348. The Sex Doctors: AKA Two Urologists and a Sex Therapist Have A Chat

Summary

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Episode Overview

Podcast: You Are Not Broken
Host: Dr. Kelly Casperson, MD
Episode: 348. The Sex Doctors: AKA Two Urologists and a Sex Therapist Have A Chat
Date: December 7, 2025
Guests: Dr. Abraham Morgentaler (Urologist), Dr. Marianne Brandon (Clinical Psychologist/Sex Therapist)
Theme:
This lively and insightful episode brings together two urologists and a sex therapist—Dr. Abraham Morgentaler and Dr. Marianne Brandon, co-hosts of the Sex Doctors podcast—with Dr. Casperson for a frank, humorous, and myth-busting conversation about sexual health, testosterone, medical dogma, and how sex and relationships evolve in midlife and beyond.

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Key Discussion Points & Insights

1. Sex Doctors Meet "You Are Not Broken"

• Dr. Casperson enthusiastically introduces her guests, noting that although they have appeared on her podcast separately before, this is their first joint appearance.
• She praises their own show, "The Sex Doctors", for being both scientifically rigorous and accessible, "flirty," playful, and actionable.

“I love that you guys are flirty with each other and it’s like super playful and you bring good, hard science into easily explainable, tactical — what do you do with this plans?”
— Dr. Casperson [00:42]

2. Testosterone and Medical Dogma

a. Origins of Testosterone Fears

• Dr. Morgentaler outlines a "broken telephone" in the history of urology: the now-debunked belief that testosterone causes prostate cancer originated from tiny, flawed studies in the mid-20th century.
• Explains dogma was based mostly on two studies with methodological flaws: Huggins’ Nobel-winning research (1941) and a small study from Memorial Sloan Kettering (1981).

“When I was in my training, nobody got testosterone. Everybody thought it caused prostate cancer… if a man got an injection of testosterone today... he’d be back within a month with an aggressive prostate cancer.”
— Dr. Morgentaler [02:43]

b. Evolving Medical Practice

• Dr. Casperson reflects on changing attitudes and compares the evolution in testosterone prescribing to similar rigidness around hormone therapy for breast cancer survivors.
• Emphasis on re-examining data, quality of life, and shared decision-making as new standards in modern medicine.

“Things change. We can reanalyze data, we can do more studies. We can consider risks and benefits and quality of life. Because I think so many people think medicine is set in stone. And it’s not.”
— Dr. Casperson [08:08]

3. Testosterone for Women & Policy Advocacy

• Dr. Casperson discusses her recent advocacy at the FDA for a female-dose testosterone product:
  • She pushed for it not to be FDA-approved specifically for "low libido," arguing parity with how testosterone is approved for men, which relates to symptoms/levels, not a libido diagnosis, to avoid insurance and social stigmas.
  • Argues for a DEA exclusion for female-dose testosterone, highlighting absurd regulatory barriers and the wasteful pursuit of physicians by the DEA.

“I want the DEA restriction off of it because I can't make a woman a gold medalist pole vaulter by giving her physiologic female T doses.”
— Dr. Casperson [09:40]

4. How The Sex Doctors Met & Early Collaborations

• Dr. Brandon and Dr. Morgentaler narrate their first meeting at the STAR sex therapy conference, the spark of academic collaboration, and their different perspectives on men’s sexuality.
• Light-hearted discussion about physician handwriting and the process of co-authoring.

“I have physician’s handwriting. It’s a syndrome.”
— Dr. Morgentaler [13:55]

5. Mythbusting: Men, Orgasms, and Sexual Narrative

• Discussion on the fact that a substantial number of men fake orgasm, often for reasons similar to women (“good job, you did good. Let’s put an end to the activities for tonight”).
• Anecdotes from clinical practice about how sexual desire and satisfaction are complicated and not “one size fits all.”

“Men fake it... for the same reason women do—kind of say, good job, you did good, let’s put an end to the activities for tonight.”
— Dr. Morgentaler [14:29]

6. Collaborative Sexual Health: Medical Teams and Bad Advice

• Dr. Brandon stresses the value of interdisciplinary teams (physicians, therapists, more) to reduce doctors' anxiety about bringing up sexual issues.
• The panel lampoons poor sexual advice sometimes given to cancer patients, e.g., using Crisco as lubricant, instead of evidence-based approaches.

“A prominent cancer center... is recommending cancer survivors use Crisco for sex.”
— Dr. Casperson [17:41]
“Are you kidding?”
— Dr. Brandon [17:42]

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Notable Quotes & Memorable Moments

| Timestamp | Speaker | Quote | |-------------|-----------------------|-------| | 02:43 | Dr. Morgentaler | “In my training, nobody got testosterone. Everybody thought it caused prostate cancer… if a man got an injection of testosterone today... he’d be back within a month with an aggressive prostate cancer.”| | 08:08 | Dr. Casperson | “Things change. We can reanalyze data, we can do more studies... so many people think medicine is set in stone. And it's not.” | | 09:40 | Dr. Casperson | “I want the DEA restriction off of it because I can't make a woman a gold medalist pole vaulter by giving her physiologic female T doses.” | | 14:29 | Dr. Morgentaler | “Men fake it... for the same reason women do—kind of say, good job, you did good, let’s put an end to the activities for tonight.”| | 17:41 | Dr. Casperson | "A prominent cancer center on the east coast is recommending cancer survivors use Crisco for sex."| | 25:07 | Dr. Morgentaler | "Between 6am and 2pm, there is not one minuscule difference in their average testosterone." | | 27:02 | Dr. Brandon | “What you’re going to see in a magazine about [boring sex]: try something new. Buy a new piece of lingerie, which has probably solved zero people’s problems long term. But is great for the lingerie industry.” | | 28:06 | Dr. Brandon | “If you bring that mindfulness to even the same activity... it’s a new activity because you’ve never been in that moment before.” | | 32:02 | Dr. Brandon | “Women think men should be like they are in sex... they have different sexual instincts.”| | 34:13 | Dr. Casperson | "If they can't, that means there's something wrong with the woman, or she's unlovable, or there's an affair... she'll internalize it—not that it's, could be a biologic pump problem."| | 39:44 | Dr. Morgentaler | “When the guys are totally in their own head, it doesn't work well for their female partner...” |

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Segment Guide & Timestamps

• Introductions/Podcast Praise: 00:18–01:46
• Debunking Testosterone Dogma/Medical History: 02:14–07:41
• Evolved Approach to Testosterone & Breast Cancer Parallel: 07:41–08:27
• FDA Advocacy/Testosterone for Women: 08:40–10:58
• How the Sex Doctors Met/Collaboration Story: 11:27–14:05
• Men and Faking Orgasms/Clinical Anecdotes: 14:14–16:27
• Team Approach to Sexual Health/"Bad Advice" Stories: 16:50–18:28
• Screening for Low Testosterone/Diurnal Variations Myth: 18:32–25:34
• Access Issues for Women/Testing Barriers: 25:34–26:12
• When Sex Gets Boring & Mindfulness: 26:19–28:48
• Adventure Mismatch in Couples/Sex Tech Solutions: 29:17–31:53
• What Women Get Wrong About Men, and Men About Themselves: 31:53–34:38
• Emotional Dynamics: Desire, Objectification, Present-Moment Advice: 36:01–40:26
• Podcast Wrap-up/Mutual Support: 40:44–41:12

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Actionable Takeaways & Resources

• Testosterone Testing:
  • Most adult men should have at least one testosterone test after age 30; the exact draw time (within the usual clinic day) is far less relevant than traditionally taught for the majority of patients.
• Mindfulness over Novelty:
  • Mindfulness and presence often trump "new tricks" or new lingerie in reigniting sexual satisfaction in relationships.
• Destigmatizing Sexual Issues:
  • Interdisciplinary care and willingness to ask direct questions are key. Don’t settle for poor advice (like “use Crisco”) from providers.
• Recommended Resource:
  • Sexuality Resources: curated information and recommendations for diverse sexual health needs.
• Further Reading:
  • Dr. Brandon’s blog on Psychology Today, the Sex Doctors podcast.

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Episode Summary Takeaways

This episode is a vibrant, myth-busting tour of sexual health, hormone science, and the human quirks of relationships. The guests blend detailed clinical evidence with honest, lighthearted banter—debunking decades-old dogmas, highlighting the slow pace of change in medicine, and offering practical, compassionate advice. Whether you’re a clinician, a patient, or simply curious, you’ll leave both better informed and charmed by the candid expertise of all three doctors.

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Transcript

[A]

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

[B]

board certified urologist, thought leader, and conversation

[A]

starter on midlife living, hormones, and sexuality. Enjoy the show, everybody.

[B]

Welcome back to the youe're Not Broken podcast. I have good friends. I'm gonna say they're new good friends, but we have Dr. Abraham Morgenthaler and Dr. Marianne Brandon joining us today. It's not your first times, but it's your first times together.

[C]

This is true.

[D]

And that's worth it right there.

[B]

That's worth it right there. You guys are the dynamic dual behind the Sex Doctors podcast, which is a new podcast. Newish. Yeah. How long has it been out?

[D]

Six months.

[B]

It's new. That's new in the podcast world. But the average podcaster doesn't get more than like seven episodes in. So you're already like ahead of. Ahead of the people who get a good idea because it sounds like a really good idea. And then people are like, oh, it's actually work. You're like, yeah, yeah, it's work. But I love your podcast. I'm obsessed with it. I follow all of them. I love that they're short. I love that there's a cat involved. I love that you guys are flirty with each other and it's like super playful and you bring good, hard science into easily explainable, tactical. What do you do with this plans?

[C]

Well, thank you so much. It's very much an honor to hear you say that.

[B]

You guys are gonna have dinner tonight and be like, oh, somebody likes our podcast. I feel so good.

[D]

Well, at least now we know that one person is. Listen,

[B]

you're like, don't forget to go leave a five star review. Kelly, it's one. It'll be you. That's how my podcast started out, though. Like, my mom listened for six months and then. And then you just get better and better and better and you find your voice and you find. But I like, I think you guys are nailing it out of the gate. It's just putting in the reps at this point.

[D]

Well, thank you so much and it's great to be with you again.

[B]

Again. So for people who want to go back, previous episodes with Dr. Morgenthaler was 257. The title of that podcast episode is Testosterone. I like to keep things simple for people. And then Dr. Brandon, was episode 242 modern sex challenges still applicable, even though probably 2 of 42 is about a hundred episodes ago. So it was probably about two years ago that we did that.

[D]

Wow, you're rolling.

[B]

Yeah, time flies.

[D]

Rolling.

[B]

People see, like, the work that goes into, like, the overnight success. So just gotta keep going. But you guys aren't an overnight success. You've been doing your craft for quite a while. Dr. Morgan Teller, you were doing your craft, like, back in the day when testosterone caused prostate cancer.

[D]

So long ago, I fell off my dinosaur to do some of that work.

[B]

Well, yeah, because you were around in the time of lizards, because that's what your recent TEDx was about.

[D]

That's how I got started with the lizards. They are like little diamond dinosaurs. So, you know my story. What I like about my story is that it was the beginning of what I think is really, in many ways, the modern era of urology and also the modern era of testosterone. You know, there was not. When I was in my training, nobody got testosterone. Everybody thought it caused prostate cancer. This is crazy. I was taught, all the residents were taught that if a man got an injection of testosterone today, he'd be back in a normal guy, healthy. He'd be back within a month with an aggressive prostate cancer.

[B]

Then that was dogma. Not rooted in meta analysis, not rooted in anything.

[D]

And it's actually amazing how that came about. It's sort of like a case of broken telephone. There were two things. One is that Charles Huggins, who was awarded the Nobel Prize in 1960, was a urologist.

[B]

Urologists like our one Nobel Prize winner. Or maybe we have two.

[D]

There's a second one named Forsman, but he who became a urologist. But what he got the Nobel Prize for was he stuck a wire in his veins and he got it to his heart, and he went. And he got. Went to X ray, and he took an X ray and showed that the wire could connect, and it became the mechanism for people doing cardiac catheterization.

[B]

That's a big deal. Apparently, Swan Ganz, for the Swan Ganz catheter was on a sailboat when he got the inspiration for the Swan Gantz catheter and how they could get it to, like, sail through to get to the heart.

[D]

Yeah, yeah. So there are two things. So Huggins wrote in 1941 that if you gave testosterone, that it made metastatic prostate cancer worse. He looked only in guys with metastatic cancer, and he based that on acid phosphatase results. We don't use acid phosphatase anymore because it's not very good. Once PSA came in, we got rid of acid phosphatase. It bounces all over. And it turned out amazingly, that it was Based on just one patient who was not yet castrated. It's an unbelievable story followed for only 18 days. And then the second piece of information that people confused and put together was that there was another paper that came out in 1981, I think it was by Fowler and Whitmore. And that was a group of a set of studies from Memorial Sloan Kettering. And they had all these different protocols, and they looked at everybody that got testosterone who had metastatic cancer. And because they had different protocols and different ways of measuring, they said, let's just use the term an unfavorable response, which could be a whole variety of things, including a rise in acid phosphatase because PSA wasn't around yet. It could be pain. It could be anything like that. And they looked at men who also had been, almost all of them castrated already. And they said at one month, what percent of these guys have something bad? And it was a high percentage was 45 out of 52 guys. But those were guys with metastatic cancer. Now, as an aside, and your audience may appreciate this, is that all but four of those 52 men had already been castrated. There were only four guys who were not yet castrated.

[B]

And back then, they surgically removed testicles. Was not a medication. There's not medical castration. This is. We removed your testicles.

[D]

Right. And I did that at the beginning of my career, too. We didn't have the medicines like Lupron. Anyway. The four guys who were hormonally, okay, intact still had their testicles. The three of them got testosterone for very long periods of time. Nothing happened to them. This is men with metastatic cancer. But so what people did is they put together this mishmash. Both of them were thought to be true. One was Huggins said testosterone makes metastatic cancer worse. The other one said, within one month, unfavorable response. But of course, they were all castrated. So if we give testosterone to a normal guy, he'll get prostate cancer, which was never checked in any of them, and it'll be aggressive cancer, and it'll happen in one month. But that's how everything. When we are so afraid of testosterone. And that's how it all went.

[B]

And now. So when I was in training, we wouldn't give testosterone to a treated or cured man with prostate cancer. And now we're of informed consent for everybody, risk benefits, blah, blah, blah. But now we will consider testosterone replacement if your testosterone is low in men who are on active surveillance, meaning low grade, low risk, risk of treating will cause More side effects than risk of keeping it there. But if you have low testosterone, we're going to replete it because it's low and you're symptomatic. So we've come a long way with testosterone and prostate cancer.

[D]

Such a long way.

[B]

Yeah. I always take it to breast cancer because we like, the quality of life in these women is some of the worst, most poorly treated quality of life in medicine, probably. And I'm like, listen, we can change things. We can re look at the data. And the same thing with breast cancer. There's like, you're saying there's like four patients in breast cancer. There's literally like 23 patients on which we have actual data. And that's why we say women can't be on hormones post breast cancer. So, like, I always use the prostate cancer, testosterone as like, things change. We can reanalyze data, we can do more studies. We can consider risks and benefits and quality of life. Because I think so many people think medicine is set in stone. And it's not set in stone. It is moving and evolving and we're always learning.

[A]

Right.

[D]

Sometimes more slowly than we thought.

[B]

Well, yeah, there's that JAMA article that takes 17 years for like, you know, good air quote, good data to get from the research paper into clinical practice.

[D]

But let's talk about changing medicine for a second. So Dr. Kelly Casperson was at the FDA.

[B]

I was just at the FDA.

[D]

Very recent. I know. I'm talking about you, actually.

[B]

Oh, yes. Yeah, I was there too. Yeah. No, it was like, it was so it was very trippy to get to the place where your name tag is on the scene seat. And you're like, my name is at this seat because I'm the best person in the country to be talking about this right now.

[D]

And not just any seat. That's an important seat. So when you be able to speak to the people in power who know

[B]

less about this than you, it's. I mean, it's cool, right? Like, they can't know everything about everything. And for them to say, let's bring in the people who study this and learn from them. I love that. I love that they did that. Yeah. And the day. So one of the things I asked for because I'm like, you know, when you have the chance to go to the moon, like, bring the party is one of the things I asked for is when we get the female dose testosterone product. Not if, but when. I don't want it FDA approved for low libido. It's not what men have it approved for. And they'll have insurance issues with that. And doctors can't talk about sex. Right. So Dr. Judgment with that, like we can't have it FDA approved for low libido. And I want the DEA restriction off of it because I can't make a woman a gold medalist pole vaulter by giving her physiologic female tea doses.

[C]

Kelly, that's brilliant.

[B]

Thank you. And I think it's a much more realistic ask than just deregulating testosterone in general. And I have had, I know DEA people have gone to physicians houses for prescribing female dose testosterone.

[D]

Wow.

[B]

And I'm like, what a waste of resources, man. So you hear that? You're like, dude, this is not the best use of your time.

[D]

And how chilling.

[B]

Oh God, it's awful. It's awful, right? So I'm like, I asked for that. I said, when we get the female dose testosterone, I want a DEA exclusion on this. Then we'll fight the fight of should a male level testosterone be deregulated? Many people say yes, but for the female dose, I'm like, that's not a nefarious performance enhancing drug at this point in those doses. And right after that talk, because Dr. Marty Makary didn't know these things.

[C]

Right.

[B]

He went and had a DEA meeting. Like the DEA meeting was scheduled right after that talk was given. So we'll see.

[D]

Yeah. Well, you were, you did a, you did a phenomenal job. I listened to all of. I missed the first two minutes or so and then I listened to all of it. It was excellent.

[B]

Thank you. And for anybody who's interested, if you go on YouTube and the FDA's YouTube channel, you can watch the full two hours there. My five minute talk is on my YouTube channel for people to go back and see. See what the heck we're talking about. I want to go back, if we can, for a second now that I have both of you here. How did you guys meet?

[C]

He was lecturing at one of my conferences and I was like, oh my gosh,

[B]

you got like the tingles.

[C]

I was like, I gotta connect with this guy. Yeah. Awesome.

[B]

So did you connect at the conference?

[C]

Well, I tried to get his attention, you know, raise my hand.

[D]

There was this beautiful woman sitting in the front row and she raised her hand to ask a question when I was done. This is sex. It's an organization for sex therapists. What's it called? Was it Star?

[B]

Yeah, Star, which I hear they're excellent.

[C]

Uh huh. They are.

[B]

The conferences. Yeah.

[D]

And it was an interesting conference because I'd written a book which had come out, which was what got me the invitation there. The book was originally called why Men Fake It.

[C]

Nice.

[D]

In paperback it's now out as the Truth about Men and Sex. And I take a very positive view of men, much more positive than they're described in our culture.

[B]

Thank you for providing the counterpoint. Every argument needs a counterpoint.

[D]

Yeah. And what guys say behind closed doors is something that's very different from the stereotype of the 18 year old or 19 year old on spring break. Right. So guys are trying hard to be good partners, good sexual partners, providers in a way on, you know, in terms of sex. It may be misguided, but that's how they're thinking. And in this group where we met, there was a lot of anti male sentiment.

[B]

Sure, it's trending right now.

[C]

That's exactly right.

[D]

But Dr. Brandon was there in the front row and she seemed really quite supportive of my point of view. So we connected and chatted and exchanged numbers. And before anything romantic happened, we actually wrote a paper together.

[B]

I'm sure many romances have started over an academic paper. That's awesome.

[C]

We were just laughing about this paper

[B]

that we were writing.

[C]

And I had written up an outline and filled it in based on what we had discussed. And as is typically the case for him, when he sees like someone's outline for a paper or a lecture, whatever, slash, slash, slash.

[B]

It's the best part, editing.

[C]

He destroyed it and then he wrote in his little chicken scratch what should be said in there in the document. And I couldn't even read his writing. So I'm trying really hard to decipher. And he asked me, well, can you read my writing now? No, I actually still can't.

[D]

I have physician's handwriting. It's a syndrome.

[B]

Yeah, yeah. No, it's a genetic disorder, probably. Yeah. It can, it cannot be cured. No matter how many electronic medical records

[D]

there are, it cannot be a requirement to enter. Medical schools used to have unintelligible writing.

[B]

Yeah, well, they don't. They probably don't screen for that anymore because it's all electronic.

[D]

No, now it's all. Now it's all taken.

[B]

Yeah, totally. So what percentage of men fake orgasm?

[D]

Ah, that's hard to say. But they did studies in college kids and the numbers were huge. It was like 20% plus of college males.

[C]

At least one time.

[D]

At least once. Right. It's a substantial number of men. And the curious thing is why do men fake it? And they do it for the Same reason women do kind of say, good job, you did good. Let's put an end to the activities for tonight. Let's get some rest. It was the key story in that book, at least one chapter in the book. And when I first the guy, it was a young man in his 20s who came to see me. And at that time I didn't know that men could fake orgasms. I never heard of it. I'd been practicing sexual medicine for quite a number of years already. And the guy came in and his story was that he couldn't actually have an orgasm with intercourse. So he was dating. And while he was dating without being seriously involved with anybody, he felt like he was a study, he could just keep going forever. And then when things were over, he would take care of himself. And then as things happened, he fell in love. And that was his undoing because then he started feeling. His girlfriend started feeling bad about herself.

[B]

Yeah. Which is what women are want to do. We want to make it mean something about ourselves. Negatively, usually.

[D]

Yeah. So he started faking his orgasm so that she would feel okay about herself. Right.

[B]

So what did you do? We didn't have medications like Addie.

[D]

No, no, we didn't. And so I put on my psychology hat and my sexual medicine hat and the question really was about what was it that got him excited and where did. How did he have his first ever orgasm, which happened to be when he was in France as a, I forget, 13 year old or something like that. And the smells and the French perfume was something that he remembers and associates with that. And so he had his girlfriend. I had him get his girlfriend to start wearing some French perfume. And it worked for him.

[B]

I love that this is a very challenging thing, I think for the average doctor when you have a 10 minute patient visit, like you can't get to the French perfume part right. Like ever. And here we are being like, well, does he need more Viagra? Does he need less Viagra? Does he need to stop porn? Does he need therapy? Like, what does he need? But it's like sometimes the answers are not one size fits all.

[C]

So, you know, I often encourage physicians to have a sort of preselected group they work within, like a therapist and other folks so that they don't feel so afraid of asking these questions because they're. Not only do they not have the time, but they may not have even the information on how to approach a treatment. So if they have a treatment team that they can rely on, it allows them to be more free. I think in. Inquiring about these sorts of things.

[B]

I think that's such a much better answer than the shit doctors actually say to people. Which to me, I'm like, that could be like a picture book I would do someday is like, the shit doctors say to people. And, like, it's really bad. I just heard today, this is, like, earlier today, that a prominent cancer center on the east coast is recommending cancer survivors use Crisco for sex.

[C]

Are you kidding?

[B]

No, I can't. I can't make this up. Like, this has to be real life to be so ridiculous. So I'm like, oh, you know, there's really good data on, like, vaginal estrogen, especially even for cancer survivors. Like, we can actually treat the physiologic problem and not. And keep the Crisco on the shelves.

[D]

Crisco's what, like lard, right?

[B]

Yeah, it's like kind of like a synthetic. Like a shelf stable.

[C]

Yeah. I didn't even know that was still made.

[B]

Yeah, right. Like, it's. It's not good for you. We don't even cook with it anymore. Not put it on your vulva.

[C]

Oh, I can't imagine.

[B]

I know. So, yeah, that's a much better answer. One of your recent podcasts was talking about low testosterone being a risk factor for prostate cancer. And I want to segue that into. Do you think we should be screening men for low testosterone?

[D]

Listen, I think every man turns 30 or so should probably get a testosterone level.

[B]

Thank you. Do they need to get it before 9am no, but what if insurance won't let you have testosterone because you got your lab at 9.04?

[D]

Well, then maybe you need to get it to have insurance pay for it. But you don't need it for biological reasons. You need a blood test. And I think testosterone is the single most important blood test a man can have. And what I mean by important is that it tells us so much about what's going on in the body. So that a low level of testosterone is predictive of all sorts of things that we care about. Right. Like obesity, diabetes. There's evidence that metabolic syndrome, mental health, dementia. I mean, it depends what age we're talking about, right? Fertility, sexual function. There's no other blood test that's like that, Right? Like, everybody gets a glucose. Okay, that's good for diabetes, crp. Okay. That's good for inflammation, whatever may be doing it. You get a cholesterol, it's good for cholesterol. But testosterone is reflective. It's certainly in the men. There's less work with this in women, but certainly in the men of a whole host of, of medical conditions that are important to know about.

[B]

Yeah, I think it's ridiculous that nobody has put that forward as a screening guideline recommendation. Or maybe they have and just nobody's taking it up. But I'm like, we check a blood pressure. Medicare requires a blood pressure at every visit. Not everybody has high blood pressure. But we want to look for it and especially the association with mental health. Like we have a mental health crisis in this country and low testosterone is associated with depression as a screening tool for depression, which we don't otherwise have. A screening tool for depression besides a questionnaire.

[C]

Yeah, Can I backtrack? Because this is, I think interesting is I asked Abe fairly recently, well, why do you say it doesn't matter what time the testosterone level is drawn? Because everyone else says it absolutely matters. You know, are you back in the dark ages? Like why do you still say this? And he did some really interesting research himself on this issue.

[E]

I started Ornod in 2013 and we make bike apparel. The best part of Shopify for me is our ability to run the business as essentially non technical people. We're able to admin everything on the back end, front end and sell things online easily. If Shopify were a bike accessory, I think it would actually be the bicycle. It's the thing that you do the thing on. We run the business on Shopify. Start your free trial on shopify.com yeah,

[D]

so, so, you know, the whole testosterone field is filled with what I call lore L O R e. So it turns out that for young men, young healthy men, which means non obese, no medical issues, what's clear is they have a higher level of testosterone in the morning than in the, in the late afternoon. And that stuff's been shown. And for older men it's also true. Higher in the morning, lower in the late afternoon or early evening. And then it rises again while we sleep. And people have said, okay then, so you have to get it in the morning when the testosterone level is highest. So first of all, if you wanted to do an EKG to find out if somebody has heart disease, would you do it when they're sit lying quietly at rest or maybe you might have them exercise.

[B]

You want to catch it. If they have it, you want to catch it.

[D]

Right. So if you do it in the morning when the levels are highest, you're going to have the lowest yield of finding something that might be consistent with what the clinical picture is. The second thing is, is that the studies that Were done. They're all very small studies where they do the 24 hour testosterone because it's hard to keep people in overnight. Right. And measure their blood every hour or a few hours. So they're like done in like 14 people, 12 people. Those are the numbers they have, those published studies that everybody says, oh, look at how amazing the diurnal variation is. Highest in the morning, less at night. Were all in the super fit. They were only in the studies. No medications, non obese, no medical issues. That's not who we see in our practices. Right. So I did a study together with my group where we also kept people in over 24 hours and measured their testosterone every. I think it was three hours, every three or four hours and over 24 hours. And it turned out that if your levels were low below 300, there was no diurnal variation at all. If your levels were above, if you had a normal testosterone to begin with, there was diurnal variation, which we know, but not nearly as now. These were unselected people. I mean, like we didn't care if they were on meds or not. Many of them were overweight. And so there was iron or variation, but it was blunted. But a very important study. I was also involved with David Crawford as the first author. This was from back in the day when we thought we were going to.

[B]

Was it E. David Crawford?

[D]

Yeah, E. David Crawford, edc.

[B]

I love E. David Crawford.

[D]

Yeah, we love E. David Crawford.

[B]

I don't know if E. David Crawford listens. E. David Crawford, are you listening right now? If so, we love you.

[D]

Well, maybe we need to wake him up to tell him he needs to listen.

[B]

Yeah, exactly.

[D]

So he started what was called Prostate Cancer Awareness Week. So we thought we had this new blood test. We were going to cure the world of prostate cancer. And urologists around the country volunteered their time to open up their clinics. It was usually one week. We do a few evenings or something. Some people did in the day and they got a blood test and somebody paid, I think there was a grant to pay for PSA checking. And David at some point became interested in testosterone and added testosterone to those blood tests. So what we had was 3,000 men, 3,001, I think, from all over the United States. We knew the time of day that their blood tests were being measured and they all had to be older than 40 because it was really PSA screening for prostate cancer. So in that group of men, unselected, except that they showed up for Prostate Cancer Awareness Week, free screening, the serum testosterone Was no different between 6am and 10am, 10am to 12pm, 12pm to 2pm it's just flat from 2pm to 6pm that time slot, it went down a little bit by about 13%. So it's something. But what it really meant was that for our average guy, that we're checking a testosterone level on your average American

[B]

of the age that comes in with, hey, doc, I'm not feeling like myself

[D]

between 6am and 2pm There is not one minuscule difference in their average testosterone.

[B]

I love that. I love, like, that myth busting.

[D]

And if you've got low testosterone, the diurnal variation is off. You don't have it.

[B]

If you have borderline low testosterone, why aren't we trying to catch it? You know, it's 304 at 8:00am they're like, you can't have testosterone because your testosterone's normal. Yeah, right. They were like, yeah, well, there's some

[D]

people who believe that.

[B]

Oh, I just. So I just had a provider reach out to me that she sent a woman to a lab, one of the big lab companies, and they refused to check her testosterone because she was female.

[C]

Oh, my goodness.

[B]

I know. It's like, again, it'll go in my book of like the shit people say to women. And so the doctor called him on it of like, you know, there's conditions in women where they have high testosterone and low testosterone and blah, blah, blah, blah, blah. And then they switch and they're like, oh, well, maybe it wasn't because she was a woman. Maybe because it was at 10am and they kept moving. The reason why they refused this person. And I'm like, you guys just check a effing testosterone. You can stop overcomplicating all of this.

[D]

Yeah, it's not that complicated.

[B]

It's not that complicated. Right. Yeah. Let's switch gears for a second and give us some help. When sex gets boring.

[D]

Oh, yeah.

[C]

So I think that's more my wheelhouse. Yeah. So I would say Morgan Teller's like,

[B]

I've never been bored.

[D]

Yeah. We're gonna leave the personal out of this. We're speaking purely professionally.

[B]

Purely your. Your academic pursuits.

[D]

Purely professionally.

[C]

Oh, that's okay. So when sex gets boring, which happens for a whole lot of folks, instead of getting overreacting and saying, oh, my God, like, our sex life is over, it's boring. A couple of things. One is mindfulness is critical in this situation. So what you're going to see here when you open a magazine about this issue is they're going to say, try something new.

[B]

Buy a new piece of lingerie, which has probably solved zero people's problems long term, but is great for the lingerie industry.

[C]

That's true. And the other problem is, generally people have already tried something new and they've run out of things to try. Right. Everybody has their sort of limit of what they're willing to do or what. Sounds interesting. So even if people are trying something new, they're done with the lingerie after a while and there's nothing. Nothing else they want to try.

[B]

Yeah. They're like, this is itchy.

[C]

Yeah. And you know, you have to hand wash it.

[B]

Like, who's got. I don't have time for the maintenance.

[C]

No, exactly. And here's where mindfulness comes in. So helpful. Learning mindfulness meditation, particularly that kind of meditation, which you can easily do by getting an app. Not that it's easy. It's not easy, but you can easily get an app and start practicing. But what it teaches you is, you know, your brain's gonna, like, go in different places and think negative thoughts or whatever. That's what brains are designed to do.

[B]

Right. It's not the flaw, it's the default software.

[C]

Exactly. That's the software. So we can't expect it not to happen. And it happens at all times, including sex. But if you learn to focus on your body, like with mindfulness, you learn things like focusing on your breath in spite of what your brain's doing. If you bring that mindfulness to even the same activity you do every day for your entire life, it's a new activity because you've never been in that moment before. You've never had that particular experience. So that in and of itself can go really far. You don't have to always be doing something new. If you're present in that moment, it's a new moment.

[B]

I love that. I mean, it's like, you know how the Buddhists say, like, washing the dishes is the whole point? Right. Because, like, washing the dishes is a huge sensory experience, actually, if you're paying attention to it.

[C]

Isn't that right? That's right. And so I would also say to people when they're practicing their mindfulness, and even if they feel like it's an epic fail every day when they're doing their five or ten minutes of mindfulness and they feel like they're failing, they're still learning something. They're definitely learning something. So it's not like you feel like you're successful at it. That's not that kind of thing.

[B]

Right. Don't like, do it once and be like, I should be good now. Right? It's a lifelong practice. Okay, so what do you do if we say like adventuresome mismatch in a long term relationship. So somebody's very fine with like boiled chicken for dinner every single night and the other person's like, I cannot eat another effing chicken meal to save my life. I need some like rigatoni and some dessert. And like a breakfast would be good. Right? And those people are like trying to have sex with each other. How do you work with that couple?

[C]

Okay, so that is so common. Probably most couples can say, you know, this person wants to. To do this and this person does not. So of course, communication and talking it through, I mean, there's no substitute for communication and seeing if you can find some middle ground. And sometimes you can. But I tell you what I look to do, if it's possible, if people are open minded, how we might bring in VR porn or some new tech that can kind of simulate in some way this behavior and give one person the experience of it while keeping pressure off the other to have to do it. So if they can bring some. There's so much new tech out there today. Different sex toys that mimic different sensations. So I as a therapist will look to see if there's anything in that realm that we could use to kind of find a compromise. Sometimes it works and sometimes it doesn't. But there is this whole new array of stuff that can be useful for some couples.

[B]

This is so fascinating and I think a lot of people fear where to go for good knowledge of like, where do you have a. Do you have like resources on your website for like, what's up and coming with sex tech? Or like, where can people go is

[D]

they should get Marianne's Psychology Today blog.

[C]

Well, that's very kind. I love that he says that.

[B]

Also see also the Sex Doctors podcast. Yeah, it's true.

[D]

The Sex Doctors podcast. Thank you so much.

[C]

Well, my blog is very close to my heart. I appreciate.

[D]

No, that's a great place for it.

[C]

But I think that like, so specifics in terms of like sex toys, I don't necessarily cover that. I don't know if people know this. You can go on Amazon and find a whole lot of stuff. Like a whole lot. Just good old Amazon.com. so there is a website that I like, sexualityresources. I think it's dot org. It's got a lot of information and they're very gender friendly in terms of what toys are best for this person. With this body trying to achieve this. So they have great information. It's run by a gynecologist and her sex therapist wife. It's just really great. So I think it's sexualityresources.org if for sure.

[B]

Okay, so what do, what do you say? Do we're going to gender stereotype a little bit here. But it's, it's for the, for the common good. What do women get wrong about men and sex?

[C]

Oh, I can. I, I mean women think men should be like they are in sex and they're actually men and women are. They have different sexual instincts. So from an evolutionary perspective, they have different like instinctive drives. We're all the same sexually in terms of like wanting to be loved, wanting to feel good, like wanting to love someone else. So for the most part, most of what we all want sexually is very similar. But there's this small instinctive piece of sex that is different for men and women. And so women expect guys should have the same libido as them. They should, you know, they should like the same stuff, but it shouldn't get too out there. We are stereotyping, but that's kind of what I hear. And the truth of the matter is they're very different when it comes down to like primal kinds of sex.

[B]

I mean, I think it's very good for people to know.

[C]

Yeah.

[B]

Because we all, I think it's like, you know, that's just again, a brain software problem is like we kind of think that everybody thinks like us and we're like, well, you're in the same house as me. But we don't think the same about this. No. Like the big insight is like if you ask your partner what, you know, why they like sex or what do they get out of sex, like their why? And then you ask the other partner and you're like, you guys are sleeping together in the same house and you didn't know that answer about each other. And they're like different reasons. That's insightful, sort of.

[C]

Similarly, what surprised me when I first became a sex therapist, what I would, I would say, when did you last have sex? And they would never agree. They never knew. Try it yourself.

[B]

Ask your no way.

[C]

Yeah. And so I learned fast and early that people are just not going to agree about anything. They can't even agree about something as obvious.

[B]

It could be a more factual, that could be an evidence based thing.

[D]

I think that from the male point of view, having seen really exclusively male patients over the years, one thing that women get wrong is Something that men also get wrong. They both get it wrong until they become a patient with a problem, which is that men are supposed to always want sex. They're supposed to always be able to get it up.

[B]

If they can't, that means there's something wrong with the woman, or she's unlovable, or there's an affair. I'm stereotyping. But she will internalize it as something very negative about her or the relationship. Not that it's like, could be a biologic pump problem.

[D]

That does happen. But it also happens that the men feel like there's something wrong with them if they don't match up to them. And, you know, it's most of what I learned about sex, sexuality, I learned from my patients.

[B]

I learned from lizards.

[D]

I learned from lizards. Lizards and my patients. And I remember I had this one guy who came to see me early years for Ed, and we were just talking, and at some point he volunteers for me that he and his wife go to the country on the weekends. And. And when he goes to the country, he's not stressed. He's not thinking about work, and there's no problem with sex. It came out way at the end of this whole conversation. And of course, if he's able to have sex in the country at his country house with his wife, same partner, and everything's fine, it means there's not a plumbing problem. But he didn't put two and two together, and he thought there was something that was physically wrong with him. And a lot of the guys feel like somehow they're letting down their partner if they're not always ready to go, if they're not always able to get an erection.

[B]

Yeah, I love that. I think that's. It's really good. I mean, it just normalizes everything for everybody. Of like, hey, hey, we're all human. Like, let's take a deep breath about things. I think one of the things that women don't want from men, we want to be desired, but we do not want to be objects. We do not want to be repositories for your sexual need. It's a Venn diagram that overlaps. We want to be desired by you, but when it turns into you using us for your sexual and us not feeling like it's for us, it's a huge turnoff.

[C]

I think that that's very fair. I would add some nuances, but I don't even think we don't necessarily need to go there. I think that overall, that's a very fair statement.

[B]

Yeah. Because I Think it's just like subtle shifts in perception and communication that can fix that problem. Yeah.

[C]

And presence and embodiment. So if in this case scenario that you're describing, if the guy is sort of like more present in his own body than in his partner's body, she's gonna feel objectified. But if he's that same guy, but he's really present with eye contact, like in her body. And I'm not even talking touching. I'm talking, like, looking. Like the experience of the guy in the room. If he's more present with her than himself, she's gonna actually probably like that objectification. It's up to where his sort of energy is. If he's like. If his energy, for lack of a better term, is really just in his pelvis, she's going to feel like she's being used. If his energy is in this connection.

[B]

Yeah. She's going to be like, let's do this all the time, please. Yeah, all the. All the time would be reasonable.

[D]

So on behalf of all the guys out there. This language is a little foreign for guys.

[C]

Yeah.

[D]

Like, that's a very subtle point that I don't think. Do you want to say more to help the guys?

[B]

Sure.

[C]

Well, the way, like, I would describe it, I guess, in my room is you can enter a woman if she wants to be entered through her eyes. If she doesn't want to be entered, that's not gonna feel good. So we have to, like, recognize that. But that means simply take your time to get to that point. You don't just, like, slam right into this, like, without prep.

[B]

Yeah.

[C]

There's so much more to seduction than your genitals and her genitals. And if it's slowed down enough, and if he's present enough with her, she's probably gonna really enjoy it.

[D]

I just wanna say I understand you because we've been having this conversation one way or another.

[B]

We met at a sex conference about a decade ago.

[D]

But I do wanna. I just do wanna point out. Cause I always feel like I need to stand up for the guys, so.

[B]

Please do.

[D]

The guys don't have the same language that women do, by and large.

[C]

Fair.

[D]

We don't have the subtleties of language. We don't have the nuance. And so for the guys. Simplify. That works for guys. I'm not saying guys are simple, but they say so. Wait a second. You two are saying women want to be desired, but you don't want to be desired.

[B]

We don't want to be objectified or a Repository for semen.

[D]

I get it.

[B]

Just to be clear, but you see

[D]

the confusion for guys.

[B]

Yeah. Well, thank you for helping us Be specific.

[C]

You know what else? Like, I think guys would, like, love to be objectified. The average guy objectified me. If his partner objectified her, he would think that was so. To them, it's like a gift. Like, because if she was doing it to him, it would be a gift.

[D]

As a fantasy, I think in real life it wouldn't work out so well on a regular basis. But as a fantasy, I think that's great. If it happened once in a while, sure. She just wants to use me for my body. I volunteer my body for kind of science.

[B]

Well. And yeah, and I think the same. I think the same for any gender. It's just as long as it's not all the time that that's. I feel like I'm just here versus I'm with you. Even as simple as, like, I want you for you.

[C]

Yeah.

[B]

I want you because you turn me on simple clarity sentences. Because otherwise she's internalizing, like, he just needs to get his sexual fix tonight. Right? She's internalizing it. Whether or not he understands that of like, I want you for you. She's like, hell, yeah.

[D]

So what I would say to the guys taking what you just said is when the guys are totally in their own head, it doesn't work well for their female partner, which is a huge

[C]

problem for all of us, I think, these days is we're so far in our heads just with, you know, technology and just not being in our bodies. Like, our lives don't include presence in our bodies very much.

[B]

Yeah. Yeah. Well, I think that, I mean, that's why sex is such a personal growth platform and like, spiritual platform. And all the things that it is is like, it's not just a certain angle of the pelvis all the time. It's not just a pump. Right? Like, it's not just. Everybody's like, what's the right lube? And I'm like, it's not always just about what the right lube is. Like. There's a lot to this topic.

[D]

Crisco, apparently.

[B]

Yeah, Crisco, apparently, if you're a preeminent cancer center on the east coast. But yeah, no, I love it. I mean, this is why, you know, you're going to have a podcast until you want to stop podcasting. And I'm going on year six of this. I was like, this is a never ending topic of fascination. People who can communicate it.

[D]

Well, Kelly, we can't wait to have you on our podcast.

[B]

It's going to be great.

[D]

It could be something like this so we get to ask you the questions.

[B]

Yeah, sometimes I'm like, what am I doing today? Am I the interviewer or the interviewee? I love it. I'm going to share your podcast and I will keep sharing your podcast. Please keep showing up and doing it because you are at the very beginning of your podcast empire and I'm very, very happy to support you. And thank you for coming on my podcast today.

[C]

Oh super fun. Thank you so much Kelly.

[D]

Great to be with you.

[A]

Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the Master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests including on this podcast are not giving individual medical advice or practicing medicine. See and consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember you are not broken.