319. ISSWSH: "Because We Don't Hate Women"

Summary

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Podcast Episode Summary

Podcast: You Are Not Broken

Host: Dr. Kelly Casperson, MD
Episode: 319. ISSWSH: "Because We Don't Hate Women"
Release Date: May 25, 2025

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Overview

In this episode, Dr. Kelly Casperson hosts Dr. Heather Quail, current treasurer of ISSWSH (International Society for the Study of Women’s Sexual Health), for a candid, in-depth discussion about the transformative role ISSWSH has played in women’s sexual health. The episode explores the organization’s growth, its inclusive, curiosity-driven culture, ongoing advances in sex medicine, and practical advice for both providers and patients navigating the often-neglected landscape of female sexual health—serving up science, humor, and real talk.

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Key Discussion Points & Insights

1. What is ISSWSH and Why Does It Matter?

• ISSWSH Overview:

  • International, collaborative society focused on advancing women’s sexual health.
  • Unique in its welcoming focus for a wide spectrum of healthcare providers: MDs, NPs, PAs, sex therapists, physical therapists, and more.
  • “For better or for worse, ISSWSH is so collaborative. You can be an MD, you can be an NP, a PA, a sex therapist, a sex counselor…everyone has a space at the table at ISSWSH.” — Dr. Heather Quail [01:15]

• Explosive Growth:

  • Membership grew by nearly 97% over the past year.
  • Driven by inclusivity, active education, and supportive environment for multidisciplinary professionals.

• Foundational Curiosity:

  • ISSWSH fosters open dialogue, ongoing learning, and inquisitiveness—something Dr. Casperson finds lacking in other organizations, like the Menopause Society [05:50].

2. ISSWSH’s Courses & Conferences

Fall Course vs. Annual Meeting

• Fall Course: Hands-on, practical, foundational—"very high level, tons of everything, all meshed in" [05:12].

  • Topics: pain, orgasm, desire, pelvic exams, vulvar disorders, and hormones.
  • Inclusive, evolving (recently added gender-affirming care).
  • "Every time you go, you will learn more. It's so incredibly high yield." — Dr. Kelly Casperson [04:49]

• Annual (Spring) Meeting:

  • Research-driven, spotlights the latest science and breakthroughs.
  • Heavy on podium presentations and posters.
  • “The posters is one of my favorite things we do at that conference.” — Dr. Heather Quail [05:50]

Agenda Highlights from 2025 Conference:

• Advances in understanding the orgasm pathway, curiosity around ADHD medication and its relevance to sexual medicine.
• Notable session: Dr. Erwin Goldstein challenging attendees with photos to discern between pain and orgasm, highlighting the overlap in neural pathways.
  • “My running joke...I’m gonna ask Steve to snap a picture right when I'm having an orgasm, and I'm gonna send it to you because it'll probably make you so happy for your day.” — Dr. Heather Quail [16:35]
• Anticipation for upcoming consensus papers on orgasm models [17:56].

3. Education Gaps and the Need for ISSWSH

• Most medical training, even at top programs, does not cover the depth and breadth of women’s sexual health.
  • “I was thinking that gynecologists knew all of this already. And she's like, Kelly, we didn't learn any of this.” — Dr. Kelly Casperson [24:25]

ISSWSH's Collaborative Strength:

• Members create a support and knowledge network—real-time sharing of tough cases, resources, and advice.
  • “If you see somebody who is ISSWSH trained, they're better problem solvers than somebody who’s doing this alone.” — Dr. Kelly Casperson [25:29]

4. Hormones, Research Gaps, and Advocacy

• Testosterone Discussion:

  • ISSWSH is a reliable resource for finding providers knowledgeable about testosterone treatment in women.
  • Ongoing struggle with the lack of FDA-approved options and overreliance on off-label use.
  • “We have nothing really for females. We don't even have freaking testosterone for us.” — Dr. Heather Quail [18:56]
  • ISSWSH-authored consensus statements guide best practices and address confusion around legal and safe use [10:59].
  • New advanced hormone course launching soon [11:22].

• Frustration with Research Inequities:

  • Disproportionate research on male sexual health and hormones, despite sufficient safety data for testosterone in men.
  • “We study blood pressure meds in men, and then we give them to women… But we're like, let's not take any of the safety data we have on testosterone in men…” — Dr. Kelly Casperson [28:33]

• The Need for Curiosity and Open Research:

  • No fees to submit abstracts at ISSWSH—supporting innovation and the advancement of underfunded research in sex med [07:20].
  • Other societies’ “pay to play” model seen as exclusionary and demotivating [08:53].

5. Reframing Dialogue: Supporting, Not Pathologizing, Women

• Challenging Biases:

  • Both hosts critique systemic biases towards women’s health, especially the skepticism and barriers surrounding hormone therapy.
  • “It goes back to...we hate women. I just...we just don’t like women.” — Dr. Heather Quail [29:04]
  • “ISSWSH: Because we don’t hate women.” — Dr. Kelly Casperson [29:17]

• Lab Values and Individualized Care:

  • Both advocate focusing less on rigid lab parameters—emphasizing patient-reported outcomes and response to therapy.
  • “A lab value is pretty meaningless...desires complex...there's so much we don't know.” — Dr. Kelly Casperson [30:17]

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Notable Quotes & Memorable Moments

• [01:15] Dr. Heather Quail: “You can be an MD, you can be an NP, a PA, a sex therapist, a sex counselor...everyone has a space at the table at ISSWSH. I think it's just why it's my favorite society ever, dude.”
• [05:50] Dr. Heather Quail: “The posters is one of my favorite things we do at that conference.”
• [16:35] Dr. Heather Quail (on orgasm session): “My running joke...I'm gonna ask Steve to snap a picture right when I'm having an orgasm, and I'm gonna send it to you because it'll probably make you so happy for your day.”
• [24:25] Dr. Kelly Casperson: “I was thinking that gynecologists knew all of this already. And she's like, Kelly, we didn't learn any of this. And that was like, Houston, we have a problem.”
• [29:04] Dr. Heather Quail (on systemic neglect): “I'm gonna say it out loud on the podcast. Delete it if you want. But we hate women. I just...we just don't like women.”
• [29:17] Dr. Kelly Casperson: “That’s gonna be like, every organization needs a tagline. ISSWSH should be like, because we don’t hate women.”

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Timestamps for Key Segments

• Introduction to ISSWSH: [00:18]-[02:41]
• Growth & Membership Inclusion: [01:05]-[02:41]
• ISSWSH Courses & Conferences Explained: [03:04]-[06:46]
• Importance of Curiosity and Research Support: [05:50]-[08:53]
• Testosterone, Research Gaps, and Consensus Statements: [09:09]-[12:23]
• Origins & Importance of ISSWSH for Providers: [12:26]-[14:34]
• Highlights from 2025 Conference: [15:22]-[18:16]
• Medications and Off-label Use: [18:17]-[20:25]
• Lab Values vs. Patient Outcomes: [29:29]-[31:59]
• Upcoming ISSWSH Events: [33:16]-[33:46]

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Additional Resources & How to Get Involved

• ISSWSH Membership & Events:

  • Visit isswsh.org for membership, provider directories, and details about upcoming events (including the 2026 Long Beach conference: Feb 12–16).

• For Clinicians & Patients:

  • ISSWSH remains the recommended hub for evidence-based, compassionate sex medicine, including hormone therapy and sexual health support.
  • Don’t miss the revamped advanced hormone course (launching soon).

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Final Takeaway

Dr. Casperson and Dr. Quail make a compelling case for curiosity, collaboration, and compassion in women’s sexual health—qualities embodied by ISSWSH. They urge clinicians and patients alike to seek communities and resources that “don’t hate women,” challenge outdated narratives, and advance care from a place of openness, rigor, and solidarity.

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Transcript

[Dr. Kelly Casperson]

Welcome to the you are Not Broken podcast. I'm your host, Dr. Kelly Casperson, a

board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality.

Enjoy the show. Hey everybody.

Welcome back to the youe're Not Broken podcast. We are going to talk about all things organizationally sexual today because we're going to talk about ishwish, which is the international society for the study of women's sexual health. Ishwish.org Go check it out. They're probably the thing I shout out the most on the podcast. And today I have the current treasurer, Dr. Heather Quail, with us today. Welcome to the podcast.

[Dr. Heather Quail]

Thank you so much for having me. Yes, you do say iswish quite a bit.

[Dr. Kelly Casperson]

She can back me up.

[Dr. Heather Quail]

I will. Not only am I the treasurer, but I listen to your podcast on a regular and I hear it all the time. We talk about it all the time. Our membership has grown.

[Dr. Kelly Casperson]

Tell me how much the issue. Membership has grown because we want people to be members of ISSWISH who can be members of isshish.

[Dr. Heather Quail]

So when we did our board meeting this past year and I actually presented it at the scientific meeting and now you're going to make me go pull my PowerPoint for it.

[Dr. Kelly Casperson]

I don't need exact numbers.

[Dr. Heather Quail]

We've actually grown to almost like 97% in the last year, like significantly. I may be a little bit off on those numbers, but yeah, huge. And honestly, it's probably the most. Because it's the most collaborative organization. And I can say this, being a nurse practitioner, because sometimes we feel like the redheaded stepchildren and that you go to these societies and it's very MD driven and they don't love us in the same way that isswish does and whatever. For better or for worse, isshwish is so collaborative. You can be an md, you can be an np, a pa, a sex therapist, a sex counselor, a pelvic floor physical therapist, and we want you and you're welcomed and everyone has a space at the table at ISSwish. I think it's just why it's my favorite society ever, dude.

[Dr. Kelly Casperson]

And also founded by a urologist, which I made it through an entire American urology residency not knowing it this thing even existed, let alone was founded by a urologist.

[Dr. Heather Quail]

Exactly. And so and when I say MD or NP or pa, we want all different who can do sex med, everyone can do sex med that are specialized, whether you're urology or gynecology or urogyne or even primary care psychiatry. All of it. We all should be talking about sexual health in particular for women because that's what we specialize at isswish. But every person should be asked about their sexual health when they are interacting with their healthcare provider.

[Dr. Kelly Casperson]

We all got here because of sex.

[Dr. Heather Quail]

Yeah.

[Dr. Kelly Casperson]

Like it's so incredibly universal, it's embarrassing. So I agree. I found ishwish because of my story was I didn't know how to deal with female sexual health. I'm a urologist, so I was pretty fine with the penises and I went to their fall course. Now I am going to put you on the spot. Damn it. Is the fall course open for registration?

[Dr. Heather Quail]

The fall course is not open just yet. It should be open soon because we're changing venues.

[Dr. Kelly Casperson]

Are you still going to do in Phoenix?

[Dr. Heather Quail]

Still going to be in Arizona and I believe. Right. Still in Phoenix. It's not as far. I mean, like it's equidistant, but it can actually take more people in the room so that we can have more registration for it. So we're actually excited about it. And our education chair is kind of changing. Like we've changed the format over the years to be more inclusive. It has like gender affirming care and some other really cool nuances and we're still evolving.

[Dr. Kelly Casperson]

The vulvar derm, when I went for the first time, Dr. Andrew Goldstein did it. The vulvar derm was excellent. I did the vulvoscopy course. It was my kind of my. One of my first dip into hormones. I went to that fall course before I was doing menopause hormone therapy. That fall course was where I learned that women aren't born without a labia minora and they just happen to be 70 years old.

[Dr. Heather Quail]

Yes. It was so eye opening, like learning about lichen sclerosis. I mean, it's one of the things. I see it a lot. I'm on a lot of different Facebook forums, particularly one like women's health, nurse practitioner and other things. And it's interesting what people put out. I've treated yeast. I keep treating it. It's not getting better. It's not getting better. And in my brain, because we're ish wish folks, I'm always like, well, has anyone biopsied her and looked at lichen? And it's like that's just where our brain goes. But I cannot believe how many people have no clue what lichen is as health care providers.

[Dr. Kelly Casperson]

100%. And how many women have pelvic issues and who've never had an exam or

[Dr. Heather Quail]

that we're not trained to assess the muscles properly on a proper pelvic exam. But you come to issuish and we will darn well teach you how to do a good pelvic examination.

[Dr. Kelly Casperson]

It's so great. And you keep going back. I went to the fall course multiple times. The last one I went to was the online one. Cause it was Covid. I haven't been back since it was in person again. But every time you go, you will learn more. It's so incredibly high yield. And I want to contrast the fall course with the spring conference because I think they're very different.

[Dr. Heather Quail]

They're very different. Very much so. So the fall course is going to be like very high level, tons of everything, all meshed in. So you're lear learning about pain and orgasm and desire, arousal. And we split it up into categories where when you think about our annual meeting, it's a lot of the newest, the latest, the greatest, and very research driven, where you get the best minds all coming together to bring what is the newest nuances in sexual medicine for females. And tons of research. We do lots of podium presentations. I learned so much from the posters. The posters is one of my favorite things we do at that conference.

[Dr. Kelly Casperson]

Yeah, the conference. So the spring commerce tends to be more like cutting edge. This is new. Where are we going to go with this? But very open to, like, new ideas. That's what's also very cool about Ishwish. In contrast. I'm going to call it out in contrast to the Menopause Society. I went to the Menopause Society conference for the first time last year. The lack of encouragement for curiosity was profound. And I think one of my themes that keeps coming back this year with the podcast is curiosity is everything. And if you don't have curiosity in the annual meeting, your group's dead. Like, what's. What are people gonna keep coming back for? And Ishwish is very good with curiosity. And you know the founder, Dr. Erwin Goldstein, he's always raising his hand and being like, what about this? What about that? Why aren't we doing it this way? Curiosity is a core cornerstone of Ishwish, a hundred percent.

[Dr. Heather Quail]

And one of the things. And if you want to be a researcher or you're a new student, like, this is one of the things Rachel Rubin always says is that sexual medicine is your place where you get to kind of do newest, latest, greatest. Because we don't have tons of funding and tons of research in sex med. And if you want to be known for something Sex Med's where you should get known for it, because we're open to it, but we don't charge our members to put in an abstract. As you know, on my text chain, I was pretty angry the other day where I was like, what we have to pay to submit an abstract? And we kind of bantered about that a little bit.

[Dr. Kelly Casperson]

Yeah, well, I think, you know, supporting researchers, yes, it's a job, but it. It costs money and to have to pay to play. And one of the problems is, well, if you're being supported by big pharma, it sure is easier to pay to play, you know, And a lot of things, especially in Sex Med, and I would say women in general is like, there's a lot of clinicians doing research on the bootstraps. They're on a shoestring budget. They're doing it out of the goodness of their heart. Why do they have to pay to get. To get this out there?

[Dr. Heather Quail]

So I have a twofold answer for you on this one. In the state of the economy, I mean, the world that we're in right now, we're cutting funding left and right. I have someone in particular who sits in my mind right now that is someone in the past on our issuish board that had a bunch of her money cut this year because of just funding. But she's a sex medicine person, so how did she get her research out there? Her funding's been cut, but yet there are organizations that want to charge for abstracts. I can wear two hats on this. I've been on the other end of the abstracts where I have to decide what abstracts go to. Isswish, that's the job of our scientific chair. So it is an unsurmountable amount of work. But also, I think that there should be pride in your organization to pick these great things to bring them. And when you sit, like you say, when they're basically bootstrapping themselves to get the research out there to charge for it, I really, really struggle with this big time.

[Dr. Kelly Casperson]

It's, like, not very welcoming.

[Dr. Heather Quail]

And it's why to the society I will not name, I won't submit an abstract this year. I've thought about it and I'm like, no, it's out of principle now. I've been on the other end of having to accept abstracts and know it's a lot of work, but yeah, it's really made me question and paused on that one.

[Dr. Kelly Casperson]

Yeah, the other. The other go to. And I think the reason why I shout out is so much on the podcast is because People tend to ask me, where do I go to find somebody to help me with testosterone. My answer is Ishwish. And the reason for that is people who understand sex med understand the role of hormones in sexual function. And if you understand the role of hormones in sexual function, you also understand the role of testosterone in all bodies and sexual function. Although Ishwish is kind of the umbrella for sexual health, I think they're probably the best trained group. If I was like, go to a place and type in your zip code. Ishwish is, I think, the best place to. I mean, even some of the big online hormone places, they can't all do testosterone right because of DEA in state restrictions and stuff like that. So it's like consistently, Ishwish is pretty good universally because even if I was to recommend one of the online companies, I can't guarantee Michigan's gonna work. Somebody. I just got a post today from a woman in Pennsylvania and she said it's illegal to give women testosterone in Pennsylvania. And I'm like, first of all, I don't think that's true.

[Dr. Heather Quail]

It's gotta be because of telehealth laws.

[Dr. Kelly Casperson]

To me, I'm like, maybe a provider told you that, but I'm basically like, my answer for everything is like, show me the data, show me the paper. Show me where this is. Because I'm like, if it is illegal, I got some, some content.

[Dr. Heather Quail]

No, it's not. I know too. I know a bunch of PA providers. It probably is that they don't have a dea and it was probably a telehealth visit, if I was to guess. Or they just don't understand it and they don't want to prescribe it.

[Dr. Kelly Casperson]

Yeah. Don't tell women it's illegal though.

[Dr. Heather Quail]

Yeah. Again, another, another thing that we have to navigate through all the noise.

[Dr. Kelly Casperson]

Yeah, totally. So, yeah, I think Ishwish is best for female testosterone. I can't say everybody does it, but I think it's a open place to find a provider who can do it.

[Dr. Heather Quail]

Well, because we also wrote the consensus statement and then had everyone back us. So that's helpful. The other really cool thing we're doing this year and it actually launches at the end of this month, is we have an advanced hormone course. So I'm super excited that iswish actually going to be a holder now of a true, tried and true hormone course so that maybe we're not so scared and can train the masses.

[Dr. Kelly Casperson]

That's great.

One of the other, I think, brave things that, that I got From Ishwish in the beginning and they still do this. But like it stuck out is like culturally in medicine it's not supported to question side effects of birth control pills and Ishwish. Again, it's a curiosity of like these medications have sexual side effects. Nobody talks about them. That doesn't mean they're not there. And so really like, let's understand these medications more fully so we can better help people. I thought that that was just a very. Maybe braves the wrong word, but it's like that's where I got like, oh, these medications don't just make you not get pregnant, they have other body effects.

[Dr. Heather Quail]

Exactly. And no one really talks about it either. A because they never learned it and didn't know. Like it wasn't until I started being a regular at ISSWISH many, many years ago that I'm like, oh yeah, birth control is great for preventing pregnancy, but let's talk about the libido and the sexual side effects and the vestibulodynia and the hormonal effects and all the things that it can cause.

[Dr. Kelly Casperson]

Totally. So how did you get involved in Ishwish?

[Dr. Heather Quail]

So I got involved in ISSWISH because I was kind of in that typical OBGYN practice. Been there for many, many years. Everyone kind of knew me. I they'd come for their annual exam and as you're closing the door right about when you're about to walk out in an insurance based model and you're like, do you have any questions you want me to answer? And it's like, actually. And they get to know you after all these years. I have no interest in sex. Oh, okay. Well, we were done with our annual exam and I don't really know how to help them and we, and I would hate to tell them like, hey, we have to start another visit because they already were there. So it was trying to come up with how you bring it up in the annual and make them feel like they're being validated and seen and heard or do you bring them back for another visit? But then if I bring them back for another visit, I'm not knowledgeable enough to know what to tell them to do. And so I did a lot of digging over my several years and I found Ishwish. And the interesting thing is I actually went to an Ishwish back in. I want to say it was like around 2008, 2009 and went to a conference and kind of went once or twice and I was. And I brought it back to the practice And I remember telling the guy that I worked with and I'd worked with him, I was there for like 10 years. He's like, no one wants to pay for libido. You'll never get it covered with insurance. And it's just a waste. And I was like, okay. And I'd have written up a soap note, a template, all the things. And he's just like, yeah, no. And so no interest. So I kind of like left this idea and didn't go back to an issue. Ish again until right around 2016 when I left, moved out of the state and joined into another practice. And forever then it has kind of been my home. And I'm like, I will build something around this. And that's kind of how it worked. And then I met the Goldsteins and got the opportunity to go spend some time and precept under him. And they've kind of forever been my sex med parents.

[Dr. Kelly Casperson]

Oh, I love it. I think they single handedly have shaped sex med in this country.

[Dr. Heather Quail]

And they're so open to training and teaching everyone. Like they're just the nicest people in the entire world.

[Dr. Kelly Casperson]

Yeah. Their attitude and their openness and their curiosity is like, you know, Dr. Goldstein embodies the true expert who knows everything, understands they don't know much at all. He embodies that of like, what about this? What about that? What about this? And you're like, dude, if he doesn't know, like, we got some work to do. Still incredibly exciting. So I did not make it to Atlanta to the Ishwish 2025 conference because I was in Sydney, Australia, getting a

[Dr. Heather Quail]

standing ovation in the Sydney Opera House.

[Dr. Kelly Casperson]

Getting a standing ovation from Australians who don't stand.

[Dr. Heather Quail]

Don't stand. Love it.

[Dr. Kelly Casperson]

Petting koalas asses.

[Dr. Heather Quail]

Love it.

[Dr. Kelly Casperson]

I know. So I would have been there. So you were kind enough to send me the agenda from it. Can we talk about like what you thought were some highlights and then I'll pull out some that kind of were curious to me.

[Dr. Heather Quail]

Yep. So of course I'm gonna. I mean, I. Like I said, I'm pretty impartial to whenever I can hear Dr. G, the OG Erwin and Barry Kamisura get in a room. It's like in the room where it's happening kind of thing. So really kind of hearing a lot about orgasm, process of care and kind of some of the things that were that are coming down the path with it. I think in Irwin speak, it was so above my head in some of the things. And so I Have a colleague that actually put it into concise little mapping of this is this, and that is that. But I think there are some really cool, novel approaches that I'm super excited to kind of see come down the line. I think some of us are doing some of the things, but, like, I'm kind of more intrigued on, like, where do ADHD meds? Where are they going to fall with this? Another super interesting thing that he talked about is he showed a bunch of pictures that were in his PowerPoint and he said, I want you to tell me, is the patient experiencing an orgasm or pain in these pictures? And I think that was just kind of this mind blown moment that they kind of exist on that same neural pathway. And you're just like, oh, my gosh. And so my running joke, because I'm really close with the Goldsteins, is he's just like, do you realize, like, when you're having sex, your eyes dilate and this is what's going on, and you make the face. And I'm like, erwin, I'm gonna ask Steve to snap a picture right when I'm having an orgasm, and I'm gonna send it to you because it'll probably make you so happy for your day. And we kind of joked about it at dinner one night.

[Dr. Kelly Casperson]

It's true. I think it was the last. It was last year's issue 2024, where they talked about they had the water faucets. Right. So, like, what your body, to explain this for people is like, your body has to have excitement but also inhibit pain at the same time. Because, like, that amount of friction in a non sexual event is uncomfortable. And when it is a sexual arousing event, you actually have to kind of inhibit the fact that you could be experiencing pain if this wasn't sex. And so kind of their process of and model of looking at orgasmic dysfunction is breaking it down as to, like, is it too much pain? Is it not enough excitement or is it not enough inhibition? Can you get close? But you can't go over the waterfall. Do you go over the waterfall too quickly? Like, they kind of are really kind of creating a structure in how to think about orgasm, which it's fun to kind of like. I just wish, like, the paper was published already. I'm kind of in a hurry. But it's also exciting to actually, like, kind of watch the cake be made.

[Dr. Heather Quail]

Exactly. I'm kind of thinking by the end of this year, I was hopeful it would have been more like beginning of the year, but which means it's almost December. That's how I look at the trajectory. I'm like, crap, we're back at the holidays again.

[Dr. Kelly Casperson]

I'm like, I thought we were going to wait a couple more years for an orgasm pathway.

[Dr. Heather Quail]

No. The hope is that it'll be out this year, which is exciting.

[Dr. Kelly Casperson]

No way.

[Dr. Heather Quail]

Yeah.

[Dr. Kelly Casperson]

Are there any meds in the pipeline, FDA approval wise for orgasm, or are we looking at if we're going to use pharmacologics? Everything's being used off label.

[Dr. Heather Quail]

I want to say from what I remember, because I need to go back and look at all of his things, because in my mind right now I'm like, like what? What were all the things? I think a lot of it is. I think most of it is going to be off label. And that's the sad reality is most of what we do in sexual medicine for females is off label. That could be a whole other day's podcast that you post about a lot. We have nothing really for females. We don't even have freaking testosterone for us. We have two drugs that are available that work about 40 to 50% of the time for females and are off

[Dr. Kelly Casperson]

label for post menopause until that gets changed on label in Canada and are

[Dr. Heather Quail]

off label for arousal. And they're off label for all the things. So a lot of it is off label. Like I said, the ADHD drugs, there's Bus Bar, which falls into. Is Bus Bar an SNRI ssri? No, it's neither. There's some other ones. Again, all of it off label.

[Dr. Kelly Casperson]

Do you have anybody on Wellbutrin for sexual dysfunction?

[Dr. Heather Quail]

So here's my take with Wellbutrin. I do have some patients that take it for sexual side effects. And I think it works well when you have a true SSRI that is kind of causing a lot of things. So, like your tried and true Prozac and your Lexapros, that works so great for depression and they need it. But then if you kind of use a taper up of the Wellbutrin, I've had a couple of patients actually do okay. I have them actually do better on sometimes the Wellbutrin than they have on Flavanserin, for example. I do use Flavanserin, though quite a bit with SSRIs and I've had good results for some and some other results that don't necessarily work for others.

[Dr. Kelly Casperson]

Yeah, I mean, I think, you know, Sex Med is not unique in the fact that like, not everything works for everybody. And at the end of the day, sex is kind of like you know, blood pressure of, like. There's like, 20 different reasons that your blood pressure could be off. It's not one reason that everybody has a blood pressure issue. And the same thing with sex is like, testosterone. Super interesting on Instagram, right? Because you. I.

[Dr. Heather Quail]

You.

[Dr. Kelly Casperson]

I have, like, this massively stoked camp about testosterone for libido. And then. But there's a fair amount of women who are like, it didn't help my libido. Yeah.

[Dr. Heather Quail]

Like, I have women with actually lower testosterone numbers than I would like. But then they're like, yeah, I'm having effects and we're great. And then I'm just like, okay, then maybe I shouldn't even be following labs. Even though the consensus guideline says to get a total T. But then they don't direct us where our parameters should fall. And you go to these courses, and they're like, they should fall between X and X maybe, but we don't know. But then I have other people telling me, like, for me personally, like, when I don't use my testosterone, my bone and joints hurt. Do I think it always helps my libido? No, but it sure as hell helps my carpal tunnel and my hip pain and all the other stuff. You and I have had this conversation.

[Dr. Kelly Casperson]

Guess what you don't want to do when your wrist is flaring up. Get late.

[Dr. Heather Quail]

I honestly started my testosterone on a regular after last year's Ishwish. When you and I sat there and you're like, why aren't you using testosterone for your hip pain on a more regular. I'm like, well, maybe I need to be better.

[Dr. Kelly Casperson]

Did I say that?

[Dr. Heather Quail]

Yes, you did. And then I was using it more regular, and it helped. It totally helped. And then my friend Dr. O' Sullivan figured out, and we don't know why, but she's like, heather, stop rubbing the damn testosterone on your wrists at night. She goes, I have a feeling it's doing something weird. Stopped rubbing it on my wrist, and guess what? My carpal tunnel went away. I started rubbing it every day on my thigh. We don't know why.

[Dr. Kelly Casperson]

Oh, that's very interesting.

[Dr. Heather Quail]

We can't figure it out. So I'm. When I figure I've stopped telling my patients to rub it because I'm lazy. I'm like, I'm going to put my dollop of testosterone on my arm, rub it together, because then I can just jump in the bed and I don't have to wash my hands if I've already washed my face and everything. And then I won't transfer it onto anybody. And my wrists were bothering me.

[Dr. Kelly Casperson]

Very interesting. I mean, the inside of your wrist is not very hair bearing, but I'm like, we could get hairy wrists.

[Dr. Heather Quail]

Dr. O' Sullivan and I were like, is it because maybe it's less surface space? So she's like, put it on your thigh. I swear to God, dude, like, it went away. It's been gone for four straight months since I stopped.

[Dr. Kelly Casperson]

I believe you. That's amazing. I think people don't understand the role of testosterone in pain receptors. Like, we've got data looking at that. Migraines are less when people have higher testosterone. There was just an abstract. I feel like I shared this with the group. I can't remember. Testosterone correlated with the risk of Parkinson's disease.

[Dr. Heather Quail]

We just talked. Yes, we. We share it with us yesterday. And I'm like, oh my gosh. I have a friend with Parkinson's and she is awful on her cycles. You. We just talked about this.

[Dr. Kelly Casperson]

Her Parkinson's gets worse during her periods. During her periods when her hormones are low. Yep.

[Dr. Heather Quail]

I think there's a total correlation. She's also had Parkinson since she was in her late 20s. And they don't know what to do with her because females very rarely get it. So they don't even. She's young too.

[Dr. Kelly Casperson]

Michael J.

Fox, I think was 28 or 29.

[Dr. Heather Quail]

Yeah. Young and even still, we're figuring out like, we don't know everything. And we're always learning from each other or anecdotally.

[Dr. Kelly Casperson]

Totally. I mean, that's the other cool thing about Ishwish is nobody. Nobody goes to Ishwa. Certain is like. I was kind of thinking this might be interesting. I don't know. Like, people tend to be. They're all in once they do a course or they do the course, you'll be all in. But like, they're at least like 80%. Like, you gotta be ballsy to like show up to a sex conference, I think. I don't know, but when I went to my first one, I was. It was like the, you know, the 10:00am coffee bar. You go out in the lobby and you make. Get your.

[Dr. Heather Quail]

You're like, can we start this at like 8? Just wait.

[Dr. Kelly Casperson]

Yeah, yeah. Can we start the conference earlier if I get coffee earlier? So I'm at the coffee bar at the 10am at the fall course. And across from me at the coffee bar is Dr. Ashley Fuller, who's a gynecologist who I went to medical school with. And we did our general surgery residency together. And she had very clean, fancy, new pink Danskos in med school. And I just remember that.

And so I'm looking at her across

from the coffee bar and I'm like, what the f are you doing here? Because that was in my beginning of education thinking that gynecologists knew all of this already. And she went to, like, one of the best gynecology or ob gyn residencies in the nation in Texas. Whichever one delivers, like, thousands and thousands of babies. So, like, prestigious place to train. And she's like, kelly, we didn't learn any of this. And that was like, houston, we have a problem.

[Dr. Heather Quail]

Yes. And that is why. Let me repeat again. Is just so collaborative. Because she and I are on this other text chain with a. And we've send each other, like, the craziest vulvar cases and we snap all these pictures and all the things. And I love her. Like I said, if you're expert that we now feel we're experts have to have a text chain with each other for hard cases. Like, we're hitting novel stuff that hasn't been researched and that we haven't been taught.

[Dr. Kelly Casperson]

Yeah. The other cool thing is, like, if you see somebody who is Ishwish trained or in the issuish organization, if you go to the find the provider first side note, people are going to think that Ishwish is paying me for this podcast right now. They are not.

[Dr. Heather Quail]

I'm not getting paid either.

[Dr. Kelly Casperson]

And also not getting. We're just super fans. Check it out. Explode their membership. If you go to the find a provider on the Ishwish thing and you see somebody and they're involved, like they know all the other people. Like, there's. They're connected. So, like, they're better problem solvers than somebody who's like, trying to do this alone or stuff.

[Dr. Heather Quail]

Well, that's what I tell my difficult sex med patients. I'm like, oh, you have me stumped. But wait a minute. I have an arsenal of this many people I'm gonna text and I'm gonna say, do I have permission to send your vulva pictures? And they're like, like, please. I'm like, because it's like this mind blow.

[Dr. Kelly Casperson]

Yeah, yeah, no, it's the best. That's what I tell. I'm like, if I don't know the answer, I'm friends with everybody, so. Which is very awesome. I want to talk about the testosterone guidelines. They came out in 2019, if I'm remembering this correctly. Do you think they're due for an update?

[Dr. Heather Quail]

I Think they actually are in the process of doing it. I remember hearing about this at our annual meeting and not our, well, our board meeting I should say. I think that, and maybe it's the HSDD consensus, I think they're both getting updated. I could be totally like making that up in my brain. But I, I hear so many things in our, in our board meetings. But I believe that is on the docket.

[Dr. Kelly Casperson]

I think they need to open it up to pre menopause perimenopause. First of all, having no periods means butt kiss when it comes to if you are a testosterone candidate or not. So the pre menopause, post menopause thing is meaningless and, and it's safe if you get pregnant, stop your testosterone, but it's not contraindicated if you have a chance of pregnancy. We let trans men get pregnant.

[Dr. Heather Quail]

I think that's what's going to guide us. I think the trans care that it's becoming so important, I think that's going to be used more of a guide. When we've talked about all our testosterone stuff, I'm always like, if we can get more guidance on trans, that's what's going to help us as females.

[Dr. Kelly Casperson]

Yeah, there was this new paper, I think Jen just shared it with a group that they looked at trans men on testosterone and this heart muscle basically got stronger but no negative parameters of the heart. Got. It doesn't hurt your heart to take 10 times the dose of testosterone. Like that's what the paper says. And I was like, well yeah, we've got 50 year safety data showing that nobody's dying more of cardiovascular disease. Right. And she's like, but we need more papers to show like we can give people 10 times the dose of testosterone and it's still sedave on their heart and like there's no other medication that we're like hey, anybody want to take 10 times the dose and we'll see how you do. Like it's an amazing opportunity and I don't think we emphasize it enough.

[Dr. Heather Quail]

Well, you want to know what's interesting is we always talk in our group texts how everything is always extrapolated from the male data. Oh, they did research on this as males. Oh it okay, we'll extrapolate it to the females. When we have tons of data on birth control pills and females with exponential amounts of this synthetic hormones, why can't we extrapolate lower dose hormone care that is not synthetic to females? If we can extrapolate male data.

[Dr. Kelly Casperson]

Yeah, I think I did a post on this because it's like, we study blood pressure meds in men, and then we give them to women. We study sleep meds in men, and we give them to women. We study cholesterol drugs in men, then we give them to women. But we're like, but let's not take any of the safety data we have on testosterone in men. It's depression benefits, it's mood benefits, it's, you know, insulin resistance benefits, it's strength benefit. All the things. We're like, yeah, but we don't have female data. And I'm like, excuse me. We didn't have female data for the sleep pills either. Like, but that didn't stop anybody from FDA approving it for everybody.

[Dr. Heather Quail]

It's just crazy hormones and females. It goes back to. I hate to say it. I'm gonna say it out loud on the podcast. Delete it if you want. But we hate women. I just. We've had this. We just don't like women.

[Dr. Kelly Casperson]

That's gonna be like, this is an issue which is like, every organization needs a tagline. Ishwish should be like, ishwish. Because we don't hate women, because we

[Dr. Heather Quail]

love our women or something.

[Dr. Kelly Casperson]

Yes,

I love it. I think. I mean, I think the question for. Just to say that there's a level that we diagnose low desire at or that we treat testosterone, too. It's a gross overconfidence in our laboratory values in understanding what normal is, in understanding what you're doing testosterone receptors are. To understanding the. Your metabolism of it. It's too. It's like. It takes an expert to understand. Like, a lab value is pretty meaningless. There was just a paper that got published in this month's Journal of Sex Med. Davis was the lead author. Basically, the gist of it was that, like, we don't really know that testosterone even correlates with low desire in premenopausal women. And I interpret that.

[Dr. Heather Quail]

That as.

[Dr. Kelly Casperson]

I always interpret it as, like, desires complex. But, like, we didn't know what these women's testosterone was when they were 22 and had desire. Right? Like, there's so much we don't know. And I just worry that papers like that, they're gonna be like, see, testosterone doesn't work. That's not what it says. It just means it's more complicated than we understand.

[Dr. Heather Quail]

Well, what if we got away from the labs? Like, what if we take the menopause society's adage, just give them their hormones. We don't need to test for it. We don't have to check estrogen and progesterone, which is not always what I. A lot of times I do get labs for better, for worse. People can hate me for it, but I do. But what if we just give the testosterone and we don't go by a parameter and say, hey, are you feeling the effects of it? Are you feeling too much of the effects? Like, what if we treated it the same way and don't have a lab parameter?

[Dr. Kelly Casperson]

I just.

Yeah, I think the lab parameters first of all, like, Quest. I'll pick on Quest for a hot second, like, normal goes down to like 5 and high is above like 34 or something. I'm making those up. But that's the range and people use that as gospel. Like it's too high if it's above or it's not low enough. And it's like, no, we got to like even get rid of what we think the normals are because we have more paper showing normal than the lab value is using.

[Dr. Heather Quail]

Oh, 100%. Because it's based on. We don't talk about optimal. Everything has to be on these ranges, which for the most part are off males, so they're not off females. And it also depends on when you did the labs. Like LabCorp is going to tell you one number, which quest is going to tell you which another. And then don't get me started on these. Woo, woo. Like Dutch and all the other things people are using. I mean, like, at least give us the tried and true blood, the gold standard, you know. But then there's variation, like, what if they drank the night before? What if they were dehydrated? What if they were sick? What if they're on biotin? Like, there's just so many parameters.

[Dr. Kelly Casperson]

What if they didn't get sleep?

[Dr. Heather Quail]

Exactly. I was talking to a colleague about men's health actually today, and she's like, you know, we have a lot of people that'll say, oh my God, your H and H is so elevated. Go give blood. I can't give you any more testosterone and I don't do a lot of male health. So she was just kind of saying. She goes. But the problem is she goes, no one asks the questions pre testosterone. Like, how much do you drink? Were you dehydrated? If you're one step dehydrated, going to get your blood work done, you're probably going to have a high HH by definition.

[Dr. Kelly Casperson]

And so many people do get labs fasting because they're kind of trained to think you need to get fasting labs. It's just so many people are like, I have elevated creatinine. I'm like, did you. Were you hydrated? They're like, no, I was fasting. I'm like, okay, maybe we should check a hydrated creatinine before we we go down that pathway. Well, this has been an absolute pleasure. We didn't even scratch the surface of what happened@ishwash 2025.

[Dr. Heather Quail]

We talked about all our other tangents, which is amazing. The research also. We'll have to do another one. The research that comes out every year is amazing. Tons of posters. We're free. So if you listen to this and you want to submit an abstract, we're free. Please do. We had 220 abstracts submitted this year. I think we took over 200 and. Or maybe we had 240 and we took 220. Biggest amount we ever had.

[Dr. Kelly Casperson]

That's amazing. Ishwish Conference 2026 Long Beach Again, we have the dates. I believe they're in February.

[Dr. Heather Quail]

They are. They actually fall around Valentine's. I think it actually is on the President's Day weekend. I'll tell you. Hold on. It's February 12th through the 16th, I think.

[Dr. Kelly Casperson]

But if you're a newbie or a beginner, you want to dip your foot in. I can't recommend the fall course more strongly.

[Dr. Heather Quail]

Yeah, it'll be in November.

[Dr. Kelly Casperson]

Thanks for coming on and chatting all things Women's health with me today. It was great.

[Dr. Heather Quail]

Thanks, my friend. Thanks for having me.

[Dr. Kelly Casperson]

Thank you for listening to this week's episode of you Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members get the Masterclass for free.

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