The Midlife Feast

#54: You are not broken: Debunking myths about sexual & reproductive health in menopause with Dr. Kelly Casperson MD

February 13, 2023 Jenn Salib Huber RD ND Season 3 Episode 54
#54: You are not broken: Debunking myths about sexual & reproductive health in menopause with Dr. Kelly Casperson MD
The Midlife Feast
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The Midlife Feast
#54: You are not broken: Debunking myths about sexual & reproductive health in menopause with Dr. Kelly Casperson MD
Feb 13, 2023 Season 3 Episode 54
Jenn Salib Huber RD ND

What did you think of this episode? Send me a text message and let me know!

You are not broken. Can I say it -maybe shout it again? We’ve just all been silently suffering and floundering alone when it comes to reproductive health in menopause. Thankfully doctors like my guest today, author Dr. Kelly Casperson have decided enough is enough. It’s time to tell the truth.

In this conversation, we’ll dive into the impact of marketed perfection on this season of life, why sexual health changes in midlife, and the difference between sexual desire versus arousal. We also unpack the overwhelming amount of misinformation around taking hormones and why they could be the missing ingredient for several aspects of our overall wellness.

To learn more about Dr. Kelly Casperson and her work, including her podcast and book, visit her website at and follow her on Instagram at @kellycaspersonmd

Looking for a place to learn more about midlife, menopause nutrition, and intuitive eating? Click here to grab one of my free resources and learn what I've got "on the menu" including my 1:1 and group programs.

Show Notes Transcript

What did you think of this episode? Send me a text message and let me know!

You are not broken. Can I say it -maybe shout it again? We’ve just all been silently suffering and floundering alone when it comes to reproductive health in menopause. Thankfully doctors like my guest today, author Dr. Kelly Casperson have decided enough is enough. It’s time to tell the truth.

In this conversation, we’ll dive into the impact of marketed perfection on this season of life, why sexual health changes in midlife, and the difference between sexual desire versus arousal. We also unpack the overwhelming amount of misinformation around taking hormones and why they could be the missing ingredient for several aspects of our overall wellness.

To learn more about Dr. Kelly Casperson and her work, including her podcast and book, visit her website at and follow her on Instagram at @kellycaspersonmd

Looking for a place to learn more about midlife, menopause nutrition, and intuitive eating? Click here to grab one of my free resources and learn what I've got "on the menu" including my 1:1 and group programs.

Jenn Huber  0:02  
Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Celine Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Hey there, welcome to this week's episode of the midlife feast. I am so excited for you to listen to this episode with Dr. Kelly Casperson. Dr. Caspersen is a urologist She is the author of the book you are not broken and the podcast of the same name. And I was so honored and excited to have her on this podcast that I toyed with actually calling it like speed dating on a podcast because we covered so many of the questions that you have all asked me or people have asked me in my practice my work about vaginal health, sexual health hormones, desire, arousal, testosterone. We cover a lot of ground in this episode. So listen in and let me know if you have any questions. I'm sure that you are going to take away so much from this episode. Okay, welcome Dr. Caspersen. I am so excited to have you on the midlife feast. How are you today?

Dr. Kelly Casperson  1:21  
I'm so good. Thanks for having me.

Jenn Huber  1:23  
So your book has become my go to reference for anyone who has any questions related to why does everything feel broken in midlife. And so many people have said that it just has been just a almost a wealth or I don't want to say Bible but has really become their go to, you know, reference for just normalizing everything. Because what I what I loved about your book wasn't just that you've offered, you know, solutions and ideas, but that you normalize what was happening. And I think that that is such a missing piece from so many things that we talk about in midlife, but especially when it comes to vaginal health, sexual health, just normalizing that it's not just you. So tell us a little bit about about how that book came to be. Why did you write the book?

Dr. Kelly Casperson  2:10  
Yeah, well, the book came, the book came because of the podcast, and that also has the same name, you are not broken. Yes. Hi, Craig. Thank you, the podcast came because I got to the point where I knew enough about female sexual health that I was like, I'm not helping enough people just being a doctor in my town, seeing people one on one, like the, the breadth of the problem is not only like nationwide, but global, right, like huge, huge problem with not getting enough education, we get that disease and pregnancy prevention plan if you're lucky in the teenage years, right? But then like, we don't get anything else, and then it just like slowly starts eating away at us and our bodies change. And we don't know why. And we don't know who to ask your doctor might not know, right? And I really had this patient who was crying in my office, and I realized I didn't know anything about female sexual health, like what's normal for desire, what's normal for, you know, a long term relationship. And because of her, I started doing all the research and deep diving and the book came about because at one point, I read basically all of the books, right, and they come into two categories. One of them is to researchy based and like very serious and very dry, like you can't get through it. And then the other book is like this, like woowoo breathe into your spleen, you know, like change your whole life. And I'm like, that doesn't really resonate with like the average western woman either, right? She's busy, she doesn't can't change the most of her life. And like she wants to know, she's not alone. She's not broken. And so I wrote the book that I thought needed to exist,

Jenn Huber  3:43  
and absolutely needs to exist, can I start by reading a quote from it? Yeah, we're gonna get into some myth busting. But I was going back through my notes when I read it. And this really, really resonates with me, I want you to know that it's perfectly okay to feel broken. We come by that easily because of what society tells us. But you didn't get here because you're broken. You got here because of people's unwillingness to tell the truth. And I think that that is such a perfect description of so many things related to women's health, like we could really cover pretty much everything there. But let's start talking about some of the myths that I think really get people stuck because they feel broken. So why do women feel broken? That's kind of the first one because that's even words that they use with me when they're talking about getting dressed in the morning, their clothes, not fitting just feels like they wake up one day, and I'm there to I'm 12 days away from my 12 month anniversary. So, you know, it really does feel like you wake up and it's like, oh my god, what is happening? So why don't we universally almost universally feel broken?

Dr. Kelly Casperson  4:52  
I think for two reasons. Number one, you know, we're marketed perfection all the time. And we're marketed that in order to be the prop For a woman, you have to be xy and z. And so we're constantly having this dialogue of like checking in with, with what we're marketed to and told like, Is this good enough? Is it not? How do we how do we get sold products, right of like realizing you're not good enough, get this dish soap, realize you're not good enough get these jeans. Right? And so that becomes an internal dialogue of AI must not be good enough. So I think a lot of it comes from our external world. You know, I love the analogy of like, no baby ever beats themselves up. Like, we don't come into this world beating ourselves up. That's a learned behavior. And which is the best news ever? Because then we can unlearn it, right? It's not in our inherent nature to beat ourselves up.

Jenn Huber  5:40  
I say the same thing about intuitive eating all babies are born intuitive eaters. We don't have to tell babies when to eat, we can't tell them to stop. If they're not full. They're very clear about what their needs are and what they need to meet them. And it's so so true. We're not born hating ourselves. Yeah. So when it comes to sexual health, intimacy, there's a lot of misconceptions about why it changes in midlife in particular, is it all about hormones? Is it you know, does HRT fix it all? What Why does desire and arousal change so much in midlife?

Dr. Kelly Casperson  6:19  
Yeah. And it's good to know that it doesn't change for everybody, right? Just to be clear, like, if some people are like, I've got a great sex life, and everything's good. It's like, that's great for you to write. So for some people, it does change. For some people, it doesn't. The good news is, it's not all hormones. Because some people can't be on hormones. And so people don't want to be on hormones. And it's not just hormones. So that's good. But hormones can play a part, both estrogen and testosterone, we can get into that if you want. But the other thing that people don't realize is we get habituated to the life that we're leading, right? Like, we get into a routine, both with our partner and with our life in general. And our brain loves novelty, it really does. And so here we are being like, I wish I had that spark. And what most people mean by that getting that spark back is that novelty, that like, I don't know what's going to happen tonight, right? And to realize, in order to get that spark back, you can do one of two things, you can change your setup your spouse or your partner, right. Which will allow people like actually, like, not having novelty, I like the long term relationship, right? And just realize that like, spontaneous desire, or that spark is wears off about six to 12 months in according to brain, the brain, your brain was done with your new relationship, it was then a long term relationship, but six to 12 months? And what that means is that like curiosity that like unknown that almost like, is it gonna happen? Or is it not like all that uncertainty, which we say we don't want, but it's actually kind of where a lot of like Spark comes from. So we can either, like, keep getting new relationships every, every one year, if you want, but most people don't? Or you can be like, What do I need to create that novelty for me so that things aren't stagnant, stale, repetitive, and again, so people can have the exact same kind of sex for their entire life? They're usually paired with somebody who can't, it's boring. And the way that dopamine works in our brain is, it doesn't it doesn't you don't get any dopamine release for boring things, painful things, monotonous things, right. And if sex has become that, no wonder why you don't desire it. So in a perfect world, you go have sex worth desiring. Don't worry so much about the desire.

Jenn Huber  8:30  
I love that. Yeah. And the dopamine connection, I think will be really relevant to to my audience, because I talked about dopamine with food a lot. And that it's the we get more dopamine from the anticipation of reward than the actual reward itself. And so in the context of, you know, sex and desire, that's probably a good thing with food, sometimes it's not. So it's an interesting, you know, kind of parallel for people to explore. Yeah. So what is the difference between desire and arousal, because I hear from women, who some of them have had a change in desire, and some of them have had a change in arousal, meaning that they still desire it, but they just can't, you know, they don't respond in the same way. And that I think, is often a bit more kind of disconcerting for them, because it's not lining up with what they think they want. Is there a different mechanism at play there?

Dr. Kelly Casperson  9:24  
Yeah. Well, desire, like you said, is the dopamine anticipation, right? And I would argue you don't really need desire in order to have great sex desires. Kind of like this bonus point. We all think we need it. We all think it's an ingredient in the in the meal, but it's not right. A lot of desire will come during or even after sex. And I think so many people get hung up because they're like any desire first. It's like, No, you need an interest in being a sexually active person, right? You want sex that you say yes to, but you don't actually need to sit around and wait for the desire to come. I use that a lot with eating vegetables and exercising. Like I do not have a spontaneous desire for eating vegetables. But I'm a person who wants to prioritize vegetables in my life, right? I'm happy when I'm eating them or after I'm eating them. And so I don't sit around waiting for the spontaneous desire for vegetables to happen. otherwise healthy eating would never happen for me. Right? And a lot of people say the same thing about exercise. That's a nice way of understanding desire, right? arousal is more blood flow, right blood flow and gorge moment all bodies have erectile tissue. Our female erectile tissue is the clitoris. It's underneath the labia that needs to get in gorge. So you need blood flow. Right? That can be hormones. But also the other thing we don't think about is erectile dysfunction and penises about 40% of people by the age of 40. Now the clitoris is the penis, the penis is the clitoris. Things that affect erectile dysfunction can also affect female arousal. We do not have as much research on this. Man probably like 5% of the research of like the 95% for penises, diabetes, heart disease, drugs, antidepressants, lots of different drugs, alcohol, cigarettes, low estrogen, low estrogen is a huge one in the menopause transition. All those things can affect arousal. And so to think of like, you know, what happens to the penis happens to the clitoris, we just don't have a lot of data on it to actually make it a thing. We basically erased the clitoris both from common colloquialism, you know, we call it the vagina, everything down there to the China. Right? So if we've erased the word, we've erased the structure, certainly we can't do research on it. Right? The doctors can't talk about it. And you can think that you might have clitoral dysfunction, because we don't talk about it. But yeah, arousal and just getting thinking keeping that body as healthy as it can, right, like activating people who exercise are known to have better sexual function. Sex is a physical activity. Right? It makes sense. But things that are bad for the penis are bad for the clitoris.

Jenn Huber  11:55  
Yeah, I've never heard the term clitoral dysfunction. That is the first time I've heard that. And so I think that that will also probably be a new concept, which makes complete sense. isn't rocket science when you think about it? But that Yeah, I think that that's a really great concept to throw out there. So when we talk about hormones, you mentioned estrogen does taking HRT, quote unquote, fix it? What is the effect of HRT on arousal or desire does it? Does it improve it?

Dr. Kelly Casperson  12:24  
Yeah. So HRT, we'll talk about estrogen because there's testosterone is also HRT, but most people think of estrogen, right. So the two the two number one or number two reasons that women stopped being sexually active after menopause are two things number one availability of partner and number two menopause symptoms. And obviously, I can't help you with number one. But certainly, I mean, it makes sense, right? If a if a woman is having hot flashes, poor sleep moodiness, anxiety, heart palpitations, joint aches and pains, all of these which are common, very common menopause symptoms, her health just doesn't feel as good. She doesn't feel like herself. Her sex drive goes down. You fix the menopause symptoms with estrogen. She feels more like herself. She's got her energy back, she feels more like having sex. So directly, does the research support that estrogen increases desire? No. But does the research support that estrogen treating menopause symptoms, which then help you lead a healthy and happy sex life? Yes. And then so

Jenn Huber  13:25  
let's talk. Yeah, let's talk about vaginal estrogen, because that is a different player and probably equally as important as systemic estrogen. Am I right? Yeah.

Dr. Kelly Casperson  13:36  
100%. Yeah, it's just so it just became over the counter in the UK. So over the counter in Finland, it's over the counter in Israel. I'm collecting all the countries or it's over the counter, because I think for you, in order for me to even talk about estrogen, we kind of have to back up because so many women talking about myths today. So many women believe the myth that estrogen causes cancer, and it simply doesn't. We actually know that women who are taking systemic hormone replacement therapy have decreased risk of breast cancer. So it's not only does it not cause cancer, it reduces your risk of breast cancer. But like, we've got about 20 years of scaring women, so it's, I can never come in and be like estrogen is the greatest thing. People aren't going to believe me until they understand. Okay, this is a very safe product so safe. It's over the counter in several countries. But vaginal estrogen is not systemic, meaning it doesn't go into your body. It's so super low dose. women who've had breast cancer are allowed to use it. I always say check with your oncologist. But the American College of gynecology, they have a statement paper on using vaginal estrogen after breast cancer because it is not systemic. It's much lower dose. So giving estrogen to the vulva, the clitoris, the labia, the vagina, keeps those structures with excellent blood flow good collagen, keeps them from getting shrinking and atrophy. You we will lose our labia menorah a good night everybody. Good majority of you Well, if you don't continue to give the hormones down there, people don't know that again, we don't die. Oh stuff. The clitoris, just like a penis, the foreskin can get tight, you can get clitoral phimosis where the head of the clitoris doesn't retract anymore, because the skin just gets atrophied. And you think about our face skincare, right? It's it's what $5 billion industry, like this is just skincare. And those tissues are very, very estrogen responsive and do have decreased arousal, decreased sensation more challenging to get an orgasm, if they are properly cared for moisturized lubricant, with estrogen after menopause. And I see so many women, they're like, well, we stopped having sex seven years ago, because it hurt. And we need to move the needle on that to be like you come in to see the doctor when it starts to hurt. Vaginal estrogen, in my opinion, should be preventative as medicine, you shouldn't come to me seven years after you stopped having a sex life. Right? Because it's a lot harder to get back into that you got a lot of like emotional barriers to it. Versus like, Hey, I'm 55 I don't want this to happen to me. Can I just start on a vaginal estrogen? Yes, of course you can. It's completely safe.

Jenn Huber  16:09  
So and I get so many questions from people that I always say I am not qualified to answer. But about vaginal estrogen. And one of them is I've asked my doctor and they said no, because I'm still having periods. Which you know, I think is, you know, it's not true. And it's really easy to find out that it's not true. Like, you know, Nam statement is really clear about that. The North American menopause society for anyone listening. But the other one has to do with, you know, how often do I need to use it because people you know, will say, I don't want to use it too much, or I don't want to, I don't want to become dependent on it. Like there's this fear of using a topical for you know, for the rest of their life,

Dr. Kelly Casperson  16:51  
I'll just add more pain to what I hear about it. Is it natural, is one of my big cringy statements. The best way to oppress a woman you want to press us tell us that we have to be natural, we will freak out. We do not know how to do that. And, you know, people will be like, Well, I don't want to take hormones, because it's not natural. And I'm like you realize that a life expectancy of 81 is unnatural. Worldwide, life expectancy in 1960 was 51 years old.

Jenn Huber  17:19  
Wow. Wow, I'm

Dr. Kelly Casperson  17:21  
brand new at taking care of ourselves post menopause for this amount of time now. Yes. The the our viewers will be like we had we had grandmas in their 80s. You know, 100 years ago? Yes. But not to the amount we have now.

Jenn Huber  17:35  
Right? And we and we want a better 80s. Right? We don't want to be sitting in a rocking chair in our 80s You don't want to be Yeah,

Dr. Kelly Casperson  17:45  
and be readmitted to the hospital time and time again, for recurrent urinary tract infections, which many 80 year olds do, which is preventable with vaginal estrogen, let alone osteoporosis, which is preventable with oral with systemic estrogen. Sorry. But yeah, there's that myth of natural, which is really hurting people. It's really I think it's just keeping women you know, silenced from seeking help. It's like, childbirth is natural. And one in eight people die naturally in childbirth. We do not allow that. Right? Like when we actually you can challenge the natural myth so fast or like you drive a car. It's not natural. I have a Waterpik for my teeth. I floss. It's not natural, or sunscreen is not natural. Like literally and then this is the one thing they're gonna die on the natural sword for it's, it's completely makes no sense to me. But yeah, you can use you can use vaginal estrogen. The standard is twice a week, which the problem with that is you just it's hard to remember to use it right. I tell people use it as much as you floss. If it's twice a week, you're doing pretty good. Every once a while I get a lady. She's like I floss every day. And I'm like, you're amazing. Yeah.

Jenn Huber  18:53  
Yeah, no, that's a really great analogy. And, you know, the thing with natural that I also, you know, and even as a naturopathic doctor that I have issue with is that it's a moralization. It is not a defined term. It's a wellness culture, you know, definition and we feel guilty if we're not doing it. And it's also never achievable. There is no goal because you can always be more natural, right? So there's always someone who's going to be above you on that ladder. It serves no purpose other than to make you feel bad about your decisions.

Dr. Kelly Casperson  19:30  
I think it's oppressive. I think it's Yeah, I think so too. I love that. But yeah, like, you know, I bring on the person who comes into my office saying they want to be natural because then I'll look at them. I'll be like, what's on your feet? Like shoes? And I'll be like, Oh, shoes aren't natural. Like where do you stop? Right? Sleeping on a beds, not natural. Get back on the floor. Like, yeah, you know, the don't die on the vaginal estrogen natural thing. For me, because I'm like, Yeah, okay, we got to stop doing a lot of things. And

Jenn Huber  20:05  
so, going back to this, you know, the genital urinary syndrome of menopause. So what I have heard more recently is people being denied a prescription for vaginal estrogen, because they're not having vaginal dryness. It's like, oh, well, you don't need it. Unless it hurts to have sex, then we'll give it to you. But if Yeah, if it doesn't, then you don't need it. So another we talk a little bit about of the other reasons why vaginal estrogen is needed, even if you're not having those classical symptoms.

Dr. Kelly Casperson  20:37  
Yeah, totally. Well, it's like, you know, you only need sunscreen when you're in Texas is like, well, there is sun and other places, even if it's not striding directly, and it's hot, right. And I think the other myth of that is like, women will say to me, Well, I don't need vaginal estrogen, cuz I'm not sexually active or by, they'll tell, they'll say it inadvertently. They'll say, I don't need vaginal estrogen because my husband died. And I'll say, how is your husband dying, relevant to your pelvic health? Because we're so tied in to a penis going in our vagina as the only function of our pelvis? Like it's insane. And so I'm like, How is why are you even telling me the story about this lack of penis in your life, this is about your urinary tract infections, your overactive bladder, you getting up four times at night to urinate, the chafing, you can't ride your bike anymore, right? Like all of these things that are genital urinary syndrome of menopause that people don't understand. But that's the other myth of like, how bad our education is, is not understanding that menopause is a full blot body change. People like I didn't have hot flashes. So you still went there? Like I didn't go through menopause. I'm like, What do you go through menopause? Like I didn't have any hot flashes? I'm like, Well, that means you didn't have hot flashes doesn't mean you didn't go through menopause, right? You're 62 you're not pregnant, like you went through menopause, you just didn't have hot flashes. But our education is so poor, that we don't understand that, like we have estrogen receptors in our ear. Why do you think vertigo goes up in menopause, right? Like, all the joint aches is because we have estrogen within, you know, the joint capsule, producing collagen and helping with joint you know, wear and tear. People don't know that. And if we have no education, we're so much more resistant to a doctor wanting us to do anything, let alone your problem that you said, Fine, I go to the doctor to get something they don't know. So I can't get it.

Jenn Huber  22:34  
Yeah, and that's I mean, that's a really big problem, I think is that, you know, we have this, this demographic generation of women who are more educated, who are learning, you know, from lots of great people like yourself about, you know, what I need, why I need it, and how you know what to get it, but there's that gate, right is that gatekeeper? Most of the time, you know, they need a prescriber, and I love that there's a movement to make the over the counter and vaginal estrogen more accessible. But it's so demoralizing when they go into these health care conversations. And they say, I need this or I want this. And they're shot down. Because I can't tell you the number of times people will say my doctor said I'm not in menopause because I am not Peri menopausal because I'm not having hot flashes. And my period is still regular. Like I might actually put it on my tombstone that you don't need to miss a period in order to be Peri menopausal. You because it is such. I mean, it's it doesn't make any sense. You know, you're gonna be in perimenopause for so many years before you miss a period. Why did we make women suffer for that?

Dr. Kelly Casperson  23:40  
Yeah, well, because doctors didn't get the education either. Really, the Women's Health Initiative hurt, hurt everybody. But doctors stopped prescribing hormones. We stopped learning about menopause, or was there anything we can do for them? We just put every, like if you look at the data on prescriptions for anxiety and antidepressants, in between the ages of 40 and 50. Right. And you know, the true experts are like those women need to be offered hormones first, not antidepressants and anti anxiety meds first. So it's a big lack of education amongst the physicians.

Jenn Huber  24:12  
Yeah. So interesting story. My dad was actually an OB GYN. He was born in the 30s. He died like 16 years ago, but he was old school, like, you know, and he, you know, he was working and I was kind of working in his office in the summers when the Women's Health Initiative study came out. And that whole thing happened. And it was just really, really apparent that my whole generation was kind of like, micro traumatized by that and that we all of a sudden had this like fear of all things related to hormones that hormones were bad. Like, that was kind of the take home message. And it's you know, it's been really interesting to see it now like 20 years later, that it's just starting to come back around and ultimately, it it's about Oh, you know, not just are our physical health but it if it if your symptoms aren't being treated like a hormonal problem and you're being offered, you know, another solution, it's only going to be a bandaid. And so how many women have suffered in the last 20 years? Because of that millions?

Dr. Kelly Casperson  25:15  
If you look at I mean, all these graphs, right that they've made since the Women's Health Initiative, the graft on hip fractures, right, like, this is what hip fractures were doing. We stopped prescribing estrogen hip fractures to do this. I think the data, you know, interesting, What's always interesting is like heart disease is the number one killer of women. Right? Nobody cares about heart disease much, which is fascinating. But the the new data on Alzheimer's and hormones, which actually isn't new data, we've got tons of data from the 90s, looking at decreased rates of Alzheimer's, for people who are on hormones, right, all that stuff pre whi got completely erased from memory. And so the new data coming out on 30% risk reduction for Alzheimer's disease, women are paying attention. Women are two thirds of the people who get Alzheimer's disease, women are the majority of caretakers of people with Alzheimer's disease, we're going to have a huge vested interest in brain health. Right? And so like, maybe Alzheimer's is what's gonna get people paying attention to hormones and menopause. You can one can hope, if you didn't care about, maybe you care about your brain.

Jenn Huber  26:26  
So I want to circle back before we come to the end here and talk about testosterone, which you talked about a little bit in the beginning. So because testosterone is, you know, I feel like it's this thing that we kind of sorta know a little bit about, but not a whole lot, and it's just confusing for everyone. So what's the deal with testosterone?

Dr. Kelly Casperson  26:45  
Testosterone is it's easy. So what we did is we gendered hormones. Think about testosterone, it's the male hormone, estrogen, it's the female hormone. And we would we, what we did when we gendered testosterone is we basically erased it from your body, right? Because that's the male hormone. What we don't know is in our 20s when we're cycling, right, when we're having our periods at certain points in our cycle, we have more testosterone in our body than estrogen. Yeah, like what like I didn't even learn that in med school. It's crazy. Right ovaries make testosterone. Testosterone plays a role certainly in libido and sex drive. In bone health. In muscle health. Muscle is the organ of longevity, you want to live good and long pay attention to your muscles. Testosterone has a role in brain health and vitality in the overall sense of wellness. And the ovaries make testosterone the ovaries also stopped making testosterone after the menopause transition. And so what really what we really need is more research on testosterone and women. Australia has an Australia equivalent of the FDA approved female testosterone dose. United States doesn't. But we use just a generic FDA approved Cream Gel basically, that's made for men, we dose it for women for low desire as the primary indication for it this day and age because we don't have a lot more data. But certainly there's good data in decreasing risk of heart disease. Women who have higher natural androgens have less heart attacks. So we need more data. And the first thing we have to get over is thinking that this hormone isn't for us getting rid of that gendered, you know, name we put on testosterone.

Jenn Huber  28:38  
Thank you for that. I have loved this conversation. I know that listeners will as well I thank you so so much for your time. Two things before we go. I always ask my guests What do you think is the missing ingredient in midlife?

Dr. Kelly Casperson  28:51  
Communication? Yes, with yourself with others with your partner? Communication because what we do is we would we feel broken or alone we isolate, isolate, isolate, right, we continue to isolate and really realizing, you know, the antidote to trauma is connection. And realizing like, Hey, you talk to people, you'll find out you're you're not all that special. You're kind of like going through what everybody else is going through.

Jenn Huber  29:18  
Self Compassion. Absolutely. I love that. That's great. So if people want to learn more about you or from you, what is the best place to send them?

Dr. Kelly Casperson  29:29  
I hang out on Instagram for people who are on Instagram, Kelly Caspersen, MD otherwise, you can find me on my website. Kelly Caspersen. MD and the podcast in the book are both you are not broken.

Jenn Huber  29:40  
And we'll have links to those in the show notes. Thank you so much, Dr. Caspersen. This has been a great conversation. Thanks for having me. Thanks for tuning in to this week's episode of the midlife feast. For more non diet health hormone and general midlife support. Click the link in the show notes to learn how you can work and learn from me. And if you enjoyed This episode and found it helpful please consider leaving a review or subscribing because it helps other women just like you find us and feel supported in midlife