Corey Allan: It is absolute treat to welcome Dr. Kelly Casperson back to the show. She's been on a couple of times already. Kelly, if you remember, refresh your memory and those in the audience that maybe don't remember too, you were on, we did first off with, I met you on the whole, you're not broken, which is your podcast, which is just killing it. And it's so, so good. So highly recommend it. And then you came on episode five 90, where we talked about perimenopause. and some of the myths and stuff that surrounds there. And that went so well, and I know the work you've been doing also has been on this topic too. So my thought today, Kelly, if you're okay with this, is I wanted to like play a hypothetical scenario of a woman going through perimenopause. And for the sake of the conversation, we'll just title her Pam, okay, as a hypothetical. So Pam,

Corey Allan: take it away.

Pam: Thank you. Thanks for letting me be here. So, and Dr. Kaspersen, I've been so excited for this day. So thank you for being on here with us.

Dr. Casperson: Oh, my

Pam: So

Dr. Casperson: pleasure.

Pam: yes, I'm gonna talk to you about this hypothetical Pam who may have just turned 50. And maybe all this stuff started happening right, like literally when she turned 50. Okay, and so there's... all these things happening and I guess I'm asking for things like, is this normal? How long does it last? And ways that we can go about it, right? So. hot flashes, how in the world do you deal with them? What's a good way to deal with them?

Dr. Casperson: Take hormones.

Pam: And okay, so you say that, I have people

Dr. Casperson: I'm

Pam: tell

Dr. Casperson: just

Pam: me,

Dr. Casperson: going

Pam: okay,

Dr. Casperson: to start with the bomb.

Pam: estrogen progesterone, is it one of those guys? Right?

Dr. Casperson: It depends. Does Pam have a uterus?

Pam: Yes.

Dr. Casperson: Okay, so if you take unopposed systemic estrogen, you have about a five to 10% increased risk of uterine cancer. So you have to protect your uterine lining with a progestin. Most commonly used today, bioidentical, micronized oral progestin. Progesterone's side effect is it helps you sleep better. So you take it at night.

Pam: That was one of my other questions. What the heck? So yes, the sleep cycle has totally flipped upside down like in the last four months.

Dr. Casperson: Yeah, it's horrible. Getting a poor sleep is associated with shorter life. You know, and I think, you know, just to back up

Pam: Mm.

Dr. Casperson: for your listeners, because there's so many people in 2023 and they're coming around, but so many people are so afraid of hormones. They're so afraid of taking medications. And what we really need to do is number one, understand where that came from because we can stomp out fear with education. But number two is realize untreated signs and symptoms of menopause in and of themselves cause immense suffering.

Corey Allan: Mm-hmm.

Dr. Casperson: Right. And so we think like, oh, I don't want, I'm all natural. I want to be all natural. And it's like, well, all natural is really crappy sleep, hot flashes, which in and of themselves are associated with heart disease, and then all the risks that happen with having no estrogen. So

Pam: Wait, back

Dr. Casperson: it's really a

Pam: up

Dr. Casperson: con.

Pam: heart disease?

Dr. Casperson: Yeah, your heart disease

Pam: Really?

Dr. Casperson: risk goes up. Why do you think women have heart disease on average about 10 years after men do? It's because we have protective estrogen for so much of our lives. So now you're taking, let's define menopause. Menopause is one year without having a natural period. Not a great definition because of all the people with hysterectomies and IUDs and birth control and all this stuff. But in general, about average age 51 in America, meaning 50% happened before that. 50% happen after that. What that means is that ovaries are no longer producing enough hormones to cause a woman to cycle, to ovulate, and to have the chance of a pregnancy. Right, so now we're talking about hormones being your estrogen, a woman's estrogen in menopause, is lower than the estrogen that a man has.

Pam: Huh.

Dr. Casperson: Let's let that sink in. And every organ in your body has estrogen receptors, your inner ear, your bones, your tendons, your muscles, your gut, your brain, your heart. This is not just like, oh, my ovary isn't, you know, producing estrogen. I just don't have periods anymore. This is a body change.

Pam: Mm-hmm.

Dr. Casperson: Now, let's be careful, right? This is very natural. Now, one might argue living past the age of 50 is actually not that natural. If you look back statistically, we've only been doing that

Corey Allan: Mm-hmm.

Dr. Casperson: for about a hundred years, right? So you could argue that being able to have the opportunity of living past 50 is amazing and in and of itself, not natural. But I think the word natural is very loaded these days with like, shoulding on what people should or shouldn't do based upon

Pam: Yeah.

Dr. Casperson: what they feel is natural. So... Let's take your body, let's take your estrogen below that of a man's and say, what are the consequences of living that way? Hot

Pam: Yeah.

Dr. Casperson: flashes, night sweats, poor sleep. We have increased risk of frozen shoulder. We have increased risk of osteoporosis. More people die from hip fracture than breast cancer. More people die from heart disease than breast cancer. So, and I'm saying that estrogen supplementation doesn't cause breast cancer, but that's the biggest fear of it. Right? So I would say we're really scared of the wrong things. And I think that's because of our lack of education about our bodies and what happens. I'll pause to let that all sink in for a second.

Pam: Yeah, that's a lot of information. You're throwing out all these little symptoms that I'm like, yeah, that's all just slammed me in the last four months. The shoulder issue, all those things. And you're saying even that gets helped by estrogen.

Dr. Casperson: Yeah. Yeah, we have a very interesting paper that looking at both men and women, because men have low hormones too. Let's remind everybody. And when men have low hormones, we don't tell them, oh, it's just natural. Have you tried acupuncture and some tea? We don't treat men the same way we treat women, which to me menopause is just a big equality issue because I treat men with low testosterone and it irks me to no end that we don't treat women the same way. But let's take men and women, if they both have low hormones, because they do, have a much increased risk of needing their shoulder repaired, rotator cuff, frozen shoulder, right? The role of hormones in orthopedic health is incredibly understudied. But certainly a lot of people will be like, oh, they're just even there's the common like aches and pains, you know, like I'm in the perimenopause phase. I'm noticing I'm a little more cracky kind of in all

Pam: Yes.

Dr. Casperson: of my joints, right? We get less anti-inflammatory. Estrogen is very anti-inflammatory. right, which is very, very trendy to be anti-inflammatory. So we

Corey Allan: Thanks

Dr. Casperson: just

Corey Allan: for

Dr. Casperson: get

Corey Allan: watching!

Dr. Casperson: more,

Pam: It's

Dr. Casperson: we

Pam: very

Dr. Casperson: get more

Pam: dirty.

Dr. Casperson: inflammation, right? We get more inflammation in our joints, more inflammation in our gut, more inflammation in our cardiovascular center because we don't have the estrogen that we used to have.

Pam: Okay, I'm just taking all kinds of notes, because...

Dr. Casperson: I think this is being recorded. You can listen back.

Pam: Good point!

Corey Allan: True, true that,

Pam: That's why you're

Corey Allan: but

Pam: the doctor.

Corey Allan: it is

Pam: Good

Corey Allan: fascinating

Pam: point.

Corey Allan: to think about as, because in general, Kelly, you're describing some of this as an aging factor for everybody that we're all going to face, but the one that needs to be, and the reason we're getting you on here again, that needs to just be, because you know, just like your show, our show is constantly, how do we give good information to let people? then make informed choices or have informed conversations with those they need to. Because obviously this isn't something you're going to be, Hey, go do this because nothing's a quick fix. So this isn't late night infomercial TV that we're talking about here. Right? So it's instead it's, it's such a valuable resource to recognize, wait, these are some of the common things. And then here's some possible things to explore. I mean, then jump in and I'm watching my wife's face as the hypothetical PAMs going through this scenario. And she's going, ah, okay, hey, wait, wait. And you can just see the buttons all kind of getting connected and everything makes sense.

Dr. Casperson: Mm-hmm.

Pam: Well, it's beautiful that all these things are like, oh, this is normal, this is normal, this is normal, all these things that are happening, but there's things she's clinging me in on that I hadn't even associated with the hormone change

Corey Allan: Mm-hmm.

Pam: specifically. And so I guess my next question, when you're talking about... I mean, you talk about testosterone, work with the men, right? What does that look like when you're going to work with a woman on getting hormone levels, where there would be to help with these aches and pains, to help with all this that's going on with the change in the body?

Dr. Casperson: Yeah, well, first of all, you know, to back up again, it just for the listeners to under because, you know, I have a very big platform now and I hear from women every single day. Number one, how much being on hormones has changed their life. They've gotten their old Pam back, you know, whatever benefit it is. So I'm hearing that left and right. But I also hear a lot. My doctor says no. My doctor says it causes cancer. My doctor blah, blah, blah. I need to alert people not to scare them, but to say doctors have not been trained for about two decades. And the reason for

Pam: Hmm.

Dr. Casperson: that is the media took the Women's Health Initiative, this huge study that came out in about 2001, and said estrogen caused cancer. Estrogen did not cause cancer. But then media never went back and said, oops, sorry, sorry, we took 70% of women off. So a reminder, in the 80s and 90s, the majority of women were on hormone. A lot of menopause women, they don't know that, right? They don't know the history. They don't know why we're so scared. They don't know all that history. But again, education and just understanding this and understanding what happened in America helps them to be like, oh, it really is safe. If you go on, and I have this in my link tree, but Google can give it to you too. If you go into the North American Menopause Society statement in 2022, it's very strong. And you know how medical societies do not like to make strong statements. the benefit of hormones between the ages of 50 and 60, that's considered young menopause,

Pam: Mm-hmm.

Dr. Casperson: outweigh the risks for the majority of women.

Pam: Interesting.

Dr. Casperson: You're not going to get that strong of a statement for many things.

Corey Allan: That's a huge statement.

Dr. Casperson: It's a huge

Pam: Yeah.

Dr. Casperson: statement, you know, and it's kind of said subtly, but they're careful. They say, we are not telling anybody to get on hormones for the primary prevention of diseases, right? Because in order to make a claim that you're going to prevent disease, that's a whole other level of medical proof that has to happen. So they're not saying that, but they're saying the benefit outweighs the risk. And that's a pretty powerful statement to come from any medical society.

Corey Allan: Well, and that's the

Pam: E.M.

Corey Allan: world that we live in in a lot of ways. If you think about it on reverse, Kelly, that don't we all do things that I'm gonna just risk it? No, I'm gonna eat fast food and just risk it. But

Dr. Casperson: Totally.

Corey Allan: it's not gonna adversely affect me. I mean, so it's like, why

Dr. Casperson: I mean,

Corey Allan: not

Dr. Casperson: totally.

Corey Allan: go the other way and talk about this same equation?

Dr. Casperson: I love that. And I think, you know, let's talk about alcohol, the most commonly used drug in the world. 70% of Americans use alcohol, right? Alcohol is a known carcinogen. It is a known toxin by the World Health Organization. It's associated with eight cancers. the benefits do not outweigh the risks in alcohol

Corey Allan: Mm-hmm.

Dr. Casperson: and 70% of people use it, right? So like

Corey Allan: Mm-hmm.

Dr. Casperson: flip that on hormones of like, they actually say the benefits outweigh the risks and here we are hand wringing like, oh my God, I don't know,

Corey Allan: Mm-hmm.

Dr. Casperson: should I, shouldn't I? We spend, we're like, I need to measure levels. Like people get all freaked out about hormones and you're like, yeah, if you drink a glass of wine, like your benefit is not outweighing the risk. But you

Corey Allan: Mm-hmm.

Dr. Casperson: know, we don't think about things like that.

Corey Allan: No, we don't.

Pam: That's an interesting comparison. So do you take estrogen based off of, I mean, what you start taking, is it based off of like how much you weigh and

Dr. Casperson: No.

Pam: age or it's

Dr. Casperson: No.

Pam: nothing like that. It's just a, okay.

Dr. Casperson: It's pretty damn simple, like truthfully, hormones are not, this is not rocket science. I'm a surgeon, I like, I love being a surgeon because I don't have to deal with a lot of medications, right, but like hormones

Corey Allan: Mm-hmm.

Dr. Casperson: are easy. Here's the thing, just to back up, because I don't want anybody to be like, she just told me to go on hormones, is like midlife is a fantastic opportunity to clean up your lifestyle, right? Like prioritize sleep, prioritize exercise, we've got to prioritize our muscles, right? Like... Aging is working against us with muscles and muscles are the organ of longevity. Alcohol, again, me just because I've done it and I no longer drink alcohol, cut out alcohol. It is not doing you any favors. So I never wanna be like, oh, estrogen's the panacea and just keep living like a teenager, right? But it's like, get rid of processed sugar as much as you can, an anti-inflammatory diet, plants, protein, all the good things, your mental health, the stress in your life, all that, and hormones. But like hormones is not a one-stop shop for a healthy body. It's just part of the plan. But if you are on the proper dose of estrogen and progesterone, if you have a uterus, your hot flashes should diminish by about 80%. That's a good gauge to say you're on the right dose.

Pam: Okay,

Corey Allan: Okay.

Pam: all right. All right, I've harped on that enough, thank you. Maybe, we'll probably come back to it.

Corey Allan: So I do, let me jump in real quick, Kelly, because there's an element we've talked about in the past of the delivery of said hormones. What's the delivery methods that are best?

Dr. Casperson: Yeah, so when you can, not always available, but when you can, FDA approved product, insurance covers it, it's FDA approved for basal motor symptoms, meaning save your money. It should be pretty cheap. Don't go do all the compounded stuff because you're being marketed to by using this bioidentical term. Lots of FDA approved products that are, regulated pharmaceuticals are bioidentical. Bioidentical just means it's the same as what your body naturally makes. There is,

Corey Allan: Mm-hmm.

Dr. Casperson: but a lot of people will use it as a marketing term to make you spend a lot of money on pellets and creams and stuff like that, which are not recommended by the national societies. So just to go back on that. But transdermal patch, usually with estrogen, you can even get a combi patch that has estrogen and progestin in it. That tends to be better as far as sex drive because it doesn't increase your sex hormone binding globulin. I like to talk about sex med. So there you go for that. Also oral estrogen. does tend to increase your clotting factor about the same as a birth control pill increases your clotting factors.

Pam: Hmm.

Dr. Casperson: If you want to have no increased risk of blood clot, transdermal doesn't have any increased risk of blood clot. But some people think that oral is, they tolerate it better or it works better for them or whatever. I don't think oral is an absolute no. You're just different formulations because of how the liver processes it will increase your clotting factor a little bit.

Corey Allan: Mm-hmm.

Dr. Casperson: How many people do we have on

Pam: Hmm.

Dr. Casperson: oral birth control?

Pam: Right,

Dr. Casperson: And

Pam: yeah.

Dr. Casperson: they have a clotting factor and they use birth control because the benefits outweigh the risks.

Corey Allan: Mm-hmm. OK.

Pam: Mm.

Dr. Casperson: As far as progestin goes to protect the uterus, two awesome ways, number one, a progestin-secreting IUD. I love it, especially in the perimenopause because people tend to bleed irregularly and an IUD will really help with that. Otherwise, an oral one at night helps with sleep as well. But the over-the-counter on the Amazon progesterone creams are not recommended. You cannot get enough of that drug in with a cream, so you can buy it. but it doesn't mean it's real or it's working or it's effective.

Corey Allan: Mm-hmm.

Dr. Casperson: It could actually be dangerous if you're not actually

Pam: Mm.

Dr. Casperson: protecting your uterus enough with the product.

Corey Allan: That's

Pam: Interesting.

Corey Allan: good. Yeah, no, that's good because that's that element of the two different paths you go with the two different processes that the delineation of the importance of the progesterone, progesterone has got to be internal, right? That that's a that's a huge component of the delivery. There's got to be something that gets past the barrier to get it in and to make it work the way it's supposed to rather than

Dr. Casperson: Yeah, because

Corey Allan: all the

Dr. Casperson: of

Corey Allan: other things that people can come up with.

Dr. Casperson: the molecular structure of progesterone, you cannot get enough cream to get it through your skin to get it into your body, just the way

Pam: Interesting.

Dr. Casperson: that it works. But you're going to go on Amazon, you're going to see progesterone cream, but that's unregulated, not FDA approved. And it's, you know, us experts have seen women get uterine cancer because they're using this compounded, you know, it's a bad product, right?

Corey Allan: Mm-hmm.

Dr. Casperson: But the FDA is not regulating supplements in this country. So it is buyer beware when you go into the supplement territory.

Pam: Interesting. Interesting.

Corey Allan: So I want to circle back also on this topic of delivery methods, because when we spoke last time on the perimenopause, you were talking about some new delivery that had just happened in the UK that was approved. It was a vaginal cream.

Pam: cream.

Corey Allan: And I'm

Dr. Casperson: Oh,

Corey Allan: curious

Dr. Casperson: well, they just

Corey Allan: where

Dr. Casperson: went over the

Corey Allan: that

Dr. Casperson: counter.

Corey Allan: is now.

Dr. Casperson: Yeah, so

Corey Allan: Right.

Dr. Casperson: the UK went over the counter with their equivalent of vagifem tabs. I don't

Corey Allan: Okay.

Dr. Casperson: see America doing that. It would be fantastic, absolutely fantastic. But that's how, you know, to get into the vaginal delivery of estrogen, that is not systemic, that is just pelvic or what we call local or another term for that's low dose. That's for genital urinary syndrome of menopause, previously known as vaginal atrophy, Nobody likes the word atrophy, but really you're gonna see that dryness, decreased sensation, overactive bladder,

Corey Allan: Okay.

Dr. Casperson: more urinary tract infections. You can put estrogen just locally in the pelvis. That's not systemic, right? Your brain doesn't see it. Your heart doesn't see it. Your bones don't see it.

Corey Allan: Okay.

Dr. Casperson: And if you just use a local vaginal estrogen, you don't need a progestin to protect your uterus because it's so low dose. It's really just helping like the bladder, the vagina, the vulva.

Corey Allan: Mm-hmm. Okay. Perfect.

Pam: It's so much amazing information. Like seriously,

Dr. Casperson: It's a lot,

Pam: you're laughing at me for taking notes because it's

Dr. Casperson: but we can.

Pam: recorded, but I'm like, okay, I have to see it and write it down to remember this.

Dr. Casperson: And I, I, truthfully, I think it takes listening to this a couple of times to be like, okay, systemic, your whole body, okay, vaginal,

Pam: Yeah.

Dr. Casperson: like, I think it takes a little bit, but you know, it's, it's, once you get it, you can speak the language pretty quick. And we can't forget to talk about testosterone.

Pam: Right, well go for it, talk about

Dr. Casperson: Okay,

Pam: it.

Dr. Casperson: so testosterone, the worst thing we did with testosterone is we gendered it, right? I mean, how many times do people learn even in the lay population, testosterone is for men and estrogen is for women, right? We gendered this hormone, which is a horrific disservice to women mostly. But did you know that depending upon where you are in your cycle in your 20s, a woman's body has more testosterone in it than estrogen?

Pam: I had no idea.

Dr. Casperson: Nobody knows that because we branded these things wrong. So women have a ton of testosterone. It's just one-tenth the dose of what a man has, right? The ovaries also make testosterone and the ovaries also stop making testosterone with menopause. So we don't have a lot of data on women and testosterone after menopause for the main reason is testosterone's for men, right? It's just not studied.

Pam: Mm-hmm.

Dr. Casperson: We have Australia. Australia has the only, their FDA approved equivalent product for systemic testosterone postmenopause for women. It's called Androfem. It's a patch. They were working on one in America and they shelved it. The FDA has put up big barriers to getting a FDA approved testosterone for women. So we basically use a man's product and we dose it appropriately. The biggest reason to take it is kind of the biggest indication post-menopause is hypoactive sexual desire disorder or low libido because we know of any hormones, testosterone is really that libido hormone a lot more than estrogen is. That's not an absolute. A lot of women who get back on their estrogen after menopause are like, oh, I want sex again. Thank you very much. So it's not cut and dry. But we just don't have a lot of data on brain, bones. muscle, we need a lot more data on the role of supplementing testosterone postmenopause for women for those organs. But we do have it for desire right now. But again, I give 10 times the doses of testosterone to men, so I'm not afraid of giving testosterone to women. We're not

Pam: Hmm.

Dr. Casperson: trying to give her super crazy doses. We're just trying to give her enough so that she feels better.

Corey Allan: Mm-hmm.

Pam: Interesting.

Corey Allan: Right,

Pam: So.

Corey Allan: because a lot of this is about functioning. It's not necessarily, it's getting to a level of normalcy of symptom abatements, you know, all of that, of just like, hey, wait, this is kind of the way normal life and a vibrant life is without some of the things that come along with it. I can

Dr. Casperson: Yep,

Corey Allan: take some of the edge of it off,

Dr. Casperson: that's

Corey Allan: because

Dr. Casperson: right.

Corey Allan: it's, again, all of this is, and the thing I love about your work, Kelly, and all the messages you have out there is, All of the framework is about, here's resources that are available, not how you become superhuman in some aspect of your life or marriage

Pam: Yeah.

Corey Allan: or body in a sense.

Dr. Casperson: Yeah.

Corey Allan: This isn't the fix all. This is just the, wait, you don't really have to suffer as much. This is something that's actually better for you. This will help. Plus, there's some benefits for it. So why not explore it?

Dr. Casperson: Totally. You're exactly right. And the medical term for that is getting you to physiologic dosing. We're not trying to get you to supraphysiologic dosing. We're not trying to transition you to a different gender, which we can do on super high doses and they do fine too. Right? We're so afraid of these very, very small amounts of hormones and then you only have to look and be like, we give much higher doses for some reasons and they do fine also. But yeah, it's all about… Our tolerance for female suffering in this country is extraordinary. Yeah.

Pam: I think

Corey Allan: Let

Pam: that's...

Corey Allan: that one sink in for a second. Let that statement sink in for a second. Yep.

Pam: And I think some to our detriment, maybe because it's male dominated society, some of it's, I know there's been plenty of times in my life I just haven't spoken up. I just have just taken, okay, I feel this way and didn't know any better and just assumed, well, that's just how it is.

Corey Allan: FOREVER.

Pam: Right? And so I appreciate folks like you that speak up and say, well, it doesn't have to be that way.

Dr. Casperson: No, yeah, I mean,

Pam: Oh,

Dr. Casperson: the

Pam: I

Dr. Casperson: fun

Pam: can.

Dr. Casperson: thing about hormones is like, just try it, change the doses. You can always stop and not be on hormones, right? But,

Pam: Right, exactly.

Dr. Casperson: and I think so many people are like, I don't know, let's write a dissertation on the pros and cons. And it's like, just go try it. It's not an amputation. Like we can adjust doses, it's fine. This stuff is like, the amount of hormones we're talking about is like, on an order of magnitude smaller than birth control,

Pam: Yeah.

Dr. Casperson: right? And it's like,

Pam: Yeah.

Dr. Casperson: look how many people are on birth control. They do,

Pam: Uh.

Dr. Casperson: there are some risks. Anytime we play with hormones, there can be benefits and there can be risks, right?

Pam: and they're on it for decades.

Dr. Casperson: Yeah, yeah, yeah, they're on it for decades.

Pam: Yeah,

Dr. Casperson: Right.

Pam: so when you're talking about timing, you know, if you start taking hormones, You know, I mean, is it a week before you start seeing effects, a day, a month?

Dr. Casperson: Usually a couple of months, because you're just trying to reestablish a homeostatic place. And I tell women, I'm like, you might see some side effects in the beginning. You might have a little bit of breast tenderness, might notice a little bit of water weight gain. Water weight gain is good by the way,

Pam: Mm.

Dr. Casperson: it's hydrating. You're not as

Pam: Okay.

Dr. Casperson: dried out. You might notice your skin's a little more glowy. Your hair gets a little stronger, right? It's like all these, if we don't wanna, if we can't think about heart disease, which is the number one killer of women by the way, be like, hey, use it for vanity. It makes your skin look better. But give it a couple of months. see how your symptoms go, and then you adjust the doses.

Pam: Okay,

Dr. Casperson: It's pretty simple.

Pam: well there's another symptom right there because I've been noticing more wrinkles and like, I just look older. And I have, you just said that and I'm like, oh, okay, I'm getting on this tomorrow.

Dr. Casperson: Yeah, you can just get on it tomorrow. It's perfectly fine.

Pam: skin will look better. It's amazing how just in a short period of time all these things, it's like a snap of a finger and all these things have changed. And

Dr. Casperson: Mm-hmm. Yeah, yeah.

Pam: anyway, I could go on and on. Okay,

Dr. Casperson: Well,

Pam: so.

Dr. Casperson: I think, I mean, I, you know, to pause, to make a note of, you know, what you're saying is like so many women because of our lack of education and because I'll blame doctors too, like because doctors are like, Oh, I think just the OB-GYN should deal with everything woman and be like, no, this is 51%

Pam: Yeah.

Dr. Casperson: of the population, internal medicine docs have to jump on board. You know how many cardiologists

Pam: Yeah.

Dr. Casperson: evaluate 50 year olds for heart palpitations when in fact it's menopause, right? And they don't know it. But it's like, just educating the women to be like, oh, it's not just me. Like, no, no, no, this is what happens when your estrogen goes to zero.

Pam: interesting.

Dr. Casperson: It's just what happens.

Pam: That's interesting. Okay, that makes me feel so much better.

Dr. Casperson: Good, then

Pam: Okay,

Dr. Casperson: I've done

Pam: so

Dr. Casperson: my job.

Pam: I, you have, you're amazing.

Corey Allan: Hehehe

Pam: You're amazing. Okay, so I kind of know the answer to this, but this has stunned me that I realize, okay, hot flashes will come. I didn't really realize so much the effect on sleep and what that would do. One of the things that... a side effect, I'm assuming this is from the same thing, is my boobs have shrunk. I mean that's normal I'm assuming. Please tell me that's a normal thing. Does estrogen help them regain some life?

Dr. Casperson: I have not seen specific data on breast bounciness with supplementing

Pam: I'm not talking bounciness.

Dr. Casperson: estrogen.

Corey Allan: How is that listed actually? What's

Dr. Casperson: Right,

Corey Allan: the

Pam: Maybe

Corey Allan: medical

Pam: it's

Dr. Casperson: how

Corey Allan: term

Pam: maybe

Dr. Casperson: do we

Pam: it's

Dr. Casperson: study

Corey Allan: for

Pam: TMI.

Corey Allan: that?

Dr. Casperson: this? Who's

Pam: Yeah,

Dr. Casperson: studying

Pam: maybe it's

Dr. Casperson: this?

Pam: TMI but

Dr. Casperson: We lose collagen, we lose elastin. Those are two incredibly important components to our connective tissue and our skin. And so I would think there's probably, there's a role in that.

Pam: Interesting. Okay. All right. But so when when you're talking about menopause, you know, the sexual side of things and the it's harder to get stimulated, you dry and all that. dryness that comes into play. I think what I'm noticing too is just sensitivity in other parts of the body, right, that seems to have have waned. And you have any color on that? I mean, fill me in on things that, is this something again that it's estrogen is the fix because it brings back stability within the body or what does that look like?

Dr. Casperson: Yeah, I mean, I think, you know, I always get in trouble on social media because people are like, not everybody can take estrogen. And that's true. We can put 100% of people on estrogen, but we can put about 92% of people on estrogen. And right now in this country, only about five, depends upon what stat you look at, only about five to 7% of women post menopause are actually being treated with hormones. 25% of them are being treated with antidepressants. About 40% of them are being treated with... you know, either a high blood pressure med or Lipitor.

Pam: Yeah.

Dr. Casperson: So let's not be afraid of all medications because we sure are taking a plenty of others, right? In the argument of like, I don't wanna take meds. Like, well, we're taking meds for everything else. But

Pam: Good point.

Dr. Casperson: top two reasons that women after menopause decrease their sexual activity. Number one is symptoms of menopause. If you're hot flashing, if you're moody, if you're more anxious and you're not sleeping, your libido is in the toilet. You're just not feeling like yourself. You're exhausted. You're grumpy. You're not well-arrested, all that. So we treat those symptoms, usually with estrogen. Your hot flashes go down. You're sleeping better. You feel more like yourself. Your energy's back and you're like, oh yeah, okay, I can have sex. The second number, the second reason that women stop being sexually active after menopause is availability of partner. So I always tell people,

Pam: Mm.

Dr. Casperson: I can help you with number one. I can't help you with that. I'm not a dating service.

Pam: All right.

Dr. Casperson: I can't help you with number two.

Corey Allan: the

Dr. Casperson: But really, you know, a supportive partner who understands what they're going through, who doesn't, you know, throw shade on them and is like, you just get over it. Just why aren't you yourself? Well, like a supportive

Pam: Okay.

Dr. Casperson: partner who's like, let's try to get you some help. I think, you know, let's read about this. Let's figure out other things that get you in the mood. Do we need to do different stimulation? Do we need to add more lubrication? Number one, non-hormonal. Everybody should just use lube. I love oil-based and

Pam: Yes.

Dr. Casperson: silicone-based lube. because it just lasts longer for dry skin, feels good. It's not cold and sticky. I

Pam: Yeah.

Dr. Casperson: was like thinking about this actually, I'm like, man, I've turned into a lube snob. Like, when did that happen? But just like high quality lube is nice. But then, you know, I think, and a lot of my friends in the business think like vaginal estrogen, again, talking about local, not systemic,

Pam: Yeah.

Dr. Casperson: vaginal estrogen,

Pam: Yeah.

Dr. Casperson: which is over the counter in multiple countries, but not in America. just really in preventing genital urinary syndrome of menopause, because it's a chronic progressive syndrome, it's going to happen in 50 to 80% of women post menopause. Why

Pam: Mm-hmm.

Dr. Casperson: wait till you have dry, painful sex? Why wait till you start getting the UTIs? Why wait till you start getting overactive bladder to treat it? To me, it seems like a preventative thing that we should do because it's so stinking safe.

Pam: Yeah.

Dr. Casperson: And it's just skincare. You know, it would be like how much Americans spend on s- face skincare in this country. It's like 13 billion or something nuts of

Pam: Yeah,

Dr. Casperson: like, there's

Pam: yeah.

Dr. Casperson: just skincare for down there. See, it's a no-brainer.

Pam: Great phrasology. Skincare for down there. I'm down with that one. I'm totally down. So, um, Cora, did you have something to chime in on that? Okay.

Corey Allan: No, I'm the hypotheticals are fantastic. So this is

Pam: As far as weight goes, like I know metabolism slows down as you get older, or that's my understanding anyway. I'm clearly not a doctor. What is a good way to manage that? I mean, obviously you pointed on before staying away from the toxins, staying away from sugars, things like that, that to me are just common sense, right? eat your veggies, lean meats, things like that. Is there something additional that going through this process now as the body is changing that is a benefit to maybe offset a metabolism that might be ratcheting back and trying to go to sleep?

Dr. Casperson: Yeah, so you're gonna get people arguing on the metabolism thing, but what you won't get

Pam: Okay.

Dr. Casperson: is people saying your lean body mass is gonna change. So when you lose your estrogen, you're gonna get more central adiposity, really kind of that lower belly pooch that you just can't

Pam: Mm-hmm.

Dr. Casperson: get rid of, even though you're a pretty lean person. It's more of like the body fat distribution is gonna change because your hormones are different. And also we really start losing muscle. it just starts accelerating. And so it's like,

Pam: Hmm.

Dr. Casperson: if you don't yet have a weight lifting plan in your week, like as much muscle as you can keep on your body, it burns calories, you know, it's energy intensive, right? So it actually like takes a lot of calories to keep

Pam: Mm-hmm.

Dr. Casperson: your muscle and you have to eat a decent amount in order to keep your muscle, right?

Pam: Yeah.

Dr. Casperson: But really it's a more about not being, I always, I'm like, it's not about being thin, it's about being strong. Like we really

Pam: Yeah.

Dr. Casperson: need to be as strong as we can. And muscle weighs, right? Like muscle weighs

Pam: Mm-hmm.

Dr. Casperson: pounds. But really how strong can we be? Because we wanna be functional. We wanna get back up off the floor. We wanna carry our groceries in. We want

Pam: Exactly.

Dr. Casperson: to live. And it's a very interesting question when I, you know, I see patients and they're hemming and hawing over should I, shouldn't I take hormones or whatever. And I'm like, who do you wanna be when you're 72? Who do you wanna be? What's she look like? What's she doing? Right? And once you

Pam: Yeah.

Dr. Casperson: start thinking about her, then you can kind of get out of your own head about like, I don't wanna take a pill. I don't wanna be on a patch. I don't wanna stop drinking. It's like, oh yeah, who do you want your 72 year old to be? And do you want her to thank you for all the work

Pam: Right?

Dr. Casperson: that you've done? Right?

Pam: Right?

Dr. Casperson: And so when we really start thinking about who that person is, I think we start kind of shaping up a little bit because it's not so much like a chore as like, I'm working for her. I want her to be proud of me. I want her to be traveling and hanging out with the grandkids and playing pickleball and whatever, right in her seventh book. Because we can be functional. It's really this myth that old age means decline, old age means frailty. It does not mean that, but we've got to be pro-ex-

Pam: That's amazing. Yeah. OK. Thank you.

Corey Allan: That is so,

Pam: I didn't.

Corey Allan: so good. So Kelly, again, the amount of information you bring in an approachable way, it is so good. It's so, so refreshing to have, just because it's casual conversations about really important things that a lot of times, I think what I find, and you probably do too with people that you work with and see and listen to your show. Um, there's this, there's like this barrier of like, yeah, I'm too scared to ask that question. I'll look foolish or I can't say those words or we don't talk about that in public or, or even in a doctor's office. And the fact that you can have the reach you have and the ability you have to convey the information you've got, uh, it's countless, the amount of people that get impacted by this, uh, particularly the two others on the show. right now on the screen with you.

Dr. Casperson: Yeah,

Corey Allan: It's huge.

Dr. Casperson: I mean, to

Corey Allan: So.

Dr. Casperson: me, I'm like, I want to make women think. I want to make men think. I want to make people think,

Pam: Yeah.

Dr. Casperson: right? Like, why are you scared? Why are you hesitant? What do you think about

Corey Allan: Mm-hmm.

Dr. Casperson: this? How do you want to live? Like, you get them to think and then you just give them the education to be like, well, let's give you some facts about it. So you're empowered.

Corey Allan: Mm-hmm.

Dr. Casperson: And it's like, when I see them thrive, like, that's the drug. That's

Corey Allan: Mm-hmm.

Dr. Casperson: the drug.

Corey Allan: Oh, totally. Totally.

Pam: Well,

Corey Allan: Well.

Pam: I appreciate it so much. You have enlightened me on some things that I, you know, there's things that I knew were from, what's going on in my body right now. There's other things that I didn't even make that connection. And so I'm stoked about that. You just gave me a lot of hope today.

Dr. Casperson: I'm glad. Well, let me for you and for your listeners, because what were you, they're gonna listen to this episode and they're gonna go to their doctor and they might not get what they need, right? So I just wanna give them

Pam: Okay.

Dr. Casperson: some tips. So if you go to your doctor and you say, hey, I'm experiencing symptoms of menopause, I would like to try hormone therapy. And they say no, right? Ask why, why can't, because you might have like five blood clots and like you've already had a heart attack and I'm sorry, you don't get hormones anymore, right? Like there are some people that you just contraindicated. So understand why. But if your doctor says it causes cancer or it's not good for you or you don't need it, I would challenge that. Challenge it nicely. Don't burn any bridges. But you can get a second opinion. North American Menopause Society. If you go on their website, menopause.org, you can find a menopause certified practitioner. You can try that out. If they don't exist in your town, we've got two great online companies just off the top of my head. Interlude is great for just vaginal estrogen. I just need some vaginal estrogen. and I don't wanna talk to my doctor about it, but I need some access to vaginal estrogen. Interlude is a great online company for that. And then for hormones, Alloy, A-L-L-O-Y, is a great online company for menopause hormones. Because I never want anybody to be like, I just wanna try it, I feel empowered,

Corey Allan: Mm-hmm.

Dr. Casperson: I think this is right for me, and then not have the access. So to

Pam: Mm-hmm.

Dr. Casperson: give people skills to be like, it's not right for everybody, you should get evaluated. Understand why not if you can't have it, but there are resources available, especially in communities where there's just the healthcare hasn't caught up.

Pam: Very good. Thank

Corey Allan: And

Pam: you.

Corey Allan: I'll also put the links to your show, Kelly, because conversations you have with your colleagues and other people that aren't just on this subject but are on a variety of the myths and the way we go about things, that's the way people can easily start to continue their education and remove those barriers to find the right information.

Pam: But give us those details again verbally. You'll put the link on the site, but

Dr. Casperson: Yeah, so my podcast...

Pam: give us how to contact you.

Dr. Casperson: Yep, my podcast is You Are Not Broken. The book is You Are Not Broken, Stop Shitting All Over Your Sex Life. And you can find me at kellycaspersenmd.com.

Corey Allan: Perfect. Well, Kelly, thank you so, so much. It's a pleasure to connect with you again. And I look forward to crossing paths again in the future soon, okay?

Dr. Casperson: Love it, thanks.