"You Are Not Broken": Transforming Your Understanding of Hormones with Dr. Kelly Casperson

Dr. Kelly Casperson, welcome to Well Beyond 40.

Thank you for having me.

Well, I've been waiting and waiting and waiting, but I know this will be worth the wait. And you just said something off before we turn on the recording. I got so excited, I got a little flustered. And I'd like to just start with this. When I said, what would you like to make sure everybody knows?

And you said that I want to tell women that they aren't broken.

And what do you mean by that?

So because of our lack of education and our lack of education about not only adult sex education, but our bodies, hormones, perimenopause, menopause, like what happens in our bodies, most women will think it's just them. It's my problem, it's my flaw, I need to be better, I should have been different, I blah, blah, blah, blah, blah. And it's like, no, you're not broken. You just didn't get an education. And that shows the power of how far education can go in making you feel like, oh, this is part of owning a human body with whatever that might be, is like, don't internalize it as a personality flaw.

It's not a psychological disorder.

It's not a psy— I mean, I get— I go to the dentist and I'm— I always feel very broken at the dentist. Like, if I'm just like a better person, the dentist would— so I'm like, I get it. Like, it's probably just brains, you know? But it's like truly the lack of decent education is what gets us feeling so crappy in the first place.

And I'm— I see it every day. And the crazy part is, I mean, my friends are all in health space in one way or the other. And literally one of my girlfriends who runs a big institute said to me— I saw her after not seeing her in person for a year, and she looked completely like And she looked so different. And I go, what's going on? She goes, oh, you know, I've just been so stressed and I don't know what's— I'm not sleeping well. I'm just stressed. I think it's the move. I go, how old are you? She goes, 48. I go, this is not stress, sweetheart. I go, here, have one of my estrogen patches.

Yes, yes. We share with friends. We're like, literally, I just got back from a trip to Australia with a bunch of people our age and we're like, 'Who needs progesterone to sleep? You need some? I got extra. We brought extra progesterone.

You have to sleep.' I know, it's so funny. It's like, what do you got in that stash? When I was 49, my 16-year-old son got hit by a car. And in this story, it's— I've told the story so many times, so I can tell it a little bit like this and not be, you know, sobbing. But he got hit by a car, left for dead in the street, and I'm literally in the hospital with him for 4 and a half months., but I'm in the hospital and one of my girlfriends comes in and she's like, here, you know, a doc, she's got thyroid support, adrenal support, she's got progesterone, she's got estrogen. I'm like, what do you need? I'm like, oh, thank God.

You know? Totally. I mean, if only we could reframe, right? Like all this, like women giving to others and helping others is like, you don't understand, like taking care of your mothership is the best thing you can do for other people. And it's like, that's a reframe that's to do.

No kidding. Why are we not like— it's not even we're not number one on our to-do list. I see quite often we didn't even make it onto the to-do list.

It's like, hello. Yeah, or like, or like we're like the whipping boy for ourselves, right? Like everything else. And then we're like, I forgot to eat today and I haven't exercised.

And shoot. Oh, that, that exercise.

I mean, I, I, I, I'm guilty. If I could just exist on coffee, like I would. You know, like I'm exactly, I'm guilty also. But we, but we try.

That was when, when my son was in the hospital, I went, you know what? I am going to allow myself to have as much coffee as I want. That is my one thing that I'm going to let myself do. You can have as much coffee. You have carte blanche to have as much coffee as you want.

I was, I was like, this is the power of marketing. The other day, a friend of mine was like, Hey, do you want some plant-based energy? And I'm like, you mean, you mean caffeine?

Oh my God.

I'm like, they figured out a new way to market caffeine. It's plant-based energy.

You know, there you go. That's great. Get my plants in, drinking my coffee. Well, let's, I'd love to start with busting just a couple myths because they're just, you're a urologist, you're in a unique position because you're a urologist. Now you're also certified. Now what are they calling? Because I'm still, blown away that OB-GYNs aren't trained in menopause. Like, I still had to get over that piece of it. That seems so strange.

But I mean, like, it's not— in all— this is me being loving on the OB-GYNs. There's 22,000 of them in America. There used to be over 40,000 of them. It's a shitty job and they're leaving. Okay, so we've got 20,000 OB-GYNs in America. We have 80 million women over the age of 40.

Yeah, there's like, even if they—

let's say they were all trained in menopause, that's not enough.

And is it just a shitty job and they're leaving because you have to get up in the middle of night to deliver babies?

That's one of the shittiest.

Why wouldn't there be OB-GYNs and then— like, you would think you would just have lifespans, like you can decide which part of gynecology you want to specialize in.

Yeah, well, they, they— I mean, it's all made up, right? So, so medicine's traditionally a male-dominated— we all learn from all the men who, by the way, were on cocaine at Johns Hopkins when they invented surgery. Like, it's a, it's a, it's a long varied history, but they actually threw delivering babies and gynecologic surgery into one, right? Like, that was created at one point and they have never uncreated that. But one could argue, like, don't you think delivering babies might be a whole separate gig to, like, surgery in the pelvis?

Yeah.

So there— so the, some of the thought leaders in gynecology are like, it probably hampers us because then we have 22,000 people should not be in charge of taking care of half of the population. It's complete medicine bias that we say like, oh, those are the women's doctors, as if assuming the rest are the men's doctors, right? Like, it's absolutely insane. And people always like, you know, OB-GYN for hormones, and it's like internal medicine, cardiology, family medicine, urology, dermatology— they should all know what happens in menopause because this is 50% of the population. This is not like an air quotes rare woman's issue.

Right. I think of just even the psychiatrists.

Oh my God. Psychiatry. Folks, think.

100%. Like, obviously cardiologists, psychiatrists, orthopedic surgeons.

Definitely ortho.

Shout out Dr. Vonda Wright.

We love her. Shout out. We love Dr. Vonda Wright. I just got to spend a week there in Australia.

You know, I still think even, you know, as an exercise physiologist, I was telling her I had these women coming in in their late 40s and I did with frozen shoulder. I had no clue what the heck was going on. Like, and then when I read her thing about musculoskeletal syndrome of menopause, I'm like, oh, that's what it was. But now you're unique. And, you know, when we look at how many women address— how many, how many doctors are there addressing menopause? And I would be biased. I would prefer to go to a woman because I want to go through some— to someone who gets what's going on with me. Then we get into urology, which I would think it would get even smaller, like in terms of women urologists and women urologists. 1,000. I know one other one. And then you get into a urologist who also has a specialization in menopause. You probably are the unicorn, I'm assuming.

Yeah, there's, there's about— I mean, it's amazing that the female urologists, of which there's 1,000 of us, just kind of this very cool niche of like menopause and sex med. And there's a decent dozen. For how many people are in America? 330 million. Wow. But I'm by no means the only one. But it's a pretty— it's a pretty small niche.

The Venn diagram, menopause, urology. And I mean, when we start to talk about sexual medicine, then it's a whole other thing, you know?

I mean, yeah. Yeah. And by the way, we all got here because of sex. Like, it's actually a huge issue, right? Like, how come doctors aren't good at talking about sex? We didn't get—

are you taught that one in medical school?

No, the data actually shows medical schools are teaching less now than they even were like 10 years ago. There's just so— and the argument is there's so much to teach, but my argument is everybody has sex except for some people, but we all got here because of sex. And I mean, erectile dysfunction 40% by age 40, genital urinary syndrome, menopause 50 to 80% of women. Uh, the data is shitty, but the decent data, 70% 70% of marriages break up because of intimacy issues.

70% break up because of intimacy.

Yeah, tough. Nobody's— nobody's like at the courthouse being like, why exactly does this end? Right? Like, the data is a little crappy, but from like me pulling together as much different— and I've got friends who are divorce lawyers and they're like, Kelly, it's untreated menopause. It's okay, untreated menopause.

So I think of just when I was dating and I was on Match.com. And you could read these men's profiles and you went, oh, not having sex, not having sex. Not like it was—

could you tell?

You can just, you know, you're like, you're like, I don't remember telling that women who are frigid and, you know, women who are like, don't wait. And I'm like, oh, oh, anger.

Oh, oh no. Now people would say swipe, whatever way you're supposed to say.

Yeah. I mean, I was like reading through going, okay, this, this man does not want a woman who doesn't want to work, who wants to be taken care of and doesn't want have sex. Like, it was like boom, boom, boom, boom, boom. You could just read it through all of them, like, wow, huh, interesting, very interesting. Okay, well, let's dig into just like some of the myths around sexual health and, you know, why, you know, I mean, there's, there's, it's just no one's talking about it. I don't even know if you had an issue, like, you went to your primary care doctor, I don't know what they would tell you to do.

Good luck. You know, like, and I mean, I come by my, I come by my, my words very honestly of like, listen, I was a shitty menopause sex med doctor at one point too, right? Like, I didn't get taught this. This is all like deep, deep curiosity, love, and like a little bit of being pissed that there is data and nobody knows it.

So what— so someone— I would assume that a lot of the struggles with women and sex start to— well, no, I wouldn't assume this because then we have women who have just given birth and they're tired. Then you have women who are now small kids and they're working their asses off and they're stressed out.

It's all of them. It's the 20-year-old whose shitty 19-year-old boyfriend tells them they're not supposed to use lube and start— and they start having sex just by putting a rock-hard penis in a vagina. Like, that's not good sex. Right? So it's like, it's— I, I think especially like the Gen Xers, we all are very hopeful that like the generations coming up behind us are doing better. But it's like, dude, they were raised on porn. That's not normal. Worse, it's worse.

You learn how to— where would you learn what a normal sex life is? What— and, you know, I'm looking at more from a health standpoint. Like, you know, I've always heard about how great it is for men's health. I'm sure it must be the same for women's as it is for men.

There's less data, but you wouldn't think we're special, right? Like, men who are sexually active, the data is that they do live longer, um, and probably multivariable. Like, it's cardiovascular fitness, right? It's a loving— it's a loving relationship, you know. You probably have a better diet because you're eating meals with people, right? So there's probably multi-layers to the— to the data that men who are sexually active live longer. But, um, it's not as researched in women, but Do an orgasm's an orgasm. Like, yeah, but I mean, the, the sex ed, I mean, I always say like, if at best you got a disease and pregnancy prevention plan, right? That's what schooling might do. If you didn't have a mom who cared, you didn't get much of a sex education.

I got a book.

Good.

I got a book of, of paper doll things. Like, and that was paper doll man putting penis into paper doll woman.

Okay.

Egg. Like, that's what I got.

I remember, I remember a book. It was The Wonderful Way That Babies Are Made. There may have been a stork. There may have been Jesus. Like, there were, there were many players in the game.

I don't quite understand where the stork ever came from.

But there's a new book called It's Not About the Stork. When people are like looking for for resources for their young children. It's called It's Not About the Stork, which is pretty good.

Well, what about resources for the, like, you know, the woman who wants to know what's normal? What is a good sex life for them? What is normal for them? Like, where is that information?

Yeah. So I would get to recommend— first of all, I would start with my book because my book is like, I'm assuming this woman got crappy sex ed because that's America 101. So my book is literally like female body, clitoris is important, responsive desire is pretty darn normal, this is what happens with menopause. So it's really kind of like a, a health-based sex ed book. And then you have to ask, like, once you figure all that out, what do you do to truly have an exceptional sex life, right? Because I joke, like, we're spending so much time just getting people out of the gutter with the sexual dysfunction that you're like, what do you have to offer the people who are like, it's pretty good, Like, can it be better? Like, where do those people go, right? Um, Dr. Emily Jamea, J-A-M-E-A, just wrote a book called Anatomy of Desire. If you've ever heard of like the flow state and the research on being in a flow state, so she basically takes that theory and applies it to sex.

Hmm.

And to be like, you have to have it be a little bit challenging. You have to actually have meaning to it. You have to be intentional about it. You have to practice it, right? So it's like all these things that create flow state to actually make truly exceptional sex. Once you're in the like, okay, I've got an orgasm happening most of the time, it's not painful. I can communicate with my partner about it. Like the 101 class. Once you've got that under your belt.

So you mentioned something that I don't think is widely known, and I want to define this term because you talked about responsive desire.

Mm-hmm.

What does that mean?

So people think of sexual desire, and this is going all the way back to Freud. So Freud said this, Hollywood movies say this, that your sexual desire is a appetitive. And I love that word, but appetitive means appetite-driven. So if you are hungry, you get hungrier. If you're thirsty, you get more thirsty. If you're tired, you get more tired, right? It's like this drive for these body needs. For many people, you don't want sex the less you have it. So Freud said, oh, the sex drive is like that for everybody. No, especially if you happen to be a female body with a stressful work life, with a long-term relationship where your brain's not saying, this is novel, this is new, what's Friday night gonna be like, right? So spontaneous design is I'm going out seeking it. I just want it sitting on the couch. Not most people's lived experiences. And then responsive desire is I am now in a sexual context, or I'm going to choose to put myself in a sexual context, become sexually aroused. Now I want it. So I want it during. I might want it after. How many people after are like, oh my God, that was so good. I totally forget how good that is. Remind— let's remind me to do that again because that was so good. That's desiring sex after you had it, right?

You're so spot on though. I'm thinking of, you know, one of my friends who literally hasn't had sex for— last I checked, 5 years. So it's even longer now. And I think it's like she could care less now.

Yeah, that's normal. And so for me, people feel they're broken, but I'm like, that's normal, especially if you're post-menopause and you have like no hormones telling you to like, hey, you have an egg. You have an egg that you just released, would you like to fertilize this? Right? You don't have that happening. Um, and so many people are sitting— and this is— it's the same thing with exercise, and it's the same thing with, for me at least, eating vegetables. Is like, if I just sit around on the couch waiting for the desire to eat my 5 fruits and vegetables a day and to get my cardio in, like, I'm gonna be waiting a while instead of like, I'm gonna prioritize putting myself in an exercise mindset, you know, chopping the vegetables, and then you're like, oh, I love it when I'm doing it, and I love it after I ate the salad, right? Like, sex is not exceptional. It's just like all those other things. But like, don't wait around to exercise, because for most people, they're like— most Olympic athletes don't have a spontaneous desire to exercise.

This is such good information, because I— when I heard this first, the first info about responsive desire, I go, oh, because the way it's presented to me is that that men are very easily aroused. Women, it's like takes quite a while to get things going. And then this idea that, you know, it's like exercise or anything else where literally you don't wake up and go, I can't wait to go do that. Like, I would love to do some high-intensity interval training.

No, I freaking— I really want to get my fiber in first today.

Yeah, that's it. Amen. No, forget the big ribeye with the salt. No, I'm going to eat those Brussels sprouts. Right. Yeah. So what does someone do then? You know, you're in a relationship, you understand the importance of it, you feel great afterwards. How do you get yourself going?

Put yourself in this— in the space, reserve time for it. I mean, you think even like 100 years ago, right? What was like the most thrilling thing that humans could do? Probably have sex, right? Like the occasional alcoholic beverage, but pretty rare. There was no Netflix. There was rare ice cream. Like, there was nothing else that was competing with your dopamine. So like, sex was the thrill. And now you're like, dude, there's easier ways to get your dopamine going. Way easier ways. And so to me, I'm like, it's, it's no wonder that at the end of a long day, you'd rather sit on the couch, eat, eat Häagen-Dazs and chill on Netflix. Like, it's easier dopamine, right? But okay, so we're in a committed relationship. We understand sex is good for our bond. We both want to prioritize it. Great. What's the time that works best for you in the week? Is it Sunday afternoons? Is it Friday mornings? Go spend the time. And not— and the only critics, the only critics of the schedule sex view are the people who they don't want it to be like, and you have to have an orgasm and you have to— it has to take 20 minutes. And like, no goals, just some, just some connected naked time. Prioritize non-sexual touch during the week. Like the more connected you are non-sexually, the lot easier that intimacy is going to be. Great data on that. But yeah, I think it's our, it's our petulant desire to spontaneously want sex in a world that's filled with like stress, exhaustion, and easier dopamine. It's like, no, it's not how it works.

It's interesting because you schedule everything else.

It's like you schedule every— would you work out as much as you were if you didn't schedule? You have to put it in your schedule. You have to prioritize it. You have to say exercise is important to me. Otherwise it won't happen.

And I would view this then like— I'm starting to really think of sex along the same lines as getting good sleep, getting in your resistance training, doing your HIIT training, getting your steps in, getting your set— like, all— I put them all together. Is that a crazy idea here?

No, I like it. The only thing I don't like is when you put— I mean, sex is magical. It's, it's spiritual. It's like, it's so precious that when you— not you, but like when one is like, and eat fruits and vegetables and don't forget to floss first. And like when you put sex in with kind of a rote, you lose the like magic of what sex can be. But yes, in the like, hey, if you want a sex life, you've got to prioritize a sex life. Don't be entitled to have something for free. There's this great book called Magnificent Sex by Peggy Kleinplatz. She's a PhD and she basically like put up advertisements and she's like, who thinks they're really good at sex? Let's chat. And then she like interviewed them to figure it out. Nowhere in any of these like self-propagated sexual experts were they like, spontaneous desire is why I have an amazing sex life. Like it's not in the top 5 criteria. So I think so many people, women especially, probably because I just talked to them more, they're like, I just don't have sexual desire. So two things. Number one, are you prioritizing it? But number two, are you having sex worth desiring? And I think that's a very important issue when you just look at the orgasm gap in heterosexual relationships nationwide, which is not getting better with time.

What is that orgasm gap?

What is it? Orgasm gap is the rate of— so take a couple, have we got heterosexual, we got same-sex male, same-sex female, or is like the traditional research ones. How often does each person have an orgasm as a marker for sexual satisfaction? Basically. So the person with the highest amount of orgasm is the heterosexual male, clocking in mid-90s. The— paired with the person, interestingly enough, with the least amount of orgasms, the heterosexual female, clocking in around 60% of the time. That's with a loving partnered relationship. Hookup sex, 7% of the time. Wow. Yeah, what the hell are you— what the hell are we doing?

You can do that then.

Why would you do that? Yeah. And then they just feel like they're broken. And it's like, no, you're existing in a, in a, in a consign where like one person's orgasm is way more prioritized. So in me learning about desire types, you know, and talking to desire experts, I'm like, okay, but you're assuming women are having sex worth desiring. And they're like, yes, we are assuming that. And I'm like, you can't assume that. Like, the data does not support women are having sex worth desiring. Like, I can't make you like melted ice cream. I can't make you like mushy broccoli. Like, if it doesn't give you an inherent reward, that's not how dopamine works.

Interesting. So let's put this together now with, you know, shifting hormones, which I would just imagine compounds the issue. So you talk a lot about testosterone. Let's— I'd love to dig into that, what you, you know, how you got into the whole testosterone thing, what you see women with testosterone, because I still am blown away by the fact that we don't get testosterone covered by insurance. You know, it's our most abundant sex hormone, and yet, like, it's just crazy.

The world's crazy, my friend. Like, the world doesn't make sense, and— but we can work with that, right? And we're working to change things. So yeah, I mean, thank you for bringing that up. Like, we gotta talk about the facts first, because otherwise I'm like this crazy person telling women to go on testosterone, and they're like, Why does she want us all to turn into men if they don't have the knowledge that ovaries make testosterone? So do our adrenal glands. So does our brain, right? We do peripheral conversion of testosterone. We have about 4 times the amount of testosterone than estrogen when we're in our cycling periods of life. That means, because then people will be like, well, all your testosterone just converts to estrogen. No, it doesn't. Only about 25% of it does. We have testosterone receptors everywhere. An absence of evidence does not mean evidence of absence. As far as research goes, people are like, we don't have enough evidence. I'm like, yeah, because we prioritize male research. We don't even know this is in our bodies. There's no funding for a generic hormone that can't be patented. So no, nobody's doing research on this.

We have the— and this drives me a little bit nuts, and I understand the need for double-blind placebo-controlled randomized trials. I understand it. But I also know that we have mechanisms of action and physiology.

Thank you. Most people. And here's the other, like, just to put the nail in the coffin of like any woman who's waiting around for 20 more years of testosterone research.

Have fun, you'll be dead.

We do high blood pressure medication research on men and then give women the high blood pressure medications. We do high cholesterol studies on men and then give women the cholesterol meds. We do depression studies on men and then give women the depression meds. You know how much, how much research we have on testosterone in men? A crap ton. So you're telling me that's the only thing, the thing that's physiologic in our body, that's the only thing we're not going to extrapolate to women? It makes no sense.

Yeah, it doesn't make any sense.

I mean, the, the data on testosterone is a brain neurohormone. The fact that we've labeled them sex hormones hurts us because sex is extra, sex is not necessary, like all the dismissive things that come with labeling them sex hormones. They're called sex hormones because they were initially discovered in testicles and ovaries. Right. But it doesn't describe all their functions like they protect your myelin. Women have less neurologic diseases when they take estrogen post-menopause. Like these are brain and neuroprotective hormones. So calling them and dismissing them as sex hormones is sad.

What would you call—

call them neurohormones?

Nero Home. That's, that's fantastic.

Yeah, because in the, the data on low testosterone for depression and dementia in men is legitimate and scary. Like, if like you have a man with low testosterone and you don't treat him, his risk of like bone health, mental health, dementia, diabetes, like it's legitimate. And so to say, well, But why are we choosing this whole natural shit we throw on women is insane because we can't handle the fact that we never used to live this long. Like living to 84 is not natural as a population, right? And nobody ever tells a man like, oh yeah, I'm sorry, you have low testosterone and erectile dysfunction. It's natural. Have you tried, like, have you tried some, meditation retreats. Like, we just— we don't hold men and women to the same standards as far as judging what they're supposed to do with their body. And to me, this is a gender equality issue.

Yeah, that sounds— that sounds like it. I mean, the first thing you think of— like, my husband had low testosterone. It actually came out he'd had low testosterone. We went and did DEXA scans when I was prepping for my 60th birthday blast and discovered that Thankfully, the DEXA discovered it. I didn't have to tell him that he was a skinny fat, totally normal weight obesity for, you know, 25% body fat for an athletic male. And I did my side of the equation with him of protein, kicked his strength training into gear, creatine. And then he added in the side with testosterone and a couple of peptides and dropped to 10%, literally in 8 months, put on 24 pounds of muscle, dropped 27 pounds of fat, which never would have happened. I mean, I look at it, I go, yeah, I'm going I'm not that good. That was testosterone. Like, I might have gotten, you know, 10 pounds, never that much. Like, are you kidding? It's not going to happen. But what a dramatic difference in every aspect of his life.

Does he feel better?

Oh yeah, yeah. I mean, remarkably. Like, he looks better now than he's ever looked in his life. But he also had, like, a dad who died of heart disease. I was watching all these things going, uh-oh, we got to go do something about this. I was fortunate And early on, like as I was going through starting into perimenopause, my doc, Dr. Alan Christianson, actually put me— testosterone was one of the first things he did with me.

That's rare and amazing. Yeah. I mean, shout out for sure. I mean, the data in perimenopause— we're behind on treating menopause. Like, that's a whole podcast. But the perimenopause, I mean, our biggest rate of bone loss is the 2 years before your period ends.

This is such an important statement.

How the hell do you know when your period's gonna end, right? Like, you don't know.

These things are going wonky. Yeah, like, you know. So I was lucky, Kelly, because I was, um, teaching this course called Overcoming Weight Loss Resistance to doctors, and one of the places that I said you would get weight loss resistance is when you start to get into peri, when you saw any disruption. First I had a thyroid one, and then it was like anything disrupting testosterone, estrogen, progesterone. So when it— when I had little symptoms, I was like, uh-oh, And so, and I had great buddies who were in the, the business who were way ahead of their time because this was what, 15 years ago?

That's way— like, I'm ahead of, I'm ahead of the time, and that was way ahead of the time.

I was never— I might have been 3 months when it first started before I went on hormones. I was— I've always been on.

So I think the future is starting hormones in peri. Why are we waiting for women to suffer? Yeah, why are we waiting for you to have disease? You know, right? Like, why wouldn't we start treating in perimenopause?

And wouldn't you see it right away in their fasting insulin and their, you know, HSCRP? And then if you were doing a DEXA, I don't know, maybe not at 65, but do a baseline one and then start to do it, you know? Yeah, I mean, that's a whole bizarre—

DEXA at 65 is nuts. I was just in Australia. DEXA is starting at age 70 in Australia.

70?

70.

What are you going to do at that point?

What's the point?

That egg is dry.

Just see how strong your bones are before you go in the grave? Like, what's the point? So, yeah, that's very bad.

And it's not even expensive.

No, they're cheap. You can get a cash— cash DEXA, usually around $100 in America.

Most people are now doing them for body comp. But I mean, think if you had a baseline, like I got a baseline in my 30s. But think if you even did one in your teens, then your 20s, then your 30s, so you could catch it. And then in your 40s, and the minute you started to see any kind of hormonal stuff, you would start to treat.

Yeah, the fact that we're not treating women's bones— estrogen's FDA approved for the prevention of osteoporosis. First of all, like, for people who think they need permission from the FDA, which is— that's a whole podcast episode. But we actually do have permission for prevent— primary prevention of osteoporosis with estrogen. Which is very exciting. Um, the— I mean, this is how I explain it to people. The body is smart. The body needs hormones. So what's the female body doing? Why are we seeing glucose go up? Why are we seeing cholesterol go up? Well, cholesterol is a precursor to testosterone and estrogen and progesterone. So our body's actually trying poorly— these are compensatory, not so great mechanisms— but But cholesterol goes up because he's— we're trying to get some hormones in our body. And then insulin resistance are the— our fat. So a lot of people will say you don't always gain weight, but at least your fat distribution, right, your body masses, shifting sands, shifting sand.

I like— it's like, oh, I do not want that shifting sands.

So adipose tissue, poorly inflammatory, makes estrogen. And so it's like the body's actually kind of smart trying to eke out some neurohormones when the ovaries have outlived their life. I just like thinking about it that way because it helps it make sense, because others, women are like, why is this happening? It's like, it's happening for a reason. Yeah, none of this is, is different. Once you are going back to what you said, once you understand physiology, once you understand cellular mechanisms, once you understand that cholesterol is a precursor to these neural hormones, it's not confusing anymore.

So how would you treat someone walking in then as they're starting to go through all of what would you be looking at? What point would you start to treat them with hormones? Where does testosterone fit in?

Yeah, well, it's all individualized.

I know it's the NF1. People can start to think— I think just that explanation is so great for people to realize, you know, your body is telling you these things. And, and, and I love that you said, you know, that whole natural thing, because I literally had a woman crying. I was doing a talk and she came up afterwards. She goes, I'm doing all the things you're saying, you know, but I want to approach this naturally, so I'm not doing hormones. She's absolutely miserable.

I'm like, well, I was doing a talk saying that about insulin. I know, I know. Or eyeglasses. I'm trying to just see naturally, so I'm not going to use eyeglasses. Like, okay. Um, I did this talk in Texas, and this woman literally redid her kitchen to make a cabinet to hold all of her supplements. That's how, like, into it. She was— her and her partner hadn't had sex in years because it was so damn painful from her genital urinary syndrome of menopause, untreated low estrogen. And I was like, a $14 tube of vaginal estrogen can fix this for you, and you remodeled your kitchen for all of your expensive supplements that aren't helping. And I'm like, just use the vaginal— like, and then you're like, um, vaginal estrogen is over the counter in multiple countries. And they're like, oh, like somehow that makes it more safe to use or something. Um, but yeah, like the, the myth of natural— it's, I mean, it's called the naturalistic fallacy, right? Like, this is a well-developed theory of just because something's natural, it's therefore inherently better.

Wow.

That's made up. Naturalistic fallacy is a common brain thought error.

And why is it that progesterone— this has never made sense to me— why do we have progesterone over the counter? And I guess in some places I actually I have been ordering estradiol cream that I've been using on my—

Yeah, I mean, the problem is just not knowing because in America, supplements are unregulated, that a lot of the progesterone creams on Amazon don't actually have— two problems— might not actually have progesterone in them and they might not have the dose if you need to protect the uterus that's actually medically required. So that's the buyer beware on over-the-counter. But yeah, it's all made up. For instance, DHEA is over-the-counter in America. It's a prescription in Canada. Mexico's over-the-counter. Or in Mexico, testosterone's over-the-counter. You can get it at the airport. Wow. Like, uh, Viagra and Cialis are over-the-counter in the UK. Vaginal estrogen's over-the-counter in the UK. Like, it's all made up. Uh, estrogen used to be in face creams in America in the 1950s before they decided that it needed to be a prescription. So like, it's all made up, my friend.

That's great. Okay, let's go back over to testosterone. So Testosterone for women. Yes. How, like, what should they be looking at if they're looking at labs with their doctor? What, you know, how with things like TSH and free T3 and all these, the norms, what we see is the levels out there are pathetic. Is it the same when you start to look at testosterone for women?

I would—

yes, that's okay.

Yes. So in America, We have two major lab companies. We have LabCorp and Quest, but there are many other labs. So remember, each lab, but Tori has different reference ranges that they use to say normal. And I, I, I can often explain this better when I talk about men's testosterone. So men's testosterone, I just, for conversation, normal is 300 to about 900 or 1,000. Massive range because they just studied a whole bunch of men and they said this is the 95% of people will fall within this distribution. Now show me a 52-year-old man with a testosterone of 302 who feels normal.

That was my Tim.

Yeah, so, so even in minutes— because people are like, why are women so weird? It's like, no, it's the same in men with testosterone, right? So just because you are within the normal distribution— now the problem is when your insurance won't cover your testosterone— this is still men— because you're 320 but you've got all the signs and symptoms of low testosterone, right? But then we have age-adjusted testosterone for the experts in So same thing with women, huge range. For, I think, Quest, it goes down to like 7 to 42 is considered normal. And again, these are American values. For the UK, for Australia, you've got to convert the numbers that I'm saying. Um, most of the data for low libido shows improvement in higher physiologic numbers. So I like to say high double digits, low triple digits. For where, where a woman's usually like, oh my gosh, I feel so much better.

So what would that look like in terms of like 70 to 100?

Yeah, but again, it's individualized, you know. And I, I never on Instagram— because people are like, what's a—

what's your— I know, they're like, nope, not tell—

nope. Yeah, what's a good number? Because then you're chasing a number.

Yeah.

And a good clinician knows it's about how do you feel, what are your side effects. Like, a woman might have side effects at a testosterone of 95, and another one has a testosterone of 150 with no side effects. Right? So it's really individualized medicine. But you can, you know, argue— you can bring in the International Guidelines on Low Sexual Desire and Testosterone, you can bring that to your doctor, you can say that most papers show an improvement in high physiologic for women. Um, you know, the— because medicine is so awful at treating hormones in women, women are suffering. So they do go to the places that make money off of pellets, so they don't offer you They don't offer you the, like, normal physiologic treatment first. You get very high, high levels, which is low male levels.

Um, some women love it. Pellets, because that— yeah, the pellet thing to me drives me nuts because you've got a pellet. How do you adjust the dose once you have a pellet in?

You don't, right? You just wait for it to wear off. Um, so it's the most invasive and it's the most expensive, and if you're lucky and blessed, you're going to live 40 years past menopause. Right? Like, so to me, I'm like, you should never remortgage your house to pay for your hormones. And it tends to be the highest dose. And people who I would call— they call them pellet pushers, but the people who sell pellets don't tend to offer any other options. And so to me, I'm like, that's a one-trick pony, not, not a comprehensive menopause specialist.

Are there certain forms that you find are the easiest or most reliable, or is it different for everyone?

What I tend to do, again, because it's easy and most reliable, is I have a good relationship with my local compounding pharmacy, and I compound a 5mg cream. One pump is 5mg, because then it's idiot-proof. It's one pump of cream. Um, the only country with a current government-approved testosterone product for women is Australia, and that's a pump of cream. That's how they do it. You can basically microdose the male gel in this country. The biggest problem with that is number one, insurance coverage. It's dirt cheap. You don't need insurance coverage, but it's dirt cheap. But then the pharmacists are actually kind of jerks to women. Do you know what you're doing? Are you trying to transition? Like lots of invasive questions when my women went to the pharmacy. And so I'm like, I don't want to deal with you guys. A woman shouldn't have to defend her healthcare. So I tend to compound, or you can, if you want the male dose to microdose, have it delivered from Amazon, then you're not going to have to deal with a farm because pharmacists this didn't get trained.

Dosage on it, doesn't it, of the microdosing? So why would they even con— I'm assuming it—

well, well, that's a good question. So in America, because testosterone is a Schedule II medication, Schedule III in New York, Schedule II med, so same level of ketamine and Tylenol with codeine, because it's restricted because of Congress from the 1991 Anti-Doping Act because of the Olympic doping scandals, having nothing to do with the risks of healthy physiologic testosterone Testosterone got labeled that. So because of that, you can only do a 3-month supply at once. So if you microdose and actually put that dosing on the box, that's greater than 3 months. Got it. So a pharmacist can say, I won't dispense this because I'll be breaking the law. And they'll also say, I don't want to break the box because they lose money, right? So it's, it's, it's tricky, JJ Virgin.

Wow. And what, how would someone What should someone feel? Because one of my favorite books I ever read was Uzi Reis's book where he went through like all the different hormones and how you would feel, you know, at the right amount, how you would feel deficient, how you feel, you know, if you had too much. With someone, a woman going on testosterone, how would they know that they're kind of where they need to be?

The most common sign is is I feel like myself again. Now that's very hard to research, but they actually have done it. The not feeling like myself, not NFLM, has actually been researched. And in the perimenopause-menopause transition, about 40% of women say they don't feel like themselves. And it's legitimate, but you're never going to get anything FDA approved for not feeling like yourself.

I would think much higher than that.

Well, that's like one study and one question.

Okay, I was like, who feels like themselves going through right, perimenopause.

But I would say, I mean, I always joke and I'm like, the, the most legitimate reason for testosterone in females in America currently is hypoactive low sexual desire disorder or low libido, right? But no woman ever comes back and says, the only thing that's better is my libido. Like, that does— because that's not how libido works and that's not how the brain works, right? So most women will say, I feel like myself, I have more energy, I don't hit the wall at 3 PM, I'm not searching for coffee at 3 PM, just like getting more stuff done. I'm finally making gains at the gym that I have been working my ass off and not making any gains. I'm more curious about the world. The world's in Technicolor and not black and white anymore. My husband says I'm asking more questions. Like, it's all of these, like, non-scientific, non-medical terms for her being like, life is better. I just know it's better.

As opposed to them being on estrogen and cycling progesterone. Like, let's say someone gets on hormone replacement therapy. I know I'm asking you the collective rather than the end of one, but just, just kind of—

you're like, bear with me.

Okay, bear with me with this. So, so a woman— because, you know, typically there are a lot of doctors out there not prescribing testosterone. They're prescribing estrogen and, you know, either steady state or cycling progesterone. And would a woman be able to feel like themselves enough with those two, or is it going to be the testosterone? That is, when you talked about, I feel like myself again, was it the combination of the three? Is it the testosterone? Could they do it without the testosterone? What's the story? And I know I'm violating the rules here. I'm aware.

I'm like, how do I answer this without saying it depends?

This is why I'm just thinking that there are so many women out there who are at least now have, have recovered from the Women's Health Initiative, are realizing that by going on hormone therapy, they are reducing their risk of heart disease, osteoporosis, dementia, all of the things, and having better quality of life. But they're just doing estrogen and progesterone and not— or if they are doing testosterone, not doing enough.

Right. Yeah, yeah, yeah. Um, it's, it's, man, it's taken us 22 years after the WHO to get 5% of American women on, on estrogen.

That just pisses me off, right?

Like, so to me, I'm like, it's a big ask to tomorrow have everybody on testosterone. But I think, I do think it's different for everybody. I mean, some people, like, their sleep, their hot flashes, their heart palpitations, you give them estrogen and they're like, oh my God, I'm so much better, you know? So it's like like one thing isn't the, the best for everybody. There's some people testosterone doesn't work well with, like there's some people estrogen doesn't work well with. And so, you know, I think where people like to get me in trouble, not really, but when I'm like, this is all you need is these three simple hormones and then you don't need to eat protein or get your sleep or work on stress or lift weights, you know, and it's like, no, you have to do all the things.

Yeah, this will help you feel like doing all the things.

This will help you feel like— and it's the same with men. Like, men are like, man, I'm gaining weight, I have no energy. And you're like, just go to the gym, dude. It's like, give them the testosterone so they actually have the energy to get to the gym, and then they can do that too.

Yeah, like watching my husband now take his testosterone from 300 to 900, and all of a sudden he's way more motivated at the gym and can recover.

Yeah, yeah, yeah. He's not wiped out after, you know.

Yeah. So, so testosterone, the biggest thing you'd be looking for as you're dosing it is really libido-ish stuff and feeling kind of back in your body.

Yeah. I mean, I ask women and the other, I think, important thing about hormones and your doctor is like, this is your choice. It drives me— it irritates me to no end when people are like, my doctor said I need to blah, blah, blah.

La.

It's like, what do you want, right? Like, this is your choice. This is a 40-year career post-menopause. You're choosing hormones. Why do you want to be doing— it's not anybody else's fault that you're on hormones, right? Like, you're choosing it. And so I really care about the empowered woman that way. She wants to try testosterone, she's going to tell me if it's helping her or not. Like, none of this— I, at the end of the day, I'm like, I don't care if you take hormones or But I was having this brunch with this, with a friend, and she's like, so what do you want? And I'm like, I want women to be educated, to be knowledgeable about their bodies, and to advocate for what they want. At the end of the day, I don't care if you use vaginal estrogen, but life's better with vaginal estrogen, right? Like, just have the knowledge.

So I want to go over to vaginal estrogen. One moment more with testosterone. My guess out there is that women who are using it aren't using a high enough dose.

So likely. Yeah, well, I mean, I think— but then you have the pellet pushers where they're using way too high of a dose. So I think it's both. You know, there are women like, oh my God, my hair fell out and my voice changed. I got acne. It's like possibly too high of a dose. Like, you know, and then the other women— the other thing I see a lot is because so many doctors don't know that like the reference ranges aren't optimal is they'll be like, my doctor says my testosterone lab was normal, or it went up to 40 on testosterone, but I didn't feel anything. It's like they don't know the nuance of like, yeah, women start really getting symptom improvement in the higher double digits. And I tell my women, I'm like, listen, your lab value says high on testosterone. Now you need to know that because if you have somebody come and look at that and tell you that your testosterone is high and freak out about it, like you need to be educated enough to be like, I'm aware it's where I feel best. I'm choosing to be on the testosterone. Like, give them the empowerment so somebody doesn't sweep in and review your labs a year from now and be like, oh my God, you know, like, where white women are happy on testosterone, their labs say hi.

I think this is really— I mean, we've, we've talked a lot on this show about lab values in general and that we are not normalizing to the normals, right? You know, yeah, you will be then in the average, and that is not where we want to be.

And I think the other thing with labs is people read labs like they're infallible. Like, there can be false positives, there can be false negatives. And especially with hormones, like, did you dose your testosterone cream 2 hours before you got your labs done, or 8 hours before you got your labs done? Like, you're gonna have different lab values. We're not— like, bodies aren't steady state. State ever. And so to pick one lab— and that's why labs are so crappy in perimenopause. People are like, that's what Tuesday at 8 AM was, right? But that's not how Thursday at 2 PM was, and, and it doesn't represent how you're feeling overall. And at the end of the day, it's like, how do you feel? What are your goals? Can hormones help get you there? Yes, we can do it safely. We should be able to do it cheaply because this is 40 40-year lifespan.

Yeah, makes a ton of sense. All right, let's, let's talk vaginal estrogen skincare for down there.

I just gave a talk at the Sydney Opera House, and it's basically like normalizing— like, I looked this up, face skincare, $96 billion industry. And then people are like, I don't want to put anything on my vagina because it's not natural. And I'm like, $96 billion up here, my friends.

Yeah, what are you putting up there? That's a whole lot of stuff that's not natural. Yeah, yeah, most of it's doesn't do anything.

You know, you like the, you like the packaging, but like vaginal estrogen is like just putting back the hormones that were always there keeping things functioning well. And again, it goes back to miseducation of like, if all you think menopause is, is a hot flash and no periods, and now menopause is done 'cause the hot flashes are done, of like, you don't understand that every single tissue in your body functions. Mitochondria function because of hormones. Hormones all over your body, and your bladder gets affected, your clitoris, your labia, your— it's, it's crazy to me that women spend money cutting off their labia and then post-menopause freak out because their labia goes away because there's no hormones. And I'm like, you want it, you don't want it either way.

Okay, so over to topical.

JJ's like, whoa, Kelly!

I was like, wait, cutting off their labia pre—

like Oh, well, the cosmetic, like, because the cosmetic people who are preying on women's lack of knowledge of what normal body anatomy is.

Well, how would we—

drives me nuts.

Like, it's not like we go out and look at them. You can't, you know, I mean, you know, it's not—

they're considered, they're considered vulgar.

So you don't know what it really supposed to look like. You just know what yours looks like. And Barbies, that's normal.

And Barbies, Barbie doesn't have any genitalia. Yeah.

Yeah, she also had a waist that I figure if I got rid of a couple ribs on each side, I could potentially— I don't even come close if I didn't eat anything ever again. Um, I've got one of those bodies where you can literally put your pants on and pull them all the way down and never have to unbutton them. So I was like, okay, so that waist curve is not mine.

All right, so back over to vaginal estrogen. Um, it's, it's over the counter in multiple countries. I don't think we're going to get that here in America. Estradiol, that's over-the-counter vaginal estradiol. So it's all about dosing, right? So people are very confused about dosing. So vaginal estrogen is low-dose estradiol. There's also a Premarin, but most commonly estradiol, which is your body's natural estrogen. And, um, it's dosed low enough that it's not going to put you above menopausal blood values if you check— were to check your blood. It's like literally skincare, and it helps everything that it comes in contact with. So vagina and bladder share a wall which is why it helps the bladder, helps with getting up at night to pee, decreases urinary tract infections by 60 to 50 to 60%. Nothing works better.

Huge, because this is such a thing.

Huge. If you, if you start getting urinary tract infections recurrent and you're 46, that might be a nice hint that you're in perimenopause, right? Like, you're so— and to explain it to people, you need estrogen to help support the lactobacillus, which is your natural microbiome of the vagina. Lactobacillus makes an acidic vagina. The acidic vagina is what prevents the poop bugs from traveling up to the bladder area. Your estrogen goes away, your lactobacillus die off, the acidity of your vagina changes. Now you're more prone to recurrent UTIs. Like, going back to what you said, it all makes sense once you understand physiology.

So why wouldn't this just be standard of care then, to be doing vaginal estradiol as part of the— part of your period?

Well, I mean, the experts think it should be. I'm like, mammogram, colonoscopy, vaginal estrogen, age 50.

Like, so—

and you floss, you wear seat belts, you— we use vaginal estrogen.

But I will tell you, I've been around a lot of, of a lot of hormone docs for years and just started hearing about Maybe they don't care about your sex life.

I mean, again, it's like I'm a urologist, right? So like my lens is like I give 10 times the dose of testosterone to men every Tuesday and I look at labias and vaginas and painful sex and recurrent UTIs every single day. So it's like that my world in the perimenopause menopause really does revolve around like how do we take care of the men? What's the pelvis doing? Like my lens is is just different.

It just seems like if someone's coming in for a UTI who's perimenopausal and up, that this should be part of their standard of care.

100%. The American, the American Urologic Association gives it a Category B rating, which is pretty good evidence for prevention of UTI. And they're coming out with new guidelines. I haven't seen them yet. My hope is that they're going to be even stronger. But emergency department doctors who know this when a woman comes in with UTIs, they'll send them out with vaginal estrogen prescription. A friend did a study looking at Medicare. So if Medicare just mailed everybody 65 and older with a vagina vaginal estrogen and they used it, it would save Medicare billions of dollars a year just in decreased urinary tract infection costs.

Holy smokes. Well, I will tell you, full disclosure, like, I've had a couple UTIs over the and no one has ever recommended this. I— the only reason I knew about it was I heard you on a podcast talking about it, and I'm like, what the hell? Why have I never heard about this?

You know? Well, most people don't care about the pelvis and female sex lives.

Like, you know, I'm around, like, really amazing docs. I just— this has to get out there. Like, this has to get out there.

I mean, the lack of curiosity. About why UTIs go up in midlife, right?

Like, could it be because of the estrogen went down? Whatever, you know. Yeah. Or testosterone or whatever. Something dropped and your hormones dropped. So it makes complete sense. Um, you know, I was using it on my face, so I was like, oh, okay, you know, totally. All right.

Yeah. So I— a lot of people will use their vaginal estrogen product on their face. I think it's a little thick. You know, it might be nice for like crow's feet spot treatment. I compound Estriol, which is another low potency just for skincare. And I didn't tell anybody that I was using it. And then I kid you not, like 2 to 3 months after I started using it, people are like, oh my God, your skin. Oh my God, your skin is so amazing. And I was like, are you kidding me?

Like, you use Estriol on your face?

I use Estriol on my face. It's just a lower potency. The risk of systemic absorption, super low. Like, it's just a very safe way of being like estrogen is getting— and again, for people to explain to people, estrogen is incredibly important with— for collagen. Collagen is where our moisture and our kind of like the softness, like the resilience of the skin comes from. And in America, before estrogen became a prescription, over-the-counter face creams in the '50s had estrogen. In it. Wow. It's not a mystery that estrogen helps skin.

So yeah, I had a girlfriend years ago. This was probably 20 years ago. She was way ahead of her time, who was like working with a compounding pharmacist getting— and she was my age, so she was in her 40s doing estrogen creams back then for her face with a compounding pharmacist. I wish I'd listened to her.

She was ahead of her time.

She was an Eastern European gal, like like very into longevity stuff.

And I'm like, I love it.

Listen to everything she said.

I went, I went to my dermatologist. She's like, what are you doing? And I'm like, Estriol, tretinoin, and sunscreen. And she's like, that's literally just what you need to do. Like, that's your, that you don't have to do many other things. Like those things all actually work.

All right. You heard it.

There's the trifecta. There you go. From the urologist. Skincare, skincare Rex.

Hey, if it works for me, like Well, you have a great podcast and a great book, and they're easy to find because they're all the same name, You Are Not Broken. So I'm going to put those in the show notes. One last word, because we really didn't touch on it. I guess we should touch a little bit on progesterone, my least favorite hormone. You know, most people love progesterone. I'm the person who gets pregnant and gains like 12 pounds in a week and cries and breaks about systemic acne, cystic acne, and like progesterone is, is just so awful for me. But for— but we do need it. So can we just address that one real quick so we don't have someone saying, I'm just going to use estrogen?

Yeah. So if you— I actually just did an Instagram on this to clear it up. So if you have a uterus and you take systemic estrogen, meaning it goes in your body and in your bloodstream, not vaginal, not face stuff, like systemic estrogen, you must take the dual of both estrogen and progesterone because the uterus needs both to stay healthy. That's that rule. So people took that and said, you don't need progesterone if you don't have a uterus. Well, progesterone, especially the oral form of micronized progesterone, it converts in the liver to GABA, the neurotransmitters in the brain. It's great for sleep, it's great for anxiety, it's great for— like, it's kind of like the calming, mellowing hormone. And if— again, not for everybody, but so we're— I think we're finally getting to a point where people with hysterectomies are like, "Hey, can I try this? Is it safe?" It's incredibly safe. Tons of studies saying it's breast protective, certainly not harmful. Like the, I think we are under, likely under-treating. And what's currently available in America, which is an oral micronized progesterone, it's short-acting. It's a big dose that's then gone. I would love a longer-acting one that didn't just hit people with a huge progesterone dose. Again, it's not going to happen because these are cheap medications. You can't make a lot of money off of them.

But I do— pharmacists do a slow-release progesterone.

You can get a compounded slower-release progesterone. And that's what people who, you know, they say they're progesterone intolerant, but you're like, is it possible your body doesn't like this big dump and then have it be gone? Some people want the progesterone effects all day long, right? Or to not take it right before bed. So we don't have an FDA-approved formula. I'm not holding my breath for one. But when people say, you know, they don't tolerate it, I always wonder, like, is it the formula? What's, what's happening?

I literally break out in cystic acne, but I do low dose, 5 to 7 days a month, even though I do not have a uterus. Ah, I still do. Yeah. Especially if I'm like having trouble sleeping, I'm like, boom.

So.

Yeah. It is great for that.

I mean, like your people probably know this, but like sleep is everything.

We can always go on a sleep rant 'cause I feel like everybody can always continue to hear this one.

Yes. Like, okay, mom.

I'm like the total sleep freak. Like I will not steal from my sleep.

Oh, I've got the Whoop on now. And so now I'm like a little bit sleepy. I'm like, what happened to my REM sleep? Last night. Was it the late night ice cream? I don't know.

Hmm. Let's put it together. Yeah. I know for a while I was doing Aura plus Apple and picking the best one and I go, I really, you know, gonna have to just pick one and go with it there. But yeah, we've been playing around with it. One thing I know for sure is alcohol does nothing good on that front.

Alcohol is not our friends.

No, don't do it.

Not our friends.

I know I was when we both were on that How to Menopause big book launch party. And it was like, that was the— we had to break up with wine.

You know, we've had— most people have had a good run.

Yeah, we had a good run. I grew up outside of Napa, so we literally used to go wine tasting in our teens. We'd skip school because they didn't card. Imagine that. Like, you know, you're in your senior year of high school. You could go to Opus One and they would give you wine and not card for free.

That is wild.

It was fabulous. Those were the days.

Those were the days. Yeah. I mean, I tell people like, hey, most of us have had a full career with alcohol. Like, we can be done with it now. We can just decide.

It actually was good because I did it when, like, I didn't really, you know, I didn't need to sleep as much, I guess.

Right. Yeah. Yeah. You're like, thank God I gave up that habit before it got worse.

God.

Well.

It's been amazing. I knew it would be. And again, I'm going to put everything— I'll put your podcast, Instagram, uh, book. I'll link all of that at jjvirgin.com/drkelly, um, just for anybody listening right now. Instagram handle is Dr. Kelly Casperson.

It's Kelly Casperson MD.

Aha.

And what about websites? Kellycaspersonmd.com. New books coming out in September called The Menopause Moment. It's going to be a very pro-hormone book because I just feel like the world needs a pro- hormone book.

I am absolutely as pro-hormone as it gets. But I've been— again, I feel so blessed that I—

You are!

Like, I'm a unicorn with this whole thing.

And you are, you know, to be celebrated.

Oh, thank God. But I feel really sad for the forgotten crew that are about 10 years older than me.

The boomers are pissed.

And they should be.

The boomers who have knowledge. Like most people don't know, but we, when we are gonna start looking at health disparities over women, we have this data, we have data on women. This was published last year, I believe. Women who are 65 who've stayed on their hormones versus those who've never been on hormones, less of most chronic diseases.

Yeah. I mean, I'm like, I have nothing except all the dumb stuff I did in my 20s to my joints. Broke a foot, blew out a knee, like the dumb stuff I did.

That's just, that's just living.

Other than that, like, and you know, I credit it to having—

but you're, I mean, like, but you're, you're protecting those joints.

Oh yeah.

With the hormones.

Yeah. And working, working out and eating right and sleeping well and sunning and all the stuff.

And remembering to prioritize sex.

Oh yeah. And my husband will love you.

I mean, you know, when people are like, you know, why do you do it? Why do you keep showing up? Blah, blah, blah, blah, blah. And I'm like, listen, I save marriages, like, which means I'm saving women's wealth, you know? Like, it's, it's a big deal, and, uh, I'll keep showing up.

Well, you're saving families, like, when you do that. Like, the, the ripple effect of all of this is so big. Yeah, you So it's, it's massive. And I didn't realize that sex was— you always hear it's sex, it's what, sex, kids, and money. Yeah, but it looks like you can—

it's looking from the data again, it's hard data because nobody's like, why did this end ultimately? Was it the soft dick or the dry vagina? Like, we don't have great data going into it, but from what we can tell, intimacy, lack of intimacy. And you stop having sex, then you stop hugging, then you stop holding hands, then you stop having dinner, then you stop going to bed at the same time. Like, it's just— and I always— I want to be careful. I'm not here to say everybody has to have sex. Like, I, I just want you to be educated about it. And if you— if it's important to you to understand, you have to prioritize it. Like, that's all I want.

Yeah, that's it. Thank you.

Thanks for having me.

I appreciate it. We'll have you back with the book too.

Sounds good.

Awesome.

Thank you. You're welcome.