Podcast Summary: "Midlife Is Not a Medical Mystery – An Interview with Dr. Kelly Casperson"

You Are Not Broken – Episode 352 | January 4, 2026
Host: Rachel (Alloy Health)
Guest: Dr. Kelly Casperson, MD, Board-Certified Urologist | [00:14–48:12]

Overview

This episode of "You Are Not Broken" centers on rethinking midlife and menopause, challenging outdated beliefs about hormones, sex, and aging. Dr. Kelly Casperson, a leading urologist and menopause advocate, discusses her new book, redefines the conventional approach to women’s health in midlife, and empowers listeners to proactively shape their long-term health and pleasure.

Key Discussion Points & Insights

Rethinking Midlife and Empowerment

• Cultural Shift Across Generations

  • Millennials and Gen X are driving conversations on proactive aging:

    “I heard in New York on the book tour, Gen X is the last generation that's gonna suffer... Millennials…they're like, we're paying attention…we'd like to prevent disease, not just deal with it once we have it." – Dr. Casperson [02:46]

  • The question "Who do you want to be at 74?" reframes midlife choices as long-term investments in one’s future self.

• Taking Yourself Seriously

  • Women are urged to prioritize themselves and combat internalized guilt for self-care:

    "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." – Dr. Casperson [06:06]

Hormones: Evidence, Myths, and Individualization

• Overcoming Fear and Misinformation

  • The Women’s Health Initiative (WHI) study is often misinterpreted and still casts a long shadow:

    “80% of women went off hormones...The WHI study… actually says that hormones decrease colon cancer by 30%, decrease all cause mortality in their 50s, decrease bone fracture by 50%...” – Dr. Casperson [08:53]

  • There’s more positive research about hormones than most realize; fear-based narratives dominate.

• Empowered Decision-Making

  • Education is vital; Dr. Casperson pushes for informed, individualized hormone decisions:

    "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." – Dr. Casperson [07:47]

• Progesterone: Beyond Uterus Protection

  • Progesterone is valuable even without a uterus; natural forms differ from synthetic progestins:

    “Oral synthetic progestin is not the same as what your ovaries naturally make, which works in your brain. It's fantastic for sleep.” – Dr. Casperson [10:24]

Lesser-Known Roles of Hormones

• Effects Across the Body

  • Hormone receptors are widespread; benefits of hormone therapy go far beyond hot flashes:
    • Musculoskeletal: Decreased rotator cuff injuries, less osteoarthritis, fewer knee replacements [16:00]
    • Pelvic/sexual health: Improved lubrication, reduced painful sex, better orgasms [16:43]
    • Eye and ear health: Fewer dry eyes, less ear ringing and itching [15:55]
    • Sleep and mood improvements lead to systemic health gains

• Longevity in Context

  • Life expectancy for women has risen significantly, prompting a new need to consider quality—not just length—of life:

    “We’re living longer on a global scale...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?” – Dr. Casperson [17:42]

Hormones as Preventative Medicine

• Risk-Benefit and Timing

  • Hormone therapy is most effective when started earlier, but it's always a personal calculation:

    “Everything in medicine is risk-benefit ratio...We have several meta-analyses looking at dementia...the sooner the better...within 10 year window, which again, arbitrary.” – Dr. Casperson [19:07, 20:36]

• Long-Term Benefits

  • Potential protection against dementia, cardiovascular events, bone loss (osteoporosis), and metabolic issues (insulin resistance, visceral fat, etc.) [19:07–21:41]
  • Even outside the prevention window: “It’ll always protect their bones, help them sleep, help mood, skin, insulin resistance” [21:23]

Questions on Practical Hormone Use

• Testosterone: More than Libido

  • For women, testosterone is about overall motivation and neurological health, not just sex drive:

    "Testosterone specifically helps nerve cells stay healthy...Women say...it's not just a sex drive, it's just a drive. Like, just the drive is back, the motivation is back." – Dr. Casperson [12:28, 14:06]

  • No set “ideal” lab value—symptom improvement and side effects matter more than numbers [27:37–32:20]

• Vaginal Estrogen & GSM

  • Essential for pelvic and sexual health; safe and cheap, useful even preventively [22:40]:

    “Vaginal estrogen, very cheap and has an excellent safety profile...Why would I wait for that to go away before I started on vaginal estrogen?” – Dr. Casperson [23:28]

• Age Limits and Hormone Therapy

  • Age isn’t an absolute barrier—therapy may still improve symptoms and quality of life, even if started at age 80:

    “Vaginal estrogen, never too old. Testosterone, no age limit. Progesterone, no age limit. Transdermal estradiol, no age limit. The best time to start is young, that doesn't mean old can't start.” [34:42–36:22]

Sex, Communication, and Mindset

• Foundations for Better Midlife Sex

  • Dr. Casperson’s “Top Three Pro Tips”: Communication, knowing how you orgasm, and then lube/hormones [24:26]:

    “Communication. Communication. Know how you orgasm and then communication.” [24:26]

  • Most people are “entitled,” wanting a great sex life without effort or communication [25:23]

• Aging, Mindset, and Coming Alive

  • The biggest shift for thriving women is a refusal to apologize for wanting more, leading to greater vibrancy:

    “They come alive...the alive women...What do you want?...it's okay to not know the answer, but meditate on that for a little bit.” [26:07–26:42]

  • Setting boundaries, self-understanding, and demanding more from care are essential new skills

Memorable Quotes & Moments

• On the Power of Individual Action:

  “Anger is energy. Use it. Go advocate. Go create. Go on a walk, go lift weights. Go do something that your body loves, right? Use the anger. This is how the world changes.” – Dr. Casperson [44:23]

• On Mindset and Control:

  “You have way more control than you think you do. 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.” – Dr. Casperson [46:08]

• On Why Sexual Health Matters:

  “It's a relationship with your body. It’s prioritizing pleasure. This body was not put here just to work.” – Dr. Casperson [36:46]

• On Vaginal and Sexual Anatomy Myths:

  “Don’t be entitled to a labia if you don’t have hormones...same with clitoris, same with a bladder that functions well.” – Dr. Casperson [41:20]

Key Timestamps

| Timestamp | Topic / Quote | |-----------|------------------------------------------------------------------------------------------------------------------| | 02:46 | Millennials & Gen X demanding proactive health; “Gen X is the last generation that's gonna suffer.” | | 05:37 | The mindset shift: “Most of us got where we are now by putting other things first…” | | 07:47 | Empowered decisions: “I don't care if you take hormones… but be educated!” | | 08:53 | Honest WHI study takeaways (reduced cancer, fractures, mortality) | | 12:28 | Testosterone: “Testosterone's made in all bodies…” & beyond libido | | 15:55 | Lesser-known hormone effects: eyes, musculoskeletal health, pelvic pain | | 19:07 | Hormones as preventative medicine; risk-benefit, window for prevention | | 22:40 | Critical role of vaginal estrogen | | 24:26 | Sex pro-tips: “Communication, communication, communication…” | | 26:07 | Mindset makeover; “They come alive...What do you want?” | | 27:37 | Testosterone: “Labs are not law...Number three…Lab values…” | | 34:42 | Hormones at age 80: “Hormones is a very large tent. Never assume you're too old for the whole tent.” | | 36:46 | Sex and health: “It's a relationship with your body...This body was not put here just to work.” | | 41:20 | Genital atrophy: “Don’t be entitled to a labia if you don’t have hormones…” | | 44:23 | Advocacy: “Anger is energy. Use it. Go advocate. Go create…” | | 46:08 | Mindset: “You have way more control than you think you do. Hormones are a teeny piece of it. Go do all the things”|

Tone, Style, and Atmosphere

• Dr. Casperson employs blunt candor (“I don’t care if you take hormones… but be educated!”), medical precision, humor, and a deep sense of empowerment.
• She is passionate about cutting through misinformation and calling out cultural and medical complacency.
• Rachel’s questions highlight real-world confusion and practical issues, making Dr. Casperson’s responses actionable and relatable.

Closing Message

Dr. Casperson concludes with a call to action: seek education, advocate for yourself, cherish your body, and know that midlife is not a medical mystery—nor a decline, but an opportunity for vibrancy, autonomy, and pleasure.

“Profound change has happened…profound. Do I still want more research? Do we still have a lot of work to do? Absolutely. But there’s very exciting things coming…You have way more control than you think you do.” – Dr. Casperson [44:23, 46:08]

For further resources and Dr. Casperson’s work, visit KellyCaspersonMD.com.

(Summary omits non-content sections, sponsored segments, and promotional announcements.)