← You Are Not Broken
You Are Not Broken
295. Lubrication, Libido, and Letting Go: Unlocking Intimacy After Menopause - A Q&A
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Foreign. Welcome to the you are not broken podcast.
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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 you're not broken podcast. And for those joining me live on Instagram, Hey, Instagram, you know, I have a podcast, it's called you are not broken. And hey podcast people, do you know I have an Instagram. I just hit 190,000 followers on Instagram today, which is larger than a lot of towns. So I'm coming live to actually record some Q and A that I got. I did an amazing live lecture, I guess you could call it, for the YPO organization, Young Presidents organization. Amazing, amazing group of CEOs. Over a thousand female CEOs, I believe, if I have the stats right. And it was all about intimacy in midlife and menopause and all that. And so they basically sent me a list of 20 follow up questions. And they're like, can you answer all these questions? And I'm like, you guys are the top 1% of people who ask this many follow up questions. And so I'm like, you know what I'm going to do? I'm going to record a podcast answering these questions because why not answer them for everybody? So this is mostly about intimacy, midlife, a Q and A that is coming on the heels of me doing like, I think I did it for like a 90 minute lecture for them on this topic. So that was super awesome. Remember, none of us got a good sex education. Nobody got a good sex education. So we're all, we're all shooting in the dark. If you didn't have an awesome mom, who did this for you? Okay, so question number one. There's 22 questions. 22 questions. Number one, mid age sexual health care tips. Cardiovascular fitness matters because heart health is vascular health. Vascular health is clitoral and penis health. We'd have the data in men that erectile dysfunction precedes heart attacks, not in everybody. Just because you have ED doesn't mean you're going to have a heart attack in a couple of years. But ED is a risk factor for heart attacks. And the equivalent in the female body is trouble with arousal, or what we call arousal. Female arousal dysfunction, much less researched. But as all the body parts are equivalent, heart health matters, cardiovascular fitness matters. So that'd be my number one mid age sexual healthcare tip. Number two sexual healthcare tip would be use lube all the time. Normalize it. Start now, start before you air quotes. Need it number three would be vaginal estrogen. Start it. If there's any sort of dryness or pain. Absolutely. Start it. In America, it's a prescription. In the UK they have estrogen tabs that are now over the counter. Me and my sex med people and my hormone people, we all kind of think it's a good preventative. Like why wait for pain with sex? Why wait for decreased arousal and lube and intimacy? Just start it. So when should you start it? I don't know, 55. Certainly earlier. You can start it in perimenopause if you have symptoms. All right, how to reignite drive while on antidepressants and after menopause. The number one way I think to reignite drive is learn about sex. Learn about sex. Learn about your body. Learn about what your turn ons are. Learn about what your turn offs are. Prioritize intimacy. Prioritize time spent. Read some books. Hashtag you are not broken is amazing. My book's really easy to read and I would argue it has saved marriages. I was talking to an amazing sex therapist today about this and about midlife divorces and how people have said that my book has saved marriages. And I'm like, that's like a $17 fix for it's not going to save everybody's marriage. And some would argue all marriages shouldn't be saved. But sex ed and communication skills go a very long time. Go far. Okay, is there any data that shows an increase in drive and arousal in perimenopause? Yeah, because there's a lot of things that are kind of liberating about not worrying about getting pregnant, not caring as much about what other people think. Prioritizing your own pleasure, getting comfortable with your body, getting comfortable talking about intimacy. So like, all of those things can increase your enjoyment and pleasure with sex. And so I think all those things happen a lot in perimenopause. All right, next question. I could live without sex, but I realized that our relationship as a couple is better if we do it. How do I motivate that need in myself? Great question. First of all, if you ever need pro help with this, sex therapists are amazing. What's the name of the book? You are not broken by Kelly Casperson, MD. That's me. Somebody just asked. The subtitle of the book is stop shoulding all over your sex life, which I love. Motivate about what works for the partnership. Love that you're prioritizing the partnership. Love that you're prioritizing connection. Love that you're prioritizing spending time with your partner. Love that you're prioritizing, getting curious about the act and getting. Not just doing it like, God, just in doing it just sounds awful, but like getting curious about it, remembering that it's supposed to be playful, remembering to try new things, remembering to prioritize yourself in the experience. So really, like if you just think of it as doing it, that's not really super motivational. But all those things, right? Like this is personal growth. What better time for personal growth than midlife? What can be done with a partner who has always had a low sex drive? Only alcohol seems to get things started. Okay, I missed my answer for all these questions is just going to be see a sex therapist. No, but really, the sex therapists are amazing people. They will help with all this. So alcohol is first of all a Class 1 carcinogen. And I don't promote alcohol at all. But how alcohol can help with sex is it takes away like the self consciousness, it takes away like the worry, thinking, brain, any shame you might have. So alcohol helps people with all those things. Now you can get help with all those things without alcohol. Sex therapy comes to mind. But so all of those, and I would say somebody with a low sex drive that's only improved with alcohol, that might be a great thing for sex therapy. What does sex mean to them? Why do they feel like they need to numb down or use a substance? Right. There's a lot underneath that. So it'd be hard for me just to be like, hey, try lube. Or hey, you know, try a medication for low sex drive. So that would be something that I want. Oh, shout out to the OB GYN in Portland. Thank you for being an OB GYN in Portland. Love you guys. How do we overcome the ingrained belief that being sexual is not what a good girl is all about? Or how does one overcome the shame imposed by parents of being sexual? You see it, you realize it. You realize it's not your fault. You realize it's not your belief. You realize that your parents were trying to do the best they could, but maybe were misguided and had their own issues with sexuality and they passed that on. You realize that you can play a very important part in breaking the generational cycle of shaming women about being sexual beings. So really it's like a. You gotta see it. You gotta see it for what it is. You gotta realize that beliefs and thoughts aren't real. This is all goes to all the coaching stuff of like, just because you think a thought doesn't mean it's true. That can be a thought that wasn't even put there by you. It can be put there by somebody else. That goes for, like, all coaching and all thoughts, and just start to distance yourself around it, see it for a thought, get coached on it if you want to. And you can start walking around that thought and being like, is this thought serving me? As an adult, you get to decide, is this thought serving me? And if it's not, you get to walk away from that thought. And when that thought pops up, you're like, of course you pop up. That's what brains do. Brains remember thoughts. But we're not going to latch onto it. We're not going to think it's true anymore. And this is what I'm going to do to live the life I want to live. Thoughts about using testosterone to increase libido in menopause. Yes. And so testosterone can work really great for libido. It does not work in everybody. If you have zero sex education and you just take testosterone and you still have shame and orgasmic inequality and you call it doing it, like, testosterone might not help your sex drive. Right. So remember, sex is biopsychosocial. Testosterone can help with the biologic. Testosterone is important for sex drive, but it does not help everybody with sex drive. These are. It's not just my thoughts. I think, and I know all the research, that testosterone's incredibly safe. Oh, sideline to this awesome question that just came on the Internet. How do I convince older women to use vaginal. Vaginal estrogen when they say they don't need it because they are not sexually active? This is what I do when women say that for people who don't know, back up the boat. Vaginal estrogen decreases urinary tract infections by about 50 to 60%. So incredibly, incredibly effective. So estrogen is not just there for you to have sex. Your vagina is not just there for you to have sex, FYI. But again, if you weren't taught that, especially the older generations, they think the vagina is there for somebody else. So I usually look at them and I say, oh, oh, did you think that you take care of your vagina for somebody else? And they mostly just stare at me. Or I'll look at them and I'll say, how is that relevant to our conversation right now? And then they'll say they don't. They'll usually say, I don't know how that's relevant. And I'm like, because it's not relevant. Somebody else putting something in her vagina Is not relevant to the conversation I'm having with you about decreasing your urinary tract infections or you're getting up at night to pee, et cetera, et cetera. But that older generation especially doesn't realize their body is their own. Doesn't realize their vagina is not for somebody else. So I usually like, thank you for telling me about somebody else wanting to put their body parts in your vagina. But I don't see how that's relevant to our conversation right now. I'm here to make you think people. Okay, going back to testosterone. So this is my joke with sex med and hormone and meds and low libido and stuff like that is I say, I rarely prescribe on the first date. And what I mean by that is, is I want to hear the story. How's the relationship? What are your thoughts about intimacy? Are you prioritizing play and fun? Do you think it's a chore? Right, Like, I want to understand all of that before I'm like, here's some testosterone or some Flo Bancerin or some violisi or some Wellbutrin or whatever you're going to use to increase your desire. I want to understand your relationship with sex first. Because if I just give you a medication and you're still like, sex is shameful and sex is dirty and sex is painful and I'm just doing it to keep somebody happy, it's much less likely that the medications are going to help for you. So that. Yeah, somebody said, what's the background story? Exactly? Get the background story. How can I reach my G spot while masturbating? I'm not sure if I've ever had an orgasm before with the G spot anyways, so you don't have to ever reach a G spot. The new termination is a G zone. G spot is basically right underneath your urethra, maybe about like a half an inch deeper, more inside than the urethra. So if you take a mirror and you look at your vulva, you. You can see the little opening at the kind of 12 o' clock of the entrance to the vulva. That's your urethra. You take your finger and like one knuckles worth. I'm looking at, I'm looking at my fingers right now. One knuckles worth. If you put it in, that's going to be where the G spot is. It's basically the pericliteral, urethral erogenous zone. They make vibrators that kind of angle up and they call them G zone vibrators. Now, if you stick those all the way in, you're going to be hitting more cervix. But some people find that to be pleasing. You don't have to put them that far in to be hitting the G zone, G spot. If somebody came to see me in clinic and asked where their G spot was, I would show them because I do vulva exams all the time. So you can have many, many. You can have orgasms doing many different things. You don't have to touch the G zone or G spot to have an orgasm. It's just the somebody said, my husband is following your instructions right now. That might be too much information, people. It's a good thing. This video is one way. All right, what's the best way to deal with clitoral adhesions? Good question. I think it depends upon how severe it is. If it's truly like clitoral phymosis, which I think of as, like, very severe adhesions, you might not be able to just take them down while awake. If they're mild clitoral adhesions, I would just try a course of topical estrogen or topical estrogen plus testosterone, which is a compounded medication, and retract the skin and really try to get the hormones up in there. Not a lot of data on this. The next step would be to actually kind of like, peel the clitoral adhesions away using numbing medication and just kind of like some gauze. Usually a clinician's going to do this for you. If you have mild clitoral adhesions and they're not bothering you, your orgasms are fine, you don't have any pain. Leave them alone. But I would get on the hormones because I wouldn't want those to get worse. To my knowledge, I don't have any data on if you have clitoral adhesions, are they going to get worse? I can't answer that. I have not seen data on that. What to do if your partner isn't into oral sex? You got to communicate, got to be like, what do you like? What do I like? What am I good at? What are you good at? I really like oral sex. What do you think about oral sex? Really hear what they say about it and see if you can explain your love of oral sex to them. And then say, like, hey, I understand that that's not super comfortable for you. Maybe it hurts your neck. Maybe you have, like, taste aversions, whatever it is, but be like, it super turns me on. Can we sometimes have oral sex? What works for the relationship. And if those conversations seem absolutely insane to you, please see a sex therapist. I was talking to a sex therapist today about the cost of seeing sex therapists. And I was like, let's see. Average divorce in midlife is a loss of 50% of wealth, okay? So keeping that marriage together is probably worth thousands, hundreds of thousands, millions, whatever. So that's what a sex therapist is worth. You're welcome. They're worth it, people. Okay, confidential question. How to deal with partner Ed. Well, first of all, normalizing Ed, the statistics say that 40% of men will have some sort of Ed by age 40. So there is an aging and health component to this. So really kind of normalizing it instead of like the stereotype, like the stereotype that women should just want to have sex all the time is not true. And holding anybody to that is the word evil comes to mind. But it's a expectation mismatch to what the truth is. The same is for erectile dysfunction. Expecting men to get erections on a dime for their entire life, all men, is an expectation mismatch. So just normalize it. Remember, amazing sex can happen without super hard penises. I know, I know, I know. That's mind blowing. You didn't get good sex ed. So you don't. People don't know that. The other thing that partners do is they make their partner's ED mean something about them. Usually like, I'm making your ED mean that you don't find me attractive or that you're cheating on me, or that you don't like having sex with me, or, you know, X, Y and Z. So really understanding what's underlying the concern about ED can be very helpful. But also say, hey, you know, ED is very common. Sometimes it means heart disease or other health factors. Sometimes it's a side effect of medications. It's important to me to feel connected sexually. And I'd like to talk about this not in a blame shame sort of way, but in a understanding what you think about it and, you know, how I can be helpful and supportive. So communication, communication, communication. Any suggestions on overcoming sex becoming painful during after menopause, besides for basic creams and gels. Okay. I'm not sure if that's like a should I take vaginal estrogen preventatively question or what? But I would say vaginal estrogen. Vaginal estrogen. Vaginal estrogen. My third thing I would say is vaginal estrogen. It's already painful physical therapy because muscles can get tight, too. When skin gets tight, muscles get tight because the muscles Are trying to protect you. Right. So if sex already is painful, there's also. If sex is already painful, there tends to be like this fear pain aversion cycle that gets built up. I wouldn't say sometimes. I would say like all the time. Except for when proven otherwise. You don't want to put your hand on a hot stove. Right. Your pelvis doesn't want to feel pain. So you tend to avoid things that are painful. So getting that cycle to release. Sex therapist, physical therapist, urogyn, who can do a good pelvic exam, help you out with hormones. Somebody said, hubby went to a therapist that did physical testing, and final analysis was that it was all in his head. Is that a thing with men? Yes. Erectile dysfunction can be psychological. I'm a urologist, so personally I wouldn't rely on a therapist doing testing to say, it's all in your head. Like, where's the urology trial? There? Where's the medical evaluation? There. But yes, it can abstress anxiety, relationship issues, shame. All of that can make things tricky with erections. So. Absolutely. Women and men have different sexual needs, and this may be amplified if they have different cultural backgrounds. True. Can a couple be sexually incompatible? Yes. There's your short answer. Yes. And remember, normalize the fact that couples don't agree on a lot of things. I don't like going out for Italian food. He likes to listen to opera more. I like romance novels. He loves horror films. Whatever. And you need to, like, normalize that. You're going to figure out what works best for the relationship. Sometimes you watch horror films alone. I won't watch horror films with you, but I will watch rom coms with you. Whatever. So the point is, like, we make sexual differences be like this big, big deal when it's like, a lot can be improved with communication. Understanding. Having a relationship based on trying to figure things out, support, understanding. I just feel like I need to say understanding again and some understanding. Also some sex therapy. But yeah. Can a couple be sexually incompatible? I think all sex therapists will say yes. Some people are just sexually incompatible and they can't find anything that works for the relationship. Very, very possible. I would like to better understand the different ways in which women orgasm. Oh, God. Many, many different. This is like my favorite story about this. Many years ago now. I was doing like, a sex ed thing. The end of the day in my office with a really great, like, sex coach. Wasn't. I don't think she was actually a sex therapist, but, like, really helped with intimacy issues and she Came and she's like, I want to tell women the 17 different ways that they can orgasm. And I'm like, whoa, whoa, whoa, whoa, whoa, whoa, whoa. A lot of women can't even have one orgasm. So please don't give them all the loaded pressure of like, not only can you not have one, you can't have 17. I'm like, let's start with one. This is not a competition. Orgasms are wild. Meaning like people have been notative or first of all, you have orgasms in your dream. You can wake up having an orgasm with no genital stimulation, thus proving orgasms are in your brain. You can. There's been documented people having orgasms just with ear stimulation, just with nipple stimulation. So different people orgasm for from different ways. What we do know is the more pelvic nerves you have stimulated at the same time, or erogenous nerves, including breast and nipple. Like, the more nerves you have firing going to the pleasure centers, the more intensely experienced an orgasm can be. So instead of just playing with the clitoris or just being in the vagina or just being on the vulva or just being on the breast, like, do all four to have a more varied experience. Sex for One by Betty Dodson is a very old book, but very good for people who haven't had an orgasm and want to try to figure that out. So Sex for One, somebody said. I'd love to buy your book. Where can I get it in Canada? Canada, Amazon, I'm pretty sure. And if you can't get it on Canada, Amazon, please screenshot that you can't. But this book is available international. Many Australians love it because Australians have very good senses of humor and I think that's what they like most about it. So I hope that helps. Sex for me often leads to or aggravates vaginal infections, such as yeast infections. What would you suggest for preventing recurrent yeast infections? I would want to know what your vaginal hormone regimen is. Are you perimenopause or menopause? Is your microbiomes just not as healthy? Right. Have you been on a lot of antibiotics? What lube are you using? What part of sex seems to trigger a yeast infection? Are there condoms involved? Does sex without penetration trigger a yeast infection? Lots of questions to that. Loss of libido in menopause. I'm on hrt. My levels are good, but my libido is still non existent. What can I do? Get a good sex edge. Read my book, understand the difference between spontaneous desire and responsive desire and that they're both Normal. I talk about hrt, I always mean and testosterone. But that's because I think there are three hormones to be replaced in hrt. Testosterone, estrogen and progesterone. So to me I'm like, are you on testosterone? You didn't tell me, you just told me hrt. So now I have to assume. What type of lubes do you recommend to keep a healthy phone. Low osmolality, which is hard to find on the package. But that's why I like a silicone based one, not a water based one. Stay away from like things that are flavored or scented or stuff like that. Does it matter what time of day testosterone is applied? Not really. If you're at like a steady state. Not really. But transdermal kicks in pretty quick. Injectable, I think kicks in like they're. The peak is like 12 hours later. So some people with injectable will put it like Sunday night, so they get a peak Monday morning or like Friday morning. So you get a peak Friday night. If you care about going out. I've been following you for a while now and know you are an advocate for vaginal estradiol. Oh, you're paying attention. I love it. In Mexico we only have available estriol, vaginal cream, 1 gram. The suggested use is 1 gram twice a week. Because estriol is a weaker estrogen. I'm wondering if twice a week is enough. I think it depends upon your symptoms. Europe also has Estriol for vaginal use. I have never seen and I actually looked for this because I'm giving a class. If you guys want to take my class. If you're a clinician, doctor, nurse practitioner, sex med person, go to the heatherhirshacademy.com and go to courses and scroll down to the one where you have, where you see my face. And it's a course that is broken into. Well, so far it's four nights. But we'll see. I think, I think I'm not going to be able to pound through testosterone in one day. So we'll see what happens. So it's female sex education, all about orgasmic inequality, desire, all that stuff. Number two would be general urinary syndrome of menopause. So in my research for that course I looked to see if there was a head to head trial on estradiol versus estriol and I couldn't find it. So I can't tell you that one is better than the other one. But we know that estriol works great for the face, right? Like who doesn't Compound Estriol for the face. At this point, you guys, it's almost 2025. Did you know that in the 1950s, slash possibly 60s, cosmetics in the United States of America had estrogen in them? It was not until the FDA pulled hormones off of the over the counter and required them to be prescription that we lost the estrogen use in cosmetics. So that's why I'm like, it's 22, almost 2025. And we're like putting estrogen back on our face, although it is compounded and a prescription. But that's what they did in the 1950s because we knew it was good for your skin. So my point is, if Estrail is good enough for the face, it's probably good enough for the vagina. I do not have head to head comparison trials. Best tips for sex after menopause. Pleasure, pleasure, pleasure, pleasure. We're not doing it for other people anymore. We're not doing it to get pregnant. We are doing it for ourselves and for our relationships. So pleasure, pleasure, lube, Pleasure, pleasure, vaginal estrogen, pleasure, pleasure vibrators, in that order. My doctor is reluctant to give testosterone. As she says it can cause deepening of voice and unwanted hair growth. Well, yeah, if you give male doses, but don't give male doses, give female doses, female doses, don't do those things. A little bit of hair growth on the chin, like a little more but like applicable amount. And you know, I ask my women who'd like notice a little bit more of that. I say like, hey, are you having benefits? Check your level, make sure they're not in a male dose range. And do you mind that? Is that worth stopping it for? And most people say no. In the famous words of Dr. Rachel Rubin, when you play with hormones, you get side effects. But dosing manners, dosing matters. Here's something I don't. I didn't say this much on the podcast, but you guys need to know this. What if we have 10 times the dose of testosterone in born as female bodies that we've studied for 50 years? Do we have that data? You know the answer, otherwise I wouldn't be asking you this question. Yes, we have that data. It's trans data. Thank God that they've been doing this for frickin half of a century that we have a 50 year study. It's on Brits and we have a 30 year study. No increase in mortality. Don't tell me this stuff is unsafe. I just, I can't handle it anymore. Especially at female doses. What do you recommend for women Experiencing lack of sex drive because of perimenopause. Treat your perimenopause symptoms. People who feel like shit don't want to have sex. That should just be my Instagram handle. People who feel like shit don't want to have sex. Female dose of testosterone is one tenth the male dose on average. You can start lower or you can go hot. You can start higher. I like one tenth the male dose. So if the male dose is 50 milligrams a day, transdermal female dose is 5 milligrams a day. Can testosterone help you climax? Yeah. A lot of people on testosterone say it's just easier to have an orgasm. Just happens faster. Not that faster is always better. Some people like that. HRT can and should. You do it for the rest of your life. Okay, so I'm trying. I try to get laughs. So when people ask me, how long can I use hrt? I. I tried this on somebody this weekend. It fell flat. So it helped me. It helped me with this joke. I was like, well, what's your plan for death? Cremation, burial? Like, what's your plan? And they're like, why are you asking me that? And I'm like, because you can take it to that. You can bury it. You can get cremated with your patch on. You can do whatever you want. 2022 North American medical Society guidelines state, as long as the benefits outweigh the risks, there is no arbitrary age or anything else that you have to start, stop your hormones. Is there a supplement that can help increase libido in Premenopausal women age 47 years. Mixed data on DHEA in America. DHEA is a supplement. It's not standardized, which is my big problem with supplements. It is a prescription in Canada, and not everybody in Europe can get dhea. So DHEA is different depending upon what country you live in. Do you like how I try to be international?
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Australia.
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What's up with DHEA in Australia? I need an Australian to tell me this, so I know the answer is DHEA over the counter in Australia. Stay tuned. So I think DHEA has mixed data. I tried dhea. It gave me crazy sex dreams. Like, super fun. I didn't notice anything else improve, but, like, that's fun. Tom Cruise was there. I didn't pick them. You can't pick your dreams. Just tmi. FYI, Tom Cruise and I had some sexy times when I was on DHEA in my dreams, not in real life. So DHEA is a supplement you can try. Some people say, say Ashwagandha Some people say l arginine. So just stay away from anything that's like super expensive and is like a proprietary blend. If anybody, if anybody says proprietary blend that usually they're making money off of you. Does per menopause affect your sex drive? Yes. Next question. How can you talk about sex with your partner without having it feel like a sex ed class in high school? Don't invite your gym teacher. I think what you're saying is how to make it not awkward. Just say it's going to be awkward. Put the awkward on the plate. Embrace the awkward. Be like, can you believe that we are 46 years old and we don't know how to do this? Isn't that ridiculous? What if we learn how to get better at talking about this? That might be helpful. So I would just say, call a spade a spade, man. If it's awkward, it's awkward. Say it. You know what's high school is you trying to be too cool to make an awkward thing not awkward. It's like you're just going to make it awkward because you're trying to not make it awkward. Like, that is high school. Just call it out. Use I sentences and we sentences. Don't use you sentences. That's my number one advice is just say like, I want to make this not awkward, but I don't know how to do with this. So is there anything doctors prescribe or suggest to take along with testosterone to reduce chance of hair loss as a side effect? Yes. Don't take too high of a dose. Don't take too high of a dose. So maybe I say with pellets, like, you gotta earn your pellet. Pellet should not be your first introduction to testosterone. Really? With female physiologic dosed testosterone, you. We don't see hair loss as a significant issue. All right, guys, how long did we talk for? We talked for a good time. That was my 22 questions, plus a lot more coming in live from Instagram. So, hey, podcast people, I have an Instagram. It's called Kelly CaspersonMD Instagram people. I have a podcast. It's called you'd are not broken. If you have a. This is. Okay, well, there's one more because I can't help myself. It says OB GYN only prescribes pellet hrt. Then that's somebody who only wants to make money off of the most expensive option and usually the highest dose option. True hormone specialists will give you a menu and figure out your needs where you are and won't say there's only One option, there are many options, including for estrogen, progesterone, many insurance covered options. So. Oh yeah, also, hey, you guys go watch the M Factor documentary on PBS.org M Factor. It's really, really good. Super good. And healthcare people can get CME credits for going on the website. You gotta watch it and then you gotta watch the 30 minute discussion and you get 90 minutes of CME for it. So that's super awesome. I think that's it for right now. The Casperson Clinic is opening in Washington State January 2024. So get on the info wait list@kellycaspersonmd.com clinic, click on the button like sign up to learn more. Something like that. And is that all my things? The Heather Hirsch course is really good. General urinary syndrome and menopause, female sex med and testosterone. So get that for some 2025 learning goals. And oh yeah, one more question. I'm in Vancouver. Will you be seeing Canadians? I totally want to see Canadians, but I can't come to you in practice. I don't have a Canadian medical license. You have to cross the border. But I am 20 miles south of Canada. I always say people ask where I live, I say I live in south Canada. So I'm very north Washington state. So come on, we can put you up. Come on, stay in a hotel. We'll get you your compounded testosterone. You could drive it back across the border if you want. I think that, I think that's totally fine. Canada also doesn't have a female dosed FDA approved testosterone. They need to compound it too. But you can compound it in Canada. All right, I think that is all the questions. I love you guys much. Leave in the comments either the podcast or the Instagram if you like the live interaction podcast things because maybe I will do more of them if you like them. What's the best? Okay, one more. Oh my God, you guys are amazing. What's the best resource to learn HRT management As a clinician? I get no kickbacks from this. This is my own personal experience. There are two. Number one, the Heather Hirsch Academy, completely worth all the money. Very in depth, very detailed. Number two is Rachel Rubin. Just did a hormone education course. I haven't taken that one, but she's top notch and she knows her stuff. So. Arachalrubin.com maybe to go on. I haven't talked to her lately about if it's a live evergreen course. I'll figure that out because those would be my top two. I think the menopause society is good as far as standardizing. People take a test and they read a book I love. I read the book. I read the book twice to take the menopause certification test. But I don't think that test and what you have to study to take the test doesn't teach you actually how to prescribe hormones. You need different training for that. So which I think you can get at a menopause society meeting. But as far as like Evergreen watch at your home. Heather Hirsch and Rachel Rubin currently are the best in class and I have a course on Heather Hirsch's platform where I teach female Sex med, General Urinary Syndrome of menopause and testosterone for women. So go on that I'm telling you it is worth is absolutely worth it. And you can use your CME money if you want to. All right, I love you guys. Thanks for all the good questions. Until next time, thank you for listening
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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 or 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 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.