108: Dr. Kelly Casperson on Female Sexual Health

Transcript

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Welcome to the Dear Menopause podcast.

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I'm Sonya Lovell, your host Now.

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I've been bringing you conversations with amazing menopause experts for over two years now.

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If you have missed any of those conversations, now's the time to go back and listen, and you can always share them with anyone you think needs to hear them.

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This way, more people can find these amazing conversations.

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Dr Kelly Casperson, welcome to this week's episode of Dear Menopause.

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Thanks for having me Always a pleasure.

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Now it's actually been gosh almost three years, I think, since we actually last sat down and chatted, because you were one of my really early guests on Dear Menopause, and so much has happened in that time.

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The world's changed right Like.

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Three years is a long time in how fast menopause is changing right now.

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Absolutely.

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The narrative has changed.

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You know, the landscape has changed.

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There are so many women now that are much more aware and educated and looking for support, and I feel like your story and the support that you put out, particularly on your podcast and on Instagram and places like that, has changed a bit as well.

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What a great opportunity for a bit of a refresher.

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How about you tell everybody a little bit about who you are and where you're from?

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Yeah, thank you.

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So I'm Dr Kelly Casperson.

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I'm from the States.

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For people who are familiar with all of them, I was born in Minnesota, did urology training, so that's medical school and then surgery for urology, which is kidneys, bladder, changed probably about seven years.

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They always say the seven-year itch, right Like you get a little bored in your career, what are you doing with your life?

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And it was the perfect time for a woman to come into my office with really big sexual health issues that were super distressing and I realized I didn't know how to help her.

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So I went pretty deep into female sexual health and what's up with desire and how does orgasm work.

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And that led me into hormones.

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And I always joke that sex got me into menopause, because people are like well, you know what happens with menopause and I'm like no, like the rumor is that your sex life goes bad.

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But there's actually a lot of people whose sex life gets a lot better, which is fun to discuss.

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But you can't ignore the role of the hormones in both desire, lubrication, arousal, ability to orgasm.

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They're all desperately important.

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Can you have a good sex life without them?

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Yes, but do they help sex lives?

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Yes, so that's what I do now.

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You do and you do it so well, and you have your own podcast which is called you Are Not Broken.

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You have a book with the same name, so super easy to find Kelly and everything that she does out there in the world.

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I guess when I was talking before about how I feel like things have changed a little bit in the sense of what you talk about, I was really kind of talking about how much more we now talk about GSM.

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So the genitourinary symptoms of menopause syndrome of menopause.

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Symptoms of menopause.

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Syndrome of menopause.

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Symptoms of menopause.

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Syndrome technically, because syndrome basically means like three or more constellations of things, so it's like a collection.

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It's the medical term for collection.

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So I feel like we didn't have that terminology last time that we spoke.

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It's a little bit of something that's become, I guess, more formalized in the sense of how people talk about it.

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So I was wondering if you could just kind of bring us up to speed for anybody that's not familiar with GSM as to what that actually means.

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Yeah, so GSM means again, like you said, genital urinary symptoms or syndrome of menopause.

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Coined several years ago, more than three years ago, but before then people really talked about vaginal atrophy, for better or for worse.

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In the 1980s we called it senile vagina, but it's certainly the names.

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Yeah, so the names are getting better.

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Generally.

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Urinary syndrome and menopause is a huge mouthful, so GSM is kind of what we abbreviate it to.

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But the nice thing about it is it kind of tells you why it's happening Menopause.

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But in order for you to know, you actually have to know what menopause is right.

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So a lot of people just think menopause is like no more periods and maybe some hot flashes, and then the hot flashes end.

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That's not what, men, I mean.

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The definition of menopause is the day after a year, after no natural periods right.

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But what's actually happening is the ovarian follicles, not the eggs.

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The follicles which kind of house the eggs.

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You're basically outliving their lifespan and the follicles make hormones.

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So truly what's happening is pelvic changes because of lowering hormones.

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Typically we think about estrogen, but also testosterone does play a role in the genital structures.

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The other reason why GSM is nicer is it attributes this to the urinary things and I'm a urologist so that's important to me.

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So urinary frequency I have to pee all the time.

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Now, urgency I got to go right now.

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Like I can't wait Getting up at night to urinate, which we call nocturia Leakage leaking of bladder or urine when you don't want to Like keys in the door, running water leaking with urgency, leaking with I just my pants are almost down but I can't get there.

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Like why is this leaking before I can get there?

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Increased risk of urinary tract infections.

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They're becoming recurrent, right.

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And if you don't know that this is because of low hormones, then you don't know how to treat it and you end up just throwing antibiotics at the UTIs and overactive bladder medications at the overactive bladder, sure associated with dementia, right?

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So if you don't know why these things are happening, you can't treat it in the best, safest way that actually can resolve the problem.

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Okay, which leads us into what is the best, safest way for a woman in her midlife who's experiencing, let's say, recurrent UTIs.

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That's not antibiotics.

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Yeah, so the most.

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This is how I tell.

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This is what I say when women come to see me.

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I say if I had something that decreased the chance of you getting another UTI by 50% to 60%, would you be interested in that?

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And universally they say, yeahame this, why don't we say what can we do to decrease the chance of a next one?

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And then they're like, okay, that's not a narrative they thought they had right.

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So vaginal estrogen what it does is it repopulates lactobacillus.

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That's a microbiome.

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Microbiomes are hot topics right now, right, gut microbiome, skin microbiome, vaginal microbiome.

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So you need a healthy vaginal microbiome, skin microbiome, you know vaginal microbiome.

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So you need a healthy vaginal microbiome, which means estrogen, right?

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So as you lose your estrogen, the microbiome changes and when the microbiome changes, the vagina becomes less acidic and the acidity produced by the lactobacillus, which is your healthy microbiome, that's what prevents the poop bugs from walking up, going past the yard into the pee, right.

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And so it's like healthy vagina actually is a barrier to keep the gut microbiome where it belongs, so it doesn't start going up into the front side and that's a bladder infection.

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It's a natural prevention yeah yeah yeah, our bodies are smart, man, our bodies are super smart and and I like thinking about it that way because, well, it feels good.

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But then for women to be like we're just giving you back something that you always had right and that was protecting you, just like we'd give you back insulin or we'd give you back thyroid, we'd give you back something that you're just body, you outlived it, and so that kind of helps them understand, because if a woman doesn't understand, she's a lot less likely to go forward with the treatment.

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And the other thing that they don't understand because they don't understand that menopause is forever right.

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When those ovarian follicles stop, they don't start again is that?

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Yes, you have to use the vaginal estrogen in order for it to work.

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It's like sunscreen, right, that doesn't matter.

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If you used sunscreen last August, you still got to use it.

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I love it.

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It's a great analogy.

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Yeah, and I know I'm guilty of forgetting to use my vaginal estrogen every week or every few days.

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It's funny, right?

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I have to remind myself.

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Yeah.

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We get kind of entitled.

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Women are like I don't want to have to use it and I'm like you put a seatbelt on every time you get in the car.

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Do you floss all the time?

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You put sunscreen on all the time.

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Do you put your glasses on every time you read?

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You forget we do things all the time.

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You've got to incorporate a new thing into your system, unless you want to live with low hormones, but then that has consequences.

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It does.

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Yeah, Now, while we're on the topic of vaginal estrogen, there's a couple of things that I want to do to clarify for me I would imagine anyone that's listening or anybody new that's listening I am an estrogen positive breast cancer survivor.

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Now there is this.

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I want to say myth, but it's even more than that, because I hear stories over and over again, Like yesterday I read of a woman who was denied vaginal estrogen because she was an estrogen positive breast cancer survivor.

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Now, that's not right, is it?

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No, you're right, that's not right yeah.

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Yeah, I love that.

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Can we record that so I can replay that to my husband later?

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Yeah, I mean, we have it in America if it's useful for people who don't live in America.

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I don't know how much weight it carries, but our ACOG, which is basically the Society of Obstetrics and Gynecologists, has a position paper online that I encourage women to print out and bring to their doctors, because we, so many women think that, well, the doctor must know.

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And I have to tell you, in regards to menopause and hormones, the doctor doesn't always know.

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We have two generations, that's worldwide.

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We have two generations of trainees that didn't get trained after the Women's Health Initiative happened in 2002.

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So now we're 23 years after right.

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So don't assume that because they say you can't have it, that that's actually based in science.

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Many, many, many studies on the safety of vaginal estrogen with breast cancer survivors and I was like I mean, I'm a urologist so I always compare it to men.

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I could call prostate cancer testosterone-positive prostate cancer.

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We don't call it that right.

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So I think that it contributes to the stigma that a hormone that your body naturally makes is trying to kill you, and the better way to think about it is that hormones are like food.

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Food doesn't cause monsters, but if you have a monster, you got to get rid of the food you don't want to feed the monster in your house.

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Right, treat the monster, then you can bring back some food.

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And vaginal estrogen is so low dose that it doesn't go into your bloodstream.

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It doesn't make you premenopausal again.

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We'll say that it's just such low dose that if you draw your blood you're still in the postmenopausal range.

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Right, it's incredibly low dose.

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So the fear?

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Fear comes from lack of education.

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You educate women.

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They understand things.

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There still might be 22 years of fear in the zeitgeist and ether right that they and their sister and their neighbor and all these other people that like want to kind of they.

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Of course they love her right.

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But it's like if the people who love you aren't educated, they're going to contribute to throwing the fear on you as well.

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Yeah, absolutely.

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And the other area, when we're talking about vaginal estrogen and I know I actually did a podcast episode with this recently with my good friend Joe Wicks and we were talking about the significant campaign that's underway in the US to remove the black box warning so can you just talk us through that a little bit as well?

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Yeah, does Australia have the boxed warning on it?

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Yeah, we do.

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Yeah, you do.

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Yeah, canada has it too.

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So after the Women's Health Initiative, our FDA so that's our Food and Drug Administration basically said we need to warn everybody about the bad things that the WHI found and they put a very scary label.

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We call it the boxed warning.

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It's like the highest scary label that a medication can have, short of it just being withdrawn as a medication, and it basically says stroke, blood clot, heart attacks, probably, I think liver disease is on there, the cancer is on there, but the most concerning one to me.

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I mean, they're all concerning because they're all wrong, but is that?

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It says probable dementia, and for anybody who knows words, probable means more than possible.

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Yeah, right, so it's like crazy strong wording.

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None of it's correct with the current medications that we commonly use.

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Most menopause experts think the boxed warning should come off of systemic estradiol as well, because that doesn't cause any of these things either.

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In addition, it might actually decrease your risk of dementia and decrease.

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It might actually do the opposite of what.

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The warning is not just neutral.

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So most people think that also needs to come off.

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But the very low hanging fruit is the vaginal estrogen because it's not systemic.

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It's incredibly safe.

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Studies after studies after studies have been shown the safety and efficacy of this medication.

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A good example is like a steroid, right?

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So like a steroid cream that you put on your hand because you got to be touched some plant outside is different than you swallowing high doses of steroids.

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Right, they're both called steroids, but the risks are different.

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And so to take estrogen and throw a warning on every single dose route type of estrogen, that's just simply not how the world works.

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My friend actually published a study last year and they said even if a woman is lucky enough to get a vaginal estrogen prescription, 23% will still not use it because she reads the warning label.

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And if the doctor isn't like, well, if you're a label reader, you're going to read this and it's wrong, right?

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So, and everybody, I see I preemptive and I'm like and I'm sorry because that means you have to decide between me and the FDA and that's a crappy position to be put in.

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But you know, the big petition now is like, people want truth.

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They want truth from government labels.

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I always joke like the other government label that we were talking about changing in America recently is the alcohol warning.

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So the alcohol warning says don't use if you're pregnant and don't operate heavy machinery.

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And I'm like that's a very toxic chemical that's associated with seven different cancers, right.

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And they're like don't operate bulldozers with it.

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It doesn't apply to most people.

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So that's that government wording.

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And then you've got this vaginal estrogen on like a product so safe.

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It's over the counter in the UK, it's over the counter in multiple countries, right, I know that's what I was going to say.

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There are countries where they have now provided availability for it over the counter from a pharmacist.

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Yeah, uk happened, maybe 23.

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That happened.

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Finland's over the counter, I think Israel's over the counter, multiple countries, it's over the counter Probably over the counter in Mexico.

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And just going back to one of the things that you were talking about, with the percentage of women that choose, then, not to use it once they get at home, because they read the warning I'm not sure if it was through you or someone else shared a story recently where the woman that took it home she knew that it was safe to use but her husband happened to pick up the packaging and read it and said I don't want you to use this.

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But I think it also goes into what we were talking about before, and that is, you know, the people that love us the most often try to keep us safe, and they're not necessarily coming from a place of education and information, but that's exactly right, yeah, yeah, hey.

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That's exactly right, yeah, yeah, hey.

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If everybody wants to keep everybody safe, like some people die when they take Viagra, what so do we tell everybody not to take Viagra?

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No, no, we do not.

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No, we do not, and that gets pretty much encouraged.

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Yes, so you know, I always say check our bias yeah.

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Great point.

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Check our bias.

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Yeah, I like that very much, kelly Kelly, one of the other areas I wanted to talk to you a little bit about was testosterone.

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It is something that can be really controversial, particularly here in Australia.

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You guys like making mountains out of molehills.

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I'm learning.

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Not all of us.

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Not all of us.

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Thank you for the clarification, but yes, there is a bit of conjecture and gatekeeping and pushback around the use of testosterone.

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So I'm really keen to hear as you know a urologist and somebody that does see male and female patients, you know, I know where you sit on this, but I'd love for you to just kind of explain to everybody listening your thoughts on the use of testosterone.

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Yeah, so it's kind of like.

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It's kind of like GSM, like you have to step back two, two or three paces because if somebody's, like Dr Casperson, just thinks all women should go on testosterone, I was like, well, no, and you know, a lot of women don't even know that testosterone is in our bodies, and so it's.

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I always now like try to step back and be like okay, just so people, so people can catch up.

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Testosterone is in all bodies four times the amount of estrogen in our bodies, right, so ovaries make testosterone.

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We just have 10 to 20 times less than men.

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Like men make tons of testosterone.

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We make more testosterone than estrogen.

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Right, but if people don't have that understanding first, then they are very confused as to why we're talking about giving a male hormone to women, because they don't know that it's an every body hormone.

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So I always lead with that, because now people are like they're a little bit more open to be like holy crap, are you telling me, ovaries make four times the amount of testosterone and estrogen?

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We don't even talk about replacing it?

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No, we rarely talk about replacing it.

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But testosterone receptors are everywhere in our body, right, you give women testosterone.

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Their clitoral artery has more blood flow in it, like.

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We've measured this right.

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It's cool stuff.

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That is very cool stuff.

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It's super cool stuff, like testosterone helps men with erections.

00:16:58.822 --> 00:17:17.596
Testosterone helps women with erections right, we all have the same body parts, so what's interesting about it is, in the sexual health studies, testosterone actually helps all domains of female sexual health, so lubrication, arousal, orgasm, desire and overall sense of well-being in regards to their sex life.

00:17:17.596 --> 00:17:18.858
That's very important.

00:17:19.319 --> 00:17:23.296
In addition, we've got data that it's good for libido.

00:17:23.296 --> 00:17:25.563
It's not great for libido because libido is incredibly complicated.

00:17:25.563 --> 00:17:27.528
This woman was like I've been on testosterone for a year and I still have low libido.

00:17:27.528 --> 00:17:28.291
Libido is incredibly complicated.

00:17:28.291 --> 00:17:35.058
This woman was like I've been on testosterone for a year and I still have low libido, and I'm like libido is incredibly complicated, right.

00:17:35.058 --> 00:17:36.763
It's like how's your relationship?

00:17:36.763 --> 00:17:37.445
How's your stress?

00:17:37.445 --> 00:17:38.175
Are you sleeping?

00:17:38.175 --> 00:17:40.038
How's work, right?

00:17:40.038 --> 00:17:42.124
Do you have a newborn at home?

00:17:42.124 --> 00:17:42.845
Right?

00:17:42.845 --> 00:17:44.788
All of these things affect libido.

00:17:45.255 --> 00:17:48.248
So the other thing to note, though, is libido is a mood, right.

00:17:48.248 --> 00:17:50.376
Where is libido located in your body?

00:17:50.376 --> 00:17:53.984
Your libido is not located in your heart or your armpit.

00:17:53.984 --> 00:17:54.887
It's in your brain.

00:17:54.887 --> 00:18:03.688
Thus proving that and we've got, you know, mri studies showing testosterone in the brain and how testosterone helps nerve cells and helps myelin and helps mitochondria.

00:18:03.688 --> 00:18:09.566
We've got tons of basic science on testosterone and cell function, mitochondrial health.

00:18:09.566 --> 00:18:11.079
Your body works better with it.

00:18:11.079 --> 00:18:21.336
Now what the problem is is we don't have many people actually studying it currently in female bodies, especially in postmenopausal female bodies, right?

00:18:21.336 --> 00:18:28.140
So it's like it's crazy that 50% of the population isn't being studied on something they make four times the amount of than estrogen.

00:18:28.140 --> 00:18:30.064
I mean this doesn't piss everybody off.

00:18:30.064 --> 00:18:31.627
That's pretty mind-blowing.

00:18:31.855 --> 00:18:33.178
It's pretty mind-blowing.

00:18:33.178 --> 00:18:39.999
In addition, we've been giving women testosterone for 80 years, right Started in the 1940s.

00:18:39.999 --> 00:18:42.586
We're giving it for multiple gynecologic reasons.

00:18:42.586 --> 00:18:47.009
We've got good data that again has gotten forgotten because of the WHI.

00:18:47.009 --> 00:18:49.441
Whi happened everybody didn't want to talk about hormones.

00:18:49.441 --> 00:19:00.267
Good data, randomized, controlled data in surgical menopause because surgical menopause is removal of ovaries your ovaries actually make a little bit of testosterone still after your period stop, right.

00:19:00.267 --> 00:19:03.683
So it is a myth that, like your testosterone falls off a cliff with menopause.

00:19:03.683 --> 00:19:04.567
That's not how it happens.

00:19:04.567 --> 00:19:17.419
But especially for surgical menopause, not all studies, but some say estrogen plus testosterone is much better because you're actually replacing better what the ovary had than estrogen alone.

00:19:17.419 --> 00:19:22.087
And we did have a female dose testosterone patch in Europe.

00:19:22.087 --> 00:19:37.185
It was for surgical menopause only, so you had to have removal of ovaries Got taken off the market, not because it was unsafe, not because it didn't work, but because it just didn't sell enough, probably because it was limited to surgical menopause and doctors just didn't know about it.

00:19:37.185 --> 00:19:40.965
And doctors were crappy at helping women with their sex lives, right.

00:19:40.965 --> 00:19:51.769
So, like all of these reasons to be like they've been trying In America, a patch went up to our FDA just about two years after the WHI Didn't get approved.

00:19:52.015 --> 00:19:57.998
Not because it didn't work, but because two years after the WHI, everybody's still thinking hormones are going to kill everybody.

00:19:57.998 --> 00:20:01.326
So the FDA said we want five years of safety data.

00:20:01.326 --> 00:20:08.001
Now for men to get an FDA approved testosterone product of which we have two dozen they needed six months safety data.

00:20:08.001 --> 00:20:12.902
Five-year placebo-controlled safety data trial is about a billion dollars.

00:20:12.902 --> 00:20:18.825
So for anybody to be like, well, we don't have an FDA-approved female dose, that must mean it doesn't work or that must mean it's bad.

00:20:18.825 --> 00:20:23.085
It's like no, this is money on a hormone which is actually very cheap.

00:20:23.085 --> 00:20:24.836
So there's not a lot of money to be made.

00:20:24.836 --> 00:20:28.386
So who's going to pony up a billion dollars to sell a generic medication?

00:20:28.386 --> 00:20:29.855
Zero people.

00:20:30.458 --> 00:20:30.739
And be made.

00:20:30.739 --> 00:20:32.763
So who's going to pony up a billion dollars to sell?

00:20:32.904 --> 00:20:33.385
a generic medication.

00:20:33.385 --> 00:20:33.807
Yeah, zero people.

00:20:33.807 --> 00:20:35.873
And we're lucky, in australia we do have a female you have androfen?

00:20:35.893 --> 00:20:36.294
we have androfen.

00:20:36.294 --> 00:20:38.438
However, it is very expensive.

00:20:38.438 --> 00:20:53.490
It is not on our pbs, so but I use testogel, which is the men's sachet and I just use a tenth of it roughly every day and and that costs me something like $5 or $10 a month or something you know it's huge.

00:20:53.490 --> 00:20:54.336
I mean how?

00:20:54.395 --> 00:21:02.625
crazy is it that a smaller dose is more expensive and that's what I say about America too of like, because the FDA approved product for women is coming.

00:21:02.625 --> 00:21:04.196
This is not a never Like.

00:21:04.196 --> 00:21:07.226
The demand is gaining force.

00:21:07.226 --> 00:21:12.994
I mean, even just if you just look at how many women are in surgical menopause, like it's not a small amount, right.

00:21:12.994 --> 00:21:14.539
So even if they went for that niche.

00:21:14.539 --> 00:21:20.326
But I'm like, listen, if you're going to put it in a pink box and make it cost $500, I'm still going to do what I'm doing now.

00:21:20.326 --> 00:21:28.079
But just having the validation of it is going to expand the conversation all the more, so I'm looking forward to it.

00:21:33.154 --> 00:21:33.817
I'm totally an advocate of it.

00:21:33.836 --> 00:21:35.038
Do you guys have compounding?

00:21:35.038 --> 00:21:35.780
Can you compound in Australia?

00:21:35.780 --> 00:21:36.382
Yeah, we do have compounding.

00:21:36.382 --> 00:21:36.903
Do people compound?

00:21:36.923 --> 00:21:37.464
female testosterone there.

00:21:37.464 --> 00:21:38.707
I don't know about testosterone.

00:21:38.707 --> 00:21:42.483
I know that there's a lot of compounding of progesterone and estrogen.

00:21:42.483 --> 00:21:44.535
I don't know so much about testosterone.

00:21:44.555 --> 00:21:46.537
Yeah because we do a lot of compounding here.

00:21:46.537 --> 00:22:12.498
Because the other thing about testosterone here I don't know where it is with you guys is because of the Olympic doping scandals of the 80s, our Congress passed something called the Anti-Doping Act in 1991, which, through testosterone, is the only natural hormone that our body makes in with all these synthetic, you know, anabolic doping steroids, and so it's classified like ketamine and Tylenol with codeine in America.

00:22:12.498 --> 00:22:14.884
So there's a lot more hurdles to getting it.

00:22:14.884 --> 00:22:16.615
You have to all the barriers.

00:22:16.615 --> 00:22:28.880
So that's the other thing we're working on is like not only is there the gender bias, but it's actually kind of stereotyped as a dangerous product because it's yeah, because it's on this more highly, highly.

00:22:28.880 --> 00:22:32.787
So we're working on trying to get that deregulated yeah, that's interesting, kelly.

00:22:33.008 --> 00:22:44.692
One of the other reasons why we're talking today and you know, doing a bit of a refresher on who you are and what you do is you are coming to australia in a matter of weeks for the so hot right now event in sydney at the.

00:22:44.692 --> 00:22:46.258
I'm very excited to be hot in sydney.

00:22:46.258 --> 00:22:49.849
Yeah, well, I can tell you it is february right now it is be hot in Sydney.

00:22:49.871 --> 00:22:51.134
Yeah, well, I can tell you, it is February right now.

00:22:51.474 --> 00:22:56.448
It is very hot in Sydney, but yeah, so they definitely nailed the theming of that event.

00:22:56.448 --> 00:22:58.738
And it's funny.

00:22:58.738 --> 00:23:04.323
I was chatting recently, or actually like last week, with Louise Newsome Dr Louise Newsome, who is also coming out.

00:23:04.343 --> 00:23:05.125
We love her.

00:23:05.144 --> 00:23:12.922
We do love her and she's also, you know, regardless of being just so super brilliant at what she does, she is one of the nicest people I think I've ever met.

00:23:12.922 --> 00:23:16.578
Yes, she's just gorgeous and smart and charming.

00:23:17.059 --> 00:23:17.781
She's everything.

00:23:17.781 --> 00:23:22.958
She really is All the things and clever and gives the best hugs.

00:23:23.109 --> 00:23:26.740
If you haven't had a Louise Newsom hug, you are in for something she's a good hugger.

00:23:26.740 --> 00:23:34.579
That's awesome, so I'm looking forward to lots of hugs from lots of amazing, clever women like yourself and Louise in a few weeks.

00:23:34.579 --> 00:23:47.307
What can anyone that is lucky enough to be attending the event or has purchased a ticket to the live stream as well now yeah, they just announced live stream, which is very cool it really is.

00:23:47.507 --> 00:23:57.210
But what can, what can everyone kind of expect to hear from you know yourself when you're out here, other than, oh my god, it's so good to be hot, I know I'm just wanting, I'm just hoping to be warm for anybody who doesn't know?

00:23:57.611 --> 00:23:59.354
america is a little chilly right now.

00:23:59.354 --> 00:24:06.244
Um so I give my my sydney House talk, so these are my tasks.

00:24:06.244 --> 00:24:17.085
The tasks are threefold General urinary syndrome and menopause, the safety of vaginal estrogen and then the role of sex testosterone and empowerment, and that's wrapped up into 20 minutes.

00:24:17.387 --> 00:24:20.825
Beautiful and that's good, because we just hit the nail on all of those ourselves.

00:24:20.845 --> 00:24:25.199
Yeah, yeah yeah, we just talked about it, so I should be able to talk about that for 20 minutes.

00:24:29.829 --> 00:24:31.682
I'll let the organizers know all of who I'm very lucky to call close friends, that you know.

00:24:31.682 --> 00:24:32.688
I just gave you a little bit of a warm up.

00:24:32.708 --> 00:24:35.958
Good, I know it's going to be super fantastic.

00:24:35.958 --> 00:24:39.237
It really is, the talk's been written Now I'm working on embodying it.

00:24:39.237 --> 00:24:51.250
We're doing so.

00:24:51.250 --> 00:24:51.750
There's a the day before.

00:24:51.750 --> 00:24:52.711
Nope Medical conference is the day after.

00:24:52.711 --> 00:24:53.152
Thank you very much.

00:24:53.152 --> 00:24:55.653
And then, for people who can't make it to Sydney because it's sold out or you just want to see me, I'll be up in Newcastle.

00:24:55.653 --> 00:24:56.634
I'm getting my Australian days Monday night.

00:24:56.634 --> 00:25:00.018
I was going to say it must be during the week on the Monday night, monday after Okay, yeah, because the medical conference is the Sunday, so so hot.

00:25:00.038 --> 00:25:00.698
Right now is Saturday.

00:25:00.938 --> 00:25:01.259
Saturday.

00:25:01.278 --> 00:25:11.686
Medical conference is Sunday and then you're heading up to Newcastle, which is our central coast, from where I am in Sydney for the event with Shauna Watts and the team up there, which is really exciting.

00:25:11.849 --> 00:25:13.336
And I just, I really want to see a koala.

00:25:13.336 --> 00:25:14.419
Well, you'll find a koala.

00:25:14.670 --> 00:25:20.258
Not that they're hanging out on the side of the road, but look, I'll take you to Taronga Zoo and we'll definitely find you a koala.

00:25:20.258 --> 00:25:30.582
The only thing you have to watch out for is they pee on you out of fear out of spite, like what's the don't know, but it seems to be a common thing.

00:25:30.602 --> 00:25:31.085
They also have chlamydia.

00:25:31.085 --> 00:25:32.128
Oh, I know, that's what I've heard.

00:25:32.209 --> 00:25:35.217
Yeah, yeah, precious thing they are also very cute and cuddly.

00:25:35.217 --> 00:25:39.914
So, oh, best thing ever, yes, no guarantee to find you I wish, I mean if I could, I have.

00:25:40.076 --> 00:25:43.711
I have children and a day job, otherwise I would make it a longer trip.

00:25:43.711 --> 00:25:45.173
But I've been to brisbane.

00:25:45.173 --> 00:25:50.682
I've been to the Gold Coast, the insane beauty of Australian beaches I've been around.

00:25:50.682 --> 00:25:51.585
I've been to Thailand.

00:25:51.585 --> 00:25:54.375
I've been to some nice beaches, australian beaches.

00:25:54.375 --> 00:25:59.211
There is no competition in the world as far as I've been to.

00:25:59.571 --> 00:26:00.375
Very hard to beat.

00:26:00.375 --> 00:26:09.981
Very hard to beat, and as someone who lives on the beaches in Sydney and does a lot of travel overseas and been to some amazing beaches as well, but always come home and go.

00:26:09.981 --> 00:26:11.912
We really do, yeah, nailed it.

00:26:11.912 --> 00:26:13.375
We really do.

00:26:13.375 --> 00:26:15.479
Uh, yeah, we're really lucky.

00:26:15.479 --> 00:26:21.143
Kelly, thank you so much for your time you're very welcome as I said, really excited to have you out here soon.

00:26:21.143 --> 00:26:27.940
Anybody that hasn't got their ticket to the opera house event in particular, there is a live stream available now.

00:26:27.940 --> 00:26:29.363
How cool is that.

00:26:29.363 --> 00:26:29.522
Yep.

00:26:31.471 --> 00:26:35.779
Like everybody, everybody who's anybody in the menopause world and the menopause.

00:26:35.779 --> 00:26:37.364
They're incredible women.

00:26:37.364 --> 00:26:45.529
They're like this is a group I get to speak for myself because I'm just part of it, but like feeling blessed of it.

00:26:45.529 --> 00:26:54.296
But like feeling blessed, but like these are women who are just willing to stick their necks out there for the goodness of women and for the goodness of women to get treated and start feeling more like themselves.

00:26:54.296 --> 00:26:57.849
And, you know, grab the bull by the horn and we've got years left.

00:26:57.849 --> 00:26:59.614
We should feel decent for it.

00:26:59.614 --> 00:27:04.073
And so, like, the women who are truly the advocates for this are incredible people.

00:27:04.294 --> 00:27:19.635
Yeah, I 100% agree and, regardless of the negativity that sometimes comes with the territory of being an outspoken, putting yourself out there fighting the good fight, that's what cuts through in the end and you have to keep it.

00:27:19.635 --> 00:27:25.377
That's the thing that frustrates me the most when I do hear any negativity that does come you know your way, or the whole menopause-y way.

00:27:29.650 --> 00:27:31.962
You know you are all just doing it for the greater good of the women that deserve it.

00:27:31.962 --> 00:27:32.827
That's just so crazy about the hate right?

00:27:32.827 --> 00:27:35.238
Really, we just want to help women.

00:27:35.417 --> 00:27:37.075
Really it does not make sense.

00:27:37.296 --> 00:27:39.836
It's crazy, it's so incredibly frustrating.

00:27:39.836 --> 00:27:41.230
This is the deal.

00:27:41.230 --> 00:27:49.897
There are a lot of people who have vested interests in status quo, whether that means they're making money from it or they have power in it.

00:27:49.897 --> 00:28:09.542
For whatever reason, there is a vested interest in the status quo, and I think that's what we see, because we're literally like dude, we're just telling you what women are telling us from us taking care of them in the clinic, right, we're not making anything up and some people don't want to hear it.

00:28:09.864 --> 00:28:22.951
I shared a quote recently with my good friend, dr Kerry Cashel, because I saw it and immediately thought of her and it's relevant to everyone in the menopause, and that is, if your voice held no power, they wouldn't try to silence you.

00:28:22.951 --> 00:28:25.315
And that's from Ruth Bader Ginsburg.

00:28:26.316 --> 00:28:28.098
Oh, thank you for that.

00:28:28.720 --> 00:28:28.920
Yeah.

00:28:29.200 --> 00:28:36.567
Yeah, I love it, my other, my other one recently, I don't know I'm not sure if this is a quotable one, but it's a different vein.

00:28:36.567 --> 00:28:41.401
But also helpful is like people who hate on you actually probably hate themselves worse.

00:28:41.401 --> 00:28:44.335
That's a good one, Right?

00:28:44.335 --> 00:28:48.323
So you're like yeah, sorry, Go sit on that for a while.

00:28:48.323 --> 00:28:56.798
Yeah, you know, like that's the thing, Like if you truly have time to hate or pick on people like we don't have time for that, we have so many people to help.

00:28:56.798 --> 00:29:01.755
Like, just going back to GSM, right, Generally that's 50 to 80% of women.

00:29:01.755 --> 00:29:05.079
We have data that maybe 5% of women are on vaginal estrogen.

00:29:05.421 --> 00:29:19.851
Yeah, right, and I know there's a lot of talk as well about you know, particularly when we're talking about vaginal estrogen before, but that is that you know there are women of the generations ahead of us that are in nursing homes that should be having this as just a part of their general care.

00:29:19.931 --> 00:29:21.814
Why is it not given to you on admission?

00:29:21.814 --> 00:29:35.115
You know, I actually heard from a nursing aide messaged me today or yesterday and she's like me and my coworkers are taking care of all these frail 95-year-olds who just get urinary tract infection after a year.

00:29:35.115 --> 00:29:44.652
She's like zero of them are on estrogen and so they're trying to figure out how to advocate for the 95-year-olds because they're like this will kill you, right, a UTI will kill you.

00:29:45.354 --> 00:29:50.519
And the prevention 50% decreased risk like there's nothing better than that.

00:29:50.519 --> 00:29:53.692
It's fantastic and it's such low hanging fruit.

00:29:53.692 --> 00:29:56.101
So yeah, we've got a lot of work to do.

00:29:56.101 --> 00:29:58.549
That's why we're like I can't get distracted.

00:29:58.549 --> 00:30:03.334
Responding to the people who think that we should be doing our advocacy a certain way or not.

00:30:03.334 --> 00:30:07.176
A certain way is like listen, I'm a Gen X.

00:30:07.176 --> 00:30:11.619
I kind of had the like thought that the world would be perfect and good, right Like.

00:30:11.619 --> 00:30:18.244
Remember growing up in like the eighties and nineties, and we're like we solved the war, you know, everything's good now because all the adults are in charge.

00:30:18.244 --> 00:30:24.292
And now, like we're, the adults are like oh dude, we got some shit to do.

00:30:24.313 --> 00:30:24.614
Still, we do.

00:30:24.614 --> 00:30:41.413
And how often do we feel like we're progressing and then we just get knocked back a few steps and it's like, yeah, I mean big change doesn't happen overnight, but even just you know, going back to the beginning of like, how different even three years has been yeah right, like we're talking about.

00:30:41.713 --> 00:30:45.220
We're talking about sex way more than we were three years ago.

00:30:45.220 --> 00:30:46.781
We're talking about testosterone.

00:30:46.781 --> 00:30:57.224
I was the crazy person who was like I think isn't it weird that these people aren't having any orgasms, but they're sleeping with the people who are having orgasms all the time.

00:30:57.224 --> 00:30:59.612
Isn't this really weird?

00:30:59.612 --> 00:31:04.960
And now testosterone what's, three years from now, going be?

00:31:05.922 --> 00:31:12.751
yeah, it's gonna be super exciting it is super exciting and that's where I get super excited is the thought of the generations that are coming through behind us.

00:31:12.751 --> 00:31:19.280
You know, not even the generations that are like our kids generations, but like the literal decade behind us that are coming through.

00:31:19.361 --> 00:31:26.602
Yeah, I mean, I think about I think about that all the time because I was at this, you know, thought leader, thought leader space, we'll say in America.

00:31:26.602 --> 00:31:42.220

108: Dr. Kelly Casperson on Female Sexual Health

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