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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. Hey everybody. Welcome back to the you're not broken podcast live. I think we're live on YouTube and Instagram tonight, which is pretty sweet. We got some decaf coffee, we've got some book promotions, the menopause moment. This is the hardcover. I gotta show you how beautiful this is for people who aren't just on the audio of this. This is a hardcover and this is. It's like so pretty. Look, the letters are kind of shiny for anybody who's a bibliophile like me. And then if you take off the dust jacket, it is a yellow hardcover book with shiny blue writing. Isn't that pretty? So pretty. So pre order now. Pre ordering is what matters, you guys. If you guys don't know that about authors yet, we're horrors for pre orders. And thank you to everybody who's already pre ordered because it helps a lot because publishers don't know how many books to print if you don't give them a heads up with pre ordering. But the other thing is I finished the audio on this, so there's also will be my voice doing audio also. So releases September 10th in America and I believe that's September 18th in all of the other British protectorates. So Canada, UK, Australia, I'm not sure where else, but definitely those places. So my biggest fans are in Australia. Sorry, Canada. Ever since I went to the Sydney Opera House, my number one city now is Melbourne. Second city is New York City. I'll see you in September. New York City and then September and October and then my third biggest city is Sydney. So pretty cool. So today's podcast is all about should I go on hormones? That's what we're gonna talk about tonight. And before then, pre order the book. Because it's all about hormones and it's all about like, here's, here's where we are. We are in phase two. Phase one, post whi was we are scared shitless. We've moved beyond that. We're not afraid anymore, are we? No. Because of people like me and the menopause, we're not afraid of hormones anymore. Now we're in the what the hell are they good for? And should I be on them? So phase. So that's phase two. Phase one was fear. Phase two is they're good for you. I think phase three is going to be like, everybody's on them except for the rare people who can't be and we'll talk about that today. Meaning most people can be on them, especially vaginal. So that's phase three for longevity. So read the book. The book is all about that the grandmother hypothesis is bullshit and that 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. So by and large as a population. So before we get into should I be on hormones? We are going to do a little bit of housekeeping. Number one, pre order the book later this summer for people who have pre ordered you just sign but you put in your receipt and then you get a link. We're going to do some Q and A with the author. That's me. We're going to do some Q and A. Live coaching. I have two dates set for that. It's going to be end of end of August, beginning of September to do for my pre order people as a thank you and that'll be nice. So three more dates left of this Casperson Clinic summer school. For those of you who don't follow me on Instagram, that's where you find out about that. So we've already done two DA summer school dates. We did genital urinary syndrome of menopause and we did perimenopause. So if you I have a link now. We'll probably send it out on my email list at some point. So if you're not on my email list, that's where you find out where I'm going to be by and large. So kellycaspersonmd.com and you can scroll down and get on the email list. So we'll send out the link for the summer school. So if you show up live for the summer schools it's free. And then the summer schools will be a cost to buy to purchase the hour long video afterwards. So perimenopause is up. Genital urinary syndrome, menopause is up. All of them. If you guys want to save yourself the most money. All of them are free and included in my monthly membership which is basically a workout accountability group where I end I have a whole bunch of resources. It's a private Facebook group for people who are still on Facebook and you see me at a sports bra pretty much every day because accountability for fitness was what finally made it click for me. That's so the in the membership you get my sex ed course and all of my summer school courses. So there are three more summer schools left Again, we've already done perimenopause and genital urinary syndrome of menopause, but we have July 14, which is sex like a woman, desire, arousal and all things pleasure. August 6th is going to be testosterone 101 for women. And then August 20th is our newest one. So it's five total and they're all free when you show up live. And then they'll be available for purchase if you miss them and want to just buy them a la carte or if you join the membership, they're going to all be in the membership. So the fifth one, August 20, is starting hormones after menopause. Is it too late? So that'll be a good one for you too. And then the two pre order gifts of live Q and A with me for pre ordering the menopause moment mindset, hormones and science for optimal longevity. If you don't want to be on Amazon, no judgment. If you want to pre order but you don't want to be on Amazon, go to the website Kelly Casperson MD Go to the book section for it. And we've got a bunch of pre orders for the UK and Australia and independent bookstores and Barnes and Noble. So if you don't want just Amazon, that's where you're going to go to find the pre order place that you want to. So I hope that works. And yay to pre orders. Thank you so much. Means the world. It's my second book. First book, you are not broken, Stop shooting all over your sex life. The second book, the Menopause Moment. All right, so I think that is all the Housekeeping book tour again, book comes out September 16th. So book tour will be one night in Chicago, like four days in New York. I'll have like three days in LA, two days in like the Palo Alto area. I've got one day in Denver. That's going to be October 5th and I hope to see you all there. So what's that? That's Chicago, Denver, New York, L.A. palo Alto. That's five. Might be doing an Austin event in October, might be doing a Minneapolis event in November. We'll see. Anyways, it's going to be a busy, it's going to be a busy fall. So this podcast is called should I go on Hormones? And I'm live on two platforms. So we are going to get your guys questions also which is super sweet. I'm gonna check this chat. Oh my gosh, we've got live on YouTube going this is so cool. Okay, I love it. Okay, so now I've got all my bearings straight. This is insane. The this episode is not for pushing hormones. It's about educating people so you can make an empowered decision about what you want to do. People always ask, they think the menopause wants like everybody on hormones. And we're like, no, we just want to get everybody to phase two after the whi, which is we're not afraid of hormones. And I always say my, my goal is to educate you enough that you can then make your own decision about hormones. I don't, I truthfully, I don't care if you go on hormones or not. I'm not living your life. I don't have your bones, I don't have your sex life, I don't have sleep issues. I don't care if you go on hormones. And I want you to have enough education where you can make the right decision and choose your decision based upon facts, not fear. Make your own decision about what if you want to be on hormones or not. So if you want to learn more specifically about perimenopause, if you go to podcast episode 324, that one was specifically on perimenopause with my friend Jackie Hand. She's a nurse practitioner and basically only does sex, men and hormones and she's a expert on perimenopause. So you can also check out my blog on perimenopause on substack. So let's start with the low hanging fruit of should I be on hormones? Vaginal hormones. So vaginal hormones are non systemic systemic means in your body. So vaginal hormones will increase your blood level of estradiol stimulation slightly, but still in post menopausal values. It's, it's very easy to be black and white on Instagram and by and large we say vaginal hormones don't increase your serum blood levels. That's by and large true. But also a little bit of truth is it raises it a teeny tiny bit. But you're still postmenopausal levels. It's as if it's not that that important. So everybody deserves a healthy vagina. I would say estrogen, vaginal estrogen or vaginal DHEA for all post menop people with vaginas is where we should be and we are a long way from that. We in america Right now, 4, 4 to 5% of people are on vaginal hormones. It's abysmal, absolutely abysmal. Dr. Rachel Rubin did a paper two or three years ago now that said if Medicare, which is our government healthcare for the elderly, if Medicare gave vaginal estrogen products, like just free prescriptions to everybody on Medicare. It would save Medicare, like 10 to $13 billion a year just in reduced urinary tract infection costs, which is insane. There's no. There's no medication or anything that decreases urinary tract infections as much as vaginal estrogen does. It works by promoting a healthy microbiome which acidifies the vagina and an acidic vagina with the healthy microbiome of Lactobacillus basically acts as a barrier between the rectum and the bladder. So that's how it works. Know how it works? It's also very cheap. Vaginal estrogen cream is the cheapest. Again, I love the cream because I like to get it on the genital structures. Be for my sexually active people. Even if you're not sexually active, nobody wants a urethra that hurts. Nobody wants a labia that pinches like nobody wants burning when they pee. So you don't have to be. One of the big rumors I see, especially in older women, is, I'm not sexually active. Do I need this? And your vagina is for you, my friend. It's not for anybody else. And it decreases recurrent urinary tract infections. There was just an abstract publi not published. So abstracts tend to be presented at Society meetings. So this was just presented at the American Urologic society meeting for 2025, so not yet published. In women with recurrent urinary tract infections, those on vaginal estrogen had decreased risk of admission to hospital, sepsis and death. And death. So I would say segment one of the. Should I go on hormones is vaginal estrogen or vaginal dhea? They are both fantastic. There's new genital urinary syndrome and menopause guidelines out this year from the American Urologic Association. They are free online. You can print them out and bring them to your clinician. Yes, you can be on systemic hormones and vaginal hormones at the exact same time. Do not let a pharmacist tell you you can. Do not let a doctor tell you you can't. It is actually in the new guidelines that you can. This is my favorite my equation for this. So if systemic hormones raise your blood levels by X and vaginal hormones, by and large raise your values by zero, X plus zero is X, meaning you're allowed to be on both. It's not too much. It's still very low. It's still much lower than a menstruating or pregnant woman. So this is a real good story about Bronx and his dad, Ryan, real United Airlines customers.
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We were returning home and one of the flight attendants asked Bronx if he wanted to see the flight deck and meet Kathy and Andrew.
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I got to sit in the driver's seat. I grew up in an aviation family and seeing Bronx kind of reminded me of myself when I was that age. That's Andrew, a real United pilot. These small interactions can shape a kid's future. It felt like I was the captain.
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Allowing my son to see the flight deck will stick with us forever.
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That's how good leads the way. Get on the vaginal hormones. Why not? All right, let's go to. That's our. That's our segment one, vaginal health. Pretty much hormones for everybody. Breast cancer with vaginal hormones allowed. They always say, like, let your oncologist know because they need to know. But by and large, now there is so much data showing no increased risk of mortality, no increased risk of recurrence, all the good things. And this has been studied on over like 25,000 breast cancer survivors at this point. American College of Obstetrics and Gynecologists have a free position statement online. You can print it out. You can print out the general urinary syndrome and menopause guidelines from the American Urologic Association. It's exhausting, repeating over and over and over again that women with a history of breast cancer can be on vaginal hormones. It's incredibly rare that they cannot. There's a very rare form of uterine sarcoma, very rare, where there is a recurrence risk. But that is like ask your oncologist, super rare, not your normal bread and butter. Endometrial uterine cancer, a rare uterine sarcoma. That is my only asterisk of why 100% of women shouldn't be on this is preventative medicine, perimenopausal and postmenopausal. And also remember other low hormone states. Trans people, trans men who are on super high doses of testosterone that can block the estrogen in their vulvas. So they are usually on a, on a pelvic hormone, breastfeeding people, people undergoing chemotherapy or radiation. So it's not just as much as the name is called genital urinary syndrome of menopause. There's many other low estrogen, low hormone states that benefit from pelvic hormones. So sometimes they just want to call it genital urinary syndrome and not even use yes even on an aromatase inhibitor. Answering questions from Instagram. Let your oncologist know there's one study that showed increased recurrence on vaginal estrogen and aromatase inhibitors. But the. The knockdown to that study is women who are taking systemic hormones did not have a recurrence. So that's like one point for systemic hormones. But even though people take that as a hit against vaginal. That's a Danish study. That's like observational and lots of questions into that one. Basically all the other studies say you can with aromatase inhibitors and vaginal estrogen. So run it by, I think you know how we pre treat so people don't lose their hair with chemo. We should be pre treating the pelvis with vaginal estrogen for cancer. All right, again, vaginal hormones, by and large, mean local low dose. I'm not talking about taking a progesterone and putting it in the vagina when I'm talking about vaginal hormones for genital urinary syndrome of menopause. Oral progesterone in the vagina is a different way of taking oral progesterone. Tends to be more localized, doesn't go through the liver. But that's by and large not a treatment for gsm. Just seeing people who are asking those questions. All right, segment number two. Should I take hormones? Perimenopause is real and it's hormonal. What's perimenopause? Pop quiz. Ovarian chaos. Ovarian roller coaster. Up, down, up, down, up, down. Symptomatic, not symptomatic. Symptomatic, not symptomatic. It's a hormone problem. It meaning it's happening because of hormones. Depression and mood issues in perimenopause are because of hormones, by and large, especially in people who don't have a past history of that. Somebody just said chaos. Yes, chaos. Give us 10 years and we will be treating the heck out of perimenopause way more than now. Somebody just said ebb and flow. That's so much nicer than chaos. So more ebb than flow. But some people flow. So give us 10 years. We're gonna be treating perimenopause way more with hormones than we are now. We're about to have a perimenopausal explosion happen. With so many books coming out about perimenopause. My perimenopause chapter. Again, for people who are new here, the menopause moment. Pre order it. Thank you so much. Table of contents. Whereas, part four, special consideration for hormones. Chapter 12, perimenopause. From Bong hits to serious risks. Your biggest bone loss is in the two years prior to you ending periods because of the dramatic reduction in hormones, that's a problem because when do you know when your periods are going to end? And so I think we're going to be talking a lot more. I'd like to see some more research, frankly, because are women who are started on hormone replacement therapy in perimenopause, are they going to have better sustained bone health? I think yes. I have no reason to think that that would be. No, but we need, we need some. Oh, somebody just asked, was Australia behind in offering treatments to their patients? That's a great question, you guys. Australia has more women on hormone therapy than America does. I think you guys are around 15%. Keep in mind, in the 1990s, 40% of people were on hormones. So like, I just want to get us back to the 90s, but 15%. So Australia has like three times the amount of people on hormones that America does. And Australia has Androfem, which is a female dosed testosterone product. It's a cream. And so does New Zealand and so does South Africa. And it's available in the uk but the government doesn't pay for it. And right now they're petitioning in Australia to get it on the pbs, which is the government medical coverage basically is way cheaper. So right now androfem in Australia is like, I think, I think you guys, they tell me it's like 103 to 108 Australian dollars a month and if it gets on the pbs, it'll be like a tenth of that. So Australia's ahead of America. And my trip there was amazing. I'm waiting, I'm waiting for somebody to say, come back with like the dollars to bring me back and ideally my kids. That would be awesome. All right, so perimenopause, Yeah, I think it's going to become. Again, I am here not to say everybody needs to be on hormones, but I'm here to get everybody education so then they can make the decision on if they want to be on hormones or not. Perimenopause is a zone of chaos. Sometimes high estrogen, sometimes low, usually trending down. Progesterone, testosterone has been trending down since your 20s. So by and large, testosterone's low for the majority of people in perimenopause. And I think more and more me and the menopausy, like the experts are. And this is not just America, this is the experts. We're treating perimenopausal people with systemic natural hormone therapy. So estradiol progesterone, testosterone. By and large, people used to, especially gynecologists, because they're so comfortable with birth control pills. Give perimenopausal women birth control pills. But birth control. When we talk about hormone replacement therapy. Birth control is not hormone replacement therapy. They're very different. This is apples and oranges. An important note. Just because you had side effects with birth control doesn't mean you can't have hormones. Same with side effects. Just because you had a side effect with birth control doesn't mean you're gonna have the same side effects with hormone replacement therapy. So I hope that that is helpful. Somebody's asking about pre menopause, the time before perimenopause with regular periods, but with all the symptoms and joint pain and hair loss. How do you know that that's not perimenopause? Again, there's no blood test for perimenopause. Hormones are all over the place. Get them tested if you want, but just understand they're fluctuating. Fsh, which is follicle stimulating hormones. Fluctuating. Well, periods are the best marker, but one third of women don't have periods. They have hysterectomies or ablations or IUDs, right? So periods are actually kind of crappy as a marker for menopause because a third of women don't have them. So it's a stupid thing. A stupid thing to be like, follow your periods. So for the person who's asking about premenopause, you can have perimenopausal symptoms with regular periods. Some doctors disagree. The menopause experts, hormone experts, say, yeah, the periods are not the end all be all of if your hormones are fine or not. All right. Does HRT cause you to gain weight or help you to better control your weight? Very good question. Can be both. If you look at the research, all humans gain weight as they get older. All genders, all humans. And that's for various reasons, biologically and culturally. So it's not. So if you put. So they have studies where they put some people on hormones and some people not on hormones. And the weight gain is the same, right? Because humans gain weight as they age. Not all, but that's the trend. So some women will notice increase in water weight. Again, this is why I hate the scale, right? I have an in body scanner in my clinic because I care about how much muscle do you have and are you gaining muscle? Are you gaining fat? What are you gaining? So a lot of women will notice they're just gaining water weight with being on hormones because it helps you stay more moisturized. Hey, my skin looks better, my joints don't hurt, I'm more moisturized, I have more fluids on board. You're not as dried out on hormones. So that can be some of the pounds. Testosterone, I think out of all of them can increase weight. And I'm not talking like 30 pounds here, I'm talking like 2 to 10. Right? So testosterone actually increases lean body mass and that weighs something. Oh, also healthy bones weigh something. So nothing will drive me more nuts than a woman complaining of weight gain and not being, not telling me like what are those kilograms or pounds? And that's why a body composition scanner is very important. Some women will drop a ton of weight on hormones because their insulin resistance is better, their bones are, their muscles are functioning better, their feeling better, they're sleeping better. Right. There is nothing like crappy sleep that will make you hang on to weight stress cortisol horrible for dropping weight. So the weight question is incredibly complex and anybody who simplifies it is trying to do a 90 second Instagram reel or just be reassuring. But what's been going around the Internet lately, which has been driving me nuts, is non hormone experts telling menopausal and perimenopausal women that it's just calories in and exercise. Like that's insane. If you eat the exact same amount and you're pregnant, your body will gain weight because you're pregnant. Right? So if you drop your hormones, the body tends to shift fat distribution. I see this especially in the fitness world of they're like just close your mouth and exercise more. It's like you'll still gain weight, especially if you're restricting calories because now your body thinks it's starving, so it's really hanging onto everything. So it's a. That's my very long winded question to hormones and weight gain. It depends. Some people will gain some. Some. I've seen people lose 30 pounds once they got on hormones. So everybody is different. And what we care about most is where's your muscles? What's your body fat percentage? I just did an Instagram reel not long ago. It was looking at a analysis that weight on the scale. So number does not correlate to risk of death as much as percentage body fat does. Percentage body fat way more correlated to death than whatever number it is on a scale. All right, so that's my perimeth segment two perimenopause. Should I go on hormones? Many menopause Experts will put perimenopausal women on hormones, not just birth control. Birth control is good for two things, though. Number one, protecting yourself from sperm. Number two, heavy periods. 20% of women in perimenopause will have very heavy periods. Cause their progesterone's going down, their estrogen's going up. Something called a loop cycle where you don't ovulate. So you're like producing tons of estrogen and you're not producing any progesterone. Then you have this huge bleed. So that's me oversimplifying it. But by and large, chaos of hormones, heavy bleeding, 20% of women, birth control mellows out everything and can be really good for heavy bleeding. Better than hormone replacement therapy for some people. All right, so that's segment two. You're not broken. Your hormonal perimenopause is real. Somebody said, I'm hating all the push for GLP1s when not obese or diabetic. Well, buckle up, buttercup. GLP1s are not going anywhere. They're not going anywhere and they're probably just gonna get better. What do I mean by that? Cheaper and more tolerated and lower dose. We're gonna start seeing more. Like, it's getting FDA approved for sleep apnea. They're researching it for dementia prevention. Like, GLP1s ain't going away. So if you are, if you hate all the push for GLP1s but not obese or diabetic, you might want to just turn off your phone.
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This episode is brought to you by Progressive Insurance. Do you ever find yourself playing the budgeting game? Well, with the name your price tool from Progressive, you can find options that fit your budget and potentially lower your bills. Try it@progressive.com Progressive Casualty Insurance Company and affiliates. Price and coverage match limited by state law. Not available in all states.
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All right, enough of that. Let's see what else we got. Do I recommend microdosing GLP1s? That's kind of like asking me, do I think everybody should be on hormones? Of like, I'm never gonna say yes to everything on that except for maybe sleep. Everybody should try to get as good amount of sleep. And I also think everybody should not drink alcohol. So Those are my two hard lines. But GLP1s individual, ask your doctor. And hormones. Again, individual, ask your doctor. But get educated on them. There's GLP1s are. They've been around for a while now. Like, they're not as much as we. They're newer in like the zeitgeist They've been around for a while and they're getting, I think, I don't want to say safer, but like the, they're getting more managed where people are tolerating them and they're doing lower doses. So I think, I mean, again, 10 years from now, where are we going to be with GLP1s is going to be super interesting. And I'm, I'm not hating them. They, I mean, they make people stop drinking alcohol. Like, they're incredible. The other really incredible thing about GLP1s that I think is not advertised a lot is that the food chatter of your brain. Like people are like, I just have. I can do other things with my brain now because I'm not like having this food chatter. And that's pretty powerful. So main symptoms of perimenopause? Well, the, I mean, the classic one is irregular periods, but that tends to be later. Perimenopause. Perimenopause is a new. A big one is not feeling like myself, which is horrifically unscientific because you can't measure it. But like 40 to 60% of women will say, I don't feel like myself in perimenopause sleep. For me, it was sleep. I was like, oh, I just drink caffeine late or I have a stressful job or something. I'm like, ah, it's perimenopause. Sleep, anxiety, depression, moodiness, periods being irregular. Starting to get that. That what they call the menno belly. But like that pooch on the bottom. Right. So that even if you're not gaining weight, your fat distribution is changing or your lean body to fat ratio is changing because your hormones are changing. Somebody just said, I never want to be off my GLP1. The food chatter's gone. Yeah. That's trippy, right? It's like super trippy. And it's not something like, it's not a. Like western medicine really likes to measure stuff and it's, that's kind of an immeasurable thing. So just like not feeling like yourself is kind of immeasurable. So people tend to poo poo it. But I think it's very real, it's very powerful and I think it's life changing for a lot of people. Yeah. And it's gonna be. I'm following the GLP1 decreased risk of dementia thing a lot. It's gonna be interesting. Somebody just said, I've been at GLP1 for. At 2 milligrams a week for inflammation. Game changer. Grateful. Yeah. See See? All right, Perimenopause, that was my thing. Peri, I think, yes, to perime. I'm on all of the things because I've got, like, all the access, all the education. I'm not afraid of this. And physiologically, I know what's happening to my ovaries. So people need to understand what's happening to their body, and then they're going to be a lot less afraid of the incredible blessing that we have to actually be able to give our body back what they made, what it made, and to make it to 80 and to 90. I mean. Okay, so here's the other interesting thing about GLP1s is the study, and this is all genders. This is men on testosterone and women on estrogen, that people who do the hormones plus GLP1s tend to preserve their lean body mass more and lose more weight. So they are, like, actually additive to each other. So I would love to see a best practice of, like, ideally, if you can be on GLP1s and hormones, because you're actually like a bigger bang for your buck than doing one or the other. All right, so he just said, I heard HRT and GLP1s pair wonderful together. Yes. Okay, so segment three. What if I am years post post menopause? Post postmenopause. Remember, for the. For the beginners who started in the middle of this podcast, menopause is one day. It is one day after one year of no natural periods. Completely worthless for everybody with IUDs and ablations and hysterectomies. Also, it completely worthless because it doesn't actually tell you what's happening, which is such a low amount of hormones that you can no longer normally cycle. Right. So that's what menopause is. Menopause is a cessation of functional ovarian hormone and egg production. And you will. You will still make. Some people will still make a little bit of Testosterone for, like, 10 years afterwards. But I digress. So the party line after the WHI was take as little for as little of time as possible. And that was kind of a nice way of being like, yeah, yeah, yeah, we're not supposed to be on these, but, like, you're suffering, so here. But we'll stop. So what happened? And the other thing that happened is because of the whi, they said, hey, older women that we started on, they did worse and they had increased risks. So because of those two party lines, the myth that is now in the Zeitgeist is you have to stop at a Certain age, which is absolutely not true. And I tell this story in my book about a woman who had taken care of for a long time. And she came in and she was in a wheelchair. And I was like, what's happening? And she's like, maybe it's all in my head. But they stopped my hormones and now everything's worse and now I'm in this wheelchair. She was like in her 70s. And I'm like, why? Why'd they stop em? Like any reason. And she's like, no, I'm just old enough. And they said I was old, too old. And I'm like, do we stop any other medications because people are too old? Like, do we stop your cholesterol and your high blood pressure and your SSRIs cause you're too old? No. So I started her back on her estrogen patch and I saw her back like a month later and she's like, maybe it's all in my head. But everything. But so many things are better now. So one big myth is that you have to stop at a certain age. Absolutely not true. You will always get metabolic benefits, bone protective benefits, mood benefits, all the things, no matter what age you're on, right? So that's one myth. The other myth is that you can't start after 10 years of menopause again, worthless. Because everybody knows this. How many people have been to a frickin high school reunion? I rest my case. Some people are looking good and fine, and some people are not looking good and fine. And they're all the same age. Therefore, age is not a reason to say if you're healthy or not or not to be on hormones. But so many will say that. They'll be like, you're too old. And I'm like, what's, what's age? It's like a driver's license. It's like there's no like legal age that you have to be under to start on hormones. So the guidelines, if you print out it's free online, go to the Menopause Society 2022. Our 2022 is the most recent guidelines for menopause hormones. So go to those guidelines, they're free online. And what they will, you'll see them say is the best benefit is when it started early in menopause, which is arbitrary cutoff. 10 years since your last period. Now, what happens at 10 years in one day? What happens at 10 years in one week? What's the difference between 9 years and 50 weeks and 10 years in one week? Hmm? Like, think logically. People I am here for you to think logically so you can think of if these things actually make any effing sense or not. So, point being, when you actually look at the data of the whi and these are oral synthetic medications in sick, unhealthy people, there is no increased risk of death from dementia. There is no increased risk of stroke. There is increased risk of clot compared to placebo because they're freaking oral synthetic medications. Right? Like that's never going to go away. But the hormones we use now, by and large, are transdermal estradiol, which is the best for older age, and oral micronized progesterone and transdermal testosterone. That's kind of your bread and butter for systemic hormones. They're all incredibly safe. Incredibly safe. So the other fun thing about the menopause moment, pre order it if you haven't yet, pre order the menopause moment mindset. Hormones and science for optimal Longevity. I go the just because I'm a badass and I like love testosterone. Why, why are we calling estrogen the female hormone? It makes no sense. We. We have more testosterone in our body than estrogen. Some of the hormones chapters in this book start with testosterone. Mother effers. Because it is. I was reading a paper today and it said estrogen is the most abundant sex. And I was like, don't say it. Don't say that estrogen is the most abundant sex hormone in women. Because it's not true. And it actually said estradiol is the most abundant estrogen in women. And I was like, there that estradiol is the most abundant estrogen in women, but testosterone is the most abundant sex hormone in women. All right, hope that helped. So can you take hormones greater than age 10 years post menopause? Yes, absolutely. Again, give me 10 years. What are we going to see more of? We're going to see more of treating perimenopause. The boomers are pissed. I've got multiple podcast episodes on this. There's an amazing paper by Susan Davis and another author, I'm blanking on her name and it basically goes into the WHI and picks apart how bad hormones starting at older age was. And it's not. Besides clot risk, which again, don't take oral synthetic hormones and your clot risk goes back to normal. Stroke was nothing. Dementia was self reported and didn't hold up and they didn't have an increased risk of death from dementia. So I hope, I hope. Yes. Can hormones be started if I am borderline osteopenic? But not yet in menopause. The question with so the answer to these questions is why not? Why can't you think about it that way? Hope that helps. Lots of people asking if I had an ischemic stroke is hrt. Okay, so remember, remember, clap the hands. Remember, transdermal estradiol does not increase stroke risk. Remember, oral micronized progesterone does not increase stroke list. Remember, transdermal testosterone does not increase stroke risk. I'm so effing tired of everybody talking about clot risk. And let's go there. Let's talk about oral estradiol, which again, is bioidentical and is not what was used in the whi. It is way lower clot risk than birth control. Way lower clot risk than birth control. So for anybody who's had a stroke or had a history of clot transdermal. Transdermal. Transdermal. And what we tell people. And when I say transdermal, I mean estradiol. I can't make your stroke your clot risk and stroke risk zero. Absolutely not. Look at you. You've got issues. But I'm not going to increase it by adding estradiol. And then you need to figure out if you get another clot or if you get another stroke or you're going to beat yourself up for being on that transdermal estradiol. Or are you gonna say, you know what, it's helping my bones, it's helping my, my mood, it's helping my sleep, it's helping everything else. Because you, you need to understand the science. There's multiple published papers on this. Like, nothing of what I'm saying I made up. Like, this is all. I'm incredibly well researched at this point, so I hope that that helps me figure it out. Would you please discuss sex hormone binding globulin? Mine is high. Thank you. So sex hormone binding globulin is a protein made in the liver. It's increased by taking oral birth control pills. Basically, naturally, it goes down over time. But then birth control can make it high, and when it's high, it tends to bind hormones more. So I see that especially in dosing testosterone of like, if you have high sex hormone binding globulin, maybe you're going to need a slightly higher dose of testosterone just because we kind of need to push more through because you've got so much of the protein that's hanging onto it. So from what we can tell, not a big problem. But somebody said, what's the metabolism of progesterone delivered Rectally. It's like transdermal. It's not through first pass metabolism. Can you reverse osteopenia with hormones? Yes. And, and what I mean by yes and is you better fricking eat. You better freaking lift weights. You better work on balance. See a physical therapist who's an expert in bones, like they're worth their price in gold. You need to lift heavy. You have to. I don't mean stress in a bad way. It's stress in a good way. You have to stress the bones and you have to feed these bones. Women like us, we were starved in the 90s, remember? Heroin chic. Not healthy, horrible. I honestly, I'm gonna get Kate Moss on a fricking DEXA scanner. Right? So hormones alone will improve bone, but if you don't do anything else, you are missing out on the absolute power that you have to improve your bone density. So if you're gonna reverse osteoporosis, lifting, eating, muscle gain, protein and hormones. This is not one. Or vitamin D. This is not one thing. This is a plan. Get on it. Get on. Get on all the things and get support because what you are doing got you osteoporosis. I was actually in Seattle recording my audiobook. I was working out in the gym at like the Marriott and this woman came up and she's like, hey, thank you so much for your work, blah, blah, blah. She fell skiing. She broke a bone, did a dexa, found out she had osteoporosis and then is now like this. This woman looked great. Like she looked very physically fit. She's like, I'm lifting heavy. I'm on the hormones now. It's like vitamin D. And she's reversed her osteoporosis in all locations in her body except for like one spot on the dexa. So pretty amazing. But get help. Don't do this alone. And you guys, the. There are other bone building medications that once you have osteoporosis, should be considered. They have their own set of risks and costs. But we really need to start taking responsibility for eating properly and exercising our body properly. We are sitting on our asses. Less than 40% of women in America lift weights. It's unacceptable. Don't think you can sit around and starve yourself and not lift weights and just take hormones and have your bones be fine. Just. That is not how life on this planet works. All right, what else do we got? Okay, segment four. Can I take hormones for prevention? So why wait till things fall apart? Why wait till you have heart disease and they tell you you can't have hormones, which you can. Many people are on hormones with heart issues. High cholesterol, not a contraindication. Diabetes, not a contraindication. Remote heart attack, not. Not a strong contraindication on the right hormones. High blood pressure, not a contraindication, but. So the question is, can you take hormones for prevention? Well, in America, they are FDA approved for the prevention of osteoporosis. So what are you waiting for? Right? We. An ounce of prevention is better than a pound of cure, my friends. I think some. Was it Osler, Some famous doctor said that. Which, like, medicine doesn't follow that at all now. But somebody famous a long time ago said that. So, yes, I think. Why? Why? I mean, women are freaking horrified when they find out that their labia minora resorb and their clitoris shrinks and atrophies and the skin around the head of the clitoris gets stuck on the clitoral head. It's called clitoral phymosis and clitoral adhesions. Women are horrified when they find out that happens. And then. But then they're like, I don't want to be on hormones for the rest of my life. And I'm like, well, guess what happens without hormones. That's the education that the menopause is doing. Get educated about why hormones are important so you understand the reason for putting them back in your body. For estrogen and bones, it seems like you need a smaller amount to prevent bone decline versus I'm trying to build back. You're gonna probably wanna push a higher dose on the estradiol then. Those guidelines have not yet been set. But the very smart people who are reading all the research, from the looks of it, and this is again, American numbers, but above 30 to protect the bones, and then above 60, 60 to 100 to actually rebuild the bones. So seeing a menopause specialist who understands that. But again, I can't quote you guidelines. I can quote you the people who've read all the literature to see what doses are actually building backbones. Building backbones, again, might need a higher dose of estrogen than just a lower dose of estrogen, where we're just trying to prevent bone loss. Obesity is not a contraindication for hrt. Does testosterone also help with bones? Yeah. So testosterone is anabolic, which means it's a builder. So it builds bones. We don't have great recent data on it because nobody's been studying testosterone, but we do have older data on it, and it does in the estrogen, testosterone, arm they rebuilt better than estrogen alone. So think of it this way. Again, I'm here. You guys need to think. I want you guys to think your body has more testosterone in it than estrogen. Prior to menopause, your body has all the hormones. So when we think, oh, should I do this or should I do that? It's like, that's not really natural, right? Natural would be putting back all the things that your body had, which means testosterone, estrogen, bone loss on HRT and weightlifting, lifting, and oral calcium. Protein, protein, protein, protein, protein. Jumping. All good for the bones. Follow Dr. Vonda Wright. She's got a book coming out in August called Forever Strong, which is amazing. Ooh. Los Angeles menopause specialist. Yeah. Ashley. Ashley. Dr. Ashley Winter. Rachel Rubin has a, basically a satellite clinic in LA that I think now has two doctors in it. So very, very exciting segment. So that was hormones for prevention. We have the best data for prevention of osteoporosis, but the WHI and others does show prevention for heart disease. We're not going to get a randomized control trial for, for heart disease. And some people will argue that transdermal estradiol is not as protective as oral conjugated equine estrogen, but from the data we have, it is. So, you know, I, I get a little testy in people who say we need to wait for more studies given the current funding of studies. And nobody's interested in doing long term placebo controlled trials on generic medications at this point. Hold your breath until that happens, you'll be dead. So you gotta make the decision with the data that we have at this point. So we have data for bone protection, we have data for cardiovascular health. We, we need more data for muscle protection. But the basic science data with the mitochondria is very promising. Skin gets better, right? Collagen. I mean, women who are on hormones, they have less. What is the word? What's the, what's the first of all? Frozen shoulder. But I'm thinking of what's in the ankle and it tears. Achilles. Is it Achilles tendinopathy that we have data show that women who are on hormones have less osteoarthritis Dunsies. That stuff's painful. I'm going to stay on hormones just to try to decrease my risk of that. Same with decreased risk of, I don't think glaucoma, but what am I thinking of? Macular degeneration. I think it's like up to a 50% decreased risk of macular degeneration, which I have in my family. So I'm like, give me all the things. I stopped all my HRT after breast cancer diagnosis, just not myself anymore. What now? See an expert. See an expert. Understand the data. Understand your risks. It's a risk benefit conversation. Absolutely, yes to vaginal estrogen. Pretty hard. It's probably pretty okay for testosterone. Just a lot less data published on it. There's more data on the safety of estrogen post breast cancer than testosterone. There's just less bad press against testosterone. See an expert. Many, I know many, many breast cancer survivors on hormones. It's just again, the party line is you can't. But that's not actually the truth. That's not actually what the guidelines say. So educate yourself and see an expert. So right now we have 4 to 5 million breast cancer survivors in America, and that number's not getting smaller. So again, 10 years from now, we'll have again, probably much more. But it's. I mean, this is what people. If I could have the general population understand two things about breast cancer, they should understand this. Number one, hormones don't cause breast cancer. Just because we call something estrogen and progesterone positive doesn't mean that that caused it. Prostate cancer is testosterone positive for receptors. And we don't say testosterone caused prostate cancer because it didn't. So two things I want lay people to know about breast cancer. Number one, hormones don't cause it. If you, if hormones caused breast cancer, your risk of breast cancer would skyrocket when you got pregnant, and it doesn't. And if hormones cause breast cancer, why do most people who get breast cancer are postmenopausal and not on hormones? Right. Like this. Think logically about these things and get educated. And that's where fear goes away. So number that's number one. And then number two, breast cancer means cancer in the location of the breast. There's literally like dozens of different types of breast cancer. And we are dumbing it down and oversimplifying it by calling everything breast cancer because your recurrence risk is different. If you can, you know how risky is. Hormones is different. DCIS versus lcis versus estrogen positive versus estrogen negative. They're all different types of cancer. They just all happen to be in the breast. So we call them breast cancer, which is dumbing it down and oversimplifying it and applying a very broad brush to people. It's quite annoying. All right, someone's in Lynwood, Washington. Come see me. I'm in Bellingham. All right, so let's just see segment number five. Do I just want everybody on hormones? No, I already answered that question for you. No, I don't want you all to be on hormones, but I want you to be educated. Most people who are educated can then make their own best decision on if they want to be on hormones or not. This is not something that you listen to your neighbor or you listen to your aunt who has outdated. W whi. Why do women lose their hormones? Because we're living longer than the age of our ovaries. Ovaries are a certain size depending upon the size of the mammal. Elephant ovaries are bigger than human ovaries, which are bigger than dog ovaries, et cetera, et cetera. After a certain amount of years, you've used all of your follicles, and that has to do with the size of the ovary. Right. We are now living in captivity, which means never before have we ever as a society had 40 years to live past the age of our ovaries. Because we have. We're living in captivity, basically. We have clean water and sanitation, and we prevent a lot of childhood diseases. We don't tend to die in childbirth anymore. We're really great at trauma. We're super good at cancer care. So average life expectancy usually got you a couple of years post ovarian life expectancy. Now average life expectancy is getting you 40 years post ovarian life expectancy. So that's why when you actually explain to people that living to 84 is not natural, they're a lot more willing to help them, their body get to 84 in a healthy way. 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? Oh, somebody said, my doctor loves. I'm educating myself on this. Good, good, good, good, good, good. I love it. My last segment. Safety. What are the real risks? Break it down. Vaginal estrogen. The biggest risk is as your microbiome's adjusting, you can get some yeast infections. We can deal with that. We'll lower the dose. We'll treat the yeast infections. We'll go slower. Pretty easy. Oral micronized progesterone. About 4% of people are progesterone intolerant. So you need to take a synthetic or put it vaginally or rectally just to get it tolerated. Transdermal estradiol. Incredibly safe. You can get it transdermal through a patch, through a gel. You can put it do a higher dose in the vagina. We'll get enough to measure it systemically. Female dose testosterone, incredibly safe. Basically, the biggest risk with female dose testosterone is if you push it too high, too high, too fast. You're going to get masculinizing side effects, hair growth or hair loss or acne, change in mood. Again, very rare stuff. Clitoral atrophy is something I know very little about, and I'm terrified now. Welcome to the hormone discussion. Welcome to understanding what happens to your body without hormones. It's a very nice place to be because you can actually do something about it. When you. When you have the education, you can actually do something about it, which is awesome. Can you take estrogen if you have a fibroid? Yes, absolutely. All right, so I mean, the other question just to close out. What are the real risks? What medication do we prescribe people that has lower risks than hormones? I'll wait. I'll wait, I'll wait. So my what my point is, everything has risks and benefits. You not. Here's the bit, here's the party line. You not taking hormones post menopause has risks, and you should understand those risks. One and two, fracture risk, 30% risk of dementia. And again, hormones aren't going to prevent all fracture, won't prevent all dementia, won't prevent all heart disease, won't prevent all diabetes. But not being on hormones, being on hormones decreases your risk of diabetes post menopause by 50%. That's like, if a drug did that that you could patent, it would have a Super bowl ad. Hormones decrease your risk of hot flashes and night sweats by 80 to 90%. Nothing's better. So I think it's about body autonomy. It's about education, body autonomy, trying to age as healthy as you can. If you're 64, you have not missed the boat for HRT. Absolutely not. That's insane. You've got, like 20 years left. Don't you want to be the healthiest? You can push back, get educated, buy my book, the Menopause Moment. I have a chapter in here. I think it's. I think I called it. The Boomer should be pissed, because that was like, a really successful podcast episode that I did. So you can go back. Yeah, it's an old podcast episode, but, like, the data's still the same. Where? Part four, Special considerations for hormones. Nope, it's in part three, Hormone Deep Dive, Chapter nine, why the Boomer should be Pissed. The timing, hypothesis. So I hate that fucking question. Why would God make us this way if he wanted us to take hormones? God wanted you to die in Childbirth one and eight. God wants you to die of tetanus by being out in the woods and live. God doesn't even want you to be in a house. And I'm not saying that God's not kind. I'm just saying, like, we've created a synthetic state of being. God did not give us air conditioning. We did. Right? We gave us a long life. Natural is dying in childbirth. Natural is. The wealthiest men in Britain in the 1400s had an average life expectancy of 41. That's natural. That's no antibiotics, no clean food. War is fricking everywhere. So, yeah, I think the grandmother hypothesis is stupid as shit. I debunk it in my book. And I think anybody being like, taking hormones is not natural. Well, 84. 84 of the hip fracture is not natural. So I get pissed pretty quick when people don't use their brains and think about that. Like, driving a car is not natural. Wearing socks isn't natural. Like, stop it with the natural. Like, absolutely insane. God gave us the ability to create air conditioning and medication. Great. And hormones. Ass. Like, you just can't fix stupid sometimes you just can't. You can't do it. Somebody said my time in hospice caring for a generation of women denied hormones was so eye opening. Yeah, yeah, yeah. We've got. We're way worse off now. Remember, you guys, Remember in the 1990s, 40% of people took hormones, right? 20% of men have low hormones. We don't give them this natural bullshit when they have low testosterone, we're like, oh, sorry, you outlived your testicles. That's what God intended. Fuck that. We don't say that to men. So I. I mean, I think there's a lot of paternalism and a lot of the myth of natural in trying to keep women weak and unhealthy and not advocating for themselves. So I'll. I'll. I'll knock down natural and any day of the week that ends. And why. All right, is that it? Too long. Didn't read. If this was too long. Didn't read. God gave us a brain. Try using it. I love it. Oh, yeah, well, Viagra is not natural either. God. God gave you a weak ass, you know, soft dick, right? And nobody goes around, be like, I'm so sorry you have erectile dysfunction. Did you ever consider that? That's God's wish. Like, start saying that then. If you think women shouldn't take hormones, knock it off. Thoughts on the O and P shots? Yeah, my quick thoughts. Just this not being a podcast about it and this already being an hour long is save your money. Hormones are way cheaper. So is a good sex ed book. So are good vibrators. So say save your money. That would be last resort for me to spend thousands of dollars on this. Most people can get somewhere with a lot less money spent, so I hope that that helps. Can you get pregnant if you supplement testosterone? Well, do you have sperm in your life? Because you can't get pregnant without sperm. Are you 73? Because it doesn't matter. You can't get pregnant if you're on testosterone. But say you're perimenopause. Yeah, yeah, yeah. And you got sperm in your life. Yeah, yeah, yeah, yeah, yeah. You could get pregnant on natural hormones. Absolutely. All right, guys, I love you. Do me a big favor. Pre order the menopause moment, get on my email list so you can come to the last three of the five summer schools. We're going to do female sex ed, testosterone, and am I too late for hormones? We're actually going to dive deep into the data on that, so. And then the perimenopause one and the GSM one will be up for purchase very soon. Join the membership if you want to see me work out pretty much every morning in my sports bra because it's a workout accountability private Facebook group and there's lots of data in the membership as well. And we're going to put all the summer school courses in the membership so you'll save money doing that. And if you love my feistiness, come see me on the book tour. I got five cities. September, October, November looking like best way to find out where I'm going to be besides be on Instagram is to be on my mailing list so you can get on that via the website. Kelly Casperson, MD. So I love you. Get educated. I don't. I don't give a if you're on hormones or not, but I care deeply that you're educated and I care deeply that you can talk back to the people who are less educated than you who try to tell you how to live your life. That's my. That's my wrap, you guys. I love you. Hey friends, if you love the you're.
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Your support helps more people find this empowering information for courses, clinic info, and all things midlife mastery. Head over to kellycaspersonmd.com and don't forget, you can grab your copy of youf Are not broken. Stop shooting all over your sex life at Barnes and Noble, Amazon or ask your local bookstore to order it for you and a friend. While you're there. Make sure to pre order my upcoming book Menopause, Science, Hormones and Mindset for optimal longevity. Coming September 16, 2025 Medical Disclaimer the youe Are Not Broken podcast, Instagram and content created by Dr. Kelly Casperson is presented solely for general information, education and entertainment purposes. The use of information on this podcast or materials linked from this podcast or website is at the user's own risk. It is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. This podcast does not diagnose or treat you. Users should not disregard or delay in obtaining medical advice for any medical or mental health condition they may have and should seek the assistance of their healthcare professionals for any such conditions. And as always, I got you, I got your back and you are not broken. Thanks for listening.