422: Debunking Hormone Myths & Understanding Testosterone with Dr. Kelly Casperson

You know, women will say, like, I can think faster. I'm more curious about the world. I'm asking more questions. Yeah, I feel like myself again, which is a huge one. These are things that are ultimately very difficult to study in a lab.

Right.

How do you. How do you study? I feel more like myself. But I would argue that that is the most important thing. Hi.

I want to welcome you to Midlife Conversations. I'm Natalie Jill, your host, and I help midlife women redefine and rebrand aging. On this podcast, I do what I do best, taking complicated information and convers around aging that are relevant to us now and breaking it all down simply with actionable steps that you can implement to level up your life, because your best years are yet to come. I also regularly interview some of the most inspiring people living in their best midlife years. On this show, I cover topics about our health, hormones, navigating weight, blood sugars, our mood, focus changes, even our relationships, career changes, beauty and more.

Migraines, brain fog, low sex drive, low energy, even bone loss, memory loss, even when we tell our doctors this when we go in and. Or even if we complain to our friends about it, our family members. When we're in midlife, a lot of times we're told that we either need to tough it up, it just age, accept it, or we're told to go on things like antidepressants or synthetic birth control pills. Well, today I want to dive a little bit more into this. A lot more into it, actually. Talking about hormones, specifically testosterone, and a lot of other questions I want to ask her today. I've got Dr. Kelly Casperson here today, and I really want to talk with her about this because she is a fascinating md if you at all are on Instagram, you've probably seen her there. She's got some great informative videos. But as she just shared with me before I pressed record, it's really hard to get things across in a minute or a minute, 30 seconds. So we are going to dive into all the topics today. Thank you so much for being here. Thank you, doctor, for jumping on today.

Thanks for having me.

So I'm gonna just dive right in because I have so many questions and I'm gonna start a little bit more basic. But let's talk about the hormone testosterone and why people associate that with being a male hormone. Specifically.

Yeah, one of my most favorite topics. So testosterone is made by the ovaries. It's made by female adrenal glands. And we convert. We make testosterone in a lot of end Organs. So brain makes testosterone. Lots of other body parts. Good. 25% is coming from ovaries. What does an ovary do with testosterone? Makes estrogen. Right. I didn't get taught that in medical school. I got taught women make estrogen, men make testosterone. And it goes back to this gender bias stemming from. Well, first of all, we like to keep things simple, even though things aren't simple. Right. But then when we discovered, not we, I wasn't born. But when they're discovering like, oh, rooster testicles make testosterone and cow ovaries make estrogen. And they were really kind of looking in their. In that basic thinking of like, what makes the man the man, what makes the woman the woman. Let's keep it super binary and super black and white. And so now 100 and some years have gone by. Google still gets it wrong. Google says testosterone is the male hormone. The Harvard website gets it wrong, says testosterone is the male hormone. That's not true. Women have four times the amount of testosterone in their bodies than estrogen. Men just have 10 to 20 times that of women.

Wow.

So to say it's the male hormone is very wrong. And I'll flip that. Men have estrogen. In fact, men have so much estrogen, they have more estrogen in their bodies than a post menopausel woman does.

Really?

Yes. I had no doubt. Very important. Very important for their sex drive. Fascinating studies they did to figure that out. But estrogen is important for a man's sex drive. And bones.

Wow. But they don't say you're. To a man, your sex drive is lower. Here's some estrogen, they say, here's some Viagra. Or they say they do other things. Why is that?

We, we simplify things again. Physicians aren't taught about hormones. Physicians certainly aren't taught about sex. Right. So I kind of, I mean, I. Everything I know, I did my own learning because a patient changed my life in clinic.

Wow.

I was a practicing urologist for seven years with woman came into my clinic crying about her sex life. And like, that was the perfect time for lightning to strike my brain. To be like, I don't know, does you know? I was told women were complicated and we'll never figure them out. And don't worry, the gynecologists are taking care of them. Anyways, keep in mind, I'm a urologist. I do all the Viagra and the testosterone in men. Right?

Totally.

So I was like, is it true? Is it true that women are complicated? And so I went into this deep dive about female Sex Med. And realized gynecologists are already busy. They're not taking care of female sexuality, and started learning a lot, enough to, like, have a podcast, write a book. And then the hormones started happening because people are like, well, you know what happens with menopause and your sex life? And I'm like, no, I don't. And I'm staring it down the barrel at it too. And so then I started getting into hormones of, like, why don't we learn about hormones? Why are we so scared about hormones? What's this whi study that's freaked everybody out? Right? And so I really. I joke and say I got into hormones because of sex. I. I love that.

That journey, though, because it. That brings me to another question. So many women, they're saying that they're not happy with their sex drive. And a big thing that comes up is that all of a sudden, their man, their husband, their spouse is working on their sex drive. They're like, wait, this isn't my normal. They go to the doctor, they get a Viagra, whatever it is. And now we're not addressing the woman's problem. So now the husband has a deeper sex drive, the woman has a lower sex drive, and they're told it's their problem, their fault, or accept it.

That's exactly right. And I'm very glad you're bringing this up, because it's a bunch of bullshit. So we. We have studies that when a man. Anybody, really, a woman could do this too. Right. But when a man goes in and he gets his sex drive treated or his testosterone treated, and then he goes back saying, I'm ready to go, you've destabilized the relationship. Yeah. And in my experience, because I have the great fortune of treating men with. For. With Viagra and testosterone, now that I know as much as I know I wasn't this good before, I say, what's your plan with this super D.

I love that question. I would love to be a fly on the wall with those answers.

Right? That's a great question. I've done a lot of study to be able to be as bold as I am. But so I use. You know, I was like, maybe 50. Maybe guys have a plan, right?

Yeah.

Like they know what the plan is. Right. I'm telling you, 9 out of 10 do not have a plan.

So they're just saying, something's changed. Help me with this. And they're not thinking this through.

I'm like, you know, who's. Do you have a partner? Do you have multiple partners? Are you like, let me know how to have this convers. Oh, okay. You have a wife. Okay, good. So does your wife. Is she interested in having more? Have you talked to her? What's her plan? And if she's perimenopausal, postmenopausal, breastfeeding, anything that can affect sex drive, being treated for cancer, whatever it is, is somebody taking care of her?

Yeah. I love that you're asking that. Yes.

Yes. Because if you go home with a super dick and you put this all on her, that now she needs to, you know, metaphorically rise to the occasion. That's not cool. And it's not gonna go well. No. So now, you know, more and more urologists are realizing, like, because the thought was, like, there's just a guy in my office. I'm going to help the guy. Yeah, but you're like, if you're. If you truly want to help him be successful sexually, that usually involves a partner, and you need to have that conversation as well. So more and more, it's still very rare, but more and more people are treating couples for hormones and sexual dysfunction. That's something I do in my clinic. That's something that some of my friends do because it's freaking brilliant.

It's brilliant. It is absolutely brilliant. And you're. I've not heard of this happening and definitely needs to happen. It's not a separate thing. It needs to be together. This is absolutely brilliant. And I love that you're asking that question because you're right. This could destroy a marriage. This could really. If. If. If we're really off there.

Yeah. I speak friends who are divorce lawyers. Oh, gosh. Yeah, yeah, yeah. There's this one friend, and, like, you want her on your side if. If ever in that room. Right. And she's like, you know, she's like, speaking of gray divorces, right? So kids are out of the house, careers going well or is winding down, whatever. Older divorces, she's like the gross majority, if not all are because of untreated menopause. And this is not to blame the woman. This is just saying we are not addressing some basic needs that could help intimacy stake. And people totally did as the years go on.

Now, I was definitely misinformed here. I feel like I'm a little bit more knowledgeable when it comes to perimenopause and menopause because of my. My questions in my podcast and what I've. How I've been curious and learned and with myself, but what I was not aware of was the idea of adding testosterone at an optimal dose or a higher dose to help fix that.

I.

My brain went right to estrogen and doing that first and then progesterone. And it wasn't until I added testosterone in that so many things, like elevated that I wasn't even aware were missing. Like. Like, I know.

Did you notice?

Like, I noticed all of a sudden, way more clear thinking. I noticed definitely higher sex drive, for sure. I definitely noticed more energy, like, no slump in that afternoon. So that. That. And then the other really weird thing I noticed was I started having, like, all these memories, like, vivid memories of things.

And.

And then I was like. And I just connected that recently that. That is probably a testosterone benefit too.

Yeah. Brain, brain, brain, brain. Totally. I mean, it's. It's fascinating. In my practice with testosterone, like, the. The accepted. We'll say that studied is for low libido. And then people. And then people will say, you can't say it's. You can't say, it helps with mood. And I'm like, what's a libido? And they're like, libido's a mood. And I'm like, okay. So it helps with mood, and it also helps with other moods because it's a brain neurochemical. So women will say, and that's why.

People say, I'm not in the mood. I mean, that's what they're freaking mood.

Like, I'm like, point to your body where libido happens. Right. It's your brain. So, you know, women will say, like, I can think faster. I'm more curious about the world. I'm asking more questions. I feel like myself again, which is a huge one. These are things that are ultimately very difficult to study in a lab. Right. How do you study? I feel more like myself. But I would argue that that is the most important thing to give a woman is her sense of I feel like myself again. One woman said, you know that part in the wizard of Oz where it goes from black and white to Technicolor? That's my brain on testosterone, the Technicolor.

You know, it's so interesting in midlife, like, the more I learn, the more I unlearn, you know, and that there's just so many different things. But I don't believe that there's just one. Like, it's just this or it's just that. It's like this whole idea of being a health detective. But why is testosterone specifically seem so hard to get from doctors? Like, you go in and unless you say, I have Low libido, low sex drive. It seems like they don't want to prescribe it.

That's right. So multiple things. Number one, the gender bias of testosterone's for men, estrogens for women. Number two, there's no big pharmaceutical push. We have no FDA approved female product. That will be changing. But currently we have no FDA approved product, which means it's a bigger hurdle. You have to figure out how to dose a male product. You have to go compound and product or you've got to go spend more money on pellets. Right. So you're, you're pushed to the fringes because we don't have something that's easy to dose and it's covered by insurance. And then number three, it's a whole bunch of number three, doctors aren't trained in sex meds. So even if you can get it for libido, nobody really wants to talk about libido. And number four, like the studies really are for libido. And we have it because if the FDA tells you, I'm going to approve this someday for libido, guess what? You're going to study it for libido. So we have a lot less studies on bone health, cognition. But listen, humans are humans and the data on men is profound. You know, we know that men with low testosterone have higher rates of dementia. So, so men with lower testosterone have a much higher rate, statistically higher rate of dementia. And so to me, I'm like, it's a. We know how it works on mitochondria. We know how it works when protecting nerves. We know how. We, we know how it works.

Sure.

Think of a study that would have to happen to prove testosterone helps dementia in women. That's going to be, that's going to be a study, a generic medication. Right? Like, it's never going to happen. So for people to be like, you can't, you can only use it for libido is like. Well, not technically, like the hardliners say. Like, that's what we have the most data for. But are you going to wait around 40 years for. No, no, you're not going to do it. You're going to be like, it helps my brain. I tried it. It's incredibly safe. That's the thing. This, this is, it's a hormone your body naturally makes. Do you, do we even, can we even call that a drug? At some point we're just giving you back what you made more of replenishment when you were younger, and now you don't make that.

It's Replenishment, not even replacement. To me, it's replenishment. You know, what's interesting is I. And believe me, I'm surrounded by midlife women in my communities, my friend, the whole. Everywhere. That's. That's who I'm with. And what seems to happen so many times is women start to justify, I'm just not interested in sex anymore. It's just not important. And they literally, like, they lose their sex drive and they start justifying and accepting and thinking that they're the normal. This is normal. I shouldn't have a sex drive. Something wrong with my husband or something's wrong with this. And I want women to understand that when you actually get that back, you will not feel like that ever again. Because it's such an important part of our life and it's not a shameful thing. Like, you. You should enjoy sex. You should want it. You should have a sex drive like that. It's actually the opposite. It's a bigger problem to not have it. I feel.

Yeah, I mean, a lot of people feel that way. My. My view is I'm never here to tell a woman she has to have sex or she needs to enjoy. Like, I'm like, if you're happy, you do you, right? Like, I don't care. But to me, I'm like a lot of people. And this is where, you know, sex is complicated. Sex is biopsychosocial. It's not just estrogen, it's not just testosterone. Of, like, if she was having shitty sex in the first place for decades, and now she wants to give shitty sex up, like, I don't blame. I don't blame her.

Yeah, that makes sense.

And so it's like a woman who's having a great sex life. If that stopped on Tuesday, she would be like, oh, my God, like, life's not as great, you know? But if a woman's like, dude, I was doing this for somebody else, it kind of hurt all the time. I never had an orgasm. And frankly, I'm happy to give this thing up. I don't know what you think is so wonderful about this. Do you blame her? Right.

No. But that makes me sad too, because I feel like she hasn't had proper hormones or whatever it is. Like, she hasn't been optimized. And so she doesn't even know what she's. Maybe.

Maybe she had bad sex when she was 28 and her hormones were perfect, right?

Totally.

So many more women are having less orgasms, less good sex, unaddressed pain with sex. Like, sex is bad, regardless of your hormone status.

Okay.

And so to me, I'm like. And that's where women get. You know, I had a woman the other day, she's like, I've been on testosterone for a year and I still don't have libido. It's like, testosterone is not a light switch. It's a no. Yeah, right. And sex is so many things. It's your relationship, your body image, your ability to focus and be in your body, communication with your partner, like prioritizing orgasm, equality. So to me, I'm like, honey, don't think testosterone is going to do it for you all the time.

No. So it's looking at the whole picture and what else is going on there and healing from that, I would imagine. And I hear what you're saying. If they. If it's just not of interest and that's fine, and they're happy with that, then that's.

That's.

You don't need to fix it, I guess if it's just not of interest to you.

But, I mean, I think that. I think the trap, people get out. Trap is right word. But it's like you got in a relationship that was sexual. Somebody wants to stay sexual. Somebody doesn't want to stay sexual. That's fraught. Like, how's that going to play out? Right, Right. And so for somebody to be like, hey, maybe I do want to learn more about how I can be interested in sex. That is a great journey worth having. And you know why? Basically why I started my podcast and wrote my book is like, we didn't get good sex ed. You got a disease and pregnancy prevention plan if you were lucky. It's true. Right. And so really, like, as an adult, especially with changing hormones, being like, maybe I never learned about this stuff in the first place. And using it as a personal opportunity, growth to be like, oh, my God, sex can be. For me, what a novel idea to learn at 47.

Yeah. Wow. What about people that want to increase their testosterone? They're. They're wanting to do this. They want to. They think this might be a thing. Can they do it naturally, like without doing hormone replacement? And what does that look like? And then I'm going to talk about hormone replacement with you.

A lot easier. And we don't have great studies, but a lot easier for men to do this because their factories, they don't outlive their factories in most cases. Meaning a lot of lifestyle issues can impact testosterone in men. Stress, sleep, alcohol, exercise, diet. Those are the five pillars of healthy testosterone. In men. And sometimes they still need help supplementing.

Right.

Shift workers, people who aren't sleeping super bad. Your testosterone is made while you sleep, so sleep's super important. But for women, we now outlive our ovaries by a significant number of years. Right. And that's interesting to get into, but for that, like, you can't yoga your way into ovarian function. Right. And so when people kind of start throwing this word natural around, which I think is really a wonderful word to oppress women.

They start being like it. Well, you know, outliving your hormones is natural. And it's like, no, honey.

Yeah.

Dying in childbirth at 24 is natural. Right. Like we, we, we're so good at not dying by natural causes now that we're actually living a very long time as a society, longer than we've ever lived before. So I get very irked when people are like, low hormones is natural. It's like, no, death at 51 is. Right. Natural.

You're right. You're right. What about supplements? Like things like. Or dhea, like supplementing with that. I know that's still a hormone, but when people talk about, like natural supplements or like taking something to increase your natural testosterone, is that a thing? Does that work?

How is DHEA any more natural than testosterone? Just because one's a prescription and one's not, why is that the dividing line of what natural is makes total. I will pick apart the natural argument seven times every single day to make people think, wow, like, oh, you think because something's a supplement, it's more natural than something that's a prescription. That's completely arbitrary. DHEA is a prescription in Canada and testosterone's over the counter in Mexico. So don't tell me that that's the dividing line of what naturalist.

Oh, I love this. This is so brilliant. Okay, I never heard it this way, but this is incredible. I need to know this because this is what you know. And there's a lot of people selling supplements that are supposed to do that. But you're right, that makes sense. So where's the dividing line?

What about the dividing line? Yeah. So to answer your question, DHEA is over the counter supplement in America probably works better in perimenopausal because you still have ovaries that are functioning a little bit. Right. DHEA has to convert into testosterone and other metabolites. So the data is stronger in perimenopause than post menop. Menopause. It's still. I don't want to use. I'll use the Word fringy, for lack of a better word. Like we don't really know who exactly DHEA is for.

Okay.

But it's, it's pretty darn safe. If you're going to do it, just start low.

Yeah, it makes sense.

Yeah.

It's going to hurt anything.

It's not going to hurt you.

Yeah.

You know, at lower doses. Take higher doses.

And you know, when it comes to testosterone replenishment or testosterone replacement, there seems to be a lot of different forms. Like some people do under the tongue, they do a troche, they do an injection, they do a pellet. What does all of that mean? And is there a preferred method?

Yeah, so everybody's doing everything because we don't have one standardized FDA approved dose for women. Right. So you have to, we have to make stuff up at this point. So a troche is basically a dissolvable sublingual, or you put it in your cheek. It's. It's basically transdermal, but not through skin. It's like trans.

Not dermal. Mucosal is the right word. I'm looking for compounded. Insurance doesn't cover compounded things. Remember this. Pellets are a little, A little incision near the buttock. Longer lasting, so nicer. Plug and play. But pellets tend to be the most expensive and pellets tend to be the highest dose.

And it's a little mini surgery. Right. Because you're like, you're having to have your doctor put it in.

It's a teeny. It's teeny. But you're planning on living 40 years post menopause. Right. Do you want.

Sure.

Do you want 40 times 4 a year incisions in your butt?

Got it. Yeah.

Right. And plus, you know, you might have to remortgage your house for that much.

So that, you know, that's what I see in women who drop off the pellets. They're like, I didn't really want to keep getting that procedure and it's really expensive. So women don't do pellets because their friends did pellets. And like, some people will feel really freaking good on pellets. Yeah. It's a big steroid dose and then you kind of chase that high because you don't get the steroid high as much anymore. So very classically, a woman's like, I felt amazing. Yeah. And then I didn't feel amazing again the other times. Times. Right. Okay.

So it's like that first boost of it, you're like, wow.

And then it's Amazing. Yeah. And then you tell all your friends how amazing pellets are and then they all get pellets and then you all stop doing pellets. And that's like, that's like how it works. Transdermal, just a cream you can get compounded super cheap. I get mine for like 60 bucks for three months supply, once daily dosing nice, steady state. Really hard to go too high on that. Sure. You can also use a male gel. Like male FDA approved gel. Again, insurance still argues, like if you're trans or if you're male, it's covered, but if you're a woman, then it's not.

Right.

May I remind you that trans end many men use testosterone off label. So the argument that it's off label is not a way to be covered. Again, doesn't hold up.

Sure.

Because other people are using it off label and they get theirs paid for women, there's a huge bias against women. So. But I covered all. Some people get injections. They just like doing once, once a week.

I do injection.

Yep. Some people like injections. So there's no. You'll find some experts who think there's one best way because that's the way they do it. But I'm more like a restaurant menu of like, listen, I got six different ways to cook chicken. Like, so you talk about the pros.

And cons to each of them with your patients and they decide how do we. So it's interesting when I share that I'm on HRT because I am on all three, people will say, what's your dose? And what I always answer is, it's not my dose. Doesn't matter. It's our blood work. And then it's custom for us. It's not real that accurate, first and foremost. And then what are. Can we talk about ideal ranges like on. On blood work? And how. How accurate is blood testing?

Horrible, but better than saliva and urine.

Okay, yeah, let's talk about that. Because a lot of people recommend Dutch test or so let's.

Well, if you want to empty your wallet and spend a shit ton of money, go get Dutch tests four times a year. Like, be my guest. I'm not getting rich off of it, but like, this is how I think the average person. How long do you want to live with. With hormone supplementation? 40 years. Yes.

Okay. Let's not spend thousands and thousands of dollars all the time to do that. I always say spend your money on your expert. Don't spend it on bullshit.

That's brilliant.

Like have a great. Have A great doctor in your pocket, that's worth. Who's gonna talk you through all of this and hold your hand way more than like, you need to pee on it. You need to pee for $400.

So Dutch test people will say it's the best. It is not supported in mainstream science as being very helpful, and it's the most expensive way.

So the reason they say that, and I, I'm totally open minded here, is they, they're their whole thing. What I've heard, at least, because I've definitely had many doctors tell me to do a Dutch test. What they say is your serum, your blood serum is kind of like a one indicator. And then your Dutch tests, or some people say saliva tells you how you metabolize it. What does that even mean?

Exactly. Who cares?

So it doesn't matter.

Okay, we have. So here's the thing. We have so little science and data on hormones that people are grasping at what they can to try to be scientific and do it right. They might be right, but we have. I am a big skeptic. I mean, I, I started. I'm an MD, you know, PhD at heart. So it's like, yeah, what, Maybe they're right. But until they have the data to back it up, that metabolism freaking matters. And why would you metabolize hormones differently now than when you were 32? Yeah, like question them.

Okay, right.

So question. Why does it matter?

It makes sense.

And it might matter, but we don't have the data on a. To like, legitimately say it matters yet. So, like, I just, I like to be a little bit cynical. Because it's your money.

I get what you're saying. You're not saying, like, it's terrible, don't do it. You're saying we don't know enough, so why do you need to do it? Because it's not. You're saying it's not. So you're like, you can if you want, it's just not. It's like, this is possible. Maybe it works, but we don't really know.

And the thing is, most people do perfectly well on cheap generic bioidentical hormones with a couple of blood work tests. And that's all they need. Yes.

So, okay, so if we do the. So what I've heard you say before, and we didn't. I didn't ask you about this here yet, but when I've heard you say you want to really go off how you feel. So less more on your how you feel versus just labs. But if we look at the lab, you Still, I'm assuming, still look at labs. Is there like some. I know it's not completely accurate all the time. I get, I get that. But like, is there. I, for me, I love my labs. For me, and I'm not a doctor, but I'm, I really know my labs and I like getting them every three months because I love, for me, maybe I just geek out over it, correlating how I feel with what it says and then it helps me understand where I want to be range wise with things. So do you do that at all with the labs? And what do you. What. Even numbers are important there?

Everybody gets a baseline and then everybody will get follow up, especially with testosterone, to see, you know, are you absorbing it? Are you absorbing it? Are you really, really. Are you a high absorber? And what I mean by that is a transdermal product, right? Like, okay, if you're injecting or getting a pellet, like it's in your body. Got it. So to check on the labs and to do that. But remember, like, I will be a cynic, Natalie. Like, yes, your labs aren't accurate all the time. And if you check them Monday and Tuesday, you're going to get two different values. And if you're just looking at that to feel good about yourself, like, good, it makes you feel great. Yeah, but labs are not gold. Like, scientists know that. And even testosterone labs, right? If I check it today, was it four hours after I got a dose or was it six hours after I got it?

I feel the same way about my bank account. Like it could say something's not there. And I'm like, no, it is there. I feel like it's there. So let's apply the same to our. I'm gonna.

Dude, I am stealing that analogy. That is so good. But yeah, so it's like when we put too much weight on things, we just need to check ourselves with that.

Sometimes it makes sense. Okay, so that being said, I heard what you said there. If, if labs were accurate, like if we knew that they were accurate, is there kind of like I'm going to tell you specifically why I'm asking. Is there, Is there a range? Like, I'll tell you, for me personally, I was on cream testosterone for years and it did nothing for me. And my labs always showed I was super low. Testosterone didn't matter how many times they applied, it didn't do anything. So I switched to injection and I feel phenomenal on it. But now I'm told it's a little too high on the lab. So so I'm trying to understand somebody else listening might feel this way too. Like, is there. I heard you say on another, another podcast I listened to, you said, kind of ideal spot on a. If looking at a lab is like 70 to 80 for a woman, is that still what you. You think or.

Okay, yeah. So. So labs. And we'll use the two most common ones in America is LabCorp and Quest, because those are the ones that I've actually researched what their testosterone. First of all, you have to get the mask spectrometry lab. You can't get the other, the male testosterone lab. Do not check that if you're a woman. Got it. It is grossly inaccurate in values under 100.

Okay.

So don't waste your money. It can't measure your testosterone. It's going to make up a number. Right. Going back to like, can labs be trusted? Yes. So mass spec is the lab. It'll the lab. If request, it'll say male, female, child testosterone. That's the mass spec one. So make sure you're actually getting the proper. Now, every lab has a range, Right. Quest, I believe off the top of my head goes down to two as normal. So lots of women, they'll be like, I got my testosterone checked and my doctor said it was normal. Well, I know that two is not normal.

No.

Right. That's just what the lab is choosing to make. Now, a lot of the low libido studies, when they found improvement in libido, it's actually slightly supra physiologic. What does that mean? Let's say if 40 is physiologic to you, then a woman's going to start feeling better with low libido at around 60 or 80.

Right.

Not crazy. Super physiologic. When we start talking 250, 300, those are low male values.

Got it.

You're going to start possibly getting some androgenic side effects.

Right.

If you use that long term. Right. So then I tell women, hey, how do you feel? She comes back, she's 60, she's six. Let's say her lab's 60. She's like, oh my God, I love it. I'm so happy. And I'm like, okay, now you need to know your lab is flagged as high. It has a red flag on it. It's flagging it as high. But for you, that's where you feel good. Right? So normal is not always optimal. Optimal. If somebody said optimal is a setting on your, on your washing machine. Not. Not what your health should be.

So the point is, yes. Above physiologic is where a lot of the data is for libido.

Okay.

Experts know that. They know. How do you feel? Are you having acne? Are you feeling anger? Are you losing any hair? Watch out for things as if you push it higher. Now, some women thrive at higher doses.

Which is me, I think, because I have none of those symptoms. And mine is definitely higher.

And it's something to watch. And this is like, I mean, again, you know me now. I'm. I'm pretty cautious on all of this. And so to me, I'm like, androgenic side effects can develop slowly over time.

Yeah. So when I heard you say that I am back, I already decided I'm backing off because I don't need to be as like, it. Mine spiked, like, went from nothing to like, whoa, like, really high. My body's just like, yes, thank you. So I'm based on that. I don't want to be that high. Like, I don't. Yeah, yeah. I want to be.

We just look at trans data. You start a woman on 10 times a testosterone dose. Does she. Does she look like a man? Immediately?

No. Now?

No. It takes a while.

Yeah.

Right. And so I just have no interest.

In looking like a man or growing facial hair or any of that.

So I feel like I'm very. I'm very. Like, some women do better at higher values. Some women have naturally higher testosterone. But I just caution, like, hey, if you like riding high and. And for. For our discussion, maybe we should not say what that number is because again, we don't know at what number does everybody get androgenic side effects? We don't have that.

There's. It's different for everybody.

It's different for everybod. Because that's the other thing about these blunt blunt tools we're using. Labs included is like, how many testosterone receptors do you have? How many testosterone receptors do you have in your hair? How. How sticky is the testosterone into your testosterone receptors? How saturated? Like, we don't have any of that data.

You know, this is interesting. So when I was listening, it was like, I was definitely binging a lot of your context. I wanted to hear how you thought about things. And I then in my ADHD brain, I texted all of my fit friends that are on hrt, all of them. And I said, what. Tell. Show me your labs. Like, what is your. Because they're all doing replace hormone therapy. And I said, what are your labs? And I'll just tell you for my own spidey research all of my friends that are, like, feeling their best and, like, still they're lean, they're strong, they're like all the things. All of their testosterone levels were between 115 and 200. That was what I. That was in my own little data. Yeah. And then any of my friends that were, like, more declining and not feeling amazing, they were under 50. So I'll say that's just. That's Natalie's research on it with just her own friends.

And I think, you know, and this is, this is expert opinion, this is not papers, but I see this is certainly true with estrogen. There is a big freaking difference between an estrogen of 0 and an estrogen of 10.

Wow.

Right? And so there's probably not that big deal. And that's like bone, like, when you have no hormones, it's way worse than even just having a little bit of hormones.

Totally.

And we have that for bone data, for estrogen.

So for me, estrogen, like, completely stopped my. My hot flashes because that, that, that I had to fix. So I do a patch for that. And I. And I love that, but I don't push. Like, I know there's a lot of people that will talk about going higher on estrogen, and I, I listen to all of that. But for me, that doesn't feel well on me. When I go higher, if I go higher on a patch, I get bloated. I get. It's like, I just don't feel good. So I, for me personally, this is not me giving anyone advice. I like a low enough patch where it takes me out of the symptoms and I don't. And I feel good. And then I like testosterone and progesterone. I like doing that as the combination. For me.

Yeah. I think it's beautiful. And I think you are explaining well to people because people want. This is incredible. This is early science. It's nuanced. We're all individuals, and people just want to be like, okay, so should my lab be 50 anyway? What exactly dose do you use? Like, they're chasing other people's dreams.

Totally. That's like chasing someone else's weight. It doesn't matter. Like, is it muscles?

Yeah. How much do you weigh? Because that's what's best for me.

I hate that question. I'm like, my weight has nothing to do with. With them.

Yeah.

So I. That's so, like, I. I'm always hesitant once people ask about doses because it literally, it's based on you. And if I'm hearing you correctly, it's basing on your labs, you have to have a starting point.

Right.

But most importantly, how you feel. And my recommendation for anyone listening is the more information like this you can get, whether it's this interview or just. You just have to do your own research and understand. So I love learning different theories, different people's opinions on it, just so I can take in what feels right for me. And then I test on myself and I go. I go with how I feel versus the lab. So even with my. The estrogen, like, I kept hearing I need more and more and more and more, but I wasn't feeling good on that. So I have. You have to balance that. That's my advice as a friend to those of you listening.

Yeah, yeah, I agree. And I. I don't always think. I mean, it's this weird thing of, like, more is better. Right. And it's like, I don't know, is that because that. Because what. That's what we think about money. Like, where is this more money?

It could be.

Right. That's what I'm like, Like, fair enough. But, like, are we like, I need more insulin?

Totally.

More thyroid?

Totally.

More like, we don't do that with other. Right, right. And so it's like, why does. Why is hormones. Like, why is the more the better?

Yeah. But some people. Maybe it, like, some people, they do thrive on higher estrogen or whatever, and.

So I'm not exactly. But more is better for everybody. Is that. Yes.

You know, I just did an interesting test. I don't even know how you feel about this, but I, you know, I'm. I'm. I am obsessive tester on thing. I just like to learn and do things, and I'm. I'm the guinea pig and I love learning. And I just did a DNA test, like, just to understand my DNA. And when I got the interpretation of it, I was like, wow, this is wild. Everything I was feeling, it said in my. In my DNA about, like, how I metabolize estrogen versus testosterone. Do you have any experience with the DNA testing and what do you think?

Yeah, so, I mean, I'm looking at multiple companies because, again, I want to be as a thought leader. I want to be on the forefront, but at the same time, I'm very careful that I'm not going to.

Sure.

I don't want to do anything that I'm going to be like, yeah, no. Right. So, like, I'm cautious but interested. Yes. I think it's starting. I think it's in its infancy. I correlated a lot, and no offense to Any of the human DNA companies really. But like, you know when you get your dog DNA tested and it's like half wolf and you're looking at like a. And you're like looking at like a 12 pound Chihuahua.

That's funny.

The science is gonna keep getting better.

You know what I felt like it was.

I'm not.

It felt like if I was going to a psychic, like that's what it felt like to me. Because it was like, you know, if you go to like a psychic and they're telling you all and you're like, wow, how'd you know that? That's how it felt with the DNA thing. I was like, wow, how'd you know that? Like, describe my add, like all the things. So I thought it found it intriguing. But I also, like you just said, I'm cautious of like any one thing. You. It's like piecing it together. And we're also unique and then our environment affects all of that too. So I just, I don't ever believe there's just one thing. Like, I like being a detective and learning all that.

What about. Very. I mean, I'm pretty public at this point too. Right. And so it's like my job is to be cautious and, and a little bit cynical and to be like, I love that, that we're figuring this out, but nothing is fixed at this point. Like, we are just starting to figure this out.

Totally. Let's. I want to back up on hormones a minute and talk about where this kind of some of this previous stuff that has gotten in our heads about hormones, starting with birth control pills, synthetic birth control pills. I was on them for 20 years, starting when I was 15 years old, to regulate my period. I wish I was not ever on those, but I was. And many in my generation were. What are your feelings on those? And why do so many doctors tell perimenopause menopausal women to start them for symptoms?

Yeah, good question. So birth control is world changing medication. Right. If it wasn't designed to be a birth control pill, that medication would have never been on the market because we'd be like, oh my God, it causes infertility.

Okay.

Wow, what a horrible side effect. Except for that's the side effect we are choosing.

Yes.

Right. It's wonderful. But it does significant things to your body. Like that's what it's designed to do. It's designed to block hormones. Right. So.

There'S a lot that's downplayed because the medications came out at a time where we weren't really asking you about your testosterone levels, your mood, your depression, your sex drive. Right. We, we weren't like, thinking those were important. We were like, hey, we need to help some people not continue to have. They need to space out their families. That's what they want to do. We like, they. It came from a very good place. People weren't like, let's design something to ruin people's brains and sex drive drives.

It came from there. But it also was given to teenagers to regulate their period.

Well, that's an off label use, except for some of them. It's on label, but yeah. Because it works to do that.

Yes.

It mellows out your hormones.

For me, it was. I just didn't want to tell my mom I was having sex, you know, so it's like, oh, my period's not regular. I mean, that's. That's the kind of teenager I was. That's not good.

But, But I mean, I think the Internet is currently. It's gotten a little bit more quiet. But that currently was like really hating on birth control pills. And I'm like, you guys don't realize, like, how amazing this medication is. Interesting. Made you not be a teenage mom.

That's true. That part's true. But what is it? What are your feelings on that long term? And, and, and I'm interested. Your personal and also like clinical. Just like, what. What's your feelings about that? And do you think perimenopausal or menopausal women should be on them?

Yeah. So long. These medications are incredibly safe. They're safer now than they've ever been because they keep lowering the dose to be like, how can we still make it effective and have lower and lower doses? Okay, so it's incredibly safe medication. Not without risks.

Right.

Keep in mind everything has risks. Hormones have risks. Not taking hormones has risks. Not. Not trying to prevent a pregnancy when you have sex has risks. Right. So I think again, my pet peeve of the week is like, people on the Internet being like, is it safe?

Got it. Okay.

And you're like, what does that mean? Right? Like, yeah, driving your car is not safe. But let's be honest, I don't say.

It on the Internet, but I definitely. Well, I am now, I guess right now. But I have, I have my own feelings about, like. And I'm not a doctor, so I'm just saying this as, as Natalie, as me, Y. I have my own feelings about being on synthetic hormones versus bioidentical. So to me, I don't feel. I feel that midlife Women that are already menopause, perimenopause. Like, how do they actually even really know what's going on if they're still on synthetic birth controls?

Well, here's what I.

Or is that just my little.

Yeah, that's a good question. So here's what I do. You come into my office. Let's say you're 44, you're having some hot flashes, your moodiness, low energy, whatever. You're still having periods though, right. And so I'm like, okay, do you need a sperm protection plan? And they always look at me super funny because they. And what I. What it means is, do you have sperm in your life?

Yes.

Yeah. Right. Do we have to protect you from the sperm? Which I think is a wonderful way of thinking about it. And so, nope. I've got a vasectomy or I'm same sex or I'm whatever, single. Okay. So we don't have to worry about sperm. Because remember, birth control protects you from pregnancy from sperm.

Yes.

Hormone therapy does not.

Right, right.

So that's your first thing.

You're like, this is what I mean for. So let's look at this first. Got it?

Yeah.

Protection. If they don't need sperm.

Don't need sperm protection, then how are your periods? 20% of women in perimenopause will have very heavy irregular periods.

Yes, I did big time when I was in Perry.

And the hormone therapy doesn't tend to help that as much as a birth control can really kind of calm that down. And so that's another big reason to consider birth control pills in perimenopause.

Makes sense.

You're going to get two schools of thoughts. You're going to get the people who love birth control pills. Everybody, everybody should just be on birth control pills until age 53. And which. There's that school and then there's the like birth control or synthetic. And. And they don't even help, you know, menopause perimenopause symptoms that. Well. So let's give people this again. I think it's nuanced. Yeah.

And I think I believe in heavy parents. Definitely. I definitely think that. But I'm also not an md And I'm not you. So I'm just. But that. That is my. Maybe it's wrong, but that's. That is what I've thought and believed.

That it's nuanced.

Yeah. Well, that it's like, that.

It's.

It's synthetic and it's not ideal. And because I'm. I'm. I know, we just talked about the word natural. I'm certainly not a natural girl. Like, believe me, I've had my share of cosmetic surgery and whatever. I'm not a, I wouldn't put myself as a natural girl. But I will say as my, my for my food and like, things like that, I'm very, very aware. So for me, I, my opinion about again, it's just my opinion. I was on birth control for 20, 20 years and I felt when I stopped it, I actually was more attract. I was attracted to a different type of person after that, like a different type of male.

Data supports that. That's well published, well published data.

My sex drive went up. Not having, being on birth control pills, I felt, yeah, so I just felt, felt for me. I felt like it wasn't letting me be my true self. Being on synthetic hormones, that's the best way I can describe it. So that's where my opinion came from.

Not to argue you, but just to like to keep going with that point. A female not getting pregnant is not her true self. I'm not saying women should get pregnant.

Right.

I'm just saying the whole point of that medication is to make you not do something your body would do.

Right. So if I'm hearing you correct, it's great for that, that if you do not want to get pregnant, it's safe and protective for not getting pregnant. But it is going to alter your true self just like a lot of other things can be.

Just like, well said.

Okay, got it.

Yeah, it's not, it's not bad. It's not a devil.

That's great.

It's just like, understand what it's there for, makes sense and see if you need it or not.

Well, and I can say probably something about, look, sorry, I can say something about antibiotics, right? Like antibiotics when we need them. You need them, you have an infection, but it also doesn't hurt your gut. It could. So we don't just take them to take them. So I guess it's the same kind of thing. Like it's important for what it's important for.

Yeah, Okay. I, I, I've, and I've caught a couple of women. Like they're on, they come to me for perimenopausal symptoms. I'm like, why are you on birth control? And they're like, I don't know. I just kept being on it.

Right.

So that's like, okay, let's take you off of that and then see how you feel and then keep going. Right. I mean, truthfully, like a Lot of the sex med experts, they're like birth control should probably come with testosterone own.

Yeah.

If you truly cared about a woman's sex drive, sexual desire because it really does lower your testosterone.

So this brings me to.

We haven't cared about that. Right. Like, right we haven't. We have to start caring about women's lived experiences.

This brings me another really maybe a strange question, but it's important because I've had a lot of different types of doctors on here. I've had MDs, I've had functional medicine doctors, I've had naturopath. What. And it's very different opinions across the board there. And it's confusing for women like me sometimes like to know who do you learn from? Help us with that too because you're an md, but you also are a little bit more, how do I say this? You're a little more out of the box than, than a lot of MDs. Like, I think you've expanded that. You're not just like, I only teach what I learned in medical school. Like, you've really expanded that. So what is, are your feelings on like functional medicine or naturopath or, and, or what are you comfortable sharing there to help us understand who to see?

Yeah, I mean I wish, I wish it was easy. It's not easy to like there is not one credential that's going to give you what you need absolutely every single time. Like these are humans trying their best to care for you in the way that they know best how to. And there's pros and cons of each. Now I think the term functional to my knowledge does not have like, I could call myself a functional urologist.

Okay.

You can put natural on a candy bar. Like it's kind of a word that kind of means something of like, hey, I kind of care about you holistically and I'm going to think about all these different pieces, maybe have a more in depth conversation. But it doesn't like mean that, that the other ones aren't good.

It's not like a new credential. It's just a name that we're using to describe.

Is that what I'm standing there is, I don't, I don't think like lots of people call themselves functional doctors and.

And then what is a naturopath do they go to? Is it the same? Is it medical school? Like, what is that?

No, it's not, it's not medical school. It's a naturopath school. So four years of college and then four years of Naturopath school. I believe there's two in the country. Best year is a big one in Washington state. And then they're a doctor of naturopathic medicine. They do not do a residency like your traditional MD and DOs do. Some are fantastic at hormones, some are better than your tradition. I'll call this traditional. But you know, some are better, some aren't. And so it's not. Again, it's. I wish it was easy, but it's a lot of.

It's not a black and white answer is what I'm hearing.

It's not a black and white answer. You know, there's great bedside manner and lots of people in bad bedside manner and lots of people and the credential doesn't help. Help. You know, you, you want somebody. If I was to rail on anybody, anything. It's the, it's the insurance based medical system.

Oh yes. I hate when insurance dictates treatment for us. It's just really. It's a mess.

Yeah. I mean Medicare, for example, Medicare and many insurances have vaginal estrogen as tier 3. Like this is a. What does that mean?

What does that mean?

It means they're not going to cover it. It basically like they'll say they cover it, but it's tier three which means it's very expensive. So this is a generic $14 tube of vaginal estrogen that decreases UTIs by 50%. It's been around for decades. The most expensive thing about the whole darn thing is the tube that the medication comes in and insurance companies don't cover it.

So I have a lot of feelings about insurance. I think I started my, my very first job after college or like my, my main job after college was a medical sales rep. So I used to, I was a medical device rep and I learned really quickly about insurance and how it was dictating treatment. And I saw a very big difference with doctors. And I felt bad actually because a lot of insurance that were really, a lot of doctors that were very insurance based, they were like held to this rigorous schedule. I can only see a patient for five minutes or whatever it is. They're cramming them in and they're just looked for, they would look for just how do I just treat the symptom. It's not, they didn't have time to go deeper and then it was always based on what's insurance, how are they dictating treatment. So I had a very bad taste about insurance from that. And I know you probably can't say this, but I'm Going to say it right here. I actually got out of the insurance system. I don't even have medical insurance anymore. We went with a health share, which I'm a huge fan of because for those of you listening that you want to know more about that, Health shares are outside of medical insurance. It basically says you're responsible for your own medical. You can go to any doctor you want, any treatment you want, want you pay for it. But then what they do with these health shares is you pay a little bit a month into this pool and if you have an incident or injury that is like over a certain amount that you agree on with your health share, then it kicks in and helps you. So it just basically puts responsibility and choice back on you. So I know it's a different tangent, but I feel very strong that letting having medical insurance always dictate our treatment is not the best way for us.

Yes. Yeah. I mean my, my, you know, here's maybe a pro tip if you're, if people can do it because I think everybody stop wasting your money on freaking urine tests and pellets. Go get an, go get an expert, get on some medications that are reasonable and then go back into the insurance based system. Have your insurance pay for it and have your primary care be like, fine, you're happy on this. I'll just do the refills.

But find your doctor first, not from your insurance. Like find who you.

Right. Find the form. You, you true hormone and sex med experts. Many are still in the insurance company. Okay. Don't get me wrong. Yeah. But do I think I can get the perfect plan for you in one 15 minute visit? Absolutely not. Especially in perimenopause, right. Where it's like the hormones are ever changing and like, and so to me I'm like, go to somebody who, like, where you understand why.

Totally. It makes me sad. I also, I mean, I also have personal stories that my dad died because of insurance. Like he went with shortness of breath and, and pain and all that and they didn't even check his heart and he died the next day. So I have like, I have, I'm anti medical insurance in such a massive way. Like just because it's my own personal. Everyone has their own experience.

Yeah. But I mean, I got, I've been in it for 12 years. Traditional. And I quit December 31st. And now I'm opening up, you know, cash base where I can spend hours with people. That's amazing because I'm like, what do women want more of? They want to be heard, they want to be listened to. They want to be believed. Yes. Yes. Yeah, I can't, I can't do that in 10 minutes.

Yeah.

So we need to.

It's amazing. I love that, I love that for you. And you can still, people can still submit on their own to insurance if they want to go through that. It's just going to be different. Yeah. Okay. I have more questions about. Sorry, I, like, I could talk to you. I, I can see why you were on some of my friends podcast like five times. There's a lot of, there's a lot of questions and I'm not going to take your whole day. But I do have a few more really important ones when it comes to. And I've asked this before of other people, but I want to hear it again. And this is so important. Why did HRT get such a bad rap from the Women's Health initiative back in 2002 or whatever it was? Can you run us down on that? And who actually should not be on hormones? Is it true if you've had cancer, you shouldn't be on them? Help us with that.

Good, good, good, good question. You're going to help so many people with this question. So Women's Health Initiative billion dollar NIH study asking the question, if we put older women on synthetic hormones, will we decrease their risk of heart disease? Disease. That was the question.

Okay.

Whenever you, whenever you take a medical study and you want to see if it is, you know, useful, does it apply to you?

Right.

Does that question, taking a 68 year old, starting her on a synthetic hormone to see if it prevents her heart disease, does that apply to the average 51 year old with natural hormones who's suffering from hot flashes doesn't even apply?

Absolutely not.

So that's the, that's the very first thing of like, oh, they were asking a question that doesn't even apply to women like me. Me noted. So what they did was they went to the media before they published the paper, they went to the media and said hormones cause breast cancer, notably estrogen was the one that got noted as causing breast cancer. Some of the researchers said, do not do this. If you let the genie out of the bottle, you will not put the genie ever back in the bottle. They did it anyways because they really wanted to shake up the world. And, and they did. They did the most, one of the most damaging things that healthcare has done in decades. And when the paper was published, it was not statistically significant that there was breast cancer recurrence. The placebo arm was flawed. The Study was not designed nor screened or randomized for breast cancer risk. Right. And so estrogen alone, two groups of people, people with uteruses and not uteruses. So estrogen alone, if you didn't have a uterus, decreased your risk of breast cancer by 20%. Where was that in the news right now?

It wasn't there.

Estrogen's breast protective. And then if you are on estrogen plus progestin, so synthetic progesterone, which is hardly used anymore, it increased the risk by like 6 out of 10,000.

That was progestin.

Correct, Justin. Madraxy progesterone acetate. So minimal increase if you believed that versus the placebo arm was flawed in the first place. And when you. When you made the placebo arm better, there was no increase in breast cancer. So either way, you want to shuffle that data, There is no significant risk. And even if there was, with the synthetic, we don't use synthetics anymore anyways. So it's crazy to me that our hormones protect us from breast cancer. And yes, people are afraid of them for these. The opposite reason.

Now, what about people that actually had breast cancer, though? Not. And I don't mean active breast cancer right now, but they had it. Yes. Treated, done. They. A lot of them.

Yeah. The most, I would say neglected, suffering group of. Not that I mean the most is dramatic. Very, very suffering, neglected group of people. So two things to know I mentioned quickly. Vaginal estrogen. So vaginal estrogen is just skin care for down there.

Okay.

It doesn't go into your face.

I put that on my face, by the way. I literally, I mean, look at my skin.

It's so good. Yeah, it's the best. So because it's skincare and. And our skin loves estrogen because it makes collagen.

Yes.

So anyways, super low dose, super safe, never been implicated in anything bad. And breast cancer survivors, like are hardly even allowed to use that.

I know they get shamed for asking. It's terrible.

Shame for asking. Did you know a divorce rate rate amongst breast cancer survivors?

Really sad.

Nobody talks about it. I feel like relationships, I will stay.

On the patch for the rest of my life, even if I have to get it from the black market. Even if I like, I don't care. Like, I know I would rather like I know how I feel not being on it. I don't want 10 hot flashes an hour. I just.

For me, it's awful. We need to start caring about women's quality of life. So to answer the other question. So vaginal estrogen in any breast cancer survivor. Multiple studies, Incredibly safe. It's a very, very rare that you couldn't be on it. It.

Okay.

And more and more oncologists are caring and allowing vaginal estrogen. Great. That's our first thing. The second thing is systemic hormones. Right. So what's the number one. If you've been cured from breast cancer, what's the number one thing you're going to die of? What's the most common thing you're going to die of once.

Once you're cured of breast cancer? I don't know. What? Okay, same thing.

That same thing. The number one killer of all women, heart disease, Right? So women are saying, hey, I. I've been cured from breast cancer. I'd like to protect my heart. I want to. I want better brain. I want to protect my bones. I'd like to protect, you know, all these things. And they're being told no. Now there's a great book. If people are like, too long. Didn't read. Read the book Estrogen Matters by Avram Blooming. It goes into all of the data on breast cancer survivors and hormones. I know multiple people who are breast cancer survivors, and on hormones, the tide is turning, especially.

The receptor negative cancers.

Okay.

They're. They have no increased risk than the general population for being on hormones. That data is very solid. The big myth, and this is worth clearing up on your podcast, that if a cancer is called estrogen positive or progesterone positive, that means a hormone caused it. That's not what it means. It just means that the cancer has receptors for those hormones, just like most cancers have receptors for the things pro. Interestingly enough, prostate has testosterone receptors, and we don't call it testosterone positive Prostate cancer. Wow. So that.

That is wild because that is what we keep hearing. And then that's.

Yes. So. So hormones are food. Food doesn't cause cancer. But if you have cancer, you don't want to feed it.

Right? Makes sense.

You got to take away the food, because if people will be. It'll be like, you got to first get rid of.

You got to anal. You got to first deal with that.

Get rid of the food.

Food, yes.

But now you killed the cancer.

So now you can address.

Can you put food back on the table? Yes, one would hope.

Total sense.

And we have a lot of studies that support that. I would say it's still in mainstream medicine, because in Maine, I mean, in mainstream medicine, we remember, we have two decades of doctors that didn't learn how to prescribe hormones. Totally.

I don't blame them. They're doing what they think is the best practice.

It's like in America where you don't want to get sued for, you know, looking at somebody the wrong way. Like they're going to be conservative. I don't blame them. So stop suing doctors for stupid.

And then we don't have this problem.

So that they can actually can want to help you, even though it's like it's not written out explicitly. Right. So it's still an informed consent discussion. Risks and benefits and. And here's what I know there's multiple. I don't want to pigeonhole, but breast cancer survivors as everybody. We're freaked out about this tumor. Like, this tumor is evil. It's awful. It does stupid shit. It comes back in nine years, it comes back in 17. It does stupid shit. And we don't have any good evidence that hormones will increase the risk of recurrence. But there will be recurrences. That's what happens in cancer.

So people link it to that. But that's not necessarily. We don't know.

We have to get over that. Cognitive correlation equals, you know, causation.

Wow.

Like, for the true woman who's like, I've read the data, I've read the books, I've read the studies. I understand this could come back. But my God, I want these hormones for my quality of life. That's who's going to get.

I feel like that was Suzanne Summers. Honestly, like, I mean, I don't know. I didn't know her personally, but like that. That's kind of what she. Because she was on HRT after her cancer. And then people said, well, that's what brought it back. But there's no way to know that.

There's no way to know. There's no way to know. But that's what taints hormones for everybody.

Yeah.

Is. Is the brain's passionate interest in trying to link things that are unrelated. Right. But if a woman has been treated for breast cancer and she's expecting her doctor to say, hey, why don't you go on hormones.

They're not going to happen.

That's not going to happen.

No.

You have to do your own if you want it. You have to be the. The person requesting trial of treatment.

Makes sense. One more question because I want to. I brought this up at the beginning and I want to make sure I don't skip over this. I know that testosterone is really linked to also helping prevent bone loss. Is that because we're maintaining muscle and able to easier Grow muscle. So we're preventing it, or is there a different thing I'm not aware of that's helping with BO loss there?

Oh, it works in bone. Bone by itself as well, specifically to.

So has nothing to do with the muscle.

Helps. Well, it helps muscles. Yeah. So what is it everybody hates? Like, everybody's so afraid of the word anabolic, right? Like anabolic steroid. Testosterone is an anabolic steroid. Like, that's a. It's meaningless words. Anabolic just means to build, right? So it helps build up the body, helps helps maintain your muscles, helps maintain your bones. Steroid just means a certain way the carbons are arranged and arranged. Ring. That's all it means. Vitamin D is a steroid. Right. So I didn't know that. Yeah, it's a. It's a hormone. As a steroid, it's definitely a hormone. Okay, but so, like, people are so afraid of what these words are. But it's like. No, it just means it helps maintain. It helps build. Right. Build your bones, build your muscles. That's what anabolic means. Catabolic means to tear down. Yeah, but like, they all. We've. They've got reputation management problems, basically.

Yeah.

We've got plenty of data in bones and men like screaming data in bones and men in testosterone. So to wrap this, we do have some studies looking at estrogen versus estrogen and testosterone and bone health. Not as many studies as we want, but we have studies saying that both of them together seem to help bones more. Which makes sense because in your body pre menopausal, you have four times the amount of testosterone and estrogen.

There's one hormone we didn't touch on at all. And I just want to, like, briefly make sure we mention it. Progesterone. Do you make sure if someone's on estrogen that they're also taking progesterone? And why is that important?

So if they have a uterus, they must. Because we don't want unopposed estrogen. Right. Your body had all of these hormones before menopause, Right? So your body actually, like, your uterus doesn't do well when it just has one of them. It needs both. So if you have a uterus, the rule is you must be on a progesterone. Progesterone. Progestin. What. Whatever it might be. And progestin secreting iud. Okay, so for the perimenophone, it's like the balance of.

It's like not just training your bicep. You do your tricep, too. You need the balance.

Exactly yeah, yeah. You don't want to be unilateral on this. So. So that. Yeah. That's how. And because of the whi. They were like. Yeah, but you only be on it if you need it. But micronized progesterone. That's the body. Identical.

So normal, so safe. Probably breast protective. Certainly not breast harming. Like incredibly cheap.

An amazing sleep.

Amazing sleep. So many people think it helps moods and anxiety.

It does. I mean it's, it's great.

Yeah.

So I feel like hormone replacement has been. I mean I look, I love some supplements and eating and working out and doing all the things but there is nothing that has helped so much with, with menopause and hrt. Like, I'm like, I can't believe.

Thank you.

It's so sad to me that so many people don't know or can't get access to it or it's like it's.

Really this, it's bad out there.

Yeah.

This is. Truthfully, it's going to be. We're going to see health give this 10 years because who's getting hormones right now? The educated.

Yes.

People with resources.

Yeah, it's sad.

Educated resource access success. Right. So put those people on hormones. These people didn't get hormones. Check on them for 10 years. Yeah.

It's not fair. And then you.

Huge health disparities.

We need to get that, that fix a thousand percent. But I also love what you said about the natural thing because when people are like, well, I just did it all natural and whatever like that. Okay, great. Let's talk in 10 years. Let's talk in 20 years. Let's see.

I like, I love picking apart natural. I'm like, shoes aren't natural. Your car's not natural. Air conditioning is not natural.

Braces. We all have braces.

You have braces. Like you're just picking your natural to like should on somebody else. I wanted to go into for the breast cancer one more time. Testosterone has never been shown to increase risk of breast cancer. If anything, there's studies that show testosterone decreases the incidence of breast cancer.

That's amazing.

So again we need more studies. But the studies we have say that's true. So when we say hormones post breast cancer, we're really kind of talking about estrogen still being the boogeyman, even though it's not the boogeyman in testosterone core.

I love talking to you because I, I feel like you just completely bridged the gap for me because I feel like I've had. I hear like the, these extreme ideas and Then I hear the like ultra conservative and so I feel like you're a really nice bridge in the like middle.

I'm nobody's friend.

Nobody. It was.

No, I thought it was.

It's perfect actually. I like that because I feel like we, we need to hear all the information and then decide what's best for us. There's, there's. And what I'm hearing from you is you're not saying like, like you. Even when we talk about Dutch test, you didn't say don't do it. You just said this is what the research is not showing on it yet. If you want to do it, go for it. It's. It's just not. So. I don't think that was like a. You're not badmouthing it. Yeah.

Same with, same with different types of practitioners and providers of like there's great ones and there's shitty ones. Just like car mechanics and like artists, you know.

Well, and I also love what you said about birth control because like, look, I'm not a fan of it personally. I don't like that it's the synthetic hormone. Awesome. But you, you brought valid point. Which made me think of it like antibiotics now like it's does its job and it's safe for that.

But like if you don't have that needing it for that, like do we need to be on it? So I, that was very practical because that's the way I literally look at antibiotic people villainize. But I'm like, but they can save your life sometimes. So I don't, I don't know.

It's gonna wreck your gut, but it'll save your life. Yeah.

So you pick and choose. Like what's the more what's it, what is what's right now, what's most important, like what's what's. If you're dying of some horrible infection, you might need the antibiotics and to fix your gut. Laughter like it's just, it's just a thing.

Totally. Yeah. I mean I think the more, you know, like to me the, the amount I know at this point makes me be sound very like nuanced and, and great. Like I'm not all about like the newest, hottest, best thing because I know it'll come and go.

Yeah.

Right. And so to me I'm like, I want what's practical, sustainable for 40 years post menopause knowing. Knowing that, you know, things are going to change and we might change dosing and we might blah, blah, blah.

And I like that you're open minded too. Like Just like you're seeing the trend with DNA testing. You're like, well, I'll look at it, I'll see. So it's. It's not. You're not saying no to things. You're just being more practical and open minded. Where can people. Can people work with you? Like, do they have to be in Washington state? Like, how do they.

So, yeah, so I only have a Washington state license. This is state. State licenses, not okay. People don't know that. They're like, my doctor, blah, blah. It's like, like, states want doctors money and they make us all pay for state licenses.

Okay, got it.

Just for. Just for people who understand, like, people like my doctor, blah, blah, blah. It's like, dude, do you think practicing medicine in Wisconsin is any different than practicing medicine in Michigan? Yeah. Right. Like, these are antiquated bureaucratic walls that they've put up. So. But I get to just be practicing Washington state because this is where I live and Lord knows there's enough people here, so. Oh, yes, you have to come to Washington state to see me.

Okay, got it. And then where. Where's your mo. Is Instagram your main social media place?

I love Instagram. I just. I just canceled TikTok again in the whole, like, what's happening? Thing, and I'm like, am I gonna reload it up again? Like, for a third time?

I heard once you delete it, you can't get it back. So hopefully that's not true. It's like, not. I haven't.

I haven't tried. I'm sorry. Oh, it's not in the App Store now.

Well, it's very confusing what's happening there, but I. I feel like I just.

Need to pick a team. And I really love the community of Instagram. I love the Instagram community that I've created. Like, I just love it. My podcast is called you are not broken. That's the same as my book.

And then that just sums that. That title sums up you. I feel that you are not broken. Like, just, here's the stuff.

Totally, dude. People will argue for their brokenness. That's the other weird thing they do. But I am. And I'm like, okay, if they believe.

They are, then they will say that way.

Yeah, I know, it's fascinating. And then. Kelly Casperson, md.

This was awesome.

Thank you so much. Thank you for joining us.

Thanks for having me.

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