sexual wellness

Libido and Dryness: Episode Link

Dr. Rachel Rubin, a board certified urologist and sexual medicine specialist, discusses the importance of addressing vaginal dryness, vaginal issues, and urinary tract infections in women. She emphasizes the need for open conversations about these topics, as they can greatly impact women’s health. Dr. Rubin explains that hormonal changes, such as decreased testosterone and estrogen production, can affect the health of the vagina and bladder. She highlights the significance of maintaining an acidic pH in the vagina to prevent urinary tract infections. Dr. Rubin also discusses the benefits of vaginal hormone therapy, which provides microdosed hormones to strengthen and maintain vaginal and urinary health. She addresses common concerns and challenges faced by women in their 40s and older, and emphasizes the importance of seeking treatment for vaginal and urinary symptoms.

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TRANSCRIPT:

Welcome back to Hot Flashes and Cold Topics, everybody. Today, we are thrilled to have Dr. Rachel Rubin on. She is a board certified urologist and a sexual medicine specialist,
and we are so thrilled to be talking about this topic today because it really affects women, and women are embarrassed or embarrassed. think it’s taboo to discuss this,
but it is so important to our health to be talking about just what’s going on with us. People refer to it as the Sahara Desert down there, but vaginal dryness,
vaginal issues, UTIs, that it’s just really important to talk about it. We are thrilled to have Rachel Rubin with us today. Thank you so much for coming on. on. – Oh my gosh,
it’s such an honor. And thank you for talking about this, doing this, and your listeners are so lucky to have people bringing them high -quality, good information. – Well,
we are thrilled to talk about it. And, you know, we get so thrilled. – I mean, I am actually, I mean, I am thrilled. – It’s a shame we have to talk about it.
It’s a shame it’s a topic that still remains taboo. taboo when you’re living another 30, 40 years and sex hurts or you’re dry down there.
But there are solutions and that’s why someone like you, Dr. Rubin, it’s so important to have these conversations. And also you deal with female and male sexual health.
So it’s not always just our menopause that we’re going through that changes our situation down there. When you, when you see women in our demographic about that, I mean 40 plus,
what are some of the common concerns or challenges they are having? Yeah, no, thank you for the question. I think I have been doing this long enough and I have decided that when you give people high quality information about how their bodies function and how they work.
they make excellent healthcare decisions for themselves. Excellent, like really, I can give someone all the information and then we can have a process where they make really good decisions and it doesn’t mean everybody needs the same thing,
right? It really does need to be customized for the person in front of me, but if your clinician doesn’t get to know you or find out what’s going on with you, how can they help give you good information?
And the idea is to make sure that you have the right information and the idea is to make sure that you have the right information and the idea is to make sure that you have the right information and the idea is to make sure that you have the right information that 10 minutes once a year with your legs up in stirrups is good healthcare for women is a joke, it’s laughable. So if that’s all you’re doing,
you’re not getting good care, you’re not advocating for yourself, and you can find a better team out there for you. And so it really is sort of I have to take a step back and say our healthcare system is a dumpster fire of brokenness right at it.
will put that on the table there. And the idea that we teach the medical world only, like A, we don’t teach them at all about menopause, less than 7 % of family practice,
primary care and gynecologists feel that they got any training at all about midlife and menopause in their training program. So we do not teach it to doctors. So your cardiologists,
neurologists, really rheumatologists, they don’t know anything about menopause. Now let me take a step back. Menopause, as many of your listeners know, because of all your great work,
is not just hot flashes and night sweats, right? It is brain fog, irritability. It’s burning mouth syndrome. It’s itchy ears. It’s a urinary frequency and urgency.
It’s osteoporosis. And if you break a hip, you die, right? It is urinary tract infections, which is killing millions of people of all ages,
right? And that’s all can be due to menopause. And so it’s really sort of this, I hate to be alarmist, but I can’t not be alarmist because this is actually crazy,
right? Oprah, right, had hot flashes, or sorry, I’m sorry, Oprah had heart palpitations, and no one picked up on it that it was Perry Menopause. If Oprah can’t figure out her Menopause story,
what are the rest of us going to do? So true. Yes, exactly. And you were talking about, and I’ve watched several of your videos, and when you bring up the UTIs,
people used to treat that as just a UTI, just to this, just to that. And I mean, I have suffered from UTIs. My mother did later in life. And it really,
you talk about how this can kill you. Can you talk a little bit more about UTIs and what are some things women can do to treat that? So it is really, really important for people to understand this because everybody knows someone who suffers with urinary tract infections.
One of my employees in my office just had a urinary tract infection. infection. She’s going through some menopausal issues. She said, oh my God, I get it now. This is horrible.
Right. Like it really is. So not only is it bad, the symptoms are bad when you have a urinary tract infection. But when you start getting recurrent urinary tract infections, right, then sometimes your body becomes less responsive to antibiotics.
There is a chance that that infection can go up to your kidneys and go through your bloodstream, which can. cause sepsis, which can lead to mental status changes, as we know of lots of people in the nursing home.
We know mental status can turn into dementia, delirium, Alzheimer’s, all these things of inflammation, and your sepsis, right, sepsis can kill you and is responsible for many deaths out there.
And so the crazy part of it all is UTIs happen because because the bladder microbiome changes and the vaginal microbiome changes after you lose hormones in your body.
So when the ovaries start to produce less testosterone and eventually stop producing estrogen, now it’s interesting ’cause women are not just estrogen and men are not just testosterone.
These hormones are for everybody. And so we really need testosterone and estrogen for all of us. bladders to be optimally healthy from a microbiome standpoint.
And so the vagina needs to be acidic. It actually needs to be a pH of four and a half. You can get pH paper and test the pH of the vagina. And that acidic pH allows for the growth of lactobacilli,
which create the acid, which then help fight bad bacteria bacteria, which can increase your likelihood of having a urinary tract infection. And so there is nothing on earth that we know of,
no probiotic, no suppository of boric acid. None of that has been proven to fully acidify the vagina to prevent urinary tract infections except vaginal hormones.
Vaginal hormones reduce the risk of urinary tract infections. infections by way more than 50%. They reduce the need for antibiotics. Now, if you have an infection,
you need it often treated with antibiotics. So this is preventative. This is like putting sunscreen on because you never want a sunburn, right? This is like putting your seatbelt on because you never want to be hurt in a car crash.
And so the vagina and the bladder, when they don’t. have hormones, it gets thin, it gets raw, it gets irritated. And then if that person then tries to have sex,
penetrative sex, think of what the friction and the irritation and the inflammation of doing that on a rug burn or on a sunburn, right? It’s going to create a very painful,
raw and uncomfortable environment. And so it’s really prone to urinary tract infections, especially after sex. And so all of that is preventative. Not like, it’s not like a small solution.
Like everyone says, oh, do cranberry pills or wipe after sex or pee after sex. All of that is like a drop in the bucket compared to vaginal hormones, which fix the problem,
prevent the future problems, but only work if you keep using them forever. And the crazy thing is, and I know I’m talking long here, here, is that these vaginal hormones are safe for nearly every single human on earth.
But there is a couple of reasons why women have been fed lies and their doctors have been fed lies that they don’t even offer it as a solution. And so that is why I am so loud and will come on any podcast that invites me and will scream on YouTube and Instagram and Twitter and my friends do too.
I’m not alone because there’s so much misinformation out there. Now that we’re talking about vaginal estrogen, can you break down the difference between a local vaginal estrogen and something that goes systemic into your body?
Absolutely. It is so critical for your listeners to understand that hormones for your whole body, right? So when it’s people talk about hormone replacement therapy they may be talking about patches or rings or pellets or injections whatever they’re talking about is very different from local vaginal hormones which are microdosed in a way that just gives the vagina and bladder the hormones that it needs to be strong and
healthy so it is very safe for your 98 year old great -grandmother to be on vaginal estrogen or vaginal DHEA that all FDA approved products, very safe for that old lady in the nursing home who has a history of blood clots or who has dementia to use these vaginal hormone products,
which is very different than, say, a whole body hormone therapy that we use early in menopause for hot flashes, night sweats, osteoporosis prevention. Now, don’t get me wrong,
I love whole body hormones very much, but they’re very very different and often for your listeners who are on whole body hormones it is often that we need local hormones as well because while your patch or your pellet may be helping with your hot flashes or night sweats your you still may have urinary frequency urgency or UTIs and adding a vaginal hormone product is necessary to prevent those things does that does that
sense? And it’s really important for your listeners to know that not all hormones are the same thing. Birth control pill style hormones are very different than hormones that go through your skin,
which are very different than local hormones. And so you have to understand that there’s nuance here and there’s some subtleties. And remember I said your doctor was not taught any of this,
which makes it even more challenging. challenging. And for you to wanna bang your head against the wall, because the doctors got the same information, hormones cause cancer, period end of sentence,
which is based on crap data from 30 years ago that was not interpreted correctly. And so unfortunately, nobody taught your doctors the subtleties and how to read the data correctly.
So it’s, we have a challenge people because I have to teach you. you, I have to teach people, the listeners, I have to teach the doctors that they, they don’t really know the details and it’s getting better.
But man, do we have a long way to go because Colleen and Bridget we call this problem, a little vaginal dryness, right. Oh, it’s just a little vaginal dryness suck it up lady use a lubricant like,
you know, buy some crap thing on Amazon that’s supposed to help you you’re okay. suck it up y ‘all this is not a little vaginal dryness this is life altering life changing I can’t wear pants I can’t wipe I can’t go out and go to the movies because I have to pee 40 times.
I have changed I can’t run I can’t sleep I can’t go on long car rides. I’m getting urinary tract infections needing hospitalizations IV antibiotics and they call this a little.
little vaginal dryness, right? – Yeah, and not to mention what it does to your mental health as well. On top of all of that, you know, you were talking about elder,
or, you know, women, maybe in their 80s, 90s or more. And I have heard this from women saying, well, I don’t know why my doctor wanted to prescribe me that because I don’t have sex.
So can you address that as well? – Oh, thank you. Because I don’t care if you are a nun, I’m not listening to you. to this conversation because it is not, you know, it’s so funny, I’m a sex doctor. I love talking about sex and I’m sure we’ll get to it later.
But here’s one case where I actually think that this is my urology hat puts on here and this isn’t about sex, although using these products will make sex not painful, will improve your orgasm,
will improve a arousal. It’s as good as Lady Viagra, like this is Lady Viagra people, like this is the best thing ever. ever. But the urinary symptoms are the thing that kills you. The frequency, the urgency,
the getting up at night to have to pee, those things kill you. The urinary tract infections, if that gets through your blood, that can really affect your brain and your whole body and all of your other organs.
And so it’s really important to understand that it’s not about sex actually. You know, it’s so crazy. I’ve seen people present to my clinic where there are a lot of people who have had sex. only symptom because they’re not sexually active.
Their only symptom is constipation. And the reason that is is because the tissue is so raw and irritated uncomfortable, the muscles underneath those pelvic floor muscles are really tight.
Think about putting your hand on a hot stove, right? Your body’s going to pull away. So if your pelvic floor thinks you’re in danger and that you’re in pain, it’s going to tighten. And so your record muscles tighten,
which makes it hard to get the stool out. And so people have constipation and they go to the GI doctor and guess who doesn’t know anything about menopause or vaginal hormones? Your GI doctor,
right? They have no clue. They’ve never heard of it. They don’t understand it. And they don’t feel that it is their responsibility to prescribe it or explain what’s going on.
on. And there’s so many layers of this that to talk about. For women who just say, you know, I’m just a little dry down there.
It’s not a big deal. Is it better to get in when you’re just a little dry down there than to wait until it will get worse, correct? Yeah, this is one part of menopause for a lot of people to hot flashes get better,
but your bones in your genital and urinary. symptoms are the gift they keep on giving ’cause they are never gonna get better without. Now, some people stop, I had a woman today, she said, “Oh, I just stopped having sex.” Right,
it got painful. So I just don’t do that, I do other things. And so, but that didn’t fix her urinary problems, her constipation issues, her wearing pants issues. And so I am very aggressive here.
Like this is where I would like to change the narrative around, oh, women… women have to be miserable in order for us to encourage treatment and preventative strategies.
I think it’s wrong and I think it’s a really dangerous way to sort of treat people. So I’m a big believer in prevention, right? We wear sunscreen so that we don’t get a skin cancer or we put our seatbelts on so we don’t have an injury.
And so I am a big believer that sort of anyone over the age of 45 should be treated. considering vaginal hormones to prevent problems. That’s not to be saying if you’re now 68 and you said,
oh my God, what have I been doing all this time? We’ve got you, we can help you. This actually will be fine. But it’s one of those things is it’s never been shown to kill people.
It’s never been shown to increase blood clots, cancer, heart attack, stroke. It has never been shown danger. The worst thing I see happen with vaginal hormones is in the first couple of weeks as the microbiome acidifies and that acid starts to increase,
occasionally you get a yeast infection. And we treat it, you keep going, the microbiome fixes itself smooth sailing. Now, not every product is right for every person. And so people say,
oh, I tried the cream, it was goopy, it burned my skin, I can’t do vaginal hormones. and that is wrong too because there are other modalities because the creams can be irritating for some people.
So there are inserts, there are rings, there are all sorts of options that we have for people. So it’s like a foundation. You have to find the foundational product that then will,
and there may be other treatments we need to do, but that’s the foundation. The hormones keep the tissue foundationally healthy. Does that make sense? sense? – Yes, and you also address,
you said these are just about, safer just about anybody. And we get a lot of questions from women that either had breast cancer in their family or had breast cancer. Can you talk a little bit about that?
– Absolutely, and we have to talk about that because we are treating the breasts of people, but we are not treating the breast. people with breast cancer.
And we must do a better job. If oncologists truly loved their patients, then we would have so much research on genitourinary syndrome of menopause,
we would have unlimited data. We know that more than 50 % of women go off their lifesaving endocrine therapy, their tamoxifen, their anastrasol. Why?
Because of what it does to the, what the, of the side effects, because of what it does to the vulva and the pain and the sexual health of our patients and the urinary health of our patients. And so here’s the deal.
There is emerging data in breast cancer that shows large studies that have come out that shows no increased risk of death of any kind in any breast cancer patient of any hormone status using vaginal estrogen products.
So the big study that just came out out of Europe. Now that being said, there are a couple of studies that have come out that show, well, maybe there’s a chance that there’s an increased risk of recurrence specifically in patients on aromatase inhibitors.
So when you’re on an aromatase inhibitor, you are lowering your estrogen to really 0 ,0 ,0. So adding back of vaginal estrogen. is maybe a counter productive because you’re adding back a little bit,
a tiny bit, and that could there be a risk of recurrence. The data is not clear. It’s not a home run data because we have lots of data that shows it’s safe in those patient population.
So my point is not so if so what the data overwhelmingly shows us is everyone can take that like so risk benefit right because tamoxifen can cause you to cancer and we still recommend it to people.
So you have to understand, if you’re having urinary tract infections and you’re getting antibiotic resistant infections and you’re miserable and you can’t wear pants, well, the potential risk of recurrence,
which is like a maybe, but probably not, is it worth the risk? And that’s where you need a kick butt team. I almost said a bad word, but I didn’t do it. That’s why you need a kick butt team.
to work with you to decide what is right for you. This is another patient population where I think vaginal DHEA needs to be studied better. That’s a product called intrarosa because it really might be important for this patient population.
So let me just say, I take care of men and we never tell men you can’t do this. Literally, those are not words. I have learned how to say to men.
It’s always, well, we don’t recommend this or well, let’s talk together and decide what makes sense for you. It’s shared decision making. Women’s health is literally,
you’re a breast cancer patient, you can’t have this. It’s really wild actually to watch. This idea of like, it’s just crazy. So, the breast cancer patients should not be suffering.
The ones with DCIS, the ones on Tamoxifen, the ones on no endocrine therapy at all, they should be using vaginal hormones loudly and proudly. And actually, there are wonderful statements from the Cancer Society ASCO,
from the American Gynecology Association, from a number of different places that are really like, this is okay, y ‘all, why are we so afraid? It’s not, this is not whole body hormones. This is really safe for you to use.
Hey. But we have a– a problem and If you get a box of ad I don’t know if either of you are on vaginal estrogen, but if you look at the box Here we go That box that box that you look and you get every month It says this product causes stroke blood clots heart attack dementia Not a paper on earth shows that this product causes dementia Breast cancer must use progesterone with it,
which is not true, right? So the box is based on oral birth control pill style hormones from a study that came out 30 years ago and no one will update the box.
Even when you ask the FDA, hey FDA, this box is wrong and actually killing women because it’s wrong information, the FDA says there won’t be just being safe.
and so we’re just not going to change the box.” That box of lies is killing people. You know, there are so many women out there that would benefit from this information and they don’t know where to find it.
Now, I know for a lot of women, they can go on the menopause society and they can look up menopause certified doctors. What about something, I know you’re on an education… chair for ISWISH, I always wonder if I pronounced that correctly,
but that’s the International Society for the Study of Women’s Sexual Health. Is there a similar list of doctors on that website? – Yes, and me and my friends are on both, right? So anyone in ISWISH,
which is a wonder, if you care about your sexual health, your doctor should care about your sexual health too. And so we have a wonderful organization and a find a provider. where you can go and find someone and most people who care about sexual health deeply care about menopausal health as well.
And so it’s rare that you’ll find someone who’s like, Oh, I don’t know anything about menopause because you really can’t be a good sexual health medicine provider not understand hormones, because there is a biological basis.
Think about horny teenagers y ‘all like they’re having deep meaningful connections like they’re not like they’re not like. each other on a deeper level, like they’re horny.
Like it’s testosterone and estrogen. So there is a biological basis to sexual health. And so understanding sex means you must also understand and tinker with hormones.
And so that’s a great website to find a provider. – And that is so important because it’s amazing. You know, Colleen and I both, we really didn’t know the depth of this.
until we started doing this podcast, the information out there. I’ve said this before and our listeners know that my first experience when I was in menopause or perimenopause was going to a gynecologist and being told I was too young to be in menopause and that I couldn’t have hormones.
And I was asking for them. And I think it’s because my mother had had a blood clot and I couldn’t have hormones. So it and I was put on an antidepressant that did not help me at all.
So it really to me, you know, I didn’t know my first line of defense I thought was going to my gynecologist and then I’m finding out even gynecologists don’t have much training in that.
So it’s it’s you should be angry, but it’s actually like misogyny in and of itself that we think the gynecologist gynecologist should know everything, right? I’m a neurologist.
Nobody expects me to know everything about a man. Nobody expects me to know about a man’s heart or a man’s bones or a man’s breasts or a man’s. They expect me to know about his penis and his bladder and his prostate and I do.
I know it very well. And so the idea that you’re a gynecologist has to know everything about women and that gives a break to all the cardiologists, the neurologists, the the rheumatologists,
all of those doctors now don’t need to know about menopause or women, because the gynecologist can do that. Now, gynecology is only a four -year training program where they spend most of the time doing surgery and delivering babies,
right? There is actually no time for the gynecologist to learn about hormones. There is no time for the gynecologist to treat midlife women, because… they don’t have time because there’s too many babies and surgeries to do.
And so the training is misogyny in and of itself. Now I had an endocrinologist call me the other day and said Ruben, can you please help me how to do menopause hormone therapy nobody ever taught me in endocrinology school.
And I was so grateful for her to ask, but really, the urologist is now teaching the endocrinologist. the hormone doctor how to do hormones in menopause because no one ever taught them and this is again if no one taught you how to do something how are you going to do it aggressively right because I am aggressive I am I am not playing anymore I am aggressive with your quality of life I want you to feel awesome
because I see the future in my clinic I started a practice two years ago and I said and I see the future. I’ve not worked with people right seven years. I’ve been out of my my fellowship training.
I’ve known people where they started one way and then you watch them and you see it click and so you see it so many times you can’t unsee it. And so when you see people that feel awful to say my libido is gone,
I have pain with sex, you say wait a minute stick with me here because it’s not an immediate fix, but I’ve got you. And don’t worry, I see that you can’t see the future, but I do because my whole clinic’s full of future you.
And these 56 year old women, these 62 year old women, these guys, they’re coming back and every six months they just say, Ruben, I’m good. Give me my refills, lady, I’m fine, right?
And those are my favorite visits because I sometimes have to sit there and be like, do you remember what it was like when we started working together? And they often don’t. And so every once in a while,
we literally have nothing to talk about but refills. And I pull out their first appointment and I read to them sort of what it was like. And it’s really, it’s a joy. Like I’m addicted to my work because I see these wins every single day.
And I can’t handle you suffering for no reason. It’s one thing to suffer when you really just, like you have no choice. but women are being told they have no choice and they have a big old choice.
They have like a huge choice that they’re not being offered. So we talked about vaginal dryness and you just kind of introduced the talk about libido and a lot of women, their libido either goes down tremendously or disappears after menopause and I’m wondering what can you do for it?
Is it something like, you know, I know there’s. 700 different male blue pills and there’s one little adipill for women, but will vaginal estrogen help with that or do you have to go to the next step and add something else?
So actually it’s a great question. And we have more options, FDA approved options for low libido for women than we do for men, which is kind of interesting if you think about it. Because there is a difference between libido.
You’re in. levels, and your boners, your erections, your arousal, right? So viagra, sealis, all those medicines, all they do is relax the muscles to the genitals to increase blood flow and get you hard on.
And they actually work for women. They work on your clitoris. It’s just that most women aren’t bothered by the lack of a hard on, right? They’re more cerebral of like, I got to want to want it to even get the lady boner,
right? So if it’s not working up. up in my brain, I don’t really care about what’s going on down below and you don’t typically need an erection, a lady boner or a male erection to have an orgasm.
And so many women can still have an orgasm, even if they’re not getting enough blood flow to the clitoris. So it’s, it’s again fascinating because your desire, your interest level from your brain is different than the arousal,
the blood flow to the clitoris, which is different than orgasm, which mostly comes from that outside. clitoris stimulation as well. And so we can, that’s why the customized approach is really important,
because you got to explain to people the difference and kind of dial in each one, okay, how is your libido? How is your interest level? Are you bothered by it? Do you not have a libido because you’re not having an orgasm and you have pain?
Because why would you ever want my friend Kelly Casperston always says, why would you want mushy broccoli? You might, you might be offered. It might be the only thing on the menu, but you’ll eat it,
but you’re not going to ask for mushy broccoli.” I love that analogy. I think it’s so funny. If you are not having good sex, you’re not getting anything out of it, why would your brain want bad sex?
It won’t. Menopause, I like to say your gas tank is empty. You got no fuel in your gas tank, and you’re expected to be a sex kitten,
and you’re like, “How am I going to do that?” Right? So what we try to do is just put some gas into your tank. And you can do that through hormone hormones, right? So estrogen can improve libido. If you’re not sleeping,
then you know, again, that’s got to get you sleeping. We have great data in menopause for testosterone therapy and women to improve libido. And so in men too, right? Testosterone helps libido in men.
And testosterone therapy is incredibly safe for everybody. everybody. It really, it’s not that serious. It’s not that scary. It’s just that we don’t have an FDA approved product for women, and so everyone goes nuts about it.
So we have to extrapolate. We mail testosterone and we kind of dose it at one tenth of the amount. So we extrapolate, but everyone goes all crazy about test. Again, here’s a problem with gynecology.
Gynecologists are not, they’re taught estrogen is the only thing to care about for women and women don’t. have testosterone. So if you tell a gynecologist to prescribe testosterone, they’ve never done it before. It’s not comfortable.
And again, if you’re not comfortable, how are you going to be aggressive? Right? Remember, I’m aggressive because I’m so comfortable. I give men testosterone all the time.
Like testosterone is not a big deal. It’s not that serious. And so to give one -tenth the amount of testosterone, not only am I comfortable, but I’m a great right? And so that’s the difference.
And so you have to know about it. You have to know the tips and the tricks and how to get the male version. What gynecologist even knows what the male version of testosterone is. So by making gynecology the only person that takes care of women,
we’re hurting women. Does that make sense? I don’t blame the gynecologist. No one taught them, right? Nobody taught them. And so, again, so testosterone is important. is a great way to boost libido.
Um, the, the, the FDA approved drugs for low libido. There’s adi and violisi. Those work non -hormonally to boost dopamine in your brain. So I’ll give you a perfect example.
Again, talk about your gas tank being empty. Bridget just said they offered me antidepressants. Guess what decreases your libido in your, uh, orgasm, right? Antidepressants.
So So even if you had a little bit of gas in that tank, you take the antidepressant and boom, the gas goes out even more. But again, that doesn’t mean that antidepressants are not helpful.
They can be very helpful if you are depressed, if you are anxious. And so it is really getting that right cocktail, if you will, and the pun is always intended there, right, to help you,
you know, to help you get more gas in your tank. So if antidepressants can cause sexual problems, why can’t a medication improve sexual problems?
It makes sense, right? So if one, so antidepressants can lower dopamine and increase serotonin. So what if you lower serotonin and increase dopamine?
You got a pretty good drug there. And so Adi and Bylesi are both medicines that do that, they’ve got that increase. increased dopamine. Do they work for everybody? Y ‘all, no drug works for everybody,
right? These drugs work in about 60 % of people who take it. For my menopausal patients, I find when you fill the gas tank with the right evidence -based safe hormone therapy,
you give some testosterone, and then you add one of these FDA -approved products, the Addie or Violisi, y ‘all, those are the women you just cannot even like. like, I had a woman the other day who was like,
Dr. Rubin, I need to lower a dose of something because I would go off and hump that tree right there. You know, there’s something like, and this is a woman who started with like, I have no interest whatsoever.
I literally would rather have a ham sandwich than be anywhere near my partner. They touch me, I shudder to, I would hump the tree outside, right? Like there, you see the biology,
right? Everything else was the same. same. And then again, listen, I’m not discounting the importance of a great partner of good communication, of therapy for everybody, sex therapy for everybody.
I mean, those cannot be discounted. Like that is so important. And so always invest in your mental health care, always invest in good communication. Because again,
the key to sex is supposed to be fun, y ‘all. Like if you’re not having fun. fun, you’re not doing it, right? And it’s not the right thing. And you, and it is a medical problem if you agree and you’re bothered by it and you want help for it.
– Yes. And you know, you were talking about, you’re talking about this, the how much testosterone could be so helpful. And I do take testosterone. And the issue is the cost getting,
you know, I have to go to a compounding pharmacy. – Okay. – So you don’t. – Oh, I don’t. – So if you’re told that you’ve had to go to a compounding pharmacy. So, so I can get you FDA approved generic testosterone for a man for $6 a month,
right? So a tube of male testosterone. – I’m sorry, I’m looking at Bridges face, I apologize. – It’s my face, I’m kind of under dollars. – So $6 a month. So, so you gotta, you gotta just know the people who know the tips and tricks.
And so first of all, So what you do is a tube of testosterone The the man would take the whole tube and use the whole tube every day you make that tube last about 10 days So I’ll have my patients either use the tube and just do a pea size or or put that tube in a 5 cc syringe and just do a half a cc on your calf every day and if you use a good rx coupon and your Doctor sends the prescription to the
pharmacy that does the good rx coupon where you get 30 of those tubes for like between 60 and 140 dollars depending on the pharmacy and 30 tubes last you 10 months so 60 over 10 months is six dollars a month and so this idea that it has to be expensive I just did a podcast earlier actually with Kelly Casperson and I were doing it with somebody else and she said you don’t need to mortgage your house to cover your
hormone therapy these These things are generic. These things, the FDA approved bioidentical hormones are fabulous and wonderful and work great. And there are lots of different kinds. And so we also,
again, in the misinformation, we tell women, they must get pellets. They must spend thousands of dollars on saliva testing. They must spend thousands of dollars on compounded products. And it’s actually not true,
right? But again, no one taught your doctor how to do it. So they actually get taught by the compounding pharmacist. They think it’s the only option because no one ever taught them the other way.
Does that make sense? There’s not other faults. They’re not trying to like bamboozle you out of money. It’s just that like no one taught them that there’s another way to do it. – So did I just save you so much money?
– Yeah, so can I ask my doctor like how, for the prescription for that? Like how would I? yeah so so iswish another plug for iswish they put out a paper i’m happy to send it to you that was a literally physicians guide to how to prescribe testosterone therapy and so it’s a really great resource to bring that paper with you to your doctor and say this is an international organization that’s very reputable and i get
that you didn’t learn how to do this in your medical school but you should consider reading this paper and you should consider going to a course course and get taught by Rachel Rubin and her colleagues because they actually seem to know what they’re talking about and I think you could help a lot of people.
Your doctors don’t want to not know how to treat you right they learn how to do new things all the time it’s just what they choose to invest in in their learning and so if you go to a doctor who couldn’t care less about menopause because they deliver babies and do surgery all day that’s not the right doctor for you when you’re in this time period.
The person who delivered your babies does not have to be the person who gives you an estrogen patch. – That’s a really good point. That’s like the tagline for this episode. So along those lines,
a lot of times for women, it’s such a testosterone that’s too expensive, but also the estrogen. And I know you’ve spoken about not only good RX, but also the Mark Cuban cost plus. plus drugs. Can you just share with women how they can get medications that,
that don’t break the bank? Absolutely. And these two resources are a must for any human being on earth to know about because things are so outrageously expensive these days.
And I’m all for spending money when you need to. So if you need to see a therapist who doesn’t take your insurance, but they’re really good therapists, that is always the right way at play. put your money.
If you need to see a doctor who’s going to take two hours with you but actually knows what they’re talking about, that actually might be a good use of your money because it may speed up the whole process. But when someone’s charging you a lot of money for a prescription that you can get super inexpensive in another way because you just didn’t know the trick,
that is offensive and gets my blood boiling like nothing else. Like so for the perfect example, Bridget could be spending. $6 a month and probably getting the same result if she switches the type of testosterone that she’s going to use.
And so there are two websites. One of them is goodrx .com and the other is costplusdrugs .com. Now, costplusdrugs .com is a company by Mark Cuban,
the guy who owns the Dallas Mavericks and is on Shark Tank. Tank. And it is a magnificent website. And so if you or any of your family members are on any medication,
high blood pressure, diabetes, cancer medications, vaginal hormones, patches, progesterone, erectile dysfunction drugs, it’s the cash price of the drug outside of insurance with no middleman.
And it is cheap. So I can get 90 pills of C – for eight bucks. You can get progesterone, a bio -identical, FD approved progesterone for,
you know, I haven’t looked in a while, 10 bucks. I mean, it’s super inexpensive. And you can get a tube of vaginal estrogen cream, which not everyone loves creams, but this is the cheapest option we have. Vaginal estrogen cream,
which use one gram every day for two weeks, then twice a week till death do you part, that tube of vaginal estrogen cream. lasts about two months, is $20. Okay. So $20,
that’s $10 a month for you to never get a urinary tract infection again. Y ‘all, grandma needs that tube of estrogen, okay? Like grandma needs that tube. So, so that’s the cost plus drugs.
So you still need a prescription from your doctor, but they send it to cost plus drugs and then they mail you the, you have to make an account at their website and they mail you the medication. It’s easy peasy.
Now, GoodRx is a website, and you can price check, cross compare, do your shopping. Think of it like you’re on Amazon and you gotta like shop around. Even Amazon has a pharmacy now where you can shop around a little bit.
And so GoodRx, you put in the medication and your zip code and then they tell you at your local pharmacies where you get the best cash price and it pulls up a good price.
coupon that you show your pharmacist. So your doctor would send the prescription to the cheapest option and it’s not often CVS. It’s a lot of times it’s like a local grocery store or something like that.
And you can get lots of drugs for much less than even your co -pays seem to be with your insurance company. So it has been game changing for our patients.
And so if you want it mailed to your house, look at cost plus drugs. If you want to go with a coupon, look at GoodRx. And these things have been really life changing for our patients. Does that make sense?
No, I think that’s great information. Fantastic to know, because that’s just been one of the hardest things is finding someone. So many women, yeah. Well, so the other thing is right,
like your patients, so many of these people said, “Well, vaginal estrogen, that’s too, the doctor’s listening or that’s too expensive for my patient to get.” So I’m not even going to offer. it because when I came out of training seven years ago, it was $500 a tube.
Right. So now it’s 20, seven years later it’s $20 a tube. So the problem is doctors don’t learn as quickly in seven years. I wish I wish seven years were we’re,
it’s quick to doctors like they don’t know, unless they’re doing menopause care all day every day they don’t really know. So I would say people come to me and again.
in my practice, I spend a lot of time with people. So they often have to invest to come see me. But the idea is I always say, I’ll save you money because because you’re not going to spend tons of money on medications. And we know all the tricks to get them inexpensively and what pharmacies we play all the games.
So we learn how to pivot with the games. Please come back again. I know this was great. This was so helpful to to so many women.
And we hear all these complaints from women, and again, we’re not doctors, but we try to bring on experts like yourself who are just going to share invaluable information with our listeners.
So Dr. Rachel Rubin, thank you so much for coming on. You are welcome to come back anytime. And hopefully, we’ll see you soon. Thank you so much.
That was great. Thank you. Thank you so much.

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Libido and Dryness: Real Talk with Dr. Rachel Rubin

Libido and Dryness: Episode Link

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