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Evening. Buyer's remorse. Buy a new car. I'll be moving in. Let's get started.
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Sorry, I think there's been a mistake. I bought it from Carvana.
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You what?
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Yeah, great price. I even have seven days to love it or return it. So there's no, no, no buyer's remorse. More like buyers rejoice.
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I guess I'll let myself out. Congratulations. I mean it.
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Buyers rejoice. Buy your car today on Carvana. Limitations and exclusions may apply. See our seven day return policy@carvana.com foreign
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welcome to the you are not broken podcast. I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality.
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Enjoy the show.
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Hey everybody, it's Kelly. I'm going to talk about an amazing paper that I've been waiting to talk about and today is the day to talk about it. So we are going to record this for the podcast to put it up there. So welcome. If you're on the podcast, the other way to see this this live sometimes is to hang out on Instagram and we are going to do that too. So this will be a smattering of me talking about this amazing paper that I want to bring you combined with some Q and as that might be coming up on the gram. So this paper is a original article published in the Archives of Women's Mental Health. I'll put the link in the show notes. It is called effective transdermal testosterone therapy on mood and cognitive symptoms in peri and postmenopausal women. A pilot study. And it is by amazing people. First author Dr. Sarah Glenn, primary author Dr. Louise Nome from the UK who probably has the largest clinic supporting women with testosterone. So I laugh because when I was doing this last time, somebody's like I wish we had somebody like you in the UK. And I'm like, have you ever heard of Dr. Lise Nome? She's ridiculously awesome. And they're like no I hadn't. And I'm like, dude, she's way bigger than me. She also publishes. So I like to read the news. I don't make the news. I like to read the news. So we're going to read through this paper because the last thing I want is anybody to tell you, me them that there's no data on testosterone in women. There's way less than men. But there is data. Do we need more data? Hell yeah, we need more data. Absolutely. Not saying we have enough, not saying we are definitive, but there is data and when you combine some data with minimal risk, physiologic testosterone is very safe. I think you have something that people can try, like, try it. There's like no harm in trying it. Worst case scenario, it doesn't work. Second worst case scenario, you give somebody too high of a dose and then they have too high of a dose testosterone side effects, which some people call risks. But I'm like, that's not a bug, it's a feature. You get too much testosterone. You get things associated with too much testosterone. It's easiest to get too much testosterone when you have pellets, but it's a lot harder to get too much testosterone in your body when you're using compounded cream or Testim, which is a male product dosed. And you'll see in this paper that they use three different types of transdermal testosterone because it's again, very easy and safe. And it's hard to push your numbers up too high on a daily transdermal product. Which reminds me, I was talking to somebody somewhere and their gynecologist had them on three times a week. Testosterone cream, which I guess is every other day, unless you're really picking like three days out of a week to do it. But by and large, transdermal testosterone products are meant for daily absorption. They aren't long acting. And remember, your body is very sensitive to changes and fluctuations in hormones. But I don't want to say more so than levels, but maybe more so in levels. So if you do, if you dose your testosterone, not every day you're getting a high level, going back down to, oh, high level, going back down to low, you're not giving yourself a steady state. So by and large, testosterone transdermal products are daily, for what it's worth, for anybody out there. Okay, so the method of this study, again, I'm going to read it again. Effects of transdermal testosterone therapy on mood and cognitive symptoms in Perry and postmenopausal women. A pilot study Sarah Glenn, Louise Newson et al Published in the Archives of Women's mental health in 2024. September 2024. So, methods. This is a retrospective cohort study. What that means is they looked at the data retrospectively. They didn't plan the study and follow people going forward. Undertaken in Dr. Newson's clinic, 510 women using hormone replacement therapy with persistent low libido, cognitive and negative mood symptoms were treated with testosterone cream or gel for four months. And the results, all nine cognitive mood symptoms. So what they did is they took people you already And I'm going to talk about inclusion criteria in a little bit, but they took people who were already on estrogen plus progesterone, and then they asked the mood and libido questions. Then they started them on testosterone, followed them for four months, and then asked him the questionnaire again. Okay, so that's what they did. So they were already on estrogen, progesterone. They were stable on that dose. Then they added in the testosterone. So the results, all nine cognitive and mood symptoms significantly improved across the study period. Mood improved more than cognition, which is 47% of women reported an improvement in mood versus 39% reported an improvement in cognition. They had a 34 to versus a 22% decrease in mean symptom score, respectively, for mood and cognition. Regarding libido, 52% of women reported an improvement. Mean symptom score decreased by 33%. So how bad is your libido? It got decreased by 33%. So your libido got better. They checked both perimenopausal and postmenopausal women, which is very cool. International guidelines on testosterone for low libido is menopausal. But I think testosterone doesn't fall off a cliff with menopause. When you hear people say there's no significant changes to testosterone with menopause, they are correct. Your testosterone doesn't fall off a cliff the 366th day with no periods in menopause. Right. So your testosterone. First of all, for the people in the back who haven't heard this before, we make women make four times the amount of testosterone than estrogen in your cycling life, and then testosterone starts to slowly decline in a linear fashion. We don't know why. After about your 20s. So when people say nothing significant happens to your testosterone level with menopause, they are correct. What they're not saying is your testosterone's low at age 50 compared to when you were 30. All right. The cool thing about this study was it was perimenopause and menopausal women, and it helped them in both. Okay, so let's go into some background on this. Approximately 2/3 of women report subjective cognitive impairment, brain fog with wide ranging symptoms, including fatigue, difficulty concentrating, poor memory, reduced verbal fluency, and reduced ability to multitask and plan. That's a lot of people. Two thirds of women in the perimenopausal menopausal transition. Why aren't we trying to help them? Is you having a brain fart? Not bad enough. The risk of major depressive episodes is Increased two to four fold in the perimenopause menopause transition. Suicidal thoughts are up to eight times more prevalent in perimenopausal women which may contribute to a higher suicide rate in women aged 45 to 64 years. That's UK data compared to younger women and and older women. The other important thing to know is there is no clear evidence of benefit for selective serotonin reuptake inhibitors or SSRIs when used to treat low mood in perimenopausal women without a formal diagnosis of clinical depression. That's nice guy. So nice is the UK's kind of like governmental standards on how to treat people. So those are NICE guidelines. 2019. So if you are perimenopausal and you go in with low mood brain fog and you've never had a history of depression before, hormones are first line therapy, not just starting people on SSRIs. But we know 25% of midlife women are on SSRIs and about 3% are on hormones. US data not including compounding, which is very hard to calculate. Okay, so way more people are on SSRIs but there is no clear evidence of benefit for selective serotonin reuptake inhibitors when used to treat low mood in perimenopausal women without a formal diagnosis of clinical depression. Good to know. That is NICE guidelines. 2019. Testosterone Improves Libido and vulvovaginal health has anti inflammatory, cardioprotective, bone protective and neuroprotective effects. In men, testosterone deficiency is associated with fatigue, depressed move and cognitive impairment. If you have low testosterone and you don't get it treated, your risk of dementia is higher in men. We have that study. I think that it's no different in women. We just don't have the data. I was texting a friend today who was sending me yet another Dr. Moscone just published a paper, I haven't read it yet about brain neuroprotection and testosterone. And I texted my my menopause and I was like 20 years from now when we say testosterone is dementia preventing for women, will you please say in 2024 Kelly was correct? Because that's what I said live last year. I'm like, with all the testosterone, female testosterone research I've done, I'm like, you guys, this is a brain protective drug. Prove me wrong. It absolutely is. We've got all the like benchtop research, what testosterone does, the male studies, the rat studies, the all the things. We just haven't researched it in Women. Cuz people are like obsessed with estrogen in women. And keep in mind estrogen is one fourth the hormone than testosterone is in women. Women just make less testosterone than men, but we make more testosterone than estrogen. So in 20 years when they finally come around, if you wanna wait that long for testosterone and brain protection, say Dr. Casperson said that in 2024. I know it's 2025 now. I was saying this before, I'm just documenting it for the Internet history. Here we go. Oh, somebody made a comment. Let me go back. My doctor tired and I cannot find another doctor prescribed transdermal testosterone. I can only get pellets and I don't like them. Yeah dude. Cause that's, pellets are super high. Print out the international guidelines, bring them in. Do not bring them in. My Instagram rants about testosterone. That's doctors, you will usually poo poo, things like that. But the international guidelines are good. And come see me in the Casperson Clinic. Washington State Open 2025. So the aim of this study was to assess the effect of transdermal testosterone on cognitive and negative mood symptoms in perimenopausal and postmenopausal women with persistent symptoms despite standard HRT estrogen with or without progesterone. So these women were already on hormone therapy and they came in and they still said they had low libido. So you had to have low libido at the start of the study. Single center UK based retrospective cohort study. This is the inclusion criteria. Now you care about inclusion criteria when you read studies. Guys, I'm giving you, I'm giving you science how to read Studies 101. Because you want to know does this apply to me or does this apply to like if you're a physician or a nurse practitioner or PA or the patient that I'm treating. Because you're like if I review this study and then you're, you have a 74 year old dude in front of you. This doesn't apply. Oh, somebody asked, can you make an appointment to see me? You guys, I only have a Washington state license and I'm only going to keep with my Washington state license. I've got like 7 million people between Seattle and Vancouver, Canada. I don't need to get multiple state licenses so you can come visit me. But no, I won't have other state licenses because I, I, I don't have time to see that many people. But I love you all and you all need care and I want to help you. All right, inclusion criteria number One, they've been using transdermal estrogen with or without a progesterone. And this was oral micronized progesterone or the basically marina iud. So they weren't on any synthetic progestins. And they had to have been on that for at least three months. They had persistent low, so that was number one. Number two, they had persistent low libido and at least one mood or cognitive symptom. Number three, they had initiated transdermal testosterone without a concurrent estradiol dose change. Because you don't want this to say the mood or libido changes were due to upping the estrogen. Right. Next, number four, they completed a menopause symptom questionnaire at baseline. And number five, they've been reviewed and have completed a questionnaire four months after initiating testosterone therapy. So this study looked at for people who can actually see this, this is what I do. I have to print out papers and highlight them like, that's how I got through college. That's how I got through med school. I cannot read on a freaking phone. I have a really good friend of mine who reads books on a phone and she's like, you got to read this book. And I'm like, can you borrow it to me? She's like, no, I read it on my phone and I'm like, God damn it. I just like the feel of a fricking book. So that was the inclusion criteria. The focus of the study was to assess the impact of testosterone on neuropsychological symptoms. Consequently, only data pertaining to cognition, which was feeling tired or lacking in energy, memory problems and difficulty in concentrating and mood, which was feeling tense or nervous irritability, attacks of anxiety or panic, feeling unhappy or depressed, loss of interest in most things, crying spells and loss of interest in sexual. This is what they asked about. All right, so this is what they did. For the testosterone treatment, patients were treated with one of three transdermal testosterone formulations according to patient preference. Androfem 1%, 0.5 mils daily. So that was five best 5 milligrams a day. Testum, 5 milligrams a day or tested gel. What's 40.5 milligrams divided by eight? Roughly 5 milligrams a day. Okay, so they are all on pretty equal doses. The UK has testosterone. It's the UK off label how they say that there is. They say it's not licensed. Right. So they don't have a licensed testosterone yet for women, but they use the male one and dose for Women. Okay, so this is 510 women. That's very important because that's actually a huge study for women in testosterone. A lot, a lot of testosterone studies are much smaller amount of people than 510. The other thing to know about this is, you guys, there's no brand name product that's like researching and to like, there's no huge pharma putting money into these studies. So like a lot of the studies are small because there isn't big money going into studies. And if you people are like, kelly, you should do research. I'm like, you realize how much money it takes to do a research study. It's insane. Okay, so 510 women, which is a huge study with persistent menopausal symptoms despite greater than or equal to three months of hormone therapy, initiated transdermal testosterone during the study period without a concurrent estrad increase. Mean age was 54, 66% of them were postmenopausal, 34% of them were perimenopausal. 91% of them used estrogen combined with a progesterone, either micronized oral progesterone or the Marina IUD. In the UK they call IUDs coils. 88% of women were co prescribed an antidepressant during the study interval. So 17% of women came into this study already on an antidepressant. Most women were treated with Androem. 41 women, 8% received Testum and 5% received Testa gel. So the Androfem one is the one that's actually dosed for women still off label in the UK as of this podcast recording that is on label in Australia. So they checked the symptoms at baseline and then at 4 months. Cognitive symptoms were more frequently reported than mood symptoms at baseline when stratified by symptom severity. Loss of libido was the most bothersome symptom at baseline. And again, these people had to have loss of libido. They didn't have to have any of the other things. So like, it would make sense that the majority of them had loss of libido. Cognitive symptoms were more bothersome than mood symptoms. 39% of women rated their cognitive symptoms moderate to severe compared with 18.4% of women with mood symptoms rated as severe. All 10 symptoms significantly improved. Four months after initiating testosterone therapy, 39% of women with cognitive symptoms reported improvements versus 47% of women with mood symptoms reported improvements. The three symptoms most likely to improve were lost of interest in most things. At 56% of women reporting an improvement, crying spells and loss of interest in sex memory problems were the least likely to improve, and that was at 34% of women reporting an improvement. When stratified by symptom severity, the number of women with moderate or severe symptoms decreased by approximately 1/3 across the study period. The prevalence of moderate to severe cognitive symptoms decreased by 31% versus moderate to severe mood symptoms, decreasing by 37% versus moderate to severe. Loss of interest in sex decreased by 42%. Between 41 and 66% of women reported no change in individual symptom scores during the study period, mainly because the majority of women without a particular symptom at baseline didn't develop the symptom during the study interval. So if you came in and you had no problems with brain fog and then at the end of the study you have no problems with brain fog, that's no change to your symptoms because you didn't have have brain fog in the first place. So that's what they're saying Summary of Findings Cognitive and negative mood symptoms were highly prevalent in this real world cohort of 510 perimenopausal and postmenopausal women despite use of estrogen with or without a progesterone progestogen? Yeah, for at least three months. Transdermal testosterone therapy for four months was associated with significant improvements in all mood and cognitive symptoms. They had reductions in both symptom frequency and severity. Overall, mood improved More than cognition 47% of women reported an improvement in mood versus 39% of women reported an improvement in cognition. 37% of women with moderate to severe mood symptoms reported an improvement versus 31% of women with moderate to severe cognitive symptoms. The findings that mood and libido improve to a similar degree is not surprising, the authors say, given that libido is a mood what do I love to say? I love to say that libido is a mood, an affective state or a pervasive and sustained feeling tone that is experienced internally, that is a mood. Further, libido and mood are closely interlinked. Women are more likely to feel in the mood for sex if they are energized and their mood is positive, whereas fatigue and negative mood symptoms, stress, irritability, low mood, anxiety have a deleterious effect on sexual desire. Captain Obvious, right? Come on. Our results suggest that testosterone therapy also benefits mood and cognition and may be useful adjunct to estrogen and progesterogen therapy for peri and postmenopausal women with neuropsychiatric symptoms. Further, testosterone therapy may obviate the need for higher estrogen doses in women with persistent menopausal symptoms after initiating hrt. Love that, right? Maybe you need a little bit of everything instead of a lot of one thing. Seems like a no brainer. Accordingly, patients using standard HRT with ongoing mood and cognitive symptoms can consider a trial of testosterone therapy, which is off license use provided they understand that the available evidence is limited and have been supported to make an informed treatment choice. This is what you need to know. Libido is a mood. Testosterone improves mood in many people, many different domains of mood. And cognition improves mood more than cognition doesn't help everybody. Just heard from a woman the other day. She's like, I've been on testosterone for a year and I still have low libido. And I'm like, have you, have you read my book? Have you listened to my TED talk? Do you know that libido is complicated? Do you know that there's different types of libido? Okay, so in 1985, a double bind randomized control trial found that surgically menopausal women randomized to testosterone alone or testosterone combined with estrogen had more energy, improved well being and greater improvements in somatic and psychological symptom scores compared with women treated with estrogen alone or a placebo. Don't tell me there's no data on testosterone and mood. That's a paper from 1985. That's 40. I'm whispering. That's 40 years ago. You guys, here's a good question. Is it normal for my provider to only Prescribe Testosterone? I'm 49. Possibly. Yeah. People who are experts in perimenopause might start with testosterone, especially if you're having regular periods and you have more like Labu. Labud. Labud is when you combine your libido with a mood. That's Labud. Yeah. You could start with testosterone. That might be somebody who knows what they're doing. Unless they're selling you a pellet, then buyer beware. But remember, remember, testosterone does not jump off a cliff with menopause. It declines slowly after, after your 20s. So I, I would need to know more. But it doesn't sound that that's not crazy. Perimenopause experts might start a progesterone and a testosterone before they start an estrogen. In 2006, a 24 week double blind randomized control trial assessed the effect of adding methyl testosterone. Methyl testosterone. Synthetic. I don't advocate doing the synthetic one. Oh yeah, the menopause association that does not mean you know what you're doing with hormones. FYI, taking the menopause societies test is not a test of if you're competent at prescribing hormones. I did not learn how to prescribe hormones by becoming menopause society certified. FYI, the bar is low, my friends. If somebody's taken Heather Hirsch's course, if somebody's taken Rachel Rubin's course, they know what they're doing. If somebody's taken my course in the Heather Hirsch Academy for Sex Med and Testosterone, you probably know what you're doing. Why am I against pellets for tea? Somebody asked. I'm not against them. Read my Oprah Daily article. So the Oprah daily article basically discusses why pellets are so polarizing and I think really explains it. It's free on the OPA Daily website. Just search. Go to Oprah Daily. Search testosterone and it'll pop up. It's my op ed in there. I basically say you have to earn your pellet, you gotta earn a higher level. You have to earn a supraphysiologic level of testosterone. Going from a testosterone of zero to a testosterone of 300 gives many people side effects. Going from a testosterone of zero to a testosterone of 60 gives you less side effects. It might be just as efficacious. Now there are some women who do better, I think at higher doses, but we have to find out who they are. And we don't start out doing 0 to 300 with a frickin pellet. So I think that's a lot more accurate of my opinion than me being against pellets for tea. Also pellets are the most expensive and give you a scar. And if you plan on living 40 years post menopause, do you want 40 years of a scar in your butt? And do you have to remortgage your house to pay for 40 years of pellets? Most people. I would love to see a paper on this. Who has the paper on this? I want to see the paper on how many women start pellets and stop. I want to see the paper on how many women start pellets and aren't on pellets two years later. Okay, right, let me start over. In 2006, a 24 week double blind randomized control trial assessed the effect of adding a synthetic testosterone. So it's methyl testosterone with or without HRT to venlafaxine, which is an antidepressant. In 72 women with postmenopausal depression. A trend towards increased remission rates was observed in each treatment group relative to venlafaxine plus placebo. That means hormones did better than venlafaxine alone. But only women in the venlafaxine plus methyltestosterone group were significantly more likely to basically get rid of their depression. Unfortunately, the study lacked power because the dropout rate was high. A third of the women dropped out, mainly due to venlafaxine related side effects. So SSRIs have side effects? You guys. Similarly, there is a paucity of randomized control trial data regarding the impact of testosterone on menopausal cognitive symptoms. In 1988, a small randomized controlled trial demonstrated a decrease in cognitive symptom scores following bilateral oophorectomy that was prevented in women treated with estrogen, testosterone or a combination of both hormones. So before the Women's Health Initiative, there was a lot more studies looking at estrogen plus testosterone after ovary removal, surgical menopause. It's like we did the data. We know women do better on all of it because ovaries make testosterone. So if you take the ovaries and put them in the bucket, those women do a lot better when you give back the hormones that their ovaries made. Like, we have a lot of data on that. It's all pre whi. I haven't seen as much data post WHI because of the fear of hormones and because a lot of the data was actually already done before the whi. So there you go. More recent randomized control trials have demonstrated a beneficial effect of transdermal testosterone on learning and memory, both in women using and not using concurrent estrogen. So the famous statement they put this in here, absence of evidence is not evidence of absence. Meaning because we haven't done the data and the studies doesn't mean that testosterone doesn't work. So that's what they're meaning about that. So the present study has several strengths. The impact of testosterone on mood and condition was assessed in 510 women, which is more than the number of women treated with testosterone in all the randomized control trials combined with. Which was 415. That's insane. So I'm pausing because. To see if I want to answer this question. Here we go. Medscape report. This is not related to this paper I'm talking about right now, but it's important to talk about. Medscape reported a study yesterday that shows a 1.3 odds ratio of getting lupus on HRT. Sounds like hooey. Thoughts? Yes, I do have thoughts. Thanks for asking. How did you know I would have thoughts? I actually pulled up the damn paper. I'm going to start. Will I get in trouble if I start calling Medscape shitscape? Like legitimately clickbait, full of misinterpreted studies. It's absolute that they published that. So you go to the actual study from which this Shitscape article came from. This is women on synthetic progestin. So that's their first problem. It also showed that vaginal estrogen increase your risk of lupus. Which is. There's no mechanism for that because it's effing vaginal estrogen and like is not absorbed. And then the women on estrogen alone, so the women with hysterectomies had no increased risk of lupus. So the Shitscape article said hormones increase your risk of lupus. The estrogen alone arm had no increased risk in lupus. The vaginal estrogen arm had an increase which you're like, that makes no sense. Cuz they're, they should still be in postmenopausal levels of hormones. It's only the women who are in the synthetic progesterone, which is a synthetic medication, they're the only ones that had an increased risk of lupus. And again, this was a correlation study, not a randomized placebo controlled blah blah blah study. It was a case, a case match cohort study. I believe so yeah, start telling them that. I now call them shitscape because that is for a company to masquerade as health news, to not break that down and for us to have to go read the frickin study and realize that it's bullshit. The estrogen. Again, I'm repeating. The estrogen alone arm did not have an increased risk of lupus. That's not what the title of the article said, is it? So shitscape from now on. Okay, so these are the critiques of this study. It was a retrospective cohort study with no control arm. Additionally, antidepressant use was recorded at baseline but not at four months. So the question is, did some people start antidepressant therapy? Maybe, but probably not. We did. They did not assess adherence to treatment. So they asked some questionnaires at the beginning in four months, but they didn't ask like did you stay on your testosterone to come off of it. So we don't know how many people dropped out of being on testosterone. We did not collect data regarding serum testosterone levels before and during treatment. That's my big criticism of this paper and I love these authors and I love These researchers. And again, it's retrospective. So, like you don't know the data you want to collect when you create a study afterwards. But I want to know. This is what I want to know about this study. Of the women who didn't respond to mood and cognition, what were their testosterone levels? Were they poor absorbers? Did they not actually get enough testosterone into their body to make a difference? That's what I wanted to know about this study. And it's impossible to know because they didn't check testosterone levels. And they say that, they say because we didn't check levels before and during treatment, we were unable to confirm whether physiological levels were achieved in all women. Given that all women received a standard testosterone dose, it's unlikely that therapeutic levels were achieved across the whole cohort because again, we absorb at different rates because we all have different skin. And further research is needed to assess clinical response following dose optimization. Moreover, it can take up to six months to see a clinical response to testosterone therapy. So assuming levels are in the physiologic range, benefit is therefore likely to have been underestimated because outcomes were assessed only after four months. It would be interesting to, number one, check levels, but number two, maybe do baseline, three months and six months questionnaires to see if things continue to improve over time. So a lot of people, Here's a, here's a critique. People will say that any benefit that a woman gets from using testosterone is from the placebo effect. First of all, there's a placebo effect in everything. Viagra study had 40% placebo effect. The estrogen studies. Placebo makes your hot flashes go away for a time being placebo effect in estrogen studies is like 50%. So to me, I'm like, yeah, well, we know that placebo works. We know that placebo works in estrogen studies. We know that placebo works in SSRI studies, like 70% of the time. Viagra studies 40% of the time. Right? But over time, that placebo effect tends to wear off. And to me, I'm like, because testosterone has a placebo effect in the placebo trials is not a reason to not give people testosterone. Just like the fact that SSRIs have a placebo effect effect that's freaking high. Is not a reason not to give somebody SSRI when medically appropriate. So it's a. That's a straw man argument, I think is the right word. No lab values. That's another critique. Did the non responders absorb less? I would love to know that one size for testosterone does not fit all, like I said, some people do better at higher, respond better at higher physiologic doses and then reminder that testosterone for libido is off label in men. Because that'll be another argument. We can't give testosterone to women because it's off label. It's like, well, giving men testosterone for low libido is actually off label also. And we do that. So let's be fair and apply the rules fairly. Either nobody gets testosterone for any off label use. Which means somebody did this study, they said like 30% to 50% of men take testosterone for off label use because on label use for men is primary hypogonadism. So not caused by lifestyle, aging, things like that. All right, those are my critiques of this. Otherwise I'm so glad that this paper was studied. In conclusion, in this pilot study, use of a transdermal body identical testosterone for four months was associated with significant improvements in cognition and mood in a real world cohort of perimenopausal and postmenopausal women. This supports the notion that testosterone has neuropsychological benefits beyond libido and signals the need for further research, including well designed sufficiently powered clinical trials to establish the long term efficacy and safety of testosterone for the treatment of menopausal mood and cognitive symptoms. Somebody said we use drugs off label all the time. Yes, we do. Pharmacists know this, so why are they so up in their tight underwear about women trying to get a testosterone prescription filled? That's my question. Yeah. Amazing paper published in 2024 Again, effects of transdermal testosterone therapy on mood and cognitive symptoms in peri and postmenopausal women. A pilot study. Yeah. Somebody said, I've been on spironolactone off label for over 30 years. Oh, what is the on what's on label use for spironolactone? Is it hair loss? Is it acne? I don't think so. I think minoxidil is blood pressure. Right. So hair loss, Minoxidil is off label for hair loss. Somebody said, I know it's rough in the pharmacy world right now. It is rough in the pharmacy world right now. You guys are just as burnt out as doctors are. Yeah. And nurses. You just got. You guys get less press because you're like behind the curtain. Let's see if there's any more questions and then we are going to la. We are going to wrap it up. You guys are so awesome. Yeah. Spironolactone is indicative for blood pressure, as suspected. You Guys are so smart. Thank you for. I'm like, calling out my audience to answer my questions. For me, this is superb. This is a superb new new adventure in podcasting in 2025. Somebody said t helped me with all of the above. Happy to be part of research if it's ever conducted. That's awesome. Getting all of my coworkers in the pharmacy onto hrt. Yes, like a boss you are. Good job. Let me know for the podcast people if you like these. Kelly Casperson alone while talking to audience versions of the podcast. I do a lot of interview podcasts and trying some new things because I think it's fun and you get to hear me being feisty. What's a common milligram to start for testosterone cream for women? 5mg. Do I prefer a compounded tea? I do. I think it's easier to dose. It's relatively cheap, and you don't get at the pharmacy from the pharmacist for trying to get the male testosterone. So if I do the male testosterone, I'll tend to do an online pharmacy like Amazon will do it because then you get it delivered to your house. You don't have to fricking fight for your right to party at the pharmacy line, which is a pain. Endometriosis and hrt. Yes, it's fine for most people. It's fine. Effective spironal lactone on orgasm. That's a good question. I haven't seen. I haven't seen the data. I haven't heard that discussed at Ishwish. Might be missing something. Send it to me if you find anything. I want to know. I want to do more podcasts about testosterone, so let me know if it's helpful. I'm like, am I going to have a. Am I going to have a podcast all about testosterone? If I have a podcast like the. I don't mean an episode, but like a podcast about testosterone, that means there's like, a ton of info on it, right? But I will not. For my testosterone pros and my people who are happy on testosterone, I promise I will not do every single episode about testosterone. Yeah, Somebody said you had to fight for your right for testosterone. That's what the Beastie Boys meant, don't you think? I think so. All right. Should every woman use testosterone?
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No.
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That's what gets me a bad reputation. Somebody's like, you. You want every woman to take testosterone. I'm like, I have never said that I support a woman's interest in trying to sell testosterone, but it won't help everybody with libido. It won't help. Do I think it's probably going to help. Do I think testosterone has a role in dementia prevention? Yes, I think that. Does that mean I think everybody should be on testosterone? No. It's your body, your choice. But I will. I will support women who want to be on testosterone until the day I die. I'm all about. I always tell my patients I'm here to make sure you don't do something dangerous. Other than that, I'm here to support you fiddling. I will not let you do something dangerous. Somebody said more testosterone talking and prescribing. I love it. There's no difference between men's and women's testosterone. It's a human hormone, just different doses. Nice. Kind of like insulin and estrogen and thyroid and vitamin D. All hormones. All right, guys. I love you. Until next time. You are Not Broken. Follow me for more Follow me. Share it. Follow me. Share it. Make this baby grow. 2025. Big goals. Let's do it. Love you. Till next time. You are Not Broken thank you for
- [37:22]
D
listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth, exclusive content, more time with yours truly, a private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the masterclass for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests, including on this podcast are not giving individual medical advice or practicing medicine. See in Consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician and 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.