Podcast Summary: "Ethics and Informed Consent in Hormone Care"

You Are Not Broken, Episode 345 | November 16, 2025
Host: Dr. Kelly Casperson, MD
Guest: Jennifer Lanoff, NP, JD

Episode Overview

This episode dives deeply into the intersection of ethics, advocacy, and informed consent within hormone and menopause care. Dr. Kelly Casperson welcomes Jennifer Lanoff, a unique expert who blends her experience as both a public defender attorney and a women’s health nurse practitioner. They discuss the shortcomings and challenges in the current medical system, shifting ethical frameworks, misinformation around hormone therapy, and how true informed consent and patient advocacy can lead to better outcomes for women during midlife and beyond.

Key Discussion Points & Insights

Jennifer Lanoff’s Unique Journey (00:39–05:02)

• Background: Jennifer describes her path from 25 years as a public defender to training as a women's health practitioner, motivated by a drive to do direct patient care and a passion for reproductive health.
  • “If there’s Armageddon, being a lawyer is not that helpful." (03:41, Lanoff)
• Medical Pivot: Initially intending to become a midwife, she found her calling in gynecology and hormone care after realizing her preference for gyn over pregnancy care and observing a lack of hormone education among midwives.
• Superpower: The blend of legal and clinical experience gives her a unique and powerful lens for patient care, especially around issues of ethics and advocacy.

Defining and Reframing Medical Ethics (05:32–08:54)

• Classical Frameworks: The episode outlines traditional medical ethics—autonomy, justice, beneficence, non-maleficence (“do no harm”).
• Update Needed: Jennifer argues that harm must now also include the harm of doing nothing, particularly in the context of patients denied care (e.g., abortion, gender-affirming treatment, menopause care).
  • “We have to start looking at how harmful it is to not do anything.” (06:06, Lanoff)
• Ethics and Lawsuits: Discussion of how clinicians are more likely to be sued for action than inaction (with exceptions like failure to diagnose), and pondering how new legal precedents might emerge as patients denied needed care begin to push back.

Hormones, Access, and Advocacy (08:54–12:55)

• Insurance and Gatekeeping: Insurance companies’ (often contradictory) stances on progesterone and testosterone, obstacles in accessing therapy, and what happens when patients feel compelled to misrepresent their needs to get care.
• Shared Decision Making: Central to informed consent—presenting evidence, discussing risks/benefits, and making decisions collaboratively.
  • “Consent is much more than just signing a piece of paper…It’s really sitting down with our patients and going through it.” (11:22, Lanoff)
• Medical Regret: Providers’ tendency to avoid offering certain therapies due to fear of patient regret, though Jennifer contends adults—when properly informed—should be empowered to make choices.

Systemic Barriers to Informed Consent (13:45–16:35)

• Time Constraints & Burnout: The 10–15 minute visit makes true informed consent nearly impossible.
  • “It’s not the people in the system, it’s the system.” (14:19, Host)
• Misinformation and Access: Research paywalls, antiquated or inaccurate public clinic resources, and the challenge of sorting trustworthy from poor quality information.
• Doctor–Patient Dynamics: Physicians can feel threatened or burdened by empowered, well-informed patients—a reaction shaped by systemic stress.

Patient Education, Misinformation, and Empowerment (16:35–19:47)

• Information Overload: Patients often turn to unreliable online sources (Reddit, social media) for answers, emphasizing the need for clinicians to direct patients appropriately.

• Changing Oncological Standards: Noting how even leading figures in breast cancer care are beginning to challenge dogma about hormone risks.

  “The goalpost for cancer care is cure… But now they need to live and not just be kept cured.” (19:47, Host)

• Risks of Untreated Menopause: The harms of ignoring symptoms—cardiovascular disease, osteoporosis, relationship impacts, and more—are often understated compared to cancer fears.

The Importance of Relationship-Based Care (21:52–23:19)

• Doctor–Patient Relationship: Loss of relational, longitudinal care in favor of hurried, narrow interventions. Reclaiming space for deep listening and shared prioritization.
  • “I think that’s called the doctor-patient relationship, which used to be a thing.” (22:53, Host)
• Recent Shifts: The menopause ecosystem is changing, with breast oncologists and major societies acknowledging more nuanced approaches to hormones.

Persistent Myths and Misinformation (23:47–25:16)

• Hormones & Cancer: Ongoing myth that all forms of hormone therapy are categorically dangerous for breast cancer survivors, and little acknowledged nuance about safe alternatives.
• Migraines & Estrogen: Outdated restrictions persist, despite new research supporting estrogen’s safety in various populations.
  • “We should be doing this research. Patients shouldn’t have to be doing this themselves.” (24:32, Lanoff)

Social Media, Telehealth, and Privacy Challenges (29:25–33:51)

• Social Media Ethics: Blurred lines—patients messaging providers for personal advice, clinicians disagreeing publicly, undermining trust in local providers.
• Licensure Confusion: Patients (and sometimes providers) often don’t grasp telehealth’s state-by-state legal requirements or associated costs.
• Digital Privacy: Patients worried about data in apps and EHRs—especially in the context of reproductive rights and escalating legal scrutiny.
  • “Our clients’ personal information is now in an electronic system and could be seen anywhere… Be very mindful of the public nature of these records.” (45:36, Lanoff)

Doing Harm by Doing Nothing—A Paradigm Shift (33:51–39:35)

• Menopause Harm: Not treating symptomatic patients with hormone therapy is increasingly recognized as a form of harm, given the overwhelming preventative data.
  • “We have to view it differently… all these old guard clinicians who are saying ‘we don’t have the evidence’… that is harmful.” (38:44, Lanoff)
• Prevention: Hormones prevent osteoporosis, heart disease, and other conditions, though US guidelines (e.g., USPSTF) lag behind the evidence.

Navigating Guidelines, Risks, and Second Opinions (47:56–50:22)

• Guidelines vs. Individual Care: Contradictions between national guidelines and current evidence. Importance of clinicians being transparent about their knowledge gaps and open to second opinions/referrals.
• Patient Empowerment: Helping patients craft “talking points” to discuss options with all members of their care team and advocating for themselves even when met with resistance.
  • “It’s never no, there’s always something more.” (48:25, Host)

The Future: Advocacy, Policy, and the Research Gap (52:22–60:09)

• Role of Clinician-advocates: Jennifer plans to combine clinical and legal skills to support patients and colleagues navigating ethical minefields.
  • “I’m a pigeon lawyer. Whatever the pigeon brings me, I’ll do.” (52:34, Lanoff)
• Research Obstacles: Many hormone therapies are cheap, unpatentable generics; thus, large clinical trials won’t happen, and providers must work with the best available evidence.
• Prevailing Myths: The belief that unopposed estrogen categorically causes uterine cancer or that every hormone product should be feared is not supported by nuanced, individualized risks.
• Dreams for the Future: Hope for normalized, affordable, accessible testosterone for women, and sustained long-term use of hormone therapies for midlife and aging women.

Notable Quotes & Memorable Moments

• Reframing Harm in Medicine:
  “Do no harm has to be also the harm of doing nothing.” (06:11, Lanoff)

• On Patient Education & Consent:
  “Consent is much more than just signing a piece of paper… I think when it comes to really important decisions, we should be really sitting down with our patients and going through it.” (11:20, Lanoff)

• Systemic Barriers:
  “It’s not the people in the system, it’s the system.” (14:19, Host)

• Empowering Patients:
  “I never want somebody to say, ‘I’m on this because my doctor told me to.’ … I’m on it because we decided.” (51:16, Host)

• On Peer Respect and Second Opinions:
  "We all need to be a little bit respectful of each other… instead of saying 'oh my god, get off that right now,' reach out… explain this to me, what’s your data?" (49:49, Lanoff)

• The Role of Advocacy:
  “I love talking about it. I do feel like I’m in this weird, unique role … and just your ability to write like a lawyer though, has incredible power in crafting advocacy and rebuttals.” (53:03, Host)

Highlighted Timestamps

• Jennifer Lanoff’s career story: 00:39–05:02
• The new face of medical ethics: 05:32–08:54
• Informed consent & shared decision making: 10:28–12:55
• Time constraints and systemic barriers: 13:45–16:35
• Epidemic of misinformation: 17:05–19:47
• Quality of life & shifting goals after cancer: 19:47–21:52
• The essence of the doctor-patient relationship: 21:52–23:19
• Dispelling hormone therapy myths: 23:47–25:16 & 29:12–31:50
• Tech privacy & telemedicine dilemmas: 31:50–33:51
• Doing harm by not treating: 33:51–39:35
• Navigating guidelines, lawsuits, and referrals: 47:56–50:48
• Empowering patients to self-advocate: 50:48–52:22
• The future: Advocacy, research, and practical challenges: 52:22–60:09

Tone & Style

The episode is candid, passionate, and occasionally humorous, offering “truth bombs” on complex issues. Both speakers blend deep clinical knowledge, legal insights, and real-world advocacy with a conversational, even playful tone. They empower listeners with pragmatic advice for navigating menopause, hormone therapy, and the health system while remaining empathetic to patients and critical of systemic obstacles.

Final Thoughts

If you’re navigating menopause, considering hormone therapy, frustrated by doctor visits that are too short or riddled with contradictions, or worried about getting “the right information,” this episode provides clarity, validation, and a call to empowerment. Above all, you are reminded: You are not broken, and real advocacy—including your own—matters.

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