#102 Sex, Drugs, and Perimenopause with Kelly Casperson, MD

Read the full episode transcript

Hey, this is Melissa Parsons, and you are listening to the Your Favorite You Podcast. I'm a certified life coach with an advanced certification in deep dive coaching. The purpose of this podcast is to help brilliant women like you with beautiful brains create the life you've been dreaming of with intentions. My goal is to help you find your favorite version of you by teaching you how to treat yourself as your own best friend.

If this sounds incredible to you and you want practical tips on changing up how you treat yourself, then you're in the right place. Just so you know, I'm a huge fan of using all of the words available to me in the English language, so please proceed with caution if young ears are around.

Melissa

Hello everyone! Welcome back to Your Favorite You.

I am so thrilled because I have been waiting to have this conversation forever, and I know that it's going to be worth the wait.

I am joined by none other than the incredible human, urologist, sexual health educator, top international podcaster, author, Ted X speaker, coach, and it sounds like soon-to-be stand-up comic in Las Vegas and friend of mine, Kelly Casperson.

Kelly

Thanks for having me. I love the name of your podcast too. It's so awesome.

Melissa

Thank you. That's so good cause you're gonna be answering questions about your favorite you in just a minute.

Kelly

Oh I love talking about myself.

Melissa

I love it.

OK, so real quick, everybody. Kelly is a board certified urologist.

Kelly

True.

Melissa

And you can correct me at any point here, Kel, whose mission is to empower women to live their best love lives.

Kelly

True.

Melissa

I met her and fell in love with her about four years ago at an event for fellow physician coaches.

Kelly

Seems like an eon ago.

Melissa

Seriously, it's only been like 4 years.

Kelly

Pre-pandemic world.

Melissa

Yeah, yeah, yeah, yeah. And since then she has written a best-selling book. I have it right here. It's called You Are Not Broken. And she is soon releasing a 2nd edition.

Kelly

Yes, it's just a re-release. I didn't have to rewrite anything. I rewrote a sentence.

Melissa

Amazing.

Kelly

Best kind of book release. Seriously, it's the best kind of book release.

Melissa

I love it.

Kelly

Hey, more people buy more of my books. It's pretty easy.

Melissa

Yeah, exactly.

So thank you, Kel, so much for being here.

Kelly

And thanks for having me.

Melissa

As you know, I've been hounding you and very much looking forward to having you on the podcast, because I know my people are going to get so much value from hearing from your beautiful brain.

So I do want to add a quick disclaimer at the front end of this episode to remind you all that although Kelly and I are both physicians, we are not your physicians and any information that we share here is not specific medical advice to you.

And it's up to you to take the info that we provide and talk to your actual doctor about your unique situation.

Anything else you want to add to that, Kel?

Kelly

No, it's awesome.

Melissa

OK, perfect. So we could talk about all the things that we're going to talk about for hours. And unfortunately, both of us, or fortunately I guess, both of us are very busy and neither of us can do that. So we're going to get right to it.

And you already, like, segwayed it so beautifully. I want to ask you the same question that I ask everyone who agrees to be on my podcast. And as you know, the podcast is called Your Favorite You.

So tell us a little bit about your favorite version of Kelly Casperson.

Kelly

Oh, she's super playful and she loves reading, and she's really liking the present moment more and more and more. 

Melissa

How beautiful is that? I'm with you on all three of those points. Like, we women need so much more play in our lives and we just don't give it to ourselves.

Kelly

Oh, I know. It's so fun.

Melissa

Yeah. So I love that.

Kelly

But you need space for it.

Melissa

Yeah. If your calendar is filled up with all the things that society has told you that you must do, it's hard to make time to actually play.

Kelly

Doctors are real bad at it.

Melissa

Real bad at it. 

Kelly

Real, real bad.

Melissa

OK -  I know that you like and you want to help every woman to empower them to live their best and healthiest love lives. And like I said, you even wrote the book about it called You Are Not Broken. So, Kel, why do you think so many of us women think that we are broken in the area of sexual health?

Kelly

Oh, we didn't get any education. So we got a disease and pregnancy prevention plan around 8th grade, if we were lucky. And we know now that the sex ed that's happening in the United States of America now is actually worse than it was in the 90s.

So you were lucky to be taught that sperm goes in eggs and there are diseases in pregnancy and how to basically, you know, how to prevent those things. We were never taught pleasure.We were never taught consent, especially the Gen X, you know, millennial eras. We were never taught how to negotiate sex. We were never taught to communicate about sex, right? And that's actually what sex is. Sex is not always just how to not to get pregnant and how not to get diseases. It's how do you navigate that in a busy family life? How do you navigate that when you both have jobs? How do you navigate that in a long-term committed relationship where novelty is out the freaking window unless you basically create novelty, right?

It's us being thrown into an environment that we never got any education for. And then what do we do? We watch Hollywood movies and that just tells you spontaneous desire and simultaneous orgasm are the default. So you feel very broken. And you know the heteronormative view of a linear sex and penetrative sex, which we know the orgasm gap is worse in heterosexual couples and the gap is not narrowing. A new study just came out, it was just in the New York Times, I think, that the orgasm gap is alive and well in really bad and heterosexual pairings. So we prioritize other people's pleasure above ours. 

Melissa

I saw that it was like 86% or something like that.

Kelly

Yeah. So like the heterosexual male will orgasm 86 to 95% of the time. Depends upon your studies. Very interesting too, because when you look at hookup sex, you know what our kids in college are doing versus, you know, committed loving relationship sex. The orgasm gap does narrow in committed loving relationship sex. But in the hookup culture, I just saw one study where 77% of men will orgasm and 13% of women will orgasm.

So they're having sex for other people, usually intoxicated. And it's a dire situation that they didn't, you know, if the adults aren't saying, hey, this is what happens, this is, you know, really consider what are you doing this for and that you don't have to do it, that, you know, they're going out untrained and uneducated and suffering.

Melissa

Oh my goodness. Yeah. To think about.

Kelly

So we think we're broken, but we didn't get it - There's no adult sex ed.

Melissa

Yes, there is. There's a TEDx talk about it by none other than Kelly Casperson. Which we will link in the show notes.

Kelly

Thank you. It just hit 240,000 views on TEDx YouTube.

Melissa

That's amazing. I love it.

Kelly

I had a cool outfit on. But yeah, that TEDx really.. I was starting that to be a female-centric talk. And then, you know, Ted X is very scripted. You know, it's what's the problem we're talking about? How do you solve it? What blah, blah, blah.

And so it really broke down into biopsychosocial. And because we don't get sex ed, we think it's super simple, like, oh, it's just your hormones. Oh, it's just that you need to buy new lingerie. Oh, you just need a toy. Oh, you just need to like… sex is complicated from desiring it to actually having a functioning orgasm to the option of having pain-free sex. Like sex is actually complicated. And so our default is believing it should be easy or it should be natural or, you know, all these shoulds, right? Which is where the book name came from. So biopsychosocial.

Melissa

Yeah, tell us more about that, because I think some of my listeners are physicians, but many of them aren't. So can you break that down for us?

Kelly

Yeah. I mean sex, I always joke that sex is what got me into coaching, which is true. Like, I'm not just being funny, but like, as a urologist, I can make you have a beautiful pelvis, right? I can give you the vaginal estrogen. I can give you the Viagra. I can send you to the physical therapist so your muscles aren't tight. Like, I can make a functioning pelvis for sex.

But if your head's not right, cause the biggest sex organ is your brain, right? If you think sex is dirty, if you think it's shameful, if you have body image concerns, if you have power dynamics going on in the relationship, if you're doing sex for coercion, right? Just to keep people happy so it becomes a chore, right? Like if any of that's going on, it doesn't matter how good your pelvis is.

So the term the experts use is biopsychosocial, which I hated because it sounded complicated. But it really just means like we're biologic beings, we're social beings and we're psychological beings. And if any of those are messed up, your sex life can be on the rails. So I actually like that term now cause I'm like, you guys, it's just biopsychosocial, but it's helpful.

It's helpful, right? Cause so many people are like, is it just testosterone? Cause I'm a big testosterone proponent, you know, for health. And people are like, “It's just testosterone for libido.” It's like not if you're in, you know, couples counseling because of everybody's anger management issues, right? Like it's not your testosterone.

So sex is wonderfully complicated, but that's what's so great about it. Like I get to podcast about it for the rest of my life cause it's a never ending, fascinating topic.

Melissa

Yeah, you'll never run out of something to talk to because there's so many different factors and different nuance and all that kind of good stuff.

I hear a lot of my clients saying things like, you know, it's just not a priority. It's, you know, the end of the day and you know, their partner is ready to go and they're like, “Oh my God, the last thing I want to do is be touched,” you know, and a lot of them will, you know, “give in” because they don't want to deal with the back end of what they call pouting and moping, that kind of thing that happens.

Kelly

Yeah, it’s coercive.

Melissa

Yeah, yeah. And when you think about it that way, it's like it makes it so easy…

Kelly

Well, no wonder why you don't like it. You know, it's a To Do list. You're just, you're trying to make another person happy in your life. So to me, I'm like, you know, acknowledge them for where they are and be like, yeah, it's not a priority for you. And that's OK.

Melissa

Right.

Kelly

But is it a priority for your relationship?

Melissa

Well, and you can see if, you know, we know that statistics tell us that penis and vagina sex is the type of sex that most heterosexual couples think of as sex. And we know that penis and vagina sex does not lead to orgasm in women unless there is accompanying clitoral stimulation.

You know, why would you want to do something that you actually don't want to do when you know you're probably not gonna have an orgasm and it's not gonna make you feel good? And it makes complete sense to me. I'm always trying to help my people make complete sense of why they are the way that they are.

Kelly

If what's on the plate is mushy broccoli, you can't start liking mushy broccoli, right? You gotta change what's on the plate. And sometimes changing what's on the plate requires an uncomfortable conversation.

Melissa

Always.

Kelly

But nobody's gonna die from that uncomfortable conversation. And it's like you have that uncomfortable conversation and the other myth is like that it's just gonna be one conversation, right? But it's like if intimacy is an important part of the relationship, then you need to talk about it. It doesn't happen by accident and it certainly doesn't happen when two people are very busy without them prioritizing it.

But this is what is very useful, I find, is to have - and you know it's heterosexual relationships get stereotyped, but this could be the male could have low desire, the female could have low desire and what I mean by low desire is just within that couple, the one who could take or leave it more than the other one.

Melissa

Right, yeah.

Kelly

But it’s talk to each other about what sex means. What does it mean to you? Why do you want it when you know I'm freaking exhausted, right?

I'm being very blunt cause it's a short podcast, but it's like you got to lay it out like and and kindly and with listening be like “When you want sex, it makes me just feel like I have to do another thing for somebody.” Say that shit out loud. Not when you're naked and just arguing about sex. Like when you're on a walk and you feel safe and you're like, can we talk about our sex life a little bit?

Like when I'm overworked and it's a Friday night and I just finished dinner and then you want to have sex with me, it makes me feel icky. It makes me feel like there's more I have to do. It makes me feel like I have to do that or you're going to be unhappy with me.

Like these are uncomfortable conversations, but you got to get it out there because you're keeping that sentiment inside. And I guarantee you, if you ask your partner what they get out of sex, you won't know what the answer is. Because stereotypically for men, it's a way to connect, it's a way to know that they're loved, it's a way to know that you care about them.

The physical connection is love, whereas a lot of women, again, I'm stereotyping and it does not apply to everybody. But for a lot of women, we must feel connected and loved before we can then be intimate, right? Often those two people are living in the same house. But we don't know that.

Like, you know, 10 years into my marriage when I was, like, getting to know a lot about sex, I asked my husband, I'm like, hey, what does sex mean to you? And he, like, told me what sex meant to him. And I was like, “No shit?” But how many years do we stay with somebody and not know the answer to that question?

Melissa

Right, right, right.

Kelly

It’s, like, fastianting. And so to, you know, I guess  my advice of like digging out of this hole of like regret because then you start avoiding and then you start feeling bitter, right? Like it compounds and then you're like, I don't like this person anymore. And it's like, “Is it possible this could have gone better had we communicated,” right?

Melissa

Well, and I think so many people are afraid to have the uncomfortable conversation because they're not counting for all the discomfort that they're feeling by not having the conversation. You know, it's like you're going to be uncomfortable either way, at least in this area of discomfort, you might learn something about your partner and be able to make a plan going forward for what might delight each of you and what might make it more that you can connect, you know, with each other on that level. 

Kelly

I mean, it's funny to role play it, right? Cause you're like, OK, what's the worst case scenario? They're gonna tell me that they're only with me because they need sex and they only are using me for like, worst case scenario how do you think this conversation's gonna go right? You're like, if it is very bad and they're like, yeah, yeah, I just like you for sex and I don't otherwise like you and I just need like, if it's very, very bad, isn't it better that you know that too?

Melissa

Right. Exactly.

Kelly

And I guarantee you it probably won't be that bad. They'll be like, “I love you and I miss you. And sex is how I get that communicated to me.” If you're lucky and you have somebody who can communicate well with you, right? No guarantee that if you ask this question, they're gonna be open to it cause men didn't get any secret class in communicating about sex.

Melissa

Not at all, right.

Kelly

So we have to give them grace also of like, I'm ready to talk about sex now cause I listen to a podcast.

Melissa

Well, and I think the other thing that we're not talking about, but that I know that you know and you talk about in the book is that so many of us women don't even really know what feels good to our bodies because we haven't ever looked at our genitalia. We haven't ever taken the time to figure out what does feel good. And you know, so I'm constantly encouraging my people, like, figure that out. Like it's the best information that you can have because you can, I'll steal your term, self-cultivate and, you know, make yourself feel good and you can teach your partner, like, this is what feels good. And, you know, be able to say, you know, a little to the left, a little higher, like, you know, a little harder, a little softer, you know, whatever it is. But until you've kind of done that homework and yourself to know what feels good and what helps you, then it's pretty hard to communicate to anyone else.

Kelly

Yeah, we're we're we're operating in the dark, really. Like we didn't get sex ed. Did you learn about the clitoris and your sex ed? I remember ovaries and uterus.

Melissa

Girl, I went to Catholic school for years.

Kelly

I went to Catholic school.

Melissa

I learned about natural family planning and got sent to the principal's office for saying it worked really well for my grandparents, seven children later.

Kelly

I was in Catholic school in 6th grade and a boy named Ryan brought a whole, like, sheath of condoms to school and was showing them off in the coat room in the back of 6th grade. And I didn't know what they were, but I just remember being like, I didn't know what they were, whatever those are, aren't supposed to be here.

Melissa

Ryan's gonna be in big trouble with Sister Barbara, is what I would have said.

Kelly

Yeah, what's happening at Ryan's house is different than what's happening at my house. I don't know where he got these from. But so we didn't learn anything, and then we learned by kind of fumbling. And if our partners are, you know, have different body parts than us, they're doing what feels good to them, right?

Melissa

Or what they've seen online.

Kelly

Which is happening a lot now. There's just this crazy pull, like it's insulting, but apparently true. Like 80% of men, when asked, think that what they see in porn is how sex works.

Melissa

Oh my word.

Kelly

No, no it's like, you're like, “Really dudes?” Which like the comparison is like watching The Fast and the Furious and thinking that's how you drive Toyota Camrys. I'm like, “No.”

Melissa

Not in my world

Kelly

But no, it's not how… that is entertainment purposes only with like multiple outtakes, props, liquids, gels and aerosols are involved.

Melissa

Well, and I mean just so much attention to the male gaze and what they want and it's like, oh my word, he hasn't paid one lick of attention, pun unintended, to the areas that are actually going to get her going.

Kelly

Men think they're broken too, though, because, you know, their penises don't act like penises act in porn. And then they think there's something wrong with their penis, right? And it's like, no, penises stop getting erect sometimes. That's not like, wherever did anybody learn that penises just don't get erect all the time when you want them to?

Melissa

Right.

Kelly

But if you don't know, if you didn't get any adult sex ed, you're gonna think that you're, you know, and you're supposed to last for like 90 minutes.

Melissa

No thank you is what I say to that.

Kelly

Those are performance enhanced. So yeah, porn is porn is fake.

Melissa

Yeah. And then I think the other thing, you know, as coaches we know that our thoughts create our experience eventually and just being in our heads and self spectating ourselves during sex and like thinking we're doing it wrong or thinking that you know, this isn't supposed to move that way and it is and you know all that it just gets in the way of us being able to actually be in the present moment and play and have pleasure and have fun and experience all the joys that are available to you if you are willing to do some of the homework.

Kelly

When they do functional MRI's of the brain with like people orgasming in the machines, right? And the frontal lobe goes dark with an orgasm, like literally the frontal lobe has to go off. The thinking brain can't function. You know, the experts are like, it's like a two-year-old brain like there's no, there's no intelligent thought happening with an orgasm. And if you're constantly in that frontal lobe being like, this is taking too long, is the lighting OK? Am I going to make a sound? Am I going to blah, blah, blah, blah? You're inhibiting that orgasmic pathway. So it's neuroscience, people.

Lori Brotto wrote Better Sex Through Mindfulness, she's a sex researcher up in British Columbia. She's amazing, done amazing work. But she's basically like being in the present moment and being able to redirect your thoughts of, like, oh, I'm thinking about the dirty laundry, bring it back to the pelvis.

I have found that really like breathing into your pelvis, focusing on the pelvic structures, getting into the body and actually making that a practice can be quite helpful because you're giving your brain a place to go. Especially if you tend to have the ADHD short focus brains of like back to the pelvis. Back to the task at hand. Here we go.

Melissa

OK, girl, let's talk lube.

Kelly

OK

Melissa

I know you love lube.

Kelly

Oh, God. The fact that people have sex with no lube to me is horrifying.

Melissa

And I know that you recommend silicone-based lubes like Gun Oil and UberLube are the ones that you recommended in the book.

And in the first podcast that I did about sex and pleasure, I talked about your book a bunch and I gave the caveat regarding the exception of using water-based lubes if you had silicone sex toys.

And then I just saw you recently posting taking your chances and living dangerously.

Kelly

This is more like less F's given as I'm getting older. Cause it's like this big rule of sex of like, wait, I need water base for your toy. And I'm like, oh darn it, who cares?

Melissa

Who has time to switch?

Kelly

Who has time? And then people are like, well, you know, if you buy low quality silicone toys, like cheap silicone toys it'll be great cause it's not medical grade silicone.

I'm like, well, there's a separate problem. If you buy cheap toys, they might get eroded more. But you know, if you buy nice toys, they hold up pretty well. Wash them when you’re done.

Melissa

Yeah, and if you're using them that much that your silicone lube is hurting your silicone toys..

Kelly

 If you're using them that much, you don’t give an F anyways.

Melissa

But you can buy a new one.

Kelly

Yeah, we're so uptight about the lube on Lube action.

I have a friend who owns a sex toy store. She has a whole wall of lubes and she sells nice silicone toys. And she actually took a thing, a silicone lube and stuck a toy in it for like 24 hours straight and was like, no, still looks good. So it's like there, science.

Melissa

Science. I love it. I love it.

Kelly

I know. I'm like, there is no special part of hell that I'm gonna be sent to if I say use silicone lube with silicone toys. So here I am.

Melissa

Amazing. Amazing. OK. Is there anything else you want to say about sexual health and that type of thing? Because I want to switch gears and talk about perimenopause and menopause and that type of thing. But I don't want to leave anything that you think that my listeners need to know. I mean, I know that there's a shit ton more, but if there was anything else that you were like, I want everybody to know this.

Kelly

That it’s your sex life. It's not somebody else's sex life. It's not your partner's sex life. It's not the sex life you think you should be having. It's your sex life.

And it, you know, like I always have the analogy of like, you know, when you're water skiing and you're like being like drug up, but then when you get on top of the water, you're like, oh, this is so much better. Like, that's my analogy for, like, where you get when you're like, this is my sex life. When do you want to have sex next? What position do you want to use? Oh, OK, What does sex mean to you? That's good to know. OK, well, like, you're on top of the freaking water. It's a nice place to live.

And so I just want to give people like that perspective of, like, there's no there there, right? But I think so many people are just being drugged by the toe rope in regards to their sex life.

Melissa

The other thing I want to get your thought on, and I think I know it already, but I used to think that it was very, like, unsexy to schedule sex and, you know, have it on the calendar and plan for it and that type of thing. I used to think probably because of Hollywood that it should, like, spontaneously, we should both spontaneously erupt and combust at the same time.

And now I think it is so sexy to schedule and to plan and to kind of know. I think it takes pressure off of me. It takes pressure off of Jon. And we know that if for whatever reason it doesn't happen on the planned day, it's like, oh, we still already have it planned for X day. Like, so it just, it has taken so much of the pressure off for us, I think.

Kelly

Yeah, I think a lot of people echo that sentiment and it'll, yeah, that it gives you freedom. You know, people are like “We didn't used to schedule sex.” And I'm like, “Yes, you did.” It was called a Friday night date, right?

So like, oh, right. And like, you didn't see each other all week. Friday was the day that you guys were gonna hang out. If sex was gonna happen, that's when it was gonna happen, right?

Melissa

Yeah.

Kelly

And then they realized, like, oh, scheduling it isn't all that terminally unique.

Melissa

Different. Yeah.

Kelly

And it does take a lot of pressure off of, like, why aren't we having sex right now? Why aren't we having sex right now? Blah, blah, blah.

And just you figure out, like, when do you have more energy in the afternoon? OK, afternoon. Like we tell, we tell our kids that it's nap time. Like we're gonna take a nap. See you later. Someday they'll figure that out.

Melissa

Yeah. Oh yeah. John and I used to have to have a sign on the door because one time Owen walked in on us and we're like, OK, like talk about having the breaks, like come to a screeching halt.

So I was getting coached by Maggie at the time and she was like, you know, you need to do something so that you can relax. And so we put a sign on the door and it basically was a picture of us and it was red and it I can't remember the exact verbiage, but it was something like “Stop. Are mom and dad both home? Is this door closed? Is the house on fire? Is anyone bleeding or broken? If you walk in you may see things that you cannot unsee.”

Kelly

That's amazing.

Melissa

And then, you know, because they just, you know, we're a very open family and like, we just bust into each other's rooms. And when they were younger, it wasn't that big of a deal. But Jon and I realized, like, as they were getting older, they were having and getting more privacy than we were. And we're like, there's something wrong here.

Kelly

Hold on. Who's the boss? Who owns this house?

Melissa

So yeah, we had it up for a little while and then their friends were gonna come over for the weekend or something and they were like, please guys, can you take that sign off the door cause it's right outside of our kitchen.

And I was like, well, can you guys agree to like either not knock when the door is closed or knock and pause and wait before you like try to bust in. So yeah, that created a lot of safety for me cause I was like…

Kelly

That's a very good example. I think people are like… People struggle in prioritizing time for intimacy, right? And it's like, dude, life is busy. And by the way, we've got way more awesome things to simulate dopamine in our brain in 2024 and 2025. Like, think of the 1700s, man. Like sex was as good of a ride as you were going to get on that day. And like, now we have like, I have mint chocolate chip in a freezer and I have Netflix. I continually can scroll Seinfeld clips while eating ice cream. Like, that's literally easier than having sex. Not everybody would agree with that, but it's like, dude, the bar for a dopamine entertainment fix it's completely accessible everywhere now.

In the 1800s you were like, we have potatoes for dinner. Hopefully I can get sex at some point in my life.

Melissa

But I gotta get through all these layers of clothing to make it happen.

Kelly

Yeah, but we have no heat. So we sleep with four animals on our bed.

Melissa

That's amazing.

Kelly

But I mean, you know, like, in all fairness, the world's pretty amazing right now. Everything can distract you from sex. It is a little bit of exercise, you know, like it is a little bit of work.

Melissa

Yeah, yeah, yeah. Work worth having, I think.

Kelly

I think it's work worth having.

Melissa

OK - Let's switch gears.

Kelly

And then menopause hits and it all goes into and then it all goes into shit. 

Melissa

Oh my God, thank you so much for sharing the information about my alloy. I have been on my estrogen and progesterone for like 5 months now. I just went to my OB last week and started testosterone and I feel so much better already. Just the difference in my sleep on the progesterone, like, life changing.

Kelly

Isn't it amazing?

Melissa

The brain fog, the emotional lability for no reason. You know, amazing. I'm so excited to see how much better I feel with adding the testosterone and how much hairier I get or don't get.

Kelly

Hopefully not too much hairier. When dosed responsibly.

Yeah. It's like, it's amazing what happens when you give your body back the hormones that it's been having for three decades.

Melissa

Right. Exactly. And OK, so if you wanted women to know a few really important things about taking care of themselves during this time of their life, what would they be?

Kelly

Exercise.

Melissa

Love it. Strength training, walking…

Kelly

And mobility, range of motion, yoga or not. If you'd have a good relationship with yoga, great. If you don't have a great relationship with yoga, there's amazing flexibility videos, range of motion videos, like get the creaks out. You're like, oh, yeah, that doesn't creak anymore today until I creak again tomorrow. But like, we will stiffen up and we got to keep it moving. We got to keep it moving.

I mean, you see this, I see it more cause I think I take care of older people than you do. But it's like you see people age and doctors have this amazing ability cause I see people age  times a day. And it's like things you just take away from people is like, if you stop moving, you're in trouble.

Melissa

Yeah, so huge.

Kelly

And you know, I did a podcast earlier and we were talking about… they were kind of seeing where my limit was with what I think testosterone can do. And they're like, do you think we have enough data to show that testosterone will help women with their muscles?

And I'm like, no, I don't think we have enough data because we know testosterone will do nothing to your muscles if you don't lift heavy things and eat appropriately, right.

So for people to think that hormones are hormones are amazing, but they're not everything. And certainly if I'm like, you know, I don't think everybody needs to be on hormones, but I do think everybody needs to move their body as much as their body allows.

Melissa

I love it. I love it. I love it. All right, so exercise. Anything else, Kel?

Kelly

Don't drink alcohol.

Melissa

I love it. Tell us why.

Kelly

It's a class 1 carcinogen associated with eight massively common cancers. The World Health Organization calls it a class 1 carcinogen, along with tobacco and asbestos. Yet it's available on every street corner. Absolutely insane.

Women are marketed to. Everybody's marketed to. But like, your body literally can't do anything else while it's processing alcohol out of your body. That's a little extreme of a statement, but like, it prioritizes getting rid of toxins first. Let's just say that. So it sucks at everything else while it's doing that. So it's like, why would you if you're so into health and wellness why would you put a known toxin in your body? It's bizarre.

But that's me now, three years giving up drinking because I was like, I just wanted the next personal growth challenge. I'm like, what's gonna be hard? I'm like, I think giving up alcohol will be hard. Let's do that. So I gave myself a six-month challenge. I used all of the coaching tools that I had learned. And at six months, I'd say it was hard for three to four months because you're literally learning. What to do with your hands?

Melissa

Yeah. And social situations.

Kelly

Yeah. And like, you know how you're switching your taste buds to, like, enjoy sparkling water, which now I freaking love Topo Chico. It's like my family's completely addicted to Topo Chico.

Melissa

Me too girl. We order it from Amazon, and sometimes it's not available in stores here.

Kelly

Then you need to know where it's available for sure. And like, I have family in town and so we like doubled up on the Topo Chico in this house.

But yeah, so your taste buds are adapting, which they do adapt. And by six months, I'm like, I don't see an upside to going back to this. But in the beginning, forever was too big of a thing. So I just had to be like six months. But I'm like, I don't want to miss any part of my kids while they're here. I like my clear-headed mornings. I like my, you know, and I think the other big thing with, this happens in doctors a lot is like, how were you trained? You were trained alcohol in moderation. We were never trained that you shouldn't drink alcohol. I think the alcohol lobby's in on that personally, but you will never read anywhere in medical literature abstinence from alcohol. It'll only say quit if you have a problem.

And then when people are stuck in this, like, do I have a problem? I don't really need to quit if I don't have a problem, so I don't have to quit. Like you're stuck in this like permission slip land of like, no, no, no, no. Life is actually way better with no alcohol in it.

Melissa

Yeah, I agree with you wholeheartedly. I just passed my five year quit date and it  just was like, you're not bringing anything positive to my life. And so I literally wrote a breakup letter to alcohol. Like, it's not you, it's me.

Kelly

You’re so cool. Right, right, right. Like, I know you'll go on to have relationships with many other people after me.

Melissa

Yes, you're gonna be OK.

Kelly

Yeah, yeah, yeah, you're gonna be fine.

It's interesting cause Canada, I think it was last year, Health Canada published there's no safe amount. And Canada has a decent drinking culture. And so the rumor is that America is also looking to say the same thing. And the wine lobbyists and the alcohol lobbyists are basically the biggest lobbyists against America coming down strongly to say that they're like, but the industries, it's like, yeah there's a lot of hands that want us to keep drinking. And for people to not know.

Melissa

It's one of those things where it is like if you're not drinking, like why not like just have a one like what's the big deal?

Kelly

Jim Gaffigan is a stand up comedian and he does this bit about like we don't do that with anything else about why you don't. He's like, oh, you don't eat mayonnaise. Is it OK if I eat mayonnaise?

Melissa

It's so true.

Kelly

Did you have a problem with mayonnaise? It's just like, why do we do that with alcohol? It's like literally no nutrients. And we're like, you have to like, you have to analyze it.

But yeah, I mean, as much as I'm pro hormone, I would be probably pro exercise and pro not drinking more. And you know how I love hormones.

Melissa

I do. I love them too, girl.

So, so many of the people that I know, the women and several of them physicians have said that they are just going to, “Power through menopause.”

Kelly

OK, your life, not mine.

Melissa

They know it's gonna suck and they're willing to put up with it. But from what I understand, yeah, it's a very short-sighted way to think about the effects of the loss of these hormones on our bodies, like our bone health, like preventing fractures, our cardiovascular health. The studies are saying for sure that it helps us not have heart disease as women, our brain health, the risk of dementia, you know, going way down like I'm like, why would you?

Kelly

Totally, all the things.

Melissa

I think it's like as women, we're expected to power through so much stuff and I'm like, that's just complete bullshit.

Kelly

Well, it's normalized suffering for sure. But I mean, I think that, I think it's multifactorial. Number one, a lot of people just don't know what menopause is, right? This is Ovarian retirement, people don't like the word ovarian failure, but it's ovarian senescence, which is a medical term for failure, but it sounds better. But like the ovaries are dunsies.

Now, is that natural? Yes, actually. Multiple species, not just the often quoted  species of whales. Multiple species stop reproduction before they die. Why is this? We don't know. There's a theory that evolutionarily it's good to live at least as long as, if not longer than your ability to reproduce, because you're not dying sooner than your ability to reproduce, right? So that's one theory on it.

But so I like to normalize it and be like, listen, yeast does this, bacteria does this, many mammals do it. It's very hard to study menopause in mammals cause most mammals don't bleed. So very hard to study. But most mammals, when kept in captivity, will live longer than their reproductive lifespan. Now it's really important because there's just this harbor seal at the Portland Aquarium who's turning 49 years old. And they're like, look at this seal it's the second oldest seal ever. Seals usually live 17 to 18 years, but in captivity, she's living to 49 years. She's not still having babies.

And we are kept in captivity, right? Because of antibiotics and sanitation alone, we are living so much longer than we ever lived before. So what we have right now is the very first generation to ever have lived as long as a large population than we ever had. You know, I'm writing a new book on menopause so I was going back and looking at, you know, everybody's like, my great-grandma lived to 92. And it's like, well, you remember that one person because they lived long. You don't remember all the people who died at 42, right?

But there's this, there's this data from like the aristocratic England of like 14 to 1600, right? Who did they keep track of? They kept track of the rich dudes. They weren't keeping track of anybody else, right? The rich dudes lived on average 42 years.

Melissa

Wow.

Kelly

And the rich dudes weren't dying in childbirth either, right? So really, this idea that we're gonna live long, number one isn't natural. We've never done it before. And yes, our ovaries stop before we die, but now our ovaries are stopping 40 years before you die, right?

And so, like, you have to say all those things before you're like, estrogen's a good idea, right? Like, if you were gonna die at 42, you probably don't need to floss daily, right? But you do, because you want to keep your teeth as long as you live. Same with sunscreen. Probably don't need sunscreen if you're gonna die at 42, but you're gonna live a lot of years, right? 

So we already do things to help preserve function, right? And if you just think that menopause is a hot flash and the end of your period, then you don't understand like endocrinology wise, what's happening. And these hormones, they're called sex hormones cause that's how they were researched, right? They were first discovered for the role of fertility, but they really are full body hormones, eurosteroids, estrogen receptors and testosterone receptors are all over the brain, not just in the libido area, all over the brain.

And frankly, you have to make a decision now. Because you can't decide when you're  with heart disease, dementia and osteoporosis to go on hormones. Hormones don't treat disease. Hormones prevent disease. So yeah, we are kind of asking you to make a midlife decision for your future self. And most experts are saying these are so safe that if you decide for you, it's worth it for preventative health, you can be on it.

Now, are we ever going to get an FDA approval for prevention of dementia for estrogen? No, that's not going to happen. Are we going to get an FDA approval on estrogen to prevent heart disease? That's not going to happen. We've done a billion-dollar study. It was called the Women's Health Initiative. It took several decades. Some of it got massively effed up, and we're not going to do it again, especially on a generic medication that's not patentable.

Melissa

Right. Nobody's gonna make any money on it.

Kelly

Nobody's gonna make any money on it. And it takes a lot of money for an FDA approval. So yeah, you have to think critically, like I've spent years doing to be able to build this case. Because if people just see me on Instagram and I'm like, testosterone's great. They're like, who's this nut? Right? But like in the reading I've done, cause again, I'm not a gynecologist. I care about the men too. So I know all the testosterone and men data. But it's like let's pick a freaking disease, pick dementia. Lisa Mosconi's meta-analysis in 2023 is the best, I think strongest, most convincing piece of evidence that when started early, estrogen, the meta-analysis suggests estrogen does decrease the risk of dementia. Because dementia doesn't happen when you sit in the doctor's office and they tell you you have dementia. Dementia happens 20 years prior.

And for example, in Parkinson's disease, 0% of the neurons in the hippocampus are done by the time you get diagnosed with Parkinson's disease. And estrogen decreases the risk of basically all neurologic diseases, decreases the risk of multiple sclerosis, decreases the risk of Parkinson's, decreases the risk of Alzheimer's disease. So are we gonna have a randomized placebo-controlled trial on this? No, we're not gonna have one. So for the purists who are like, I'm gonna wait for one. Like, OK, the Gen Xers don't want to wait. We're taking care of our parents. We see what aging poorly looks like. We want to feel like we can get on top of it.

Melissa

Yeah, I feel so bad for my mom's generation.

Kelly

Yeah, yeah, the boomers are pissed. One of my top episodes on my podcast is the boomers should be pissed. And then they're all like, “We are pissed.” And I'm like, “Well, you're not loud.” Try pissed and loud like. 

Melissa

They've been taught to tamp themselves down and repress themselves

Kelly

Yes, exactly. Which is why I think women don't complain, right? Because we're taught not to. But the world, the world doesn't change.

Melissa

Well hell no. I do not subscribe.

Kelly

I do not consent.

Melissa

Unsubscribe.

Kelly

But yeah, that's my long, like, you can't just come in being like hormones for everybody, it helps everything. Like and a good lifestyle and you have to think about it. Like, what's Western medicine do? We treat disease. We suck at prevention. Come to me when it's bad enough, right? And really, aging well requires that paradigm to be flipped on its head.

Melissa

Yeah, forward thinking. And I think the other thing that we really suck at is, in Western medicine, separating out our body and our mind like they're one and the same.

Kelly

Oh yeah. Let's blame Freud. I think he had something to do with that.

Melissa

I want to leave people on a hopeful note. So what are you excited about coming for us amazing women in the future in terms of either perimenopause, menopause, biopsychosocial sexual health. What are you most excited about, Casperson?

Kelly

Well, one of my favorite things that I do is like helping a kick-ass woman feel better so she can go out. Like, I'm like, I changed the world by helping women go out and change the world.

Melissa

I love it. Me too.

Kelly

That's what I do. I get people off the couch. I get people to be like, you know, they come back and they're like… Just by reading the book. Like, I don't put everybody on medications. You just get a little bit of adult sex ed and then they're like, Oh my God, I talked to my partner about this and we tried XY&Z and like, it's fun. It's like, it is fun.

Melissa

Yeah. Rediscover the joy. Rediscover the playfulness. Rediscover the fun.

Kelly

Yeah, exactly. So yeah, life is not so serious all the time.

Melissa

Right. Yeah, we can have fun.

OK, lady, how can people find you if they want to know more, if they want to work with you, if they want to come to your new practice? I know they have to be local to where you live in Washington.

Kelly

Well, they have to have to come to Washington State. They don't have to be local, they just have to come to Washington State.

Melissa

Oh, OK. Say more that's sexy.

Kelly

Yeah, that's sexy. Yeah, I know. Not everybody is able to do that. But many people are able to do that. You come here, we have a nice time.

People are like, are you going to get multiple state licenses? And I'm like, first of all, I don't have to. Second of all, I do a lot of testosterone. And until testosterone is deregulated or it's not a schedule 3 medication by the DEA, you need multiple, you need a state DEA license, which the states won't even give you. And so for me, I'm like, listen, it's like what I do requires me. I can't get 26 state DEA’s right. First of all, it's $1000 per state. So it'd be insurmountable. But yeah, I do a lot of testosterone. So to me, I'm like, I like Washington State. 

So yeah, I'm opening up a boutique micro practice where I will get to know you. I think that one of the things I think in my burnout is the loss of the doctor-patient relationship and what do people inherently want? They want a relationship. What do doctors inherently want? They want a relationship. I hate it when people don't come back and tell me how they're doing. And I hate it when patients are like, she didn't spend enough time with me. It's like, of course I didn't spend enough time with you. I have 26 people I need to listen to, write orders for and then type up notes for. Like there is not enough time in the insurance-based model. Which is fine if you have a stubbed toe, but it's not fine, especially with hormones when you need to adjust and like the perimenopause, you know, and then we're adding things like testosterone and stuff like that.

Like that's not a one 15 minute visit a year, right? That's not healthcare.

Melissa

Yeah, Nope.

Kelly

So anyways, they can go to kellycaspersonmd.com on my website. I have a clinic page. I like to hang out on Instagram. That's my social media drug of choice. @KellyCaspersonMD. And then the podcast is You Are Not Broken.

Melissa

Amazing. And they can get the re-release of the book. It'll be coming. They can get it at the bookstore.

Kelly

It's on Amazon and Barnes and Noble.

Melissa

OK. Amazing. Thank you so much for sharing your beautiful brain with us. Appreciate it. I love you.

Kelly

Thanks for having me. Love you too.

Melissa

All right. Bye, everybody. Come back next week. I mean, it'll be amazing, I don't know if it'll be this amazing, but it'll be amazing.

Hey. It's still me. If you're listening to this podcast you might have followed all the rules and ticked off all the boxes, but you still feel like something is missing. 

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