← You Are Not Broken
Loading summary
Transcript5 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
Hey everybody. I'm going live on Instagram and recording a podcast. We're going to talk about perimenopause and incontinence today. First things first tonight, Heather Hirsch Academy and I'm teaching the three of four live classes. Tonight is genital urinary syndrome of menopause, vaginal estrogen, vaginal dhea, vaginal testosterone and then we're going to go into the non hormonal medications for female sexual dysfunction. So flibanserin, brimalanotide, bupropion and then we're gonna skip a week because of Thanksgiving and then whatever that first week of December is on the Wednesday that'll be the fourth class live and that is going to be all about female dose testosterone. All the data, all the safety data, all the side effect data. Do we have data? Is there data? Come to the Heather Hirsch Academy. So go to heatherhirshacademy.com, go to the courses, you're going to scroll down, you're going to see me, my face to do live. So go register now. Everything's evergreen. If you miss this, they'll be recorded. This was going to be a three class course. It is now a four class course. Because it's a lot, I'm telling you. I'm basically doing like my brain download for you guys. Come and learn. You do not have to be a physician. You do not have to be a nurse practitioner. But if you are, there will be continuing medical education. Credit pay with your CME money physician in another country still applicable, just probably not credit for your countries. And then if you're just a lay person who wants to know more so you can talk to your doctor, nurse practitioner, blah blah blah, you can listen too. You're going to get massive, massive info download. We are going to do a little bit. If you don't follow me on Instagram, go to Instagram KellyCaspersonMD and we can learn there. I'm going to be answering a bunch of bladder slash perimenopause bladder slash perimenopause questions today. So come on, come all somebody, we're going to start with a question right off the bat. My doctor tried to tell me you don't start vaginal estrogen until menopause to treat GSM of menopause. But I started having UTI infections when I didn't used to get them. Here's the answer. There's nothing magical about your last period. It's not like your hormones are great and then they fall off a cliff one year after your last period. And one third of women don't have periods to tell them when they're going to be in menopause. So for the people who have periods, what the F is the point of a period? Meaning general urinary syndrome of menopause can start in perimenopause. Your estrogen can go crazy low all the time. Sometimes in perimenopause, you can still have bleeds. You can have bleeds without ovulating. That's why it's harder to get pregnant in perimenopause. Right? So those periods aren't like your hormones are normal. They're not like your hormones are normal alert signs. So you can absolutely start it. And think of it this way. Vaginal estrogen is skincare. Skincare for down there. It's not risky, it's not unsafe. It's over the counter in multiple countries. There's absolutely no reason not to give it a try. In people who are starting to suffer from UTIs and perimenopause. I do. I mean, to me, it's like it will repopulate the lactobacillus and reacidify the vagina, which is how it works in helping decrease UTI by 50 to 60%. And there's very few studies on vaginal estrogen in perimenopause recurrent uti. I would love it if somebody did those studies, but there aren't, so I can't quote it, but, like, scientifically it makes a whole bunch of sense why it helps. So I hope that that helps. Interlude getinterlude.com Code Not Broken will get you a discount. That site is online strictly for vaginal estrogen. Great place to get it without having to go into the doctor's office. Okay, somebody said intrarosa and vaginal estrogen saved my life. I was getting chronic UTIs. Now I haven't had one in a long time. You guys, this is what I asked my women. If there was a medication that could decrease your risk of urinary tract infections by 50 to 60%, would you want to know about it? And they're always like, yes, I'd like to know about it. So that's vaginal estrogen. It's the best we have. I always joke. I'm like, I can never make your infection risk zero because, like, you're alive. But it can decrease It a lot. Pee more every two to three hours while you're awake. Hydrate more. There is some data that a high quality cranberry can help. I love Alura by Solve Wellness. Another one is Theracran. They're both excellent. Buy a high quality cranberry, not just stupid cranberry from a supplement score. Is interstitial cystitis a perimenopause condition? Not specifically, but I think that and many urologists that know think that interstitial cystitis is over diagnosed. It's a chronic incurable condition and perimenopause is very common. Basically every female will go through perimenopause. Not everybody will be symptomatic. But I spend more time taking interstitial cystitis diagnoses away from people than giving them to people. Chronic incurable condition. Basically inflammation of the bladder. The classic sign with interstitial cystitis is my bladder hurts as it's filling and it's relieving to urinate. Urinating relieves the pain. That's very actually rare. A lot of people will have burning with urination, recurrent UTIs, pain in the vulva. None of that is interstitial cystitis. So get a proper diagnosis. There's no reason to put a chronic ankle. Yeah, I see so many women, they're like, I've had interstitial cystitis for 30 years. I just, I haven't had any symptoms for 20 years and I'm like, probably don't have interstitial cystitis. Somebody just told you you had it and you've been carrying this 10 pound brick backpack around with you. All right. Can you use hormone replacement therapy if you have fibroids and endometriosis? Yes. Somebody said vaginal estrogen has been a game changer for me. After only three months, bladder issues are greatly improved and my libido, let's just say my spouse is very happy. Yay. Vaginal estrogen for the win. All right, let's get back to these questions that people sent me. Mark Cuban has vaginal estrogen. Very cheap. Yes, Mark Cuban Cost plus drugs online pharmacy. Just have your prescriber put your prescription into that. Pharmacy is $13. It's very nice. Is there any way to avoid migraines during the menopause or should I keep taking hormones? Intermittent hormones can actually improve migraines. There's data for testosterone, there's data for estrogen. Is there data for progesterone? I can't remember off the top of my head. This is the deal. The brain is very sensitive to the change in hormones. It's not so much the hormone level, it's the change. And that's why headaches and migraines go up in perimenopause in the menopause transition, because your hormones are fluctuating like a mother. I have bladder pain with no uti. Any suggestions? Yes. See a physical therapist. See somebody who can do a good vulvar exam. Make sure a lot of people, when they say my bladder hurts, they're pointing somewhere on their body that is not their bladder. So see somebody who can suss that out for you. I'm breast cancer, a survivor. It's been seven years in full menopause. I get UTIs. Never had them before. My oncologist won't even talk to me about topical low dose estrogen. Okay, how many studies do we need to publish and how many meta analyses of the studies do we need to publish before we can just accept the fact that vaginal estrogen does not increase your risk of recurrence? If you've had breast cancer, there's just another meta analysis published literally last month. The American College of Obstetrics and obstetricians and gynecologists. ACOG has a position statement on. I think it's acog.org you just need to Google position statement. ACOG, breast cancer, vaginal estrogen. You can pull it up, you can print it out, you can bring it in, you can see another oncologist for help. Women are suffering. We have data. We have good science. Help them not suffer. Lots and lots of data on that friend saying that estrogen isn't a necessity in menopause. I don't agree. And I think HRT will help stop us getting illnesses later in life. What are your thoughts? Remember, my thoughts are the data. This isn't just me having thoughts in a basement. There's a lot of data on this. And it's complicated in the sense that current medical practice tries to get you better once you're sick. Current medical practice does not try to prevent you from getting sick short of vaccinations and like wearing seatbelts and gun safety, probably dental hygiene is better at preventative medicine. The dental people, for all the dentists out there, you are doing a better job at preventative health than the doctors are. So as a nation, the medical profession will never say, go on hormones for preventing disease. They will never say that. Do not hold your breath. You will die waiting. And if you Want to live 40 years past Ovarian function or hell, testicular function for people who have testicles that aren't producing enough testosterone. Like, let's be all inclusive. If you want to live that long and preserve your health. Preservation of function matters. 50% decreased risk of bone fracture. About 50% decreased risk of heart disease. And that is heart failure. That's cardiomyopathy. That's heart attack. Decent data. We need more data. But again, it's hard to study long, slow things like dementia. But there are multiple papers, including a 2023 meta analysis by Dr. Lisa Moscone, saying that people who start hormones early, meaning when you're 50. When you're 55, the earlier you start, the better. Remember, hormones prevent disease. Hormones do not treat disease. Your friend cannot decide at 68. You know what? You were right. Maybe I will start. It's not how it works. So those are my thoughts, if you want. So in 1900, the average life expectancy factoring in infant mortality, factoring that in was 47 years old. God willing, I hope to not be dead in a now ish sort of situation. I Hope to live 40 years past my ovarian function. We've never lived this long. We need to start caring about preservation of function because we're seeing how people are living long. And that's the thing. Yes, you don't need it in the sense that, like you're not going to die. Except for we do have data saying if you take hormones, you actually have up to a three year increase in life expectancy, which is a big enough data point for me. You actually do live longer. But your friend is technically right, it's not a necessity. Like oxygen, coffee, sleep, et cetera, et cetera. The coffee was funny, you guys. Don't forget to laugh.
- [11:38]
C
Shop the Sherwin Williams 4th of July sale and get 30% off paints and stains. June 26th through July 6th. Whether you're refreshing your interior or exterior, we've got the coffee colors to bring your vision to life. And with delivery, getting everything to your door is easier than ever. Shop online to have it delivered or visit your neighborhood Sherwin Williams store. Click the banner to learn more. Retail sales only some exclusions apply. See store for details. Delivery available on qualifying orders.
- [12:07]
B
Can I take HRT if I get migraines with aura? Absolutely. And it might help. My testosterone level is low. And doctors suggests a pellet. I already have a hairy face. What would you suggest? I would suggest seeing somebody that doesn't just offer pellets. If all your doctor does is offer pellets, number one, they're making money from Pellets. Number two, they're not a comprehensive hormone, Doctor, because the comprehensive people know that a pellet is the highest dose on the menu. I'm sorry, all we have is the $300 bottle of wine. You don't get the $12 glass of wine and you don't get the $40 bottle of wine. All you get is the $350 bottle of wine. That's all we serve here. Some people want that. Not the best for everybody, though. Somebody said hormones have helped improve my migraines. Yay. Can you take turmeric supplements while on hrt? Sure, why not? Can you take vaginal estradiol and intrarosa alternating nights for severe gsm? I think so. When you're doing higher than recommended doses, which is what that is, because the recommended dose of vaginal estrogen is twice a week. When you're doing higher than recommended, I want you to be seeing somebody who can check you and make sure that that's ok. Allowed to have systemic. Are you fine with systemic if you absorb enough? That's what I think about. If you're using a high, higher dose of vaginal estrogen is two things. Number one, are you pushing it to systemic levels, which is fine in a lot of people. Except for in the people, it's not. And number two, should you just be on a higher systemic dose because you're needing so much vaginal estrogen? My insurance will only cover the pellets. That's weird. What planet are you living in? No offense. I've never seen insurance just cover pellets. How can hormone therapy help urinary and vaginal health? Okay, well, hormone therapy is like 101 for GSM. Genital urinary syndrome of Menopause. Super useful. Everybody should know about that. I think vaginal estrogen should be preventative medicine. Vaginal estrogen helps urge incontinence, getting up at night to pee, urinary frequency and burning with urination. A lot of that's local hormone therapy. There is some data. It's actually the WHI data and the HERS study data that oral, both estrogen and synthetic progestin increase risk of stress incontinence and urge incontinence. Nobody really knows why that is, but they'll say the side effect of hormone replacement therapy is incontinence. What they mean by that is systemic. And we don't have a great mechanism for knowing why that is. We're kind of confounded by that. But I wouldn't say, like, don't consider hormones because you might have incontinence. Conversely, testosterone, systemic testosterone. There's at least two papers looking at testosterone and stress incontinence that it helps stress incontinence. And I know several people whose stress incontinence has gotten better on systemic testosterone therapy. What types of hormone treatments are commonly recommended for symptoms like urinary incontinence or vaginal dryness? Man, what a generic question. Vaginal dryness. Most common is a vaginal estrogen product. The cheapest, again, is the vaginal estrogen cream. $13 Cost plus drugs Mark Cuban Pharmacy urinary incontinence. Pelvic Floor Physical Therapy 101 Pelvic Floor Physical Therapy 101. Any sort of incontinence helps with all of it. And again, vaginal estrogen can help specifically with the urge incontinence. Some people say stress, but stress is a lot trickier. Stress incontinence again. Le with cough, sneeze, laugh. Can you start HRT at 64? And what are the benefits? Listen to my podcast, episode 291 with Dr. Corinne. Men listen to that episode. Also, go back a while ago to the episode Boomers should be pissed. They're both helpful. Are there specific risks associated with hormone therapy that could affect the bladder or urinary tract? Yes, there is some data that says oral again or I haven't seen it with transdermal. I need to look that up. Have we seen incontinence with transdermal estradiol? Somebody send me a study. But with oral, yes. We don't really know why. For women experiencing recurrent UTI during perimenopause, is hormone therapy a viable treatment option? Yes, I think we already went through that one. Again, no studies for it. But remember, estrogen starts going low in perimenopause, especially if you've taken a couple of rounds of antibiotics, too. Your microbiome's crap. And I really think the vaginal estrogen helps rebuild the lactobacillus and the acidity that you need to help prevent the poop bugs from migrating through to the bladder bugs. How many days a week do you recommend for estradiol vaginal cream to prevent uti? Standard dosing is twice a week. I joke. My dentists hate this joke. I joke and I'm like, twice a week, like, how much you floss? I went to the dentist with my daughters this week and they're like, how are you doing with flossing with them? And I'm like, we're doing really good once a week. And she laughed and she's like, how about really good once a day? And I'm like, oh, yeah, I forgot the recommendations. Once a day for flossing. What alternative treatments are available for genital urinary symptoms in patients who cannot undergo hormone therapy? You guys. Who can't undergo vaginal hormone therapy. Who Possibly a rare, currently actively treated breast cancer patient. Actively treated breast cancer patient. But remember, we don't have a lot of studies that. That support. That that's dangerous. It's really more dogma that people are afraid of. Again, the ACOG position statement. And you gotta talk about risks and benefits and how much you're suffering. And as low a dose as possible just to get the needs done. Why is my doctor telling me you can't take vaginal estrogen and estrogel, which I'm assuming is the topical systemic gel at the same time? Divi gel is the other name for that, because they're not an expert in hormones. Okay, let's do some math. This is a fun math problem. If systemic estrogen raises your blood level to. We're gonna say 30, gonna pick a number. 30, which is still very, very low dose. That's like a man's estrogen level for those in the know. And vaginal estrogen raises your level to 0. 30 plus 0 equals 30, so thus proving the point that you can be on systemic estrogen and vaginal estrogen and it doesn't increase. There's no reason you can't. And remember, systemic estrogen is still very, very low dose. It's often not enough to address all the symptoms of menopause, including the vaginal urinary symptoms of menopause. So that's why you want a little bit of extra skin care down there in the vulva and the vagina. You put it in the vagina. Vagina and the bladder share a wall. That's how it helps the bladder. Does estrogen actually cause blood clots? Oral, slight increase. Still less of an increase. Here's a question. Do we not give women birth control pills because of the side effect of blood clots? Do we say, like, sorry, nobody gets birth control because there's a risk of blood clots? Do we say that? Further question. With systemic hormone therapy, where transdermal causes no blood clot risk, increased blood clot risk, and oral does have a blood clot risk, but it's lower than birth control blood clot risk, why do we say no women can be on hormone replacement therapy because the risk is blood clots. That's insane. As somebody who's not educated in the actual data. Would you recommend vaginal estrogen as a prevention for UTI prior to surgery? You should just be on vaginal estrogen all the time. As like. The answer is yes, but why not just be on vaginal estrogen all the time? Here's the question. If we know that genital urinary syndrome of menopause affects 50 to 85% of women, gets worse with age, and the treatment is incredibly safe and cost effective, why are we waiting for them to suffer instead of just saying, you know what, Let me know when you're gonna get in a car accident and I'll remind you to put your seatbelt on. No, you just wear the effing seatbelt. So wear the seatbelt. My endocrinologist says no HRT after 60. I'm 60 next month. Okay, I, you know, I pause for the cause. I hate telling women to get second opinions because it puts a burden on you. Number two, it puts burden on you. Number three, it puts burden on you. But you're literally talking to people who don't know the current data pull up. So for that question, my endocrinologist says no HRT after 60. I'm 60 next month. Two choices. Number one, don't turn 60. Second choice is print out the 2022 North American Menopause guidelines. Print them out, bring them in. The lowest dose for shortest amount of time is old dogma. It's not seeped into any sort of data. And there's actually a new paper, I think it came out in the last year, looking specifically at Medicare recipients. So for people who are international, Medicare is our federal health insurance over age 65. So these are women older than age 65 on hormones. So they didn't stop them on hormones. Compared to their compatriots who never started hormone therapy. Decreased risk of death, amongst other things. Decreased risk of death. So there's a strong argument for staying on them. Just saying, oh, progesterone after hysterectomy. That's always a good question. So the dogma was you don't need progesterone if you don't have a uterus. That's true. When you take systemic estrogen and you have a uterus, you need a progesterone because that counteracts unopposed estrogen on the uterine lining. So what they said is, hey, you don't need it if you have a uterus. If you don't have a uterus. But oral micronized progesterone is number one, very cheap, very safe, incredibly Safe really helps people with sleep and mood. So nowadays we're doing a lot more like, yeah, progesterone, if you need it absolutely doesn't matter what happened to your uterus. The only absolute on that is currently is if you have a uterus and you're taking systemic estrogen, not vaginal estrogen, you must take a progesterone either. Iud, oral micronize. There's a couple of other options. Combi patch. There are some synthetics that some people use. So a couple options with them. Oh, you know what? Good point here. Okay, the other point, somebody was commenting about the risks of blood clots with OCPs. The risk of blood clot with pregnancy is actually higher than the risk of blood clot with birth control pills, which is higher than the risk of blood clot with hormone replacement therapy. And we don't tell women don't get pregnant because there's a risk of blood clot. So I think it's incredibly inappropriate how we scare women with hormone replacement therapy without putting things in context. So, yes, thank you, my friend, for giving that other excellent point out. Somebody said they fired their endocrinologist for the lowest dose, shortest time. You guys, there are some good endocrinologists who. What do I mean by that? Everybody is. Doctors try their best, but endocrinologists, by and large didn't get trained in the air, quote sex hormones because they're labeled sex hormones and the whi scare of 2002. So it's, I would say, stereotypically. Also, the endocrinology position statements are not very favorable for testosterone for women. So I know some amazing endocrinologists who are very supportive, but by and large, they're kind of crappy when it comes to sex hormones. Prove me wrong. I know there's outliers. All right, here we go. How safe and effective are topical or vaginal hormone therapies for urinary and vaginal health? Very safe. Amazingly safe. In what situation would you not recommend them? A premenopausal woman who has no symptoms. They've got great estrogen. They don't need vaginal hormone therapy. How easily are they to be prescribed? You need a prescription from a prescriber. There are online clinics that you can go to. So many online clinics. If I list all of them, I'm going to miss some of them. So I'll try. But give me the on the spot privilege of missing some midi Evernow Alloy Joy Interlude. Get interlude specifically for vaginal estrogen. They're awesome. Code not broken for A discount. Lots and lots of online prescribers now for hormones. Is there a connection between estrogen levels and pelvic floor health? Yes. And can hormone therapy help in strengthening pelvic floor muscles? Probably so. Both estrogen and testosterone are very important in muscle strength. Mixed data on prolapse and hormone levels, but most prolapse happens in older people. Most older people aren't on hormones. Most people's muscle strength goes down with age. It's all correlated. Certainly. Any idea why? The Medicare study showed increase in ovarian cancer with progesterone but not synthetic. Doesn't make sense. I think that was faulty data. Progesterone alone didn't have an increase. I think that's what it was. Progesterone alone didn't have an increase. So I think that was just bad numbers. We don't have a mechanism for that. The other theory about people on hormones having more ovarian cancer, again, mixed data, but there is some and rare cancer, small increased risk. But you know, some experts have said like, yeah, if women live longer and healthier and are being dying of other things, they are more likely to get that cancer because it is an older person cancer. That's another opinion about that. Can low hormones cause dental issues? I'm perimenopause and having issues with gum inflammation. Absolutely. Watch the M Factor documentary. The Teeth. The teeth. Everybody who's seen that documentary is like the teeth. Is there a place to get vaginal estrogen cream? Prescription cheaply? Yes. Mark Cuban Costs plus drugs. You need a prescription, so you need a provider to do that. But it's very good. Will MIDI prescribe testosterone? I think it depends upon the state that you're in. That's the last I've heard about that. My endocrinologist won't give me progesterone because breast cancer risk. So oral microns, progesterone, multiple studies, it doesn't increase risk of breast cancer. Maybe the synthetic medroxyprogesterone acetate, but that's not the most common. The most common progesterone now is. What do I mean by common? The most accepted by the current menopause experts is oral micronized progesterone, which is excellent breast safety data. Are there bone and cardiac benefits with just progesterone? I haven't seen cardiac, but I have seen bone. Do you see a connection in hormones in pots? I think so. I think that pot strikes a lot of people in perimenopause, but I haven't seen data. If somebody has a Paper on that, please send it to me. I'm in perimenopause and was told by my menopause specialist that birth control is my only systemic option. That is not true. But I always say this. If you have sperm in your life that you want to protect yourself from, you need a birth control option. Whether that's a vasectomy or condoms or oral birth control or an iud, whatever. So at a perimenopause you can still get pregnant, so protect yourself from sperm first. But if people are like, oh, my partner has a vasectomy or I'm same sex or I'm not sexually active or whatever, you don't need a birth control pill. Birth control pills are good for managing heavy periods in perimenopause. So are Mirena IUDs and systemic. Regular hormones aren't as great for managing heavy periods. So that's another thing to think about. So when a perimenopause person comes to see me, those are my two big questions. Where's the sperm in your life? Do we have to worry about that? And what are your periods doing? Are they super heavy? It's like the pellet people. Like, all we have is pellets, all we have is birth control. That's not a true hormone expert. The true hormone experts, like, here's a menu. Let's see what's best for you. Can vaginal cream help with libido? Yes, because it helps arousal, because it helps lubrication, because it decreases pain. Yes, but it isn't systemic, like in the brain, like the systemic meds are. So I hope that helped. Can intrarosa be used in the morning? Sure, if you want to. Not a problem. Intrarosa is vaginal DHEA for people who don't know. Partial hysterectomy four years ago. Currently started progesterone and testosterone. Do I need estrogen too? The question would be like, why not be on estrogen? It's great data on estrogen. Are you in perimenopause? Why are you on progesterone? Testosterone but not estrogen? It's a little non standard, but consider estrogen. Unless there's a reason not to be. Remember all of my podcasts and Instagrams and everything else? This is for educational purposes only. Educational and empowerment and edutainment purposes only. This is not individual medical advice. I am not developing a doctor patient relationship by teaching you things online. So everybody knows that though. Get informed. Get the documentation, print out the papers, go talk to somebody. Somebody says 68 year olds too old to start a patch? No. Listen to episode 291 with me and Corinne. Men. Where is natural estrogen sourced from? Good question. You want the right answer? You want the cute answer? There is a man with a wheelbarrow and he picks yams and he puts his organic yams into the wheelbarrow and then he drives his wheelbarrow to this massive fucking manufacturing plant which makes all modern pharmaceuticals. And that's where they're made. I hope that one made you laugh. Okay. All right, my loves. One more. Can I use testosterone topical in the vagina? Yes, you can watch out for systemic levels, though, because this is the vagina and the vulva. Suck that stuff up like a mother. It's pretty unorthodox. Meaning not standard. It's not unheard of. But I would say common menopausal experts aren't giving you testosterone for the vagina. There are some papers, but I do. You're going to get systemic levels a lot of times on that. So I didn't mention the Casperson Clinic. Okay, so if it's true that we used to only live to 47 years old, even 100 years ago, and it's true that you replace everything in your life when it wears out. Your car's tires, the gas tank, glasses, your teeth, your hips, but you're not replacing your ovarian hormones. But you want to be as healthy as you can and not have a broken hip when you're 80, you have to start hormones. The younger the better, for brain, for heart, all those things. So. Casperson Clinic, Washington State, January 2025. Get on the waiting list. Kellycaspersonmd.com clinic we'll sending out emails probably end of December, January to start seeing people, and I can't see everybody. So this is for people who want to get in, be seen by me. You have to come to Washington State or be in Washington state or drive down from Canada. It's a beautiful clinic. It's lovely. It's being developed right now and I'm very excited about it. So come one, come all. Except for I can't see you all. So get on the waiting list for the people who want to be seen in the Casper Syn Clinic. Okay, one more question. 49. Too young for HRT? H E L L N O. No. What is estrogen good for? Oh, God. Go back to the first podcast and start at the beginning. What is it not good for? All right, my loves. I hope that that was a good Q and A. I love you very much. And let's See, after you've established your patients in Washington, can you see them through telehealth for their follow ups? Yeah, I'm pretty sure I can. I gotta check with a couple more people, but pretty sure that's the plan. All right. Oh, also, Sydney Opera House Australia March 1, go buy your tickets. It's in the link in the Instagram. Or you can go to the Sydney Opera House website I think it's called. It's getting hot in here. Why am I blanking on what it's called? But March 1st, Sydney Opera House. I'm going to be there. I love you. I can't wait to meet all the Australians. I want to hold a koala manifest. All right. I love you guys.
- [32:19]
A
Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests including on this podcast are not giving individual medical advice or practicing medicine. See and consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, 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.