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You Are Not Broken
Episode 350: Six Years In — The Big Winter Blowout, Hormones, Health, and Being in the Arena
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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 you are not broken podcast. Episode 350Up the fifth year, January 1, 2026, the you are not broken podcast will be a first grader, meaning it will be six years old. Crazy. When I started my podcast for Those, there are OGs here that have been with me since the beginning and many, many super fans that have been like, I'll start at the beginning and watch her evolution. So those people who know there were zero other urology podcasters, me and my friend Dr. Garrett Pullman, who has the prostate health podcast. Check it out if you have prostate needs. Were the first two, to my knowledge, the first two urology podcasters that started this. And now doctors podcasting ain't no big thing. Like, just this year, at least to my knowledge, two more urologists started podcasts. So one of my favorites, the sex Doctors podcast with Dr. Abraham Morgan Teller, check him out. Just two or three episodes ago, I interviewed him and his wife, Dr. Marian Brandon, who's a sex therapist, who's amazing. So they have a newer. They have a baby podcast. And you know how baby podcasts are. Like, nobody listens to you in the beginning except for your mom, and you worry that you're not good. But I'm telling you, they're good. They're good. And I've certainly gotten a lot better myself after doing this for five years. People are like, you're a really good interviewer. And I'm like, I've been doing this for a half a decade now. Like, I legitimately at this point could call this a media company if I wanted to. I did that with my husband the other day. I'm like, oh yeah, me and my media company. So maybe I'll just start manifesting that. I mean, when you, when, when you've got a big Instagram and like a sub stack and a YouTube and an Instagram, like you kind of have. And you speak on stages, you kind of have a media company, don't you? Like, I'm sure people have media companies with less than that. So today is all about episode 350, one year in review, wrapping up five years of the you're not broken podcast. I am live on Instagram while I'm doing this. So we'll see if there's some awesome Q and A's that come in. But I have an agenda. I Need to catch you guys up. This year was nuts. If you would have told me at the beginning of this year or even like three years ago if you would have been like, hey, so you'll quit your insurance based job, open up a clinic and in 2025 you'll start a clinic, go to Australia, speak on the Sydney Opera House stage, go to the FDA three times, be part of the team that got the boxed warning up of vaginal estrogen. Oh, and have your second book released in 2025. Like, and keep a marriage intact and have children who still love you. Like, oh, and also be in the best shape of your of the recent years because medical school, I was actually in very good shape. I um, because that's just nerd camp and you just study and exercise and you're poor so you don't eat much. But besides that, I'm in very good shape now because January 1, 2025 stopped taking insurance based healthcare, which means I stopped taking call at the hospital, which means I sleep through the night every single effing night of the entire year. You all who've always done that your whole life, you don't know, you don't know. And shout out to all the people still taking call, still working night shifts, I hear you, I see you. I love you. I, I did that for 20 years. Like, no, no, no shame in that game. It's incredibly noble and I'd like to thank you. Today actually, I got up at 2:40am not to catch a flight, but because I needed to do the second half of my prep for a colonoscopy. So that wraps up 2025 is baby's first colonoscopy. Um, and I'm like, I have not been up this early since even to like get the 5am flight, 5:20am flight out of my town. When I travel, I, I don't have to get up that early. So I've not been up that early or out of bed at that hour since I took call. So today I was like, oh, it's dark. There's many, many hours before 6am so welcome to everybody who's here. We'll see if we can get some good Q and A going on the Instagram. In the meantime, let's talk about this year. So this is episode 350. I'm calling it endo of the year because I had a colonoscopy today. Of note, I got a squeaky clean colon. Don't to go back for 10 years, you guys. Colonoscopies are good. I actually like, went into consensus, went into perplexity, read a Cochrane review. Because during my second part of my bowel prep, I'm like, casperson, what the hell are you doing this for? Is this even reasonable? Should you do this? Do colonoscopies, save lives? So I like, decided to do a literature review because what else are you going to do? I up at 2:40 in the morning. So I did a literature review. Turns out colonoscopies are very, very healthy for you. They actually did a. The first ever randomized control trial of no colonoscopy to colonoscopy. This was European. And when they factored in for the, like, the people who did the colonoscopies compared to the people who didn't do the colonoscopies, it significantly decreased death from colon cancer. I believe it. So you want to catch those buggers early. And to me I'm like, listen, I know way too many general surgeons who. I put ureteral stents in the ureters when they get colon resections. So I know too many of them to know that bad, bad shit lurks in the dark. Let's just say that. Oh, and colon cancer is being diagnosed at a younger age ever. Maybe because of the toxins in the world, maybe because of crappy diets. I don't know. But for. In case you missed the memo, the old guidelines used to age 50 and now current guidelines are 45. And I'm older than 45, but I'm under 50. So I made it in. I made it in under the line. So shout out. And my heart goes out to the Australian shootings on Bondi beach during the Hanukkah celebration. I know some of you and I love you and I am horrified that that happened. So thinking of Australia right now because it's awful. In addition, Washington state has had unprecedented floods. I am surrounded by people whose homes are underwater. I live in a hilly part of Bellingham, so Bellingham was relatively unscathed, but Skagit county was not. So shout out to all of the first responders, all of the people who helped out Washington state. Like, when Washington state makes NBC news because of rain. It's a lot of rain. It's a ton of rain. So wanted to acknowledge those current events because it is not all good. Negative colonoscopy. Yay. Everything else not so great this week. So let's recap what happened to me in 2025. Start with Sydney, Australia. I went and got invited with my friends. What's more fun than talking on the Sydney Opera House? Stage with friends. So fun. So did that March 1st. It was amazing. I learned a lot. I loved the country. Am in the go. Let's just say we're. We're. We're going to do some manifesting this episode, my friends. So let's just say we are currently trying to figure out negotiations for a Sydney tour. I don't know if that's going to be 2026 or 2027, but I would like to do it. Shout out to Australia. I'm not done with you. And I really, really, really want to see New Zealand. What else happened in 2025? The second book came out. The menopause moment Mindset. Hormones and science for optimal longevity. It was a bestseller. Did very, very well. Thank you to everybody who enjoyed that and bought it on Kindle and bought it on audio. And for the super nerds, I know you. I see you who bought it on hardcover and audio. So you can highlight as you listened. Yeah, you're my people. I still print out journal articles and highlight them because that's how it gets into my brain. All right. I opened a clinic. So I opened the Casperson Clinic in Bellingham, Washington. We currently see people in Washington state, so people come up and travel. I've had people. I've had Europeans come in Hawaii, Midwest, multiple Californians. It's been wonderful and I'm pretty full. But we are expanding. Gonna get some help from some advanced practice providers. So come on up and talk about manifesting. What if the Casperson clinic went nationwide? We're gonna manifest that because I just see it happening. I mean, who doesn't need concierge love? Hour long visits. People who can listen. Hormones, sex, medicine, lifestyle, longevity. Bring it. Bring it. I want clinic number two and three to be in Bellevue, Washington and Santa Barbara. There you go. Um, okay. What else happened in 2025? Recap. Zero nights of interrupted sleep until this morning. I started lifting consistently again. At least every. At least three times a week, increasing now to four times a week because I've got some muscle. Goal. Muscle goals for 2026. My health is better. My cholesterol went down. Certainly I'm less stressed. I tried spin class for the first time, which was awesome. The you are not broken book, which was my first book, won an award. That was in August. That's fun. I did my second annual retreat in Sedona, which was amazing. First retreat, amazing. Second retreat, amazing. the time of this recording, there are three spots left for August 2026. Whistler. Four Seasons. Come and relax. We've got an amazing, amazing dinner planned. And we really like. There's really a lot of transformations that happen at that retreat. It's like a time to get away, to think about what you want to do. How do you want to practice? Most people that come are nurse practitioners, PAs and physicians. But sometimes other people come, like educators and lawyers and pilots and business people doing startups. Let's see, clinic managers. So lots of diversity in who shows up and why they're there, which is awesome. So as of right now, if you're hearing this live, go to my website. If you go to events, there will be a link. So there's only three spots left. So it's three spots left, and that is legitimately eight months away. So it's almost all the way sold out. And I only, at this time, I only do one retreat a year. And we keep it small. It's like 20 people. First come, first serve. Come on over. Drew. Anybody who has continuing medical education Credits left for 2025, get it, get it done. Okay, what else happened in 2025? I got my Alaska Platinum status because hashtag book tour, hashtag FDA. Washington state to Washington D.C. are very far apart. And I did that three times. So I got Alaska Platinum status, which is great. FDA three times. For anybody who is living under a rock, the boxed warning came off of estrogen products, which is a incredibly long story to tell. And I don't fully want to bore the OGs that are listening to this podcast right now, but here's the TLDR. The Women's Health Initiative of 2002 was misinterpreted by the media. A huge fear mongering campaign happened one year after the FDA put botched warnings on all estrogen products. Synthetic, bioidentical, systemic, vaginal, oral patch, vaginal, all the things completely put a box warning on, not because of science. Basically, Queen Carvania stood haloed by the morning sun. An army hung on her every word. My champions, I have sold my chariot on Carvana. Twas a lovely suv, an inexplicably queenly offer. They're even coming to the castle to collect it. Tonight we feast. An offer you can feast on. Sell your car today on Carvana. Pick up fees may apply. The Women's Health Initiative studied one type one medication, one dose of one medication, to be specific, which didn't increase heart disease and did not increase breast cancer. But they put a box warning on and, and for other people. This is where, like a big confusion came about with the box warning coming off because people were like, they Just decided on Monday to take the warnings off of medications. And that's going to hurt women. No, no, you troglodytes. That's not what happened. Is troglodyte an insult or is that just calling somebody a dinosaur? Luddite is like the people who worked in the old English, like Mills, who were afraid of modern things anyways. So no, you guys, if you didn't know the history, like, not my problem. But that's not what did they decided to do. The box warning coming off has been in progress for over a decade. Multiple FDA administrations have not done it, mostly because of stasis. Like, there wasn't a groundbreaking paper that just got published that was like, hey guys, oops, sorry. This is, this is not right. We've known this for decades that these medications did not. And the other thing, people don't understand what the box warning is. So the box warning is significant threat to life. Most medications don't have box warnings. And a lot of medications have boxed warnings that you don't even know about. Like, do you know that your SSRI antidepressant has a boxed warning that says death by suicide? So like some box warnings are on there and people completely ignore them and then some box warnings are incorrect and people freak out and don't give women hormones. So point being, that's the too long didn't read if this was decades in the making. Momentum because of social media, because of grassroots, because of let's talk menopause and the unboxing estrogen campaign because of all of these factors coming in together and papers and papers and papers being published that said there's not a risk of probable dementia on your vaginal estrogen or your transdermal estrogen or any of the things. So really a lot of data to support. And these warnings are still on the piece of paper. They're just not in a boxed warning, which means significant threat to life. So to clear that up for anybody who didn't understand that, and that was kind of like, for anybody who was kind of complaining about it, they didn't understand like warnings just went into the regular warning section. No box warning. There is still, there still will be a boxed warning on unopposed systemic estrogen products for risk of uterine cancer if you don't take a progestin with a systemic estrogen. If that's too confusing to you, don't worry. Your menopause specialist knows about that. Exciting things. So went to the FDA in July for the roundtable, if you wanna watch that. It is literally a Masterclass in female hormones that is on the FDA YouTube and it has like over 200,000 views so far. Just cause it. It's so high quality. And then I went back to the fda. I actually did not go to the Menopause Society meeting because I got called back to the FDA to podcast with Dr. Rachel Rubin and do Marty McCary, which was amazing. And I put that audio on my podcast. So just go back a couple of episodes. What would that be? October. October, Early November, probably. And you can hear that episode, which is fantastic. That gives you the whole history of the box warning and the estrogens and all that stuff. So if you want a deeper dive in understanding that, listen to that podcast. Then I went back because they're like, hey, we're going to announce it. HHS is actually going to announce it. Will you come back and give a talk? And I was like, yes, yes, I will come back and give a talk. So then I went back. So that's three. That's why I have Alaska status, platinum status. Because I went back three times to the FDA to get like, think of what I'm going to get done in 2026 because I don't have a book coming out and I don't have an FDA project. Although I want to come back to the FDA when they announce a female dose testosterone. But I don't think it's going to be in 2026. It seems a little soon for it. But like, I am one of the most optimistic people now because I'm like, look what we just did. Look what we just got done. It's so good. What else can we do? Very exciting. The other cool thing about the box warning coming off is more and more people are like, my doctor is giving me hormones now because the box warning came off. And that's fantastic. And it's also slightly concerning because that box warning was always incorrect and doctors are very busy. But it's like, you guys, that was always incorrect. Like, can you know a little. Can you know a little bit about the drugs you prescribe? I'm allowed to pick on them because I'm a doctor. They get a little more leeway. And I understand how overworked and I don't know a lot about medications. I don't prescribe frequently either. I did get in a little bit of hot water by a couple of pharmacists this. This year, at the end of this year, because I on one, I was just like having you guys on the podcast. I like have conversations with people and we were talking about how kind of rude and gatekeepy the pharmacists are, which I know, like, many of my followers tell me this, like, every single day, how obstructionist the pharmacists are. And I think. I do think there needs to be a hormone education movement in the pharmacist, but I. I can't take that on. I'm not a pharmacist. I need other people to take that on. But it's quite possible in that podcast, I said pharmacists are assholes. And although I did not mean all pharmacists are assholes, that got interpreted by some pharmacists as all pharmacists are assholes. Um, and apparently they identify with assholes who are pharmacists. So they got upset. And I can't please everybody, especially when I'm trying to, like, be funny and make a point. So sorry. Sorry to all my pharmacists. I love you. You know who you are. You do great work. Please start changing your industry, because it is true that you are jerks to people and you are obstructionist with some hormones. And we do. I do. I like, where's the national campaign on that? Get something started. Let's see a movement. I'll have you on my podcast. It'll be fantastic. And then we can say, I had to be on my podcast because you started a national movement, because I said all pharmacists are assholes, but I didn't mean all pharmacists are assholes, just like some physicians are assholes. And I don't identify as an asshole physician, so it doesn't offend me there. I said what I said, so I love you. Sorry, sorry, pharmacists. Didn't mean to make your butt get hurt. I just meant to speak up for my ladies who are getting obstructionist. All right, do, do, do, do. What else? My clinic, the Casperson Clinic. I'm getting help so I can see more. So we can see more people. We do have a wait list. Some people, though, they're like. I'm like, oh, we didn't sign up because you have a wait list. Wait list doesn't mean that we don't work through the wait list. Like, here's the great thing about my clinic. We dial people in with their sexual health or their hormones or weight loss, whatever they're working on. We dial people in, like, by four to six months, and then they, like, go and get refills by primary care, and they're feeling dialed in. It's really good. Contrast this with my Sex therapist. I'm going to. Now I'm going to call it the sex therapist because, like, I'm like, can you see more people? And they're like, no, we're full. And I'm like, but can't you make them better with your therapy so that you can then see more people? Like, we don't want to be full all the time. We want to solve people's problems so they're not stuck with us forever. Right? So maybe that's the surgical brain talking. So, yeah, we get people better and then we set them free. And it is so effing bittersweet and sad and sweet and happy. But, like, I don't. We get you feeling better, then you get on a plan, and then we give you the graduate plan, which means see me twice a year for refills and check it in labs or you, you graduate to your primary care doctor. I actually texted a friend of mine this week and I'm like, hey, sending you back your patient. She's dialed in. She's completely happy. She has no symptoms here if you need me. So that is a good thing. So, yes, we have a wait list, but that doesn't mean that we aren't working through through it. Somebody says, oh, my God. This is my complaint of other physical therapists. Discharge people, get them better. Yes, exactly. Our goal is not to make they've got better things to do with their time. Even though I love them, I love them, I love my patients. But get them better and then they go out and they do better, and then we can see new people to get them better. And it's a happy, happy, happy revolving door. A bittersweetness all the time. All right, so that's the story about that. Oh, and the other cool thing about my clinic is we have a monthly book club. It's not a monthly book club. It's a monthly, like office hours with me and I kind of pick a topic. But we did our first book club this month, which will, like, leave it to the Casperson clinic to, like, pick some heady stuff. I picked Esther Perel's Meeting in Captivity. Excellent, excellent, excellent book. And it's a little personal though, because it's about, like bad sex and long term relationships. So maybe, maybe, you know, I started with the master's degree. The other two book clubs coming up will be Marty Makary's Blind Spots, which is exceptional if you love the history of medicine and, like, where doctors have been wrong before. Excellent book. And then we're going to do the Comfort Crisis by Michael Easter. I believe his name is Fantastic book. Basically the too long didn't read of the comfort crisis is move, move your body, move your body. We have a lot of problems because we don't move our body. Somebody asked what is the name of the FDA meeting recording from July? So go to the FDA YouTube and type in like Women's Health Roundtable. It's like the second thing on there because there's like 215,000 views. It's big. All right, so yes, that's the other cool thing about the Casperson Clinic is we have monthly ask me anything topics. January's topic is going to be male sexual function dysfunction. So erectile dysfunction, premature ejaculation and Peyronie's disease. So come one, come all. And they're recorded. So like, I know not everybody can make it at the same time. So they're recorded. Those are for Casperson Clinic members only. All right, what else? Oh, big news today for people watching this live. Flobanserin is now FDA approved for postmenopausal women. Addie has been FDA approved for many years. It was originally researched in all women 18 and up, I believe. And the FDA put premenopausal on it. So they just excluded postmenopausal women, even though they were saved. Saved. Studied. And it worked on them. Oh, somebody said their order of the menopause moment just came in. Woohoo. Woohoo. Woohoo. So today the FDA approved Addy flobanthrain 100 milligrams for the treatment of hypoactive sexual desire disorder in women less less than 65 years. This long awaited decision closes a gap in care for millions of postmenopausal women experiencing frustrating low sexual desire and marks a historic first approval for the fda. Crazy thing about Addie is it's not in Europe and it's not in Australia. I don't know, it's also, I think, not in Canada. So we've got a lot of work to do internationally for that. I know I have several international women who are like, can I literally, can you just meet me on the tarmac in Seattle? And I'm like, no, no, I don't think that's called doctor patient relationship enough. All right. Supported by the largest and most rigorous clinical trials ever conducted in women's sexual health, Addi first received FDA approval in 2015 for premenopausal women. And we've been waiting for this expansion ever since. Ever since Addie's established efficacy and safety profile, including a Decade of on market safety data has been reaffirmed globally with approval for pre and postmenopausal women in. Wait, it says in Canada too. You guys. Fantastic. Okay, so Addie is infligeneric is the first and only FDA approved pill to treat HSDD in women less than 65 years of age. It's non hormonal. It works in the brain through the dopamine pathway. Addy requires a prescription. You can learn more at addyadyi. Com. Here's the deal. Don't just get a prescription at like Walgreens or Walmart. Use their specialty pharmacy which is called FIL P H I L R X. They do prior auths. Prior auth success rate I think is around. Don't quote me exactly, but it's around like 60, 65% which is pretty good for prior auth. And cash price now is less than $200 a month. I can't exactly remember, but it's becoming more and more reasonable. All right, is Addie the same as Viagra? No. Viagra increases blood flow. Addi targets your brain chemistry. Addi works on sexual desire. Viagra does not. Viagra is a blood flow drug. Sex is complicated, y'. All. That's what that means. Sex is complicated. So Addie works on the key neurotransmitters in the sex center of the brain. So dopamine, norinephrine, serotonin, responsible for sex drive. You have to take it every day at night. So it is a daily medication. You can't just like take a pill and be horny. It's not how it works. Side effects are sleepiness, but like better sleep basically is what their trials showed. There is a documentary that is coming out. It's been premiered in New York and LA now and it's called the Pink Pill. And it is about the decades of work by advocates to get this done. Remember, Viagra had six months safety data. Even the. And they point this out in the documentary. Even the. There's an injection for men for curved penis. What is it called? I want to say Xiaflex. Is that right? Anyways, it was only studied in a thousand men and the side effect is rupture of the penis. And that got FDA approved. So like the barrier is so much higher for women to get sexual health medications than men. Somebody asked, can you take progesterone even with no uterus? I had a hysterectomy and I only use estradiol. Yes, you can take progesterone even with no uterus. In fact, most menopause experts recommend it because it really helps with sleep and it can help with mood and it also helps with bones. Great bone data on progesterone. Nobody knows that. All right, do I want to say anything else about Addi? Addi builds up in your system over time like many other medications that work on neurochemistry. So it doesn't work immediately. Most patients notice symptom improvement in as little as a few weeks, but full clinical benefit is usually seen around 12 weeks. That's very common with like, other, other medications that you take daily. Okay, so where do you need to see Addie fill? P H I L R X Mail order pharmacy is where your prescriber needs to put that prescription into cash. Programs for Addie are $149 a month or $279 for a three month bundle. That's what I would do because you want to give it time for it to work. So I would. I would just say do three months. And if it doesn't work, then you tried for three months, so that's good. My doctor told me I wasn't a candidate for HRT because I'm overweight and have estrogen in fat cells. Would love your thoughts. Omg. Overweight is not a contraindication. Fat cells actually make the inflammatory estrone, which is not as good for you. All the things. Basically your doctor said several stupid things there. See, pharmacists. I say doctors are jerks too. It's a. This is an equal opportunity hazing. And keep in mind the you're not broken podcast has some humor in it. And this is not a medical conference like, have you seen me on stage? There's a little standup going on. So can you get Addi in Australia? No, not yet. All right. Alcohol is not contraindicated for use with Addi if you take. If you have more than two drinks a night. My personal opinion is you need to reconsider your relationship with alcohol. But the party line says if you have more than two drinks a night, skip your addy dose. That at night can lead to low blood pressure. Just like every other medication that you're not supposed to drink alcohol with and then resume it the next day. And the other. That's the other note in Canada when it. That's right. It is approved in Canada. In Canada, when it was approved, it was just approved for postmenopausal women. So remember the FDA put a, like an artificial line in the sand in America, so that now they just released that. And why did they say 65 and under? They Say that it wasn't studied well over 65. Just that was a small sample size. But here's my bias call on that. Did they say statins weren't like aren't for over 65? What about antidepressants? What about sleep meds? Hello, way more risks in sleep meds. What about overactive bladder medications? Those are definitely not good for people over age 65 but that they don't have a 65 year old age on it. So again more bias in the fda I think unequally applying false fences where there should not be some. Can you take ADDI in addition to testosterone? Yes, probably only additive effects hasn't been studied. I haven't seen a study doing ADDI and testosterone but I would like to see a study because you're probably going to see an improvement from testosterone for libido and an improvement from addi and they work in different ways so it's probably additive. All right. My doc prescribed estradiol patches for me but refuses testosterone despite my lab test of near zero and very low libido. Good lord, let this woman try some testosterone. Does any telehealth provider prescribe testosterone? Yes, two main ones are Joy J O I which has I can't keep up around 17 states at this point and then midi I think they're around 15 states at this point. But again I this is off the top of my head. This is what we are predicting because the Men's Health just did a panel at the FDA December 10th and a lot of people asked for this and I agree with it is we need testosterone deregulated so it doesn't require a DEA prescription. That is why Telemed can't just have all states because every provider needs a DEA license in every single state. Massively prohibitive DEA meds are under threat for telehealth anyways. So all the testosterone experts by and large I'm grossly stereotyping as I tend to do. Please see previous comments about pharmacists. But most testosterone experts want deregulation because it was the doping scandals of in sport that basically caused this massive limitation for average Americans. And most people aren't going to try to become gold medal pole jumpers. And if you are going to try to become a gold medal pole jumper, don't dope. But if you're going to dope, you're going to be taking lots of other things besides physiologically dosed testosterone. So it makes no sense that this thing is regulated at this point. But I don't know how they're going to do it? Can the DEA just say that? Can the FDA just say that? Does it take an act of Congress to deregulate testosterone? I don't know. What's the book title about? Movement for Health. Oh, the Comfort Crisis by Michael English. Yeah. All right, all right, that is enough about Addy. We love you. To all the people who worked very, very hard. Is it worth exploring HRT for a 67 year old? Yes. If you're otherwise healthy and have no absolute contraindications, which are few, you probably won't get as much preventative benefits caus. Preventative benefits come the younger you start, but hormones will always help your bones. There's actually multiple placebo randomized controlled trials looking at older women in their 70s. Estrogen patch versus placebo. Excellent safety data. So everybody says that age is a contraindication. Look, Addy just did it. The FDA just did it with Addie. There's nothing. Matt, what's the difference between a 64 year old and a 66 year old? Tell me. I have a. If you go to my website and go to the summer school courses. Summer school. I have a one hour lecture on am I too old for hormones? And it really breaks down what people's fear are and what the actual data says. So I highly encourage that. Can a 74 year old woman restart estrogen patches without a uterus? There you go. Same question. Go to the summer school. My course is an hour. If you don't want to pay for that, I've got multiple podcast episodes on that and that are free. So my thesis is that the benefit outweighs the risk in the majority of people. People who say it's unsafe are quoting non followed up on oral synthetic WHI data and that's all laid out in my course. So a transdermal estradiol patch is very different than an oral high dose synthetic data and 18 year follow up data on the WHI women, what was it, 70 and under had no increased risk of heart disease. So the fact that we're telling women this is unsafe is meaning a transdermal estrodial patch is unfounded. They've actually done a randomized placebo controlled trial of estrogen patch versus placebo in women who previously had heart attacks and they did no worse than placebo. So I think this is the next chair that's gonna fall. Is that a metaphor? Is a chair gonna fall? Chest piece that's gonna fall is taking care of the boomers. Cause the boomers have been so desperately not taken care of. I Actually see a lot of. But so in my clinic, a third of people are perimenopause. Hands down, the hardest people to take care of. Because not because they're difficult, they're amazing, but because your ovaries are like up and down and up and down. And it's very challenging to like steady a boat that's on some waves. Postmenopause is easy. You don't have any hormones. So about a third of my practice is perimenopause. A third of my practice is normal Barbies. Normal Barbies is like 51 year olds with hot flashes. And then a third of my practice is age greater than 10 years. So we go through all this science, we go through all the data, all that. Oh, you guys, you're so cute. Absolutely adore you. Thank you for advocating. Thank you so much. You guys are so sweet. All right, moving on. What else did I want to tell you? Talked about Addie. This is a random shout out in the middle of a podcast because I'm desperate. So I've been wearing like the same Patagonia kapoline briefs for like 20 years. Like the ones I have, they're so blown out. Like, I wore them through my pregnancies and that's like more than 10 years ago. Patagonia is no longer making women's Kapoline briefs. Does anybody know a wholesaler? Does anybody, anybody have non unused Patagonia size medium briefs? If so, please email me and send them to me and I'll pay you for them. They like can't be found on the Internet. So this is my random Easter egg in the middle of this podcast. Anybody knows. Anybody who has a Patagonia outlet store size medium briefs? I would love them. I will buy them from you. They, they, they're no longer. They no longer exist. All right, Somebody else said those are my favorite too. Come on, Patagonia. Yes. Thank you. How are we going to function? And for anybody who thinks that's bougie, listen, these, these pieces of clothing have lasted me over a decade. Like, only now I'm like, you know what? I'm an adult. I've got like a best selling book. I should buy some new underwear. It's been a decade. Tmi. Bring back the brief. Somebody said. Yeah, exactly. All right, Online courses. Going back to that in the summer school. Kellycaspersonmd.com website. Do the thing that says courses. I've got a testosterone for women course, a female sex ed course. Am I too old for hormones course. Genital urinary syndrome of menopause. Course, perimenopause course, and then I have two more coming in January. Alcohol. I wonder what Dr. Casper is going to say about alcohol. And then hormones for longevity. Haha. Because that's the next conversation. Lack of hormones causes many things. One of them is symptoms. The other is things that don't cause symptoms, like low bone mass, neuronal changes, insulin resistance, et cetera, et cetera. So are you familiar with hormonally mediated vestibulodynia? Yes, I am. Yes, I do have podcasts on it. You have to go way back. Check out my episodes with Jill Kraft. K R A P F. She also has two amazing books. What do I. What do I have? The name of the When Sex Hurts. Excellent book about that. Excellent book. Highly recommend it. All right. People are recommending notori women's underwear. I'm taking notes. I need like, good underwear with no wedgies that lasts in a perfect world. Like no lines. Yes. Briefs. Now you know too much about me. Okay, so online courses. Follow me on Instagram and be on my email list to find out. So what I do with my courses is the live one is free and then I edit it and put it up on the website. And that costs money because the website. Guess what websites and podcasts cost money. You guys throw me a dollar. All right, my top five podcast episodes of 2025. Number one, episode 328, should I take hormones? Good topic. Number two, episode 318, how and why to prescribe hormones. Number three, episode 329, GLP1s with Dr. Salis Whalen. She's coming out with a book end of this year. End of December. Go grab it. She's amazing. I interviewed her for my podcast, episode 329. Fourth most top most top podcasts. Episodes of 2025, Getting Better at Sex Part One. That is with Susan Bratton. She's a firecracker. We had a lot of fun. It was so Good. We did two episodes. All right. And then the fifth most listened to podcast episode of 2025 was episode 324, pre menopause is real. It's not a belief system. It's not Santa Claus. It's real. All right. It's very good. If anybody is interested in the male FDA panel that's also free on the FDA, YouTube. Excellent experts in there. What are the takeaways from that screen? Men for testosterone. Somebody just wanted to ask what number four was again. Episode 333, Getting Better at Sex Part One. Okay, male FDA panel takeaways. Screen men for low testosterone. What a novel concept. I love that idea. If we know low testosterone in men is associated with depression, bone fracture and dementia risk and diabetes, why are we not screening them for it? Thought leaders. Okay, number two, deregulate. Agreed. When Sex Hurts is by Andrew Goldstein and Jill Kraft. And I did a podcast episode with them way, way back. But Google search. Hey, guys, Google search works really great. You are not broken. Dr. Andrew Goldstein, you are not broken. Dr. Jill Kraft, you are not broken. Perimenopause is real. It will tell you what episode it is. You don't just have to scroll, but you can. You can go listen to all my podcast episodes. Number three, I'm. I'm trying to get through the male FDA panel takeaways, you guys. Number one, screen men for testosterone. We want to check for it. Number two, deregulate testosterone. Make it not dea restricted. It is not dangerous, deadly, or addictive at physiologic doses. Number three, they want more options to that. I say really? Women have zero options. Like how about we get women to have three options before we make another option for men? That'd be fine. Men have injections, oral injection, long lasting gel. Gel packets, gel pumps. They had a. They had an intranasal one. I think that one might have gone off the market. Yeah, Oral. Did I say oral? Lots of things. Okay. And then the other, their other takeaway is that the testosterone and care of men with testosterone is hurt by the stigma of doping and sporting. So what is coming up? This episode is now in the what is coming up in 2026 part number one, I'm making a vibrator and it's pretty. And it's called the Explorer and it will be in your hands probably end of January, early February. So vulvar blood flow. Go check out that recent podcast, Vibrators is medicine with Dr. Eleanora. Not. No, it's not Teplinsky. But I just manifested. I need her to have. Come on. It is Put me on the spot. Who did I just. Who did I just interview about vibrators? I can't remember. Go listen to it. It's fantastic. It's about the research on vibrators and blood flow. Alexandra Dubinskaya there came to me. All right, Retreat and Whistler. August 2026. Three spots left. We've got the M Factor 2.0 before the pause coming out March 2026. Look for premieres to happen starting in February. What do I think about Red Light Joy Luxe? It's too big. It's too big for the average menopausal woman who has pain, that would not be my go to. Also, it's too expensive. So that would not be my first one. You gotta earn, you gotta earn that one. Great product, female owned company. But don't, don't let that one be your first vibrator for multiple, multiple reasons. So M Factor 2.0 before the pause coming out March 2026, look for the premiere to happen, start happening in February. I'm going to be in Seattle. I have an events page. So if you go to kellycaspersonmd.com, it's the events page that will be on there when it happens. And then the sex ed course coming out with Kommune, first quarter of 2026. So that's going to be awesome. And I want to leave you with one thing. Then I'm going to leave you with a poem. It's not actually a poem, but I think it's a poem. Okay. This is called. This is to all the creators, all the. All the doctors who are brave, all the pharmacists who are going to start educating people, all the pelvic floor physical therapists, all the amazing people who took care of me today when I had my colonoscopy. This is called the man in the arena by Theodore Roosevelt. It's very interesting to actually go read the full text. So the man in the arena part, which is famous, is cut from a very large speech called Citizenship in a Republic that he delivered at the Sorbonne in Paris, France, on April 23, 1910. So I'm going to read this to all the people who show up, risk offending people, and continue to do good work, because we're only human. Here you go. It is not the critic who counts, not the man who points out how the strong man stumbles or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs, who comes short again and again because there is no effort without error and shortcoming, but who does actually strive to do the deeds, who knows great enthusiasms, the great devotions, who spends himself in a worthy cause, who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat. Try reading that out loud without goosebumps, like everybody. Thank you from the bottom of my heart. This podcast has now been going on for a half a decade. I'm on episode 150. I'm on book two. I've been to the Sydney Opera House stage. I can't believe my life. I've helped more people than I ever thought possible, have made more friends than ever thought possible, have learned, learned more than ever thought possible, and at the end of 2025, have a clean anus and rectum and colon and don't have to get scoped again for another 10 years. Go get your colonoscopy. I love you. Keep listening. Please share thank you from the bottom of my heart. I love you so much. Hey friends, if you love the youe're Not Broken podcast, please show me your support by liking, subscribing and sharing it with someone you care about. Your support helps more people find this empowering information for courses, clinic info, and all things midlife mastery. Head over to kellycaspersonmd.com and don't forget, you can grab your copy of youf Are Not Broken. Stop shooting all over your sex life at Barnes and Noble Amazon, or ask your local bookstore to order it for you and a friend. While you're there, make sure to pre order my upcoming book, Menopause, Science, Hormones and Mindset for optimal longevity. Coming September 16, 2025 Medical Disclaimer the you Are Not Broken podcast, Instagram and content created by Dr. Kelly Casperson is presented solely for general information, education and entertainment purposes. The use of information on this podcast or materials linked from this podcast or website is at the user's own risk. Risk. It is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. This podcast does not diagnose or treat you. Users should not disregard or delay in obtaining medical advice for any medical or mental health condition they may have and should seek the assistance of their healthcare professionals for any such conditions. And as always, I got you, I got your back and you are not broken. Thanks for listening.