← You Are Not Broken
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- [00:01]
Podcast Announcer
Welcome to youo Are Not Broken, the podcast that challenges everything we've been taught about midlife hormones and sexuality. I'm Dr. Kelly Casperson, board certified urologist, author and a leading voice in women's sexual and hormone health. Enjoy the show.
- [00:14]
Rachel
Hello everyone. Welcome, welcome. I am Rachel. Excuse me. Your host and community manager here at Alloy Health. We are a digital health platform bringing evidence based menopause solutions direct to your door. And today I am so pleased to welcome Dr. Kelly Caspersen once again to the Alloy platform. Dr. Caspersen is a board certified urologic surgeon, CEO and founder of the Caspersen Clinic, a modern practice dedicated to hormones and sex medicine. Renowned public speaker, sex educator, author of youf Are Not Broken, and host of the top ranked podcast by the same name. Dr. Casperson is also author of the most recent holding it up for you, the Men of Hosmer.
- [00:58]
Dr. Kelly Casperson
It's so pretty. Isn't it pretty? It's pretty.
- [01:03]
Rachel
Empowering women. Dr. Caspersen blends humor, candor and science to demystify sexual health, intimacy and midlife wellness. Welcome, Dr. Caspersen. Before very quickly, we get into it, one housekeeping note. I want to invite you to drop your questions for Dr. Caspersen into the Q and A. I will facilitate those for you. About midway through our discussion. We're ending just short shy of the hour. Also, please be sure to take advantage of today's code CASPERSEN20 over on the Alloy website. Dr. Caspersen, so good to see you. Thank you for being here with us today. I had opportunity recently to hear you speak and you asked the audience, who do you want to be? What will you do today for your future self? And I love that. And I felt so inspired by it and I hoped you could share sort of the meaning behind it with more people here today. And it is the foundation really of this book. So talk to us about that.
- [02:03]
Dr. Kelly Casperson
Yeah. Well, thank you for having me and it was awesome to hang out in New York with you. It really comes from, I think the. What we're seeing right now is Gen X has really moved this conversation forward. And now we're seeing the millennials say we're paying attention, we see what the Gen X is doing and we have a question we would like to not suffer in the first place. I heard in New York on the book tour, Gen X is the last generation that's gonna suffer. Right? And that, that resonates with basically all the generations. And what's happening is the millennials are this big wave, right? Tons of millennials. They're like, we're paying attention. We're seeing people age poorly, we're seeing the frailty, we're seeing what that costs to, you know, not only your pocketbook, but your family's and your quality of life. And we're paying attention to the pissed, to the piss boomers and the empowered Gen Xers. And we don't want to suffer going up against the trad which says you're not sick enough. Come back when you're more sick. Is it really all that bad? Why don't you just deal? And what we're having to do with this hormone discussion is say, hey, hormones work best in keeping healthy cells healthy. Which is again going against the traditional medical system of come back when you are sick enough and you have a disease and we'll give you some medications for it. Right? So this is really a culture change. And going back to your question of who do you want to be when you're. I always say on that awful Tuesday when you're 73 and you or a loved one gets diagnosed with dementia, that dementia didn't happen on that Tuesday that you got the diagnosis that dementia started 20 years earlier. So what I say, when I say, who do you want to be? Is what do you need to do now to be the best 74 year old that you can be? Because once you have the disease, once you have the diagnosis, you can't prevent it anymore. Anymore. And we again, it's a really big culture change of, and it's coming from the millennials of we would like to prevent disease, not just deal with it once we have it. Once you have a hip fracture, what do you do? A lot of women come to me, they're like, well, when I have another uti, what do I do? And I'm like, why don't you work on preventing it? And they're like, I didn't know that was an option. Right. And so it's like, who do you want to be? Start living your life with that in mind. And I think it really clears things up for average 51 year old woman. She's like, I don't know, hormones, is that do I want, you know, this is big thing of do I want to take a medication? I think hormones should be called something else besides a drug. And I say, well, what do you want to be doing when you're 74? I want to be able to get off the ground. I want to be playing pickleball. I want to be traveling. I want to be writing my seventh book. Whatever the answer is, you got to be doing the work now, because thriving at 74 is not guaranteed. Getting to 74, pretty guaranteed. Thriving at 74, not guaranteed. You actually have to do things for that. And so that's kind of where the, you know, when you're 74, be super stoked that the Rachel of midlife did what she did to set you up.
- [05:08]
Rachel
I love that so much. I really, really found it so inspiring. You, you write that we're living longer than ever before and we're learning how to age well. It's like a brand new learning curve. You know, as you talk about like you hearken, the culture is changing. It is that curve, that learning curve that happens in that what would you say are the most important skills or habits that women need to learn for that next, that next third of life?
- [05:37]
Dr. Kelly Casperson
You gotta take yourself first. Most of us got where we are now by putting other things first and putting, putting the bodies on the back burner. And you know what our body can tolerate in our. Is frankly insane, right? Like, it's pretty impressive. But here's the wake up call of your body. Can't keep handling that. Like we're so anabolic in our teenagers and twenties. Like we can, we can suffer many, many insults, but now it's really repair, repair, build. Because there is a natural physiologic decline over time. Any living animal, trees, right? Any living animal. And so it's really prioritizing. Hey, I have not put myself first. And that's a lot of mind work as much as it is body work, right? Of like, what do we call women who take care of themselves, right? Lucky, privileged, smart, right? Like loving, right? Like, what do we call that? What are we making it mean? How do we become the person that says spend the most time in your life with you? Why wouldn't you take care of that person the most? And then, you know, people who take care of themselves know this. When I feel great, I have more to give, right? And looking at it that way instead of like, but I might be taking away from somebody else. No, you're going to be able to give more when you feel amazing.
- [06:56]
Rachel
Yeah, I. You said it may have been a post. It may have been somewhere I was with you. It may have been all of those things. But you've said that we'll never have 100% certainty about hormone safety, but that we can use the best available data to make empowered choices for ourselves today. So want to turn the page on the long shadow cast by the WHI study? How do you, other than like banging this drum as you have been every day for several years now. Help women find that confidence in that gray zone between fear, education, education, and awareness.
- [07:37]
Dr. Kelly Casperson
Like, it's actually quite simple. It's just a lot of work. But it's a lot of work. And I say that in my book. I'm like, I don't care if you take hormones. Frankly, I don't give a. I don't. I'm not living your life. And I say that very bluntly to wake people up, because so many people are like, if I just. If I just find the right person to listen to. Right. At the end of the day, this is your decision. And although I don't care what you do with your body, I care deeply that you're making a decision based upon education. And nobody is more in charge of your education than you are. Right. So the book basically says, I'm not. This book is not to tell you what to do. It's to give you the information. Because although I always say, I will always agree with, yes, we need more research. I'll always agree with that. But let's not forget the amazing research. We already have a lot. I did a Talk last night. 150 women in Seattle. I said, raise your hand if you know that we have two randomized placebo controlled trials on estrogen patches in women who already have Alzheimer's disease. Raise your hand if you know that information. That, you know those things exist. Zero hand. Well, one hand went up. Follows. She follows me. But. But that's the thing is, like, women don't have the. They don't have the knowledge. They don't have the education. They're sitting here making decisions because of fear instead of being like, is that true? Is the WHI like. By the way, the WHI study that. That took 80% of women off of hormones in this country. That study is free online. Yes, you can go read it whenever the hell you want to go read it. And it actually says that hormones decrease colon cancer by 30%, decrease all cause mortality in their 50s. In your 50s, decrease bone fracture by 50%. Even in people that didn't have a diagnosis of osteoporosis.
- [09:25]
Rachel
Yeah. So, yes, yes.
- [09:29]
Dr. Kelly Casperson
This horrible study actually told us many, many useful things. We don't have a news system that spreads good news as well as we have a news system that loves to keep you afraid.
- [09:40]
Rachel
Well, you do. You have a chapter titled Progesterone, the vindicated soul, which made me go, yay, progesterone. You know, you deserve your flowers. Progesterone. Tell us what you Meant by that. Vindicated from what?
- [09:54]
Dr. Kelly Casperson
Well, the big myth is that if you don't have a uterus, you don't need progesterone. This whole like, need thing. And there's always a grain of truth in all of this, right? And so really whi they used an oral synthetic progestin which your body doesn't make, has inflammatory properties to it, has some has more risks than what your ovaries make. And because of that, we're like, but you'll only need it if you need to protect it. We're like, we've turned progesterone into this. Like, you only need it if you have a uterus. Like your ovary designed progesterone just to protect your uterus, which is not how the body works. And so now it's, the tides are turning to be like, oral synthetic progestin is not the same as what your ovaries naturally make, which works in your brain. It's, it's fantastic for sleep. It's a lovely thing. A lot of people like a lot of. There's a decent amount of women who are like, yeah, yeah, take or leave estrogen. I love my progesterone. Right. But I think their voices aren't heard or reflected. And the myths are often stronger than the truth.
- [10:52]
Podcast Announcer
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- [12:08]
Rachel
You talk about testosterone a lot. And I would be remiss if I didn't give you opportunity to talk about it here and sort of letting us know once and for all that it's far more than useful for libido. But for women hearing about it who are unsure what it does, what's a simple way to understand its broader role?
- [12:29]
Dr. Kelly Casperson
Yeah, so testosterone's made in all bodies. Testicles make testosterone, ovaries make testosterone. Testosterone works by, remember, what do hormones do? Hormones travel around the body to keep healthy cells healthy. That's all they do. There's not magic. So testosterone specifically helps nerve cells stay healthy, helps the glial cells. For any of my neuroscience nerds, glial cells are the supporting cells of the brain. They help support the neurons. Testosterone helps support glial cells. Testosterone helps support the myelin sheaths around the nerve, the insulation of the nerves. Right? So for anybody who's nerdy, and that's what you have to do because you hear a lot of noise to say like, you know, the testosterone's trending or something. I'm like, we've been giving Women testosterone for 80 years. I haven't, I wasn't alive. But clinicians have, you know, we have actually a ton of old data. 1980s, 1970s, 1990s, right? And then we, we forgot all of that after the WHI. And basically nobody studied anything for 20 years, right? So I love, I love quoting old data because I'm like, yes, we always need more. But let's realize we don't have a lot of new stuff because everybody stops studying hormones after the whi. So what is libido? So they say, you know, testosterone is only for libido. That's not true. Again, that's not how the brain works. The brain doesn't have a little box that's marked libido on the right hand side, right? That's not how the brain works. So libido is a motivation towards it is a seeking, right? And what many women say, when I used to do a follow up with a woman man yesterday, and she's like two years ago, and she's like, it's not just a sex drive, it's just a drive. Like, just the drive is back, the motivation is back. Now that's something that's very difficult to measure in a laboratory setting. So is libido, by the way. Libido is very complicated, right? But we use things that are challenging to study and then we tell women it doesn't matter. Or it's not real. Hard to study doesn't mean it's not real. And I think the most vocal proponents for female dose testosterone are the clinicians who prescribe female dose testosterone. Because we hear zero women come back and say, this only helps with libido. Why? Because that's not how the brain works.
- [14:44]
Rachel
Right.
- [14:45]
Dr. Kelly Casperson
Like it's literally anti science to say that the testosterone only helps libido.
- [14:51]
Rachel
I all of a sudden remember the first time we spoke, which was pre. You are not broken publishing, you said. I don't even remember what you were saying. But it hit me in a moment that menopause specialists are so special and so important, but urologists hold this special place where you understand the hormones and all of them and the nuances around them in such a unique and critical way. So, you know, constantly being at the front of this conversation is so helpful to all of us. So let's just hover over hormones and the benefits of them for another minute. Sort of beyond mitigating symptoms. I noticed in the book, I read in the book that you mentioned eye health and I squealed because I swear eyes are one of those body parts rarely spoken about, but damn if my dry eyes didn't stop feeling so bad when I started taking mht. What are a few of the lesser known ways hormones support the body that surprise women so much?
- [15:56]
Dr. Kelly Casperson
Yeah, it's crazy. I mean, it makes sense once you realize hormone receptors are in every single cell in the body. I think the things women don't know about, there's more rotator cuff repairs in people with low hormones. Right. Frozen shoulder happens average age 51.
- [16:14]
Rachel
Right.
- [16:15]
Dr. Kelly Casperson
When your estrogen finally hits the toilet. So it's like the musculoskeletal stuff, the aches and pains, the joint aches. People who have normal hormones have less osteoarthritis. They have. Women with higher hormone levels have less knee replacements. Right. So this orthopedic landscape is completely ignored, but huge, right? Musculoskeletal syndrome, menopause, man. It's like at least 50% of people haven't read the paper in a while, but it's very big. And most people don't know about that. Pelvic health, women don't know that sex hurts now because hormones are low. Women don't know that orgasms are challenging because hormones are low. Ear itching, dry ears, ear ringing, vertigo. Right. Not sleep so bad. Like, I get hormones and they're like, I'm dreaming again, right? And that's the. That's the deep sleep, right? Which your body needs to repair itself. So it's like, I don't, I don't know what the most shocking thing that women don't know is, but really, this whole like thinking menopause is no more periods and hot flashes. Those are symptoms of low hormones, but they're not the thing. Right. And I try my best to communicate that to people of like, we're saying it's the symptoms. No, no, it's the thing. The thing is your ovaries only have so many packets of eggs and hormones. Ovaries are a certain size based upon the size of the mammal. Right. Elephants have bigger ovaries than humans and after a certain amount of years, all the packets are gone.
- [17:42]
Rachel
Right.
- [17:43]
Dr. Kelly Casperson
We're living longer on a global scale. Unprecedented in America in 1971. In the 1970s in America, women's average life expectancy was 71. We've added almost 10 years in like, in like 40 years.
- [18:01]
Rachel
Wow.
- [18:01]
Dr. Kelly Casperson
Right? And it's like people don't know that. And then they're here. Like, I don't know if hormones are natural or not. And I'm like, listen, 84 as a 84 is incredibly awesome. None of us want that life expectancy to be taken away. But what the Gen X is doing is we're saying, what if there's something we can do to not have the hip fracture, to not have the dementia, to not like that's why this is happening is because the globe is aging at a rate it's never aged before.
- [18:32]
Rachel
So, Dr. Kasperson, it sounds like you think of hormone therapy as preventative medicine. So how do you think about its role in protecting long term heart, brain, bone health? There's a lot of screaming evidence out there about it. Brain and heart seems to like, still live in this nebulous place of, you know. Well, we don't have the data because women's research hasn't been funded, you know, in the over. Ever or certainly over the last 20 years. So how do you think, do you, am I correct in saying that, that you think of hormones as preventative medicine?
- [19:08]
Dr. Kelly Casperson
Yeah, I mean, everything in medicine is risk benefit ratio. Right? What it is risk benefit ratio. And so to have to have a medication, we'll call it a medication to take something long term, it needs several things. It needs an excellent safety profile. Hormones have that, it's cheap. Hormones have that it's effective. Even if it doesn't prevent a disease, it's helping other things. Right. Helps you sleep, which actually prevents disease. Sleeping well prevents disease. Right. So even if it does it. Let's say we have no data, say we don't know if this is going to prevent things long term. It's going to help your insulin resistance right now. You can't feel that it's going to help your. It helps blood pressure, it helps cholesterol levels, it helps. And again, don't think. People think black and white. It doesn't help everybody. Yeah, people still don't exercise and smoke cigarettes and drink alcohol, right? Like this doesn't help everybody. We all have our own, we're not Toyotas, but. So let's say we have no data on prevention. Still cheap, still safe, still helps you right now. But the things it helps you with right now are things that affect long term cardiovascular health. Visceral fat, insulin resistance, blood pressure and flexibility of your arteries, decreasing the risk of diabetes, helping you sleep, helping your joints not hurt so you can actually exercise. Right? So then this is where the education comes in. Like don't take my word for it that it's going to prevent stuff. Understand how it works. The way it works prevents things. Right? This is not a pie in the sky leap to be like, these are things that help preserve your function. How do hormones work? They help keep healthy cells healthy. So now what we do know, we have several meta analyses looking at dementia. We've got decent data looking at cardiovascular health. And what we do know is the sooner the better. And that's with the within 10 year window, which again, arbitrary. What happens at 10 years and one day? Are you very different between 10 years in one day and nine years in 12 months?
- [21:06]
Podcast Announcer
Right.
- [21:06]
Dr. Kelly Casperson
So do not take this as like an absolute of everybody's got different risk factors, but to the best of our knowledge is because about a third of my practice is women in their 70s, I tell them, like, the hormones probably won't prevent dementia. Remember that awful Tuesday started 20 years ago?
- [21:22]
Rachel
Right.
- [21:23]
Dr. Kelly Casperson
They might not get the preventative benefits, but it'll always protect their bones, it'll always help them sleep, it'll always help your mood, it'll always help your skin. Like it'll always help your insulin resistance. Like it's. If there were medications that did what transdermal estradiol does, they would have super bowl ads.
- [21:41]
Rachel
Yeah.
- [21:41]
Dr. Kelly Casperson
And Vioza has a Super Bowl A.D. two years running, right? Because it does what estrogen does, which is decrease hot flashes, but it doesn't protect your bones, it doesn't help you, you know, it doesn't help you with all the other things that estrogen does because estrogen works all over the body.
- [21:58]
Rachel
I was at an event last night and when it concluded, I was speaking to a number of women and one of them was sharing some symptom things. And I said, well, you have to come to my talk tomorrow because I'm speaking with Dr. Caspersen and just get her book and skip to the senile vagina chapter. And she was like, okay. And I thought after that, you know, and I kind of tweaked my question about the senile vagina and how might she be revived. And one of the things I said to this woman last night and I say to just about every woman I meet anywhere anymore, is vaginal estrogen. Vaginal estrogen, Vaginal estrogen. Please tell us again why it matters so much.
- [22:41]
Dr. Kelly Casperson
Yeah. So hormones help healthy cells be healthy. Hormones are work everywhere in the body. Menopause is not hot flashes and no periods. Those are symptoms of what's actually happening, which is we're outliving our ovary function. When we outlive our ovary function, estrogen goes down in all tiss. Our bladder gets more overactive. What does that look like? Urgency, frequency, getting up at night to pee, bladder leakage, burning when I pee, pain with penetration, diminished orgasm, diminished arousal, more prone to BV and yeast infections because your microbiome's off because you don't have any estrogen. And lactobacillus in the vagina loves estrogen. That's how it decreases UTIs. So that's all called the genital urinary syndrome of menopause. And again, going back to what I said, in order for something to be preventative, it better be cheap and it better have an excellent safety profile. Vaginal estrogen, very cheap and has an excellent safety profile. As far as pelvic health, again, the Gen Xers are like, I love my sex life. And the millennials are like, I love my orgasms. Why would I wait for that to go away before I started on vaginal estrogen? So, you know, the big question is like, if you wanted to start on vaginal estrogen preventatively, at what age? I don't think there's ever going to be an age. Certainly if you have symptoms, start. But that within, within menopause, perimenopause, because remember, hormones can go down and you can still have periods. There's nothing magical about having a period. So certainly there's perimenopausal women with GSM symptoms that are under treated because their doctors are like, you still have a period. It's like periods, meaningless. Periods are meaningless.
- [24:14]
Rachel
If you could give women. Dr. Kassersson, let's say your top three pro tips for better sex in midlife. What would they be, and is there one that surprises your patients the most?
- [24:26]
Dr. Kelly Casperson
I would say communication. Communication. Know how you orgasm and then communication. Communication. Communication. And then lube and hormones. Hormones are nice, too, but I think the communication shocks people the most because they're entitled. People are very entitled to have an amazing sex life and not have to talk about it. Ask anybody. There's this great book called Magnificent Sex by Peggy Kleinplatz, and I need to have her on my podcast because I. I talk about her book all the time. And she basically, like, interviewed sexperts who were like, I love sex and I'm really good at it. Right. She was like. She's like, raise your hand. If you love sex and you're good at it, you want to talk about it. Right? Nowhere in there do people say, yeah, I just sit around till I spontaneously desire sex and then I go have it. No, that's the big myth. Like, I just have to sit around and if I had desire for it, like, that'd be nice. So I think that's one. They all are excellent communicators. Yeah, excellent, excellent communicators. And I think a lot of people are. They are very. I don't know, for lack of better words, they're entitled.
- [25:23]
Rachel
Yeah.
- [25:24]
Dr. Kelly Casperson
Like, I would love a six pack and amazing biceps and, like. But not actually putting in the work to have those things right is like. That's what entitlement is. Right. Like, you want an amazing sex life, but you don't actually do the things that lead to have it. And having an amazing sex life. That's entitlement.
- [25:39]
Rachel
Perfect word. I absolutely didn't think of it that way. And it absolutely is right on the money. You encourage a midlife mindset makeover, and your book feels like really just like a culmination of that message. What would you say is the biggest mental shift you've seen in women who stop apologizing for wanting more from their bodies, from their doctors and their lives? I saw you speak about this recently as well, and it was quite moving.
- [26:08]
Dr. Kelly Casperson
I'd love for you to tell me what I said. Oh, I would say they. They come alive.
- [26:13]
Rachel
Yeah.
- [26:14]
Dr. Kelly Casperson
You know, like Rachel, you know. You know who. The alive women.
- [26:17]
Rachel
Yeah. Yeah.
- [26:18]
Dr. Kelly Casperson
Right. They come alive.
- [26:20]
Rachel
Yeah.
- [26:21]
Dr. Kelly Casperson
I think the big question, what do you want? What do you want? And if you've made it to midlife and you don't know the answer, it's okay to not Know the answer, but like, meditate on that for a little bit. Oh, my God. I don't know what I'm gonna die and I don't know what I want to get out of this life. Like, the world's not entitled just to give you what you want without you knowing what you want.
- [26:42]
Rachel
Right.
- [26:43]
Dr. Kelly Casperson
You know, and women come alive and they figure it out and they also enjoy the journey.
- [26:49]
Rachel
Yeah, right.
- [26:49]
Dr. Kelly Casperson
Like, and, and those awake, alive women, they actually like, can't tolerate people who complain all the time anymore.
- [26:57]
Rachel
Yes.
- [26:57]
Dr. Kelly Casperson
We actually don't want to spend time with those people. I love you, I have compassion for you. But oh my God, oh my God. What's the point of life on earth? You're just going to complain about it the whole time. So, yeah. Happy to hear what I said when you heard me say something else.
- [27:12]
Rachel
Hit it. You hit it right. You hit it right. I want to turn to questions that have come in. I'm very aware of our time. This first question is, what is the level of testosterone most women do well at? That's part one of her question. What is the level of testosterone most men do well at? What is the difference between testosterone free and total testosterone?
- [27:37]
Dr. Kelly Casperson
Yeah, good question. That's probably an hour long answer. I'll try to keep it short. Labs can be useful as a guide. So I say there's three things that are important in assessing testosterone in humans. How do you feel? Do you have any side effects? And lab values. Lab values in that order are number three. Right. So I can't just say this is the lab value that most people do best at because it's different across the board. We're not Toyotas. So I always hesitate to give numbers because people, people like to be perfectionists. They like to try to optimize to those numbers. And it's truly individualized. Like I've got, I'm speaking in American values because I'm an American. But some women, like, we get their testosterone to 30 and they're like, love it, happy, great. Some women, they need to be up at 150, they have no side effects. They love being that high. But I'm not going to put everybody at 150 and I'm not going to stop everybody at 30. So how do you feel? Do you have any side effects? Lab values?
- [28:42]
Rachel
It sounds a lot like menopause, hormonal therapy. Like, are we getting at mitigating your symptoms? And we're not going to test your levels because you're going to let me know the physician how you're feeling does that correct important.
- [29:00]
Dr. Kelly Casperson
And I think levels are, especially with estrogen, are becoming more important because what we're, what we're learning is I can make, if you have, if you have an undetectable estrogen, so you're Postmenopausal, your estrogen 0. I can make your hot flashes get better by giving you an estrogen of like 10.
- [29:15]
Greenlight Sponsor Voice
Right.
- [29:15]
Dr. Kelly Casperson
Which is still a postmenopausal level, but again, this different for everybody. But I'm speaking in generalities. But to preserve bone, probably should be between 30 and 40. To build bone. Let's say you already lost some bone. To build bone, you might want to be 60. Right. But at 60, you might be highly symptomatic with side effects because you've been living at zero for a while.
- [29:36]
Rachel
Right, right.
- [29:36]
Dr. Kelly Casperson
Right. So how do you feel? Do you have any side effects?
- [29:41]
Rachel
In that order?
- [29:42]
Dr. Kelly Casperson
Okay, in that order.
- [29:43]
Rachel
Next question.
- [29:44]
Dr. Kelly Casperson
What's the difference between testosterone free and total? We don't, we don't know if that matters as much in women. In men, testosterone can be bound up more. It's less of an. Absolutely. I'll see, you know, disputes on online of what's more important in women right now. This is what's most important. How do you feel? Do you have any side effects? Lab values?
- [30:08]
Rachel
Okay, next question. Well, I know.
- [30:10]
Dr. Kelly Casperson
Well, I have one more thing just to beat the. Beat the lab value horse. If I, if I, if I have you on hormones and I check your labs four times in one day, you will give me four different results. Labs are not law there. And sometimes those lab results, they're totally crazy. Like I have you on testosterone, it came back in zero. Or I have you on a reasonable testosterone, it came back at like 500. Lab values are wrong sometimes, so we just have to repeat them. Right. So lab values aren't law. I know people want cookie cutter medic medicine. I know people want it to be easy, but my God, this is an art and a practice, not law. So that you've got to have a clinician who knows how to interpret the labs. And most people who know how to interpret the labs also know. How do you feel the side effects? Lab values.
- [30:58]
Rachel
Awesome. While I know hormone levels fluctuate all through the day every day, and they are not the end all be all. What would be the ideal serum testing level ranges for testosterone?
- [31:10]
Dr. Kelly Casperson
People can't help themselves.
- [31:11]
Rachel
I know. And progesterone. I'm about to start hrt, so. So she wants to know what to be looking for. Yeah.
- [31:19]
Dr. Kelly Casperson
How you feel? Do you have any side effects?
- [31:22]
Rachel
Yeah.
- [31:22]
Dr. Kelly Casperson
Then lab values. And the thing is, if I give you a number and now you go to your clinician and you say Dr. Caspersen said 50, that's not going to work out for you. Right. Like you should be going to somebody who knows how to interpret, ideally, who knows how to interpret this. And we are not Toyotas. Yeah, right. Like there are some things that are cut and dry hormones. Because remember, and to explain this to the science people, what the hormones are in your serum does not explain. How many receptors do you have? How sensitive are your receptors? How much is your bone getting versus your brain getting? That's why lab values are not law. There's a lot going on. A lot going on. And the answer to all those questions, how do you feel? No side effects. Right? So somebody at 30 might feel very different than another person at 30 because lab values are not law.
- [32:20]
Rachel
So interesting. Next question. How would someone find out if they are a poor absorber of prt? How would a woman advocate for herself to her doctor if she wants further testing for poor absorption as opposed to her doctor telling her PRT just isn't working for you?
- [32:37]
Dr. Kelly Casperson
Usually. So if your symptoms are better, you're probably absorbing the product. If you're still having a lot of hot flashes, either you're not absorbing it or you need a higher dose. Right. And then you can check labs, be like, is this, is this picking up in my serum? Right. Or is it not? So those are the things.
- [32:53]
Rachel
What are the best ways to engage a healthcare professional about what estrogen options make sense for you? And will taking estrogen increase your period if you're already experiencing lapses?
- [33:06]
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- [33:35]
Dr. Kelly Casperson
Yeah. So in perimenopause, hormone replacement therapy can influence your period, but it won't prolong your perimenopause. It won't. It's certainly not birth control, so understand that. So it will influence it. Most people you know, it depends upon where you are in perimenopause, but it tends to tend to mellow. It Out a little bit for the people who, who are having really heavy periods and then for people who have it spaced out. Yeah. You might experience more because your body has hormones again.
- [34:02]
Rachel
Yeah.
- [34:03]
Dr. Kelly Casperson
And the, and the uterus is a hormone responsive organ. So it's different for everybody. But you say, yeah, it's real, it happens and we just have to see how it goes for you. And engaging a healthcare professional, I would ask them, hey, do you like taking care of perimenopause and post menopausal women with hormones? If you don't, do you have somebody you can refer me to? I mean, that's what's so amazing about these telehealth platforms is like when you go to Ally Alloy, you have a warm audience. It's literally your brand is to take care of hormones. Right. And so it's like, what's the best way to engage? Have a warm audience.
- [34:33]
Rachel
Yeah.
- [34:34]
Dr. Kelly Casperson
And if you don't know if, if your clinician's a warm audience, ask them.
- [34:38]
Rachel
Okay, next question. I am 80. Is it too late for hormones?
- [34:42]
Dr. Kelly Casperson
I love this question. Is my favorite current question.
- [34:46]
Rachel
Yeah.
- [34:47]
Dr. Kelly Casperson
So for anybody who wants on my website, I have a course under courses, I have an hour long course. I don't know if it's called the Boomer should be pissed or if it's called am I too late for hormones? Or something, but I do a whole hour breaking down the facts, the science on hormones in age. Where did, where did, where did you get the idea that you're too old for hormones? Where did that come from? Right, so that's in the course. I explained that all and this is what I say, I say again, we're not Toyotas. We're all individual. What are your goals? Why do you want to be on hormones? That's important, right? Body autonomy, remember, hormones is a very large tent. And when people are told I can't be on hormones, they usually mean oral synthetic estrogens because that's the, that's the scary data. But they don't know that. They just say hormones. So hormones is a very large tent. Remember in the tent of hormones, vaginal estrogen, never too old. Testosterone, no age limit. Progesterone, no age limit. Transdermal estradiol, no age limit. And the best time to start is young. That doesn't mean old can't start. It just means there's more, there's more pros and cons. You might not see the preventative benefit. So that my, my too long didn't read is the hormones is a very large tent. Never assume you're too old for the whole 10.
- [36:02]
Rachel
And I would add, remember to find a warm audience to have the conversation with, as you just said. Right. Somebody who's well versed and willing to sit down and hear what's going on and come.
- [36:16]
Dr. Kelly Casperson
And again, I'll reiterate, one third of my practice is women in their 70s and older.
- [36:21]
Rachel
Yeah. Yeah.
- [36:22]
Dr. Kelly Casperson
If you're not allowed at age 80 to decide what you want to do with your body, I don't know what age you're allowed to do that at.
- [36:29]
Rachel
Yeah. Dr. Caspersen, as I mentioned earlier, you've been banging the drum for years about how sexual health and overall health are intertwined. What do you want women to understand about why that connection matters just beyond a satisfying sex life?
- [36:47]
Dr. Kelly Casperson
It's a relationship with your body. It really is. It's prioritizing pleasure. This body was not put here just to work.
- [36:55]
Rachel
Yeah, right.
- [36:56]
Dr. Kelly Casperson
Like, it's really getting good at a sex life, whatever that means for people. And that's why I don't define it. But getting good at a sex life means you're prioritizing, understanding your body and understanding the pleasure that your body can provide to you and understanding. Communicating about awkward, difficult topics that we never got taught about.
- [37:17]
Rachel
Yeah, Right.
- [37:18]
Dr. Kelly Casperson
And if you can communicate about that, you can communicate about anything. Right. So getting good at sex actually gives you a lot of tools for getting good at a lot of other things. Boundaries. Right? Oh, my God. Boundaries. Do you feel safe? Do you feel like you. Like, you're prioritized in this sexual relationship? Right. Like, there's so many huge tools to be learned in adult sex ed. It's not like, you know, people break. They're like, it's all about the orgasm. No, it's not. It's much, much bigger than.
- [37:47]
Rachel
Was at some event. I want to say this is a few years back, and it was you and several urologists in the room talking about cardiovascular disease specifically, and how with men and sexual health, there's this, like, automatic bright light. You know, there is a connection there. And I'm wondering if you can sort of expand on what that might be for women, what the connection might be.
- [38:16]
Dr. Kelly Casperson
Even for men, it's pretty great. So. So we have some data saying men who are sexually active live longer. And penises are pumps, clitorises are penises. Right. It's a blood flow. Sex is blood flow. And blood flow is great for the heart, blood flow is great for the brain. Is it possible that people with better blood flow live longer? Yes, highly possible. So I Think when people say, hey, sex will make you live longer. Maybe the things that are making you live longer also make you have a good sex life. Right. Because you're. Because people who exercise have a better sex life. People who aren't sleep deprived have a better sex life. Both of those things make you live longer. Men, and these are male studies. We don't have female studies. Men who are having sex later in life are usually in a committed, loving relationship where food's provided at dinner every night. That makes you live longer.
- [39:02]
Podcast Announcer
Right.
- [39:02]
Dr. Kelly Casperson
So sex might more be a flag of. I've got the longevity things going that help me live longer more than. It's the orgasm and the erection that makes me live longer.
- [39:15]
Rachel
Okay. Okay. I got a question in from someone in my DMs, and I know you get asked this a lot. I have asked you this question in the past. This woman had just heard a conversation about the potential of losing her labia.
- [39:34]
Dr. Kelly Casperson
And it breaks the Internet every time. I know.
- [39:38]
Rachel
Could you talk about that and talk about prevention there?
- [39:42]
Dr. Kelly Casperson
Yep. So genitals become adult genitals because of hormones. You take the hormones away, the adult genitals atrophy, disappear, shrink, whatever. They're not as healthy as they used to be. Pick a word. I don't think there's a great word for any of this. And that's true. No matter what gender you are. Penises get smaller, testicles get smaller, labias get smaller, clitorises get smaller. The fact that it's shocking to people tells us we don't know how our bodies work. We don't know the role of hormones. We don't know that genitals become adult genitals because of hormones. Right. We go through puberty, and now we have adult genitals. Why? Why do we just. Is it because we got bigger? Right. No, it's because we have hormones. How do we know that? There's some people that go through puberty that don't have great hormones. They don't have adult genitals. Right. So that's what that tells me is like, people are so shocked by it. And I'm like, well, you would be shocked if you don't know how your body works. That's what happens. Right. And so all the. We're always. The doctors are always, like, shocked that women are so shocked by it. Because we're like, yeah, you don't have any hormones. Don't be entitled to a labia if you don't have hormones is what makes the labia an adult labia. Right. Same with clitoris. Same with a bladder that functions well. Same with the vagina that functions well. So it's so shocking to people because they don't know how their body works, the role of hormones. But you explain it to them. You're like, huh? If you don't want your labia to disappear, which is. Again, remember I was talking about the millennials. The millennials are like, we're paying attention. We'd like to just like, why learn that you're labia. Yeah. The millennials are like, how about we don't lose it in the first place?
- [41:21]
Rachel
Exactly.
- [41:22]
Dr. Kelly Casperson
And then we're all like. We're like, that's a good thought.
- [41:24]
Rachel
That's a great idea.
- [41:26]
Dr. Kelly Casperson
That's a great idea. Because all these women are like, nobody told me. And the millennials were like, we're paying attention. You're telling me. Yeah, let's get on the. Let's get on. So likely vaginal estrogen. This is. It's horrifically understudied. Nobody really likes to study labias, but horribly understudy can. If a woman doesn't have a labia, can we get it back? With what dose of vaginal hormone do they need some testosterone? How about vaginal dhea? Like, these are all the questions. Once you've lost your labia because you haven't had hormones in 10 years, can I get it back? And with what dose of hormones can I get it back? We don't have data on that, but we try the sex med doctors try to get it back. You do, but every single one of those women, Women say, nobody told me. So here we are. We're. We're like, we don't want to shock you, but we're telling you. Don't. Don't kill the messenger.
- [42:14]
Rachel
What is something else? I'm just thinking as you're saying that that's like, you know, the urologists know, but women don't know. Certainly not the boomers. The Gen Xers are catching up. The millennials probably know already. What is another thing, Orgasm doesn't happen.
- [42:31]
Dr. Kelly Casperson
By putting something in your vagina. And don't be entitled to an orgasm if you have no arousal. Sex ed 101 is massively lacking. Massively lacking. So we're like, don't just put something in your vagina and expect an orgasm to happen. Like the vagina doesn't know. You didn't turn on the brain, you didn't turn on the pelvis. There's no blood flow happening. Right. It's much harder for a penis to orgasm when it's not erect. Right. Same thing happens in female bodies. You've got to. You've got to get it erect. You've got to get it aroused. People don't know that. They just, you know, they watch Hollywood movies and think that something should go in their vagina and that they should enjoy it. That's not how sex works.
- [43:08]
Rachel
Yeah, yeah. I'm giving you time back. I'm so grateful to have spoken with you. I do. You know, I said this earlier in our conversation, but truly, truly, if you haven't picked up your copy yet of this pretty book, the Menopause Moment, please do you truly do cover, you know, top to bottom, inside and out, what you've been talking about for so many years. And it. It's much more than sexual health. And that chapter, you know, you're. You're ending on this sort of midlife mindset makeover. I, I really. I really, really was moved by it because I felt like, you know, four years ago or five years ago, whenever it was that, that we first had opportunity to speak, you were. You were like, threading the needle then about the shift that needs to happen and that you are certainly pushing the needle on happening in your practice every day. And luckily enough, you know, all of us on social media get to follow you and hear your.
- [44:09]
Dr. Kelly Casperson
Your.
- [44:10]
Rachel
Your teachings and listen to your podcast and read your book. Is there anything else, I guess, that you would want to leave us with about all of that? Anything? I missed so much, I'm sure.
- [44:24]
Dr. Kelly Casperson
Yeah. I mean, I think, you know, what I. Feedback I get after a lot of my talks is like, number one, nobody told me before, so thank you. But number two, now I'm upset and I'm pissed. Right? Likely because nobody told you or because it's so hard to access or because the fear is wrong. Right? All these things. And to me, you know, I said this last night when I had a live audience is like, good. Anger is energy. Use it. Use it. Go advocate. Go create. Go on a walk, go lift weights. Go do something that your body loves, right? Like, use the anger. Judges sit here in anger is like, go do something. This is how the world changes. You know, like, profound change has happened in the last three years. Profound. Do I still want more research? Do we still have a lot of work to do? Absolutely. And profound changes in the last three years, and it's. It's only accelerating at, like, breakneck speed. So there's a very exciting things coming from the fda. There's very exciting things coming in the pharmaceutical pipelines. There's very like I looked at it, I was looking at a article today as a JAMA article that got published in 1989. I love old studies because, because I'm like, people give me a crap for posting old studies on the Internet. And I'm like, listen, like I stand on the shoulder of giants, right? So this study was basically like, hey, exercise decreases mortality. Was it really 1989, well published jama. And I'm like, here we are like Peter Atiya just got a 60 minute, you know, one hour thing basically saying exercise decreases mortality. And I think, you know, especially, especially people who can't take the tent of hormones which remember most people can take vaginal estrogen but they feel bad about it. And I'm like, that doesn't mean I'm going to stop telling people how their bodies work.
- [46:08]
Rachel
Yeah.
- [46:08]
Dr. Kelly Casperson
Just because I might make somebody feel bad. And you better not be drinking, you better not be smoking, you better not be sitting on your couch all day, you better be prioritizing your sleep, you better be lifting weights, you better be exercising. Like what do I mean by that? Is there's so much within your control. Yeah, there's so much within your control. Hormones are a teeny piece of it. Go do all the things and don't complain if you can't have one piece of the whole longevity.
- [46:36]
Rachel
That I love the reminder of that truth and that all of those things the reminder that as I say in my layperson way, all of the things that matter anyway will always matter. So do them anyway. Move your body, get good sleep, you know, eat a nutritious meal, spend time with friends, read a book.
- [46:57]
Dr. Kelly Casperson
Like the data in my book on the chapter on mindset is like you having a good mental view of aging. That's like a seven year old gain. Like it's hormones aren't going to give you a seven year gain. Right. Like it's insane how the researchers are showing us what moves the needle on this and a lot of it is within your control. So this passive like, well, I can't pay take hormones. I might as well sit back and complain about how awful I have go do all the other things. Most people aren't doing them. Most people are not doing them. And so that's the thing is like you have way more control than you think you do.
- [47:34]
Rachel
Dr. Kelly Caspersen, thank you for your proactivity and your encouragement, your inspiration, your book. You are not broken. I don't have next to me but go get that one as well if you have not read it. Thank you so much for your time today. It's a pleasure always to be in your presence and to learn from you. Thank you.
- [47:52]
Dr. Kelly Casperson
Same. Rachel, I love hanging out with you and Josie. Thanks for your help today too.
- [47:56]
Rachel
Thank you. Oh, that's so awesome. Shout out to Josie.
- [47:59]
Dr. Kelly Casperson
I love Josie.
- [48:00]
Rachel
Right? I love Josie. I loved her first, so that's probably.
- [48:04]
Dr. Kelly Casperson
I just. I just got to meet her.
- [48:06]
Rachel
Thank you.
- [48:07]
Dr. Kelly Casperson
All right. Wonderful day.
- [48:08]
Rachel
Be well, everybody. Thanks. Thank you.
- [48:11]
Dr. Kelly Casperson
Cheers. Bye. Bye.
- [48:13]
Podcast Announcer
If you found this episode funny, helpful, insightful, please take a moment to follow rate and share the youe Are Not Broken podcast with someone who might need this conversation too. That support is how this information reaches more people and thank you. For courses, books and my monthly membership and the Caspersen clinic information, visit KellyCaspersonMD.com this podcast and all content from Dr. Kelly Casperson is intended for educational and informational purposes only, and this is not a substitute for individual medical coaching or psychological advice, diagnosis or treatment. Always seek the guidance of your qualified healthcare professional with any questions you may have regarding your health. Never disregard or delay medical advice because of something you've heard on this or other podcasts. Thanks for being here. And remember, you Are Not Broken.