Dr. Kelly Casperson: EPISODE LINK
Dr. Kelly Casperson book: YOU ARE NOT BROKEN
TRANSCRIPT:
Colleen: – Welcome back to Hot Flashes and Cool Topics. Today, we have a guest on that
honestly should have been on like a million times by now, but please welcome to the
show Dr. Kelly Casperson. Welcome.
Dr. Casperson- Thanks for having me.
Colleen: – Well, we’re thrilled
because you are doing such amazing work for women’s health. And, you know, we’ve
been doing this podcast five years and we’ve heard a lot of stories
Dr. Casperson: Oh, thank you. – Oh, thank you, thanks. – I just hit five on mine. Five,
2 .3 % of all podcasts make it to five.
Colleen: – Wow. – Well, see, we’re an unusual group.
Dr. Casperson:- There you go.
Colleen: – Yeah, it’s very good to have a connection. But it’s because
there’s just, you think that you’re showing one thing and then there’s five other
things that open up from that topic. So it’s just never ending. And there’s some
women need information so that they can make educated decisions on their body. And
one of the topics that we hear a lot about is sexual health, especially in the
post -menopause world where Bridgett and I have finally gotten to, thank goodness. And
women still have this anxiety over talking about their sexual health.
It’s like, it’s still taboo. Why do you think with all the conversations on
menopause women are still finding it challenging to talk to their doctors about
sexual health?
Dr. Casperson: – Oh, I mean, there’s so many layers, right? Like sex is everything
and then never talked about it. I was just doing a stage show last week for the M
-Factor documentary and I’m like, I have the two biggest niches in the entire world,
menopause like women and sex and I’m like, and nobody wants to talk about either
one of them. So here I am. But I mean, it’s like society’s shame. Doctors didn’t
get trained. Doctors don’t know what the hell they’re doing with female sexuality.
And like, I’m allowed to say that because I didn’t know what I was doing. And I
was, I’m a urologist. So I was like, definitely trained in the male. And I was
literally told, don’t worry, the gynecologists are taking care of them. And when you
do the math, like the math doesn’t math. So there’s about 50 ,000 gynecologists,
OBGYNs in America practicing right now. And that is projected to go down to about
47 ,000.
which is absolutely absurd. 50 ,000 doctors, it’s not enough.
You know, we’ve got 80 million women over the age of 40 in America. Primary care
needs to take care of this. Internal medicine needs to take care of this. Like,
OBGYN can’t be the only sex med doctors. There’s just not enough of them.
Bridgett: Right.
You know, your book, your first book, I know that the second one’s going to come
out September 2, but I’m going to hold up a cover. If anybody is watching a video
of this, “You are Not Broken: Stop Shoulding All Over Your Sex Life”, which I
love. You address so many things that women our age were taught societally just,
oh, you can’t talk about this. And as I read your book, it hit, like religion. You
know, how were you brought up religiously and what told you that’s bad? Your parents
didn’t talk to you about it Or if they did, can you address how that was an issue
and how that affects women now? Like especially we’re post -menopausal and we’re
hitting this thing why my libido is not working anymore? I don’t know what to do.
I don’t know what’s happening? Can you talk about what happened to us in the past
that is holding us back?
Dr. Casperson: Yeah. So sex is biopsychosocial, right?
Biologic, psychologic, social logic of Like, I always come back to the biggest
problem is we don’t get sex ed and we don’t get adult sex ed, right? Like as a
teenager, you got a disease and pregnancy prevention plan. If you were lucky, the
people who say, you know, like it’s the very rare person who’s like, my mom told
me everything I needed to know and to prioritize my pleasure and what the clitoris
is. And like, it’s the rare person who has that mom. But like, if anybody got good
sex ed, It’s either from a mom or like a very good early relationship. And most
people don’t have very good early sexual relationships because they’re having sex with
somebody else who also didn’t get sex ed, right? So you’re limping along like
probably with the help of some hormones and then midlife happens and you’re like,
well, my relationship is routine, it’s not new anymore. Like the newness factor of
relationships goes a long way and the brain thinks things aren’t new after about a
year, right? So relationship might not be newest. You don’t have that like dopamine
surge. You don’t have the hormone surge. And then you’re like, oh my God, everything
I learned about sex was wrong in the first place and not even neutral. It’s like
negative, right? Like just sit around and wait for Prince Charming to come. And then
he’s supposed to turn you on all the time and he gives you the orgasm that you’re
not in control of that, Right like there’s all these like unspoken Dogma,
and then you’re like oh my god. It’s all wrong. You mean I am the one? This is my
sex life? You’re like yeah, it’s yours. It’s your sex life, and then women are like
I don’t know. I don’t know anything
Colleen: And I would suggest if People haven’t who are
listening that they go over to YouTube and watch your Ted talk because you do talk
a lot about the biopsychosocial aspects. And can we talk a little bit more about
the dopamine in the brain? Because one of the things that you said that struck with
me is, are you having sex worth desiring?
Dr. Casperson: – Yeah. – And that’s just,
women don’t even ask themselves that question. – That’s a good question though, right?
Colleen: – Absolutely.
Dr. Casperson: – I was talking to an expert in female sexual health and we were
talking about low desire and what’s available for low desire and I looked at him
this is an aha moment like years ago and I looked at him and I’m like you’re
assuming women are having good sex and he’s like well yeah and I’m like oh well
that’s a pretty big assumption right like it’s one thing if you have low desire and
it’s good sex and it’s another thing when you have low desire and it’s mushy
broccoli and like painful nails on a chalkboard, right? Like you’re never ever gonna
desire the latter one. So that’s like, and then go to go back to dopamine. So
dopamine’s actually released in the brain. People think you get like a dopamine hit
when you get something. Dopamine’s actually released in the anticipation of getting
the rewarding thing, but the Everything has to be rewarding,
right? You’re not going to get that dopamine from like making out with cardboard.
Bridgett: Yeah. And you talk about responsive, yeah, spontaneous.
Dr. Casperson: Yeah. So the two
types of, again, Hollywood tells us you’re supposed to be spontaneously desiring all
the time any gender. Men feel broken when they don’t spontaneously desire sex. And
it’s very normal for not everybody to desire sex all the time, right? Like we
wouldn’t have a functioning society if all we did was crave sex 24 hours a day. So
everybody thinks spontaneous desire is the default. That’s what Hollywood says. That’s
what your top 10 country hits say, right? And then they get into midlife and
they’re like, but I’m not just sitting around, like they feel like there’s
something’s wrong with them. And it’s like, well, do you like sex? And they’re like,
oh yeah, I like sex. And I’m like, “You have a good time at the party?” And
they’re like, “Oh yeah, I have a good time at the party.” And I’m like, “Well,
that’s spontaneous, that’s a responsive desire.” Meaning you’re not sitting, like
you’re doing a job, you’re writing a podcast, you’re writing a book, you’re taking
the dog out to poop. Like you’re not thinking about sex when sexual context isn’t
present. But when you put yourself in a sexual context, you’re like, “Yep, good
party, love it, great.” That’s normal. That’s totally an adult brain normal and so
it’s many people Rosemary Bassan was one of the researchers to kind of like discuss
how female desires different is like you can desire sex during sex. You can desire
sex after sex and people are like what and it’s like well how many times do our
people like oh my god That was so amazing. I loved that remind me that we should
do that all the time. we should probably do that every day. I like that so much.
That’s somebody desiring sex after they just had sex, right? But if you don’t get
adult sex ed to be taught this, you think you’re broken.
It’s like, no, you’re not broken. You just didn’t learn the rules in the first
place.
Bridgett: – Right. You know, so many women, I mean, goodness, we hear this so much
Colleen about people. What do we do about And then a big thing you bring up a
lot, not only in your book, but in your podcast at the same name, you are not
broken, is you call it PAV, penis and vagina sex,
and that is not the only kind of sex. Can you talk about why that is an issue?
Dr. Casperson: Yeah, so the hetero normative view of what sex is is an erect penis goes in a wet vagina and then somebody orgasms and that usually sex is done. That’s somebody who
orgasms is usually the male because that is a very effective way for a male to
have an orgasm. Highly effective. Seventy percent of women don’t have an orgasm by
putting something in their vagina because the vagina is not to be crass and this is
not a perfect example but the vagina is kind of like the scrotum and the fact of
like it’s close but rub a scrotum and see how many orgasms you get right is like
you have to care about the organ of pleasure, which is the clitoris. So one of the
big things we see in in heterosexual relationships is what we call the orgasm gap.
And that is the persistent, they’ve been studying this for a while, it continues
that men have more orgasms than women. Well, if somebody’s getting more pleasure out
of this event than the other person, don’t be shocked that one person doesn’t want
to do it as much. And then she goes around beating herself up for having low
desire. And it’s like, no, no, you’re just, your reward isn’t as good. So focus on
sex worth desiring. And then we can worry about desire. Now there are things
available that help with sexual desire. Usually it’s assumed that you’re working on
sex being a good thing though. You can’t make, I can’t make you desire something
that’s not worth desiring.
– And for some women, they don’t desire it because it
hurts.
Colleen: – That’s right. – Sex can hurt. Can we talk about that?
Dr. Casperson: – Yeah, well, women come in to see me and they’re like, “I have two problems. I have low desire and I have pain with sex. And I always like taking problems away from people.” And I’m like, “No, you have one problem. You have pain with sex. Nobody desires that.”
Right, so you have to work with that. So genital urinary syndrome of menopause,
which is a huge mouthful, but women don’t understand that But women don’t understand
what menopause is, first of all. If you think this is just a hot flash in your
period’s end, you’re woefully and uneducated about what’s actually happening in your
body. So ovarian function of hormones, both estrogen, and testosterone,
and progesterone, go down. Other hormones too, but those are the commercially
available ones, so that’s why we talk about them. But they go down because it
changes throughout your body. And in the pelvis, it’s painful sex, thinning of the
vulva, resorption of your labia, minora, clitoral atrophy, decreased arousal, decreased
abuse, it’s a lot more hard to have an orgasm, pain with penetration.
All of that is because your hormones go down. And so the other thing about it is
it can happen like after your period’s end. So women will see me seven years and
they’ll be like, “I haven’t had sex in seven years.” Or they’ll be like, “How is
this menopause?” And I’m like, “Cause you don’t understand “its low hormones that the
situation keeps getting worse.” But very treatable, you just have to be on top of
it. We think the sex med docs and the hormone docs were like vaginal estrogen is
so safe, so inexpensive. And if 50 to 80 % of women get these problems in their
pelvis, why wouldn’t you want to focus more on a preventative regimen? Then like,
hey, make sure to go see your doctor when you can’t have sex anymore because it
hurts like razor blades and then try to undo the pain cycle you created. Right. I
need a vaginal estrogen.
Bridgett: I have it and it is awesome. It’s great. And then you
also, can you address the
So can you address that and how you’re really working hard to get this black box
label removed from the vaginal estrogen?
Dr. Casperson: So when we talk about hormones, we talk
about two different things, meaning systemic and local, local is also called vaginal
because you tend to put it in your vagina also on your vulva. Very, very low dose.
A year’s worth of vaginal estrogen is equivalent to one tab of oral estradiol.
And remember, one tab of oral estradiol is still like 10 % of what one birth
control pill is. So let’s just zoom down to like how minimal of hormones this is.
And 75 % of women at some point in their life took birth control pills. So don’t
tell me you’re afraid of hormones, right? So the vaginal estrogen has a boxed
wording on it as do all estrogen products because of the WHI that was this big
study in 2002 basically said, “Hey, throwing high dose synthetic hormones on people
who aren’t very healthy can cause some side effects.” Actually, that was overblown.
There’s way less side effects than the media took, but because of that, the FDA
said estrogen needs a boxed warning, which is the highest level of warning that the
FDA can put on something. And so, to this day, even on vaginal estrogen,
which doesn’t go… If I drew your blood, I wouldn’t know you were on vaginal
estrogen. That’s how low it is. But it says heart disease, cancer, blood clot,
and then it says probable dementia. Not possible dementia, probable dementia.
So there’s a study that was recently published that said even if a woman was lucky
enough to get a prescription for vaginal estrogen because it’s a prescription in
America, 23 % of them still won’t use it because they go home and they read the
label.
But yet, now women will put just about anything on their face for skincare.
Colleen: And it’s, I love that you use that argument, it’s skincare, just a different area
of skin. I mean, we’re quick to put estrogen on our on our face we’re quick to
put all these chemicals on our face yet. We’re clear.
Dr. Casperson: We’re quick to drink alcohol, It’s a known carcinogen. I actually I did a reel it was like the tale of two
government warning labels Because the vaginal estrogen one is basically like it’ll
kill you be real damn sure you want to use this and then the alcohol ones like
Don’t use while you’re pregnant or operating heavy machinery, and I’m like that’s not
applicable to most people. Yeah. Do you think that this kind of ground swell
movement will make them take a listen to it because they haven’t as of yet in
other ways? I’m a pretty optimistic person, like by default,
I’m pretty optimistic, but I’m like, physicians have tried twice. The most recent
meeting with the FDA was like June 2024. So physicians have met with the FDA and
of one before that was like four or five years ago. And both times they won’t take
the label off. And then, so now we have a citizen’s petition. Basically,
we’re making it very easy. You can go on to letstalkmenopause.org. There’s a button
for unboxing estrogen. If you’re a provider, you click this button. If you’re a
layperson, you click this button. It’s been really sweet ’cause like I have a pretty
international audience now on Instagram and they’re like, I live in Canada, can I
click the button? And I’m like, well, I don’t think the FDA, I don’t think the FDA
really works for you, but nice. But it’s amazing how many women don’t value that
their voice matters, you know? They’re like, what can we do? Like they’re so upset
about things now, which is great, wonderful. We’ve got them upset, but it’s like do
something about it. Another one that I’ve hearing a lot these days is insurance is
requiring prior authorization for hormones, which is insane because it’s your body’s
literally has low hormones. It is the treatment of choice that there’s no drug
that’s more effective than hormones and that insurance companies are giving another
barrier to your receiving care. And I’m like, you better write your legislator, write
your congressperson, write your senator, write your state insurance commissioner, like
this is absolute bullshit and it will not get better until women do something with
the anger that they have.
Bridgett: Yeah, you know, you’re talking about that. I just know
personally, I am on, I am on a patch, estradiol patch, progestin,
oral, and then I have my vaginal estrogen. And the past few times that I have gone
to get my prescription filled, I was waiting for my refill for my patch and I got
a call that oh they haven’t refilled it because we haven’t gotten results from your
mammogram and it had been six months, it wasn’t a year, it was six months and I
was like well I had a mammogram, and I know that this my particular physician is
not associated with the hospital where I’ll go through to get my mammogram. And I
was so shocked. That has never happened to me before. And I was, I said, well, I
signed the release that you could have results. But I’ve never had an issue. I’ve
never had any concerns with a breast cancer scare, or, you know, I don’t have it
in my family. And I was like, they’re not going to give me my patch until I have
my mammogram. Have you ever heard of anything like that?
Dr. Casperson: Yeah, I don’t mind that
actually, like, you know, you, you should, uh, if it’s only been six months, like,
yeah, give the woman her hormones. Cause may I, you follow, just follow regular
mammogram screening guidelines, right? But it’s a good time to remind your listeners
that hormones are food, right? And so food can feed monsters. Food,
food doesn’t cause monsters, but food can feed monsters. So if you have a monster
in there, you want to know about it. You got to get rid of your food till you
treat the monster. And so that’s really important. And it’s very, very common that
most people who prescribe female menopause hormones, not vaginal estrogen, again,
very super low dose, but systemic will require that their women be up to date on
mammograms because you want to detect something if it’s there early and you want to,
if there’s a monster, get the food out till you treat it.
Bridgett: Right. Yeah, and you
know, I do have a little bit of difficulty with my vaginal estrogen that it is
expensive, even though I have insurance.
Dr. Casperson: Don’t use insurance. Don’t use insurance.
Don’t use it. Don’t use it. Go to send your prescription to Mark Cuban Cost Plus
Drugs. That’s about $14 plus $5 shipping. You don’t have to stand in line. They
ship it straight to your house. Okay. It is an absolute crime in this country that
you pay a ton of money for insurance and then they make money off of you when you
fill a prescription. And that in 2025, it’s cheaper to get your drugs paying cash
than to go through your insurance. My progesterone was like $230 and I paid cash
using the GoodRx app, which is another thing to check out for cash -based prices,
and it was like $28. So you pay money for insurance And then you enrich them
additionally when you give them more money for something that doesn’t actually cost
that much. Hormones are dirt cheap.
Colleen: And do you think one of the reasons that the
information is not getting out there is because it’s not a moneymaker? Testosterone
for women would not be a moneymaker? I mean, do you think that’s one of the
issues?
Dr. Casperson: Oh, yeah. Yeah. 100%. And why do you think they’re coming out with brand
name hot flash medications because they’re synthetic, patentable,
expensive, and there’s a huge unmet need. It’s like most women can safely take
hormones. And I don’t mean most women like 51%. I mean like most women can safely
take hormones. But right now in America, about less than 5 % are on So,
wrongly, they’re going to go get the new brand name, super expensive, $300 a month,
like insane medications.
Bridgett: How much is testosterone for men?
Do you know how much compared to women?
Dr. Casperson: Well, yeah, it depends upon how you do it.
So if you inject it, that’s the cheapest. It’s like $10 a week.
The gel for men is about, for a month’s supply for them, it can be like almost
$200. So if you dose that for women, that’s one tenth of the dose.
So like 20 bucks a month, super cheap. So yeah, testosterone is cheap.
Colleen: An interesting thing that I was listening to is also when you talk, someone asked you about andropause, and you were like, it’s more lifestyle than necessarily,
you know, what they’re eating, how they’re exercising. Can you talk a little bit
about how men’s conversations on erectile dysfunction and testosterone use is just
kind of blown up and it’s fine. But for women, they don’t even realize they make
testosterone.
Dr. Casperson: Well, in like the huge gender bias on what you should do.
So with a guy, a guy doesn’t come in with like low T and low libido and we’re
like yeah well but but that’s natural and I’m really a natural person so I think
you should do it naturally too and like it’s just normal to like have a limp—- when
you’re 45 right like we’re just let’s there’s a new yoga class for limp—- on Tuesdays
like let’s go do that with all the other natural people who want to naturally just
age.
Take that conversation, turn it to women,
and that’s what happens.
I’m just gonna do menopause naturally.
I got some essential oils. That’ll make the ovaries be okay,
right?
Bridgett: And I’m giggling when you say that about the man, but then the women, it
sounds like, yeah, we’ve all heard this before.
Dr. Casperson: 100%. I mean, that’s my superpower.
My superpower is a meteorologist, right? Like this whole entire argument, whether it’s
sex or it’s hormones, or it’s how you want to age, it is gender bias and gender
inequality until the cows come home for me. And how women oppress women, how doctors
oppress women, how everybody keeps women down from living their best life, we do not
do that to men. And until that is equal, I will have a job to do.
Bridgett: – Right, and that’s also addressed in your book, just circling back to the sex topic,
just sexual relationship, heterosexual relationship, that women just take on all the
guilt and all of the, if there’s an issue going on in your relationship when it
comes to sex, women take on that responsibility other than the man. And you really
address conversation with your partner. And I know that there was,
I was looking for it. It was your ideal version of sex. And there were four steps
and I was reading your book and I gave it to my husband, which I got to say he’s
really good about that. So he’s like, “Aw, that’s awesome, that’s so good.
Dr. Casperson: – Yeah, well, I mean, You know, we didn’t get sex ed, right? You had disease and pregnancy prevention plan. Where in that did they tell you, this is gonna be a really hard thing to talk about, but here’s some tips for how to do it. And it’s okay to
fail. And it’s okay to try again. And it’s okay to not get it right. And it’s
okay to feel awkward, right? Like all of that, ’cause then people are like, okay, I
get that I need to talk to my partner about I don’t want to fail.
I don’t want to seem goofy. I don’t want it to be awkward. And I’m just like,
“Girlfriend is going to be awkward.” Like,
yeah, get over it, right? Like, we’re adults, we can do adult things.
And you know, to me, I’m always like, “Dude, I’m not making anybody have sex or
I’m not making anybody talk about sex.” But if you want to improve your life, like,
what we are doing and limping along is not serving.
Colleen: – We talk a little bit about testosterone in terms of mood because I think that
women don’t always understand that the testosterone isn’t just for men. It’s for you.
You make it in your body. It could help your mood a little bit. Can you talk
about that?
Dr. Casperson: – Yeah, so testosterone is made in the ovaries. ovaries cannot make
estrogen without making testosterone first so cholesterol to oversimplify biochem
cholesterol testosterone estrogen so you got to say that first because you can’t come
out of the gate being like Kelly thinks people should be on testosterone and because
then people are like Kelly wants people to transition or be like a man or give
them something that’s not natural right so So you really have to be like,
nobody told you that your ovaries make testosterone. Nobody told you that your
ovaries make four times the amount of testosterone than estrogen. Sit on that for a
hot sec. Okay, let’s move forward. So testosterone starts to decline in women’s
bodies after your 20s. We don’t really know why. We don’t know why. Oddly enough,
it starts to go up again after you’re 70. We don’t know why in some women, but
those women actually have more heart protection. They have less heart attacks, right?
So there’s a role for testosterone and heart protection. So much of what I say
though, is extrapolated from observational studies, animal studies, like all this
stuff, because again, it’s not a branded product. There’s not a lot of money in it.
It’s incredibly expensive to do these studies. So it’s very hard for me to say
we’ve got strong data, but with how much we know in men, how much we know in
women, it’s not a leap to say this is a neurohormone. It decreases the risk of
joint replacements in all genders. It decreases the risk of dementia in men. I think
this is neuroprotective in women. We don’t
Men with low T have a higher rate of dementia.
You give a woman testosterone, you ask her how she feels. It’s her brain.
It is her brain. She’s like, I feel more like myself. I have more energy. I don’t
hit the wall at 3 p .m. I’m not reaching for that cup of coffee. And the other
big argument, which I love to point out to people about testosterone and mood, is
where’s libido in
your brain in your brain? What’s what is libido? It’s a mood. Yeah.
We have multiple multiple randomized control placebo control trials showing testosterone
is better than placebo for libido in women. So that’s a mood. And it helps your
helps your moods. So I mean, the other thing, you know, I get with sex is like,
you don’t have a great sex life or libido in a bubble, right? Like everything else
can’t be sh *t, but like this one amazing like sex drive and sex life you have.
It’s usually like, it’s all part of how you’re living your life. And it’s like
testosterone doesn’t just help libido, like your energy is better. You’re more clear,
like you have more like pep in your step, right? Like, of course, the sex life is
going to get better. The other thing about testosterone and libido is
testosterone in those studies is actually shown to help all domains of sexuality. So
arousal, orgasm, blood flow to the clitoris has been measured. That goes up with
testosterone. So it’s not that testosterone is just the mood of libido. It’s
literally like genitals and blood flow and like all those other things. It is,
you’re like, if we’ve measured clitoral artery flow onto testosterone, which we have.
Are you telling me testosterone only works on the clitoral artery for blood flow? Or
is it possible it works all over your body for blood flow? They’re actually looking
or they’re researching Viagra in men for dementia prevention and the reason being
blood flow.
It’s like, doesn’t just help blood flow in the penis, It might help one flow in
other places. So when people get, like people want, especially on the internet,
right? People want black and white, people want yes or no. People want, does it
work for this or not? And like, it truly takes the expert to be like, I know all
the data and all the pieces and like putting it all together,
dismissing testosterone in women is a fool’s errand and you’re gonna be wrong. And
it’s like, I’m gonna be on the right, I’m on the right side of history on this
one. Besides the fact, we’ve been giving discussion to women for 80 years.
Like this is not new people.
Colleen: – Can we just clarify it for a second, the topic or
controversial topic of pellets because never do we get yelled at more by listeners
and followers than we tell them you have to be careful and you’re taking pellets.
Can you talk about that?
Dr. Casperson: – Yeah, so you see one of them to yell at me too now.
Colleen: – Yeah, exactly. Why should we be by ourselves?
Bridgett: – Share the wealth, yeah. – Perfect.
Dr. Casperson: I actually did an Oprah daily op -ed on this. So if people want to read it, they
can go to Oprah daily in the search bar, type in testosterone and it pops up.
So why do testosterone, so what are testosterone pellets? Testosterone pellets are
medication in a small little, I call it bird birdseed, a small little pellet, and
you make a teeny little incision in your thigh, hip, upper buttock, and it lasts
its slow release. You can’t pull it out once you put it in, but slow release for
like usually four months, right? So like three times a year, you got to go get a
pellet. So why do they exist? Pellets exist because women are suffering, they’re
looking for solutions, traditional Western based insurance based health care is not
helping them, and the pellet people can make money off of it, right? Like, I don’t
make any money off of giving you
transdermal testosterone. I want you, you’re gonna come and pay me because of my
brain. I’m not making money off of hormones, right? That’s like where my ethics lie.
So you can make money off of pellets. Pellets are the most expensive, highest dose,
most unregulated. And so to me, I’m like, Listen, they’re an option. Some people are
like they should be banned. I’m like, I don’t think they’re ever gonna be banned
like no But people need to know and I think it’s ethical and fair That if you go
in and somebody’s like, I think a pellets best for you to be like what else is
available What and why I’m a lot of pellet people don’t have it because you if you
make money off the pellets and you don’t make Money off of giving somebody a
prescription
That’s your issue, right? So my view, do I think some women benefit from a higher
than, significantly higher than physiologic dose of testosterone? Yes, I do.
Do I know who that woman is? Not off the bat, no. So do I think you should earn
your pellet? Yeah, what do I mean by that? Start physiologic testosterone replacement.
See how you do. Go up slowly. If you get to the point where you’re like, I’m one
of those people that like really likes the higher testosterone and I have no side
effects that I’m bothered by and I want to pay more money and I don’t want to
apply things, you know, weekly or daily, go get a pellet. But that’s a minority.
That’s a minority of people.
Bridgett: You know, also you’re working hard to get the FDA
approval of testosterone. of testosterone. Is that correct? Can you talk about that
and what we can do to help in that situation?
Dr. Casperson: Yeah. So what you can do for that
situation is write the FDA and /or write your senators and say, “I want to
deregulate testosterone because that’s its own issue and I want a female -dosed FDA
product.” If you go to thetestosteroneproject.com, that has all of the pillars,
the three pillars of the testosteroneproject.com is deregulation of testosterone
because right now it’s regulated like narcotics and ketamine, which is insane. But
there’s lots of prohibitive restrictions put on it because of that category got put
there not because it’s unsafe, but because of the Olympic doping scandals of the
80s. Fascinating story, but it needs to be rescued. It’s a hormone just like estrogen
or thyroid insulin. It should be a prescription just like everything else number
two a female dose testosterone product And then number three is for men Will we get
will we get here in my lifetime with women? I don’t know But for men at least
screening of testosterone So what you turn 40 or you turn 50 and it’s part of your
health screening is you get a testosterone level, And you think that one would
say one would say shouldn’t women yeah And you could say you could say yes, and
then you can go down the whole rabbit hole of is menopause a disease And that’s a
whole can of worms so remember in the in the traditional medical system. You
need a disease to get something paid for so Or just looking right and so it’s very
interesting when it starts getting into like who’s paying for things and screening If
it’s not a disease, it’s you have to like literally change the
they don’t have the bandwidth for that. They can’t handle the sick people, let alone
all the healthy people who wanna stay healthy. So it really, it’s a paradigm shift.
Colleen: – It’s interesting ’cause you do talk about the fact that as Gen Xers, which we
are, we’re watching our parents age in not the healthiest way. And we’re starting to
question, wait a second, what could we put in place when we age.
And I mean, it’s insane that screening for the average person for osteoporosis starts at 65 That’s insane Though your greatest, you know rate of bone loss is the last two years before your period ends So that’s 15 years past like you’re up the
creek already, right and It just seems like it’s very relatable When you say that
because so many of us do have parents that are not aging well And we don’t want
to walk in their footsteps. So to speak. Do you think it is? advisable for women
in their 40s to go to their primary and say listen, I’m concerned about x y and z
What steps can I take? What tests can I have done to be preventative?
Dr. Casperson: Yeah, I Every woman is allowed to go to their doctor and say anything they want and whatI mean by that is it’s gonna be dependent upon if your doctor thinks the same way you do. I mean the amount of women I see who come to me and they say my doctor said come back when you’re more sick you’re not sick enough yet. Really? But I mean so this is a good thing to know insurance will cover, should cover, a DEXA scan
for bone health if you have a first degree relative with osteoporosis. So if your
mom has osteoporosis, get in there and get your scan. And truthfully, paying cash
for a DEXA, it’s dirt cheap. It’s like a hundred bucks.
So just to know, so many, I just get DEXAs on all my women because I’m like, I
just want to know your baseline. Like let’s just know where you are because if, you
know, the argument for menopause therapy is symptomatic, treat symptomatic,
treat them when they’re symptomatic. And to me, I’m like, osteoporosis isn’t
symptomatic. And we have an FDA approved medication for the prevention of
osteoporosis. It’s called estrogen, right? And so it’s like, it’s like,
you’re talking out of two sides of your mouth, when you’re like, only treat the
symptomatic women, but we have an FDA approved drug to prevent osteoporosis, but you
can’t feel osteoporosis is like you really do have to be proactive. And for many
women, especially many healthy women, the thing you’re looking at is you’re looking
at a hip fracture at 80, right? You’re not gonna die of cancer. You’re not gonna
die of heart disease.
So you can prevent hip fractures by about 50%, 30 to 50 % on hormones.
We still have gravity. We still age, right? We can’t prevent all hip fractures,
but hormones are huge for bone health, huge for bone health.
I mean, the other thing, just because I’m on a prevention bandwagon at this point,
we’ve got two pretty powerful studies showing, suggesting that hormones started early
in menopause. What do we mean by early? 50, less than 60, right? Decreases the risk
of dementia by about 30%. And for a devastating, deadly, incurable,
hardly treatable drug, 30 % is actually freaking huge.
Nobody like, you know, we’re shouting it, but like many people, they’re like, people
don’t know this, the day you get diagnosed with dementia, that started 20 years ago.
Like prevention is the key people are like they’re looking for a cure and it’s like
that’s not how this disease works You got to prevent this thing
Bridgett: And you know so many women that we talked to are just different platforms were on They you brought this up earlier. They’re like, oh, I don’t want to use hormones I don’t want to use this and they’re going back to the WHI study They’re going back there to what
they’ve heard. And I mean, you’re doing, you’re doing a whole lot to get
the word out. Colleen and I are doing what we can to get the word out. What can
we do to get these women to know that this is a very safe option for them?
Is there any other suggestion?
Dr. Casperson: Yeah. Well, so you can provide the education, you can
provide the knowledge, you can have your amazing five year long podcast, which is
exceptional, right? And at the end of the day, you got to let adults be adults.
It’s not your job. This is not your job to make all women understand science and
understand the show that happened with the WHI, right? And understand,
do you want to think about when you’re 73 and what kind of life you want to be
living, right? It’s not your job. And at the end of the day,
you say, you know what? I’m going to make the best decision for me. But this is,
I mean, two things on this. Number one, the health disparity between the women who
are 50 and start hormones and the women who don’t start hormones and then look at
them in 10 years. We’ve got that data. We have data on 65 year olds who’ve been
on hormones compared to the 65 year olds who aren’t on hormones. Like that’s
Medicare data. It’s been published, right? Like what do you want me to say? So
number one is health disparities. You’re You’re just you’re simply gonna have less
health care costs because you’ve prevented a whole bunch of things So that’s number
one and then number two is look at the boomers right now Look at all the pissed
75 year olds who say is it too late? Can I get on it now? I want to get on it
now, right? And so you tell all your 50 year olds who don’t want to be on it
You’ll come knocking because you’re seeing the hip fractures You’re seeing the
dementia You’re seeing the people not do well and you’re now you’re now you’re
really eyes are opened Right. And so those are those are my two perspectives for
people of like, yeah, we know how this plays out Yeah, and the ones that stopped.
I mean the ones that got that WHI study when it came out early 2000s and they
were in their fifties and they stopped and you’re watching that now You’re watching
the process.
Bridgett Mother -in -law, I’m looking at you, but I have to, you know, really
seeing that.
Dr. Casperson: And the flip of that coin is not everybody stopped.
Some women kept going. They found doctors that kept their prescriptions going. Many
doctors knew that the WHI was not applicable to their patients. Those smart doctors
kept saying, “You know what? I know there is a It is a storm around them and they
kept the prescriptions going and now those women are 80 Right and what do those
women say those women say over my dead body? You’ll you’ll burn me with this or
you’ll put me six feet under with this.
Colleen: That’s what Bridgett says
Dr. Casperson: Yeah So, you know, you just ask just ask them ask the ones who didn’t didn’t stop. And why did they not stop? Number one, they had a doctor who truly cared and was
able to understand the science and the data to be like, this isn’t actually as bad
as what the media said. So they were fortunate in that sense. And number two is
they knew how much better they did on this stuff. They knew it. And they continue
to know it. They’re still alive. Right? Like I always joke, I’m like, think of a
time when 40 % of women were on hormones. It was called the 1990s.
(both laughing)
We’ve already lived that. – Right, right. – So it’s not a crazy thing to be
somebody, I was walking with a friend yesterday and she’s like, “What would make you
happy? “100 % of women on hormones?” And I’m like, “No, I don’t need that. “And I
don’t think 100 % will go on it. “Like some truly can’t, some don’t want to. to. I
don’t think that. I’d be happy with 50%. The 90s had 40%.
Let’s just go back to how it was and then get a couple more people on board.
Bridgett: Yeah. I mean, when they’re at 5%, is that what you said?
Dr. Casperson: Yeah. We don’t have great
data on compounding. We know a lot of people get compounded hormones. So that that
part’s hard to measure. So it might be 10%, the UK doesn’t have compounding and it
all goes through the NHS. So they have really good data and the UK is about 15 %
right now.
Colleen: Thank you so much for coming on this show. This was such a great conversation and we can’t wait to share it with the listeners.
Dr. Casperson: Thank you. It flew by.
Colleen: And before we, well, before we end, we want to make sure that everyone knows that you have a new book coming out September 2nd.
Bridgett: Right now it’s September 2nd.
Dr. Casperson: – Yeah, right now it’s September 2nd. – It’s cool. Go ahead, can you talk about it? – Yeah,
so it’s called The Menopause Moment. It’s like science hormones and mindset for
optimal longevity or something. Yeah, mindset hormones and science for optimal
longevity. There you go.
It was interesting. So I wrote, I wrote, “You Are Not Broken. Stop Shouldting All
Over Your Sex Life.” And people loved it. And the publisher was like, “Will you
write another sex book?” And I’m like, I think I would want to write a menopause
book. And this was still like two years ago when like there weren’t that many
menopause books. But to me, I’m like, there’s not gonna be too many menopause books.
There’s 80 million women over the age of 40. Everybody’s gonna listen to a different
voice. But what I wanted to create is I wanted to create a very pro hormone book
because so many books are like talk to your doctor if it’s right for you like
there’s risks and there’s benefits blah blah blah and I’m like listen I just need a
book that’s like tells you all the benefits you make up your mind there’s enough
fear out there but I just I wanted a very supportive pro hormone book and so
that’s what I wrote
Colleen: well hopefully you’ll come back on in September. Thank you.