lower, you're not going to get that hit the same way you're not going to get that enjoyment. Having one glass of wine, you might need a bottle or just, you know, having line of cocaine, you'll need more. But also with addiction, it is this behavior, isn't it, that's happening. But a lot of these people can't afford to gamble, they can't afford to do this behavior. So it's really worrying actually and it's not being recognized and it is increasing and in younger people as well. So not just women who are older, but we know, you know, one in 30 women under the age of 40 will be menopausal. More than that will be perimenopausal. It's a sad read looking at the results, but it's reality, actually. And I'm sure it's the same over in us as it is over here.
- [22:35]
Dr. Kelly Casperson
Like you literally made me speechless. I did not know. Why would I not think they're doing other drugs besides alcohol? Right? But it's like when the medical system fails women so profoundly, they are desperate for care and you know, everybody poo poos the supplements, right? And it's like, well, supplements are probably way safer than cocaine. But it's like women will throw Money at untested things to try to feel
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Dr. Louise Newson
better, but you're desperate to feel better. But the other thing, just in case your listeners don't know, is there any sort of stressful behavior? Any behavior that's going to be negative on the body will mean that the ovaries will switch off. So if I was a drug abuser, if I was an alcoholic, my ovaries are likely to switch off, maybe temporarily when my lifestyle's bad. If your ovaries don't work, that means you're protecting your body from being pregnant because your body really doesn't want to get pregnant unless you're healthy. If your ovaries aren't working, you're reducing the number of hormones you've got in your body. So you're giving yourself maybe a temporary menopause. And we know symptoms of the menopause can include low mood, anxiety, catastrophizing with your thoughts, all that, you know, loss of joy. So that's compounding things. So a lot of people I've spoken to recently who are drug abusers and have been for many years go, wow, is that why I'm getting those symptoms? And it's like, yes, it's not all because you've got, had a fit life or whatever. It's because you know your body's working against you actually. And they feel so relieved because they've all been told, oh, it's because you've had trauma, it's because you've been abused. And the other thing about domestic abuse is there's some work. It's not great work because not much has been done that people who are subject to domestic violence, so psychological, physical, sexual, are more likely to have menopause at a younger age and they're more likely to have more severe symptoms. And that really scares and worries me because we know a lot of symptoms such as reduced self esteem, low self worth, are going to be great for that abuser. They love people feeling very vulnerable because it's a power control thing, as I'm sure you're aware. But these poor women are thinking they're feeling like this because they've been in an abusive relationship, so they deserve to be like that. And there's this spiral of doom that's just going down and down. Whereas if any of us could lift those women up and say, look, some of this is going to be related to your changing, reducing hormones. Even if I can make you 10% better by having your hormones back, that's going to be better. And a lot of women we speak to. They also have physical symptoms. So I've been doing some work in prisons, and a lot of women in prisons have very dry, very itchy skin. They have cystitis, they have recurrent urinary tracts. Now, you could tell me that I'm stressed because I've been abused or whatever, but you can't tell me I'm making up my dry skin or my urinary tract infection. So I think as doctors or any healthcare professionals, any women we come to who we're not sure, is it their domestic situation? Is there something going on? Or have they got clinical depression or psychiatric disorder? Ask them about the physical symptoms. Because for me, that's a great red flag. It's probably related to hormones. And a lot of psychiatric drugs will increase prolaxin, which will suppress FSH and lh, basically, which will suppress your hormones. So women have been given a chemical straight jacket, giving themselves a chemical menopause. So if they have hormones, if they're lucky enough to have some, they'll be even worse. But again, asking or thinking, you know, are there other physical. Am I getting palpitations? Am I getting heartburn, reflux? Am I getting cystitis? Did that coincide with my mental health symptoms? And if the answer is yes, then you have to go and speak to someone who understands hormones. You might need psychiatric treatment as well. That's fine. And as you know, Kelly, we can give. We can have more than one diagnosis in medicine. There seems to be so much politics at the minute. It's like it's either all the menopause and all HRT or nothing. And that's just stupid thinking, actually, because we can give more than one treatment for more than one condition, and that's fine.
- [26:58]
Dr. Kelly Casperson
I was astounded by, I think, quote, if it's wrong, correct me. I think it was the British Menopause Society. I'm going to generalize the quote. But we shouldn't be giving testosterone because it doesn't work in everybody. And we also shouldn't be giving testosterone because there's a placebo effect. And I'm like, that's all medications. Antidepressants don't work in everybody. High blood pressure medications don't work in everybody. That means we still give them to some people. And there's a placebo effect, certainly for the SSRIs and lots of medications. That doesn't mean we don't try them. So, like, the statement was so stupid.
- [27:33]
Dr. Louise Newson
Yeah. So I. I have a bit of an issue with placebo effect in that. Yes, everything can have a placebo effect, but not as much as we think. And actually there are two things really. I was reading something from the 1930s 40s when hormones started to come out and they noticed that women were having this feeling of improved well being. They were calmer, they were happier, and they couldn't explain it. So what they did, they ignored it and only focused on the flushes and sweats because they were objective symptoms that other people could witness. So that's where first of this misunderstanding was. But secondly, when you know how a drug works, and when I say a drug, I really mean a basic hormone. Like we know that we've got these hormone receptors in our brain, every cell in our brain, well then it makes sense that if you get the docenter right, it's going to improve. Whereas SSRIs, we still don't really know how they work. So, okay, you might have placebo effect then. But you can't keep dissing science to say it's all placebo. But the other thing is, even if you didn't feel like me and think placebo is 80%, so what, you're giving people a natural hormone and they're getting great placebo. Like, how can our own hormones suddenly turn on us because we're giving them back? I don't. That's what I can't understand.
- [28:51]
Dr. Kelly Casperson
This is a male. Women aren't feeling better, they just think they're feeling better. You're like, is this an insane world? How is that not the same thing and legitimate? We're dismissing the fact that you're saying you're feeling better.
- [29:07]
Dr. Louise Newson
So there's somebody, I won't mention her name, but you can look up studies from the 70s wrote in the Lancet about HRT being addictive and women were coming and asking for more. It was implants mainly. And I've been thinking about this quite a lot because what does addiction mean? And I like doing exercise. If I haven't done yoga for a few days, I know I get a bit twitched and my mind starts racing. So, yeah, maybe I am addicted to yoga. But can you be addicted to things that are good for you? Like, I really like being with my family.
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Dr. Kelly Casperson
Yeah. The definition of addiction is that it's causing some sort of harm. Like, you can't live without oxygen, but you're not addicted to oxygen. Right.
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Dr. Louise Newson
Like, but that's the whole thing. You can live without hormones, but you're not going to have the same quality of life. But then I think this is where I suppose I've maybe upset, annoyed I don't know what the adjectives is, people, because let's forget all about the symptoms and the placebo effect, whatever. Let's think about how these hormones work in our body. And I said at the beginning about. I'm very interested about inflammation, this inflammating, the inflammation that increases as we age. I'm very interested in mitochondrial functions. So mitochondria is the powerhouse of all our cells. We have trillions of them all around our body, and they work better in the presence of estrogen, progesterone, testosterone. So we've got to strip it back to the basics. And the basics are there. We've known for decades, but we've ignored it because we've been so worried about synthetic hormones, which is irrelevant to our conversation anyway. And even when we talk about testosterone, There are about 300 anabolic steroids, which are testosterone, like they're synthetic testosterone that people are injecting and doing goodness only knows what. And, you know, you need to walk down the street and you see often men with these ridiculous muscles. It's awful. My husband, you might see them as urologists. My husband sees them. They're infertile, they have all problems, but they're using synthetic hormones. It's not the same as the natural testosterone.
- [31:08]
Dr. Kelly Casperson
They can't. I mean, part of it, I don't want to say I'm an expert on anabolic steroids, but part of it is what I see in the men I've talked to about this is again, what it comes down to for everybody. Lack of care by the traditional health service. My shoulder hurts or I'm not getting gains in the gym, or I'm still tired. Right. It's like lack of seeking. People want to go. They want to use their insurance, they want to see a doctor that is well respected, and then they go outside of the medical system to try to solve their problems. So I don't think it's all that. These men just want to be bigger. It's like they want to feel better, which is what women want to feel, too.
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Dr. Louise Newson
Yeah. And I do think it's a bad thing to feel better.
- [31:47]
Dr. Kelly Casperson
I would say this is my argument. What is the role of the doctor? If the role of the doctor is not to help you feel the most like yourself that you can, what are we doing? Because it's hard to measure. How do you measure, you know, wellness. Right. And I'm like. I would say it's the most important thing.
- [32:09]
Dr. Louise Newson
Oh, absolutely. For sure. You know, I was thinking back recently to my interview when I went into medical school. You know, you're 18 and you're really young, really naive, you know, why did you go into medicine? Because I wanted to help people feel better. That's just a standard response, but it's true.
- [32:24]
Dr. Kelly Casperson
It's the answer you have to say to get into medical school. Let's talk about the end of the aging spectrum. Let's talk about frailty. I am recently obsessed with the. There's a lot of small studies really, looking at testosterone in men in frailty. There's one study, what they did, they gave a man very high testosterone dose. I think it was like 600 milligrams. Like, injection of 600 milligrams was very high. But right before he had it, they had knee replacement or something like that. And they were able to stand faster after surgery. The only thing that wasn't significantly changed was like the length of time in the hospital. I'm like, had they moved that needle, this research would have gone somewhere. But I saw a woman yesterday, wheelchair, multiple comorbidities. She knows how to get around her house by what she can grab onto, right? Like, she's literally a hip fracture away from being institutionalized. And I'm looking at her with my hormone lens. She's there for a completely different urology issue. And I'm like, have I lost my freaking mind that I want to put her on testosterone? And like, we care a lot about this, like, you know, young menopause and get on the horn, prevent the harm. But I'm like, can I talk for a second about the 78 year old who's maybe got a couple of years left? And I'm trying to just not get her fall to fall. Like the role of hormones and I would say testosterone more than estrogen, just because I've seen that data more. Looking at frailty, what are your thoughts on that?
- [33:49]
Dr. Louise Newson
I think it's so important, Kelly. I really interested in healthspan, not lifespan, but, you know, we live longer as women than men, which is great, but we're less healthy than men in our last, on average, 10 years. And a lot of it is this first frailty, these chronic diseases, these inflammatory diseases and osteoporosis just looks like a bit of a nothing. It doesn't reach the headlines of the papers. It's like, oh, it's just thinning of the bones. You can't even see it doesn't usually cause symptoms. I tell you what, if you're like one of my patients, mothers who tripped on the washing, the stairs, fell over and Fractured her neck because she had osteoporosis, didn't know it, and now she's paralyzed. You wouldn't think it's a bad thing. I was telling my daughter this morning, the number of women I've seen who have. Have had micro fractures of their spine from sneezing because their bones are just like this honeycomb, because there's no. There's no strength in them. We didn't see that 100 years ago because we didn't live very long. We reproduced. And actually, I was reading some books from the 1870s, and people were still having some periods in their late 50s, even early 60s, and that's probably because they were pregnant so long they had more reserve. I don't know. But we don't have that now. So if you have 30, 40 years without hormones, anything building your bone, it's as dry as a literal crisp and it will shatter and break very easily. But it's also, the bones are drawn biologically active. We obviously, they're not just there to hold up the body, but our muscles are really important. But our muscles shrink. You know, we know this osteo sarcopenia, so bone muscle getting thinner, basically. And you see that, you know, people laugh about women's bingo wings, but actually it's a real problem because people might still do the same exercise. They can't build muscle the same. And it's not how we look. I really want to be independent when I'm older. I want to get out the bath. I don't want my husband pulling me out of the bath. I want to get out from the chair and, you know, go and do whatever, make a cup of tea, lift the kettle, you know, and that sounds Silly now, age 53 thinking like that, but my goodness, people fall off a cliff when they're older. But if it's shrinking your bones, there's more inflammation in your heart system, it's shrinking your brain. This is a real problem. And so I don't see why people are so scared in starting hormones at an older age. Because there's decades where people have been so scared of hormones. We see in future a lot of women in their 70s, 80s, even early 90s who've been either come off HRT because of the scare from 2002, or been told you can never have it, or you're too old. And that really frightens me because we know from studies even low doses of estrogen will help build bone. Like you say, the testosterone data is really interesting. One of my friends who's a doctor, his Mother is lovely. She's quite fit and well until she became 50. Funny that. Was diagnosed with an autoimmune condition. Funny that, because we know that's related with menopause. Well, actually was fortunate because this was in the 90s. She was given HRT, felt amazing, then told to come off in 2002, and her health deteriorated after that. And she's got some cognitive decline, early dementia. She's just about managing at home. And about a year ago, he said, louise, I'd like her to try some hrt. And we did a proper consultation. She knew because she remembered being on HRT before. So I'd given her some and given her a little bit of testosterone as well. And she recently had a really horrible fall and didn't fracture anything. And she stayed at home. And her cognitive decline has improved. So she has carers at home, but she's not in a nursing home. She's not been admitted to hospital. She's had no more urinary tract infections. And he said, this is a miracle. And he understands, he's a doctor. But why aren't we going around to nursing homes looking at this? I can't quite understand it.
- [37:59]
Dr. Kelly Casperson
The lowest hanging fruit is vaginal estrogen. We have rings so women don't have to apply it twice a week. You can just pop a ring in. Like admission to the nursing home equals estring in the vagina.
- [38:10]
Dr. Louise Newson
But, you know, I never realized that. I feel so embarrassed because I used to go, when I did home visits, always to the local nursing home, residential home. Women with UTIs, you go into their rooms and you could smell it and you think, oh, here we go again. Didn't think about their vaginas. But then what are we doing with these women with irritable bladders? We're giving them drugs like oxybuty, which increase the risk of dementia. They're horrible drugs and falls and probably heart disease as well. They're not nice drugs, so. It's so wrong.
- [38:40]
Dr. Kelly Casperson
Yeah, it's awful. Let's talk a little bit about heart disease, because this is a. This was a very fun text thread that you and I were on a little bit ago, because prevailing wisdom start estrogen early. It doesn't treat heart disease, it prevents heart disease. And so then people extrapolate and they say, well, there's an amount of heart disease that then you are disqualified from hormones. And I'm like, show me the papers, show me where it is. Because we actually have secondary prevention studies. So they've taken women with heart disease, then put them on hormones and they fared no worse than placebo. So my understanding is it's not going to flare anything, certainly the transdermal especially. But people will be like I couldn't get HRT because my blood pressure was high. I couldn't get HRT because my lipids were high. And then people are like, what's the coronary artery calcium score that disqualifies you from hormones? And we're like is there one? Does it actually make sense that you're disqualified if you have hard calcifications that we're looking at? Not the soft calcific. Right. It's measuring the wrong thing perhaps. So there's my introduction for people of like, I think we need to reconsider all of these non proven limitations on starting people on hormones. What are your thoughts specifically your thoughts on pre existing heart disease?
- [39:58]
Dr. Louise Newson
Yes. Yeah, I think it's really interesting and I'll tell you what I think and what I've learned over the years because when I again went to my first menopause society meeting with my notebook and you know, I heard a lecture which we've seen quoted and it's from the WHI saying and the first bit's true, the earlier people take HRT the better, better for their future health, reduced risk of heart disease. But there's this window of opportunity is what people like talking about. And over the age of 60 then there's even pictures like you've probably seen them when you're looking down someone's blood vessel and it shows all the anti inflammatory effects of estrogen. Over the age of 60 it completely changes. On your 60th birthday, did you know Kelly, your whole physiology changes in your body and it increases inflammation and increases your risk of heart disease. So when I saw this picture I was like, hang on, this doesn't add up. Let me find out where it's come from. And it's come from the who, of course, this study which I know you've spoken about before, where they were giving women over the age of 60 that magic number synthetic hormones. So conjugated equine estrogens. And just for those listeners who don't know, it's full of different types of estrogen because it's from pregnant horses urine, but it also contains different types of progesterone and different types of testosterone. Did you know? So people inadvertently have been giving testosterone with premarin with probably without realizing, which I think is quite amusing.
- [41:26]
Dr. Kelly Casperson
Hold on. Conjugated equine estrogens has testosterone in it?
- [41:30]
Dr. Louise Newson
Yeah, synthetic it has like, it's, it's chemically different to. There's about 10 different.
- [41:35]
Dr. Kelly Casperson
It has our testosterone, but it has androgens.
- [41:38]
Dr. Louise Newson
It's from pregnant horses urine. I'll show you the paper later because
- [41:42]
Dr. Kelly Casperson
you just exploded my brain.
- [41:43]
Dr. Louise Newson
Amazing. Yeah, okay, I know. I read it again this morning and I was like, hang on, this is something else.
- [41:50]
Dr. Kelly Casperson
This is fair. Let's, let's focus on the heart. But I gotta come back to that.
- [41:53]
Dr. Louise Newson
Okay, we'll come back to that. So the heart disease, they, we know that oral oestrogen, especially that when it gets converted to estrone is quite pro inflammatory, increases inflammation. But we also know that the synthetic progesterone does. So the redoxyprogesterone acetate MPA that was in the WHI study increases risk of cardiovascular disease and clot. So they were giving these high dose tablet oestrogen with synthetic progesterogen. No surprise these women had an increased incidence of heart attacks. A lot of them had had heart disease before, but we don't give those sorts of HRT to women. Now if I see a woman in her 60s and 70s, I'm going to give her estradiol through the skin, anti inflammatory, natural progesterone, no effect on heart disease or clot. And if she needs it, testosterone, pure testosterone, anti inflammatory as well. And then some people say, okay, Louise, but if they've got a little thrombus, a little clot there, oestrogen can dilate, can open up the blood vessels, so the clot might dislodge and then they have a problem. But hang on a minute, estradiol is only slightly works as a vasodilator. In cardiology we give drugs like calcium antagonists like amlodipine that cause a lot of vasodilatation or GTN spray. If someone's having a heart attack that opens up the blood vessels to get more blood to the heart, well, that's going to dislodge a clot a lot more than a little bit of oestrogen. So that argument, I'm afraid, doesn't add up at all. But we also know that estradiol, because it's so anti inflammatory, it works on prostaglandins, prostacyclines, it works on lots of cytokines, it's chemicals that our immune cells are producing all the time. But there are good ones to reduce inflammation. But it also really importantly works on something called nitric oxide, which is a really good protective anti inflammatory vasodilator. Very calming for the lining of the blood vessels. So the more we have that slashing around in our system, the better. And the other thing is, you might read there's some great papers from the 1980s where they actually gave sublingual under the tongue estradiol to people coming in with heart attacks. And they had a better prognosis, they had less stain in heart disease, you know. Yeah. So Philip Sorrell and Whitehouse, Michael Whitehouse did some amazing papers. Incredible. Because we know estradiol affects thousands of reactions in the body, so it's very good for heart disease. So, again, it's. I know this sounds really awful. It's like lazy medicine trying to sort of fit in some results and then say, no, it must be because of this. And it's a bit like saying, you know, hot flushes cause heart disease. Of course they don't. Let's take a step back. What's causing hot flashes and what's causing heart disease? The lack of estrogen. And so we. But so many cardiologists, I haven't met one cardiologist yet who prescribes hrt, whereas they see so many women in their clinics with palpitations, with raised blood pressure, with heart disease, like. And it's the number one killer with dementia.
- [45:02]
Dr. Kelly Casperson
Yeah. No, it's insane what you need to do. You gotta go wear your heart monitor. You gotta make sure there's not everything. You have to get a workup for other things. But then you should just shrug your hands and say, we don't know what's causing your heart palpitations now that you're 48, is lazy. And I think you and I were talking about this on the phone last week, of the lack of curiosity on the hands of physicians, I can't blame them. I can blame the system. When you've got 10 minutes to see 30 people in one day, there is no room for curiosity. But when you're. When it's dark at night and you're at home on the couch and you're thinking about your career and you're wondering about all this repeated stuff you keep seeing, can you be a little bit curious?
- [45:44]
Dr. Louise Newson
Yeah. And totally. And I think, you know, I've been really privileged in my medical career, like I said, because I've had this portfolio career. So the last 10 years of general practice, I only did one day. I did a Monday. And my children still remember. They go, mummy, on a Monday night. We knew there's no point talking to you. Your brain was empty. You were fried. You'd sat on the sofa and stare into space. But the other four days of the week, I'd be writing articles, I'd be reading papers, I'd be going to meetings, I'd be talking to lovely people like you to really challenge my brain. So when I came back the next Monday, I was quite fresh and I would think, oh, let me ask this lady about this or this man about, you know, whatever. I'd have more in my brain. I'd come back to my GP practice and I'd see the others and think, gosh, every day they've been here, like, it's a. It's a sort of conveyor belt, so that you're on a hamster wheel in medicine and you often learn by who tells you something over a cup of tea, which I know is wrong. And if you haven't got the time or the experience to get the papers to read, to have that independent thinking. Yeah, it's difficult.
- [46:49]
Dr. Kelly Casperson
Then you just listen to podcasts on your drive to work. Work. Listen to Luis and me. Okay, let's go back for a hot second about. Because everything comes back to testosterone in my world. Premarin, the conjugated equine estrogens. There is a thought in the menopause world that perhaps the benefits of the brain, specifically on the women who were taking conjugated equine estrogen, was better than estradiol on the brain, and we don't know why. This is what I've heard. Is it possible because there's some androgens in there? Am I making too big of a leap because I'm just excited?
- [47:24]
Dr. Louise Newson
Yeah. No, I think it's very interesting. So if you look at how our hormones are formed, you've got cholesterol at the top. So it's a whole nother debate whether statins actually block some of the natural hormones, and I'm sure they do. But then you've got progesterone, but you've got lots of other hormones. You've got dhea, you've got pregnagolone, you've got other ones, and they also form cortisol as well, which is our stress hormone. So it's not just. We make it very simplistic. These three hormones, there's a myriad of hormones and goodness knows how many others that we don't know about. I've already said that. Conjugated equine estrogen. Pregnant horses urine contains Hundreds, like, literally 200 different types of hormones, mainly estrogens, but progesterones and testosterone, so they probably are stimulating some receptors that we don't do with the simplistic hormones. But the other thing is, the more I read, the more I help women and treat women, is I think about progesterone so much more than I ever did before. Because we're always told progesterone is to protect the lining of the womb. You don't need it if you have got a marina in or if you had a hysterectomy. Well, actually, let's read what was the first thing that happens in our brain if we have a stroke or a head injury. Guess what? It produces progesterone because it reduces inflammation, it helps cells repair, it helps neuroplastic. So why aren't we giving ourselves progesterone even before oestrogen? And progesterone often drops before oestrogen, as, you know, as we get older. So a lot of the studies are looking at estradiol, or they're looking at estradiol with a synthetic progesterogen, which is completely different. So the synthetic progesterones block. They're really like, I always sort of say to people, you know, if you have a key cut and it fits the lock and it doesn't unlock, it's just there's a little bit missing or wrong. It's a bit like that with the synthetic progesterone. It gets into the receptor, but it doesn't unlock. And have these lovely, beautiful biological actions, but it's in that lock. So the nice progesterone hanging around will not have an effect. So it's worse than having nothing, really. And then you're absolutely right. Testosterone has the most brain effects, I'm pretty sure. And obviously our brain produces that hormone as well. But I can't ever rationalize why we should be giving ourselves pregnant horses urine. And I was reading a lot last night. I'm preparing for this theater tour. That's why I'm reading so much. But I was actually reading about the horses and about these big farms, mainly in America, and what they did to these horses. And I'm not going to talk about it online because it's so harrowing. But you can't tell me, Kelly, when you were pregnant and I was pregnant, that our. We contained the same amount of hormones. Hormones. Because that would be not possible. So how can every single horse have the same balance and amount of hormones? It doesn't make sense. So. And metabolically, there will be some hormones that horses produce that we don't need in our body. But it was controlled initially by Wyeth, and Pfizer took over Wyeth it was a multi million at one stage. It was a billion dollar industry and they patent it, they made it a secret concoction, whereas you can't paint natural hormones. So if you look at the politics behind it, some of it will be controlling by pharma, which I suppose I didn't really appreciate so much until recently.
- [50:49]
Dr. Kelly Casperson
Yeah, yeah. And that'll be super interesting to uncover. I think as time passes, the secrets start coming out. Right. You can never see it when it's happening. You can't know the secrets when it's happening. But like, who funded the whi? Why did the WHI actually happen? Who are those people paid for? Paid by. Like that's gonna. Now that we're 20 to 20 years past those, those stories are gonna start to be told, I think, which only helps us understand things. Tell us about your, your talk, your theater tour and your Balance app. I want people to know what's happening within your world because you've got a lot of exciting things.
- [51:26]
Dr. Louise Newson
So. Yeah, well, that the theater is exciting and scary in the same way. So I'm going on it in next month at the end of September, because we're at the beginning of August now recording this and I'm going to 35 different theaters around the UK to a live audience.
- [51:43]
Dr. Kelly Casperson
That's insane and amazing.
- [51:44]
Dr. Louise Newson
Yeah. So I'm going to be talking a lot, obviously about hormones. What they do, what they don't do, how they work. I'm going to be talking a lot about the history of hormones. That's why I've been reading so much, to really try and unpick what's been going on, but not just of hormones, about how, how doctors have evolved, especially male doctors, and how women have been portrayed and how our role in society has changed and whether hormonal health has caught up or not. So it's called the Great Debate. There's a huge amount of debate in it, but I wanted to have different content so people don't think, oh, I've heard that on a podcast or I've read that in her book. So it's fun. And I've got a comedian actually who's joining me so she can liven it up because there's only so much people want to hear me. And then we'll have a Q A as well. But I'm very fortunate. Kelly. I'm going with one of my close friends. Amanda is going to be my sort of tour manager and I've known her for 21 years. I met when we were both pregnant with our Eldest. So we're gonna have a bit of a road trip as well. So hopefully it will be fun.
- [52:50]
Dr. Kelly Casperson
Are you gonna film it? So it's gonna be available at some point online for the, for the rest of the world.
- [52:55]
Dr. Louise Newson
Well, let's see how it goes first.
- [52:57]
Dr. Kelly Casperson
Oh, come on, you're gonna.
- [52:58]
Dr. Louise Newson
I might not want anyone.
- [52:59]
Dr. Kelly Casperson
After 35 stages, you're gon like, this has to be filmed. This must, this must be.
- [53:04]
Dr. Louise Newson
I'm gonna have some slides, so I've got some. Great. Honestly, it's amazing what you can find when you stay up till far too late looking on the Internet. But. So, yeah, it's a good content. So, yeah, I'm looking forward to that. And then Balance app is the app that. It's just had its four year birthday actually. And I brought it out because I was so frustrated. It took me about six months, months to realize what was going on with my symptoms. And my husband and I really close. But you know what, Kelly? I hated him. I hated his breathing, I hated the way he ate, I hated the way he spoke. Like, if he'd said to me, louise, I'm done with this relationship, I'm going, I would have gone, good, just go, I don't want to see you again. But then a day after my period came, of course I would have gone, oh, I need him now, actually. He's a real rock and he's, you know, voice of reason, but I didn't realize. And then, you know, people shouldn't have to come, they shouldn't have to pay privately to come and get some basic hormone treatment. So when I set it up, I was really committed that it would be a free app. And we don't have external funding, so we're not like a lot of femtech companies where we've got to make money from it. And I know I've annoyed some of the people who work with me because it would be great if we had more money, but I don't want to because it's made by women for women. We've done a lot of market research, we give a lot of information, constantly updating, like articles, information on it so people can monitor symptoms, they can get information relevant for them. They can also join a community. So if they want to exercise more or reduce their sugar or meditate, they can do that as well. And what we have learned is nearly 80% of our users of Balance can get the treatment that they want from using it. We haven't asked what treatment. I don't mind what treatment they have as long as it's what they want. So that's really good. But they've also found their physical health and mental health has improved. And I think that's because they're part of something, you know, they're working with others because it's so isolating sometimes, especially for some cultures where they're not allowed to talk or that it's more shameful to be talking. So it's great. I've got lots of ideas that I do want to do going forward when we've got some more backing for it, or not backing, when we've just got some more profits from the clinic really to pry into it. But it's been great looking at it and you know, you learn a lot. It's like your social media and my social media. You hear from women and you realize that this is such a massive problem that you need technology to approach it and you need other people. Like, it's great being connected with you and colleagues in different countries because also medicine can be quite isolating, can't it? And you think, oh, am I a lone voice? But we're not anymore. And I think that's really powerful.
- [55:49]
Dr. Kelly Casperson
Yeah, I mean, just me yesterday, wanting to give this wheelchair bound, 78 year old testosterone. I'm like, am I mad? Or is it quite possible that I know a lot and you know, surrounding yourself with other people who think like you is very mentally helpful to not feeling like you're isolated and crazy, you
- [56:09]
Dr. Louise Newson
know, it's so important. I'm very fortunate. When I set up the clinic six years ago, I was with Rebecca Lewis, who you will meet in real life at some stage. And she's a great friend and a doctor and she used to be an anesthetist and went into general practice and she's got an inquisitive mind like me and we set it up together. And what's great is that when I'm being pulled down or shot at and just all this abuse on social media, she will say, louise, no, keep going. You are Semmelweis. You know that Austrian gynecologist who learned that hand washing was the best thing to help maternal ill or reduce maternal death. But she's been great. And a lot of people don't have a Rebecca. They don't have someone who can say, no, you're right, don't listen to this noise. And I think that's what we've got, this groundswell of great clinicians who support each other. We're not in it to be better or bigger than one or the other. And I think maybe. Do you think it's because we're women? Maybe, Kelly. I don't know, we just don't want to.
- [57:10]
Dr. Kelly Casperson
I like to think it's because we're highly evolved. But you know, like, just for people who don't know, we're talking about like the menopause, right? Like providers who talk all the time about changing the world this way we're not in it for fame and fortune, we're in it literally to change the world by getting women to feel better. And that is a internal fuel that doesn't stop burning.
- [57:34]
Dr. Louise Newson
Yeah, for sure.
- [57:35]
Dr. Kelly Casperson
One more question before we end it. Paint me a picture of menopause. Let's not even call it menopause care, women's ovarian hormone care, because that extends from pre menopause, postpartum depression, like women's hormone care. Paint me a picture eight years from now or pick a year. What do you want?
- [57:55]
Dr. Louise Newson
I want it to be that women are in control. Women can have the choice. Women get what they want first off. So a lot of it is knowledge and empowerment for women. So giving the information that's right for them in ways that they understand. That's evidence based. Got the evidence. We've got a lot of clinical evidence, we've got a lot of basic knowledge as well and common sense. So allowing women to choose is the most important thing. And then thinking about it as this hormonal insufficiency and looking at all ages and I've already said to you, I've got three daughters, they have hormonal insufficiencies. My 13 year old's period started a year ago. She sometimes spontaneously cries in the shower and is quite relieved when a period comes the next day. She doesn't need treatment now, but if symptoms get worse, I'm not going to wait till she's menopausal before thinking about her hormones. That would be barbaric. I want people like my 21 year old who's made the decision to be on hormones for her pms, who's really open, talking to others. She's a trombonist, so she's educating, talking to people, how safe hormones are, how all these myriad of symptoms can occur. It's got to be really, really open and non judgmental the conversations that we're having. But my biggest wish is that all clinicians understand hormones and can prescribe them and that they're cheaply or freely available for women in every single country because they can't keep doing more and more education and then finding that we can't actually access these basic hormones. And so we've got to do it together. But we have to also work with other clinicians, with politicians, with governments. We've got to do it from the top as well as from the bottom. And I think a lot of our work, we're doing it from the bottom really well. But we need to have this joined up global movement so we all allow women to have hormones if they want them and that. I don't know whether it will take eight years. Years, but it can't take 80 years, Kelly, because that would be terrible.
- [60:01]
Dr. Kelly Casperson
Yeah, it would be absolutely terrible. Thank you for being my friend. Thank you for podcasting with me. Thank you for loving curiosity and chewing on ideas and and questioning the status quo. And I loved our chat today. I know people are going to love this. Thank you so much.
- [60:17]
Dr. Louise Newson
Oh, it's been great. Thank you so much.
- [60:20]
Dr. Kelly Casperson
Thank you for listening to this week's episode of youf Are Not Broken 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. Medicine. See it 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.