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Dr. Kelly Casperson — a urologist, sex educator, and host of a hit podcast — wants you to have great sex. And she knows you probably aren’t. A lot of that, she says, is because most of what we think we know about sex — especially in midlife — is flat-out wrong! She and Reshma get to the bottom of some fundamentals around libido, desire, and hormones, and also give you some tips on how to improve your sex life.

Follow Kelly at @kellycaspersonmd on Instagram. Check out her book and podcast You Are Not Broken.

You can follow our host Reshma Saujani @reshmasaujani on Instagram https://www.instagram.com/reshmasaujani/?hl=en

Let us know how you’re doing in midlife! You can submit your story to be included in this show at speakpipe.com/midlife

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

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To follow along with a transcript, go to lemonadamedia.com/show/ shortly after the air date.

Transcript

SPEAKERS

Speaker 1, Dr. Casperson, Reshma Saujani

Reshma Saujani  00:11

Welcome to My So Called Midlife, a podcast where we figure out how to stop just getting through it and start actually living it, I’m Reshma Saujani, all right, so I’m just gonna come out and say this out of the gate, everything you know and everything I thought I knew about libido and sex in midlife is wrong. Maybe that’s not a surprise to some of you all, but the messaging that I’ve heard for most of my life is as you age, women’s libido drops, the desire for sex goes away, and the only way to keep a healthy sex life is to schedule it and just not talk about it, whether it’s fun or not fun. Here’s the good news. I learned it doesn’t have to be like this. I talked to urologist, Dr. Kelly Casperson, who has literally dedicated the last eight years of her practice to women’s sexual wellness. And you know what her main message was, you’re not broken. You can have good sex. In fact, you can have the best sex of your life. In midlife, Dr Casperson realized that while she’s often able to fix pain or dryness for women, she wasn’t able to fix their lacking sex in their lives. So after years of studying what she wasn’t taught in school, she realized that libido is just more than biology. It’s got to do with what’s happening in our heads and the social aspect of our lives. Dr Casperson set the record straight for me, like you actually don’t have to have sex a certain number of times a month, sex is not dead and over after you turn 35 that men don’t have to be the ones that dominate in bed, that libido is complicated for everyone. She taught me that it’s okay for women to have sex and desire and for us to talk about it and not be ashamed of it if you don’t like the sex you’re having, guess what? It’s time to have a conversation with your partner. So if you’re struggling to figure out how to have good sex in midlife, this is the conversation for you. I want you to listen to it and literally share it with every woman you know. Let’s get into it.

 

Dr. Casperson  04:04

Thanks for finding me. Thanks […]

 

Reshma Saujani  04:06

I know I stopped you. I was like.

 

Dr. Casperson  04:08

Oh, yay, perfect.

 

Reshma Saujani  04:09

I need to talk to this incredible woman. Awesome. My sister and I were nerding out about you yesterday because I sent her one of your videos. She’s a she’s a gynecologist.

 

Dr. Casperson  04:17

Oh, awesome.

 

Reshma Saujani  04:18

Yeah, so and a doctor. Doctors love talk about doctors.

 

Dr. Casperson  04:22

Doctors love doctors.

 

Reshma Saujani  04:26

We talk a lot. Dr Casperson about the midlife mindset and how it is like literally different for everyone. Where do you land? What’s your midlife mindset?

 

Dr. Casperson  04:37

Oh, God, anything’s possible.

 

Reshma Saujani  04:39

Like best time of your life, or medium time of your life?

 

Dr. Casperson  04:43

Best time, and like, I know it, and I know that it’s gonna be fleeting, right? Like I know enough to be like, at some point I won’t be this young, this healthy, my kids at home, all the things, right? So, like, I know how precious it is, which makes it all. Little more special.

 

Reshma Saujani  05:01

It’s almost like, when I was listening to, it’s like the way people talk about their like, life in their 30s, like I gotta.

 

Dr. Casperson  05:07

I was saying I was in surgical residency in my 30s. There was no best of, best of times happening.

 

Reshma Saujani  05:13

I’m just thinking about, I think on Instagram I saw, like a note that Kim Kardashian wrote to herself. And it was basically like she had notes she wrote to herself in her 20s, and she was like, remember, you’ll never look this good, and to be kind to yourself. And it’s kind of like what you’re saying right now about your 50s, which is pretty damn cool,

 

Dr. Casperson  05:30

Yeah, well, you know, we live in this, like, society that says we’re never supposed to age. And, you know, but it’s like, inevitably, we all do. We all will get sick at some point. We all will have loss not to be a downer at the beginning of your talk, but it’s like, no, there’s something very spiritual in that, like knowing that this is fleeting and precious, so choose wisely.

 

Reshma Saujani  05:50

I actually, I was thinking about that the other day. I was playing tennis with my son, and you know, Bucha from 50, he’s like, nine. He’s kicking my ass, by the way, but I’m like, wow. Like, I’m so grateful to be able to be on the court with my son and play right now, yeah, and to move and to at least make him run for it a little bit.

 

Dr. Casperson  06:14

Is there for like, another couple of years?

 

Reshma Saujani  06:19

Yeah, if even, is there anything you’ve done in your 50s that’s, like, been a game changer?

 

Dr. Casperson  06:24

Well, I’m in my 40s.

 

Reshma Saujani  06:25

Oh, sorry, I’m like, aging you.

 

Dr. Casperson  06:26

I’d have to manifest if I was to talk about my 50s right now, game oh god. Well, I just quit my job.

 

Reshma Saujani  06:33

Yay. That’s amazing.

 

Dr. Casperson  06:34

I know I’m on my second book. Second book manuscript just went in. So, yeah, no, the 40s are amazing. Like, you, I got to a point. I hope everybody gets to this point, but I got to a point where you’re, like, the rules are all made up, and you can do whatever you want to do. And like, once you once you truly believe that, watch out, your life can change.

 

Reshma Saujani  06:55

So, like, that’s that’s interesting, because you’re a doctor. And like, I think, like, I know this about my sister, right? It’s like that identity is, like, something that’s really important and to kind of let go of.

 

Dr. Casperson  07:07

Very important. It’s very.

 

Reshma Saujani  07:09

So how’d you do that?

 

Dr. Casperson  07:11

Well, realizing the hospital is not gonna love me back.

 

Reshma Saujani  07:15

Tell me more.

 

Dr. Casperson  07:16

Um, I wasn’t a doctor in the 90s and the 80s and all the like, precious good times that the old people say it was, but it’s like, they current medical system, they will take and take and take and take and take until you get sick and have to quit because you’re sick. And for me, I was like, I want to quit before I get sick. I want to quit because I’m ready for something bigger. And with the education I do now, with the podcast and the writing and the speaking and all of that. I’m like, it is pointless for me to be in the emergency department at two in the morning anymore. Like it doesn’t fulfill me. I But the problem is, you never get taught. Like, do you get taught this growing up? Like, you’re gonna get really, really good at something, and it’s okay to quit that.

 

Reshma Saujani  07:59

No, you don’t get taught that.

 

Dr. Casperson  08:01

You do not get taught that. And so, like, so for me, it was like, but you’re really good at it, right? Like, that was the hardest thing, more than like, because I’m like, I’m a mom, I’m a writer, I’m a podcaster, I’m a woman, I’m a like, I’ve got, you’ve got all these labels, but at the end of the day, you are you, right? So, like, doctor wasn’t the only thing I was hanging on to, and I’ll always be a doctor. Yeah, right. I don’t have to take Medicare to prove that. So it was the, it was the I’m really good at this, and giving it up, that was the biggest problem, because, like, where’s your context for learning how to do that?

 

Reshma Saujani  08:35

You don’t I wrote a book called Brave, not perfect, and it was in the context of girls and young women. But it’s actually the opposite. It’s why women stay longer in jobs like men are actually constantly quitting and growing, and that’s why their promotion rates are much higher. Whereas for us, we get stuck, and we often get stuck because we’re good at our job, not because we’re happy, and we get confused between being good at something and being happy with something. And that’s the thing that we have to actually unlearn and ask fundamentally different questions. I love this.

 

Dr. Casperson  09:05

I’m glad this isn’t just a me problem. I feel so much I feel so much better now.

 

Reshma Saujani  09:09

it’s not a problem. It’s actually a you. It’s a lesson like and I’m so glad we’re starting this podcast with you, sharing that that it oftentimes when you do get good at something, it’s when you’re supposed to quit. Yeah, because now, right, like, doctors don’t get told that that’s for sure. No, no. I think my sister, I totally see that my sister’s life. Okay, so you’re a board certified urologist. You study conditions and diseases that affect the urinary tracts in reproductive organs in people. For a while, you focus on pelvic health, but then about six or seven years ago, you started focusing on the sexual health and women’s sexual wellness. Why? What happened?

 

Dr. Casperson  09:47

It was like the intersection of like, several different things, probably three things. Number one, it was a seven year itch. So I was told in residency by a very wise attending, watch out for the seven year itch. Whether it’s your marriage, your job, whatever it is, it it’s real. And so I was like, Oh, crap, it’s, I’m seven years in. Is this why I’m so bored? I was like, recurrent urinary tract infections over and over, saying the same thing over and over. Like, what was the point of all this training? Is this all there is, am I going to do this until I decide to retire. Like it was kind it was a 70 year inch. It was just like, Yeah, you know, this existential crisis of like, hey, I have an amazingly well paid indoor job, and I’m unsatisfied, right? And so I had actually treated a woman for a long time for bladder cancer, done a very large surgery, cured her of her bladder cancer, and got to really know her, like, loved her. And so she was cured. She would just come in we do our checkups, blah and one day she was crying about her sexless marriage, and I was like, handing her the box of Kleenex, and then the lightning strikes your brain, and the lightning’s like, you don’t know how to help her. And I was and so then I went back to, like, my training, and we were trained like women were difficult. They’re complicated. We’ll never figure them out. And don’t worry, because the gynecologists are taking care of them. Wow, like, that was what I was told. And so at that point I was like, is that true? Is that real? Do we not know anything? Are the gynecologists taking care of female sexual issues. Because, you know, the urologists are the bosses of Viagra, right? Viagra has been on the market since 1998 so I’m like, who’s taking care of the people who are supposed to be sleeping with the people that we’re giving Viagra to?

 

Reshma Saujani  11:33

Right? It’s so it’s like, who is talking to the women. I was listening to one of your podcasts, and you said, when a man would come in and say, I need Viagra. Sometimes he would bring his partner, but no one would turn to her and be like, do you want him to have that Viagra? Like, what’s happening in for you, is sex pleasurable? Are you in pain? Like, what’s happening with your libido? Like, no one asked women the same questions. And so you’re telling me because you weren’t taught that you were supposed to, because that was the work that was like the terrain of the gynecologist.

 

Dr. Casperson  12:04

Gynecologists were taking care of them. And, I mean, I don’t blame the urologist, because it’s like, do you take care of the patient in front of you, but now that I’m wiser and smarter and an expert and and I understand how many women are having incredibly mediocre sex, so a guy comes in for Viagra and I’m like, what’s your plan? And he’s like, I don’t know. And I’m like, so you’re here for a Viagra prescription, and you don’t know what your plan for a harder penis is? And he’s like, I haven’t talked to my wife about it. We haven’t had sex in eight years. And I’m like, do you think walking into the bedroom with a hard dick tonight is gonna solve all your problems. Like, it’s like, it’s so funny to me, it’s a tragic story for them. But like to me, I’m like, oh my god, he has no idea. He thinks this is the answer, right? And so now I do ask, and I thought, like some guys didn’t, wouldn’t have 90 to 95% of guys have not talked to their partner that they were going to go get Viagra that day.

 

Reshma Saujani  13:05

And what they thought about it. So this light bulb goes off, and you’re like, so do you start then asking women who come to your practice like, what’s going on with their sex life, or what happens next?

 

Dr. Casperson  13:16

No, because I didn’t know anything, so I had to learn everything first. So I’m like, you know, started reading the book, started reading the journal. Started just like going to the conferences, like, really, started understanding, like, arousal, desire, general urinary syndrome of menopause, or orgasmic inequality. Like, oh, the vagina is not the organ of orgasm. The clitoris is right. Like, all of this, just all of the things. And then about a year into that, then I started talking to people and helping them out, and like, just saying, like, hey, I care. And a voice in my head was, like, you need to talk. And I’m like, It’s really annoying, but the voice would be there, like, you need to talk, you need to talk. And I really liked podcasts, and so I’m like, Okay, I’ll start podcasts. So five years ago, I started podcasts, and the voice got quiet.

 

Speaker 1  15:56

I think a lot of women don’t know, so I want you to tell me the basics, and what you tell our community the basics. Let’s start with what is a libido.

 

Dr. Casperson  17:22

Libido traditionally means sex drive. Freud kind of coined the term. It’s It’s described as, this is a really awesome word, appetitive. Appetitive means appetite, like, right? So Freud described libido as an appetitive thing, like hunger, thirst, sleep. The only difference is, if you don’t have those three things, you want them more. If you don’t have sex, you don’t often some people be like I do, but most people won’t want it more the less you have it. So it’s not an appetitive drive in many people. But Hollywood portrays sex as spontaneous desire. We kind of get taught that sex is spontaneous desire. There’s a lot of spontaneous desire happening when our hormones are through the roof in teenage years, new relationships to the brain. The brain thinks a new relationship ends around six to 12 months. So in what that means is like, you know the person, you know how they’re like, you just you get habituated.

 

Reshma Saujani  18:18

So that’s so is that your brain when you’re like, married to someone for seven years and you’re no longer really have desires at your brain saying, okay, that’s why?

 

Dr. Casperson  18:26

Yeah, I bet if you put yourself in the right context, you would have desire for some thing. It just might not be the thing you know. You know everything about. That’s just the way the brain works. But people don’t know this because we didn’t get any sex education. We got a disease and pregnancy prevention plan, if you were lucky.

 

Reshma Saujani  18:42

So when women are coming to you and they’re saying, I don’t have desire, or it’s painful, what is going on? So if everyone’s if people are listening like, what is going on for many of them, if they’re sitting and they’re having kind of a mediocre to no sex life.

 

Dr. Casperson  18:57

Yeah, well, I mean, first of all, libido is very complicated. Desire is complicated. Humans are complicated, right? So sex is biopsychosocial, meaning it’s biologic. Can be your hormones. It can be your body. Do you have a sore back? You know, you’re not going to desire sex if you’re Are you a shift worker and you’ve got have, you have a newborn at home, right? So it’s like, what’s going on with your body, affects it, and then your relationship, and then society. What does society say about women who like sex? We give them bad names, don’t we? So here we are not supposed to want sex until you get married, then you’re supposed to want it all the time, and so you’re broken no matter what. Got it right. So that’s society also not serving us so biopsychosocial. But you know, common there’s, I mean, there’s lots of common things, common women have responsive sexual desire. What that means is, when you’re at your job, you’re not thinking about getting laid, but if you put yourself in a sexual context, things are looking good. You’re nice and relaxed. Maybe you’ve got a nice full tummy, whatever you’re like, oh, maybe sex, or maybe you start into the act. You. And then you like it, or maybe you have a great act, and then afterwards, that’s where your desire is. It’s like, oh, my God, I love that. Isn’t that so good? I forget about that. Let’s do that again. Sometime soon, you’re desiring it after it happened, right? So this whole, like stereotypical dogma that desire must come first or sex doesn’t happen, is completely wrong and only explains like a narrow amount of people.

 

Reshma Saujani  20:23

What about women in midlife? Do hormones? Does our aging change?

 

Dr. Casperson  20:29

That it can. For a lot of people in midlife, sex is now freedom. You don’t have to worry about getting pregnant, right? Kids might be out of the house, so you have a lot more time on your hands. You give a lot less F’s about anything, and you’re more there to be, like, I want to connect. I want to feel good. So it’s this myth that the best sex is in your 20s. There’s, you know, there’s this great book called magnificent sex by piggy Klein Platz. And like these are not young people, like, people are having the best sex of their lives, 50s, 60s, 70s, and again, it’s a what does society tell us? Society tells us that only certain people are allowed to have sex, so we don’t have in our mind that the 70 year olds are having a really great time now they might need Viagra. They certainly I hope they’re on vaginal estrogen, right? I hope they’re using lube. So we might have to help ourselves out, because our bodies do change, but they’re the myth that older people aren’t sexually active is a myth.

 

Reshma Saujani  21:28

Have you seen Baby Girl?

 

Dr. Casperson  21:29

I haven’t seen it yet.

 

Reshma Saujani  21:30

Okay, so I will ruin if you, but I want to just throw it up, because I saw it last week with my girlfriends, and it opened up this entire conversation about sex and desire, right? So in the movie, Nicole Kidman has an affair with an intern, and her kind of fantasy, I hope I’m not. I’m ruining it for you, but I have to ask so her fantasy, right? Is to be dominated, right? She has some BDSM fantasies, and the movie kind of portrays it as something that she’s always been ashamed of, and she kind of should be ashamed of. And so I thought that was interesting, right, this idea that a woman over 50 having desire, that there’s something wrong with that, that there’s something to be ashamed of. And I think the other thing that the movie sparked for many women was that, wow, like, we don’t talk to each other about sex. Like, even though most women are probably struggling with their libido or discomfort, or maybe they have a bigger sexual appetite than their partner, they think they’re the only one, right? It’s not a conversation that we’re having out and open, even with our best friends, even with your sexual partner, even with your sexual partner. And then maybe it’s not even gendered, right? Because men are doing the same thing. What is that about?

 

Dr. Casperson  22:56

It’s just so shameful. I mean, we know we traditionally in America, it’s better than some countries, but it’s a, you know, pretty puritanical place, you know, where there’s this big fear that if we teach people about sex, then, like, you know, the 17 year olds are gonna go crazy, and the data doesn’t actually support that. But we don’t get sex education. We don’t get the tools. We don’t know how to communicate about hard things, right? Like, we don’t get taught how to talk about it. And I would say a large amount of people’s sexual issues in midlife is because you’ve been limping along, and then you’re kind of doing like the repetitive Tuesday night buttered noodles meal, and then at some point you’re just like, Oh, right. And so people just need to learn how to talk about it like my, you know, my book, again, is it’s called, you are not broken. Stop shooting all over your sex life, because we just take all these shoulds right? You shouldn’t have fantasies. If you have fantasies, it shouldn’t be BDSM. If you’re a powerful, high powered woman, you shouldn’t want to be dominated. So they’re all wrong.

 

Reshma Saujani  23:59

Yeah, that feels like the social and the psychological parts that you were talking about. Like, how do we change that as a culture?

 

Dr. Casperson  24:05

Start talking, you know, have people like me on your podcast, right? Yeah, is like, because the funny thing is, as soon as you, like, make it safe to talk about, everybody wants to talk about it, right? Like it’s, it’s in everybody’s life. Our society uses it to sell hamburgers and cars, right? Like sex is literally everywhere. Sex is everywhere.

 

Reshma Saujani  24:30

Well, I think the problem with women, or at this age, or actually at any age, is, I would say after marriage, is like, you don’t want to talk about it because you think that you’re not having enough, and that then your friends will judge you right there, there’s, it’s, it’s that same kind of comparison issue. And you don’t want to be like, Oh, if we’re only having sex once a month, that there’s something broken about my marriage. I think that judgment piece is big too.

 

Dr. Casperson  24:55

Huge, and the, again, the myth that a you should be having sex a certain amount of. Times, like, Who made that up, right? And, yeah, is it not quality versus quantity for many people? So yeah, like, it’s, you know, we were talking about earlier, is like you get to a point where you realize it’s all made up, my friend.

 

Reshma Saujani  25:15

Wow, it’s all a con. And is it really just made up for women or for men too?

 

Dr. Casperson  25:20

No men, men are also suffering in our shame filled silent society. Their stereotypes include, are not limited to, but include that they should dominate, that their penis should always be hard and be without fail and never go soft, that their sexual desire should be higher than their female partner sexual desire, that they should want sex all the time, right? Those are all myths that are, again, are untrue, and really make men feel not manly, right there, because they’re comparing it like this is the definition of a man, right? And they don’t feel like they live up to that. And then you realize, like, no, that’s all made up too.

 

Reshma Saujani  26:01

That’s made up. You’re being con too, yeah.

 

Dr. Casperson  26:03

That’s some people some time in your life, but not all people for all the time in their life.

 

Speaker 1  28:32

So what advice do you have for women who are trying in their midlife to improve their sex life? Like, what’s the first what’s 1, 2, 3, what are the first three steps?

 

Dr. Casperson  29:29

Lube, communicate, my book like my book is saved marriages. It’s ended one marriage because it was, it is, and I say, I say it jokingly, because it was a man. Man told me. He’s like, Thank you for your book. It ended my marriage. And I’m like, what? And he’s like, I realized that I was worthy of love and I wasn’t gonna get it, or I was and it was like, the most beautiful thing. So I do my disclaimer is, the book, to my knowledge, has. Did one relationship, but it’s, it’s helped. I mean, everybody’s like, we just didn’t get sex education now we did how to communicate about it, how to prioritize your pleasure. People are like, I don’t desire sex. And I’m like, do you do like the sex you’re having? And they’re like, no, I could take it or leave it. And I’m like, You’re so you’re beating yourself up about not desiring mushy broccoli, right? Like you gotta change the mushy broccoli.

 

Reshma Saujani  30:22

It’s so true. I want to talk about hormones. Um, one of the interviews I was listening to with you, Kelly, you said, you know, the mistake that we made was gendering hormones that right now, any man walking down the street in New York City probably has more progesterone than me right now at like, 49 like, what did you mean by that about gendering hormones?

 

Dr. Casperson  30:47

Well, when they discovered so, you know, we had to discover these things. So we discovered them. And we discovered estrogen first in ovaries, and we discovered testosterone first in testicles. Those are the other things in our bodies make these hormones. But those organs, like, really make a lot of these hormones, and so we discovered them, and was like, oh, male and female, boom, there it is, right? And then we keep forgetting, like, we’ve been giving women testosterone since the 1940s Right? Like men have more estrogen in their body than a post menopausal woman. If you take a man and you block his estrogen, his libido goes down. Estrogen is incredibly important for a man’s sex drive. So it’s like, we keep forgetting all of these things. Like we want it easy. We want it black and white. We want we want testosterone to work for everybody’s libido, and it doesn’t. But in engendering things we we, we keep the conversation too simple.

 

Reshma Saujani  31:45

So what are the basics? Right? Because, again, I think there’s a perception. I had a perception, right, that we have three hormones, but we have hundreds of hormones. If you’re gonna have hundreds of hormones.

 

Dr. Casperson  31:53

Vitamin D is a hormone in our body, right? Like with hundreds of hormones, as far as the sex hormones. And I hate the term sex hormones, because it takes away the fact that it helps your bones, your muscles, your brain, your heart, all the things. But they call them sex hormones again, because we discovered them in testicles and ovaries, but three, four, if you want to count DHEA, which is more of an adrenal hormone, but three commercially available products that we can purchase and use. And so we kind of dumb it down to three, testosterone, estrogen and progesterone.

 

Reshma Saujani  32:27

And every person has different levels of each of those hormones, right? Every person is different.

 

Dr. Casperson  32:32

Well, on any on any given day. I mean, you have, you have in one month, if you’re menstruating, you have like, 30 different days of different hormone levels.

 

Reshma Saujani  32:41

So then what happens in perimenopause for people? So people at a certain age? What happens?

 

Dr. Casperson  32:46

Yeah, so perimenopause is like the big the big black box that, like, you’re gonna it’s hard, you’re hard pressed to find doctors who, like, believe that it’s real. And it’s like, I don’t care what you believe it’s real. It’s like, saying puberty is not real. Is like, puberty is a time that the gonads start producing more hormones, and, like, get online and your periods are wonky, and your moods are crazy, and your skin’s nuts, and it’s like this crazy fluctuating getting online, right then you stay online for a while. But I mean by that is a regular period, and then perimenopause Perry just means surrounding so usually means the time before menopause. There’s no test for it, so you don’t really know, except for, like, ages, a decent ballpark, it can be late 30s, certainly in your 40s, you’re in perimenopause, whether you feel anything or not. But the ovary is sputtering in its ability to put out eggs, and so in in sputtering, it wants to slam more hormones in to try to get an egg out, and that’s why, you know, you lose your fertility, or early 40s, it’s very hard to get pregnant, right? So we’re losing our fertility, but you still have periods for years afterwards, right? People are like, I’m 54 I’m still having periods, but it’s like, you couldn’t have gotten pregnant even five years ago. But in perimenopause, you can spit out periods, but they aren’t always associated with an egg release or ovulation. So that’s why they’re wonky. They’re spaced out. They’re super heavy, they’re super light. Is because that that ovary spitting out an egg and the period it’s starting to become it’s starting to go offline, and that’s why the hormone spikes super high, super low, and that’s why a lot of the experts are like, don’t check your labs on Tuesday and think that that’s how you are. That’s just how you are on Tuesday.

 

Reshma Saujani  34:28

So then, how are you supposed to know what like, if you’re doing HRT like, I’m taking testosterone right now, it’s really improved. I mean, I was like, a bitch on wheels took some testosterone game changer, right? Because I was like, why am I so mad all the fucking time? Like, what like? And it really helped me.

 

Dr. Casperson  34:48

I really glad that you bring that up, because going of a woman, going to a doctor and saying, I’m mad, we are not going to admit that women are not and I have a story about. Thought a woman came in with bladder leakage, started on bladder leakage, and she was like, you know, in late 40s, I was so I asked everybody about hormones now, because I’m Kelly Casperson, and I’m like, you know what’s going on? And she’s like, oh, yeah, really, hot flashes, night sweats, blah, blah, blah. So I threw on an estrogen patch. Sar back fixed her bladder leakage. And I’m like, oh, how’s the estrogen patch going? And she’s like, I have to thank you. You fixed my rage. But she would have never come in and said, I have rage. And to the average person, if you go in and you tell your doctor you have rage, are they going to think about hormones as the first thing I would guess, I would wager some good money that they would not, and so hormones are incredibly important. That’s why I hate that they’re called sex hormones, because these are brain neuro chemicals.

 

Reshma Saujani  35:52

So when you said that, like, we’re fluctuating all the time, and how do you know which hormone to take and how much?

 

Reshma Saujani  35:58

Now, why hasn’t the FDA approved testosterone for women? Because, like, I got some, but I had to find a way.

 

Dr. Casperson  35:58

Again, everybody’s different, and that’s why you have to see it. See an expert for your own thing, but stereo. Stereotypically, testosterone starts declining in women after your 20s. It’s a much more linear decline. We don’t know why, but there’s no cliff that you know. You don’t fall off a cliff at menopause with your testosterone. So slow decline, and then progesterone tends to go down before estrogen does. And so the perimenopause experts will usually start with progesterone and testosterone. Because especially in perimenopause, if you’re having those high spikes again, try to push out the egg, your estrogen can go really high. Sometimes it’s called a loop cycle, breast tenderness, moodiness, stuff like that. So you tend not to start with estrogen in perimenopause, but I just talked to a woman. I’m like, what’s bothering you, you know? And if she tells me what’s bothering her, I can usually decide what I want to start first.

 

Dr. Casperson  36:55

Yeah, this is one of the other big pushes, is in changing the world is an FDA approved female testosterone. It’s gonna come. I think it’s, I think it’s three years away. Again, this is like my gut. So the Women’s Health Initiative was the big study that scared the whole world and said that estrogen causes cancer, and estrogen just to follow up on that, if anybody’s living under a rock, estrogen doesn’t cause cancer. Women’s Health Initiative all has been walked back, but the damage was done. The junior went out of the bottle. Couldn’t get it back in. Still, 22 years later, we still haven’t fully gotten it back in the bottle. That was 2002 women’s testosterone product went up to the FDA right after that, like, oh, four or something like that. And so when they pushed to get it done, it was like too soon, just hormones could not be trusted, and so they said, We don’t have enough safety data. Now, just as a thought experiment, what if we gave you 10 times the dose of any drug, but let’s say it’s testosterone, what if we gave you 10 times the dose because you asked for it, and then we followed you for 50 years and you didn’t die sooner? We have decades of trans male data, decades of transmit the UK published a 50 year study looking at trans men. This is 10 times the female testosterone dose. There’s not any other drug where we can be like we’ve got 10 times the safety data for five decades. That’s how safe testosterone is.

 

Reshma Saujani  38:36

But do you think the reason why the FDA is holding back approval is because we’ve gendered these hormones, and we feel like that, that that is supposed to be for men. Why would we have to approve that for women?

 

Dr. Casperson  38:46

Yeah, I mean, listen, the FDA shouldn’t be stupid. I again, I didn’t learn this in med school. Many people didn’t, but women have four times the amount of testosterone than estrogen in their body.

 

Reshma Saujani  38:57

And I don’t think people know that.

 

Dr. Casperson  38:59

People don’t know that. So, yeah, we gendered it. We said this because this was the pink one and this is the blue one. But it’s like the FDA is not dumb. I don’t think it’s because the FDA doesn’t know that testosterone is not in women’s bodies. It’s because the bar for safety for women is much higher than the bar for safety for men.

 

Reshma Saujani  39:17

Why?

 

Dr. Casperson  39:17

Testosterone got approved for men with six months safety data. Viagra got approved for men, which I’m pretty sure six months safety data. We’ve got multiple year safety data in women, in testosterone, and we’ve got efficacy data, and we still don’t have a product. So number one, the bar for our safety is so much higher that nobody gets anything because it might hurt one person. And we don’t think that way in men.

 

Speaker 1  39:41

Do you think it’s better because they want to control us? To control us? I don’t know. Part of you feels like you just want me to feel like shit in a raging bitch, right? Like, so it’s like, it’s like, yeah, like 15% of women about 50 have left their jobs because of menopause systems. It’s huge.

 

Dr. Casperson  39:55

I have heard, I have heard from a friend, that somebody within the FDA said, what do we need? A bunch. Horny women walking around for so there is that attitude embedded in.

 

Reshma Saujani  40:03

Exactly.

 

Dr. Casperson  40:04

Yeah, and then the other problem is, testosterone is a natural occurring hormone that is very cheap, right? Testosterone is cheap in order to get five year safety data to do that study, to go to the FDA and then only be able to sell it for pennies. That’s not a business plan for anybody. So yeah, we Oh. The other problem with testosterone real quick, is that it is a DEA class three medication. It is categorized like ketamine and Tylenol with Codeine because of the anti doping Act passed by Congress in 1990 because of the Olympic doping scandals of the 80s. So with the other thing we’ve done with testosterone is we’ve made people feel it’s very safe. It must be addictive if it’s scheduled, like ketamine is but that limits our access to getting it and perpetuates the myth that it’s dangerous.

 

Reshma Saujani  40:54

So how do women get testosterone? Right now?

 

Dr. Casperson  40:57

Good question. You can get everything’s off label in America, Australia has an approved female testosterone dose. It’s called androfem. It’s coming to the UK and South Africa as well. So it exists in countries where you can actually get this. By the way, testosterone is over the counter. In Mexico, you can buy it at the airport. Remember going back to everything’s made up, my friends. You can get it in pellets. You can get it injected. You can use a male dose and just dose 1/10 you can compound a cream. I have a cream, that’s what I my practice compounded cream, easy to dose, hard to get too high of a dose. Cheap, idiot proof.

 

Reshma Saujani  41:38

Yeah, idiot proof me.

 

Dr. Casperson  41:40

Yeah, it’s nice.

 

Reshma Saujani  41:43

I do think that what I will say it like I was a little nervous, right? So I’m not doing the dosage I’m supposed to. I’m doing a little bit less, but I noticed that when I do it, I feel it’s literally my husband’s like, what happened to you today? Like I am a different person.

 

Dr. Casperson  42:01

The hormones are important. So you give women testosterone, and they come back, and you check their levels, and you make sure they’re not having side effects, the things they say. And it’s this quality of life. It’s this feeling like myself. It’s this stuff you can’t measure. It’s the my glasses on my face don’t feel as heavy. I actually like people again. Humans are attractive.

 

Reshma Saujani  42:24

I don’t like lose my shit at that the slightest.

 

Dr. Casperson  42:27

Like, lose my shit. Somebody, somebody. One of the women told me, you know that part in The Wizard of Oz where it goes from black and white to Technicolor? That’s my brain on testosterone.

 

Reshma Saujani  42:39

What’s the most powerful information you’ve learned that you think a woman needs to change her midlife experience.

 

Dr. Casperson  42:46

Oh, orgasms are easy if you know how to have them.

 

Reshma Saujani  42:48

Ah, tell us more, Kelly.

 

Dr. Casperson  42:51

Well, it’s you know, especially again, if you look at the heteronormative when, when partnered with a male, she will take longer to orgasm, but when she masturbates, she takes just as long as a man takes to masturbate. But society says they’re difficult. They’re challenging, they’re hard. Like, you know, society put all this on like, Oh, it must be very hard. And it’s like, well, yeah, if you rub a guy scrotum, it might be harder for him to have an orgasm. Meaning, if you put something in a woman’s vagina, it might be hard orgasm, but if you focus on the organ of pleasure, which is the clitoris, it’s actually pretty easy, given what a woman needs to be successful to orgasm is her own body knowledge combined with her sharing that knowledge with her partner, and that combo is orgasmic success for women.

 

Reshma Saujani  43:38

So how do we change the lack of information about women’s health.

 

Dr. Casperson  43:43

Like things like your podcast, like podcasts are incredibly powerful. Podcasts, books, speaking to senators, writing to the FDA, like, it’s grassroots, it’s I think of it. Think of the AIDS epidemic, because this is how I remain out domestic AIDS epidemic was devastating, and nothing was really happening. Who changed it? The patients and the patients advocates changed AIDS healthcare for everybody. See what they were like. Wait for the doctors. Are you kidding me? They see 30 people a day.

 

Reshma Saujani  44:15

Yeah, they’re exhausted.

 

Dr. Casperson  44:16

They’re they’re exhausted. They aren’t curious. They’re just trying to urinate once in their in their day, right? And so it’s like, it’s not going to come down from them, it’s going to come from the people. And doctors will change because they’ll say, God damn it, I had six women in my office this week asking me for for hormones. I should probably figure out what this is about. That’s how it changes. It the ship is turned by the ocean, not the ship.

 

Reshma Saujani  44:44

All right? Well, you’re the best. You’re like my favorite find of 2025.

 

Dr. Casperson  44:49

Well, thanks for friends to for sharing everybody.

 

Reshma Saujani  44:51

This was so awesome. Yeah, and just keep sending us all the amazing things that you’re doing so we can just lift it up and share it with the community. But thank you so much, Dr Casperson.

 

Dr. Casperson  44:59

Oh, thank you. Thanks for your amazing podcast. This was great.

 

Reshma Saujani  45:15

Dr. Casperson said it is a urologist, podcast host and author her book and podcast are both called You Are Not Broken. If you want more advice and information from Dr. Casperson, I highly recommend checking both of them out. Thanks so much for listening to My So Called Midlife. If you haven’t yet, now is a great time to subscribe to Lemonada Premium. You’ll get bonus content from episodes like this one where Dr. Casperson and I talk about why hormones are so helpful for women outside of just libido. Check it out on Apple podcasts and see you next week.

 

CREDITS  46:00

I’m your host, Reshma Saujani, our producer is Claire Jones. Our associate producer is Isaura Aceves.  This series is Sound Design by Ivan Kuraev. Ivan also composed our theme music and performed it with Ryan Jewell and Karen Waltuck.  Our senior supervising producer is Kristen Lepore, and our senior producer is Kryssy Pease. Our VP of new content is Rachel Neel.  Special thanks to our development team, Hoja Lopez, Jamela Zarha Williams and Alex McOwen. Executive Producers include me, Reshma Saujani, Stephanie Whittle Wachs and Jessica Cordova Kramer. Series consulting and production support from Katie Cordova. Help others find our show by leaving a rating and writing a review and let us know how you’re doing in midlife. You can submit your story to be included in this show at speakpipe.com/midlife. Follow My So Called Midlife, wherever you get your podcast, or listen ad free on Amazon music with your Prime membership, thanks so much for listening. See you next week, bye.