Podcast Summary: "You Are Not Broken" with Dr. Kelly Casperson, MD

Episode 328: Should I Take Hormones?

Date: July 27, 2025

Overview

In this engaging and practical episode, Dr. Kelly Casperson dives into one of the most persistent and controversial questions in women’s health: “Should I go on hormones?” With her hallmark humor and candor, Dr. Casperson breaks down hormone therapy options in midlife, debunks lingering myths from decades-old studies, and urges listeners to seek evidence—rather than fear—in their decision-making. She also fields live questions, passionately advocating for informed, individualized choices and shaking up outdated cultural narratives surrounding menopause and aging.

Main Themes

• Demystifying hormone therapy in perimenopause and menopause
• The evolution of societal and medical attitudes toward hormone use
• Practical distinctions between different hormone treatments (vaginal/local vs. systemic)
• Risk, prevention, and the “real" dangers and benefits of hormones
• Empowering women to demand evidence-informed care and body autonomy

Detailed Breakdown

1. The Three Phases of Hormone Attitudes

[03:00–07:00]

• Dr. Casperson describes societal shifts:
  • Phase 1: “We are scared shitless” (post-WHI study fear).
  • Phase 2: “We’re not afraid anymore—what are they good for?”
  • Phase 3 (coming soon): “Everyone’s on them except rare exceptions.”
• She challenges the outdated "grandmother hypothesis" and the consequences of living 40+ years post-menopause without hormones.

Notable Quote:
"If you are planning on living 40 years without hormones, you’re going to have bigger risks than people who want to live 40 years not without hormones, basically.” — Kelly Casperson [06:07]

2. Vaginal Hormones: The Low-Hanging Fruit

[14:00–19:00, 24:00–27:00]

• Vaginal hormones (estrogen/DHEA) are safe and effective for nearly everyone; they’re distinct from systemic hormones because local application leads to negligible systemic absorption.
• Massive benefits for preventing urinary tract infections (UTIs), maintaining vaginal and vulvar health, sexual comfort, and urinary function.
• Advocates for everyone post-menopause to consider vaginal estrogen/DHEA, even breast cancer survivors (with rare exceptions).
• Frustration with the underprescription: Only about 4-5% of American postmenopausal women use vaginal hormones.

Notable Quote:
"Everybody deserves a healthy vagina…your vagina is for you, my friend. It's not for anybody else." — Kelly Casperson [16:37]

• New guidelines (AUA 2025) affirm vaginal hormones’ safety, including in combination with systemic therapy, and for most breast cancer survivors.

3. Perimenopause: Navigating the Hormonal Rollercoaster

[30:00–38:00]

• Defines perimenopause as “ovarian chaos” — fluctuating hormones, unpredictable symptoms, and a zone under-treated by current medical practice.
• Urges more research and early intervention with hormone therapy for bone protection, mental health, sleep, and overall well-being.
• Notes the inadequacy of using menstrual periods as the sole indicator of hormone status, especially for those with IUDs, ablations, or hysterectomies.
• Birth control pills and hormone therapy are not the same; having side effects with one doesn’t preclude you from the other.

Notable Quote:
"Perimenopause is a zone of chaos…your biggest bone loss is in the two years prior to you ending periods because of the dramatic reduction in hormones." — Kelly Casperson [33:21]

Key Symptoms:

• “Not feeling like myself”
• Sleep disruption, anxiety, depression, “menobelly” (change in fat distribution), irregular periods

4. Weight, Hormones, and Body Composition

[40:30–44:00]

• Weight control is complex; studies show humans tend to gain weight as they age, regardless of hormone use.
• Some women lose weight on hormones (via improved sleep, insulin resistance), some gain water weight, some gain muscle.
• Advocates for body composition measurement (muscle vs. fat) rather than scale weight due to hormone-induced shifts.

Notable Quote:
"Non-hormone experts telling menopausal and perimenopausal women 'it's just calories in and exercise'…that's insane." — Kelly Casperson [42:15]

5. Systemic Hormones: Myths, Risks, and Realities

[49:00–56:00]

• Debunks myths:
  • You do not have to stop hormones at a certain age.
  • You can start hormones after age 60 or 10+ years postmenopause, especially with transdermal options.
  • Age is not a reliable indicator of individual health or risk.
• Newer hormone formulations (transdermal estradiol, oral micronized progesterone, transdermal testosterone) are safer than those used in the WHI study—they have no increased stroke/clot risk.

Notable Quote:
"Do we stop your cholesterol and your high blood pressure and your SSRIs cause you’re too old? No." — Kelly Casperson [51:03]

Addressing the “Natural” Fallacy

• Challenges the idea that “not taking hormones is natural” and argues that longevity itself is now “unnatural”—we’ve outlived our ovarian lifespan due to advances in medicine and public health.

Quote:
"Getting to 84 with no hormones, your risk of osteoporotic fracture is 1 in 2. Why wouldn’t you want to do something about that?" — Kelly Casperson [54:44]

6. Hormones for Prevention and Longevity

[53:00–56:00]

• Hormones are FDA-approved for osteoporosis prevention but also support heart, muscle, skin, eye, and joint health.
• Prevention is preferable to waiting for disease—hormones are part of an overall plan that includes nutrition, weightlifting, and physical therapy.

Recommended Actions:

• Consider bone, cardiovascular, and cognitive benefits when evaluating hormone use.
• Don’t wait until things “fall apart”—prevention matters.

7. Risks, Side Effects & Who Shouldn’t Take Hormones

[58:00–62:00]

• Vaginal estrogen: occasional yeast infections as the main risk.
• Transdermal estradiol and female-dose testosterone: very safe, with masculinizing effects only if dosing is excessive.
• Oral micronized progesterone: ~4% have intolerance.
• Safety in breast cancer survivors: Vaginal estrogen is widely accepted (with rare exceptions); testosterone likely safe though less data.

8. Body Autonomy, Empowerment & Advocacy

[Entire Episode, especially 07:00–10:00, 54:00–56:00]

• Dr. Casperson’s primary goal is to educate so that women can make empowered, evidence-based choices.
• Critiques medical paternalism and cultural double standards:
  • Men aren’t shamed for using hormone therapy (e.g., testosterone, Viagra), so why are women?
• Calls out “the myth of natural”—reminds listeners that many things about modern life are “unnatural,” including indoor plumbing, antibiotics, and long life expectancy.

Notable Quote:
"We don’t give [men] this natural bullshit when they have low testosterone…We don’t say that to men." — Kelly Casperson [55:52]

Timestamps for Major Segments

• 00:00–06:30: Book talk, changing phases of hormone attitudes
• 14:00–21:00: Vaginal hormones: evidence, benefits, underuse
• 27:30–38:00: Perimenopause: chaos, symptoms, need for early intervention
• 44:00–49:00: Weight gain, body composition, hormones
• 49:00–56:00: Myths, starting/stopping hormones, “what’s natural”
• 53:00–54:30: Prevention and longevity with hormones
• 58:00–62:00: Safety, side effects, who should/shouldn’t use hormones
• Throughout (esp. 07:00–10:00, 54:00–56:00): Empowerment, advocacy, logic-over-fear

Memorable Moments & Quotes

• On vaginal estrogen’s underuse:
  "It's abysmal, absolutely abysmal…If Medicare gave vaginal estrogen to everyone, it would save $10–13 billion a year in UTI costs." [16:12]
• On societal hypocrisy:
  "Viagra is not natural either—God gave you a weak ass, you know, soft dick, right? And nobody goes around being like, 'Did you ever consider that's God's wish?'" [55:32]

Key Takeaways

• There is no single right answer—Dr. Casperson urges individual, well-informed decisions, not blanket prescriptions.
• Hormone therapy, especially newer forms, is much safer than most realize.
• Vaginal hormones have a stunning safety/benefit profile and are tragically underutilized.
• Prevention—of bone, brain, and genital aging—should be a key factor in decisions.
• Women deserve evidence-based, personalized advice, free from outmoded myths and medical paternalism.

Final Message:
Dr. Casperson’s aim isn’t to push hormones on anyone—it’s to arm women with the science and logic to claim their health, challenge outdated dogma, and live their midlife and beyond as vibrantly and fully as possible.

For more resources, podcast episodes, or to pre-order Dr. Casperson’s new book, visit: kellycaspersonmd.com