← You Are Not Broken
Loading summary
Transcript125 lines
- [00:04]
A
Welcome to the youe 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. Hey everybody. Welcome back to the youe Are Not Broken podcast. Today we're going to talk to my friend Joanna Strober, who is huge in the menopause world because she is changing a lot of people's lives. Joanna, thanks for coming to the podcast.
- [00:31]
B
Ah, I'm very excited to be here.
- [00:33]
A
So we're going to talk like all the halfs, a third, maybe a third business, a third empowerment, a third menopause. Because I want to get into the story of like how you are running this massive company that you're running. People don't just come out of the gate running massive companies. There's always a buildup. So can you tell us your story on like your career and how you got to. And for anybody who doesn't know yet, she runs MIDI Health, M I D I Health, which provides hormone therapy to what, hundreds of thousands of women.
- [01:03]
B
At this point, about 25,000 a week.
- [01:06]
A
25,000 a week. So Mitty takes care of a town of women every single week. That's like a large stadium of women every single week. And we're just getting started because there's 80 million women over the age of 40 and as of the last data collection only about 5% are on hormones. We're working to change that. So tell us how, how did you get to helping 25000 women a week with hormone therapy?
- [01:32]
B
Yeah. So God, if you had said we would get here, I, I'm not sure I would have believed you a few years ago, but we started MIDI a few years ago in only less than four years ago. But we knew that getting insurance covered care for menopause was incredibly difficult for a whole variety of reasons. And, and my co founder Sharon and I had experience trying to get people to give us appropriate menopause care. And we both ended up using concierge doctors, which is great. But what we realized is that there was a huge need for insurance covered menopause care and also for a huge need for education for providers who could provide this care. So we started with a pilot. It was actually really fun. We went on Facebook and we did a pilot and we had two providers and we recruited about 150 patients and we said we will take care of you for free for three months and we will get you your hormone therapy. We're going to include testosterone, we're going to include weight loss, we're going to include all the different things that women need in midlife. And we're going to take great care of you. And during that process, you're going to give us feedback and you're going to tell us what we're doing right, what we're not doing right, how we can improve this to be a great consumer product for you. And at the end, there was this panic when we said we were done. And they said, no, you can't go away. We don't have any place else to go to get this care. And that was really our aha moment, that we were building something that the world needs and that women would appreciate. So we went out and we spent the next few years really trying to train expert providers to do this care and also to get insurance contracts throughout the country. So for us, our key differentiator is that we believe women deserve this care covered by insurance. And so it's taken us years, but we now have about 70 million women who are covered by insurance contracts that we have. And we're working on more, but we are getting the country to be covered so that we can offer insurance covered menopause and perimenopause care to anyone who wants it.
- [03:35]
A
Absolutely love it. People who listen to the you're not broken podcast, they're educated and they're, a lot of them are clinicians. But for anybody who's been living under a rock, physicians, nurse practitioners, PAs prescribers, they didn't learn for like the past two decades because of the Women's Health Initiative. And so it's changing quickly, I think. But even if this is the numbers game again, because it's, it's shocking to say the numbers out loud. We've got 1 million physicians. I think they all need to be trained in menopause care. Cause this is 50% of the population. One million physicians, about 300,000 nurse practitioners. Even if all of them get trained, it's not enough because so many women are outside the system and haven't gotten care. Like, even if you trained everybody to know about it, it's not enough. Like, we need your platform. Because even when everybody is trained, it's not enough people to take care of all the women. You know, because people are like, you want every woman to be on hormones and we can chat about that. And I'm like, I want every woman to be educated enough to make the decision. And it would be nice to go back to the 1990s, because in the 1990s, 40% of women were on hormones safely. And so to me, I'm like, even if we got to 40%, which is really just getting back to 30 years ago.
- [04:46]
B
Well, I joke about that menopause math, right? I mean, the reality is, and we can talk about it, I believe about 90% of women over 40 should be on hormone therapy. So the menopause math is actually pretty disconcerting. If we have less than 5% on it now and over 90% should be on it. That's a huge care gap that we're addressing.
- [05:04]
A
No, it's absolutely huge. You've got a lot of work to do, but you've come a long way in three years.
- [05:09]
B
Yeah, we're scaling fast. A lot of it is making sure we have expert providers. So we have to do a lot of training. People come to us not trained in how to do this. They don't have any understanding of the complications and the intricacies of providing hormone therapy when it's appropriate, when it's not appropriate. Too often they come to us saying no too often. So they have been trained to say no. You had breast cancer?
- [05:32]
A
No.
- [05:33]
B
You had a stroke? No. You had a blood clot?
- [05:36]
A
No. You're 10 years and one month past menopause. No. No.
- [05:40]
B
Exactly. So most of them have been trained on no, and our goal is to get them to yes as long as it's safe. So we think of it as a getting to yes training system to understand when yes is appropriate and then make sure that anyone who is eligible for these medications are given to them.
- [05:58]
A
What I say when I talk is the word hormone. It's a very large tent. Right. So there's so many things under the tent. Testosterone, progesterone, systemic estradiol, vaginal estradiol, DHEA for the vagina. Like, there's so many things under the tent. Synthetic, not synthetic. Patches, creams, gels, blah, blah, blah, blah, blah.
- [06:16]
B
The whole thing. It's an apothecary. I joke. We have an apothecary.
- [06:21]
A
It's a huge tense. So for people to say you can't have hormones, I'm like, what you're meaning by saying hormones isn't what I think when I think about hormones, which is like this large tent of options instead of like oral synthetic estrogen is what people usually say when they say they can't have hormones. So you're not a doctor. How fast did your education have to be? Because you're very savvy. When you talk to the doctors who are trained, we're like, yeah, yeah, she's. We all have to catch you up. How did you get your education in this to the level of like, you can talk with the experts at a level where we're like, oh, right, she's not a doctor. Thanks for reminding me.
- [06:57]
B
I mean, the good news is there's a lot written about this, right? So I start with books. I have a whole lot of books sitting here on my counter, starting with Estrogen Matters, but I have a whole lot of books. I have yearbooks sitting here. I have lots of books. I read lots of books and read lots of research. And then what we have is at midi, we have a complex care channel. And so when there are complicated patients that come in, the NPs can come and write questions to the doctors. And then we have Dr. Experts on the back end. So for example, Dr. Mindy Grossman, who's an expert in cancer, she will come and read the Cancer channel and say, oh, this woman had breast cancer, but it's been five years and this and this. And she is actually eligible for hormone therapy. So I've had the ability to read these things for the past four years. So I've really been very immeshed in. I would never say that I'm a doctor, but I have, I have learned the protocols and I've learned most of the questions are pretty repetitive at this point. And so I can. There's not so many different ones.
- [07:56]
A
Were you interested because you were in business and had companies before this? Were they health oriented or was your own perimenopause menopause journey the reason where this came from? Like, what was the, like aha in seeing this need?
- [08:09]
B
So for me, it was actually. So before this company, I actually started a company called Kerbo Health, which was a. The first digital therapeutic for childhood obesity. And I learned doing that company how well you could use digital health to provide a solution that you didn't need in person care in order to help children lose weight, you could use an app and a remote coach and that could be as impactful. And we proved that it could be as impactful as in person programs. So I sold that to Weight Watchers and after integrating that company into Weight Watchers, I had extra time. So I started looking at the weight loss medication space. And I basically said, look, Weight Watchers, you have this big issue coming. Weight medications are coming and you should be paying more attention to this. And so while learning that, that's when I learned how to set up a national health care practice. I learned how to get medication sent to people's houses. I Learned how to basically set up this national care practice. Turns out I was ahead of my time. I thought I actually had good support from the company to do this. And then eventually it got to the board, and the board completely shot me down. And they said, you're turning us into pill pushers. We're a behavior care company. We are not a medical care company. And that's when I quit. But what I had realized is that I could take all of that learning and turn it into a menopause company, which was much more interesting to me than just being a weight loss company.
- [09:32]
A
And now, I mean, I don't follow this, but isn't Weight Watchers like, getting on menopause?
- [09:37]
B
Yes, they're copying.
- [09:38]
A
Yeah. Like, Weight Watchers is like, oh, wait, we lost that person. And she. She was actually the visionary.
- [09:44]
B
Yes. They first got it. You know, they first realized they had to do medications, and then they're realizing. I mean, the truth is, Weight Watchers audience is hormonal and is perimenopause. So it makes sense for them to go into this, because what I've learned is that women's health between 40 and 60 is essentially hormones and weight. Like, a lot of those things are related. And so, you know, I don't think you can take care of weight without thinking of hormones and vice versa.
- [10:12]
A
Well, we have data, and I think there will be more and more, but we have data that when women are on both, they're more effective, they're complimentary. So to. To say, like, we're just going to do one or, you know, blah, blah, blah, is like, at the end of the day, the body is an integrated system. And when you give it. Give it more tools to work with, it tends to work better. So less muscle loss and more adipose tissue loss when you're on hormones and GLP1s compared to either one alone is what the. For people who don't know the data that I'm talking about, that's. Those are the papers that I'm saying. And men have it too, for testosterone and GLP1. So it's. It's all bodies work better when you've got both on the plate.
- [10:51]
B
We are absolutely seeing that. And we were one of the first menopause companies starting offering GLP1s. And it was because we saw that the weight loss, when you combine the hormones and the GLP one was the best.
- [11:01]
A
Yeah, yeah, it's. Winner, winner. A lot of this is slow stuff, right? And Americans tend to like fast fixes. And when women, you just give like they get a little bit of like, aha, something's working. You're more likely to stick with it. Truthfully, like creating the healthy lifestyle and lifting weights and seeing that changes, it does take a while. And so you want to tell people the truth, but also let them start seeing a win. 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 women's telehealth clinic founded and supported by world class leaders in women's health. MIDI 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 join midi.com today to book your personalized insurance covered virtual visit. That's joinmitte.com midi the Care Women deserve. Now back to the show.
- [12:15]
B
The other thing that takes a while is research. And it's one of my bugaboos. I have to say. People are always saying, well, I want to wait for the research and if I have to wait for the research that demonstrates 100% that hormone therapy presents Alzheimer's, I might be dead.
- [12:34]
A
Yeah, yeah. Or at least you'll be having Alzheimer's.
- [12:37]
B
I'll be having Alzheimer's. Yes. So I'm very much thinking about how we look at early research, smaller studies, really spending the time to go out into the early research instead of waiting for the final research to come out because it just takes too long to get the right information.
- [12:52]
A
Yeah. Since you're going there, let's talk about that. So I think the naysayers who say we don't have enough data to say the hormones for prevention of Alzheimer's, what they're saying is we do not have a 30 year randomized placebo controlled trial showing significant benefit for hormones and decreases. Right. So like that's what I think they're saying when they say we don't have enough research. Because to me, I'm like, if you talk to the people who know the data like you do, like I do, if you look at basic science data, how neurons work, how hormones work to protect glial cells and myelin sheaths, how estrogen helps glucose metabolism in the brain. Right. So if you take all this data, how Hormones help people sleep. How sleep protects you from dementia, Right? Like, how hormones. I'm like, I'm just giving people the laundry list of, like, this is why I would add how estrogen prevents diabetes, which affects the brain. Right? So it's like there's a laundry list of. Once you understand how this stuff works, we're like, oh, well, add in Dr. Lisa Moscone's meta analysis. Let's add in the male data with low testosterone. You just add on this pile. You're like, listen, maybe I'm wrong. But in the meantime, I'm protecting my bone, helping myself sleep, preventing diabetes, likely. It's all the things that lead to dementia. Right? And so to me, and I think. I don't know if you've seen this, too, is like, the end of this year, I think the beginning of 2020, like, the news media on hormones preventing dementia. It's getting loud. And so to me, I'm like, I think we're on the right side of it. And I think in a year, in two years, we're going to be like, listen, we don't know for sure, but, man, it's neuroprotective, man, it's metabolically protective, man, it helps you sleep, which prevents dementia. Like, that's what we mean when we say likely hormones prevent dementia. But, like, you have to have a podcast so you can actually, like, dispel all of that down. Did I miss anything that you'd like to add of why we think hormones prevent dementia?
- [14:52]
B
No, I just feel like I just need to be yelling it from the rooftops.
- [14:55]
A
Yeah. I feel like when people yell, and if I was to yell on. I broke the Internet one day when I said that the brain eats itself after. It was not my best clip, but. So when hormones go down, the brain can't utilize glucose, so the brain needs ketones. So where does the brain get ketones from? From the white matter of the brain. So it starts to catabolize, which is breakdown, which is what our bones are doing, which is what our muscles are doing, which is what our skin is doing. It's what our vagina is doing.
- [15:24]
B
Right.
- [15:24]
A
Like, is anybody surprised that the brain does this also?
- [15:28]
B
Right. Yeah. So I think that's the interesting issue. And, you know, one thing that actually makes me really sad, Kelly, is how many people say to me, I'm done with menopause. They say this all the time. They'll say, oh, I like your shirt. Menopause is hot. I'm so glad I'm done with that. Like, you're not done. I don't know how to, like, say to them, you're not done. Like, you actually, you're 53 years old. There are real benefits that hormone therapy can have for you. You're not done with aging. It's almost like saying you're done with aging, like saying you're done with menopause. So one of the things I'm actually trying to really explain to people that, yes, you should get treated in Perry, and yes, you should get treated in post, and none of this, like, I'm too old to get the treatment because the hormones are showing really good efficacy, both with the brain stuff, but also with the bone stuff and the heart. So that's something else I've been trying to get people to stop saying is that I'm done with that.
- [16:21]
A
I think that would be good marketing for midi, because it'd be like, midi because you're not done.
- [16:26]
B
Because you're not done. That's exactly right.
- [16:28]
A
It's so uplifting, too. And I think people say that because they do not understand fundamentally what menopause is, because the word menopause is no more periods. And with that comes hot flashes, right? So they're like, I don't have hot flashes anymore. My periods were eight years ago, So I must be done. And we're like, you don't understand. You're fundamentally live outliving ovarian hormone production. That's what the truth is.
- [16:52]
B
That's right. So we have to change that. We have to change that whole dialogue. I feel like that's my mission, is to change the whole dialogue. I really am trying to kind of yell about these things and get people to understand them better so that we have a different discussion about. About this. And it's the same issue with people thinking that menopause equals old ladies. If you think that's what menopause is, then employers certainly don't care about helping with menopause because they think all those women are gone and society just cares less about them. So trying to show young, vital women in perimenopause and menopause so that people understand that it's not an old lady thing, I think is actually really important.
- [17:28]
A
Yeah, totally. On the other end of you're done with menopause, which you're not. You always have low hormones. As long as you choose to live, live past your ovarian function is the you can't have hormones yet because you're have. You still have a period.
- [17:41]
B
Right. Another crazy one.
- [17:42]
A
Completely random.
- [17:44]
B
Yes.
- [17:44]
A
You can't have hormones because you have like blonde hair and you need glasses. Like having a period's irrelevant to actually what your hormones and your ovaries are doing. And the level in your body of hormones that your body needs to produce a period is actually quite low. Right. So like by the time your periods end, you really got low hormones.
- [18:03]
B
Yeah. So it's another thing. Right? Or just doctors will only prescribe birth control pills and they won't prescribe hormone therapy. So there are a lot of misconceptions we need to be getting rid of.
- [18:13]
A
I think in the next five to 10 years, hopefully. God bless. Hopefully five. We are gonna start treating perimenopause way more than we are now. And I think we're gonna start treating 10 years post menopause a lot more than. Cause the more and more I read and I break down the data on the risk of a transdermal estradiol patch in a 72 year old, there ain't a significant risk compared to. Look at all the other drugs 73 year olds are put on. Name a drug that is more safe in a 73 year old than a transdermal estradiol patch. I would argue vaginal estrogen, but besides that, like it is damn safe.
- [18:54]
B
No, I think that's right. So we have to just get rid of all these misconceptions. And I think, I mean people like you, people like us, like that's our job is to really. But what we have to do really is get women to look for this and demand it. This is going to be a movement demanded by women. It's not going to be a top down movement. It's very much a bottoms up movement of women saying I deserve better care and looking for that better care and then the market responding and giving it to them. So that's really the approach that I'm thinking of. It's not led by the government, it's not led by the medical organizations. It's going to be very much led by women who are looking for better care.
- [19:28]
A
Yeah, absolutely. I mean, women ask me all the time, they're like, how do I have this conversation? What do I do if my doctor doesn't want? And very often I say go to the online companies where this is their job, this is their job, this is what they do. Like I'm like, they're a warm audience. You want a warm audience when you want to present your pitch for this. And that's what's so great about your company is like, this is what you do. You don't have to be like, I hope they're good. Or, you know, do they prescribe hormones? No. That you prescribe hormones medically appropriate, you're going to evaluate everybody's risk and benefit differently is still healthcare. But you're like, we know the data on hormones. You don't have to teach us that part.
- [20:09]
B
No, that's exactly right. We need to know women's bodies and we need to understand women's bodies really well. And then we can give you the right medical advice because we understand how women are different than men. And you know, as we know, women were not even included in research studies until 1992. Right. So there's just not enough research out, men versus women's health. But our job is to do that research, to learn the research and then educate our providers on that research.
- [20:33]
A
Yeah. I mean, the exciting thing that's gonna come out of the big companies is your, I mean, your data sets. So many and so many wins and especially, you know, I'm excited about is like, what do we not know? What are you gonna be able to pick up that we haven't picked? What else is this helping with? You know, like all of that exciting stuff of like, when you look, you're gonna find stuff that's so exciting. What are some of your, like when you hear when people send you feedback and wins, like, what are some of your, like, favorite wins that you get from women? Starting the year with a wardrobe refresh, Quince has you covered with luxe essentials that feel effortless and look polished. They're perfect for layering, mixing, and building a wardrobe that lasts. Their versatile styles make it easy to reach for them day after day. Quince has all the staples covered. From soft Mongolian cashmere sweaters that feel like designer pieces without the markup to 100% silk tops and skirts for easy dressing up to perfectly cut denim for everyday wear. Their wardrobe essentials are crafted to last season after season. And here's my personal story. My decades long trusted brand of underwear discontinued its women's underwear line in 2025. So who to trust that is comfy and high quality. But as I have sweaters, a puffy jacket, and now a down comforter from Quinn's, I thought, heck, I'll give it a try. Well, they nailed it. High quality and comfortable even below the belt. Refresh your wardrobe with Quint. Don't wait. Go to quint.com notbroken for free shipping on your order and 365 day returns. Now available in Canada too. That's q-u I n c e.com notbroken to get free shipping and 365 day returns. Quint.com notbroken oh, you know, I often.
- [22:20]
B
Feel like I have, like the luckiest job in the world. I mean, I could just read you the things that came in today. We have this channel of kudos that come in and people basically saying that they usually we save their marriage, we enable them to go back to work. Lindsay was great. She was able to get me started quickly on my plan. She was informed and I feel like she really heard me and genuinely wanted to help. They go on and on and on. It's pretty remarkable. I mean, honestly, you don't need to know this, but the reality is once you get someone on the right medication, they feel better very fast. And then they're kind of amazed how fast. Right. That they're feeling better and how much better they spent. Right. I mean, this person says, this person has so many great things to say about how Mitty changed her life. We were teary at the end of her call when she recapped the last year of her journey. Another one, I feel incredible. And recently received a promotion at work. I couldn't have done it without Mitty getting me back on track. I mean, they just come in all day. It's really, it is very rewarding.
- [23:20]
A
Thank you so much for sharing those. And to me, I'm like, yeah, Joanna, I know. That's why.
- [23:24]
B
Exactly.
- [23:26]
A
For the people who don't know, like, the wins. And this is what I always tell people. Like, I gave up surgery to make high functioning women be high functioning again. That's my job. Make smart women function again. Because the wins are so big. It's insane. I'm like, when you fix somebody with surgery, you're like, don't get me wrong. Taking a kidney stone out, that's a big deal. You're turning their life around for sure. But like, the wins that you get when you get women to feel like themselves again is absolutely insane. I just did a follow up with a woman yesterday. It was my first follow up. The first time I saw her, she was ready to quit her job and now she's like, oh, yeah, no, no, no, I'm good.
- [24:07]
B
Exactly. That's exactly right. That's what I think. I feel like my job is that I save marriages and I save jobs and mental health. We save mental health. Yeah, definitely. A lot of women just present with anxiety, Right. And they were never anxious before and they find that it's debilitating.
- [24:24]
A
I had a woman who stopped vaping when we Got her hormone doses, like, dialed in. Cause she's like, I just don't need it anymore. And it's like, I feel like society where we are, we look at the general population, we're like, some people are just anxious and some people just need to vape. And so, like, we're so used to just being like, that's how you are. And we've lost our curiosity of, like, what could we do to make it a little bit better?
- [24:50]
B
I think that's right. Particularly for women. I think. I mean, I just think there is some misogyny about this. And I think women have just really been told that if you're suffering, it's just okay. And I don't really understand that. But I feel like that is just a big part of our society. When you think about it with giving birth. Right. Like, the pain that women feel has been part of that. I think accepting women's pain has been. And accepting women's aging has just been something that is just par for the course. And when our eyes go bad, we get glasses. Right. Like, we don't. Why is it that we have not thought about the same for women's bodies? And instead we've just been very willing to accept the fact that they are just less important as they get older. And maybe that's why we don't need to take care of them.
- [25:33]
A
Yeah. Hearing aids, eyeglasses, teeth, shoulders, hips, knees, heart valve, take out the appendix if it bursts. If you need insulin, give it to you. If you need thyroid, give it to you. But don't replace your ovaries. Like, it becomes this one exclusionary organ. When you look at it like that, you're like, that doesn't make any sense, though.
- [25:52]
B
Yeah. So I don't understand that. You know what? But it's really clear to me that has to change. And that's going to come from women. It's going to come from women demanding better care. And that is just, you know, it's not going to come from the government. I mean, we can talk about this. You know, the government's trying to pass these menopause bills, and that's not going to be the answer. It's going to have to come from women, and it's going to come from women demanding better care. And that's how the change is going to happen, with women basically showing up at their doctor's office with your book and saying, I would like to do what Kelly Casperson says. That's how the system is going to change. And I feel really strongly about that it is going to be driven by women being proactive about their care.
- [26:27]
A
Yes. And I. When I was doing my book tour, I came upon something that now, I repeat, because it makes a lot of sense, is like, culturally, we've got two waves hitting each other. We've got the millennials. The millennials, because they're like, how do we tell these young people about what's going to happen? And I'm like, that's important. But let me tell you something. They're paying attention. They're watching, right? So these millennials are watching the Gen X. They're watching the boomers, and the millennials are coming up. They're like, hey, I've got a new idea. How about we don't suffer in the first place? Right? And then the Gen X and the boomers are looking at the millennials and they're like, oh, what an idea. So let's start the hormones earlier. Why are we waiting for bone loss before we try to replace bone? Why are we waiting for depression and anxiety? Why are we waiting for diabetes to happen? Why do we not suffer in the first place? So that's this big cultural wave that's happening, and it's hitting this big cultural wave called the medical system, as it currently is. And I'm like, you got these two waves that are crashing on each other right now. And I know who's going to win. The millennials are going to win. And every time I say that with a. With an audience, people are like, damn straight. Blah, blah, blah, blah, blah. It's like, dude, they're demanding change. They ask a great question, why suffer? Right? We're like, oh, it seems. Why didn't we think of that? Like, we're like, why didn't we think of that?
- [27:46]
B
Yeah, well, look, and we look at our old ladies, like, you know, you see old ladies who are crunched over. And I feel so sad about that, right? That they weren't given things that could have helped them or told they should do weightlifting or told about hormones. Like, there's so many things that could have been done that you don't end up like that. And so, you know, I'm sure that the younger women are looking at women like us going, I don't want to end up like her.
- [28:08]
A
Yeah, yeah. Well, totally. Cause, like, you know, like, they're like, why are you bitching about something that you can do something about?
- [28:14]
B
Right?
- [28:14]
A
Well, I think about this, like, when I get off an airplane and I see the women have to have help to get into a chair to be Pushed. Like, they're. And they're not independent. Right. And my mindset has changed just in learning about this. Instead of, like, that's how it is. That's how it's going to be now my mindset is, why did nobody help her? Why didn't she go get help if she knew? Like, it doesn't have to be like that. And I think that's the culture change is we're like, we're watching enough old people do it default. Like what it looks like if you aren't proactive. Default sucks.
- [28:47]
B
And I think it's, you know, that's the concept of longevity. Right. But I think it's female longevity is just, how do we live healthier. Right. It's not so much I'm not trying to live longer. I just want to not be that woman in the wheelchair. I want to run after my grandkids. Like, I want to have energy and live a vibrant life. And so what can I do? I think a lot about this. Like, what can I do in my 30s, 40s, and 50s so I can live the life that I want in my 70s and 80s? And that's a lot of what menopause care is, quite honestly.
- [29:15]
A
Oh, man. Hormones is female longevity. And I say this over and over. Cause I don't think people understand it. Hormones help healthy cells stay healthy.
- [29:23]
B
Yeah. So that's the ultimate longevity medicine for women. And I really believe that.
- [29:27]
A
The ultimate longevity medicine. The other huge bias, I think is in medicine, we study blood pressure medications on men and then give them to women. We study sleep meds on men, we give them to women. Study antidepressants on men. Give them to women. But with, like, all of the decades of testosterone data in men, we're like, but now we need individual woman data before we can give you any testosterone.
- [29:48]
B
Yeah.
- [29:49]
A
And I'm like, that doesn't make any sense. And furthermore, that's massively expensive. It's not gonna happen. Understand how testosterone fundamentally works, which is neuronal support, muscle support, bone support. Like, it's a brain neurohormone. The fact that we're, like, on the Internet is, like, its primary job is male sexual characteristics. I'm like, well, male brain. It's brain. The stereotype is so profound with testosterone. Tell me about your journey with that and where, like, did Mitti, from the ground up say, we're always gonna start trying to do testosterone. Like, why bring it in when so many people think menopause care is just an estrogen patch?
- [30:28]
B
So what was interesting about testosterone Is that. I mean, the world has really changed just in the last few years. Maybe not you, but overall, the research wasn't there for more than libido a few years ago. So initially, when we started offering testosterone, right now it's in 12 states. It will be in 30 states starting in January.
- [30:49]
A
If they deregulate it, we're actually holding our breath because we think they're close.
- [30:53]
B
Okay, well, we're going to find out, but I'm not. I will. By the time this comes out, we'll know who's right or wrong, but I am not optimistic.
- [31:00]
A
Ooh, this is good.
- [31:01]
B
But regardless, because right now you understand, just for the audience to understand, it's a DEA regulated substance, which is crazy.
- [31:09]
A
Because of a sport doping.
- [31:11]
B
Because a sport doping scandal in 1990.
- [31:14]
A
Yeah. Not because it was dangerous to the general population. At general population doses.
- [31:18]
B
No, it's ridiculous. But because of that, it's incredibly difficult for telehealth providers to do it. We've figured out how to navigate in 12 states. We're working. We're going to have 15 to 20 more states in January. But, boy, this has been an insane amount of work. Maybe Kelly's right and we will not have had to do it, but we'll find out.
- [31:35]
A
Joanne is such an optimistic, optimistic, energetic person that I'm like, oh, my God, I'm more optimistic than you on this one. This is wild. I'll take it.
- [31:43]
B
I know, but the research, even if you look at the protocols we wrote four years ago, we were only talking about testosterone for libido, but the research is really emerging, often from Europe, showing that there's many more benefits of testosterone, that there are some mental health benefits to it, that there's bone strength benefits to it. So it's exciting to see that emerging research. And so we are now retraining all of our providers on this new research, and this is what I say. Yes, yes. It's not FDA approved for women.
- [32:15]
A
Proven.
- [32:16]
B
No. Is it 100% proven? No. But again, we'll all be dead by the time that proof comes out, so. But the research is good enough that now I feel really good about saying there are other things that we can be offering it for. And since there's no downside, as long as you test your blood levels, it's worth trying.
- [32:31]
A
Yeah. I'm going to go out on my plank on this one, because if you read the male data on the risks of low testosterone and the risk of depression and dementia, and then you think that doesn't apply to female brains like neurons are fundamentally the same people. We've got rearrangements in different ways, but the neurons function fundamentally the same. We've got the same building blocks. Right. So like this is my argument going back to the dementia. It's the number one killer of women in Australia right now. It's quickly likely by next year will be the number one killer of women in the uk. America's headed that way. Two thirds of dementia people are women. Devastating psychologically, but certainly financially. No good cure, no good treatment. So that's the argument. Okay, and now you're telling me there's something that's cheap, fantastically safe, has data in men that it decreases the risk of depression and dementia and we're not curious about this. Like it becomes a fool's errand at this point because I'm like, tell me again why this doesn't make any sense to anybody. Fiscally responsible financial geniuses, monetary magicians. These are things people say about drivers who switch their car insurance to Progressive and save hundreds. Because Progressive offers discounts for paying in.
- [33:51]
B
Full, owning a home and more.
- [33:54]
A
Plus you can count on their great customer service to help when you need it. So your dollar goes a long way. Visit progressive.com to see if you could save on car insurance. Progressive Casualty Insurance company and affiliates. Potential savings will vary.
- [34:08]
B
Not available in all states or situations. I do want to make a pitch for the shingles vaccine. There is good research also on the shingles vaccine of helping prevent dementia. Really exciting new research.
- [34:20]
A
It's exciting because of decrease in inflammation. Is that the mechanism?
- [34:23]
B
But it looks like. So if you're over 50, you should be getting that shingles vaccine.
- [34:27]
A
Inflammation is bad for the brain.
- [34:29]
B
Yes. Right. And that's the same thing with GLP1s could be. So it's all interconnected. Right. Our bodies are so connected and it's. I think part of the problem is the healthcare system has said, oh, here's a brain doctor and here's a bone doctor and here's a, you know, it's not all seen as a one body.
- [34:43]
A
Well and I think the other problem that medicine did is they said, and I think that, you know, they started doing this like really 20 years ago, is that they're like the gold standard is a randomized placebo controlled trial. That actually is true in certain circumstances, but it's like for long term things for preventing disease. For like there's so many things we do that don't have randomized placebo controlled trials. For example, exercise. We're never going to tell anybody hey, you're the group that we don't want you to exercise because we got to see if exercise is actually good or not. And exercise can cause harm. Sometimes you can get hurt. There are risks to exercise, right? So to me, I'm like, there's plenty of things we recommend that don't have randomized placebo controlled trials. So for people to die on that stake, I'm like, you're just willing to say status quo is acceptable?
- [35:31]
B
Yeah. So that's. I think that's the really interesting thing. If it doesn't harm you, why not try it? And so what I've tried to do at midi, and this is like my. And our philosophy, not just my philosophy, is give women access. Stop saying no. Stop being a gatekeeper. If women are interested in things, whether it's testosterone or hormones or, you know, we're looking at things like Samorelin and other peptides, like, give them access to what they'd like to try, see if they feel better. If it's no downside, why not? Why should we stop people from getting something that could actually make them feel good or can prevent them from getting sick in the future? And it's just a different way of thinking about medicine. But I think it's a very empowering way of thinking about medicine. And I think it is what women deserve, which is access to the best solutions, and then they can choose whether they want to take them.
- [36:17]
A
Ultimately, it comes down to body autonomy of like, listen, if I want to eat four sticks of butter every day, people can tell me, that might not be the wisest thing, but my body, my choice, I'm going to eat four sticks of butter every day. And with prescriptions, it does require a partnership, right. With somebody who can prescribe. And I learned in medical school. So it's like 25 years ago, shared decision making, shared decision making. And every time women's health comes up, it's like we forget about shared decision making again. Is like, this is supposed to be a partnership. It's supposed to be, let's try it, come back, adjust, see how you do. It's not a black and white open or closed door. And so often women's health is treated like a black and white open and closed door.
- [37:01]
B
That really is one of our top beliefs at MITI is in shared decision making, autonomy and shared decision making. I think that is key. We talk about breast cancer patients who come to us, right? And some of them are really suffering. And if it's been some number of years post breast cancer, we're Willing to give them hormones. And we think that's a shared decision you can make together. So I think that is what is really important. You shouldn't just be told no. You should be given options. And I don't know that. To me, that is certainly what I'm trying to empower women to get.
- [37:29]
A
Yeah. With breast cancer, it is, again, culturally, having to change medicine, because what's medicine rewarded for? What are all the studies for? How long can you live without having this disease come back? No matter if you get divorced, have to quit your job, can't get off the couch, Hot flashes are so bad. Like, these women, their genital urinary syndrome, menopause, is so bad they can't wear pants. Right? And so it's like, we've completely lost the humanism in the. Like, don't do anything that might affect our statistics or don't do anything that.
- [38:02]
B
Might affect the breast. Have you noticed that, like, the breast is the. Like, you know, everyone's so worried about the breast. The breast is important. I'm not downplaying that. And breast cancer is terrible, but, like, women are more than their breasts. Like, we really are our whole bodies. And I think that's really important.
- [38:16]
A
Yeah. And I will stereotype, and I don't mean to, but the average post breast cancer survivor will come in and wonder about hormones. And we downplay her suffering. We just don't think her suffering is ever bad enough. And I'm like, who are we to judge? Who are we that are the litmus test that say they aren't suffering enough? It's not like, these women are like, I am perfectly fine. Can I have hormones? Like, I have no issues. Can I have hormones? Like, these are profoundly suffering humans, and we've lost the humanism in healthcare because of us saying nobody wants their breast cancer to come back. And breast cancer is stupid and evil, and it comes back super late. And I hate that about it because it makes this all difficult. But, like, we've lost the human part of caring for humans.
- [39:04]
B
Yeah, I think that's right. I had just last week, I was at a party, and there was a woman who came to me. She started. She him hugged me, and she started crying. She said, you know, I had breast cancer 10 years ago. No one would give me hormones. I thought my life was just over. I couldn't have a partner. Like. And she said, and Mitty did give me hormones, and it has changed my life. And she started crying, and I was like, oh, you know, that's my job. I'm so lucky.
- [39:25]
A
Why do we treat women like they're stupid? I mean, you're very, very smart. And I think I'm at near the top of the bell curve on some areas of intelligence. Like, we're really smart people. It's like, why do we assume that women are stupid? We know we're smart. It's so incredibly true. One of the other myths I know that we wanted to bust was, how long can I take these hormones? Do I have to stop at a certain age? A woman came to me just to elaborate on this point, and she said, I hear this all the time on my Instagram. My doctor said I shouldn't start hormones. Cause I'll have to stop them at some point.
- [39:58]
B
Isn't that horrible?
- [39:59]
A
Which we don't say about anything else. Don't get married cause you might get divorced. Don't treat your blood pressure because someday you might not need a blood. Like, we don't talk about that with anything else. It's this really weird thing we say about hormones. Hormones.
- [40:11]
B
It's just as far as I can tell, you're the doctor, but wrong. You should never go off of your hormones. Like, because they're keeping your bones strong. And so why would you ever want to go off of them? And I don't actually even understand why they think you should go off. And I think the menopause society has changed its position on that. But I tell women I'm gonna die with my patch on, and I don't know why they would ever stop taking it.
- [40:33]
A
Yeah, I always tell women we've got the menopause guidelines on our side because it says yearly benefit outweighs risk. As long as benefit outweighs risk, you can continue. That's what the guidelines say. So to me, I'm like, the guidelines are on our side on this one. You can take it to the grave. And I always think, I've gotta find these people for my podcast or we need a documentary on these people. So when the WHI hit, about 20% of women stayed on their hormones. And now it's been 25 years, and some of them are still on their hormones. Like, they have fought and found doctors, and the doctors retired and they moved towns. Like these women have stayed on hormones through hell and high water finding somebody who will do it back in the day when the culture was so against it. And so now these women are 84 years old, they're in their 80s. And I thought I was like, is it just me? But like, my friends say this too, of like, when they walk in we're not perfect, but we could tell. We could tell you're on hormones, right? There's this vitality, there's this like, speed of movement, there's this like, effervescence of energy, right? They're not worn down. So my point is, and I tell this to women, I'm like, go find an 84 year old who's been on hormones ever since menopause. They exist. Go find one, ask her what she thinks about stopping hormones.
- [41:52]
B
People tell me all the time they can tell who's on testosterone. Women, right? That there's like a certain look of women who are on testosterone and they look a little happier than everyone else.
- [42:01]
A
They're starting. They're starting the businesses I have. So, like, my rough study is I know eight people who've started businesses since starting testosterone. And people are like, you can't tell. You can't say, women start. And I'm like, well, women have told me they've started businesses because they got started on testosterone.
- [42:17]
B
I mean, I've heard, like, they definitely feel really good. And, you know, feeling really good enables you to do a lot of things.
- [42:24]
A
I mean, I think that's the bias. Like, I'm a sex med doc. I help people have better sex. And I hate that testosterone's gotten stereotyped as libido. I think there's at least eight issues with that. But it's number one, just how the body works. Like, you don't have this, like, secret organ that's just for having sex. And it's like one inch big, and it's on the left side of the. It's insane to be like, just for libido. Like, it's just for your left thumb of like, libido is. Libido is a motivation, which is a mood. So when people say it doesn't help mood, but it helps libido, I'm like, you just said two opposite things. You don't get to be right in all of those things. It's not how it works. It's why are they starting businesses? Why are they rebuilding their deck? Why are they getting a project done? Why did they ask for a promotion? It's a motivation towards something. This is a neuroendocrine drug that is a motivating thing, which is hard to study and it's hard to X ray. It's like, how do I know Joanna isn't motivated today? Right? Like, I have to believe her when she tells me that. This episode is brought to you by Peloton Break through the busiest Time of year with the brand new Peloton Cross Training Tread plus powered by Peloton iq. With real time guidance and endless ways to move, you can personalize your workouts and train with confidence, helping you reach your goals in less time. Let yourself run, lift, sculpt, push and go. Explore the new peloton cross training tread plus@onepalaton.com so what are all of our myths today? There's no absolute age limit. You can start in perimenopause. You're not done with menopause ever. You're always low hormones. I think the big myth is you can't start after 10 years.
- [44:01]
B
Oh yeah, that's a big one too.
- [44:03]
A
That is absolutely. Based on initial WHI data. Because even if you read the 2004 New England Journal of Medicine paper, let alone the 18 year follow up paper. Right. So even time adjusted WHI people did not do poorly. Hardly at all. So. And that was oral synthetics. I just think that we're looking at the wrong data when we say women over the age of 10 years post menopause can't be on hormones. Plus hormones is a big 10.
- [44:32]
B
Yes. There might be less benefit. It doesn't mean there's not any benefit. And so again, it's the risk benefit analysis that every woman should get to make for herself.
- [44:41]
A
That's exactly right. Yeah. And shared decision making and body autonomy, all the things. What do you think the biggest challenge is for a company like yours looking into the next year or two? Like certainly it's not a saturated market.
- [44:54]
B
No. Right. It's just, we're just getting started. Honestly, the way I think of it is that what MIDI is building is a healthcare home for women. And we want to make sure that women have a place to go for all of their women oriented things. And I start thinking about hair loss and I start thinking about aging skin and I start thinking about postpartum issues. Like there's a lot of different areas that we want to go as we build out this health care home for women. The biggest challenge for us is actually finding and training great providers. So we have a very extensive training process and we do a lot to try to make sure that everyone gets really good care. But that's a hard challenge for us because as you mention all the time women were not trained in this earlier. So we have to do the training and a lot of providers come to us with the old information. So we have to retrain it. Right. They've been told no hormones after 10 years, you know, they've been Told a lot of the old rules that we have to get out of them, and that's hard. And so my pledge is that we get all of those providers to be experts in women's health and, and then make sure that everyone gets access to great care. And that's really what we're working hard to do.
- [46:01]
A
I love it. I love it. I couldn't thank you more for solving this problem. So this is what I, what I say when people talk to me about, like, what do I think about the online companies and blah, blah, blah. And I'm like, I call online hormone clinics mass transit. And I'm like, we need mass transit to solve. Going back to the menopause math problem of like, we need mass transit. I have a concierge clinic. We cannot concierge our way out of this problem. I think concierge is good for certain things. Mass transit's going to actually move the needle on this.
- [46:32]
B
I think the reality is the healthcare system is what it is. Like, the healthcare system pays a lot more for procedures and surgeries and complex care and specialties than it does for this type of care. Which means that the healthcare system itself is not going to build more of this care. It is not financially incentivized to do so. So no healthcare system is incentivized to hire a whole lot of menopause providers because for that slot that they have a doctor for, they will make so much more money on cancer care, so much more money on surgery. And so we need new incentives. And what we've realized building MIDI is that because we don't have to have in person care because we're able to license people in multiple states, we can actually build a business that works and that can provide this type of care in a way that in person cannot. Build a business that. A scalable business that works. Absolutely. The concierge is great. And if you can afford that, that's fantastic. It's just not easily accessible for everyone.
- [47:34]
A
It's not going to solve the problem.
- [47:36]
B
So what we need to do is build a new healthcare system and we need to build a new way of people getting healthcare. And that's really what we're thinking about is our thought is that we become the first trusted brand for women's health and we're building a national trusted brand for women's health, a healthcare home for women. And that national company will be able to take care of a lot of women. If you need in person care, we will always get you there. We will always make sure women get their mammograms they get their colonoscopies, they get their DEXA scans, they get their blood tests. We'll always make sure that if you have cancer, which we're diagnosing every week, we get you to a great cancer doctor. But essentially there's this layer of virtual care for menopause that this is the best business model to solve that. And that's really what we're doing.
- [48:18]
A
You're so inspiring. You are a visionary. You're a weight watcher's loss for sure, but women's gain for sure. Like, thank God, you know, you're like, you're like, these people aren't moving fast enough. I know what, I know what the future looks like. Like, let's go get this done.
- [48:35]
B
Honestly, I'm so lucky to get to do this. I feel extremely lucky every day.
- [48:39]
A
Oh, I know it's the best show. Like, I came home yesterday, my mother in law, my father are in town, and they're like, how was your day today? And I'm like, it was the best day. Like, it was just a day of wins, you know, it's not everybody that gets to say that. It's so rewarding. Ah, well, thank you so much for joining me. This was a blast. I hope you had a good time too.
- [48:59]
B
Thank you. This is really fun. I'm such a fan.
- [49:02]
A
Ah, well, the feeling's mutual. I'm like, look at what she built. People, we must talk about this. All right, until next time.
- [49:09]
B
Great.
- [49:10]
A
Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment. And you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and adult Sex Ed Masterclass members get the master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests, including on this podcast, are not giving individual medical advice or practicing medicine. See in consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember, you are not broken.