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- [00:01]
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- [00:56]
Dr. Kelly Casperson
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.
- [01:10]
Hey everybody, welcome back to the you're Not Broken podcast. I am excited to have another female urologist on today because there are some of my favorite people because I'm completely biased. So we're going to talk to Dr. Helen Bernie today, D O MPH, Assistant professor at Indiana University and a star of the FDA men's panel Health on testosterone. Which was was that December or November 2025?
- [01:30]
Dr. Helen Burney
December 10, 2025 2025.
- [01:33]
Dr. Kelly Casperson
Welcome to the podcast.
- [01:35]
Dr. Helen Burney
Thank you so much for having me, Kelly. Super excited.
- [01:38]
Dr. Kelly Casperson
So for anybody who wants to watch the FDA men's panel focused on testosterone, it's free online at the FDA YouTube. Only 46,000 people have watched it. So I want to open this podcast is mostly focused on men, but I just need to open with like the big news of this whole thing. So after the FDA did their cause we we've already submitted an abstract and like I've already done a PowerPoint on it. So FDA did their men's testosterone panel. They opened up a website portal for public comment which most people don't know about those things, but we went on social media and we're like, go tell the FDA what you think about testosterone. And it was interesting because a lot of women were like, hell yeah, here I go. And a lot of women were like, it says men. And we're like yes, we know. But they didn't do a woman's one. So just tell them what you think about testosterone. So we've pulled all of the comments. The FDA panel closed, pulled all the comments around. 86% of all of the comments were asking for women's testosterone. Take that, men's panel on testosterone. And one of the more powerful quotes, and again, we're, we're just starting to roll this out. One of the more powerful quotes from a woman is, I feel like a criminal. The way we currently have to access testosterone.
- [02:52]
Dr. Helen Burney
Yeah, it's the same for men too. There's such a surprise.
- [02:54]
Dr. Kelly Casperson
It's the same for men around, isn't it?
- [02:55]
Dr. Helen Burney
Right. These guys that actually need something that it takes a disastrous event to bring them into the doctor. Right. Like takes up the courage and the nerve to get to a doctor. Now the doctor goes and has to check on a database because It's a Class 3 schedule drug to see, oh, are you getting testosterone from anywhere else? Then you prescribe them a one month supply that can't be refilled until exactly four weeks or 28 days later. Then they go to get that filled and then they have to double check. Then after three months or maybe six months, whatever their plan is now they have to get another prior authorization, have to go through the whole screening. It completely stigmatizes it. They feel like they're drug addicts, they feel like something's wrong when there's already so much public misinformation about testosterone use, its benefits, its cons, what it can do, what it can't do, its risks. And then now we're treating it in this way. This is also why physicians are scared to prescribe it. Right. Because it's such a big deal and they're worried they're doing something wrong and they weren't educated how to do it and they don't want to hurt patients and it's just too much work. So this leads to the huge disempowerment for both men and women of getting normal hormone levels.
- [04:00]
Dr. Kelly Casperson
Most doctors don't know because I didn't know. I went through urology residency, I prescribed testosterone periods. I didn't know why it was DEA class restricted because I'd never bothered to look it up. Right. And so the stigma of that is that it's addictive, that rumors around a lot. It's addictive, it's dangerous performance enhancing, which isn't real medicine. Like all these stigma against it. And then you realize, oh my God, a DEA class restriction came because of a vote of Congress, not because of any harm to the average American. It's actually not based in science that it is DEA restricted. We just got pissed that the East Germans won some golds in the 1980s.
- [04:39]
Dr. Helen Burney
It was completely political. You're absolutely right. And actually when they did the steroid controlled act in 1990, because of this, there's now been studies since. There's a great one from University of Michigan where they looked at it. So did we actually prevent high school, middle school students from actually getting prescriptions of testosterone? We showed it didn't change anything. So the act being prescribed to help or back being in place to help prevent the people that shouldn't be on testosterone from getting it instead. All it did was the reverse. It made it harder for people that actually need the medication to get it. And it didn't change anything. And the young athletes, you know, this is where work is more being empowered by groups that are looking to, you know, bring athletes to major schools and colleges to show them that, you know, you don't need to have performance enhancing medications or drugs. But actually it's harmed the people that actually need it the most.
- [05:29]
Dr. Kelly Casperson
That is absolutely wild. My hope for 2026 is that we're gonna get it deregulated. I'm losing a little bit of sparkle hope because The Men's Health FDA panel was December 2025 and we're many months into 2026 now and we haven't heard. But I'm like, don't lose momentum. I hope something good comes from that men's panel. The most good being deregulation, I think.
- [05:53]
Dr. Helen Burney
Same, same. And normalizing screening. Right. Like we're missing a huge window of preventative healthcare to help improve men's overall health. And men in this country need that.
- [06:03]
Dr. Kelly Casperson
What's the push for urology and the AUA to have screening guidelines? And again, urologists aren't primary care, so it's not really screening. Usually you're symptomatic when you see a urologist. Right? But like getting into the societies for screening because. Let's talk about it. Testosterone deficiency is common and there's increased. We can talk about increased risk of diabetes, we can talk about increased risk of body fat mass being up. But mortality is really like, do you really need to say anything else when you just say there's increased risk of mortality in men with low testosterone. So if that is true, two times
- [06:40]
Dr. Helen Burney
higher rates of all calls.
- [06:42]
Dr. Kelly Casperson
We screen for high blood pressure, we screen for diabetes.
- [06:45]
Dr. Helen Burney
Here we have a test that can predict and detect earlier diabetes, cardiovascular disease, osteoporosis, and yet we aren't using it not because of science, but because we don't have the permission to use the science. And the decades of data that show us that low testosterone predisposes to cardiovascular disease, diabetes, metabolic syndrome, osteoporosis, and two times higher rates of all cause mortality in men. I mean, this is the biggest fallacy of medical health care, right? Like not normalizing. Here we have a marker that's a blood test, a routine blood test, and yet you go to a primary care doctor's office and you get screened for thyroid stimulating hormone, your lipid panel, your glucose, but not testosterone. Something that could actually predict earlier intervention to help change men's overall health and outcomes. But yet we don't even screen for it or check for it. And so this has really been my biggest, like, TED Talk pushing is like, let's screen for this. We are missing huge areas where we can improve not just older men, but younger men, because men in the United States are dying earlier than women. By 7 years of 9 out of 10 of the leading causes of death, 7 years from 9 out of 10 of the leading causes of death. Men have lower fertility rates, overall health rates, cardiovascular disease, suicide, mental health issues, depression, mobility, all of these things. And we're not screening for a routine test. And in fact, people feel uncomfortable screening for it because of the Class 3 Scheduled Drug and because no one was taught it, just like you. I wasn't taught in medical school. I think maybe I was given one lecture that lasted maybe 30 minutes that briefly mentioned testosterone in the terms of fertility, and that was it. There was nothing teaching me how to prescribe it.
- [08:30]
Dr. Kelly Casperson
Totally. The other crazy thing about testosterone is it kind of stereotype is like, oh, urologists handle that.
- [08:35]
Dr. Helen Burney
Blah, blah, blah.
- [08:36]
Dr. Kelly Casperson
We're comfortable with that, blah, blah. But actually, a lot of urologists don't do testosterone, let alone female testosterone. But like, a lot of urologists don't. And now what you're finding, what you're telling me before the podcast, is that when you get guys stable on their testosterone dose, you say, hey, you can go back to your primary care, and you're finding primary care won't take the guys back on to do refills.
- [08:55]
Dr. Helen Burney
Exactly, exactly. And I think a lot of that is from miseducation. They're scared of the risk of hurting a patient. They weren't trained how to do it, the stigma that follows testosterone and the Class 3 scheduled labeling. So those are the biggest areas where we're missing improving men's health.
- [09:09]
Dr. Kelly Casperson
It's so wild because I spend most of my day Advocating for female health. And people do pipe up and I listen to them, but they're like, but the men, it's not good over there either. And we're like, I don't think we're saying it's good over there. Right. Like, it's. Nobody saying, like, oh, I mean, in all fairness, men do have, what, 12, approximately, depending upon what's available at the pharmacy, 12 testosterone products. For something where they have maybe a 20% population deficiency, when you can argue women 100% will have testosterone deficiency, we have zero products. That is a glaring inequality. But nobody's saying it's good or easy for the men. We aren't handing out Testosterone at the 7 11.
- [09:50]
Dr. Helen Burney
Right, right. And I really don't see this as a zero sum issue between men and women's health. We have made incredible necessary progress in women's health, still have miles and miles to go and attend, you know, and actually think that's the model, what we've done with women's health. You know, the question now is, how do we bring that same level of attention, of coordination of care, of research focus to men's health? Because what's striking is that men are falling behind in multiple areas. Shorter life expectancy, higher rates of suicide, lower healthcare utilization, they have more access to guns, lower health care utilization. And yet there's no coordinated national strategy to address this. And so that's really where this new bipartisan support for the idea of a foul federal office of Men's health comes in. And it's not to compete with women's health at all, but it is to complement and create a more complete public health approach. Because when we improve men's overall health, when we have stronger men in the country, they make better partners, they make better families, they're better in the community, they're better in the workforce. It strengthens everybody. And as we know, most women are oftentimes the partners that are helping utilize that health care source. Bringing men to the doctor, their sons, their kids, again. So it's not a zero sum. I really think that this is the biggest thing is that this is a public health issue where we are falling behind in both areas that we really need to direct federal coordinated approaches to fixing this.
- [11:11]
Dr. Kelly Casperson
I love that. And thank you for speaking up. I mean, I think what. What the women would say or the people, you know, I see, because I see on the Internet all the time, you see these reels, I guess, and they're like, hey, women weren't even researched until 1993.
- [11:23]
Dr. Helen Burney
Right.
- [11:23]
Dr. Kelly Casperson
And so we feel like, there's this really big catch up that needs to happen. And then we're like, what men need amend fda, blah blah, blah. Like women weren't even researched for. And it's, it is trying to be a zero sum game of like, hey, let's make sure we get ours. But then we're like, if we haven't been researching women and men's health come is so much worse than women's, what the hell have we been doing for anybody?
- [11:47]
Dr. Helen Burney
Exactly. Exactly. This is where healthcare system really needs a reform on both sides. This is a public health issue, not a men issue, not a women issue. It's a public health issue. Right? Our country is not healthy. 30% of kids are obese. We have epidemics of diabetes, obesity. And you know, with men, unlike women in the hormones, you know, with the men's space, people always attribute the low testosterone to aging. It's not, it's such an insignificant amount that's related to aging. It's related to comorbidities, obesity, diabetes, metabolic syndrome, other comorbid conditions that cause this. So again, for men, this is a big preventative screening marker because men don't like to go to the doctor. But you know what, as urologists, you see it too. If you can't have sex, if you can't pee, and if you can't make a baby, those are three really strong motivators to get a man into the doctor's office. And then this is where we can screen them, we can plug them in, and we can improve their overall health by prevention and education.
- [12:45]
Dr. Kelly Casperson
Yeah, totally, totally. And again, it goes back and this is not specific to women's health. Like, men don't know either. I was talking to a guy and he was having trouble with erectile dysfunction. And I'm like, dude, alcohol's really bad for erections. Like, it's super bad for erections. And he's like, what? He didn't know. And he was spending a lot of money trying to solve this problem. And I'm like, you got to stop with the daily alcohol. Like, penises hate daily alcohol. And he's like, I didn't know that, you know, so it's like, erectile dysfunction is a great opportunity to clean everything else up because people aren't aware. Like, the penis doesn't like diabetes, it doesn't like heart disease, it doesn't like cigarettes, it doesn't like alcohol. Like, it's, it needs sleep. The penis has very specific needs.
- [13:29]
Dr. Helen Burney
And men don't know that it is an erectile dysfunction. Is an early marker of cardiovascular disease. In fact, it's a better biomarker of a man's health than lipid panels, than smoking or hemoglobin A1C levels, which is a marker of diabetes. It is a better marker and it's a harbinger for men's overall health.
- [13:48]
Dr. Kelly Casperson
It's kind of like the male periods, how much weight we put on women's periods. Are they regular, are they painful, are they heavy, are they blah, blah, blah. And we're like, dude, the same sort of health biomarker is the erection.
- [14:01]
Dr. Helen Burney
That's so true. And no one's talking about sex, right? Because we're in the US and we can't talk about sex or erections. And so everyone comes with their own, like, backgrounds, right? Like, it's, oh, gosh, you know, shame or guilt or I can't talk about this. But yet this is your normal body. And if we can't educate and talk about your normal bodily functions, how can you advocate for yourself and your overall health? And so, again, whether you're a primary care doctor, an internal medicine doctor, an endocrine, a urologist, whoever, this is all questions we need to be asking. And it's as simple for men and women. You know, for men, obviously, that's the field, that's mine. But again, focusing on any problems achieving or maintaining interaction, yes or no, Bam. Now we have pathways. Let's check your testosterone. I mean, that's part of the AUA guidelines. Let's check your lipid panel. Do you have obstructive sleep apnea? What's your sugars? Right, all of these areas to plug in and improve overall health instead of never asking about it. Now, 20 years later, this guy that's been smoking cigarettes and had poorly controlled diabetes all his life, he doesn't understand why now he has zero erections.
- [14:58]
Dr. Kelly Casperson
It's a lot harder to pun intended. It's a lot harder to get erections working after that many years of penile abuse.
- [15:06]
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- [16:12]
A negative shout out to the companies that are selling these. Very expensive. I'm going to pick on them. The shockwaves, the PRPs. We need some more research. There is something there, there's a signal that it helps. But if you sell that without looking at, do you have high blood pressure? Are you smoking, are you drinking? What's your cholesterol, what's your glucose? If you just sell $8,000 to beat on the penis and you don't look at the body, I get a little bit pissy about it.
- [16:42]
Dr. Helen Burney
No, absolutely. And this is the problem, right? Because the public's enthusiasm is really outpacing the actual evidence and data behind it. And this is where I think, you know, when you look at these men's health clinics that popped because physicians aren't educated, they're not trained on how to prescribe testosterone. There's a demand for it from patients that feel horrible, feel awful that it's causing them to develop diabetes. All these things. What's happened is they come up and they just do these modalities that make money and then there's no oversight, there's no physician with evidence based criteria that's actually talking to them. And it leads a very unfair hope. The AUA guidelines and the SMSMA both don't recommend using these therapies. Shockwave therapy, platelet rich plasma stem cells, outside of the guidance of a clinical trial. And that's because we find it unethical to charge patients three to $5,000 for sessions when the data just isn't there yet to show that something works. We know from the viagra trials that 30% of people have a placebo effect. So 30% of people in these trials will say it got better just from a placebo, nothing else. Right.
- [17:43]
Dr. Kelly Casperson
I just read a, it was platelet rich plasma in the anterior vagina for female sexual health and they had a placebo, they had a saline injected placebo, arm prp. The platelets improved sexual function more than placebo, but not statistically. Significant. Which means it didn't. Right. And they are, but they're hanging, they're, they're hanging on that. It was better, but it wasn't statistically significant better. But the placebo the saline injections had, it was between 30 and 40% improvement in sexual health. On the sexual function questionnaire.
- [18:14]
Dr. Helen Burney
Placebo effect exists.
- [18:16]
Dr. Kelly Casperson
You know what people say about testosterone. I see this a lot in wi, in the women's health world. Do you see this in men's. Women are only getting the placebo effect with testosterone. It's not testosterone that's working, it's just placebo effect. Are they saying that to the men who are getting testosterone and it's working?
- [18:33]
Dr. Helen Burney
I think that that's certainly available in all spaces anytime you give a medication for people. But on the same token, we'll see patients where we've normalized their testosterone levels. We took them from 250 up to 550, 600, well within a normal range where you should feel better and they aren't feeling anything different. And that's because the symptoms of low testosterone are multifactorial. Right. You can have same symptoms of fatigue, decreased energy, low libido if you're depressed, if you're not sleeping well, if you have obstructive sleep apnea. So you're not getting regenerative sleep when you're sleeping. So there's so many different things. And I think the more important thing is a, we need to normalize it because we know that lower testosterone levels have higher rates of all cause mortality. But it doesn't mean it's a save all, be all. It's not the end all catch all for something, right? Like it's one of the pieces of the piece.
- [19:21]
Dr. Kelly Casperson
How long would you want somebody to be in that normal range of testosterone before you were like the problem X that you were hoping to solve isn't being solved, but like you gotta give these things a little bit to work, right? Like libido in women of testosterone's like four to six months sometimes. So like how long would you say for a man if he's like, I'm starting to feel better. Cause sometimes it's freaking fast. But can there be like a 3 month, 4 month, 6 month leg? Are you seeing that?
- [19:45]
Dr. Helen Burney
I usually will see it in the first month in our clinical practice. You know, we have about over a third of our whole practice is testosterone therapy. And then I, as I was talking to you earlier, we started to build up this huge medical practice that I need to transition away since I'M a surgical subspecialist who does penile implants and Peyronie's. But what we see is usually within the first four weeks, you should be able to notice something. Now, let's say I prescribe them on, like, Clomid, which is not exogenous testosterone, but a medication that we've used routinely for years to help improve or stimulate a man's natural testosterone production. Sometimes we will see the testosterone levels increase in Clomid, but we won't see the symptoms. So then I may try a different modality. We may try Enclomiphene. If it's someone that's interested in fertility, or if it's not someone interested in fertility, we may try testosterone cypionate or pellets or one of the other exogenous testosterone modalities. And then they'll say, wow, now I feel a big difference. And so I think with some men, it's really a different marker of which testosterone modality you're on. I'm assuming you probably see the same thing with women. It's a little bit of a trial and error and everybody's a little bit different.
- [20:48]
Dr. Kelly Casperson
But, you know, you're an expert when you're like, we know nothing, right? Like, with the hormone levels, that's what we're measuring. They move around all day long, right? This isn't like a creatinine. These are hormone levels that fluctuate and move around all day long. We know nothing about your androgen receptors. We know nothing about your keg repeats on the end of the, on the end of the receptors. We have no idea how much is translocating inside the cell. We have no idea that your serum blood level even is what your brain's seeing. And it's so complex that. And I think we see this a lot with testosterone because we're like you. Sometimes you gotta push a guy up to 800 for him to be like, there it is. But what I see a lot is, you know, the guys will get pushed up to 500 and the doctor will be like, you're normal, you're good. Because we really treat for range. Instead of being like, maybe that Guy lived at 850 for 15 years, though. We don't know. So we're still treating towards lab values, which is like, man, it is a black box inside of there. Lab values is all we have. But it's not the hu. Like, I think symptoms matter, and pushing people, some people up higher matters 100%,
- [21:59]
Dr. Helen Burney
and you nailed it. It's. We don't Know where they were in their normal range in their 20s and their 30s, what their body's normal biological function of testosterone was before they got diabetes, before they got obesity, before they were smoking for 10, 15 years, right? We see this so commonly in the space of testicular cancer with men, right? They have an orchiectomy or a removal of a testicle for testosterone, and everyone's like, oh, well, their testosterone level is normal. Okay, You've just lost half of your production of testosterone. And yes, it may be above the 300 threshold, but maybe he was 850 before, maybe he was 900 before. I don't know. And so when you take someone who's norm is in the 800s and now you drop them to 400, they're going to feel different. It's going to be different their whole body. We have androgen receptors on almost every organ in the body. So I think you nailed it. You know, a lot of times it's not about a number, but it is about treating symptoms within a safety profile.
- [22:51]
Dr. Kelly Casperson
Yep, totally. And I think, you know, the range for male is so wide, and I would say the range that we have in our, you know, the big labs in America for women is so narrow, right, because everybody's like, don't go above 40. And I'm like, dude, look at the normal data, look at the, all the libido data. Like, these women are we just. The high step study that was published in JAMA, which had hip fracture 73 year olds, they titrated testosterone to get them between 100 and 140, right? So here we are being like, oh, a woman's got 47, too much. You gotta stop. Is like, no, not at all. But it's complex and it takes a while for people to learn this. Like, I understand why it's not easy medicine.
- [23:34]
Dr. Helen Burney
No, absolutely, absolutely. Now, it was one of the reasons why I started putting together a course because I had so many physicians and patients that they just didn't understand it. They were confused. And learning about your body and your health and what it needs shouldn't be confusing. It should be at least straightforward evidence based within a safety profile that you educate so that people can take control of their health and can go to the doctors and ask for what they need and that physicians feel uncomfortable and empowered to prescribe it, similar to what you do.
- [24:01]
Dr. Kelly Casperson
Yeah. What I see a lot for men is like, if we know that low testosterone in men is usually a signal of metabolic dysfunction, sleep apnea, overweight, X, Y and Z, a lot of people Will be like, so get to the gym, lose the weight X, Y and Z and watch your testosterone go up. But a lot of these guys, like you gotta give them testosterone, then they feel better, then they go to the gym. Right? So I think my question is like, should we be so strict on being like your low testosterone's for these reasons fix it versus here's some testosterone just so we can get you feeling good enough so you can actually fix these other things. Carton horse question, I guess.
- [24:38]
Dr. Helen Burney
No, absolutely right. Like you're telling someone go outside, go run when they feel like they're pushing a thousand pound boulder up a hill. No one wants to do that. And then you're not helping them. They've central adiposity, they have lower muscle mass, all of these things. And in fact, we actually have good data supporting this. We had the T4DM study. It was a large randomized, double blind placebo controlled trial where they took over a thousand men with diabetes or pre diabetes and they put them into two groups. One was testosterone and lifestyle modifications and the other was just placebo and lifestyle modifications. And they found the testosterone group. Okay, the testosterone plus lifestyle modifications group reduced and or eliminated diabetes. Okay. Took people that were pre diabetic or diabetic. 41% of people no longer had diabetes by just normalizing their hormone levels.
- [25:29]
Dr. Kelly Casperson
41%. Geez Louise, that would be a super bowl ad if testosterone was new. Why can't we just call testosterone a peptide?
- [25:38]
Dr. Helen Burney
Right?
- [25:38]
Dr. Kelly Casperson
That'll get it. That'll get it.
- [25:40]
Dr. Helen Burney
I mean, but we have, we have so much data around this era too, where we took patients had metabolic syndrome and we did lifestyle, diet, exercise, plus or minus T in two different groups again. And we saw significant increases in weight loss and reversal. Complete reversal of metabolic disease. And the patients that you did the testosterone to versus just the lifestyle, diet and exercise alone. So there's no question we need to be normalizing hormones. Yes, we should counsel patients on preventative health. My God. Healthy diet, exercise, healthy sleep. I mean, Dr. Mokira always talks about the four pillars diet, exercise, sleep and stress modification. No medication on earth is better than those. Testosterone is a pretty close runner up.
- [26:21]
Dr. Kelly Casperson
I love that. Let's switch for a second just to talk about finasteride and dutasteride. Urologists know them a lot because we use them. We used to use them more. I think we're using them less because of the side effects, but so they block the conversion of testosterone to dihydrotestosterone. I don't think this is Very well known. But there are hints or signals that some young men who are taking finasteride for hair loss are getting Peyronie's disease. And there's some sexual health issues with finasteride, but these drugs are handed out like proverbial candy. Dermatologists don't get mad at me for saying that, but there's some unscrupulous people who are throwing finasteride and dutasteride at people with no, I think proper informed consent of the genital and sexual health issues that these medications have.
- [27:09]
Dr. Helen Burney
No, absolutely. So as someone that specializes in Peyronie's, many of us who do this research believe that it is a genetic component. So if you look online, you can read things like smoking, sexual trauma, penile injections, diabetes, all these things lead to Peyronie's disease. But the truth is, is it's an abnormal wound healing response of the body and genetically predisposed men. So while medications may be provoking it, while some injury, most commonly, you know, while we see that again in men, that typically 50 and up is, if you think about sex in general, you have a rigid rod going against an axial force. And if you're not, you're 10 out of 10 one day or maybe you're a 6 out of 10, you get buckling and you can get these micro shears in the erectile tissue bodies. And what happens is the body has this abnormal or hyper stimulated wound healing response and it starts laying down collagen fibers. Well, collagen's non elastic. So when a man gets an erection, they get turned on, they get aroused. Blood goes into the penis, the penis stretches and, and wherever you have that plaque or that collagen, it's going to cause the penis to pull or curve or get an indentation or a narrowing or constriction, any of these shape deformities that can cause that. So, you know, while it can be attributed to 101 things, I don't necessarily see it contributed to finasteride or dutasteride. I do see a lot of people that will ask, well, it lowers testosterone and you know, I think again that's one of the biggest misconceptions because these drugs don't lower testosterone. If anything, testosterone levels actually go up slightly because you're blocking its conversion into dht. So the testosterone doesn't disappear, it just gets rerouted per se.
- [28:43]
Dr. Kelly Casperson
If your face needs a moisturizer, your
- [28:45]
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- [29:53]
Dr. Helen Burney
But Peyronie's in and of itself, it's so common. And you know, thank God for those purple carrot ads because now people are recognizing, hey, wait a minute, I have this too.
- [30:01]
Dr. Kelly Casperson
Is this normal?
- [30:03]
How common is Peyronie's?
- [30:04]
Dr. Helen Burney
So if you read the literature, it could be anywhere from like 9 to 16%. But honestly, I think personally with my clinical experience in the practice that we see, probably a third of men develop Peyronie's disease in their lifetime. And the reason why more people don't come in is if you have erectile dysfunction, you're not going to be able to see that you have a curvature. If you can't get an erection, you won't see that you have Peyronie's. We see this all the time when I'm taking patients to the operating room to place a penile implant for erectile function. And they never said they had a history of curvature. And then you put the implant in and sure enough, they have a 90 degree curvature.
- [30:37]
Dr. Kelly Casperson
Oh my goodness.
- [30:38]
Dr. Helen Burney
Right?
- [30:38]
Dr. Kelly Casperson
Yeah.
- [30:39]
Dr. Helen Burney
So it's very common and it's just an abnormal wound healing response of the penis.
- [30:44]
Dr. Kelly Casperson
Interesting. So a third of it. Remind me, I don't take care of Peyronie's anymore. After you've had it for about a year, it's pretty rare to get better on its own. Where do we get like, it is what it is, but in the beginning, like remodeling phase, it can get a little bit better. Can you talk about so if a guy's like, when am I supposed to get Treatment for this, is it going to get better on its own?
- [31:04]
Dr. Helen Burney
So most of the data, even when we look at basic science stuff, is the sooner you can get in, the better. The problem is a lot of our treatment modalities like Xiaflex, which is the only FDA approved medication to treat Peyronie's. It's an injection that we inject into the penis that basically digests or breaks, breaks down the collagen, breaks up that plaque and then you use it with a traction device to help break it up more, weaken the plaque and we try to break it up more. But what we actually see is that most people don't get in early, right? They wait or they're a little nervous, they call their doctor, then they go to a primary care doctor, they go to a urologist who maybe doesn't know about periodics or maybe that's not their area of expertise. So then they get rerouted. Finally, six to eight months later, they get in with a Men's health urologist, where this is their specialty. And then it's just the consult visit and then we book them for a curvature assessment, a penile Doppler ultrasound to really evaluate the curvature and then to decide are we going to do xyflex traction or surgery to help correct this. So I'd say earlier is always better. About 40% of men will complain of pain with erections when they develop Peyronie's disease. And pain always goes away, Always, always goes away. But it can take anywhere from three months to 18 months, depending on the patient. So as soon as they can get in to start a treatment therapy, typically that acute phase is usually when they still have pain or discomfort. So most people say once you have no pain or the curvature has been stable for three months, you are a good candidate to undergo treatment options of whichever treatment that is based on your discussion with your Men's health urologist.
- [32:33]
Dr. Kelly Casperson
And you do need a certain degree of curvature to get insurance to cover the injections for treatment.
- [32:38]
Dr. Helen Burney
Yeah. The current FDA guidance for Xiaflex is that you need a 30 degree or more curvature. We've done several multi institutional studies, actually it's going to be published soon. And we presented at several conferences for we actually did it in acute phase patients. We injected Xiflex and we did it for ventral curvature, which is a downward curvature, which it is also not FDA approved for. And we found that patients improved the same. There was no increased side effects or risks. And so hopefully those guidelines will change. But currently, in order to get it Covered still because it's a pretty expensive medication. You still have to follow the 30 degree.
- [33:12]
Dr. Kelly Casperson
Yeah. It's not something you're like, I'll just write a check. It's quite expensive of. For people who wanted to know, was there any talk at the Men's health panel in December about expanding the FDA indication for testosterone for men? So right now none of the FDA approved testosterone products are approved for use in men with low testosterone levels who lack an associated medical condition or age related, et cetera, et cetera. Is there talk about expanding it or are we good with where we are? Insurance covers it pretty well with the current indication. Cause people will say many men will use are currently using testosterone off label because the indication is actually quite narrow.
- [33:50]
Dr. Helen Burney
Absolutely. A huge push. When a big talk was on expanding the regulations and indications for it, My Fellowship Director, Dr. John Mulhall actually led that part of the conversation. But because right now the majority of men who need testosterone and that we currently prescribe it to in our own practices aren't FDA approved to receive the medication. And again, this is where you get the stigma and you get where men that actually need a medication can't get it because it's only proved in men that have testicular dysfunction or hypothalamic pituitary access dysfunctions with it. So yes, we need to change this because it's not a age related decline. It's for men that are hypogonadal and symptomatic. Right. That have low testosterone and they're symptomatic. Men need normal testosterone levels. It's not some longevity or lifestyle medication. This is restoration of their normal health and overall health. Just like women, we all need normal testosterone levels to function at our best.
- [34:45]
Dr. Kelly Casperson
Again, again, cart and horse question. But it's like a loop, right? Because people, people will be like, well, we don't know if postmenopausal women should have testosterone. And it's like, well, we don't know if 80 year old men should have. Like we are aging at a rate society wise that we've never aged before. Average life expectancy in America in 1900 was 47, 7. It's mind blowing how many older people we have. And then here we are arguing about should they get care or not because we haven't studied them enough. And it's like, how about we just care for them and help them feel better and kind of learn as we do because we're sitting around waiting for studies that aren't happening right now. And, and I think.
- [35:25]
Dr. Helen Burney
And they may never Happen?
- [35:26]
Dr. Kelly Casperson
Oh yeah. Do you? Yeah. Do you see new studies happening right now? But I think this is the power of number one, social media, but number two, Gen X, because we're seeing frail parents, we're seeing frail aunts, we're seeing frail grandparents, we're seeing frailty and we're like, what if we could do this different? Right? And I think there's that backlash of like, we don't have enough studies to be like, all the 70 year olds should be on 23 year old testosterone levels. And we're like, but this looks like it sucks though. Like, you know, and so it's kind of these two different thought leaders being like, you know, the conservative medicine's like, well, we don't know. But then everybody else is like, but sitting in your living room 50 pounds overweight, with a diabetic foot ulcer, with no energy to play with your grandkids, I don't know that this is the goal.
- [36:15]
Dr. Helen Burney
Right?
- [36:15]
Dr. Kelly Casperson
So I think it's really two different thought and beliefs and they're kind of colliding with each other 100%.
- [36:21]
Dr. Helen Burney
It is quality of life, it's dignity as we age, it's having restoration of normal functions, connecting with your family, being able to have mobility, being able to move and walk instead of sitting, leaking of urine and sick in a wheelchair. We can't do anything to see your family. So 100% we know that men with low testosterone, 50% more likely to develop osteoporosis. Men with osteoporosis can suffer hip fractures, right? You fall down all of a sudden, now you've broken your hip. People that break their hip in older age, you know, 50% mortality rate, right? This isn't just a lifestyle medication. This is about mobility and muscle and frailty and an aging generation not being able to do the things that are normal functions of being a member of society, of enjoying life, of quality of life with your family, of connection, of joy. So again, this is where we're really failing people by not screening this. Who normally gets screened for osteoporosis? We don't screen people early. Right.
- [37:19]
Dr. Kelly Casperson
Men never get screened for that. Women, if they're lucky at 65, which is 15 years too late. But yeah, for men, unheard of.
- [37:27]
Dr. Helen Burney
What if testosterone was a normal marker that men and women got every year, annually at their primary care physician's visit to see their baseline so that we started to see it and that we could see when that level gets lower? Hey, a trigger for getting a DEXA scan to check for osteoporosis so that we could catch things earlier and prevent them instead of this catch up. What we're doing now is treating symptoms after they've already developed or putting band aids and trying to fix disease after it's already occurred. So again, we're missing a huge window by not screening.
- [37:54]
Dr. Kelly Casperson
I'm having a major flashback right now because my grandfather, he's now since passed. My grandfather was at a restaurant and this restaurant had like one step down between like the bar area and the restaurant area. One step down, he took the step down, femur snapped. So atraumatic hip fracture. To my mind, nobody screened him for testosterone, nobody screened him for osteoporosis. And he recovered, was able to be independent again. But I'm like, dude, my grandpa took one step atraumatic, didn't slip. It was like he literally stepped down and the femur snapped at the hip socket. And I'm like, dude, that would have been an opportunity for testosterone and osteoporosis screening.
- [38:35]
Dr. Helen Burney
Right? That 100%. We even see this in like 40 something year olds.
- [38:39]
Dr. Kelly Casperson
I'm having a moment. I'm like, oh, yes, right.
- [38:41]
Dr. Helen Burney
It's so sad.
- [38:41]
Dr. Kelly Casperson
I'm like, I was a urologist. Ah.
- [38:43]
Dr. Helen Burney
Hey, when we know better, we do better. And we're educating the public so that everyone can learn this. Because this is not information people know.
- [38:51]
Dr. Kelly Casperson
Totally. Here's the other interesting thing. 30% of Americans so far have been on a GLP1. Like these things have taken off. Like, few things have taken off. And the data shows that when these people are on testosterone, if they had low testosterone and they're on testosterone and GLP1s and at the same time they have preserved lean body mass. And I think where this is going is they're actually going to start doing anabolic, synthetic anabolics with GLP1s to try to really get muscle mass on these people and drop the body. I think that's where it's going to go. But I would encourage anybody who's taught, who's GLP1 curious to screen for hormones because they are so complementary in how they work. Do you have any thoughts on the that?
- [39:34]
Dr. Helen Burney
No. Absolutely. So medications like your semiglutide, tirzafide, all these GLP1s that you're talking about, these receptor agonists, they're actually changing the game because they're targeting the root cause. Right? They're targeting the weight, the obesity, the insulin resistance, the visceral fat. All of those directly suppress testosterone levels. Right. So more visceral fat is going to increase Aromatase activity, which converts your testosterone to estrogen, so your testosterone drops. So when men lose weight again, especially Whether it's with GLP1s or whatnot, we see testosterone levels rise naturally, so then we're restoring it. So it's another way to increase testosterone levels. So used together, it could be very synergistically. That said, we do see signals that people have maybe potentially increased risk of thyroid cancer. And at my VA patients, I'll see a lot of times in men that aren't able to empty their bladder well. Well, what do GLPs do? They dump sugar in our bladder. If you already have a very big prostate and you aren't emptying your bladder, well, that's a nitis for urinary tract infections or kidney infections in men. So just different things to think about that we've seen an increased risk of, like urinary tract infections in those men.
- [40:38]
Dr. Kelly Casperson
Interesting. I didn't know that. I just saw something.
- [40:40]
It was.
- [40:41]
This was looking at a Veterans Administration group and it was men on GLP1s. This is going in, like, promoting the men's health arena thing. Men on GLP1s had less alcohol abuse and drug abuse. Like, they're getting healthier for multiple reasons on these medications. They just don't have the craving to use these substances.
- [41:01]
Dr. Helen Burney
That is one of the biggest things I see in my men's clinic is when you restore their testosterone levels or you restore their erections. All of a sudden they feel so empowered and they feel better and they start taking better control of their health and they stop smoking. I mean, one of the biggest examples is when I'm seeing a patient for a penile implant, right, to treat erectile dysfunction, when pills no longer work or injections. And I personally, in my practice, I have a cutoff. I have a cutoff of hemoglobin A1c, meaning their blood sugars. It has to be below a certain level before I operate on. Because I tell all my patients, like, I can fix your erections, but if you don't fix your diabetes, you're going
- [41:38]
Dr. Kelly Casperson
to get this thing infection. Oh, yeah. And you're going to infect your penis.
- [41:41]
Dr. Helen Burney
Yes, you're going to get an infection, but even worse, you're going to lose your ability to orgasm, to have penile sensation, to see your partner, to carry your partner. You're going to need a kidney transplant. It goes on and on. And so it's a huge motivator for men and encouraging them to improve their men's health. And when you restore their testosterone when you restore their erection, they are empowered, they feel better, they feel restoration. They want to start working out. They eat healthy. You see this transcendent in all areas of their life.
- [42:11]
Dr. Kelly Casperson
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- [43:17]
Dr. Helen Burney
Their partners come in and they're like, this is the husband I married. Married 20 years ago. Like, I've never seen him happier. Like, he's a better father, he's a better partner to me now because they feel better. And the same thing with women. Think about it. Imagine you have this couple, right? And the female's postmenopausal. She's tired, she's not even sleeping at night, right? She's waking up all night long. She's irritable and tired. And the next day she's got a long, busy day and she's, she's got to clean, she's got to do this or she's got to go to work. And then you also have her partner who's overweight, who's sitting on the couch. She's frustrated that he's not doing that. His testosterone is low. He feels awful. What kind of intimacy is that partner that couple gonna have? It's so much could be contributed to
- [43:59]
Dr. Kelly Casperson
our hormones for stress, right? It's like the camel that breaks the back. Let's talk about energy, because I think traditional medicine, where we trained, you're still in it more than I am. Traditional medicine, poo poos, energy. And I saw Dr. Kara said this on the FDA panel. He's like, testosterone gives energy back. And I'm like, here we are in mainstream medicine, actually validating. And we know this biologically testosterone helps mitochondria. Mitochondria is energy. But I see a lot, and I see this maybe more in the women's health space of people poo poo energy. Like it's not worth it or it's not worth. We're never going to get anything FDA approved for energy. Energy. We would argue it's how Helen is Helen, because Helen has energy to be Helen. Right. Like energy is everything. But it's like this is what these hormones do. These hormones make mitochondria function, which is energy. I'm just noticing this, the poo pooing of like, helping people feel like themselves or like. But we especially testosterone for women, it's for libido, not for energy. Still helps mitochondria function. Where do you think energy comes from? From, like, it comes from functions of the cell. I don't know. I just, I just hate how that gets dismissed so much.
- [45:12]
Dr. Helen Burney
Exactly. So testosterone plays a major role in energy levels. Right. It's not as simple as low testosterone equals tired. It affects multiple systems. Your muscle mass, your red blood cell production, your mood, your motivation, even your sleep quality. So when you're thinking about testosterone supports muscle and mitochondrial function, so you get physical energy, it supports red blood cell production, so you get, get increased oxygen delivery in your body neurotransmitters like dopamine. That's your motivation, your focus. So on levels drop, men and women can feel both physically and mentally drained. And then these are the people in society as we're getting older, that we want to be strong family members, strong
- [45:50]
Dr. Kelly Casperson
communities, strong good parents, excellent patient lovers.
- [45:55]
Dr. Helen Burney
Exactly. We're missing this whole point of how just normalizing someone's hormone levels, like how we're supposed to be, you know, is. And, and it's not trained, not taught, no one's screening.
- [46:06]
Dr. Kelly Casperson
I, I just love that we're like both clearly fanatics about this because, like, once you see it, once you see somebody come back, once George, you know, comes back and George is like, oh, my Lord, who knew? You know, you're like, yes, this is why we do what we do. I, I had a guy who was older. He had some comorbidities. He was anemic. So low blood, low red blood cells. He was being worked up. He had like an upper gi. A lower GI CAT scan. He had all this workup, the, all the workups. For anemia were neg sent to me as a urologist for like two red blood cells in his urine or something like that. So it was a microhematur workup which was, guess what? Negative. But I'm like, two red blood cells in your urine is not making you anemic. Like, it has not enough red blood cells. I was like, why don't we check your testosterone? You have low testosterone can cause anemia because you need testosterone to make red blood cells. But it's. It's crazy that that's not in the like, yes, please make sure you don't have colon cancer. Do the workup. But then than the root cause of, like, you need hormones to make red blood cells.
- [47:05]
Dr. Helen Burney
100% testosterone stimulates erythropoietin. It's the hormone that tells our bone marrow make red blood cells. It also has direct effects on bone marrow itself. So when testosterone is low, red blood cell production can drop, leading to mild anemia, moderate anemia, and it's one of the first things we should check. In fact, I think I remember one time on like, either an Instagram or Facebook, someone reached out to me and was like, helen, you got to help me here. I have a patient who's telling me I need to keep his testosterone on because his doctor prescribed it for anemia. Is this legit? And I was like, yes. And I'm so proud of that doctor that prescribed it for this patient. Like, yes, we win.
- [47:44]
Dr. Kelly Casperson
That's so awesome. What do you say to people who are like, well, I don't want to start this guy on testosterone because he's never going to be able to get off of it.
- [47:51]
Dr. Helen Burney
Ah. So. So think about anything in life, right? Like, you're not going to start someone on thyroid hormone because they need thyroid hormone, right? We're going to keep them off of it because, oh, it might need to be a lifelong medication. Some people, if you're not able to make the hormone that our body needs to function at our optimal, best self, sometimes you have to stay on things longer. Right? Now, not everyone, right? Like, some people will come in and they're symptomatic, and maybe their testosterone levels are technically in the normal range, right? Like, it's above 300, which is what our guidelines say is low. And you start them on testosterone, and they're like, I don't feel any bit better. We tried it for three to six months, they still don't feel any bit better. Then those people can come off. I mean, their normal levels are already at a normal range. So they're not at any increased risk for the all cause, mortality, cardiovascular disease, diabetes, all of that. But otherwise I'd say just like anything in life, we don't think twice about prescribing medications that keep people healthy and alive. Just because something's lifelong, if your body needs it and you feel better on it and you're healthier on it, then why, where does this push to be off of something? Like, I don't think that that should scare people. It's restoring our health. It's not some longevity lifestyle medication, even though it is doing those things.
- [49:06]
Dr. Kelly Casperson
It is. But what you mean is like. Yeah, what you mean is like, don't dismiss it as fluff. It's not fluff. Do you have enough data? So say a guy comes in, is 52. He comes in, he's got two testosterones of 305 and he feels like crap. He's got all the stuff, symptoms. I'm going to treat him because I don't care that he's not 295. He's 305. I know that's normal, but it's in the lowest 95th percentile, et cetera, et cetera, et cetera. But let's treat him for a little bit and he's like, I feel better or not. My question is, I didn't knock out the testicular function that gave him the 305 in the first place. Like, I didn't like knock that out by giving him testosterone for six months to try. Did I like. Is that a good, decent question? I'm not doing harm to the rest of his testicular function by just trying some testosterone.
- [49:54]
Dr. Helen Burney
Not short term. Not at all. Not at all. And in fact, actually one of the things that we argued and kind of advocated about, which also the AUA and multiple other societies, the Endocrine society, the Androgen society, the SMSMA and ours. Letters to the FDA responding in the Men's Health testosterone panel was that threshold should probably be higher. Right? It should probably be higher than 300 because I see this all the time.
- [50:17]
Dr. Kelly Casperson
The lowest 95 percentile is not optimal.
- [50:19]
Dr. Helen Burney
No. And that's where it was based on. Right. So most people aren't there. So, you know, I treat personally in my own practice, I'll treat anyone about 450 or less if they're symptomatic. Like, sure. Because I don't know where their T was. Maybe it was 800, maybe it's 750. You know, everyone has an optimal range that they function best at. And again, if Your hematocrit's normal. If other surrogate markers, objective markers are in normal range, you're not causing harm here. We're helping patients. So, you know, I think this is again, just where the lack of education and teaching patients, where you see physicians and patients that are just uneducated about this, because We've made this Class 3 scheduled drug because it wasn't taught in schools, because it has all this taboo around it, I think is where we're just missing the mark. But no, you're not harming at all. In fact, you're doing a great job.
- [51:06]
Dr. Kelly Casperson
Okay, that's fantastic. Wrapping up. A lot of people are worried about the side effects of testosterone, specifically blood clot. It doesn't increase. You know, it helps treat anemia, it helps increase red blood cells. Inject. Remind me. Injectables are the route of testosterone administration with the highest risk of increased hematocrit.
- [51:26]
Dr. Helen Burney
Correct? Correct. A lot of times I think it's due to the carrying agents or most of the time, if you see too, you'll see these people that do these injectables like once every two weeks or once a month. So what's happening is they're getting this really high dose because you're trying to make it last through the whole month or for the whole two weeks. And so what happens is you get these really high spikes and then it slowly declines, and then a high spike and then it slowly declines. And that's where you're going to see a lot more variability with the elevated hematocrit levels or erythropoiesis.
- [51:56]
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- [52:26]
Dr. Kelly Casperson
So you think weekly injections have less risk of increase to Medicare?
- [52:31]
Dr. Helen Burney
Yeah, and we actually studied this in my fellowship. We actually looked at this in my fellowship and we saw that about weekly, you may see a rough change of about maybe 200 points points, but it stays in this kind of nice, more steady state rather than these big highs and big lows or people that are injecting multiple times a week getting these spikes, spike, spike. With high doses and things like that. So the Traverse trial also came out. The Traverse trial came out. It was a large, huge, randomized, controlled trial came out in 2023 that removed the FDA's black box warning on testosterone for cardiovascular disease. And they looked at this as well, and they actually didn't see any increased change in pulmonary embolism. And so while VTE was a little higher, this wasn't educated, meaning adjudicated. They didn't go and look to see. So most of us think that this is probably not testosterone related in and of itself. Right. Because think of places like maybe where you live or like in Colorado where higher elevation and they have higher hematocrit levels at baseline. We don't see people in Colorado on testosterone with higher dvts or pes or vtes. So again, I don't think it's testosterone related.
- [53:37]
Dr. Kelly Casperson
Yeah, I think that's the big fear or the big reason of like, oh, my doctors don't want to start me on testosterone because I clot risk. And it's a. The. Correct me if I'm wrong, this is a theoretical clot risk because of. Sometimes you can get a high hematocrit, but in absence of a high hematocrit, there really isn't a Clot risk.
- [53:55]
Dr. Helen Burney
Risk 100%. You nailed it. Perfect.
- [53:58]
Dr. Kelly Casperson
Awesome. Okay, wrapping up. What did we miss? What do you want people to know? What do you want everybody to know about testosterone and men's health?
- [54:06]
Dr. Helen Burney
So testosterone is the most important biomarker, one of the most important biomarkers of a man's overall health. Health. You should all be going and getting an annual screening of your testosterone, men and women, to look for your overall health as a marker.
- [54:20]
Dr. Kelly Casperson
Okay, my listeners love that last part that you included the women.
- [54:22]
Dr. Helen Burney
Yes, yes. It's so true, though. I mean, we should.
- [54:24]
Dr. Kelly Casperson
A third of women don't have periods that end, so I think we should be screening them for menopause.
- [54:29]
Dr. Helen Burney
No, it's true. It's true. Know that, Ed. Erectile dysfunction is an early marker of cardiovascular disease. Go see a physician. Go see it. Peyronie's undiagnosed. It is treatable. There's many things we can do. Penile implants can be life changing. Not a last resort failure. But again, this whole thing about improving men's health and women's health is not a zero sum. We need healthy men to be good partners, to be supportive, equal partners, to be good dads, to be good family members, for healthy communities, for healthy workplace support, to make our country A stronger, better country. And we need healthy women. So, again, take control of your health. I'm so proud of everyone that's listening to your amazing podcast where you are spreading all of this awareness and helping empower people. And I'm trying to do that on the other and with men because we know that improving men's health improves women's health too.
- [55:14]
Dr. Kelly Casperson
Totally. And to me, I'm like, I, I love your zero. It's not a zero sum game. Like, I think a lot of women are rightfully angry and upset and feel a little short stick, short stick syndrome, but realizing, like, it doesn't have to be. It doesn't have to be, you know, take from, take from Peter to, to help Susie. It's like, it's, it's all hands on deck, and most households have multiple people living in them, and we really want everybody to live their best life. And I appreciate you coming on. I think the other thing for men and the social media and physicians is like, safety. Men might not say safety, but I don't want to go treat, get treated. I'm worried about shame. I'm worried about not being a man. And so for, for people like you to come on. So people are like, okay, they're safe physicians who. This is what they do every single Tuesday, right? And I always say that to people of, like, see if your physician treats these things before you actually pay for parking. Take a day off of work and show up is like. And then people are like, oh, the receptionists know. And I'm like, by and large, the receptionists know what the doct doctors do. You can call and just ask the receptionist so that you have a warm audience and you don't waste your time or your money going in 100%.
- [56:24]
Dr. Helen Burney
I have three young little boys. I want them to live in a world where their average lifespan isn't in the 70s, where they feel comfortable going to a doctor, talking about sexual health, talking about testosterone, getting their hormones checked. Like, I want them to be strong emotionally, mentally, and physically. And when we have strong men, we have strong women. Women, and vice versa. So it's a public health issue and go for it.
- [56:44]
Dr. Kelly Casperson
Thank you for being an advocate. Thank you for being so passionate. Thank you for speaking on the FDA panel. Thank you for writing your course. I hope that we have dinner at the AUA sometime soon. I can't make it this year.
- [56:54]
Dr. Helen Burney
Yes. Thanks so much for having me on. I love you, Kelly, and thanks for everything you do.
- [56:58]
Dr. Kelly Casperson
Totally. Where can everybody find you?
- [57:00]
Dr. Helen Burney
I am at Dr. Helen Burney on all social and my website Dr. Helenburney.com awesome.
- [57:07]
Dr. Kelly Casperson
Get loud, stay loud. Help help all the people until next time. You are NOT Broken. Thank you so much if you found
- [57:15]
this episode funny, helpful, insightful, please take a moment to follow, rate and share the you 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 members membership and the Casperson 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.