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Perimenopause | Dr Kelly Casperson #590

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Dr Kelly Casperson joins us again as we dive into the world of women’s sexual health – specifically the world of menopause and perimenopause.

Let’s face it, every woman will face these stages in life – what are the things you need to ask, know and do to help you through this life stage?

Learn more about Dr Kelly here –

Enjoy the show!

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Speaker 1: You are listening to the regular version of Sexy Marriage Radio,

Corey Allan: Welcome to the show. I'm Dr. Corey Allan alongside my wife, Pam.

Pam Allan: Hola.

Corey Allan: We have regular weekly conversations that try to expand the wisdom and skills of all married people. Plus, we like to be bearers of breaking news.

Pam Allan: We do have breaking news today. I'm excited.

Corey Allan: We do.

Pam Allan: Yeah.

Corey Allan: There was an accident in Oklahoma City on I-40 where a truck carrying toys and lube semi-overturned and spilled all over the roadway in the morning.

Pam Allan: Really?

Corey Allan: Really, and so it created quite a bizarre, awkward exchange with the anchors on the station because they didn't know what had happened.

Pam Allan: I've got to Google this. Okay.

Corey Allan: So the wording that was said was there's a semi that overturned and it lost its load here. There's a lot of stuff to clean up. Then when the other one, "Jim, can you tell what's he's carrying there? What's all over the road?" "Not really. Maybe you can tell. I can't tell. There's a lot of stuff laying on the road and whatever it is, it's going to take a while to clean it all up," and it was actually sex toys and lube.

Pam Allan: Lost his load pay.

Corey Allan: Lost his load and he's going to take a while to clean up. Well, if you're new to the show, we're so glad that you've spent some time with us. If you want to tell your friends about the show, the easiest way to do that is our episode starter packs. There's a collection of our favorite episodes organized by topics and they help new listeners, maybe like yourself, figure out what we do here on the show. Go to and you can learn more. If you got some feedback we want to hear from you, (214) 702-9565 or email us at We're coming up on today's regular free version, and today, extended version because everybody gets the whole show.

Pam Allan: Mm-hmm.

Corey Allan: It's a conversation with Dr. Kelly Casperson. Huge friend of the show now. Love her work. We are talking all things menopause, perimenopause, women's sexual health, sexual health, testosterone, estrogen, and the like.

Pam Allan: And she's so fun to listen to. She's captivating to me.

Corey Allan: Absolutely. So all that's coming up on today's show. It's my privilege to welcome back a friend of the show, Dr. Kelly Casperson, physician, a urologist actually, but also just a woman that's out there using all of your schooling and all of your experience to truly help people. The way I'm finding you help the people the most Kelly is you just talk straight about the stuff that's going on and try to educate people, because let's face it, frankly, a lot of the information that's been out there, it's landed to one side so it doesn't help both very often. Too often, unfortunately, the women are the ones that get pushed aside or run over or just expected of, and that needs to change and you're doing that, so I thank you so much for that. I'm glad to have you back on the show, Kelly.

Kelly Casperson: Thanks for having me. Super excited to talk to you again.

Corey Allan: Yeah. I want to just jump in because you've had a lot going on with your You Are Not Broken podcast and the book you've got and the social media things you've got going. There's a whole lot happening for you, but I guess let's start global and then we'll go a little more specific. What are some of the things that you keep coming across that women don't know about their sexual wellness aspects of them that they really need to know?

Kelly Casperson: I think two come to mind. The first one is that responsive desire is normal. You're not thinking about it, but then you start having it and it's awesome and it's fun. Totally normal. Because so many people think that spontaneous desire is something we're supposed to have in our day or in our week or in our long-term relationship and to normalize that it's okay if you don't. I had a 26-year-old come into my office this past month and did not have spontaneous desire and she thought she should have spontaneous desire. Long-term relationship, you get into your sexual script, you do get your pattern going, you do your thing and she thought she was supposed to have spontaneous desire for it. We're like, no. You don't need a med. You don't need your hormones checked at age 26. If you're enjoying it, you love what you're doing, you just don't crave it and spontaneously desire it all day long, totally normal. So that would be number one, if you're not thinking about sex when you're not having sex, you have a normal brain.

Corey Allan: Well said.

Kelly Casperson: Right? Then number two would be what happens when perimenopause and menopause is that our estrogen goes down, specifically for the pelvis, sex can become painful. Sex can become dry and it's very easy to treat. You can use non-hormonal or you can use vaginal estrogen. Late breaking news literally this morning, the UK announced over-the-counter vaginal estrogen.

Corey Allan: Okay.

Kelly Casperson: Boom. Mic drop.

Corey Allan: Yes.

Kelly Casperson: As of September, will no longer be a prescription in the UK.

Corey Allan: Okay.

Kelly Casperson: That's how safe it... Like, is it safe? It's over-the-counter in the UK.

Corey Allan: Yeah.

Kelly Casperson: Right.

Corey Allan: So all our UK listeners, head out right now because you can find it.

Kelly Casperson: Yeah, exactly.

Corey Allan: Soon, you'll be able to just pick it up.

Kelly Casperson: It's going to be about £30 for 90-day supply.

Corey Allan: Okay.

Kelly Casperson: My frame of reference is American drug prices, so it's completely biased, but that was a screaming deal. That would be off the shelves in Target here if it was 45 bucks for 90-day supply. So that's number two, is as our bodies change, sex can become challenging and now I see this all the time. I have low libido and painful sex. I like to give people as few problems as possible. It's like, you do not have two problems, you have one problem. You have pain with sex. We'll fix that, make the sex better and then the desire can come back.

Corey Allan: Right, or the responsiveness can come back or the engagement can come back. The choices can come back and it's less likely I'm going to be trying to avoid these things because it's common sense. If it's painful, I'm going to avoid it. Actually, we just did a show where Pam and I did a feedback show and there was a question that came in, Kelly, that a disparity and differences, the size. He's well-endowed. She's petite. I failed to mention, well, it likely would be painful for her then, which yeah, it likely would be. I didn't have that data if it was or not and so a woman was, to her credit, saying she needs to get that checked because if it's painful, then of course she's not going to desire it more. That is common sense. Why would I want things that are painful more?

Kelly Casperson: Yeah. The narrative of the female is there's always something wrong with us. We're the problem. We're too small. Somebody came to me and was like, "I'm too small." I'm like, "How about he's too big?"

Corey Allan: Let's make that a problem.

Kelly Casperson: Flip it. How does that feel? It's just taking the weight. I tell you, I'm taking the bricks out of your backpack that you're carrying around.

Corey Allan: And that's good. Let's land there for a second because you're talking about all right, so it's pain during sex. As a urologist, what are some of your first things that you say to address that? Obviously, you need details and so we can make a fictional woman if you want, a fictional patient or just in general, what do you keep seeing?

Kelly Casperson: I keep seeing two things. Again, two things are common. Number one would be the low hormones and this includes breastfeeding women. I just had a baby. I'm breastfeeding, so my estrogen's really low down in my vulva and vagina. That's almost acting like a menopausal pelvis because of our prolactin, our low estrogen. People don't know that. They just think something's horrifically wrong. So breastfeeding and then perimenopause. Perimenopause, again, defined the 10 years around menopause. So we're talking late 30s, this can start happening for people. Just because I think if you made people pick a picture of what a menopause person looks like, I think they're going to check the 75-year-old looking box.

Corey Allan: Yeah. That's what most people think of? It's like, oh, that's way,-

Kelly Casperson: That's what most people think of.

Corey Allan: ... way, way back in our life, yeah.

Kelly Casperson: Yeah. That's like my great grandma or something. It's like no, no, no. Late 30s, you can start having burning with urination, vaginal dryness, dryness with sex, decreased arousal pelvicly. I would say number one, it's hormones for pain with sex, and then number two is they don't take the time to become aroused both psychologically and physically and they just put something in the vagina. Because look at Hollywood. When does sex start? You just put something in the vagina.

Corey Allan: Right. You just start.

Kelly Casperson: As you start, you just start. That's starting. The vagina needs to lengthen, elongate, and tilt and also start having secretions and that comes with arousal, both arousal with vibration and touch externally in the vulva and then psychological arousal. If we put a tampon in, it's not sexually arousing to us. So if we just put something in our vagina without being like, "I'm into it. This is what I want. I'm thinking some good thoughts," whatever we did to warm us up, it's like putting a tampon in and it's like, oh, except for it's bigger and there's a human attached. But it's the arousal part. I always say, are you making sure that you're aroused before you put anything in the vagina? It hurts.

Corey Allan: Yeah. That fits the number one thing I keep telling couples particularly when I get a chance to speak is the best advice I can get to anybody at the start as a couple is slow down. Slow down the process.

Kelly Casperson: Yes.

Corey Allan: Don't speed it.

Kelly Casperson: Slow down.

Corey Allan: Yeah. Don't speed it up.

Kelly Casperson: I have that in my book. It's like, do you try to speed through your vacations? Do you try to speed through your fabulous five-star meals? We literally don't speed through anything else that's supposed to be there just for pleasure.

Corey Allan: Correct.

Kelly Casperson: We're like five-minute home loan, three-minute sex. We're like in a hurry in this country.

Corey Allan: Yeah, but I don't want to equate sex with home loans. I'm sorry. That's not appealing.

Kelly Casperson: Not good. That's not good sex.

Corey Allan: No, that's not. Okay. Then obviously, there could be some medical things that happen and then it starts to go specific from there with the uniqueness of the situation.

Kelly Casperson: Yeah. There are specific conditions such as vaginismus, tight pelvic floor muscles, things like that. More rare things, imperforate hymens, very specific, but then you're going to be like, has this always been this way? Is it this way with tampons? How old are you? What about masturbation? An exam stuff. But I'd say gross generalization, it's a hormone problem or an arousal problem.

Corey Allan: Okay. That's the first places to start. Tell me if I'm off base with this because one of the ways we've always, through the course of Sexy Marriage Radio now, we look at the different aspects of our life. There's an emotional side. There's a spiritual side. There's a mental side. There's a physical side. I got to look at all of them because it could be if I'm having trouble with painful sex, it could be a physical thing. It could also be a mental thing. It could be both. It could be an emotional thing. There's so many aspects. What's sad, tell me if you believe in this too or you're seeing this, I think you agree, I know where we're going with this already because I know what you do for a living, that there's so many of us that don't take it serious enough, put enough emphasis on trying to actually keep finding answers, keep asking questions, keep seeking out. Instead, we just think, oh that's just the lot I've got. That's just what I'm facing.

Kelly Casperson: Well, yeah and I think especially with pain with sex, it's like sex was already not about her. She was already just doing it for him. So she didn't have this great like, this thing was... I'll see that. I'll have women who are like, "I had an amazing sex life and now it hurts. Fix it." But a lot of women are like, "It wasn't that great to begin with. I don't really care. It's just a reason I can stop having sex now." If you don't have that reward center already built up and you don't realize sex is for you, it's for your partner, if that's how it already is, then you're like, "Well, I don't know. What am I really fixing this pain for? I didn't like it to begin with."

Corey Allan: There's not a lot of motivation then to solve something that hasn't really been enjoyable. This don't also fit with the culture in some regards of it's been tilted towards the man and there's also been this thought out there. Well, yeah, the first time is going to be uncomfortable. It will hurt, and oh, well that means every time should.

Kelly Casperson: Mm-hmm. Yeah. We've definitely set women up to expect pain.

Corey Allan: Which is so sad.

Kelly Casperson: That's not super nice.

Corey Allan: Yeah.

Kelly Casperson: That's not super awesome. It just goes to how bad the sex ed. Our sex ed is so bad that instead of educating people on arousal and lube and how to make it not painful, we just tell them it's going to be painful instead of a little bit of education. I was doing another podcast last week and I'm like, a little bit of education fixes a lot of issues.

Corey Allan: Yes, it really does, which that's what I'm hoping we can do. Let's go with the other side of this where you talk about the perimenopausal and the menopausal. That's something that we get quite a bit of emails on as well like you would too. Let's walk through that medically speaking and then physically speaking from your take and your lens. What's going on here? What do women need to know with this? Obviously, you talked about the hormone. Hormone levels are going to change. Estrogen levels are going to go down and so you got vaginal dryness. What else? What do they need to know?

Kelly Casperson: Yeah. I really got into hormones because of my listeners, because they started really, really asking me, so I got into it. One of the questions over and over was like this rumor, I'll call it a rumor now, is that once you hit menopause, there goes your sex life. So I'm like, is it true? Is it true that low estrogen equals no sex life or bad sex life? It's not true. Some of the people who are the most exceptional at sex and have great sex are postmenopause for various reasons. They're completely comfortable. They've got a solid relationship. They know how to ask for what they want. They prioritize their pleasure, all these things that make great sex. So it's not true. But two biggest reasons that women in menopause stop having sex. Number one's availability of partner. Makes perfect sense. Again, we're not always seeking out sex. So partners not around, so we're like, no, we're not having sex. I can't help with that one. That's on somebody else.
But number two is vasomotor symptoms of menopause. Now vasomotor symptoms of menopause are hot flashes, night sweats, changes in mood and anxiety, poor, really crappy sleep. If you're feeling bad, you don't have a sex drive. You're not feeling sexy. You're not feeling desirable. You're not feeling like you want to prioritize paying attention to your body because it already is not being very friendly to you. So vasomotor symptoms of menopause specifically are a huge reason that women decrease having sex. That's where the hormone replacement comes in. If you can fix your sleep, your hot flashes, you're going to feel a heck of a lot better and feeling a heck of a lot better, well, you might want to exercise and eat well and have sex then.

Corey Allan: Okay. On those symptoms of this, do you take them one at a time? Do you take it all across the board? Does hormones address them all? Educate me because I want to help the audience, but I'm married to the currently speaking 49-year-old woman, so preview of coming attractions.

Kelly Casperson: Yeah. Right. That's why men need to know about this too.

Corey Allan: Absolutely.

Kelly Casperson: This is natural and normal. There is nothing wrong with menopause. Now it's really been pushed. It's shameful, again, because I think women's health has just not researched the way men's health is. So we're like, well, they're not even researching it, so this must be super shameful. Let's define menopause just because I think a lot of people again check the box of the 75-year-old. We know she's postmenopause. But the 49-year-olds, you're not really thinking about it. And if you're not thinking about it, you wonder what is wrong with you because you're sleeping poorly. You're getting hot and sweaty, clammy. Your mood has changed. You used to be pretty chill about stuff and now you're a little jumpier. The definition of menopause is the one day. You're in menopause for one day.

Corey Allan: Okay.

Kelly Casperson: One day, that's your day of menopause, one day after 365 days of not having a natural period.

Corey Allan: Okay. That's menopause.

Kelly Casperson: Day two. So it's 367 days, that's day two of menopause, you're now postmenopausal.

Corey Allan: Interesting.

Kelly Casperson: Just to get the language down.

Corey Allan: Okay. Thank you. Okay.

Kelly Casperson: Right? We don't even know that so how can we talk about it if we don't know the right words. Well, then, perimenopause, the 10 years surrounding that one day. You don't know when that one day is ever. It's like retrospective of like, oh, it was 12 years ago or 12 months ago exactly. Now this is a bad definition because many women have hysterectomies. A lot of women have uterine ablations or of IUDs, so they're not getting natural periods.

Corey Allan: Okay.

Kelly Casperson: So it's not a great definition for a lot of people. Then the other thing to know is on average in America, average age of menopause is 51, which means 50% of people, it's happening before age 51.

Corey Allan: Right. Wow. Okay.

Kelly Casperson: Just to normalize that.

Corey Allan: Mm-hmm.

Kelly Casperson: So yeah. Let's say I have a 43-year-old, 44-year-old and she's complaining of these vasomotor symptoms and she's like, "Could it be?" I was like, "Well, yeah. We were within 10 years of 51." Right?

Corey Allan: Right.

Kelly Casperson: So what happens is the estrogen and progesterone go down low enough that they're not spiking that normal ovulation, which isn't triggering the uterine lining to shed and so the ovaries are just slowing down. We don't know why this happens.

Corey Allan: Okay.

Kelly Casperson: There are three other mammals where it happens and they're all in the porpoise family, killer whales or orcas being the most well-known.

Corey Allan: Okay.

Kelly Casperson: There's a theory and this is all theory, but there's a theory that called the grandmother hypothesis. This is more about menopause than you ever wanted to know, but theory called the grandmother hypothesis where evolutionary. If you haven't had a grandma around who wasn't taking care of her own littles and could devote her time and attention to taking care of the other littles, that group of people is going to do a lot better.

Corey Allan: Okay.

Kelly Casperson: That's one theory.

Corey Allan: Okay.

Kelly Casperson: The other theory is we're living way longer than whatever normal was supposed to be and the ovaries didn't catch up. Because you do. If you look at average life expectancy in the 1700s in America, it's pretty low.

Corey Allan: Yeah.

Kelly Casperson: Its pretty low through the 1800s actually.

Corey Allan: Yeah. Well,-

Kelly Casperson: So this is the first time-

Corey Allan: ... throughout human history,-

Kelly Casperson: Throughout human history.

Corey Allan: ... we're anomalies.

Kelly Casperson: Which is why I love when people get up, they get this "natural" on me like, but is it natural to take hormones? I'm like, is it natural to be 62? No.

Corey Allan: Right. Right.

Kelly Casperson: So yeah, I have fun cutting down the natural argument because I'm like, well, if you really want to be natural, typhoid should have gotten you when you were 28, but we actually like not being natural.

Corey Allan: Yes. There's some benefits to it.

Kelly Casperson: There's some benefits to it, yeah. So that's menopause. Estrogen goes down, testosterone goes down. Did you know that women make more testosterone than estrogen in their 20s?

Corey Allan: In their 20s?

Kelly Casperson: Yeah.

Corey Allan: Okay.

Kelly Casperson: Because that's when all of our hormones are the highest, so we're just peaking on the 20s. But there's more testosterone in a woman's body than estrogen.

Corey Allan: Okay.

Kelly Casperson: But what we did is we gendered the hormone. We called it the male hormone. When you gender a hormone, well, now women can't have that. I can't have that. That's the men hormone. We have one-tenth of what men have, but we have more testosterone than estrogen. Just crazy. So that goes down too. If we talk about hormones of desire, that spontaneous desire, that would be the testosterone. Estrogen's a little bit more receptive to sexual advances. If we're going to give a hormone a role, some people say estrogen, it provides lubrication and arousal. It's really important in the pelvis, but estrogen itself is not there for desire. Although some women will say, once I got on my menopause hormones, my desire went way up. But as you know, desire's very complex inaudible psychosocial.

Corey Allan: Yeah, there's not a linear thing with that. It's not like, "Hey, do this," and it'll create that. It's not binary like that.

Kelly Casperson: Yeah. So desires tricky, but I've heard a lot of women. But truly I believe, you start feeling better, your desire's going to naturally go up because you've got more energy. So did estrogen linearly give you desire? I don't know, but you feel a heck of a lot better and now you're desiring sex.

Corey Allan: Okay.

Kelly Casperson: Awesome.

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Let's pivot this just slightly because we've got a message that's come in I want to get your take on as well. If you're talking about hormone levels go down, particularly in the pelvis, what remedies are there? Because there was a woman that talked about she tried hormone pellet therapy and it really helped her, but what are the pros and cons and what else can people do? Obviously, if we move to the UK, we can go get stuff over-the-counter as a breaking news today, but what else? What else can they do?

Kelly Casperson: If we decide that hormones are right for us and I would say vaginal estrogen is very right for all people with vaginas. Vaginal estrogen is just low dose local estrogen. It's not going anywhere else. It's not going to help your hot flashes. It's not going to help your night sweats. It's not going to prevent your bones from getting osteoporosis. This is local hormones, so great for moisture, great for the skin, great to keep blood flow and collagen in the clitoris and the vulva, keeps those structures really sexually healthy and keeps your bladder really healthy too. A lot of women start peeing more having burning with urination with menopause. It's called genitourinary syndrome of menopause. Used to be called vulva-vaginal atrophy, but nobody liked calling it atrophy because it's not nice,-

Corey Allan: No.

Kelly Casperson: ... so they got rid of it.

Corey Allan: That's again degrading to women in the sense of ah.

Kelly Casperson: It's like calling erectile dysfunction a penis failure. It's like we don't do that.

Corey Allan: Or penile atrophy. That's not a good thing either.

Kelly Casperson: Penile atrophy. Yeah, exactly. It's called GSM now. So that's vaginal estrogen, very, very different and one-one hundredth lower the amount of what hormone replacement is. Hormone replacement, still on the order of magnitude, 10 times lower than what birth control is.

Corey Allan: Okay.

Kelly Casperson: Let's not think these are crazy amounts of hormones because it's not. We're not trying to give you your 18-year-old hormones back. We're trying to give you your 30-year-old hormones back, enough to make you feel better and protect your bones.

Corey Allan: Yeah,-

Kelly Casperson: Inaudible

Corey Allan: ... just to boost things, give a little bit of a jump start.

Kelly Casperson: Just to boost things up.

Corey Allan: Yeah.

Kelly Casperson: We're not trying to get you pregnant again.

Corey Allan: Okay.

Kelly Casperson: Let's talk specifically about pellets. Pellets are systemic, not vaginal. It's for your whole body. They're not FDA approved. The national guidelines by the North American Menopause Society actually recommend against compounded or pellet therapy. We do have several papers saying that your risk of side effects are much higher. They're untested. You can't reverse them. You can't pull them out, so they're in there for a couple of months. What I tend to see is a couple of things. Number one, these are from people who really want to make money off of you because the average doctor is pretty bad at hormone management, truthfully. This is why this exists. It's very expensive. Women will say, "I'm spending thousands of dollars on my hormones." I'm like, you do realize menopause is a 40-year-thing. This is why we need cheap vaginal estrogen at Target. This is not a course of antibiotics. This is maintenance forever, so-

Corey Allan: This is an ongoing thing.

Kelly Casperson: ... thousands and thousands of dollars for your hormones. Why would you want to do that when we have safe, proven, insurance-covered, FDA-approved products that have been around for decades? I think the reason is women's doctors, we've stopped teaching doctors how to do this after the Women's Health Initiative came out in 2001. We scared everybody off of hormones.

Corey Allan: Okay.

Kelly Casperson: So that's the number one with pellets is they're not as safe. We do have more side effects, but with higher dosing and then number two, they're very expensive.

Corey Allan: Okay.

Kelly Casperson: So I'd say if you like them, if they're great, go talk to your doctor. Get on an FDA-approved, insurance-covered product, because if you're going to do hormones and you like them, you might want to be on them for a long time.

Corey Allan: Right. We probably needed to lead with this, but there is this element of we're trying to inform and educate with this conversation and then follow up as a listener with your physicians. Ask good questions.

Kelly Casperson: Yeah. It's embarrassing to say. This is for entertainment and educational purposes only. I'm not your doctor. Go talk to your doctor, but everything I say for the most part, unless I'm saying this is my personal opinion, is this is national guidelines stuff. I'm just following the gurus.

Corey Allan: Right, no, I understand. Because what we're trying to do with this conversation, this is what we both try to do with our shows is we're just trying to present really good quality information. Use it, but also for your specific situations, ask specific questions within the context with the people that are walking alongside or helping you to that level, like a doctor-patient relationship.

Kelly Casperson: That's right, because they know your health so much better. Are you healthy? Are you as healthy as you can be? If you're on three high blood pressure medications, you've already had a stroke and a heart attack, you've got gallbladder disease, and your cholesterol's out of whack, you shouldn't be on hormones.

Corey Allan: Right. Okay.

Kelly Casperson: Probably somebody's not going to give them to you. So it's really in the context of, are you healthy enough to take this?

Corey Allan: Okay. Let's pivot from here then. If somebody's hearing this and they're like, okay, I need to bring this up with my doctor. What's the best way they can do that?

Kelly Casperson: Yeah. I would go to the NAMS website. I can send you this link. You can post it in your show notes, but the NAMS, North American Menopause Society just came out with new updated 2022 guidelines for hormones.

Corey Allan: Perfect. Then I'll put them in the show notes. Absolutely.

Kelly Casperson: Print that out.

Corey Allan: Okay.

Kelly Casperson: Yeah. If you read that, you're ahead of 320 million people in this country. But I would bring that in and be like, "Hey, I'm very interested in trying out hormone therapy." What's so interesting, and I think again, this is just part of we have fear so we get stuck, is when we're like, "Should I? Shouldn't I? Should I? Shouldn't I? Should I?" I'm like, how about just try it and see what you think? You can always stop.

Corey Allan: Right.

Kelly Casperson: It's not an amputation.

Corey Allan: Right.

Kelly Casperson: You hate it. You try it, try a couple different doses. See if you tolerate it. Again, going back to like, should I be on hormone therapy? Hormone therapy is not FDA approved for primary prevention of any disease. Because you'll get on the internet now because we're actually starting to support more and more women and be like, hormones are great. How many women do I hear of? You're going to pry this out of my cold dead hands. I'm so much better on hormones. It's life-changing, but it's not a slippery slope, but again, that lack of education like everybody should be on hormones. Everybody should do it. It's going to prevent death and heart disease. We have some evidence that women between the ages of 50 and 60 who are on hormone therapy do live longer. We have some evidence to say it decreases the risk of heart disease. We have some evidence to say it decreases diabetes, midgut weight gain and insulin's resistance. But does that mean it prevents all diseases and everybody should be on it? No.
The other thing it does is decreases your risk of osteoporosis. We can't feel that. We can't feel our bones getting weaker,-

Corey Allan: No.

Kelly Casperson: ... but it's 2% a year starting at age, I think before 50, but it is FDA approved for prevention of osteoporosis.

Corey Allan: Okay.

Kelly Casperson: So point being going back to your lady who's going into her doctor to say, "Hey, I want to be on this." You can be like, "I really want to decrease my risk of osteoporosis. My sleep's horrible. This is all started around age 50." This is my advice for him. Can I just try it and we'll stop if it doesn't work?

Corey Allan: Okay.

Kelly Casperson: Give your doctor an out.

Corey Allan: Right.

Kelly Casperson: Be like, just write for three months and I'll follow-up. If it's not going well, we'll change it or I'll stop.

Corey Allan: Right.

Kelly Casperson: It's a pretty nonthreatening way to ask for a medication.

Corey Allan: Absolutely. But again, that's one of the things I think that's coming clean to me in this conversation, Kelly, is how often do we take these different aspects of our lives and we don't collaborate with the people that are there to help us? We just expect them to lead the charge or tell us what to do or fix it or I do it myself. It's this idea of, oh, no, no, no. I'll figure it out. I've got Google at my disposal. I'll figure it out. I'll find the cure. I'll solve this problem when no, it's still a collaboration all the way through, not even to mention the collaboration-

Kelly Casperson: 100%.

Corey Allan: ... that happens maritally.

Kelly Casperson: Oh, totally.

Corey Allan: Husbands are the ones that are walking alongside going, "What in the world could be going on? I don't have a clue what's going on with your body."

Kelly Casperson: We take your testicles at age 50 and we cut them off. That's menopause.

Corey Allan: That's not a good picture.

Kelly Casperson: It's not a good picture. That's what's happening.

Corey Allan: Right.

Kelly Casperson: But when people are like, "Oh, she's so moody and she doesn't sleep and something's really weird." It's like, yeah, we just cut her testicles off, but you can't see them.

Corey Allan: No.

Kelly Casperson: Right? And she doesn't have the words to explain what's happening because she might not even know what's happening. But this is a legitimate, again, normal, natural, but there's lots of normal, natural things that we do to support people so they feel a lot better.

Corey Allan: Right. But again, that's taking the steps to seek the help, ask the questions, educate yourself, walk alongside. That's the idea. In some regards, that's the reason your show is what it is, is I have a safe place I can ask some questions.

Kelly Casperson: Yeah, because I say funny things like cut off your testicles.

Corey Allan: Well, that adds for the entertainment value of it.

Kelly Casperson: But it makes it real.

Corey Allan: Yeah. Absolutely.

Kelly Casperson: Yeah, exactly. My good friend, Dr. Rachel Rubin, she's a urologist, partner in crime on trying to get this education out, but she's like, "If men's testicles fell off at age 51, there would be a national vaccine. They would take it very, very seriously."

Corey Allan: Right.

Kelly Casperson: You'd be like, they're not interested in sex anymore. They actually don't want to have sex anymore. We need to help them. This is a problem. That's not normal instead of like, well, it's natural. Sorry about your testicles.

Corey Allan: Yeah. Okay. Well.

Kelly Casperson: Have you tried acupuncture?

Corey Allan: Here's a pellet. Stick that under your skin. This will help.

Kelly Casperson: Yeah. I don't blame the women who go get pellets. Truthfully,-

Corey Allan: I get you.

Kelly Casperson: ... they don't know. They don't know it can be cheaper. They don't know their insurance can pay for it. They don't know that the risk of side effects is higher and they just want to feel better. Maybe their doctor didn't help them.

Corey Allan: Yeah. Well, that's the element-

Kelly Casperson: I never want to come across as uncompassionate to her. It's the society she's living in.

Corey Allan: Well, in this also, the element we face is humans and those that are in the helping profession like yourself, that a primary motivator for most humans is when I got pain or discomfort, I just want that to go away. It's not necessarily what's underneath it that could be causing it, it's just make the headache go away. That's all I care about rather than wait, I could have something wrong that I maybe need to keep exploring and that's the impetus of trying to encourage people to take this seriously, ask the good questions, seek the good help to make sure. Not go on expeditions just for fishing purposes necessarily, but to seek it out if it's something that's repetitive and it's known, because that's that same kind of thing. The corollary would be a guy comes in and he had a sexual encounter with his wife and lost his erection or couldn't get one.
Then that's the sneaky little thing of once it's in there, once in the back of your mind, when's it going to happen again? Even though we can all know, well, it's possible that we're all going to face it at some point and I try to normalize that too. Yeah, you will. That can happen, absolutely. But if it happens over and over and over and over and over, well, you might want to check some things out. If it's just a one off, well, okay, what was the circumstances there? What was going on? Okay, and then you're moving on. Some of that can happen with women too of wait, what's the circumstances here? Because it could have been you come across the idea of woman that's been engaged in sex is enjoyable. She has no problem with the lubrication, the arousal, reaching climax, and then all of a sudden, I just don't have the same drive. Well, okay, what else is going on in your life? Some of it's circumstantial.
This is what science is. Nobody has a clear cut this causes this. We can just give you correlations to help make sense of it and then you still have to navigate your path.

Kelly Casperson: Yeah. That's right. It's absolutely right. Think of this. We're just starting to really start giving women hormones again because we were very scared for about 20 years. When women came in and they said, "Hey, I'm a little more anxious. My mood's a little bit more down. I'm having trouble sleeping," we gave them antidepressants and anti-anxiety medications. Well, those have huge sexual side effects. So you're actually creating another side effect from the med that's trying to... Now the hormone experts are like, maybe she just needed some hormones. Maybe we have all these women on these meds and they just needed hormones. Because there are antidepressive, anti-anxiety effects to estrogen. So you decrease your estrogen and you see more of that go up. But it's like now we have sexual side effects from the meds trying to fix the first problem.

Corey Allan: Right.

Kelly Casperson: We're complicated.

Corey Allan: That's also the pharmacological industry. Let's solve a problem and create another one.

Kelly Casperson: Yeah. Absolutely. 100%. To encourage women because I hear this a lot is like, I'm on my second doctor. I'm on my fourth doctor.

Corey Allan: Yes.

Kelly Casperson: After a while, if they're all telling you the same thing, they might be right and they might just not following guidelines. There are some that are way more receptive to understanding that a woman's like, something's just not right. When a woman tells me something, I tend to believe her. She's not coming to hang out with me because she has nothing better to do on a Tuesday.

Corey Allan: Right. She's got something going on that is interrupting her normal functioning or what optimal could be and she's trying to find solutions for it.

Kelly Casperson: Yeah.

Corey Allan: I'd be curious your take on this because of your schooling is the benefits of the whole pelvic floor therapy and understanding what that is, what that can provide, why that's useful.

Kelly Casperson: Totally. Our pelvic organs, bladder, rectum, vagina, uterus, all of that, it meant to just different parts, rests on a bowl of about 12-ish, different small muscles. These aren't biceps and we're not always like, "Hey, I can flex my bicep. I could see what's going on," but we're not as aware of our pelvic floor and our pelvic bowl. Those muscles are incredibly important. They number one, hold things in, but number two, allow things to come through them, urine, poop, babies, stuff like that. So very important that they're dynamic and that they are functioning well. They're a big source of pain and people will be like, but why did I get pain in my pelvis? I'm like, well, I don't know. Why do people have shoulder pain? Why do people have low back pain? Why do people have neck pain? It's just another place we get pain.
We don't always know the reason, but I say, some people just carry their tension. To me, it's my left shoulder. That's where I carry my tension. Some people carry their tension in their pelvic floor, but we're so organ-centric in Western medicine. We're like, it must be my bladder or it must be my uterus or it must be my ovary. We pick an organ and think that's the problem when we have pain because we're not muscle-centric. There's really no doctor that's the muscle expert.

Corey Allan: Okay.

Kelly Casperson: It's really the physical therapists that are the muscle experts. I see this a lot because people will come to see me with "kidney pain," just lateral to their spine. They've got either lumbar pain or costovertebral pain. It's our muscle, but nobody thinks I have muscle pain. We're very organ-centric in Western medicine. So after we have babies, when we put huge strain on these muscles, they need rehab. So pelvic floor physical therapies can help us not leak, can help us not have pain. The other thing that does happen, again, the perimenopause-menopause transition is as much as we lose bone mass, we start losing muscle mass. So as these pelvic floor muscles get weaker, we can develop issues like difficulty holding our organs in, that's vaginal prolapse, or difficulty holding our urine in or getting our urine out. So to me, sometimes I just feel like I'm the gateway person to get people to physical therapy because so much is helped by the muscle gurus, not the organ gurus.

Corey Allan: Right. No. That's so beneficial because I think there's this element of these are the things I don't really want to have to focus on because it requires more maybe.

Kelly Casperson: I know. We shame our pelvises a lot because people are like, do I really need to do vaginal estrogen? Let's pick on vaginal estrogen for a second. Do I really need to do vaginal estrogen? I'm like, I don't know. Do you really need to floss and wear sunscreen and wear a seatbelt? Then they're like, oh. I'm like, you already do tons of stuff that is so routine in your day, you don't even think about. I'm like, I would really prefer not to floss, truly, but it goes poorly when I make that decision.

Corey Allan: Yeah. Me as well. Yes.

Kelly Casperson: That's what it is. I would love to not exercise, but it goes poorly when you don't exercise over the long-term. So I normalize it like that. As far as physical therapies, we need 10,000-mile tune-ups. I'll joke with my patient. You just need a 10,000-mile tune-up and then they're always like, it's probably an 80,000-mile tune-up.

Corey Allan: Yeah. My doc-

Kelly Casperson: Okay, you said it, not me. Let's get you feeling better.

Corey Allan: My doc last year because I hit 50, I'm like, "Dude, I got to come in." He is like, "Yeah, it's a 50,000-mile checkup." I'm like, "Dude, don't frame it that way. I mean it's 50. Yeah, you're right, but 50,000 miles, really? That's a lot of wear."

Kelly Casperson: Right?

Corey Allan: But it is a lot of wear.

Kelly Casperson: I know. So much of I think what humans do is we like to fight with reality.

Corey Allan: Yes.

Kelly Casperson: We just love it.

Corey Allan: Yeah or throw a pill at it.

Kelly Casperson: Oh, definitely. I know. If I could swallow a pill and not need to floss, that's inaudible.

Corey Allan: Or swallow a pill and then leave exercise, yeah.

Kelly Casperson: Yeah, no, they're working on it, but there's-

Corey Allan: I'm sure they are.

Kelly Casperson: ... just nothing like exercise.

Corey Allan: I'm sure there are.

Kelly Casperson: They are. I think that's why the supplement industry, the placebos, the online placebos is what I call them, the people, they just want to feel better and they don't want to have to do any work. Dr. Corey Allan, do you know how challenging it is to talk to your partner about sex?

Corey Allan: Yes, I do.

Kelly Casperson: Could we just have a pill instead?

Corey Allan: Right. Can you just say-

Kelly Casperson: That would be lovely.

Corey Allan: ... "Can you implant my thoughts into their brain so that they just know and then I don't have to say it?"

Kelly Casperson: Yeah.

Corey Allan: Okay. Another topic that keeps coming up-

Kelly Casperson: Or can you just change their desire for me?

Corey Allan: Make it go away. Could I actually cut their testicles off at 50?

Kelly Casperson: Right. So you're saying there could be something. Yeah, but that's hard work, but there is nothing actually that's better than communicating with your partner and understanding your body, taking care of your body. We're so entitled. We're entitled people who like to fight with reality.

Corey Allan: Yes. We need to end it there. So how can people find you so that they can learn more?

Kelly Casperson: Nobody's going to find me now. No, no. She just called me-

Corey Allan: Oh, yes. No, no, no.

Kelly Casperson: ... entitled. I'm not going to find her at all.

Corey Allan: Because I think that if we're intellectually honest with ourselves, we recognize there's truth in that statement among every one of us. Because I actually came across this the other day with the great resignation that's gone on in our country and in the world in a lot of ways over the last two years of COVID and the stimulus money. This was from Mike Rowe, the Dirty Jobs guy. He just made a comment of, if you give humans an easy button, they're going to push it. Right?

Kelly Casperson: Totally.

Corey Allan: We are wired to do good work and be involved in meaningful things and produce things, but we're also going to take shortcuts and take easy ways if it's available to us.

Kelly Casperson: That's right.

Corey Allan: That is part of what our society is, is here's an easier way to do that rather than what's the best long-term benefit of what I should do.

Kelly Casperson: Yeah. To wrap up on this, just to tie up the whole, should I take hormones or should I not, if I'm talking to that 50-year-old woman, she's maybe having some symptoms or she's trying to decide, I say, who do you want to be when you're 74?

Corey Allan: Okay.

Kelly Casperson: What do you want your relationship to be? What do you want your body to be like? How do you want your mind to be and start thinking long-term because we never pay attention to that future self. But when we talk to her, we realize I got to take care of myself for her. She's actually depending upon me to take care of myself for her.

Corey Allan: Right. Yeah.

Kelly Casperson: I just think it's a beautiful thing to think about.

Corey Allan: I'm kind of a cog in this story for my future self that I might want to take that seriously.

Kelly Casperson: Yeah. How can I make her proud?

Corey Allan: Right. Well said.

Kelly Casperson: Okay.

Corey Allan: How can people find you?

Kelly Casperson: Find me. Kellycaspersonmd on Instagram. You Are Not Broken is the podcast. Then here is my beautiful, lovely cover of the book, You Are Not Broken: Stop "Should-ing" All Over Your Sex Life.

Corey Allan: Right. It's very, very good. Highly recommend the book and your show. You do good work, Kelly. It's always a privilege and honor to catch up with you again.

Kelly Casperson: Oh, it's fun to chat. Thank you for having me.

Corey Allan: There's a lot to take away from this episode.

Pam Allan: So much. I appreciated it as a 49-year-old in some of the things that, even talking to my regular physician, that there's not been discussions of some of this stuff.

Corey Allan: Right.

Pam Allan: So much appreciated. You know girl friends that are actually doing the pellets and I'm like, I don't know much about it. I had never asked. From what she's saying, holy cow.

Corey Allan: There's another alternative you could do before and ask some serious questions if you're going to.

Pam Allan: Right, exactly.

Corey Allan: Right, yeah. Because it is so interesting to me and it makes sense in a lot of ways because science is so astounding in the medical world and the fields how things have evolved. If you think about it, I'm 51. You're almost 50 at the time of this recording. Go back several hundred years and we're not alive.

Pam Allan: Well, go back 50 years, I'm not alive.

Corey Allan: No, no, no.

Pam Allan: I guess I'm not following that one.

Corey Allan: In generational times of like-

Pam Allan: Oh, got you.

Corey Allan: You're right though.

Pam Allan: I'm slow today.

Corey Allan: I like how you did the math there. That's good, baby. Well done.

Pam Allan: Yes. Longevity was not expected. Yes.

Corey Allan: Right. So-

Pam Allan: Unless we go back to Methuselah pre-flood years.

Corey Allan: Very well, yes. But it is that idea of just how much has changed and it's so easy to think, well, science will just fix this, solve it with this, do this rather than hold on, there's other consequences that could come from these fixes.

Pam Allan: Yeah. But she added so much into it. Her point of we're entitled and we fight with reality.

Corey Allan: Right.

Pam Allan: So much to grasp from that. Appreciate all. Appreciate her being on.

Corey Allan: Absolutely. Well, transcripts are available in the show notes on each of the episode's pages and all our advertisers' deals and discount codes are also on each of the episode's pages at Please consider supporting those who help support the show. The greatest compliment you can give us is to share the show with those you care about particularly any women in your life that this is speaking to, this particular episode with Dr. Kelly. Share it. Let them know we want to be bearers of good information to help people make informed decisions and have better conversations with their loved ones, their medical professionals, everything. We improve those around us when we improve ourselves, so take on yourself first by applying what you hear from us each and every week. Thanks for listening. We'll see you next time.