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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. Enjoy the show.
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Hey, welcome to I'm going to do this in August. This is an August you are not broken podcast and I'm live at the same time. I like when I do it solo. I like going live on Instagram because I get some interaction and some questions and some love and all the things. And man, I've got so much to cover tonight. We'll basically see how long the family will let me do this for because I need to talk about the book tour, the book, pre order the FDA event, some, some papers. I've been reading all of the things. So. Welcome to the you're not broken podcast. This podcast is like kicking ass, you guys. We're at like 4 million downloads at this point. We're in the mid-3002 for episodes. Please like it, please follow it. Thank you. Sharing it. It's literally grown by word of mouth. The only marketing for this podcast is people like you and like me doing it on posting, posting reels from it on Instagram. So thank you so much joining me while I am doing my evening decaf coffee.
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Hello.
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From Ontario, Canada, Wisconsin, Anaheim, California, Ohio, San Diego. Where else do we got? We got North Carolina. Where do we got? And yeah, thank you for the doctors and nurse practitioners and providers who recommend this to patients. So I'm completely honored that I'm both engaging and entertaining and empowering. I think I'm all those things. So the first thing I want to talk about because I have not done a podcast episode on it yet, is the FDA event that happened in July. The roundtable was insane. Like, the biggest joy. There's like many big joys, but one of the biggest joys was being like, we all were all in this like, lunchroom area right before the event started and being at a table with people who could have the conversation at the level we were having it. So I mean, there's like, there's a whole spectrum of knowledge on this, right? Like there's the people who still think hormones cause cancer and are dangerous and are going to give you blood clots and like all the bullshit lack, like then they believe the WHI data, all that stuff. So you've got that and then you've got the people who are like, estrogen patches are good, right? You've got like the boots on the ground people. And then you have like the experts who publish the data, wrote the data Critique the data, podcast about the data, read journal articles for fun level people who are at the fda. And so it was like that level of knowledge, of being able to, for lack of a better word, nerd out about all of the challenges that we have helping women get accurate medical knowledge and advice and empowerment and how do you change the prescribing habits of a million doctors? And how do you get this into the hands of 40 million women if they want it? So like, to the questions that were coming out of our mouths, like we didn't have to explain ourself, right? Like we were at that level of expertise. Everybody on that panel deserved to be there. Everybody on that panel was an expert in their own right. I really feel like there were two generations represented. There was the Gen X elder millennials and then there was like the boomers, the people who were practicing during the whi, who like lived through it, who wrote about it, who critiqued it. And it was so important to have all of those voices there. And the other lovely thing about the diversity of that panel is we had researchers, we had clinicians, we had PhDs, we had boots on the ground, we had educators. Like, it was very diverse. And Dr. Marty Makary, bless him for supporting this panel, having this panel, and he asked us to bring facts and to bring heart. And I think we brought both facts and heart very, very well. And I'm incredibly proud of the work that we did. So the first person to go, I'm going to kind of like go around the room for you. If you haven't seen it, first of all, if you haven't seen it, go on YouTube and go to the FDA YouTube site. It's like just Google, FDA, YouTube and it comes up. It's a two hour event. The whole thing is worth listening to. There's knowledge all over the place. And if you want to just see my five minute talk on testosterone, go to my YouTube. Kelly Casperson MD and we have just searched through my videos. You don't have to go far back. So it was like a month ago and it's a my five minute talk. So we were all asked to bring one slide and five minutes is what we were asked to bring and basically speak for the American people. So I think personally we all knocked it out of the ballpark. And I'm really, really proud of what I brought. And I think it was, what I brought was new and refreshing for people who don't know I talked about female dose testosterone. If you again want to listen, go listen to it. It's Excellent. So I asked, I asked that we need female dose testosterone because women are already on testosterone. Many, many women are already on testosterone and are doing much higher doses, supraphysiologic doses, very expensive, very invasive, super physiologic. We've got 80 years of safety data, we've got 50 years of trans man safety data. There's a 50 year and a 30 year trans man safety data on hormones. So to me I'm like, if it's safe for female bodies for 50 years at 10 times the dose, we pretty much know it's safe for female bodies at physiologic dosing. Lots of interesting stuff there. The other thing I asked for is when we get a female dose testosterone to have it FDA approved for hypogonadism, to not have low libido or hypoactive sexual desire disorder be the indication. Because for two reasons. Number one, insurance often has exclusionary riders on sexual health, which is fine if Your Viagra costs $2, but it's not fine if your testosterone formulations hundreds of dollars then. So yeah, so that's the first reason is have it, have it be approved for hypogonadism, which is what the male testosterone's approved for. So I want equality in labeling. And number two is that doctors and clinicians aren't even comfortable talking about sex. So don't make it for sex. How do you objectively measure low libido? How do you objectively measure that the testosterone is being successful with low libido? You can't. So have it be for hypogonadism. Um, and then the third thing I asked for is when we get a female dose testosterone, because this is a when. This is not an if, this is a when that I don't want it DEA regulated. This is not like I, this is like experts. But this is what I was talking about at the FDA is that because of the Olympic doping scandals of the 1980s, testosterone got on the DEA restricted list at the time, allegedly. And so Congress did that. Congress passed the Anti Doping act of 1991 in response to the doping scandals of the 80s in all of athletics slash Olympics. So you cannot be a gold medal in pole vaulting on female dose testosterone. It just can't be done. Physiologic, female dose testosterone, it can't be done. And so I think the risk for cheating and doping is so low that to put a DEA restriction on it, which limits telehealth access, DEA licensing requirements on top of medical licensing requirements, that it, it's prohibitive to half of the population, which is female, to make it DEA restricted. And plus, listen, the DEA's got a hard job to do with the opioid crisis, et cetera, et cetera, et cetera. We don't need to be putting physiologic dose testosterone on something else that they're doing. And you might think, you know, you might think that like, oh, don't worry. The DEA is not really worried about testosterone. Actually, they are. I've heard of DEA agents going to people's houses for prescribing physiologic dose testosterone. So, yeah, let's take that off of their list. They don't need to worry about that, especially female. And the other thing, yeah, the other thing of the DEA script being just for testosterone is that you can only give up to six months of the hormone, not a year like all other prescriptions. So I'm not asked, just to clarify for people who don't know what I'm talking about. I'm not asking for testosterone to not be a prescription. I'm asking it to not be regulated like ketamine, Tylenol with codeine, et cetera, et cetera, et cetera. So I know that is one of the big issues, especially with the telehealth menopause companies is like, let's get rid of the restrictions so we can help more people. This is a physiologic hormone and dosed physiologically, it's incredibly safe and should not be DEA restricted. So I went off on that tangent, but there's all your testosterone knowledge from the dea. Okay, so if I can walk around the room, it was like a circle panel, and we started with Dr. Heather Hirsch, who's amazing, and she basically set the tone with heart and enthusiasm and basically the premise of why we were there. And she spent some time really giving definitions of things because we knew that this was also open to public comment and it wasn't just doctors listening, it wasn't just the FDA listening. And so she really started off the bat of like, this is what we mean when we mean systemic and what we mean when we mean, you know, all the other things. So loved Dr. Heather Hirsch. She started us off first. And if I forget anybody, because I'm literally going off memory, like, everybody that was there was amazing and I'm just like brain farting on a podcast if I forget you. So I'm sorry. But also on that side was Dr. Barbara Levy.
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She.
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She talked about something that I had not given much attention to. And so I want to give it attention to it. Now, hormones. Estradiol, which we know is very, very stinking safe, is on the beers criteria, which is a list of unsafe medications for people over the age of 65. It's also labeled if. If any of you guys have experienced this, when you get your estrogen patches, especially from Amazon, there's a big, like, hazard sticker on it now because it's considered a carcinogenic, which is insane. But apparently if you give high doses to fetuses, it's not good. So anyways, it's like labeled as a carcinogen. It's on a beer's criteria of dangerous medications after age 65. So people who go into nursing homes that are like reimbursed by the Medicare for being following directions get dinged if these people are on air quotes. Unsafe medications. And so women get pulled off of their hormones because they're deemed, like, unsafe based upon the lists that they're on. So she had brought up a point to like, get estradiol off of those lists because especially for vaginal estrogen, if the women are taken off of that, their risk of hospitalization, sepsis and death from uti, if they have recurring UTI skyrockets. So I loved that she brought that up. Cause that was not something I was aware of. So we had Dr. Barbara Levy, we had Mary Jane Menken speak. And so she gave her talk as well as Joanne Manson's talk, because Joanne Manson couldn't participate in person. They did wonderful jobs. Then we had Dr. James Simon talk about basically how intrarosa, which is intravaginal dhea, which does basically the same thing as vaginal estrogen, there's like subtle pros and cons of them, but it's a hormone that's local, that doesn't raise systemic blood levels. It does not have a boxed warning on it. So that's the bias. The vaginal estradiol does have a box warning on it and the intrarosa doesn't. And he just called that out very nicely to be like, hey, fda, be fair in your labeling. You actually didn't require intrarosa, which again, vaginal dhea, which converts to estrogen in the pelvis, to have a boxed warning on it, but you have it on vaginal estrogen. Let's be fair and equal in our labeling. Pull off the vaginal estrogen warning. So that was very useful from Dr. Jim Simon. Then we had Phil Sorrell talk about how incredibly important estradiol is. He wrote a very important paper looking at the risks of death from not going on estrogen. That's gonna be a. That's gonna be a very short podcast episode someday is like, and you die more if you don't take hormones post menopause. Like, it's literally multiple papers show that. And then everybody's like, stop medicalizing menopause. And we're like, you know what? Helping people live longer is actually a physician's job. It's actually our job. So swear. Insert swear word there. So Phil Sorell gave some nice history on that. You know, how many women were on hormones before the whi? How many women have been harmed because of these labels and the WHI and the fear of hormones because they were not given the opportunity to be on them? And again, I think every, like, in any field, experts all have nuances. We all have our own history of why we came to our thoughts. We all think of things differently, which is awesome. And in the menopause expert world, if I could say menopause, they often get. We. They often get accused of wanting everybody to be on hormones. Like, first of all, none of us are making our pockets any bigger from this, from. From pharma, saying, thank you so much for the hormone kickbacks. We don't care. We just want people to know how important they are, how safe they are, how useful they are. Somebody on Instagram just said, we need a class action lawsuit going already. Who are you going to, like, who are you going to sue? You going to sue the FDA for having a box warning? Are you going to, like, you can't sue. You know what happened after the whi, A, whoever they is, a class action lawsuit sued the pharmaceutical industry for having these products exist. Well, what does that do? Put a break on pharma. So now we realize that the WHI is wrong. So, like, to me, I'm like, I. I don't know. There was a class action lawsuit against Pfizer after the whi. Like, basically saying, your drug's dangerous because the whi. And now we're like, oops, the wh. I was wrong. Drug's actually not that dangerous. Even if. Even if bioidentical estradiol went away and you were trapped on a deserted island and all you had was oral Prempro, most people would say, you know what? It's not. It has risks. Yes, but it actually doesn't have risks. More than most other major pharmaceuticals. It's not first line now, but it's still in the healthy young people, not all that bad. And they got a billion dollar lawsuit against them because of the whi so I digress. All right, who came next? Dr. Simon. And then we had Dr. Vonda Wright, who talked about bones and hip fractures and how the F. We actually have an FDA indication for estrogen for the prevention of osteoporosis, which is freaking amazing. And so that was a very powerful talk. Then I gave my talk, which I've already talked about, so I'll stop boring you. Then I had one of my. These are all my favorite people at this point. But if. If you've had the grand luxury. And she needs to be on my podcast, and she will be on my podcast, if you had the grand luxury of ever meeting Dr. Mary Jane Minkin, if you don't want, after that meeting, for her to be your grandma or your mom. Like, you haven't met Mary Jane Menken. She's a powerhouse. She's hilarious. She's fantastic. And she really talked about how after the WHI medical school stopped teaching about menopause, nobody learned how to care for menopause. Even. Even OB GYNs, which are a minuscule amount of doctors in this nation, but get blamed for all female things and that they're supposed to be taking care of all female things. But even them, who can't literally take care of 50% of the population, don't put all on OB GYNs. They're already busy and we need them to handle all the other things. But even that specialty didn't get trained at menopause. So really, the education gap, that happened because of the WHI. So I loved that talk. And then we had Dr. Rachel Rubin, which gave the mic drop moment, like, watch. Go watch this stuff, you guys. Like, each of these talks is only five minutes long. Um, and so she gave a talk about the data, you know, the data that she's published on vaginal estrogen. And then in the middle of her talk, she said, and I'm here for something personal because of your boxed warning, fda, you tried to kill my mom. So her mom is all public. It's on her talk. Her mom was in the ICU knowing that a hospital acquired UTI can be deadly in immunocompromised people. She advocated to get her mom on vaginal estrogen, but the ICU people didn't know how to do it. And there was a box warning, and then the pharmacy didn't want to do it, and there was a box warning and it could be dangerous. And then they finally got it, and then the nurses didn't know how to give it, and it was like, over and over. And over again. So very powerful personal story. Like I said, Dr. McCarry asked us to bring science and heart, and we all brought science and heart. It was amazing. And then to close up our group, the amazing. The amazing Howard Hotis, who's a cardiologist based in California and really talked about cardiovascular safety and tying it all together of like, women are not just our breasts, right? And you need hearts. You need hearts. So I'm a urologist. I always tell, like I always tell people when you're going into, like, getting evaluated for surgery and blah, blah, blah, is like, if you don't, if your heart's not working, doesn't matter. What your prostate's doing, doesn't matter. Most important is the heart. So he was amazing and closed it all down. And then so that was like about an hour. And then the second hour was Q and A. And it was. It was interesting because it was like Q and A kind of from us and kind of from the audience and like some questions that were brought in ahead of time that people submitted. So it was awesome. And if you've been sleeping under a rock, then you haven't seen any of the clips of us speaking at the fda, but otherwise you've seen them and I think we did a very good job. So I'm very happy about that. And now I shall move on. Okay, we are at the point in the podcast where I ask you guys to go pre order the Menopause Moment. This book is my second book and it is coming out September 16th in America, September 18th in Australia, Canada, UK. I don't know if it's more than that. So pre order it. We have officially, we have pre orders in the thousands now. So I can say over. Over a thousand people, thousands of people have. It's. It sounds. It sounds so cheeky. Thousands of people have pre ordered. Why not? Why not for you and your book club? Why not you and your book club and for your sisters. So I love this. There's a whole chapter in perimenopause, believe me. Do you know anybody who's an author knows the title's all about Amazon? Click search Terms. So it's called the Menopause Moment. Mindset. Hormones and Science for Optimal Longevity. At some point, I will have to commit the subtitle to memory. I still am, like, not quite sure about it, but mindset. Hormones and Science for Optimal Longevity. That's what it's called. There's an entire chapter in here about perimenopause. That's the thing. That's the Concern about putting menopause in the title is that people who aren't in menopause aren't going to read it. But you should know it's coming. It's like, you know, my kids have not yet hit puberty, but we read books about puberty because we don't want it to be a surprise. So I suggest the same for everybody on this planet. Because if you aren't going to live longer than your ovaries, number one bummer, because that means you're dead. But if you are going to live longer than your ovaries, then this book's for you. Or if you want to work with people who are living longer than her ovaries, sleep with people who are living longer than their ovaries, or be brothers or fathers or other people around people who are going to live longer than your ovaries know what the hell is going on. There's a whole chapter in here about work. There's a whole chapter in here about how to talk to men. There's a whole chapter in here about how to talk to your doctor. I will pause while you go on Amazon or Barnes and Noble. If you want to pre order from an independent bookstore, go to my website kellycaspersonmd.com on the book page. And there are multiple independent bookstores that you can click on because you know I love you and you know I hear what you think about that. There is a chapter in here about breast cancer. So I think I covered a lot. This book is longer than my. My first book was a little over 200 pages and this one, the hardcover, 313. But you can do it. It's not that hard. We made it nice and easy for you guys. If you like me and my voice and my podcast, I also recorded the audiobook. So you can also pre order the audiobook available on Amazon, etc. Etc. So yes, now the pre orders have officially been in the thousands and that's pretty awesome. So get on the, get on the train so we can have some fun in September and have some good things. Here's the offer there. You know people love their pre order bonuses, right? I get it. It's hard to spend money. So this book's like 21, you guys. This is like literally cheaper than a lunch meal at this point. But pre order offers include. So if you go on the website, on my website and you put in your, your email and your receipt number, then you get access to two live Q&As with me which are end of August and the beginning of September. And then the. Your other pre order treat is all of my summer schools that I've done this year are yours. They will be bundled and I think available free for you, like September 1st. So I've done three already. Let's see if I can remember them. We did a sex one. We did a. What was it? Was it perimenopause? I feel like I did sex perimenopause. Somebody on Instagram right now is going to correct me, what are my summer schools so far? And the last one I did so I was sex. I have sex like a woman. I think perimenopause. The one I just did was testosterone, which my Zoom free webinar zooms are the 500 person one. And we sold, we saw. Can you sell out of a free live Zoom?
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If.
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So that's what I did. Which was super fun because the chat was like on fire and a lot of people didn't get in to that one. And then the next one is going to be am I too old for hormones? And we're going to talk about all of that. So are you, are you too old for vaginal estrogen? Are you too old for progesterone? Are you too old for testosterone? Are you too old for oral estrogen? Are you too old for estradiol patches? What does risk benefit mean? What does the data show? Have we. Have we given old people hormones to see how they do a little bit? Let's review that data. Right, so at the end of the day, I think that one's probably also going to sell out. So we're going to have four courses. They're all available free live. This is my summer school. If you don't follow me on Instagram. Somebody just asked, is 78 too old to start bioidentical hormone replacement therapy? Hey, go check out my summer school course on that. And if you pre order the book, you'll get it for free if you can't attend live. All right, So I think 200 people have already signed up for that free class called Am I too Old for Hormones? And again, the Zoom Live, it's free for people who show up. Live only holds 500 people. Yeah, the testosterone is testosterone one is done, it's recorded, it'll be available for purchase on the website. And if you pre order the book, the pre order people. So basically the book comes out September 16th, if you haven't pre ordered it. But you can't buy the book after September 16th and get the course for free. So you can pre order the book. And then fill out the form on the website and you can get free access to all of them. Yes, free access to all. All the previous ones. Now I'm just repeating myself on the podcast. Cause I have a live Instagram thread going. But free access to the perimenopause, sex like a woman, testosterone. And then the fourth one is am I old for hormones? So all good things, all good things. By the way, I have a clinic in Washington state if you want a very concierge practice where you get to text message me and my team whatever you want and ask your questions because it's sweet. All right, so book tour. Book tour dates. The best way for you to know. Like I get. I get message all the time. Like when are you going to Blah, blah, blah, blah, blah. The best way for you to know the up to date. Because all this will change. Like I talked on a podcast in July that I was going to be in Austin and now I'm not going to be in Austin. Sorry. So the best way to stay up to date and get links is my email list, kellycaspersonmd.com get on the website, sign up for the news and to follow blah, blah, blah. So that is the best way to get up to date on everything happening. The first event's going to be in Chicago. It's going to be the weekend. No, that's not even true. See, I'm not even the most up to date. La. Thank you.
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La.
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I think the very first public book event is going to be in LA at Dr. Susan Gilbert Lentz's clinic. That's going to be a small event with like 35 or 40 people only. We don't have tickets for that yet. Then I'm going to do some podcasts in la and then there's a couple other events we might be doing in la. At least one other event, but it's not locked in. And so the next locked in is going to be. Somebody's going to be listening to me and be like, what the hell is she talking about? Believe me, the best way to know, get up to date on all this is like be on my email list. Go get on it. I'm going to Palo Alto September 18th and 19th. We're doing two events there. One event is going to be with at Town and Country at Books Inc. So that's exciting. And then another event with MIDI as our sponsor. Again, I don't have locations or tickets on that one yet. I do believe the tickets for the book Inc. In at Town Country are available. That's probably again, people who are on my email know. So that's la, that's San Francisco. Then I go to Chicago the weekend of September 29th, 28th is the event. Those tickets are almost available. That should be a pretty fun event. I've got. I've got somebody flying in, so that's gonna be super fun. And then I go to New York City and I do some more podcasts. I'm doing an event in New Jersey, one of those nights in the beginning of the week of like October 1st. I don't think tickets are up yet. And then we have. I have two swell events that the tickets are available, but I don't exactly know what I'm going to talk about. And then the luminescence event in Times Square, which is going to be amazing. And that's on October 4th. The tickets are available. And then I fly to Denver. I have an event in Denver. It's the Thrive event, which is awesome. Tickets are available. So again, I'm a broken record. So that's Denver and then, sorry, yeah, Denver, October 5th. And then October 26th is a village Books event. That's right on the tail of the Menopause Society conference. So I'll see you there. I don't currently have any book events in Orlando. And then October 26th, Village Books in Bellingham, Washington. And then October 20th with Cary Gran sponsoring October 29th in Seattle. So if I'm still married and have children who know who I am after all that. Oh, last but not least, November Oct. Orlando with Dr. Vonda Wright's conference. I know she's already sold a couple of hundred tickets and tickets are available for November on that. So like, literally me just telling you my book tour makes my voice hoarse. Oh, my God. All right, so the too long didn't read is like, just get on my email list if you want to see me in Chicago, New York, Louisiana, Palo Alto or Orlando or Denver. Those are all of my. That's my book tour. Oh, Bellingham and Seattle. That's my book tour. That's absolutely nuts. All right, a couple more things I wanted to talk about before the end of this podcast because I've been waiting to talk about these things is the Economist. I've been getting a paper subscription to The Economist since 2006. I love it. I love waiting for the mail and getting the Economist. I love reading my international news without advertisements and people yelling, AKA television. So the science in the Science and Technology section in the July Health issue of the Economist is all about when hormones hijack the mind and talking about psychology. And it says many cases of mental illness resist treatment. Could hormones be the key to understanding them? Yes, highly likely. Depression and anxiety skyrocket in perimenopause. All right, so it says mental illness, resistance to treatment affects millions of people worldwide. Around a third of those seen by doctors for major depression, for example, are in this category. From a biological point of view, the connection between hormones and the brain has been hiding in plain sight. And they talk about testosterone being produced by both men and women, which is very, very nice. So proteins sensitive to estrogen are found scattered across many important regions of the brain. And studies have shown that hormones that this hormone can enhance memory formation, recall, decision making, and problem solving. Progesterone and testosterone, meanwhile, exercise a calming effect via interactions with the brain region called the GABA receptor complex. I just love the economists that they're talking about this. This is good. So, like, you know, it's just sweet. So my husband also, like, we both read the Economist and then talk about it, and it's adorable. And so he's reading this, and he's like, hey, this is the stuff you talk about all the time. And I'm like, yeah, this is my entire career right now. So it's super fun to see it reach the Economist. I don't know. I'm always giddy when the Economist wants to talk about, like, sex and hormones. So it's really good. The Endocrine society says about 35% of men over the age of 45 have hypogonadism. Yes. That's why I think. And testosterone experts think we should screen men because unlike menopause, when. If you're 58 and you haven't had periods in years, I know what your hormones are. Your hormones are low physiologically. Your ovaries have stopped doing their jobs. So. But in a man you don't know, right. He doesn't have a period. And so it's like, if we know that in men, low testosterone is associated with not only osteoporosis, but depression, earlier death, and dementia. I think also Parkinson's and diabetes. So if we know low testosterone is correlated with all of those things, why are we not screening them? We check every.
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We check everybody's blood pressure because some people have high blood pressure, right? Like, we do some lab work, we get, like, metabolic panels and blood counts. Like, some people have anemia. So we check blood counts on tons of people. I would guess there's more low testosterone than anemia, statistically speaking. Somebody just asked a really good Question on Instagram and I have to grab it because it's so good. J Oliday612 asks, do you see HRT shifting some to preventative versus waiting for women to be symptomatic? Yes, absolutely. I absolutely see that. Stop holding your breath. For some national society to say it should be preventative medicine. So it's kind of this like tail dog wagging the tail, tail wagging the dog circular argument, right? Like we say we can't use it for preventative medicine because nobody says to use it for preventative medicine. But then nobody's actually going to say to use it for preventative medicine because the bar like listen, we don't tell the nation to take anything for prevention. We don't tell them to take baby aspirin, we don't tell them to take a statin. We don't tell them to take like there's no medication that on a societal level we tell people to take for prevention. So it's a very high bar, you know, like the like high bars in like frickin track. Like the pole vaulting. It's like a pole vaulting level bar because we don't tell the nation or a society to be on hormones. So what this means is you have to have a clinician who understands the preventative health benefits of hormones. It's like it's so incredibly complex and like this is why I wrote a 300 page book about it. Like one of the chapters in my book is can we use Hormones for Prevention? I think now I gotta check the chapter title because I'm pretty sure that's what it's called. But that's where I lead to in the book of like if I tell you hormones are good for X, Y and Z, then why aren't we using them for prevention? All right, what's it called? Chapter 23, Can Hormones Be Preventative Medicine? Page 299. Pre order your book now. Thousands have. All right, 290. I'm just going to read my chapter of your book. My book to answer your question. Oh, it starts with the Benjamin Franklin quote, which is really nice. An ounce of prevention is worth a pound of cure. I don't think the insurance companies think that. I'm also not convinced the current medical system thinks that. 1990. I'm going to read you the first chapter because I can't help myself. 1890s pre the women's Health Initiative scare doctors and especially the cardiologists knew how beneficial estrogen was in regard to reduction of both morbidity Disease and mortality. Death, usually as a result of the large decrease in cardiovascular disease. Hormones were some of the most widely prescribed medications in the 1980s and 90s. Around that time, people were starting to take an interest in the prevention of diseases, specifically cardiovascular disease, cognitive decline and osteoporosis. Then the scare based skewed results of the WHI broke and the curtain dropped for two decades. Okay, pre order Amazon, Barnes and Noble if you want. Somebody just asked again. And if you want to do it from a mom and pop, a local home bookstore, I have a couple listed on my website. Kelly Casperson, md go to the book dropdown menu for menopause moment. I also have pre order links in there for the uk, Canada and Australia. So come on, come on. So going back to prevention, United States Preventative Services Task Force said no to prevention and hormones. But their biggest piece of Data was the WHI, which started people on hormones 10 years after menopause on average, using oral medications that are not bioidentical. So they're synthetic and have a different risk benefit profile. And they said because of the risks of those medications, it's not worth the benefit of prevention. Well, that's very fair, except for the fact that the medications we use now aren't usually an oral synthetic progestin and conjugated equine estrogen. So to answer your question, like, literally, it's already taken me four minutes because I had to segue into reading my book. But if I just say yes, like, if I just say yes, I think people should be on hormones for prevention. Like, I'm just not willing to stick my neck out with that. Because you have to explain that statement. And you have to explain. And then you have to explain the fact that no, we don't have a randomized control trial looking at dementia prevention starting women on bioidenticals at age 50. And if we were to do that, it will take 20 years and cost a billion dollars. So it ain't gonna happen. We have to use the data we have now. The data we have now says in order to prevent disease, you must start these things before the disease has started, AKA in your feet. So the short answer is yes, I think it is moving, and I think it is moving the most with vaginal estrogen. Because if you get, here's just simple math. If you get a, if you have recurrent UTIs, we put you on vaginal estrogen. We don't stop it once, you don't get a UTI, we keep you on it to prevent future UTIs. Right. And remember, estradiol is FDA approved for the prevention of osteoporosis. So it's completely legitimate to ask your doctor to take it for prevention because it is FDA approved for the prevention of osteoporosis. So, yeah, here. Okay, so this is a really good question, too. Do animals suffer with lack of hormones? Sorry if this is a dumb question. It is not a dumb question. It's actually a very smart question. And I talk about it in my book. God. God. It's like. It's like, I've covered all these topics, you guys, so pre order the book now, seriously, if you want.
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I feel like.
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Do you guys remember. Do you guys remember being kids and watching, like, the TELLA marathon things on, like, your public broadcasting system? And, like, I remember people, like, dressed up as Ernie and Bert and Big Bird, and, like, they literally were on there asking you to call them and take money. You remember that? Do they still do that? I don't know. I have to see. See what the people on Instagram are saying. Do you remember those? It was, like, fundraisers for our local public broadcasting system thing. Anyways, so here we go. Order this. So I talk about that in the whole, like, myth of natural. But here's. How do I want to answer this besides, like, go read the book. September 16th. Yeah, the Jerry Lewis telethon. Totally. So if you.
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In this.
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So I wanted to name this book Aging in Captivity. And my publishers didn't want me to name it that because they said it kind of sounds like people are in prison. And I'm like, well, we kind of are in prison in the sense that. Not. It's a metaphor in the sense that we are aging. Not in nature anymore. And so the whole point is, like, people are like, oh, four whales and male. And four whales and fe. And female humans are the only people that go through menopause. It's like, first of all, most mammals don't menstruate. They resorb their uterine lining, so they don't even have periods to stop, which is what menopause is called, so to say, the other. They don't. And we do. When we're special, it's like, well, we. We don't resorb our uterine lining. It'd be sweet if we did. There'd be a lot less tampons and pads and messes. So most mammals don't menstruate. Right, but most mammals, and not only mammals, Fruit flies, freaking things that aren't even mammals. So it's a. It's Preserved along evolutionary chains that if you take them and you put them in captivity, what I mean by that is good food source, clean water, no disease, no predators. They live longer than their reproductive potential. It's well tested. There is a. I always like to say this. There is a harbor seal in the Portland Aquarium who is now 49 years old. This harbor seal makes it into my book. In nature, harbor seals live approximately eight. This harbor seal in the Portland Aquarium is 49 years old. That's aging in captivity. So when protected from natural causes of death, not only mammals, but other animals live longer than their reproductive potential. So they'll stop having babies, then they'll die later on. And they believe that that is reproducing especially for the female is so economically expensive. Like, it's expensive. It's a lot of energy, it's a lot of work. It's a big stress on the body. It's economically expensive to reproduce. So they want. They like God, right? But it's beneficial for an animal to live longer to make sure that they get all the way through all of their reproductive that they can. Right? So to answer what was the initial question, do animals have low hormones? Yes. Animals kept in captivity will live longer than reproductive potential. Look at the female harbor seal in the Portland Aquarium right now, who's fricking 47. Do dogs need HRT? Yes, they do. So they're actually looking at that both for all gender dogs. They're looking at replacing testosterone in the male dogs. And they're. I don't know how much they do that, but in the female dogs, after they get spayed, they will give them back oral estrogen to help with their bladder leakage. And I actually had a dog, but our first dog we got married was named Pica. Not from the eating, not from. For any medical people, it's not from the eating of the dirt. That's like a medical condition where you eat dirt. It's called Pica. But in Colorado, there are these high mountainous mammals that look a lot. They're like in the rabbit family, they're called the pika. And they have these little ears and they make super cute chirping sounds when you're like hiking the 14ers in Colorado. And anyways, Pica was our first dog and we had her on oral estrogen and she didn't piddle in the house. So my current puppy, who's 11 months and has been fixed, piddles when she gets super excited about seeing people. And so I'm always like, ah, needs to go on estrogen. What's the disease to go on estrogen. So I haven't put her on estrogen yet, probably because I'm a bad puppy owner. But yes, it's current standard that when female dogs get their ovaries removed, oral estrogen is given to them so they don't have bladder leakage. It fixes their bladder leakage. Shockingly, the same thing is with females humans. All right you guys, so that was the science and technology section of the Economist that went on a super big tangent. And this is why ADH traits make for really good podcasters. All right, here we go. Women, this is. This is page two, science and technology page 68. Women in the run up group to menopause, a period known as perimenopause, are another group that may be missing out. Menopause experienced serious mental health problems. They looked at a UK biobank of 130,000 women who'd gone through menopause and had no history of psychiatric disorders. During perimenopause, the risk of major depression and bipolar disorder increased by 30% and 112% respectively, compared with the risk of developing the illnesses during their younger reproductive years. So mental health and hormones are a thing. First line treatment in midlife hormones. Well documented. Not all doctors know that. Go get advocated. Go get advocated people. I love you. Check out the menopause moment. Get on the email list. Thank you for following and sharing this podcast. The podcast and Instagram are exploding right now. I can't imagine what's going to happen after the book tour. I love you guys so much and until next time, you are NOT Broken. I love you. Hey friends, if you love the you
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are Not Broken podcast, please show me your support by liking, subscribing and sharing it with someone you care about. 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
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you and a friend.
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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 you 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.