95: Why Women Are Being Misled About Hormones and Cancer with Dr. Kelly Casperson

Foreign. Hello and welcome.

I'm Dr. Jen Simmons, a breast cancer surgeon turned integrative oncologist on a groundbreaking mission to transform the conversation around breast health. If you're seeking to redefine the way that you think about breast health, you're in the right place. Breast health isn't just an aspect of well being. It is health, integral and indispensable. Here on the Keeping Abreast podcast, we delve deep into the innovative ways to diagnose, treat, screen for, and prevent breast cancer. But it's more than that. It's about having the crucial conversations that empower, enlighten, and drive us all to a healthier place. As someone who has navigated the front lines of breast cancer treatment and now champions an integrative approach, I bring a unique perspective to these discussions with blending rigorous science with holistic health principles. Health is a journey, not a destination, and I am truly honored to accompany you on this path. Each episode aims to provide you with actionable insights and cutting edge strategies to take charge of your breast health and.

Your overall well being.

So whether you're here to learn about the latest in medical advancements or seeking tips on lifestyle changes that foster real health, they the Keeping Abreast podcast is your go to resource. Let's embark on this journey together. Because when we talk health, every conversation matters. And now stay tuned for this week's episode.

All I can tell you about today's podcast is if you don't know Dr. Kelly Caspersen, you need to know Dr. Kelly Caspersen. And we just had the most unbelievable rapid fire conversation about the state of medicine today, about how women are treated in medicine today, and the distinct difference between what happens with men and their medical treatment and what happens with women and their medical treatment and the things that men will tolerate, the things that women will tolerate, and how the system will change rapidly for men. Because when they say no, they mean no. And women, it just is not true. It's not the same. And we actually have a system where we are being mansplained to and it's time for it to stop. And as providers, we absolutely need to approach this with curiosity all the time. We always have to be curious, but we have to allow that curiosity to educate us and then to impart change. Because as the information changes, and it does, we must change our minds and we must change the system. So sit down, tune in, because you are about to have an amazing hour with me and Dr. Kelly Casperson. Okay, so I'm just off the BHRT cruise, right? So we have a whole group on the BHRT training cruise. Bioidentical hormone replacement. And I have never been in a room with so many women so hopped up on testosterone. Like, I just. And you can tell that there's a lot of goodness there. Right. But they are so up in your face and so overdosed. And I'm just not accustomed to being in that environment. And it was, it was a little off putting for me, if I'm being honest.

Well, I mean. And they're all fangirling, right?

Yeah, yeah, yeah.

Right. So it's like, that's a lot. Fangirl energy is. You can solve the energy crisis with fangirling. Like, it's so much energy because they're like, dude, you represent them being hurt. Right. And you represent them, you represent teaching other people how to help women.

Yeah.

And so, like, they're so stoked about you. Yeah, yeah. Yes.

But it was. It, it. That. That is a new thing for me. Like, I'm not used to seeing that much testosterone in a room full of women, especially because, you know, I'm like you. I come from a very conventional medical background and for the vast majority of my career, actually until very recently, like, it was totally taboo to talk about breast cancer and hormone replacement in the same conversation.

Oh my God. It's. It's changing fast though. Don't you think? It is like even two.

Fortunately. Fortunately, yeah.

I mean, I think the testosterone thing, we were talking about this earlier, but it's like there's almost a rebound effect that like women have been so ignored, so gatekeeped with hormones, but now there's like, we don't do this with any other medications. We're like, well, my blood pressure medication's working, so let's do more. Yeah. Like, we don't do that with any other medication.

You're right.

You're right. With hormones, we're like, it's working. Let's do more. Yeah. And it's like. And I think there is, you know, in the extreme of things, people who are pushing more as like, yeah. Don't you think we should all be having our periods when we're 75? And I'm like, that's untested. I'm not going to be the guinea pig. Right. And so like, there is this like, of extreme of it. And there is this like, more is better rebound effect to like, women have not had this for 20 years. We want our fair share. Yeah, yeah.

And there's very much the if some is good, more is better men mentality. Right.

Which we don't do with much.

Anything else.

Anything else.

Right, Right.

Okay.

So I do want to hear, though, because I'm always curious when you have those two letters behind your name, what are you doing here in this. In this openly thinking space? Because we are not trained to do any of this. I mean, you're an md. Like, I am.

I know.

So, you know, I think you wind up here.

I think about this a lot. And to me, I'm like, why did we get here? Why did we go to medical school? Because we were curious and we liked learning. When did that go away? Right. And I think for a lot. And I. I blame the system. I don't blame the people. This. You cannot be curious when you have 27 people on your appointments to see every single day. There's no room for curiosity. There's no room for. Can we do this different? There's room. There's no room for. Is this working well enough?

Right.

Like, the system literally takes the curiosity out of us. But then to be. To pop out on the other side and to be like, how come there are these MDs here who aren't thinking, like, how. You know, traditional medicine still is thinking with all of the incorrect labeling and incorrect boxed warnings on estrogen, like, there's a lot of incorrectness happening in traditional medicine that's blatantly wrong.

Yes.

In the hormone area. And so what are these. What are these MDs doing over in this. You know, call it a longevity space. Whatever you want to do is like, yeah, we owned curiosity. We kept wanting to take the damn classes. That's how we ended up in med school. Right. And so for me, I'm like, one of the best things in life is to not know an answer and to figure it out. Right. And it's like, you just. The system, beat it out.

But most doctors feel very uncomfortable with that. Most doctors feel very uncomfortable with. I don't know. And I don't know if it is just part of that busyness that you were talking about that you don't have the time and space and luxury to think and to do research and to really look into that, but it takes up a lot of humility to look at your patient in real time and say, I don't know.

Yeah, right. I had an attempt, an attending in residency, and he's like, what's the difference between an amateur and an expert? And he's like, the expert knows enough to know they don't know, and the amateur doesn't know enough to know that they don't know.

Yeah.

And that always has stuck with me of like, the more I know and I like, I am self proclaimed at this point. Like, I read multiple published papers behind paywalls daily, if not weekly. And what that has taken to get me, like, you know what they say, if you just read about one topic for about a year, you know, more than 90% of the people on that topic. Right?

Yeah.

The point where you're like, listen, I know a freaking a lot. Yeah. It's crazy. What I don't know. I don't know a lot. And there's a rare person who's probably read as much or more than me on a lot of these topics. And I'm like, dude, we, we don't know at this point.

Yeah.

So. But people can't handle that. They can't handle you.

They can't. They feel totally uncomfortable with it. I also think that so much of medicine healing, whatever you want to call it, it's magic, right? Like you can do the same thing to 10 different people and get 10 different outcomes and 10 different responses because it's not the doctor, it's the patient. It's not. Right. And yes.

And to think we are all Toyotas.

Right.

You know, is like, is. It's horrible because you're like, you know, read the manual.

Well, wait, that manual isn't my manual. Yeah.

And that all surgeries.

Someone else is manual.

Yeah. Like, surgeries have risks, but they're never actually supposed to happen. Like, no, that's not what risks mean. Risks mean they do happen. They just don't happen to everybody. Yes.

Right.

But it's like, because we're not Toyotas, Susie sailed through on Tuesday and like Martha did not do well, you know, but somehow in our culture that's the doctor's fault.

Yes.

It's always the doctor's fault. To me. I'm like, I can't. You know, cats love surgical wounds and surgical bad. Like I've seen more cats like get infected surgical site thing. Like, and so like I get to the point where I'm like, do you have cats at your house? Because they're gonna mess with you after surgery. Yeah. It's like, you can't let them lick your wounds. Yes. You can't control how many cats are at their house. You know, but somehow it's like always the doctor's fault and that's incredibly damaging. We're losing tons of good doctors because of that. And people can't handle. I was reading this this week, like, most people don't understand compound Interest. And you're like, dude, that's for sure. The background of investing and saving money and, like, banking.

Right.

Of, like, most people. That's where we are. So to say. And to say, like, this surgery has a 2% risk of something. People don't understand what that means. And, you know, it gets me thinking of, like, you know, informed consent's very important, but how informed is the actual person?

Yeah.

Are you ever actually.

Informed consent doesn't actually exist.

Right. Yeah. Yeah, I agree. And I'm like, why can't we just be honest about that?

Yeah, no, I agree with you. And. And doesn't exist across the board. Like, I'm not just talking about surgery. Informed consent doesn't exist for mammograms. If. If informed consent existed for mammograms, no one would get one.

Yeah, no one. Way too. It's way too vague. Yeah, yeah, yeah, yeah.

I mean, but if. If, you know, if we were honest with women and said, you know, the more of these you get, the higher your risk is of breast cancer. Do you want one? People are like, hells no.

And the other thing about mammograms is, like, it's very emotional. That's a very emotional part of medicine because, like, well, some guidelines say every two years. Some people say every one year. And then people are like, for you to make a decision that, I don't want to get this every year. I want to get it every other year because I want to follow this guideline because it seems like that's. They will deride. Like, they will get on you.

Oh, yeah. I mean, I. I forget who said it, but someone said, like, if you're not. If you're not getting your mammogram every year, you need more than your breast examined. Right? Implying that, like, somehow you're insane or dangerous or, you know, whatever it is, it's such an emotionally charged thing, and it. And it has a lot to. It's like a. It became a morality issue.

Yes, let me judge you.

Righteous. Yes, let me judge you.

Dude, talk about informed consent. If people had true informed consent about SSRIs, do you think 25% of American women would be on them?

Oh, no, of course not. Or birth control pills. How about birth control pills, Louise? And, like, where are we getting the informed consent from birth control pills since we're giving them to teenagers? I mean, like, it is crazy.

Yes, crazy. 100. And then. And then. Then let's. Let's take the flip. A woman is cured of breast cancer out of her body can't find it. Cured. You are not allowed to take hormones.

I know. It's insane.

It's insane.

And they don't even know why. Or. Or how about. How about the ones that have had triple negative breast cancer? So no hormonal relationship to that. To that breast cancer. Causal propagation, none of it. Right.

Yep.

Where's the justification there? Because they're not allowed to take hormones either.

Yeah, well, calling all of everything that is found in the breast breast cancer. Yeah. Is, like, way oversimplifying it.

Of course. Of course. And even, you know, how about dcis? How are we giving. We're treating people that have dcis, or ductal carcinoma in situ, for those of you that don't know what that stands for. We're treating them like they have invasive cancer.

Can we be blunt? We're castrating them.

Yes.

Why? I'm a urologist, so everything with breasts to me is filtered through the. Do we do this with men with prostate cancer? Do we call it testosterone sensitive prostate cancer? No, we do not call it that.

We do not.

But we could if we wanted to scare men about a hormone their body naturally makes.

But I don't think men would tolerate that. And women tolerate. Like, we basically go, okay, like, we tolerate everything that they throw at us.

Why do you think that is? Do you think that's because we burned witches?

Maybe. I definitely. My. My. My people were definitely burned at the stake. There's no question about it.

It's amazing there's any redheads in. In society the way that they've been. I know, right?

But.

But that's. It's a good question. It's like, why. But. Okay, why do the female physicians allow it?

It's astounding to me. Or the ones that. That actually. Well, so I think it goes back to medical school, and I think it goes back to that. That place where we started about curiosity. Because while curiosity definitely got us to medical school, I really believe that that's where it ended for all of us. Not that we wanted it to end, but what happened to the curious medical students and the curious residents? They were tagged as annoying, right? They were pests. You, like, just sidelined them. You didn't want to be pestered with questions because, you know, everyone's going one up. So the medical students who are curious are pestering the residents, and the residents are working. I. Now their hours are better, but still, I can't imagine they're good. But, you know, my. The. The people I trained under, the surgical residents, they were working 80100 hours a week. Like, I was. They were like, leave me alone. I'm flicking for those that are just listening and not.

I'm putting, like, I. I'm putting this quote in my next book and I'd forgotten about it, but I was told this. I think I was. I was young surgical resident, like, somewhere between first and third year. What do you call a surgeon that only operates every other day?

What's that?

Somebody who's missing half the cases.

Oh, my. Yeah, exactly, exactly. I mean, I literally had to be told to go home. That's how much I wanted to. I was a sponge. A sponge for my five years of surgical residency where literally my chief would tell me to go home, my attending would tell me to go home. But I was the person that I wanted to be there every single day, wanted to see everything through. I wasn't going home. Post call. Like, that's who I was in residency. But it's hard to be that person because they really do try to get that part out of you. Like, they want you to walk the line. They want you to be a good little sponge.

Well, especially in practice now you've learned. You've learned everything there is. That's all there is to learn. Which is not true. Right. Which is, I think, is why we're in a big problem with hormones. But now you need to produce. Are you producing? How many units have you seen? How can you see another? Can you just add on another patient? Like, you are literally a workhorse for a massive corporation.

Yes.

And I'm like, I'm like, I want to, like, connect with people. I really, like, connect. I love long form podcasts. Like, I love connecting with people. And I'm like, I want to create this thing where, like, I have a relationship with people. And I'm like, oh, that's what the doctor patient relationship was. That holy, special, amazing, sacred thing that's gone.

Gone. I mean, I think that that's why I gravitated towards breast surgery, because it really is one of the few surgical specialties where you did have that relationship, where you, where you, um, you actually follow people. So follow people for their life. Like, once they got that breast cancer diagnosis, they were yours for life. Right. They're coming and see. Even the ones that you say, like, hey, it's been 10 years since you had your breast cancer. You know, you don't need to see me anymore. And they're like, what? No, of course I'm coming to see you. Like, you become their lifeline.

Yeah, absolutely. Yeah, absolutely. And I Think in the current system where doctors are changing jobs all the time, people are moving in and out of towns. Like to have, if somebody has you now for 10, like that sacred right. And it's not a guarantee anymore that that's how your doctor patient relationship's gonna be.

Yeah. Well. And now in the days you're like, I don't know if this is true in the urology world, but almost all the surgeons are employed now. Almost all the surgeons work for the hospital. They don't work for private groups anymore.

No, you can't keep the. You can't keep the lights on.

Yeah.

Medicare cut surgery reimbursement by 10% just like two or three years ago, and then cut it another 3% this year. Is like, if you're not employed, you're out of business.

Yeah. Yeah. So really became a matter of, like, it just feels really corporate. You. You are expected to see a certain number of people. You are literally given time limits in which you can spend with people. And, you know, you're expected to take this long to write your note, this long to get a history, this long to prescribe. And it's literally a formula that you're forced to follow. And it's awful.

Yeah. And you don't get paid. You only get paid for in. You don't get paid for. I actually had to go look something up and I had to, like, change a pharmacy and I had to get my note done later. You don't actually get paid for any of that?

No, no.

So, like, so there's not a lot of incentive to spend a lot of time doing things that you're not getting paid for because you're already not getting paid for other things. Right. Like, that's where it's like. You know, I think inherently, physicians are incredibly intelligent people. Like, by definition, you had to be. But the system has beaten the brain out of us.

Yeah. And we started talking about, like, where the curiosity went. And it is nearly impossible to have curiosity when you have to fill your schedule and you have quotas to meet and you're not gonna come home at the end of the day and say, hey, I'm really gonna look into that. To that functional medicine approach. Like, it's just not happening. It's not happening.

It's not happening.

For you.

Exactly. That's what I struggle with. Why did it happen for me? And so part of me is like, the universe needed me to go on a journey. Like, I kind of like, default to divine. I'm just, you know, doing what the universe has for me, because I waver, and I want your opinion. So part of me is like, I'm special because I cared. And I get obsessed about topics a little bit, and, like, that's why it happened. And a patient, like, I did this because of a patient. That's how I started. And I was seven years in. I was getting kind of bored. Oh, my God. What did I do all this training for? I'm seeing recurrent UTIs over and over and over again. I'm just repeating myself. I'm effing bored. One of my partners said, kelly, please don't say you're bored in front of the nurses. I don't want them to hear it. And so I got a little bit, like, I got pushback for the flaw of being bored. Yeah, right. And so, like, it was like all these pieces were kind of coming together of like, I was bored. I had a patient I absolutely cared about 100. This wasn't some random stranger off the street crying because of her sexless marriage. This was, like, incredibly cared about this person. And I was like, the lightning struck. I handed her the box of Kleenex, and I was like, I don't know how to help her. And that's what started it for me. And so for me, you know, when I see physicians be like, I don't know this. I don't have time to learn, blah, blah, blah. And I'm like, I understand that, but I could have said the same thing. I have two young kids. I was running a private practice. I have 35 employees. I take Q4 call, right? And I did it. And so I have this weird, like, am I unique, or is everybody else just making up excuses? I don't know. At the end of the day, I don't really care. Like, I don't need to feel better about my journey. But, like, a patient did it for me. My innate curiosity, that was completely gone. You get to the point where you're like, do I. Did I have a hobby?

Right?

And, like, so, like, curiosity's gone. You're bored. So I'm like, the universe really did. It was like, she's ready. Here we go. Boom. Yeah. Like, my career's taken off because of it. And so, you know, long answer of, why did it happen to me? I don't think I'm exceptional. But it takes exceptional things to understand something on the level. I understand it that I got zero. I did urology training. I didn't know women had testosterone. I did urology training. I didn't understand that my mid urethral slings wrapped around the clitoris. Right. Like, and I did. I went to a damn good program, and I was the top of my class. And so, you know, when I finally, like, got my labs drawn and calculated my testosterone and my estrogen, and you gotta change the deciliters per milligrams. You gotta, like, do the conversions. Right?

Yeah. Conversions.

Well, yeah. Right.

So amazing, and we talk about this a lot, is that we think of doctors, especially, like, gynecologists, urologists. We think of them as hormone experts. Right. Like, you figure they're in charge of the. The private parts that use all the hormones. They must be hormone experts. How much training did you get around hormones in your training?

A lot. For men in testosterone.

Okay. But you didn't know women had it.

I didn't know women had it because, I mean, I. When I interviewed for residency and this was the program I ranked, they were like, do a fellowship so you don't have to deal with women. Women are difficult. Women are challenging. Women take too long. Like, I make none of this up. You know that, like, shit you're told in residency, right?

Yeah.

And now I'm like, they're the most grateful fucking humans on the planet because they've been treated so shitty. And for me, it was Instagram that really opened my eyes. And what I mean by that is we all think we're doing a good job. Like, you show up your parent, your patients say thank you. You finish your day and get into trouble. You get a nice paycheck, rinse and repeat. There's your. There's a good job. We all think we're doing a good job. Yeah. And then I got on Instagram, like, four and a half years ago just to start promoting the podcast. And you start opening the door to a world of women telling you their stories. I'm on my fifth doctor. I'm on my fourth doctor. The shit doctors tell women, right? And then you realize, like, oh, I get it. We all think we're doing a good job, but we're not actually doing a good job. And, like, I've gotten, like, nothing but love for my advocacy work and my podcast and my books and blah, blah. Except from some physicians who think that I'm, like, calling out doctors or, like, like, they don't want to be threatened. They don't want to be threatened. And I'm like, listen, have the humility to be like, is it quite possible we could always, always get better at what we're doing?

Yeah.

Right. But most doctors, I would say most doctors are like, I didn't get taught. I want to learn. You know, and the menopausy and the educators, like you just did on the boat is like, we're teaching the women. Because that's actually how we're going to get the world to change. Because changing finding the 1 million doctors, changing all of the medical schools, it's a very slow moving ship.

Yeah, very. But if each of us can teach a thousand people, and I believe that we easily can, you know, that's gonna make a huge impact. It was huge.

And why do doctors finally get curious and take the time. My God, I had four women today coming into my. And the same people who hate on their reputation being threatened are like, all these women are coming in. There was. I was on Fox News. It was some big news thing. They're like women being influenced by doctor influencers to go and ask for testosterone. And I'm like, how about women being educated about their bodies and being encouraged to advocate. How about that for a headline? Yeah, right. Yeah. And so doctors are like, they're coming in and it's like they're suffering and you're not hearing it.

Yeah, but it's almost like they can't hear it because they don't know. They don't have the answers. They weren't educated on hormones. They don't know. And also, there's still so much left over from the whi. I mean, there's so much fear, there's so much misinformation, there's so much unlearning that needs to happen. We have two decades worth of physicians trained, or not even just physicians, all providers trained, thinking that estrogen is bad, progesterone is bad.

How about I was, I was two years ago when I learned this fact, you know, that an American's actual female, American's actual risk of breast cancer for the average person is not 12%. That's if you take the CDC's risk of breast cancer every single decade and you add it up, and the only way to do that is to be living in your 20s, in your 30s, in your 40s, in your 50s, at the exact same time. Yes, that's true. So if you haven't had breast cancer by the time you're 60, it's not 12% because you didn't get it all the other years. Yes. And I'm like, stop saying. And once I figured that out and I like, I went on the website and I added up the math. Yeah. And I'm like, it's the same with the testosterone and then I got my testosterone drawn and damn. So now when people are like, your lifetime, you know, your lifetime risk of breast cancer is 13 is like, it's wrong. It's not.

People don't, they, they don't know what that means. They don't know what that means. They think it means all comers, Are.

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Yeah, and the other wonderful thing about breast cancer is that we survive.

Right.

And so it's like you don't have a bunch of, you know, what am I trying to say? It seems more common because it's cured and then you keep living.

Yes. And also, you know, when we talk about the commonality of it, we have to remember that the harder you look, the more you're going to find. When we look at autopsy studies, like if we sectioned every breast of every woman that died not from breast cancer, from car accidents. Right. 80% of them would have breast cancer cells in their breast, but they don't have breast cancer.

Same with prostate. Forget prostate has same thing. Autopsy on 80 year old men. A lot of them have that. Give me your opinion now. I'm like, now you're on my podcast. All right, give me your opinion of. There's no guidelines. This is kind of just like common practice. But as hormones do not cause cancer, but can be a food because they're anabolic and they help build things. The guidelines of getting a mammogram before one starts on hormones. That's reasonable, right?

Well, I don't do it.

Okay.

But I'll tell me everything. I'll just tell you my practice because I don't believe in exposing healthy women, which is what the screening population is. Right. Screening by definition is the women that you have no reason to think that they have the disease, so you're screening for it. So I use self breast examination. The ARIA test. Do you know about the ARIA tears test? Oh, so this is what you need to know about. You need to know about this in your practice because it's gonna become your best friend. So this is a test where you are using people's tears to determine if they have elevated levels of the S100A8 and A9 proteins. These are inflammatory precursors to breast cancer. And don't ask me why it's abundant in tears. I have no idea.

It seems a little woo.

I, I, I hear you, I hear you. But I guess like it's an easy body fluid to obtain and for whatever the reason it is, if you have an elevated levels of these proteins. It is found abundantly in your tears. So you get a little kit with a little tiny piece of litmus paper. You fold down the corner, just put it inside your eyes.

You have to watch the Hallmark channel.

I mean, it's five minutes. It's like five minutes. You don't even have to cry. The paper doesn't even look wet. Afterwards, you put it in this little tube, send it back, and a week and a half later, you get your result, and you either have elevate clinically significant levels of these proteins or you don't. And it is 93% sensitive for breast cancer. That's better than any of the imaging we have.93% sensitive, and then the specificity is 58%. But it's because it's not actually testing for breast cancer. It's testing for the inflammatory precursors. So if you have a clinically significant test, yes, I send all of them for imaging. But if their imaging is negative, what you have is opportunity. You know that that person is at increased risk.

And so that was my next question. Can diet and exercise change that?

Yes. And alcohol cessation.

We need to talk about that.

That's the biggest one. That's really. That is the number one modifiable risk factor. And, like, no one wants to hear it. I know.

Nobody wants to hear it.

Nobody wants to hear it.

I talk about it on my Instagram.

Yeah, yeah. And we need to. We need to, you know, like, everyone got through the pandemic by drinking their faces off. But it's terrible.

It's terrible, and people really like it. The Surgeon General in January 2025. The most common. I want to get this right. The most common cancer by, like, volume caused by alcohol is breast.

Yeah.

So they're like, like, far more than liver cancer. Yeah. Bile duct cancer. And like, you know, like, that's related also, but not like there's. By sheer numbers.

Certainly cirrhosis. Certainly cirrhosis is directly related to. And I. I don't know if the majority of cirrhosis is caused by alcohol, because I think it's being. It's being a fatty liver disease, Right?

Yep, that's right.

But I would say that probably 20 years ago, alcohol was the number one cause of cirrhosis. But what we have to remember is not every cirrhotic will go on to get liver cancer. That's right. Like, they'll die of liver failure, many of them, before they get. Before they get liver cancer. So by far the big. The. The by volume, by Numbers. The biggest association between alcohol and cancer is breast.

This is my other question.

So you.

So you have a breast cancer survivor, You've cured them. And you say you, not you. But the. The popular word on the street is they can never have hormones again. But you let them drink alcohol.

Right? Right. Oh, and. And every.

I love the.

And everything in moderation.

I was like, that's what doctors were taught.

Really? Are we gonna. Are we gonna tell everything? Everything in moderation? Like heroin.

That's okay.

In moderation.

What were we talking?

Cocaine in moderation. Like, it's so ridiculous. Arsenic in moderation. I mean, and that's why I'm like, talking about here.

Doctors are never going to tell people not to drink because it's not how we were taught. Do you remember the Cage questionnaire? Do you have a drink in the morning when you wake up? Yeah. If not. If you don't have an eye opener. Yeah. Doctors were taught, if it's not a problem, it's fine. Yeah. And I'm like, 25% of women in this country are on SSRIs. If you struggle with anxiety or depression, what the hell are you putting a glass of alcohol in your mouth for? It's horrible for moods. It's horrible. If you struggle at all with being able to drop the last five to ten pounds, why is a glass of alcohol going in your mouth? Yeah, it's horrible for that.

And I think we probably. When did you train? I'm not gonna ask your age.

Backwards. That many years. That's how long? Med school was 02 to 06 and residency was 6 to 12.

Oh, my God, I'm so much older than you are. Okay, so when I was training, we were talking about the benefits of alcohol and that a glass of red wine a day had significant health benefits. Now, no one asked who paid for that, which was, incidentally, the wine industry. Right.

Yeah.

And so, you know, we really, like, on our cardiology rounds would talk about make sure everyone's drinking their red wine. And everyone loved that. Right. And the. And the news that people like gets very well distributed and very well supported and gets hard to dispute.

Yeah. Right. Well, same with fear. There's this new. There's this new anti hormone paper sweeping the news feeds, and it basically.

Dementia one.

The dement. The Harvard dementia. You put Harvard and dementia and hormones and people can. They wet themselves over this shit? So the. The study.

Can you. Can you right now dispute it here so that we set the record straight?

Yeah, I mean, I looked. I read the paper weeks ago.

And I did a review, but it's about oral estrogen. Isn't it? About oral estrogen?

And it has like, it literally has so little to do with actually taking hormones. It's like, yeah, women who were taking hormones in their 60s were fine, but then the women in their 70s weren't fine. By the time you get diagnosed with dementia, the pathology in your brain has been going on for 20 years.

Yes, yes, Right.

We know that same thing with breast cancer. Right. By the time you get diagnosed with breast cancer, you've had it for many, many, many years. Nobody likes to hear that. Yes. So. So it makes absolutely no sense that you're completely fine in your 60s taking hormones and then all of a sudden you, the clock turns 70 and you're not. So off the top of my head, I can't pick it apart anymore. But I read it and I'm like, this is not even what the paper says. It's just that the fear of hormones and brain Alzheimer's is a new breast cancer. Okay? We can't beat hormones and breast cancer anymore, so now we're going to beat Alzheimer's with it.

Yeah, yeah, I agree. I think that, that it. That was just done for to be sensationalist and like all the other anti hormone rhetoric. The point is that because bioidentical hormone replacement cannot be profitable for pharmaceutical companies, they just look for more and more ways to discredit it. I really think that's what all of this is about.

I don't disagree with you. And I think it gets darker. So the company, one of the companies that's doing one of the new. And I won't call out the name because I'm always afraid that they're going to come after me, but one of the companies that's doing one of the new neurokinin inhibitors for hot flashes, the super bowl ads, I will not name their name, but it's a very expensive drug that has issues that only helps one thing. That thing is hot flashes. Helps hot flashes a decent amount. It helps by 50%. Not as well as hormones, but helps hot flashes. The owner of that company also owns generic estrogen patches. Guess who's had a shortage of generic estrogen patches in the years leading up to this drug launching in Australia. Yeah, it's the same damn company.

Yeah.

It gets dark so quickly. And then I have to pull myself out of the darkness because not all pharmaceutical companies are bad and not all people are bad. But if you start looking at like, how much do we hate women? It gets dark pretty Quick.

I know, I know. Okay, so I know I have limited time with you, and I have, like, the queen of female sexuality here. So you can't have Kelly Casperson here without talking about, you know, you make the uncomfortable. Comfortable. Right.

Yeah.

And you. You talk about things and you help women with things that aren't spoken out loud. And you go into all the things that we feel we should be and we don't and we're not. And so there is so much sexual dysfunction in the breast cancer space.

Oh, yes.

And I would be totally remiss if we didn't start to talk about that, because I know there's sexual dysfunction across the board. You know, it's not exclusive to women who have had breast cancer, but women who have had breast cancer have it even worse. Because if you had self image problems before. Yeah, they're even worse now that your breasts are deformed or absent. If you had intimacy problems before, they're even now worse. Because all of your drive for. Not all of it, but a lot of your drive for intimacy gets changed when you take away all of your hormones. And most women, if they weren't menopausal before, before they got their breast cancer diagnosis, they're. They're rendered menopausal afterwards. And so it brings up a whole issue in the intimacy department. So what is stop shoulding all over yourself mean?

Yeah. So that's the subtitle of the book. The book is called you are not broken. Stop shooting all over your sex life. And it just came from all of the shoulds that we. My. This is my main thesis. Adults suffer because of lack of education on sex. We need adult sex ed. We got teenager sex ed when we weren't having sex. Right.

Hopefully.

And it was a hopefully. Please. And it was a disease and pregnancy prevention plan. It was not a pleasure communication consent plan. Right. So it's like.

Because that's not something that's okay to talk about.

Yeah, totally. Well, heaven forbid women have desire, but now that you don't have desire, that's a problem too. So, like, everything you were. The whole part of you is a problem. Like, everything about you is a problem. Yeah. And so, like, you know, the whole thesis is like, dude, give women and men. All the people who want to sleep with women need to set information too. They don't have our body parts. They don't know what the hell's going on. We gave them the power, but they don't know what the hell's going on. They didn't take a secret class Right. So give people good information to normalize that. This is not a personality flaw. This is you just not understanding that having a cold start by putting something in your vagina is not pleasurable for anybody. It's very challenging, actually, to have an orgasm with an unaroused vaginal penetration. It's not how bodies work. Right. And so just, like, normalizing all of that and the shoulds kept coming from, like, but I bet I should have an orgasm by putting my husband's penis into my vagina. And I'm like, you should. Like, you. Are you God, did you make our bodies. Right. But that's where Hollywood is. What's Hollywood? Where's your sex ed? Your sex ed is because you got crappy adult sex ed. You have porn and you have Hollywood.

Yeah.

Right. You have spontaneous desire. Simultaneous orgasm. Orgasm from penetration to orgasm is about 23 seconds.

And it's.

There's no clitoris involved anywhere. Yeah. It's like, well, rub a guy's scrotum and see how well he gets off. Like, it's close, but it's not the organ of pleasure. Right. And I always, like, my superpower is that I take care of men. Right. Which I think just really sets me apart from the gynecologist because it's like, I see how those dudes are treated. We would never say, like, well, this is just the part of your life that, you know, it's. It's an opportunity, really. Like, you know, we don't talk to them the way we talk to women.

I know.

That's what drives me. I'm like, this is an equality issue until I die. And that's why I do it. Because until we treat them, when they come in with low libido, low testosterone, and a penis that doesn't get erect, we're not like, have a glass of wine.

Or, you know, it's just a part of your life that's over.

Right.

It's an opportunity, really.

It's just normal for aging, right?

Yeah.

Like, we don't. We don't talk to men, but we don't talk to men across the board the way that we talk to women in urology.

So we remove testicles for cancer, we remove penises for cancer, we remove prostates for cancer. If you do any of that and you do not have a upfront, you're going to ejaculate differently or not at all. You're going to lose some testosterone. When you orgasm, it's going to be dry. This is based upon whatever body part. Right. If you. That is considered malpractice. That is not informed. Going back to what is informed consent, you must talk about how sexual function has changed before you operate on these body parts. Every urologist knows that. Everybody knows that. Like it's so, like, it's not special for me to say, like when you have prostate cancer, like there's issues with erections. You need to know that going in. The stronger your erections are up front, the better they're going to be coming out. Right. Different treatment modalities affect these in different ways. There are treatment options we can have. Like that's the, that is the whole conversation. Women are told, just be grateful for a cure.

Yep.

And I think the other thing I see with breast cancer is like, dude, nipples are incredibly erogenous. Like they are directly linked to the clitoris. Nobody ever talks about that.

No one, ever. And let me tell you, like the number of women that have mastectomies out of fear, out of pure fear for dcis, for non invasive.

Right.

For a disease that would have never killed them.

Never, never killed them.

And allegedly have informed consent when honestly, I don't think that you can ever prepare a woman for the impact that mastectomy is going to have for her. Because there will never come a day for the rest of her life. I don't care. Reconstruction, no reconstruction, whatever. If a woman has a mastectomy, there will never come a day for the rest of her life that she will forget that she either had breast cancer or had that surgery. Never. It forever changes you and your. Those scars run so deep. So deep.

I was sitting next to somebody on an airplane who is younger than me. Dcis, bilateral mastectomy, castration, medications. And they won't even let her married. They will not even let her have vaginal estrogen.

Yeah, soon. Now that I don't even get. Because every single society has come out and said that vaginal estrogen is safe for everyone. Breast cancer, no, breast cancer doesn't matter. Young, old, like vaginal estrogen is safe for everyone. Who is, who is saying this? Who is not? Who are you under a rock?

How do you. This is at a cancer center. I know where she was treated.

How do you not know?

The other crazy thing for me is like the amount of time, energy, time and energy and money people put into preserving their hair with chemotherapy. I'm not saying that's not important. I am not saying it's not important. But I'm saying we do a shit ton to keep our hair. Why is vaginal estrogen not a pre medication why are we not treating it like hair to be like, listen, some shit goes down when the hormones change. Let's avoid razor blades, peeing, you know, peeing, sex, all the razor blades, all the pain that happens, recurrent urinary tract infections, urgency getting up at night to pee, all the bladder issues. And I'm like, if we care that.

Much about hair and the urinary tract infections and because you know what this is? This is what I mean, this goes back to informed consent. These women are not being told this. They're not talked about. And I think a big problem and a big reason why is because remember the purpose of a, of a medical oncologist is to get people through chemotherapy. They don't care what state they get them through chemotherapy. They get lived for five years. Check the box.

I agree with you. I mean that's where I've gone to in my life. Until the culture changes that we are not, we, they are not judged on cure rate alone. It's not going to change.

I know, I know.

But I learned more. I had a breast cancer oncology nurse come up to me after I gave a talk and she said this was very helpful in opening my eyes to the suffering that's very unique and severe to this community. She's like, do you realize the amount of divorces that happen after breast cancer treatment? And I was like, no, I'm not aware of the amount of divorces. And she's like, first of all, you have a change in the dynamic of now you have a care caretaker instead of a lover. Right. So like that's a different dynamic.

Yep.

Then we've got the nipples and the breasts are being removed. Then we have the castration and the hormone treatment. These and these women are, they come out alive. But the stories I read, I just recently, I'm not going to remember the name. Maybe you know about it though. I just read this memoir of a breast cancer survivor. I'm not going to remember the name of it. It was chilling. This is a non medical person.

Yeah. But she's, this is, this is like.

What the hell are we doing in this book?

Yeah, it's called the Forgotten Woman because we treat these women for breast cancer and we tell them that they should be grateful to be alive. And they are grateful. But it is very hard to feel grateful when you can't think. You're anxious, you're afraid, you can't sleep, you have palpitations and are worried that you're going to have a heart attack. Your bones ache, your joints ache, you're slow, you can't move, you have fatigue, you've gained weight, your breasts are deformed or absent, you have no libido. Sex is unwanted and painful. You have frequent urinary tract infections, frequent yeast infections. It's really hard to feel grateful when all of that stuff is going on.

Yeah, totally.

And a large percent of the time we're doing this to people who didn't even need to be treated.

Yeah. We're not, you know more about breast cancer than me, but I have the great joy of. I'm young, I'm not at the very end of my career. But where prostate cancer has gone in a very short period of time is fascinating and I think very illustrative. Not in the. Prostate cancer is breast cancer. They're very different things. But how fast shit can change, right? And I do not see it changing fast in the breast cancer, except for we're liberalizing the hormones. And I think even in five years, a lot it's gonna be a lot more liberalized. So in my training, a urologist won a Nobel prize because of the correlation of testosterone feeding prostate cancer. So we're like, oh, Nobel Prize, blah, blah, blah. Testosterone causes prostate cancer. You get rid of the testosterone, you cure the prostate cancer, you can never have testosterone again. That was how I was trained. Guess what? The guys were miserable. Guess what? The guys said, don't you care about my life? Thank you for saving my life, but don't you care about it? I want my libido back, I want my sex drive back. I want my energy back, I want my muscles back. I want my sleep back. And so we said, okay, let's study it though. And we gave some people their testosterone back. They did well. And now we're to the point. So with a lot of prostate cancer, which I think is where you were saying with breast is, we diagnose prostate cancer, but we don't even treat it because we know you're not going to die of it, the low grade stuff. So now we're at the point, and this is all in my. Just in me being a doctor. We're at the point where I diagnose you with prostate cancer. You can continue on your testosterone. I don't even have to treat you for your prostate cancer. You can continue on your testosterone. You're going to follow up, we're going to check the labs, we're going to be safe. If something moves, we're going to address it. But that's how fast that has moved in my career. So I know that with great energy, things can change.

Yes. The reason that it's not going to change so fast in women is because breast cancer treatment is way too profitable and industry is biting it like crazy. And remember, when you treat a woman for breast cancer and all that stuff, stuff happens, first of all, women will tolerate it because they think it's for the greater good. So because they're so convinced that they've been cured, even the women with DCIS have convinced, have been convinced that they've been cured rather than harmed by the treatment, which it's actually the opposite. They've been harmed and they haven't been cured of anything at all. But if you take that woman and give her all those medical problems, you can get her like, you know, 5, 6, 7, 8, 9, 10 pharmaceuticals, you really, really, really create a customer.

What do you think about the new move to put high risk women on aromatase inhibitors preemptively?

I think it's very intentional. But when we really look at breast cancer, when does breast cancer happen? It happens in states of estrogen deficiency. Breast cancer isn't happening because there's too much estrogen around. Breast cancer happening because there's not enough estrogen around. And so those receptors upregulate as a survival mechanism. They are looking to how can I stay alive? There's no estrogen around the hormone of my life. My lifeline is missing. Let me up regulate so that I can stay alive. And until we realize that and recognize.

That.

We'Re just feeding into this same system and the system's very happy that we're doing it. So that's going to create more disease.

That'S not going to create less. This is the whole like curiosity of us that, you know, we're the troublemakers.

Right.

Because I'm like, if there was a medication that decreased breast cancer incidence by about, let's be generous, 20 to 40%. We'll just say 20% because that seems like a block. But there certainly would be a Super bowl ad for that medication, right?

Yeah, for sure.

Why are we looking at testosterone? More like the. And this is pellet data. So this is high dose testosterone pellet data. Multiple papers have a decreased risk of breast cancer in the pellet people versus, versus, you know, the SEER database of what this is how much breast cancer we're expecting and this is how much breast cancer it's. I think it's more than 20%. But I'm just being.

Even the Women's Health Initiative. Even the Women's Health Initiative. Estrogen alone led to a 28% reduction in breast cancer.

If there was a medication that made pre diabetics not become diabetic by about 30%, that would be a Super bowl ad.

That's estrogen for sure. For sure.

Yeah, that's what estrogen does. We've got, like, randomized placebo controlled trials on that.

Yes, I know, I know, but it doesn't fit the narrative, unfortunately. And that, I mean, I know that this is my conspiracy theory coming out, and it hurts. It hurts. Especially for do gooders like us.

Yes, it hurts.

It does. But the truth hurts.

The truth hurts. And I mean, I always worry. I just did a. I just did a podcast episode with this amazing investigative journalist who wrote a book called Doctored. And this book is about the doctoring of images for the amyloid hypothesis for Alzheimer's disease. And, like, the big cover ups of people publishing saying, hey, the amyloid hypothesis is what causes Alzheimer's disease. What do we do? We actually made drugs that went against amyloid and got several FDA approved and the host of cards just fell. And we're like, it's not actually amyloid. Yeah, that's not it. And. And my big fear is, like, to me, I'm like, we have to show the sunshine, like, shed the light, because that's how we make sure we're doing it right and that things are being. There are checks and balances and blah, blah. But people will take that and they will be like, that's why I never go to the doctor and that's why I never take any meds. And, like, I don't want people to completely say fu to the system.

Yes, of course we can't throw the baby out with the bathwater. Yeah.

But it's like, you know, some people can't handle that. It's not good all the time.

No. All right, I need. I know I need to let you go, so I need to have you come back because we just have too much to talk about. We're good friends.

Real fast. We gotta hang out in irl.

Yeah, we do. We absolutely, positively do. Whoever introduced us was like, who did this? Oh, my God. Someone who listened to your TED Talk and was like, oh, my God, you guys need to meet. So anyway, well, thank you for that, Dr. Casperson. Where can people find you?

I hang out on Instagram @kellycaspersonmd. My podcast is called you are not broken. The book is called you are not broken. Stop shooting all over your sex life. And the second book is called Menopause Matters. It's basically. It's coming out in September. It's basically the 201 and the 301 coursework because I feel like the 101's been written.

Yeah, amazing, amazing. I can't wait to get it.

We just need a book that says I got your back. Look at all this data that says hormones are safe. Yeah if you choose to take em I got your back. And so that's the next book in September.

Amazing, Amazing. Well, thank you so much for being here today. Loved spending time with you and we'll get you back here real soon.

Thanks. Talk Soon.

And for all of you who joined us today, thank you so much for coming like this. Share this Give us a comment and know that I will be back next week. Same time, same place.

It's Dr. Jen.

Bye for now.

Thank you for joining me on this episode of the Keeping abreast podcast with Dr. Jack. I hope you found the Discovery discussion informative and empowering. Remember rest. Health is health, so by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Rjensimmons and remember, my Jen has two N's, so until next time, remember to stay proactive, informed and confident in your breast health health journey. The key to your health is you.