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Foreign. 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. Thumbs up. Thumbs up. All right, very good. Let me open the chat box. Where's everybody coming in from today? Give me a shout out because I love. I love saying where everybody's coming from. Boston, Florida. Kansas. Toronto, Orlando. Boston. San Antonio, Kansas. Detroit, Wisconsin. Utah. South Dakota. Michigan. Harker Heights, Texas. Michigan. Arizona. Williamsport, Pennsylvania. Ontario, South Dakota. Yes. Germany. Texas. Maryland. California. Vancouver. Long Beach, California. Bozo. Montana. Love it. Oregon. Kansas City Chiefs. Northern New York. Puerto Rico. Steamboat. Steamboat Springs, Connecticut. Wisconsin. Georgia. Moore, Ontario. Asheville, North Carolina. Yes. Northern California. Walnut Creek, California. Arlington, Virginia. Florida. South Florida. I love all of it. Bellingham, Washington. Oh, my. Oh, geez. North Dakota, New Hampshire. Excellent. Welcome. So glad you're here. This is our second the menopause moment mindset, Hormones and science for optimal longevity. Author Q A. And you guys are all here because you pre ordered like the badass author readers that you are. Let me know. What did you. What do you like? Do you like hardcover? Do you like audio? Do you like Kindle? What do you. How do you guys like to read? I'm a hardcover for sure. Hardcover. My. My audio is reserved for podcasts, so. Audio, Audio, Hardcover, Hardcover. Audio and hardcover. Yeah, some people are doing both. Kindle. Soft cover. Soft cover is not out yet. Hardcover and audio. Yeah, I need to be able to underline. I agree. Audio. Audible for me. Both audio. All of them. Paper. Paper. I love that, dude. So I am the same. Yeah, I use highlighters. Like, I have to have highlighters. And when I read academic papers, I have to print them out. And so I highlight in my books. And my daughters, we go to the library a lot and they're like, you're writing in your book. You're like, when I bought the book, I get to write in the book. So that's how I tell them that they can't do that, but I can. All right. Yeah. Gotta hear nc. A lot of people do audio and read at the same time. I was reading something about this. It's like it's two different parts of the brain. And so like, especially for like learning or like things where you're going to be tested on it. It's like a superpower. It's hitting the brain from like multiple angles and apparently works very well. So I didn't know that, but now I know there's another person. Audio and hard copy. I know for people who missed the first one, I'm going to put these up on the podcast so you'll be able to listen to them at your convenience at a future date or right now if you're listening to this on the podcast in the future. But books coming out September 16th, so by the time this is on the podcast, it's already out. Go get yours now so we know what we're talking about. Um, yeah, other people are learning about listening and reading at the same time. So, like the first one, this is all about the book. The menopause moment mindset. Hormones and science for optimal longevity. And then I want to do Q and A. So type them in the Q and A. This is not individual medical advice, so don't ask something that would be like. It's got to be applicable to, like, more than one person so that other people can think. This is actually interesting. Where do we access the podcast? You are not broken podcast? I actually, like, should do a tutorial on Instagram because, like, the amount of people listen, listen. I was told this week that women listen to more podcasts than men do, so get on it. But I think women are too busy listening to their audiobooks. But apparently women listen to podcasts more than men. I don't know that. Why is Joe Rogan the number one podcaster then? That doesn't math. Not that he can't have female listeners, but get on it and support your female physicians on the you are not broken podcast. So you go to. I feel super silly telling you how to access a podcast now, because for people who are going to listen to this recording, it's going to be on the podcast. So it's very meta. Google how to listen to a podcast. Apple Podcast. If you've got an iPhone. Padcast app is on there. Amazon, Spotify. Go on Spotify. Search. You are not broken. The podcast comes up. Okay, so. And no pressure for the. For the. The true fans. They start at the beginning of my podcast and they go forward. And by. By then, you know, a ton. You know, a ton. A ton. And it's not out yet, but hopefully by the end of 2025, we're. I'm going to hook up with a company that's going to give continuing medical education. So for at least the physicians, you will now get CME for listening to the podcast. How incredibly cool is that? Oh, somebody said Antenna Pod is a good platform for podcasts. I haven't even heard of that one. I love that. So, yeah, you can listen. Literally get. I'm in the 3002 now on the podcast. So I've had the podcast longer than I've had Instagram. So I've got goals. I've got goals, people. I've got gold. I need. I need you guys to share the podcast. I've got goals. I send the episode to my people all the time. Thank you. Okay, so one of the things, I was reading my subtitle today because I don't know if I'll ever fully memorize the subtitle of the book, because I'm sorry, but it just sounds. It's like, so generic. Mindset, hormones, and science for optimal longevity. I was. I've been thinking about mindset a lot this past week, and so I thought I would start this hour in talking about mindset and mindset. I don't know what mindset means to the average person, but what I take it to mean is your thoughts matter. And if you've never been told that your thoughts matter, get ready to have your mind blown. So the way you think and view the world shapes the world that you are in. That's the way the brain works and the computer works and the filter of the information works. And if you think that you can't or it's too hard or you're too old, that is true. And if you don't think that, that is also true. And people think of their thoughts, people who are untrained in mind work, people think of their thoughts as a fixed state. They just are. They are fact. Oh, somebody just said, as a mental performance coach, I call it mind shifts versus mindset. Oh, I like that. Because the mindset seems. Seems like static and concrete. But mind shift gives you the possibility that it can be changed. I like that a lot. So, you know, when people come see me in clinic, usually the first. So hormones are the building blocks. They are the bricks of the house. I was using this metaphor this week, and I'm working on it because I think I like it. So hormones are the bricks of the house. It's hard to have a house without walls and a floor, right? Bricks are nice and solid. So hormones are the bricks. But you can't just say, I have a bunch of bricks and therefore I have a house, right? Like, you need a family and dishes and wall hangings and some nice rugs. Maybe there's a puppy involved. Like, that's what makes the house a home. And so a lot of people come and they, like, think their hormones are going to give them muscles or make their sex life better or, like, do these things that they can't do. They're just bricks. And the people, I think that they, this is what I joke. I'm like, there's the people who start on hormones and like in two weeks the light switch goes off and like the sex life is better and the like the brain's fresh and like everything's going great. And then there's everybody else who hates those people because like it doesn't work that way for everybody. And hormones are amazing, but you can't just have them and have everything work well. And like complaining about the way things are is such an insane waste of time for like how, how much we're on the planet and how much complaining actually does anything. And so mindset's everything. And I've just, I've seen it so much in clinic because like women come, they get on hormones, they're starting to sleep better, like they're getting better, but then they get stuck where their mind work has taken them. Which for a lot of people, if they've never done mind work or never done coaching, they have no experience of like thoughts, your thoughts are completely optional and you get to change them and you get to question them and you get to play, you get to walk around them, you get to play with like what's the opposite thought? Is that thought absolutely true? What would be true if that thought wasn't true? Right. It's like these gymnastics sounds like too much work, but just this like artistic movement around thoughts in how it can really change your life. And I see women stuck like they're stuck in relationships or they're stuck in anxiety or they're stuck not eating more protein because of their thoughts. And that's how we fall victim to, you know, the proprietary supplement brand companies and the latest workout fad. And the next, you know, the tenth book on this is like you get stuck to realize like so much of what you can control is within how you think. Yeah. Somebody said our attachment to those thoughts can keep us stuck. That's the question. How do you get somebody to see that your thoughts aren't real? They might be there a lot because you've practiced them. They're like a well worn path. And there might be other thoughts that aren't as easy for you to think because you haven't practiced them. But like all hearts beat, muscles contracts, brains think. But you give way too much power and attention and authority to these non existent things that are on repeat in your brain. All right. I love it. Yeah, I think and I think, you know, getting the hormones down and getting the sleep down, it helps the body heal enough where you can then do this work. But I often and, and I think it has to come in that order, at least in my experience. I mean I'm a clinician, I prescribe hormones so it's, it's easy for me. But it's like hormones aren't everything. But if the body is inflamed and more prone to anxiety, you can't thought work your way out of that. But there comes a point where now you got to work on the mindset to eat the protein, to lift the weights, to get rid of the toxic relationship. It's really the next, the next phase. And so my mindset, you know, in writing the, the menopause moment, I have a book on basically or I have a chapter on basically where I decided like I needed to pivot in my career and like stop being in this totally wear me down toxic health care insurance based health care that I was in where I'm like dude, I've got nothing left to give like and it's making me be who I don't want to be. But once I saw that it was up to me to make that change because nobody else was going to come to save me. This show is sponsored by MIDI Health. When we experience perimenopause, menopause and midlife issues, we feel unheard, dismissed and unserved by the traditional healthcare industry. And here's the powerful truth. It's time for a change. It's time for miti. MITI is not just a healthcare provider. It's a woman's telehealth clinic founded and supported by world class leaders in women's health. MITI is leading the way by providing expert personalized insurance covered virtual healthcare for women in midlife, empowering us to thrive and experience our second act with vitality and confidence. Ready to feel your best and write your second act script? Visit joinmidi.com today to book your personalized insurance covered virtual Visit. That's join MIDI.com MIDI the Care Women deserve. Now back to the show. So that's the thing is like you can get your gurus, you can read your books, you can get your hormones, you can get your, you know, best physicians, best therapists. But nobody is going to do this for you. And furthermore, it wouldn't be the same work if somebody did it for you versus you did it for yourself. So I just want to start dropping and I don't in all fairness talk a lot about mindset on my podcast, which is ironic because I literally Wouldn't be where I am in my career and with my platform and with my influence had I not had coaching and not understood thought work and. And not really worked on a lot of thoughts that were holding me back. But I was, you know, and I understand not everybody thinks like me, but once I understood your thoughts create your actions, your actions create your results. Like, once I understood that it's immense power. And I don't think everybody wants that power. Right? Like, oh, my God, like, my life might blow up if I actually leave the husband or tell the brother that I need boundaries, whatever it might be. Like, yes, your life might be different because it will be different, because you're acting different. It is literally your superpower. A hundred percent. Yes. And somebody just said, and I love this, it's important to think about how those thoughts might have been or at present are serving us. Right. I think so much. I mean, our brain is designed to keep us safe, right? And so, like, continually trying to solve an unsolvable problem set feeling feels very important to do, but you realize, like, it's actually keeping you stuck in something. But I like that, like you said, it helps us look a bit more kindly and make it a bit easier to shift. But I. I mean, I truly think a lot of people don't want to know that they have as much power as they do. I think that's part of it of, like, what would you do if you realized you had unlimited power over what you wanted to do with your life? People don't want to believe that. But yeah, I think a way to know when people are like, how do you start? How do you start? You start with just awareness. Just, I'm having a thought. The thought is saying this. I have this thought a lot, right? When I have this thought, this is how I feel. So that's the awareness of, like, just start noticing what the dominant thoughts in your life are, and if you feel like you're in control or not in control over those. The unknown is too scary for folks. Yep. Changed my whole Life career at 45 and never been more on purpose. Totally. A really great book. It's a couple years old now. Is Martha Beck's way of integrity really talking? Which is less thought work, but more just like, do you know what you truly want? Are you living the life you should be living? And it's silent, but it's present. And I don't think everybody knows, but some people do know and they're still choosing to not live in integrity with what they know their body wants. Oh, My gosh, we've got a market. Martha Beck, trained coach on here. Yes, yes, yes. I love it. Somebody said, I found my purpose and have never been happier. Agreed. I mean, to me, people are like, how do you do it all, Kelly? And I'm like, I don't. I mean, I know I work a lot. Like, I. I'm a surgeon at training. I. I know how to hustle. Probably more than 98% of people, probably less than the military people, they've got me beat. And Wildland Firefighters, they have me beat. But I know how to hustle. But I am living my purpose. I know what I'm doing. I know who I'm serving. I know. Know what the problem is. I know who I'm helping. Right? And it's like, I am so in alignment that it's. This is just, like, joy and fun to do it. Right. It's not like, it's not like a job bonus that it helps pay some bills. But, yeah, somebody else said yoga and meditation helps the thought process also. Yeah, I think so. But. So that was like. That's the long. The long intro to the subtitle of the book, which is Mindset, hormones and science for optimal Longevity. Because it ain't just hormones, people. It ain't just bicep curls. Yeah. Do what you love and you'll never work another day in your life. Is that Confucius? Did Confucius say that? Yeah. Somebody said the energized feeling from doing work that you love in the way that you love doing it is qualitatively different than that buzzy energy from overworking. Overextending. Yes. Like, when I'm not getting something done, like, then I'll check in and I'll be like, is it. Do I like doing that thing? Is it an alignment? Right. For. Whereas, like, I can just, like, decide a new project and pound it out in a half a day when it wasn't even on the to do list. It's like, because it was easy and it was in flow, Somebody said, you had me at you were not broken. Like, wow, this isn't all there is. And can do something to feel like the old me. I love that. Yeah. You guys, dude, that's funny. Like, I'm gonna. I'm gonna expand on that comment. So my first book for people who don't know is called you are not broken. Stop shoulding all over your sex life and the amount of people who want to argue for their brokenness. No, but I am broken, and let me tell you why. Let Me tell you why I am broken. It's like, why are you doing that? Why do you want to identify as that? Why do you want to fight for it? Let alone like the whole spiritual thing of like, all of us are here for a reason and none of us need to fight for our worthiness or fight for our good enoughness. We're all inherently valuable and all inherently, like, worthy and chosen. And so for people to come up to me and they'll be like, no, but I am broken. Like, why are you fighting for that? And they don't see that they're fighting for their identity of brokenness or they can't see that that's just a thought that you could also decide is not true. Yeah, I mean, it was, you know, somebody brought up. When you have chronic problems, the doctors tell you you are broken. That's their thoughts. That's the, that's the amazing thing about thought work, my friends, is once you identify thoughts, you see other people have thoughts, and then they get to keep their thoughts. And you can choose to agree with their thoughts, but you can also choose to not agree with their thoughts, but you no longer give them more power that their thought is better than you. And I think, I think this is a book waiting to be written. I don't think I'm the right one to do it. But the medical world of giving people labels, giving people diagnoses, useful for two things. Number one, to like categorize, like, hey, people who have this tend to get better when we do this. Right? Like, useful for learning, categorizing. But I get that. And then the other thing it's useful for is billing. Right? Medicine for the business of medicine. If you have this, this is a worse condition, this gets paid more, this gets paid $43. This one gets paid $800. Right. So you need a diagnosis and a label and there's the business of medicine there. But I don't think enough people are looking at what happens when you tell a 21 year old that they have anxiety, but you don't explain to them that anxiety might be there for other reasons. And at some point they could not have anxiety. They just add these labels to these, this like heavy backpack and then they carry it around with them for the rest of their life instead of, you know, interstitial cystitis is a, it's a chronic, chronic, incurable inflammatory, likely autoimmune condition of the bladder. But there are many other things that cause pain of the bladder. And interstitial cystitis is a diagnosis of Exclusion meaning I've shown it's not an infection. I've shown it's not pelvic floor muscle pain, I've shown it's not low estrogen. All these things, right? So doctors will just throw this IC label on people and then they come see me as a urologist. One one, like, funny. Not funny is a woman will be like, oh, Yeah, I have IC, but I haven't had pain in 30 years. And I'm like, is it quite possible you don't have IC and you've just been carrying this label around with you? And so I tell women, I'm like, listen, the label of IC is a chronic incurable disease. Would you like to keep that label? Or would you like me or would you like just to call this a sensitive bladder? And we find out what the sensitivities are and we work to make things not not sensitive, right? And like nine times out of 10 people, if they given the choice, they. They will choose not to carry around the label of ic, especially if they don't need to identify it or don't identify with it, right? But it's like, why put a label on somebody? And furthermore, why carry that label around? And they're talking about like, I'm a person who has diabetes instead of I'm a diabetic. Because there's a possibility that at some point you can do things where you're then not a diabetic, but if you own the label, if you own the brokenness, it can be a lot harder to get rid of that. So I think there's a real damage to labels and, and people don't think about what they do when they put that label in a backpack and decide they're going to carry it with them permanently. Yeah, somebody said it's also trauma not processed and why people stay broken. Oh, yeah, tons of un. Dude, tons of unprocessed trauma in the medical system for sure. I mean, I think, you know, with doctors having to see people in like 10 minute visits, it's like, how can you connect with somebody in 10 minutes? How can you be empathetic with somebody in 10 minutes? Like, I don't even know that it happens. Is amazing. Oh, somebody said they just downloaded you are not broken. He couldn't put it down, but had to get to sleep. To be continued during my lunch break today. Love it. Yeah, my first book is like 100 pages less than the second book and it's easily finished in a weekend, which is really nice. Somebody said, can be a challenge for me to Remember? Oh yeah, that's their thought opinion, it's not mine. They can keep it. Such a relief when I do remember it. Yeah, it's the best thing ever, right? Alright. September is sexual health awareness month and a key issue tied to sex worth talking about are urinary tract infections. Sex is the most common trigger for UTIs in premenopausal women and the risk only increases during menopause. As estrogen declines, your vulvovaginal tissues become thinner and more delicate. This also leads to a drop in Lactobacillus acute protective bacterium on. All these factors together lower natural defenses and increase the risk of UTIs. While vaginal estrogen is my first line therapy for menopausal women, I also recommend Jenna MD by Solve Wellness. Jenna MD defends against UTIs in a different way than vaginal estrogen does, so together they offer maximum protection. Jenna MD is also a great standalone option for premenopausal women who aren't experiencing estrogen decline. Jenna MD is a clinically backed and contains the proven 36mg of soluble PAC from Pure Cranberry juice extract. Many of my patients take it daily, but for those whose UTIs are linked to sex, there's also a sex related dosing option. To learn more about Jenna MD visit jennamd.com that's G-E-N-N a m d.com where new customers can get 20% off their first purchase and for an additional $5 off, use coupon code Dr. Kelly 5. That's D R K E L L Y 5. Providers can request patient education materials and samples by visiting jennamdhcp.com Somebody said, I think all this correct information helps understand that we aren't broken or that it's not something we need to accept as normal menopause and aging. Because doctors have been telling us that it's normal for years. We now understand we are not broken. But it took me doing a lot of research to understand that. I love this point. Okay, we see this a lot in perimenopause. So hormones are changing. You go to a doctor, you say you're tired, you say you're angrier than normal. Which is actually I think a very unsafe thing to say to most doctors. But you're not sleeping well, blah blah. And they tell you this is normal aging. You might be like 44 and they're like, oh, it's normal. It's not normal. I mean, normal being common. Right is what I mean. So like every female will outlive her Ovaries. If you're lucky, that means you didn't die yet. It's a blessing. But ovaries only live a certain length of time. So like, just like teeth. But we replace the teeth and we replace the eyes and we replace the hearing and we replace the heart valve and we replace the, all the things, the knees and the hips and the ankles and the shoulders and the hair. But with hormones, we're like, oh, it's normal. Like it's common, but it doesn't mean we can't do something about it. All right. Somebody said, I didn't feel broken. I just lack key information. And now I have it. Thank you, Dr. Casperson. Oh, I love that. HRTs changed my life. I no longer feel broken and I feel like I have superpowers now. I love it. I wonder if some women who insist they're broken don't have enough vibrant role models. They've seen moms, aunts, older sisters drop like flies and don't believe they have a chance. Interesting. I think this is also where the role of like, you don't have to know the person to have them be your role model. Or this is the role where like books come in. I'm reading a book right now called the Comfort Crisis, written by a man. Can't remember the name. Somebody remembers it, shout it out. He's. He basically starts the book by saying like, brains are designed to find and have problems. Like that's a survival skill. It's what again, brains have thoughts, brains find problems. And they did the, and he describes these, this research where people, they did a TSA thing where they actually like took all of the like hazard things away from the TSA agents and they were just scanning normal suitcases and they started finding threats in the normal suitcases because there were less like actual threats around. They did another one where they told people research subjects to like push a button when they saw a threatening face and then they took out the threatening faces and then people started pushing buttons when they were seeing non threatening faces. And so the whole point is like, brains are going to find a problem. And his whole point in the Comfort crisis is we've like eliminated hard stuff. And so like the brains still think there's a problem and sometimes then we turn that inward and we think we're the problem. And I'm not saying there isn't problems in the world. I'm just saying we don't have saber toothed tigers and freezing temperatures and like 20 mile hikes to do every day. So like the things that we think are problems. If we had bigger survival problems, wouldn't be problems. We wouldn't be worrying about how soft our belly is if. If we were back in the cave. Right. Because it just is not a big enough problem. But. But that's helpful in thinking, like, oh, that's what brains do. Brains find problems. Nice brain. Thanks for keeping me alive. Right. The amount of women who don't use their voice to advocate for themselves is like fingernails down a chalkboard for me. Ooh, Ooh, I like that one. Why. Why don't they learned helplessness? They've tried and they. They've been poo pooed. They've tried and nobody listened to them. That's very interesting, right? That's very, very interesting. Oh, thank you. Michael Easter. That's who wrote the Comfort Crisis. Michael Easter, Comfort Crisis. Yeah, absolutely. All right, let me see if there's any more comments on Mindset, and then we can do some Q and A. I love this one. Hormone replacement therapy is a revival of what we always had. We aren't replacing our biology, we're replenishing it. Yeah, Love it. Yeah. Comfort Crisis. Good book. Highly recommend. In my clinic. So in my clinic, people who see me, we are going to start doing book clubs. So the Comfort Crisis is going to be a book club. Meeting in captivity is going to be a book club. I'm very excited about it. Prevention should be the mindset. I love it. And like, here's the. Here's my final takeaway. Unless anybody has any further comments about mindset, what you tell your brain to focus on, it will focus on. It's, you know, the classic thing of, like, when you're in the market for a Toyota, all of a sudden you see all the Toyotas on the, on the highway. Right. Like, you've told your brain, like, I'm interested in Toyotas, they're like, let me show you how many Highlanders there are. Right? What color Highlander do we want? And if you start paying attention to your mindset, you will notice that. And this is how, like, how your thoughts create your world, right? Is you will notice. It really does make an absolute different. Somebody said yellow cars. Yeah, absolutely. Yeah. With skiing, don't look at the tree if you don't want to hit the tree, Right? So if you want to find positive, amazing friendships in life that put that out there and like, this is where people get into manifesting, but it's like what you want and you making it manifest, then you're more likely to see the opportunities. It's not that, like some angel's going to drop a bank account on your porch. No, but you're going to start seeing the yellow cars. You're going to start seeing the Toyotas. You're going to start seeing, oh, I can sneak in 10 minutes for a workout here. I. You're going to start seeing, oh, I can put in some more protein in my diet here. You're going to start seeing that. Like, I have to be a little bit uncomfortable because weight loss means feeling hungry sometimes. But hunger is okay, right? Like, you have to be okay with, like, seeing these things to actually change your life. So. Yeah. I love. Somebody said, I love the woo woo manifest stuff. It totally works. Oh, my God. Have you seen my life manifest? Manifesting works. We're still. It's a work in progress, but here we are. Okay, so for people who want comments, stay in the webinar chat and then Q A. I'm gonna head over there now and we're gonna do some Q A questions. Here we go. I love this. Every thought creates a vibration. Wait, where'd that one go? Every thought creates a vibration. Just like sound has frequency, your mental patterns resonate at certain energetic levels. Repeated thoughts build momentum, shaping your inner and outer reality. Yes, that somebody else said. I finally learned how much women really need to advocate for themselves, especially with their doctors. After entering the medical field myself and having to advocate for my strong feminist mother as she aged and was not able to do it for herself, I realized every doctor who does not know everything. Yes, and sometimes they are wrong. I did the research and pushed for the right thing for both of us. I love it. What else? I love you guys. Comments are so good. Okay. All right, I'm gonna head over to the Q A section. And here we go. Just started. Hrt, including tea and hair is shedding. Make sure you didn't go too, too high too fast. What does hair hate? Hair hates drastic changes. Hair hates drastic weight loss. Hair hates thyroid issues. Hair hates postpartum. Hair hates massive stress. Right. So if you went from zero to 300 on your hormones, you shocked your hair follicles. The sad thing about shocked hair follicles is they're not. They're not. Hair follicles aren't fast to forgive, so it can take a while for that to go. So go slow, start low, don't shock the hair follicles. That's. That's the big reason why I don't like. That's why I say you got to earn your testosterone pellet, because I don't want you going from 0 to 350. I want you to go to 40 first and then maybe live at 80. You shock hair follicles in a woman, you piss her off. Don't do that. Go slow with your hormones. All right, what's my ideal total testosterone level for women? Symptom based. How are you feeling? Are you having side effects? Remember, labs are not perfect and they. There's a lot in a lab that isn't said. So it's hard to say that all women should be X, Y and Z. But what I'm looking for when I put a woman on testosterone is she feels the benefit and she does not have side effects. And I'm keeping her usually below 150 because I think 150 is really where I start seeing side effects kick in. Androgenic side effects, acne, mood changes, hair loss. But one woman will be at 40. And these are again, our American nanograms per deciliter. So it's not European. Sorry, but one woman's happy at 40, one woman's happy at 60, one woman's happy at 120. They don't have side effects. Great. So I'm not trying to get you to a level, but if I see a woman in her testosterone. So remember, in America, the testosterone labs, especially at Quest, normal goes down to like 2 or 3. There isn't a woman at 2 or 3 who, like, would not benefit from a trial of testosterone. Remember what I said? I didn't say she will benefit from testosterone. I said she'll benefit from a trial of testosterone. So just because the labs are normal doesn't mean she can't have a trial of testosterone. Because our labs in America go down, their normal goes down so low. Do you treat testosterone based on symptoms or lab values? Yes, and you're welcome. I got national the not. They're international guidelines. International guidelines say check a baseline tea. We're looking for those women with high testosterone levels. I have yet to meet her, but I've had friends meet her. You know, pcos, some other conditions, other more rare conditions, you can have a high testosterone. You wouldn't give that woman more testosterone. So you get a baseline, do a trial, recheck it in six to eight weeks, check symptoms. But remember, so I don't go up right away. If they're not feeling anything at like two months, I'm not pushing it up. I'm letting. I'm letting them ride where they are. If their values have shown they're absorbing because testosterone can take a while. I. Some people recently, I'm like, is testosterone working? And they're like, well, I don't really know, but I had amazing sex last night, and my partner wrote me a thank you note the next day. And I'm like, let's take that as a win for testosterone. Remember, testosterone helps every single domain of sexual function except for pain. So it helps helps decrease distress, it helps increase desire, helps arousal, helps orgasm, Right? Another woman's like, I don't know if testosterone's really working, but I've had, like, several days of complete invincibility. And I'm like, okay, we're gonna say that testosterone was further away. So testosterone can be subtle sometimes. Like, these women aren't like, yes, definitely testosterone. This is what's happening. They're like, I don't know, but X, Y and Z, like, testosterone's not a light switch for everybody. Does HRT help vertigo? I haven't seen any studies showing treatment of vertigo, but there are studies showing women on HRT have less vertigo. So again, hormones work better for prevention than treatment. So I know vertigo sucks. And if there is a paper on treatment of vertigo with hormones, please send it to me. All I have seen is decreased incidence of vertigo in women who are on hrt. Another reason to take it. Another reason to take medicine for prevention. I'm singing that like a crazy person, but it blows my mind how many people are like, can't take hormones for prevention. And I'm like, let's clarify. There will never. To my belief. This is what I believe. There will. No, there will not be a medical society nor an FDA approval, besides the fact that estrogen is FDA approved for prevention of osteoporosis, but there will not be. The medical society is not going to come out and say, women should take this for prevention. It's too bold of a statement. It's not going to happen. So you really have to decide that you want to take it for prevention, because a society. We're not going to do that. You see how many people got burned after the whi. It's not going to happen. You see that Pfizer got sued for a billion dollars for a crappy WHI study. That turns out that that drug was actually not that bad. But, like, people aren't going to stick their necks out on a population base anymore. So it is. It is what it is. You got to advocate for yourself. All right, 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. Is there any chance of an estradiol patch that is greater than 0.1? So I don't have to use 2 at a time? I don't think they're going to come out. They should come out with another one for sure because everybody's absorption is different. But I have not heard that they're coming out with a bigger patch. They should, though. What are your thoughts on HRT for women who have a history of ERPR positive breast cancer? Even in the pool of ER positive breast cancer, there's a wide spectrum of risk of recurrence, right? Was it T2? Was it lymph node positive? Was it T1? You know, so know that even within an ER PR positive breast cancer, there's a big spectrum of recurrence risk. And also know that in ERPR positive breast cancer, about 50, if I'm getting my statistics right, about 50% will recur greater than five years out. Now, that's a bummer for multiple reasons, but what it does is you say, well, I'm feeling shitty. I'd like to go on hormones. And some of those women are going to recur late, not because they started on hormones, but because that's the nature of that disease. That disease is an asshole. So the best resource currently to answer that question is Avram Blooming and Carol Taver's book Estrogen Matters. And once you get the knowledge on the Habits trial, the Stockholm trial, you need to know about all of those, because that is the reason why they say you can't be on hormones. You need to understand that it's not strong data that's putting a moratorium on that. You also, there was something. There was something. What was it? That of all breast cancer patients In America, like 20 of them are on hormones. Like, people think these women aren't on hormones, but they are. A lot of them are. So it's very interesting of like the letter of the law, but what people are actually doing. And then you then. So you get educated, you realize your recurrence risk is not very significant, if at all. But you're still going to have this risk of late recurrence because of the nature of this beast. Then you need to find a prescriber who will prescribe it for you, who's taken the time to be as educated as you are. So it's a very It's a big, big challenge. So, yeah, but I will never answer that question with a quick yes or no, because that is not a quick yes or no question. This is very, very complex. And remember. Yes, thank you very much. The WHI data showed a 45% reduction in breast cancer occurrence in women on E only. And here's the thing, not only breast cancer occurrence, but death from breast cancer. So if so, people who take hormones and then get breast cancer die less than the people who got breast cancer who weren't on hormones. So if that's not preventative medicine of like, hey, I want to take these hormones because if I get breast cancer, I want a better chance of living. They don't know exactly why. There's probably multiple reasons why that decreased risk of death was there. Are these people just healthier in general? Are they getting a less aggressive form of breast cancer? So yeah, it's not just decreased risk of breast cancer, but it was decreased mortality from breast cancer. So both separate. They're both are separate statistics, but both very compelling. All right. Can progesterone benefit a non uterus woman? Yes, absolutely. Remember my friends, we have progesterone receptors everywhere, not just in the uterus. And it's a long story. The long story short is medroxyprogesterone acetate, which was the asshole synthetic med from the whi, which if there was any risk for the whi, it was that synthetic man made medication, right? But people extrapolated that and they said, well, let's not have people on the progesterone, which is what your body naturally makes, which was not in the whi and is incredibly safe and helps a lot of people. So it helps you with sleep a lot, helps with mood a lot. So there's no re current menopause expertise says if you've had a hysterectomy, you can still take progesterone. You don't quote, unquote, have to. Nobody has to. But you can. So there's again two different things. Very subtle. Is that yes, you can, but when people say you can't because your uterus was removed, that doesn't even make any sense. Oh, this is interesting. I've been tracking sleep with Apple Watch and made a notable discovery that I need extra testosterone on days I take my tirzepatide. Have you seen that in practice? And why would that happen? I don't know. What are you noticing on your Apple Watch? Because you're not noticing testosterone levels. So we have to explain that a little bit more to Me? No, I haven't seen that. But we do. There was a abstract that just came out at an endocrine conference on Tzepatide that people who are on PET therapy, progesterone, estrogen, testosterone, aka hormone therapy, lost 35% more weight with tirzepatide than if they were on tirzepatite alone. So very. What's the word? When they work well together. Why am I totally blanking on that word? Yes. Coexistent. I don't know what the right word is. Okay. Synergistic, integrative. Thank you. That's the word. Okay. Says, going back to my previous statement, hormones, the bricks are vital. Yes. You are also saying mindset is critically important and doing different stuff is equally important. Yes, absolutely. Menopause moment will give the ideas about what to do as well as the mindset. Yeah, I mean, here's the thing. Like lift weights, eat healthy, don't drink alcohol, sleep regularly, rinse and repeat. Rinse and repeat. But have novelty in your life with other things. For sure. 66 year old had just been diagnosed with osteopenia and so requested estrogen patch. Two doctors have refused me due to increased risk of cardiovascular disease. Please speak to this and if appropriate, direct me to relevant studies. All right, ask them. Ask them what is my increased risk. Give me a number. What is my increased risk of cardiovascular disease on an estrogen patch? And wait and see if they can show you data. They can't. They can't show you good data because there is no good data because transdermal estrad patches are incredibly safe. So challenge them. So what they're doing there is. They're extrapolating unanalyzed WHI data. So if you look at 18 year follow up WHI data and remember, oral synthetics, not transdermal patches. Apples and oranges. No increased risk of cardiovascular disease at 18 years in the treatment. Arms versus placebo and the WHI. Right. And those are with way more unsafe meds. So there isn't. The risk of cardiovascular disease is minuscule. And if they say blood clot, there's no increased risk of blood clot versus baseline on a 0.05 patch or less dose. Multiple papers on that. All right, this is a real good story about Bronx and his dad, Ryan. Real United Airlines customers. We were returning home and one of the flight attendants asked Bronx if he wanted to see the flight deck and meet Captain Andrew. 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. Allowing my son to see the flight deck will stick with us forever. That's how good leads the way. See, somebody said. Thank you for your knowledge. Any suggestions on how to find docs that will work with post, post post menopause women? And yes, I'm pissed off. Women now have greater info. Thank goodness. Love you. I would say about a third of my practice is women in their 70s and beyond who want a transdermal estrad. And remember, there's no age cutoff for progesterone, testosterone or vaginal estrogen. There's also no age cutoff for a transdermal estrad. So I think within the next five, the next five years, because I'm unwilling to wait 10, I think we're going to see a huge upsurge in treatment for perimenopause and also a huge upsurge in the treatment for greater than 10 years post menopause as people are understanding my data. So everybody who pre ordered my book gets free my five summer school courses. Everybody else, it's behind a paywall. Feel free to come and give me money for my hard work. Thank you very much but. So there's five of those classes. We've got Sex Like a Woman, which is just female sexual health, Genital urinary syndrome of menopause, perimenopause, testosterone and am I too old for hormones? I thought the testosterone was going to be the bestseller. But the amount of people who came in for the greater than 10 years post menopause was more than the testosterone one. So I break it down. It basically to encourage you to go watch the Amit Tool for hormones lecture. It's an hourong lecture. I break it down into three pieces. Why are we afraid of giving hormones to women greater than 10, 10 years post menopause? Dementia, cardiovascular disease and stroke. Right, that basically I'm building a thesis. Okay, what's the actual risk of those three things with synthetic oral whi data meds and then with transdermal estradiol meds. And if there is a risk, which my argument is there's hardly a risk, there's also a benefit, right? Building, rebuilding her bones, helping her sleep, treating her hot flashes. Right. These, these women want these medications for legitimate reasons because there's a benefit to them. And so if there is a risk, or which I argue is incredibly low, lower than any antidepressant or Statin that you're on, by the way. There's also a benefit and her body, her choice. She should be allowed to be part of that and be willing to accept the risk. Some medications cause risks. 25% of American women in midlife are on SSRIs, which have legitimate risks, including but not equal to weight gain, suicidal ideation, decreased sexual function, osteoporosis. Sorry, not. It's not, it's not so much osteoporosis as bone fracture and also incredibly hard to get off these medications. Yet 25% of women are. Are taking those medications. Right. So, like, we've lost our ever loving mind when it comes to like, statistics, facts, risk analysis and benefits. All right, Yeah, I would agree. The Heather Hirsch directory for docs who will treat that that late. The online clinics. I have to reach out to the online clinics to see if any of them want are taking on this niche because I truthfully think it's a massively untapped market. Market. Like I said, about a third of my clinic is women in their 70s. I don't need a guy for my HRT, but need one for my exams. You can't get a pap smear from a primary care doctor. Like, I like guidance. Don't get me wrong, do not hear me wrong, but we have about 28,000 in America right now. So, like, don't think you need them. Like, if you're, if you need surgery for heavy bleeding or you need a history hysteroscopy or like procedural. Yes. Babies, yes. But you do not need a guy to order a mammogram. You do not need a guy to order a pap smear. You do not need a guy for hrt. Like, stop buying into the up belief that there's only one type of doctor for women. Like, knock it off. Primary care doctors can handle these. Somebody said, I've got a few women who are over 10 years post menopause. They understand the data and are doing well with hormones. Yeah, I think that's like the, the menopause experts, they're seeing, like, these women are very much benefiting from hormones. So that's awesome because, like, once you actually read the data of like, oh, this is not. This is not all that risky. We give Coumadin to people. Oh, my God. Okay, is osphena a better option? Let's talk about that. Ospina is an oral serm. It's structurally kind of related to tamoxifen, but it works a little bit differently. Side effect is hot flashes. Why they don't Love giving it to younger postmenopausal women. It's FDA approved for genital urinary syndrome of menopause because it acts as an estrogen agonist in the pelvic tissue. So vaginal moisture. It's expensive, it's not generic. But for women who need GSM treatment and would rather take a pill, ospina is an option. But usually you have to do prior ops etc. Etc. For insurance, so it's kind of a pain in the ass. B Somebody says everchanging Hormones started hormones January 2023 My hormone therapy has been challenging to optimally dial in. Will I always be chasing balancing the hormones? Probably not. Cuz remember what post menopause is? It's just the cessation of all ovarian function. So per per menopause moving target like be patient, be kind, adjust as needed and know that you're just trying to smooth out roller coaster in reverse puberty. But menopause is the estrad should be undetectable in most people, so should be pretty easy. Unless maybe you're just with the clinician who's making you feel like it's difficult. I. I don't know. But what do I mean by that? I mean like somebody like keeps adjusting things on you all the time. All right, you shared that you support using vaginal estrogen in addition to systemic estrogen. True. Do you also think using estradiol cream on the face also can you use the same cream for vagina and face? So yes you can. I don't like the vaginal cream on my face. I think it's greasy. I think it works in the vagina involva. Well, because it doesn't absorb right, it kind of like sticks there for a while. Like I like my face cream to feel like face cream. So to me that's a compounded estriol. And remember, these are superficial low dose. They don't increase your systemic hormone levels by anything. So you can be, you can be on all of them. All right. Can a woman who is postmenopause not on hormones have incontinence and undiagnosed UTIs without knowing or realizing it? So incontinence means bladder leakage. Are you saying she has bladder leakage without knowing or realizing it? I'm not sure exactly what you're asking, but I would get that worked up by a primary care doctor for sure. All right. How do we cost effectively get access to testosterone when insurance and compounding pharmacies don't even offer a scale for women? My dad's a compounding pharmacist and he says they don't even fill it for women. Ooh, ouch. Dad. Not cool. Does your dad know we've been giving testosterone to Women since like 1942? This is not a new thing. So my compounding pharmacy is very reasonably dosed compounded Testosterone. It's like 60 bucks for three months or something. Also when you micro dose the male test them, it's really cheap because that's like $200 for a 30 day supply. So I would. My argument is once we get an FDA approved female testosterone dose, it'll probably be more expensive than the current cost effective options that I use. So. But I'm excited to get an FDA approved female dose because insurance will cover that because remember, insurance doesn't cover compounded things. So it's going to move the needle forward but I don't think it's going to be the right thing for everybody. Somebody just said Blue Cross approved my most recent testim. Hell yeah. Get loud. Get loud. I love it. Oh, somebody said I went to my primary care person. I went armed in with my education. After sharing everything with her, she said no problem. I can see you understand why you want hrt. And I put someone on your age on HRT last week. Yay. I love it. Is micronized progesterone the same as progesterone? Yes. Micronized progesterone is just the way they formulated it to make it like get it through your GI tract when you, when you, when you swallow it. Can you share how you can enjoy your book club? Yes. In order to join my book club you have to be in my clinic. So if you go to the clinic page on my website you can get on the waiting list. But I only see people in Washington state unless you want to travel, which is awesome. But that, that's the book clubs in my clinic is vitamin D supplementation related to renal stones. They. So they've done a lot of research on this. It doesn't look like it, it doesn't look like it. Is a twice weekly patch better than weekly? Many people think so. Number one, it's just smaller. Number two, it's a more of a steady state than, you know, level drop off. Level drop off. So I think I, I tend to use twice weekly patch for that reason. Curious if there's any data on coming off statins once starting mht. I haven't seen deprescribing data on that. I have seen deprescribing data antidepressants though. That's coming out of Luis Newsom's clinic. And what the. What her data shows is you're more likely to be able to get off the antidepressants once you've added testosterone to your pet regimen than just estrogen alone. So that's very fascinating data, but I have not seen any deprescribing data for statins. Now, we do know that both transdermal and oral can have positive effects on cholesterol. Not in everybody, but I haven't seen that people are deprescribing statins yet, but maybe more. I mean, between HRT and GLP1s, are we going to see less statin use? There's going to be a study on that for sure. Somebody said, I signed up for clinic info last year, but never heard anything. Shoot an email or get on the list again because we're up to date on that waiting list now. So if you didn't hear from us, not sure. Or you missed our email that we sent out to you. So get back on the list. All right, I think we have time for one more. Do I cover pcos and perimenopause menopause in your book? Yes, I have a whole chapter on perimenopause. I don't have a ton on PCOS in there, but I do have a whole chapter on perimenopause. Because you can't have menopause without the perimenopause. It's a spectrum, and they all go together. Also, the exciting thing is many people are coming out with perimenopause books now, which is very exciting. What insights do I have on initiation of hormone therapy affecting thyroid function? Yes. Can help for sure, especially estrogen. So I always tell people if they're having their thyroid monitored or medication a couple of months after starting pet therapy, get your thyroid checked with your clinician because you might need things adjusted. So very exciting. I haven't seen recent papers on that specifically, but I know it does affect it. All right. Can. Can testosterone cause sleep problems? Started three months ago and sleep is getting worse. Yeah. So testosterone is very interesting because some people's sleep gets better and some people's sleep gets worse. So make sure you're taking it in the daytime, not at night is one thing. If you tend to be somebody who gets, you know, energy from your testosterone, that would be my first thought. But, yeah, some people will say, like, nothing got me sleeping like testosterone did. And then other people say it makes me not sleep. So we need more. We need more research on that. For sure. All right. And don't ever don't forget women are allowed to have sleep disorders as well. And I wish there was better sleep study clinics in this country to refer people to, but I always consider sleep study in people. All right, guys, I love you. Thanks for checking out the book the Menopause Moment. Woohoo. Great questions. Love that we started the first half hour on Mindset because it's everything and the hour goes by really fast, doesn't it? So thanks for thanks for everything. For those of you who don't know about the podcast, find the podcast like follow, share because we're gonna manifest that podcast. That podcast's going places, let me tell you. All right, Love you guys so much. Till next time. Remember, you are not broken. Hey friends, if you love the you 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 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.