Podcast Summary: You Are Not Broken — Episode 350: Six Years In — The Big Winter Blowout, Hormones, Health, and Being in the Arena

Host: Dr. Kelly Casperson, MD
Date: December 21, 2025

Episode Overview

In this milestone 350th episode, Dr. Kelly Casperson celebrates six years of "You Are Not Broken" and reflects on her journey, the whirlwind of her personally and professionally transformative 2025, and the bigger picture of women’s health, hormones, and sexual wellness. The episode is candid, humorous, and uplifting, balancing real talk on medical advances, Dr. Casperson’s personal experiences, and audience Q&A. She highlights key changes within the field—including the FDA removal of the boxed warning on vaginal estrogen, her bestselling second book, opening the Casperson Clinic, and the recent FDA approval of Addyi for postmenopausal women. The episode is also punctuated with gratitude, memorable moments, and an empowering reading of Theodore Roosevelt’s “Man in the Arena.”

Key Discussion Points & Insights

1. Six Years of Trailblazing in Urology, Media, and Sexual Health

• Dr. Casperson reflects on starting her podcast when there were “zero other urology podcasters” (01:01).
  • She credits Dr. Garrett Pullman and mentions more urologists starting podcasts recently.
  • Humorously discusses how she might now have a “media company” thanks to her podcast, Instagram, YouTube, and event speaking.

2. Personal & Professional Highlights of 2025

(Timestamps throughout this section are approximate as the narrative flowed freely)

• Career Moves & Achievements

  • Left insurance-based medicine, opened the Casperson Clinic in Bellingham, WA, and is expanding with new providers. (Ref: 05:00–07:30)
  • “If you had told me...you’ll quit your insurance-based job, open up a clinic, go to Australia, speak on the Sydney Opera House stage, [and] go to the FDA three times...I would not have believed you!” (04:20)
  • Dr. Casperson enjoys consistent sleep and improved health after 20 years of night shifts/call.

• Writing & Publishing

  • Released second book: The Menopause Moment: Mindset, Hormones and Science for Optimal Longevity—became a bestseller. (07:40)
  • First book You Are Not Broken won an award.

• Travel & Speaking

  • Invited to speak on Sydney Opera House stage (March 1, 2025).
  • Actively manifesting a return to Australia and a possible New Zealand tour.
  • Multiple trips to the FDA, contributing to hormone health policy change.

• Retreats & Community

  • Hosted her second annual Sedona retreat; upcoming Whistler Four Seasons retreat now nearly sold out (08:55).
  • Retreats attract a varied audience: NPs, PAs, physicians, educators, lawyers, pilots, start-up owners, and managers.

3. Yearly Health Reflection & Advocacy

• Colonoscopy Experience

  • Dr. Casperson candidly discusses preparing for and getting her first colonoscopy (“baby’s first colonoscopy”), highlighting the importance of screening and how guidelines changed from age 50 to 45. (03:50–04:55)
  • “Turns out colonoscopies are very, very healthy for you...It significantly decreased death from colon cancer. I believe it.” (04:30)

• Current Events Acknowledgment

  • She somberly notes tragic international events (Sydney shootings, Washington floods, local disaster response). (05:05–05:35)

4. The Boxed Warning Removal on Estrogen Products

• Context and Advocacy:
  • Key milestone: FDA removed the boxed warning from estrogen products thanks to decades of advocacy and recent social media, grassroots, and academic efforts.
    • “The Women’s Health Initiative of 2002 was misinterpreted by the media…one year after [that], the FDA put boxed warnings on all estrogen products—not because of science.” (11:20)
    • “It was decades in the making, momentum because of social media, because of grassroots, because of Let’s Talk Menopause, and the Unboxing Estrogen campaign…” (13:00)
  • Explains the difference between boxed warnings and general prescribing warnings.
    • “The box warning is significant threat to life. Most medications don’t have box warnings…Some are ignored. Some are incorrect.” (14:00)
• Lasting Effects:
  • Expresses slight frustration that the information was misunderstood or overlooked by generalists.
  • Advocates for more hormone education in pharmacy and medicine.

5. Clinic Model & Patient Philosophy

• Expansion & Waitlist Philosophy

  • Focus on getting patients dialed in, then “setting them free” so there’s room for new patients.
    • “We want to solve people’s problems so they’re not stuck with us forever. Right?...We get people better, and then we set them free. It is so effing bittersweet…” (19:40)

• Monthly Book/Office Hours

  • First book club: Mating in Captivity by Esther Perel; upcoming: Blind Spots (Marty Makary) and The Comfort Crisis (Michael Easter).
    • “Basically, the TLDR of the Comfort Crisis is: Move your body, move your body, move your body. We have a lot of problems because we don’t move our body.” (21:30)

6. FDA Approval of Addyi for Postmenopausal Women

• Groundbreaking News

  • Just announced: Addyi (flibanserin) is now FDA approved for postmenopausal women, the first of its kind for hypoactive sexual desire disorder (HSDD) in this group (24:45).

    • “This long-awaited decision closes a gap in care for millions…marks a historic first approval for the FDA.” (24:55)
    • Emphasizes Addyi is non-hormonal and works in the brain (dopamine pathway).

  • Notes difficulty accessing Addyi internationally (not yet available in Europe or Australia).

  • “Sex is complicated, y’all. That’s what that means.” (26:10)

  • “Viagra increases blood flow. Addyi targets your brain chemistry…You have to take it every day at night. It is a daily medication. You can’t just like take a pill and be horny. It’s not how it works.” (26:20)

  • Discusses side effects (“Sleepiness, but like, better sleep basically is what their trials showed”), insurance, specialty pharmacy, and cash pay options.

  • Addresses skepticism and bias in prescription access for women over 65: “Did they say statins aren’t for over 65? What about antidepressants? What about sleep meds?...Again, more bias in the FDA.” (28:45)

7. Q&A: Hormones, Age, and Misconceptions

• Answers audience questions about HRT in older women (67, 74).

  • “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...A transdermal estradiol patch is very different than an oral high-dose synthetic.” (30:40)

• Calls out “stupid things” said by misinformed doctors about contraindications based on weight or fat-derived estrogen.

• Riffs on ongoing pharmacy challenges, playfully apologizing for previously calling some “pharmacists are assholes”, clarifying, “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.” (17:30)

8. Top Podcast Episodes of 2025

• #328: Should I Take Hormones
• #318: How and Why to Prescribe Hormones
• #329: GLP1s with Dr. Salis Whalen
• #333: Getting Better at Sex, Pt 1 (Susan Bratton)
• #324: Premenopause is Real
  • “Premenopause is real. It’s not a belief system. It’s not Santa Claus. It’s real.” (37:00)

9. Men’s Health/FDA Panel Takeaways (38:30)

• Advocates for screening men for low testosterone.
• Calls to deregulate testosterone (“It is not dangerous, deadly, or addictive at physiologic doses…”)
• Points out men’s options vs. women’s: “Women have zero options. How about we get women to have three options before we make another option for men?”

10. Looking Ahead: 2026 and Beyond (40:40)

• Launching the “Explorer” vibrator for vulvar blood flow (Jan/Feb 2026)
• Upcoming M Factor 2.0 course (“Before the Pause”) and collaborating with Commune for a sex ed course.
• Continuing retreats, events, and expanding online courses.
• Playfully laments Patagonia discontinuing her favorite briefs and requests listeners’ help finding them. (34:49)

Notable Quotes & Memorable Moments

• On Professional Transformation:
  “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.” — Dr. Casperson (01:30)

• On FDA Advocacy:
  “The box warning coming off has been in progress for over a decade…that was always incorrect. Can you know a little bit about the drugs you prescribe?” — Dr. Casperson (15:00)

• On Colonoscopies:
  “Turns out colonoscopies are very, very healthy for you…You want to catch those buggers early…bad shit lurks in the dark.” — Dr. Casperson (04:30)

• On Doctor/Pharmacist Bashing (with Humor):
  “It’s quite possible in that podcast, I said pharmacists are assholes…Apparently they identify with assholes who are pharmacists. So they got upset…But see, I say doctors are jerks too. This is an equal opportunity hazing.” — Dr. Casperson (17:00; 29:00)

• On Addyi Approval:
  “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.” (24:55)

• On Setting Patients Free:
  “We get people better, and then we set them free. It is so effing bittersweet and sad and sweet and happy…” (19:50)

• On Bias in FDA Age Restrictions:
  “What’s the difference between a 64-year-old and a 66-year-old? Tell me.” (30:00)

• Empowerment and Manifesting:
  “Let’s just say we are currently trying to figure out negotiations for a Sydney tour. I would like to do it. Shout out to Australia. I’m not done with you.” (07:50)

• Final Reflection — Reading “Man in the Arena” (41:15):

  “It is not the critic who counts, not the man who points out how the strong man stumbles...The credit belongs to the man who is actually in the arena…who