February 13, 2025 • 33 mins
Join me today to dive into the intricacies of vaginal and sexual health with Dr. Kelly Casperson, a leading figure in female sexual health and hormones.
We unpack everything you need to know about Genitourinary Syndrome of Menopause (GSM), highlighting the critical need for understanding and treating these symptoms beyond conventional methods like antibiotics for urinary tract infections.
We dissect the FDA's boxed warnings on estrogen medications, which we also have here in Australia, leading to widespread confusion and at times, fear.
Unpacking the misconceptions surrounding these warnings, particularly the safety of vaginal estrogen, drawing parallels with other regulated substances like alcohol. We also shine a light on testosterone use, unraveling the stigma and biases, especially in countries like Australia, and advocating for a more informed approach to women's health. This episode promises to equip you with the knowledge to challenge outdated views and navigate the evolving dynamics of hormone therapy.
We wrap up by celebrating the powerful advocacy work being done for menopausal women globally, focusing on events in Australia and the ongoing battle against entrenched interests.
Tune in to be inspired and informed about the promising future for women's health!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Sonya (00:01):
Welcome to the Dear Menopause podcast.
I'm Sonya Lovell, your host Now.
I've been bringing youconversations with amazing
menopause experts for over twoyears now.
If you have missed any of thoseconversations, now's the time
to go back and listen, and youcan always share them with
anyone you think needs to hearthem.
This way, more people can findthese amazing conversations,
(00:24):
needs to hear them.
This way, more people can findthese amazing conversations.
Dr Kelly Casperson, welcome tothis week's episode of Dear
Menopause.
Thanks for having me Always apleasure.
Now it's actually been goshalmost three years, I think,
since we actually last sat downand chatted, because you were
one of my really early guests onDear Menopause, and so much has
(00:46):
happened in that time.
Kelly (00:47):
The world's changed right Like.
Three years is a long time inhow fast menopause is changing
right now.
Sonya (00:54):
Absolutely.
The narrative has changed.
You know, the landscape haschanged.
There are so many women nowthat 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 likethat, has changed a bit as well.
What a great opportunity for abit of a refresher.
(01:16):
How about you tell everybody alittle bit about who you are and
where you're from?
Kelly (01:20):
Yeah, thank you.
So I'm Dr Kelly Casperson.
I'm from the States.
For people who are familiarwith all of them, I was born in
Minnesota, did urology training,so that's medical school and
then surgery for urology, whichis kidneys, bladder, changed
probably about seven years.
They always say the seven-yearitch, right Like you get a
little bored in your career,what are you doing with your
(01:50):
life?
And it was the perfect time fora woman to come into my office
with really big sexual healthissues that were super
distressing and I realized Ididn't know how to help her.
So I went pretty deep intofemale sexual health and what's
up with desire and how doesorgasm work.
And that led me into hormones.
And I always joke that sex gotme into menopause, because
(02:10):
people are like well, you knowwhat happens with menopause and
I'm like no, like the rumor isthat your sex life goes bad.
But there's actually a lot ofpeople whose sex life gets a lot
better, which is fun to discuss.
But you can't ignore the roleof the hormones in both desire,
lubrication, arousal, ability toorgasm.
They're all desperatelyimportant.
Can you have a good sex lifewithout them?
(02:32):
Yes, but do they help sex lives?
Yes, so that's what I do now.
Sonya (02:36):
You do and you do it so well, and you have your own
podcast which is called you AreNot Broken.
You have a book with the samename, so super easy to find
Kelly and everything that shedoes out there in the world.
I guess when I was talkingbefore about how I feel like
things have changed a little bitin the sense of what you talk
about, I was really kind oftalking about how much more we
now talk about GSM.
(02:58):
So the genitourinary symptomsof menopause syndrome of
menopause.
Symptoms of menopause.
Syndrome of menopause.
Symptoms of menopause.
Kelly (03:03):
Syndrome technically, because syndrome basically means
like three or moreconstellations of things, so
it's like a collection.
It's the medical term forcollection.
Sonya (03:11):
So I feel like we didn't have that terminology last time
that we spoke.
It's a little bit of somethingthat's become, I guess, more
formalized in the sense of howpeople talk about it.
So I was wondering if you couldjust kind of bring us up to
speed for anybody that's notfamiliar with GSM as to what
that actually means.
Kelly (03:29):
Yeah, so GSM means again, like you said, genital urinary
symptoms or syndrome ofmenopause.
Coined several years ago, morethan three years ago, but before
then people really talked aboutvaginal atrophy, for better or
for worse.
In the 1980s we called itsenile vagina, but it's
certainly the names.
Yeah, so the names are gettingbetter.
Generally.
Urinary syndrome and menopauseis a huge mouthful, so GSM is
(03:55):
kind of what we abbreviate it to.
But the nice thing about it isit kind of tells you why it's
happening Menopause.
But in order for you to know,you actually have to know what
menopause is right.
So a lot of people just thinkmenopause is like no more
periods and maybe some hotflashes, and then the hot
flashes end.
That's not what, men, I mean.
The definition of menopause isthe day after a year, after no
natural periods right.
But what's actually happeningis the ovarian follicles, not
(04:17):
the eggs.
The follicles which kind ofhouse the eggs.
You're basically outlivingtheir lifespan and the follicles
make hormones.
So truly what's happening ispelvic changes because of
lowering hormones.
Typically we think aboutestrogen, but also testosterone
does play a role in the genitalstructures.
The other reason why GSM isnicer is it attributes this to
(04:39):
the urinary things and I'm aurologist so that's important to
me.
So urinary frequency I have topee all the time.
Now, urgency I got to go rightnow.
Like I can't wait Getting up atnight to urinate, which we call
nocturia Leakage leaking ofbladder or urine when you don't
want to Like keys in the door,running water leaking with
urgency, leaking with I just mypants are almost down but I
(05:00):
can't get there.
Like why is this leaking beforeI can get there?
Increased risk of urinary tractinfections.
They're becoming recurrent,right.
And if you don't know that thisis because of low hormones,
then you don't know how to treatit and you end up just throwing
antibiotics at the UTIs andoveractive bladder medications
at the overactive bladder, sureassociated with dementia, right?
(05:21):
So if you don't know why thesethings are happening, you can't
treat it in the best, safest waythat actually can resolve the
problem.
Sonya (05:29):
Okay, which leads us into what is the best, safest way
for a woman in her midlife who'sexperiencing, let's say,
recurrent UTIs.
That's not antibiotics.
Kelly (05:38):
Yeah, so the most.
This is how I tell.
This is what I say when womencome to see me.
I say if I had something thatdecreased the chance of you
getting another UTI by 50% to60%, would you be interested in
that?
And universally they say,yeahame this, why don't we say
what can we do to decrease thechance of a next one?
And then they're like, okay,that's not a narrative they
(06:10):
thought they had right.
So vaginal estrogen what it doesis it repopulates lactobacillus
.
That's a microbiome.
Microbiomes are hot topicsright now, right, gut microbiome
, skin microbiome, vaginalmicrobiome.
So you need a healthy vaginalmicrobiome, skin microbiome, you
know vaginal microbiome.
So you need a healthy vaginalmicrobiome, which means estrogen
, right?
So as you lose your estrogen,the microbiome changes and when
(06:32):
the microbiome changes, thevagina becomes less acidic and
the acidity produced by thelactobacillus, which is your
healthy microbiome, that's whatprevents the poop bugs from
walking up, going past the yardinto the pee, right.
And so it's like healthy vaginaactually is a barrier to keep
the gut microbiome where itbelongs, so it doesn't start
(06:54):
going up into the front side andthat's a bladder infection.
It's a natural prevention yeahyeah yeah, our bodies are smart,
man, our bodies are super smartand and I like thinking about
it that way because, well, itfeels good.
But then for women to be likewe're just giving you back
something that you always hadright and that was protecting
you, just like we'd give youback insulin or we'd give you
(07:14):
back thyroid, we'd give you backsomething that you're just body
, you outlived it, and so thatkind of helps them understand,
because if a woman doesn'tunderstand, she's a lot less
likely to go forward with thetreatment.
And the other thing that theydon't understand because they
don't understand that menopauseis forever right.
When those ovarian folliclesstop, they don't start again is
(07:35):
that?
Yes, you have to use thevaginal estrogen in order for it
to work.
It's like sunscreen, right,that doesn't matter.
If you used sunscreen lastAugust, you still got to use it.
Sonya (07:46):
I love it.
It's a great analogy.
Yeah, and I know I'm guilty offorgetting to use my vaginal
estrogen every week or every fewdays.
It's funny, right?
I have to remind myself.
Yeah.
Kelly (07:56):
We get kind of entitled.
Women are like I don't want tohave to use it and I'm like you
put a seatbelt on every time youget in the car.
Do you floss all the time?
You put sunscreen on all thetime.
Do you put your glasses onevery time you read?
You forget we do things all thetime.
You've got to incorporate a newthing into your system, unless
(08:17):
you want to live with lowhormones, but then that has
consequences.
Sonya (08:22):
It does.
Yeah, Now, while we're on thetopic of vaginal estrogen,
there's a couple of things thatI want to do to clarify for me I
would imagine anyone that'slistening or anybody new that's
listening I am an estrogenpositive breast cancer survivor.
Now there is this.
I want to say myth, but it'seven more than that, because I
hear stories over and over again, Like yesterday I read of a
(08:43):
woman who was denied vaginalestrogen because she was an
estrogen positive breast cancersurvivor.
Kelly (08:49):
Now, that's not right, is it?
No, you're right, that's notright yeah.
Sonya (08:53):
Yeah, I love that.
Can we record that so I canreplay that to my husband later?
Kelly (09:03):
Yeah, I mean, we have it in America if it's useful for
people who don't live in America.
I don't know how much weight itcarries, but our ACOG, which is
basically the Society ofObstetrics and Gynecologists,
has a position paper online thatI encourage women to print out
and bring to their doctors,because we, so many women think
that, well, the doctor must know.
And I have to tell you, inregards to menopause and
hormones, the doctor doesn'talways know.
We have two generations, that'sworldwide.
(09:23):
We have two generations oftrainees that didn't get trained
after the Women's HealthInitiative happened in 2002.
So now we're 23 years afterright.
So don't assume that becausethey say you can't have it, that
that's actually based inscience.
Many, many, many studies on thesafety of vaginal estrogen with
breast cancer survivors and Iwas like I mean, I'm a urologist
(09:44):
so I always compare it to men.
I could call prostate cancertestosterone-positive prostate
cancer.
We don't call it that right.
So I think that it contributesto the stigma that a hormone
that your body naturally makesis trying to kill you, and the
better way to think about it isthat hormones are like food.
Food doesn't cause monsters,but if you have a monster, you
(10:05):
got to get rid of the food youdon't want to feed the monster
in your house.
Right, treat the monster, thenyou can bring back some food.
And vaginal estrogen is so lowdose that it doesn't go into
your bloodstream.
It doesn't make youpremenopausal again.
We'll say that it's just suchlow dose that if you draw your
blood you're still in thepostmenopausal range.
(10:25):
Right, it's incredibly low dose.
So the fear?
Fear comes from lack ofeducation.
You educate women.
They understand things.
There still might be 22 yearsof fear in the zeitgeist and
ether right that they and theirsister and their neighbor and
all these other people that likewant to kind of they.
Of course they love her right.
(10:45):
But it's like if the people wholove you aren't educated,
they're going to contribute tothrowing the fear on you as well
.
Sonya (10:51):
Yeah, absolutely.
And the other area, when we'retalking about vaginal estrogen
and I know I actually did apodcast episode with this
recently with my good friend JoeWicks and we were talking about
the significant campaign that'sunderway in the US to remove
the black box warning so can youjust talk us through that a
little bit as well?
Kelly (11:09):
Yeah, does Australia have the boxed warning on it?
Yeah, we do.
Yeah, you do.
Yeah, canada has it too.
So after the Women's HealthInitiative, our FDA so that's
our Food and Drug Administrationbasically said we need to warn
everybody about the bad thingsthat the WHI found and they put
a very scary label.
We call it the boxed warning.
It's like the highest scarylabel that a medication can have
(11:30):
, short of it just beingwithdrawn as a medication, and
it basically says stroke, bloodclot, heart attacks, probably, I
think liver disease is on there, the cancer is on there, but
the most concerning one to me.
I mean, they're all concerningbecause they're all wrong, but
is that?
It says probable dementia, andfor anybody who knows words,
probable means more thanpossible.
Yeah, right, so it's like crazystrong wording.
(11:58):
None of it's correct with thecurrent medications that we
commonly use.
Most menopause experts think theboxed warning should come off
of systemic estradiol as well,because that doesn't cause any
of these things either.
In addition, it might actuallydecrease your risk of dementia
and decrease.
It might actually do theopposite of what.
The warning is not just neutral.
So most people think that alsoneeds to come off.
But the very low hanging fruitis the vaginal estrogen because
(12:21):
it's not systemic.
It's incredibly safe.
Studies after studies afterstudies have been shown the
safety and efficacy of thismedication.
A good example is like asteroid, right?
So like a steroid cream thatyou put on your hand because you
got to be touched some plantoutside is different than you
swallowing high doses ofsteroids.
Right, they're both calledsteroids, but the risks are
(12:44):
different.
And so to take estrogen andthrow a warning on every single
dose route type of estrogen,that's just simply not how the
world works.
My friend actually published astudy last year and they said
even if a woman is lucky enoughto get a vaginal estrogen
prescription, 23% will still notuse it because she reads the
(13:09):
warning label.
And if the doctor isn't like,well, if you're a label reader,
you're going to read this andit's wrong, right?
So, and everybody, I see Ipreemptive and I'm like and I'm
sorry because that means youhave to decide between me and
the FDA and that's a crappyposition to be put in.
But you know, the big petitionnow is like, people want truth.
They want truth from governmentlabels.
(13:29):
I always joke like the othergovernment label that we were
talking about changing inAmerica recently is the alcohol
warning.
So the alcohol warning saysdon't use if you're pregnant and
don't operate heavy machinery.
And I'm like that's a verytoxic chemical that's associated
with seven different cancers,right.
And they're like don't operatebulldozers with it.
(13:51):
It doesn't apply to most people.
So that's that governmentwording.
And then you've got thisvaginal estrogen on like a
product so safe.
It's over the counter in the UK, it's over the counter in
multiple countries, right, Iknow that's what I was going to
say.
Sonya (14:03):
There are countries where they have now provided
availability for it over thecounter from a pharmacist.
Kelly (14:08):
Yeah, uk happened, maybe 23.
That happened.
Finland's over the counter, Ithink Israel's over the counter,
multiple countries, it's overthe counter Probably over the
counter in Mexico.
Sonya (14:19):
And just going back to one of the things that you were
talking about, with thepercentage of women that choose,
then, not to use it once theyget at home, because they read
the warning I'm not sure if itwas through you or someone else
shared a story recently wherethe woman that took it home she
knew that it was safe to use buther husband happened to pick up
the packaging and read it andsaid I don't want you to use
this.
But I think it also goes intowhat we were talking about
before, and that is, you know,the people that love us the most
(14:41):
often try to keep us safe, andthey're not necessarily coming
from a place of education andinformation, but that's exactly
right, yeah, yeah, hey.
Kelly (14:51):
That's exactly right, yeah, yeah, hey.
If everybody wants to keepeverybody safe, like some people
die when they take Viagra, whatso do we tell everybody not to
take Viagra?
No, no, we do not.
Sonya (14:57):
No, we do not, and that gets pretty much encouraged.
Kelly (14:59):
Yes, so you know, I always say check our bias yeah.
Sonya (15:03):
Great point.
Check our bias.
Yeah, I like that very much,kelly Kelly, one of the other
areas I wanted to talk to you alittle bit about was
testosterone.
It is something that can bereally controversial,
particularly here in Australia.
Kelly (15:15):
You guys like making mountains out of molehills.
I'm learning.
Sonya (15:20):
Not all of us.
Not all of us.
Thank you for the clarification, but yes, there is a bit of
conjecture and gatekeeping andpushback around the use of
testosterone.
So I'm really keen to hear asyou know a urologist and
somebody that does see male andfemale patients, you know, I
know where you sit on this, butI'd love for you to just kind of
explain to everybody listeningyour thoughts on the use of
(15:42):
testosterone.
Kelly (15:43):
Yeah, so it's kind of like.
It's kind of like GSM, like youhave to step back two, two or
three paces because ifsomebody's, like Dr Casperson,
just thinks all women should goon testosterone, I was like,
well, no, and you know, a lot ofwomen don't even know that
testosterone is in our bodies,and so it's.
I always now like try to stepback and be like okay, just so
people, so people can catch up.
(16:03):
Testosterone is in all bodiesfour times the amount of
estrogen in our bodies, right,so ovaries make testosterone.
We just have 10 to 20 timesless than men.
Like men make tons oftestosterone.
We make more testosterone thanestrogen.
Right, but if people don't havethat understanding first, then
they are very confused as to whywe're talking about giving a
(16:24):
male hormone to women, becausethey don't know that it's an
every body hormone.
So I always lead with that,because now people are like
they're a little bit more opento be like holy crap, are you
telling me, ovaries make fourtimes the amount of testosterone
and estrogen?
We don't even talk aboutreplacing it?
No, we rarely talk aboutreplacing it.
But testosterone receptors areeverywhere in our body, right,
(16:46):
you give women testosterone.
Their clitoral artery has moreblood flow in it, like.
We've measured this right.
It's cool stuff.
That is very cool stuff.
It's super cool stuff, liketestosterone helps men with
erections.
Testosterone helps women witherections right, we all have the
same body parts, so what'sinteresting about it is, in the
sexual health studies,testosterone actually helps all
(17:08):
domains of female sexual health,so lubrication, arousal, orgasm
, desire and overall sense ofwell-being in regards to their
sex life.
That's very important.
In addition, we've got data thatit's good for libido.
It's not great for libidobecause libido is incredibly
complicated.
This woman was like I've beenon testosterone for a year and I
still have low libido.
Libido is incrediblycomplicated.
(17:28):
This woman was like I've beenon testosterone for a year and I
still have low libido, and I'mlike libido is incredibly
complicated, right.
It's like how's yourrelationship?
How's your stress?
Are you sleeping?
How's work, right?
Do you have a newborn at home?
Right?
All of these things affectlibido.
So the other thing to note,though, is libido is a mood,
right.
Where is libido located in yourbody?
(17:50):
Your libido is not located inyour heart or your armpit.
It's in your brain.
Thus proving that and we've got, you know, mri studies showing
testosterone in the brain andhow testosterone helps nerve
cells and helps myelin and helpsmitochondria.
We've got tons of basic scienceon testosterone and cell
function, mitochondrial health.
Your body works better with it.
(18:11):
Now what the problem is is wedon't have many people actually
studying it currently in femalebodies, especially in
postmenopausal female bodies,right?
So it's like it's crazy that50% of the population isn't
being studied on something theymake four times the amount of
than estrogen.
I mean this doesn't pisseverybody off.
That's pretty mind-blowing.
(18:31):
It's pretty mind-blowing.
In addition, we've been givingwomen testosterone for 80 years,
right Started in the 1940s.
We're giving it for multiplegynecologic reasons.
We've got good data that againhas gotten forgotten because of
the WHI.
Whi happened everybody didn'twant to talk about hormones.
Good data, randomized,controlled data in surgical
(18:52):
menopause because surgicalmenopause is removal of ovaries
your ovaries actually make alittle bit of testosterone still
after your period stop, right.
So it is a myth that, like yourtestosterone falls off a cliff
with menopause.
That's not how it happens.
But especially for surgicalmenopause, not all studies, but
some say estrogen plustestosterone is much better
because you're actuallyreplacing better what the ovary
(19:14):
had than estrogen alone.
And we did have a female dosetestosterone patch in Europe.
It was for surgical menopauseonly, so you had to have removal
of ovaries Got taken off themarket, not because it was
unsafe, not because it didn'twork, but because it just didn't
sell enough, probably becauseit was limited to surgical
(19:35):
menopause and doctors justdidn't know about it.
And doctors were crappy athelping women with their sex
lives, right.
So, like all of these reasonsto be like they've been trying
In America, a patch went up toour FDA just about two years
after the WHI Didn't getapproved.
Not because it didn't work, butbecause two years after the WHI,
(19:55):
everybody's still thinkinghormones are going to kill
everybody.
So the FDA said we want fiveyears of safety data.
Now for men to get an FDAapproved testosterone product of
which we have two dozen theyneeded six months safety data.
Five-year placebo-controlledsafety data trial is about a
billion dollars.
So for anybody to be like, well, we don't have an FDA-approved
(20:16):
female dose, that must mean itdoesn't work or that must mean
it's bad.
It's like no, this is money ona hormone which is actually very
cheap.
So there's not a lot of moneyto be made.
So who's going to pony up abillion dollars to sell a
generic medication?
Zero people.
Sonya (20:30):
And be made.
So who's going to pony up abillion dollars to sell?
Kelly (20:32):
a generic medication.
Yeah, zero people.
And we're lucky, in australiawe do have a female you have
androfen?
Sonya (20:35):
we have androfen.
However, it is very expensive.
It is not on our pbs, so but Iuse testogel, which is the men's
sachet and I just use a tenthof it roughly every day and and
that costs me something like $5or $10 a month or something you
know it's huge.
I mean how?
Kelly (20:54):
crazy is it that a smaller dose is more expensive
and that's what I say aboutAmerica too of like, because the
FDA approved product for womenis coming.
This is not a never Like.
The demand is gaining force.
I mean, even just if you justlook at how many women are in
surgical menopause, like it'snot a small amount, right.
So even if they went for thatniche.
(21:14):
But I'm like, listen, if you'regoing to put it in a pink box
and make it cost $500, I'm stillgoing to do what I'm doing now.
But just having the validationof it is going to expand the
conversation all the more, soI'm looking forward to it.
Sonya (21:33):
I'm totally an advocate of it.
Kelly (21:33):
Do you guys have compounding?
Can you compound in Australia?
Yeah, we do have compounding.
Do people compound?
Sonya (21:36):
female testosterone there .
I don't know about testosterone.
I know that there's a lot ofcompounding of progesterone and
estrogen.
I don't know so much abouttestosterone.
Kelly (21:44):
Yeah because we do a lot of compounding here.
Because the other thing abouttestosterone here I don't know
where it is with you guys isbecause of the Olympic doping
scandals of the 80s, ourCongress passed something called
the Anti-Doping Act in 1991,which, through testosterone, is
the only natural hormone thatour body makes in with all these
synthetic, you know, anabolicdoping steroids, and so it's
(22:09):
classified like ketamine andTylenol with codeine in America.
So there's a lot more hurdlesto getting it.
You have to all the barriers.
So that's the other thing we'reworking on is like not only is
there the gender bias, but it'sactually kind of stereotyped as
a dangerous product because it'syeah, because it's on this more
highly, highly.
So we're working on trying toget that deregulated yeah,
(22:31):
that's interesting, kelly.
Sonya (22:33):
One of the other reasons why we're talking today and you
know, doing a bit of a refresheron who you are and what you do
is you are coming to australiain a matter of weeks for the so
hot right now event in sydney atthe.
I'm very excited to be hot insydney.
Yeah, well, I can tell you itis february right now it is be
hot in Sydney.
Kelly (22:49):
Yeah, well, I can tell you, it is February right now.
Sonya (22:51):
It is very hot in Sydney, but yeah, so they definitely
nailed the theming of that event.
And it's funny.
I was chatting recently, oractually like last week, with
Louise Newsome Dr Louise Newsome, who is also coming out.
Kelly (23:04):
We love her.
Sonya (23:05):
We do love her and she's also, you know, regardless of
being just so super brilliant atwhat she does, she is one of
the nicest people I think I'veever met.
Yes, she's just gorgeous andsmart and charming.
Kelly (23:17):
She's everything.
She really is All the thingsand clever and gives the best
hugs.
Sonya (23:23):
If you haven't had a Louise Newsom hug, you are in
for something she's a goodhugger.
That's awesome, so I'm lookingforward to lots of hugs from
lots of amazing, clever womenlike yourself and Louise in a
few weeks.
What can anyone that is luckyenough to be attending the event
or has purchased a ticket tothe live stream as well now yeah
, they just announced livestream, which is very cool it
(23:46):
really is.
But what can, what can everyonekind of expect to hear from you
know yourself when you're outhere, other than, oh my god,
it's so good to be hot, I knowI'm just wanting, I'm just
hoping to be warm for anybodywho doesn't know?
Kelly (23:57):
america is a little chilly right now.
Um so I give my my sydney Housetalk, so these are my tasks.
The tasks are threefold Generalurinary syndrome and menopause,
the safety of vaginal estrogenand then the role of sex
testosterone and empowerment,and that's wrapped up into 20
minutes.
Sonya (24:17):
Beautiful and that's good , because we just hit the nail
on all of those ourselves.
Kelly (24:20):
Yeah, yeah yeah, we just talked about it, so I should be
able to talk about that for 20minutes.
Sonya (24:29):
I'll let the organizers know all of who I'm very lucky
to call close friends, that youknow.
I just gave you a little bit ofa warm up.
Kelly (24:32):
Good, I know it's going to be super fantastic.
It really is, the talk's beenwritten Now I'm working on
embodying it.
We're doing so.
There's a the day before.
Nope Medical conference is theday after.
(24:52):
Thank you very much.
And then, for people who can'tmake it to Sydney because it's
sold out or you just want to seeme, I'll be up in Newcastle.
I'm getting my Australian daysMonday night.
I was going to say it must beduring the week on the Monday
night, monday after Okay, yeah,because the medical conference
is the Sunday, so so hot.
Sonya (25:00):
Right now is Saturday.
Kelly (25:00):
Saturday.
Sonya (25:01):
Medical conference is Sunday and then you're heading
up to Newcastle, which is ourcentral coast, from where I am
in Sydney for the event withShauna Watts and the team up
there, which is really exciting.
Kelly (25:11):
And I just, I really want to see a koala.
Well, you'll find a koala.
Sonya (25:14):
Not that they're hanging out on the side of the road, but
look, I'll take you to TarongaZoo and we'll definitely find
you a koala.
The only thing you have towatch out for is they pee on you
out of fear out of spite, likewhat's the don't know, but it
seems to be a common thing.
Kelly (25:30):
They also have chlamydia.
Oh, I know, that's what I'veheard.
Sonya (25:32):
Yeah, yeah, precious thing they are also very cute
and cuddly.
So, oh, best thing ever, yes,no guarantee to find you I wish,
I mean if I could, I have.
Kelly (25:40):
I have children and a day job, otherwise I would make it
a longer trip.
But I've been to brisbane.
I've been to the Gold Coast,the insane beauty of Australian
beaches I've been around.
I've been to Thailand.
I've been to some nice beaches,australian beaches.
There is no competition in theworld as far as I've been to.
Sonya (25:59):
Very hard to beat.
Very hard to beat, and assomeone who lives on the beaches
in Sydney and does a lot oftravel overseas and been to some
amazing beaches as well, butalways come home and go.
We really do, yeah, nailed it.
We really do.
Uh, yeah, we're really lucky.
Kelly, thank you so much foryour time you're very welcome as
I said, really excited to haveyou out here soon.
(26:21):
Anybody that hasn't got theirticket to the opera house event
in particular, there is a livestream available now.
How cool is that.
Yep.
Kelly (26:31):
Like everybody, everybody who's anybody in the menopause
world and the menopause.
They're incredible women.
They're like this is a group Iget to speak for myself because
I'm just part of it, but likefeeling blessed of it.
But like feeling blessed, butlike these are women who are
just willing to stick theirnecks out there for the goodness
of women and for the goodnessof women to get treated and
(26:52):
start feeling more likethemselves.
And, you know, grab the bull bythe horn and we've got years
left.
We should feel decent for it.
And so, like, the women who aretruly the advocates for this
are incredible people.
Sonya (27:04):
Yeah, I 100% agree and, regardless of the negativity
that sometimes comes with theterritory of being an outspoken,
putting yourself out therefighting the good fight, that's
what cuts through in the end andyou have to keep it.
That's the thing thatfrustrates me the most when I do
hear any negativity that doescome you know your way, or the
(27:24):
whole menopause-y way.
Kelly (27:29):
You know you are all just doing it for the greater good
of the women that deserve it.
That's just so crazy about thehate right?
Really, we just want to helpwomen.
Sonya (27:35):
Really it does not make sense.
Kelly (27:37):
It's crazy, it's so incredibly frustrating.
This is the deal.
There are a lot of people whohave vested interests in status
quo, whether that means they'remaking money from it or they
have power in it.
For whatever reason, there is avested interest in the status
quo, and I think that's what wesee, because we're literally
(27:59):
like dude, we're just tellingyou what women are telling us
from us taking care of them inthe clinic, right, we're not
making anything up and somepeople don't want to hear it.
Sonya (28:09):
I shared a quote recently with my good friend, dr Kerry
Cashel, because I saw it andimmediately thought of her and
it's relevant to everyone in themenopause, and that is, if your
voice held no power, theywouldn't try to silence you.
And that's from Ruth BaderGinsburg.
Kelly (28:26):
Oh, thank you for that.
Sonya (28:28):
Yeah.
Kelly (28:29):
Yeah, I love it, my other , my other one recently, I don't
know I'm not sure if this is aquotable one, but it's a
different vein.
But also helpful is like peoplewho hate on you actually
probably hate themselves worse.
That's a good one, Right?
So you're like yeah, sorry, Gosit on that for a while.
Yeah, you know, like that's thething, Like if you truly have
(28:51):
time to hate or pick on peoplelike we don't have time for that
, we have so many people to help.
Like, just going back to GSM,right, Generally that's 50 to
80% of women.
We have data that maybe 5% ofwomen are on vaginal estrogen.
Sonya (29:05):
Yeah, right, and I know there's a lot of talk as well
about you know, particularlywhen we're talking about vaginal
estrogen before, but that isthat you know there are women of
the generations ahead of usthat are in nursing homes that
should be having this as just apart of their general care.
Kelly (29:19):
Why is it not given to you on admission?
You know, I actually heard froma nursing aide messaged me
today or yesterday and she'slike me and my coworkers are
taking care of all these frail95-year-olds who just get
urinary tract infection after ayear.
She's like zero of them are onestrogen and so they're trying
to figure out how to advocatefor the 95-year-olds because
(29:41):
they're like this will kill you,right, a UTI will kill you.
And the prevention 50% decreasedrisk like there's nothing
better than that.
It's fantastic and it's suchlow hanging fruit.
So yeah, we've got a lot ofwork to do.
That's why we're like I can'tget distracted.
Responding to the people whothink that we should be doing
(30:01):
our advocacy a certain way ornot.
A certain way is like listen,I'm a Gen X.
I kind of had the like thoughtthat the world would be perfect
and good, right Like.
Remember growing up in like theeighties and nineties, and
we're like we solved the war,you know, everything's good now
because all the adults are incharge.
And now, like we're, the adultsare like oh dude, we got some
(30:24):
shit to do.
Sonya (30:24):
Still, we do.
And how often do we feel likewe're progressing and then we
just get knocked back a fewsteps and it's like, yeah, I
mean big change doesn't happenovernight, but even just you
know, going back to thebeginning of like, how different
even three years has been yeahright, like we're talking about.
Kelly (30:41):
We're talking about sex way more than we were three
years ago.
We're talking abouttestosterone.
I was the crazy person who waslike I think isn't it weird that
these people aren't having anyorgasms, but they're sleeping
with the people who are havingorgasms all the time.
Isn't this really weird?
And now testosterone what's,three years from now, going be?
Sonya (31:05):
yeah, it's gonna be super exciting it is super exciting
and that's where I get superexcited is the thought of the
generations that are comingthrough behind us.
You know, not even thegenerations that are like our
kids generations, but like theliteral decade behind us that
are coming through.
Kelly (31:19):
Yeah, I mean, I think about I think about that all the
time because I was at this, youknow, thought leader, thought
leader space, we'll say inAmerica.
And here I am being all radicalof like sex equality and
testosterone's in everybody, andlike I'm thinking I'm this
crazy radical, right, and I'msitting listening to these women
on stage, phds in science, andthey're like what if menopause
(31:41):
is optional?
Mm-hmm.
Sonya (31:43):
Now, that's coming out of one of the research centers in
California, isn't it?
Kelly (31:47):
Yeah.
But that's when you're like,okay, here we are being, like
people need their hormones.
It's like, dude, 10, 15 yearsfrom now.
It's like eyeglasses for theovaries, right, just figure out
what keeps the follicles going.
And menopause is optional.
And so it's like we're going tolook back on now and be like,
oh my God, we people didn't.
(32:08):
Are you kidding me?
People didn't want to be onhormones.
Now we just don't let ourovaries fade away.
Right, it's going to be sodifferent?
Sonya (32:15):
Yeah, it's the Buck Institute, just kidding, thank
you.
Kelly (32:19):
So to me I'm like you know.
Here we are thinking we're,we're rat, like people are
hating on us for being too boldand too radical.
And I'm like girlfriend in 15years we're just gonna take,
take something that's gonna keepthe follicles.
Making our own hormones likeprescription hormones will be a
thing of the past yeah, bring iton, kelly.
Sonya (32:37):
Thank you so much for your time.
I cannot wait to see you andgive you a great big hug when
you're here in sydney thank you.
Kelly (32:42):
I hope to be wearing less clothes when I see you.
Sonya (32:45):
I was finding a really diplomatic way to say that, but
it just didn't come to me.
I'll take the heat.
Kelly (32:51):
Thanks, kelly, thank you.
Welcome to the Dear Menopause podcast.
I'm Sonya Lovell, your host Now.
I've been bringing youconversations with amazing
menopause experts for over twoyears now.
If you have missed any of thoseconversations, now's the time
to go back and listen, and youcan always share them with
anyone you think needs to hearthem.
This way, more people can findthese amazing conversations,
(00:24):
needs to hear them.
This way, more people can findthese amazing conversations.
Dr Kelly Casperson, welcome tothis week's episode of Dear
Menopause.
Thanks for having me Always apleasure.
Now it's actually been goshalmost three years, I think,
since we actually last sat downand chatted, because you were
one of my really early guests onDear Menopause, and so much has
(00:46):
happened in that time.
Kelly (00:47):
The world's changed right Like.
Three years is a long time inhow fast menopause is changing
right now.
Sonya (00:54):
Absolutely.
The narrative has changed.
You know, the landscape haschanged.
There are so many women nowthat 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 likethat, has changed a bit as well.
What a great opportunity for abit of a refresher.
(01:16):
How about you tell everybody alittle bit about who you are and
where you're from?
Kelly (01:20):
Yeah, thank you.
So I'm Dr Kelly Casperson.
I'm from the States.
For people who are familiarwith all of them, I was born in
Minnesota, did urology training,so that's medical school and
then surgery for urology, whichis kidneys, bladder, changed
probably about seven years.
They always say the seven-yearitch, right Like you get a
little bored in your career,what are you doing with your
(01:50):
life?
And it was the perfect time fora woman to come into my office
with really big sexual healthissues that were super
distressing and I realized Ididn't know how to help her.
So I went pretty deep intofemale sexual health and what's
up with desire and how doesorgasm work.
And that led me into hormones.
And I always joke that sex gotme into menopause, because
(02:10):
people are like well, you knowwhat happens with menopause and
I'm like no, like the rumor isthat your sex life goes bad.
But there's actually a lot ofpeople whose sex life gets a lot
better, which is fun to discuss.
But you can't ignore the roleof the hormones in both desire,
lubrication, arousal, ability toorgasm.
They're all desperatelyimportant.
Can you have a good sex lifewithout them?
(02:32):
Yes, but do they help sex lives?
Yes, so that's what I do now.
Sonya (02:36):
You do and you do it so well, and you have your own
podcast which is called you AreNot Broken.
You have a book with the samename, so super easy to find
Kelly and everything that shedoes out there in the world.
I guess when I was talkingbefore about how I feel like
things have changed a little bitin the sense of what you talk
about, I was really kind oftalking about how much more we
now talk about GSM.
(02:58):
So the genitourinary symptomsof menopause syndrome of
menopause.
Symptoms of menopause.
Syndrome of menopause.
Symptoms of menopause.
Kelly (03:03):
Syndrome technically, because syndrome basically means
like three or moreconstellations of things, so
it's like a collection.
It's the medical term forcollection.
Sonya (03:11):
So I feel like we didn't have that terminology last time
that we spoke.
It's a little bit of somethingthat's become, I guess, more
formalized in the sense of howpeople talk about it.
So I was wondering if you couldjust kind of bring us up to
speed for anybody that's notfamiliar with GSM as to what
that actually means.
Kelly (03:29):
Yeah, so GSM means again, like you said, genital urinary
symptoms or syndrome ofmenopause.
Coined several years ago, morethan three years ago, but before
then people really talked aboutvaginal atrophy, for better or
for worse.
In the 1980s we called itsenile vagina, but it's
certainly the names.
Yeah, so the names are gettingbetter.
Generally.
Urinary syndrome and menopauseis a huge mouthful, so GSM is
(03:55):
kind of what we abbreviate it to.
But the nice thing about it isit kind of tells you why it's
happening Menopause.
But in order for you to know,you actually have to know what
menopause is right.
So a lot of people just thinkmenopause is like no more
periods and maybe some hotflashes, and then the hot
flashes end.
That's not what, men, I mean.
The definition of menopause isthe day after a year, after no
natural periods right.
But what's actually happeningis the ovarian follicles, not
(04:17):
the eggs.
The follicles which kind ofhouse the eggs.
You're basically outlivingtheir lifespan and the follicles
make hormones.
So truly what's happening ispelvic changes because of
lowering hormones.
Typically we think aboutestrogen, but also testosterone
does play a role in the genitalstructures.
The other reason why GSM isnicer is it attributes this to
(04:39):
the urinary things and I'm aurologist so that's important to
me.
So urinary frequency I have topee all the time.
Now, urgency I got to go rightnow.
Like I can't wait Getting up atnight to urinate, which we call
nocturia Leakage leaking ofbladder or urine when you don't
want to Like keys in the door,running water leaking with
urgency, leaking with I just mypants are almost down but I
(05:00):
can't get there.
Like why is this leaking beforeI can get there?
Increased risk of urinary tractinfections.
They're becoming recurrent,right.
And if you don't know that thisis because of low hormones,
then you don't know how to treatit and you end up just throwing
antibiotics at the UTIs andoveractive bladder medications
at the overactive bladder, sureassociated with dementia, right?
(05:21):
So if you don't know why thesethings are happening, you can't
treat it in the best, safest waythat actually can resolve the
problem.
Sonya (05:29):
Okay, which leads us into what is the best, safest way
for a woman in her midlife who'sexperiencing, let's say,
recurrent UTIs.
That's not antibiotics.
Kelly (05:38):
Yeah, so the most.
This is how I tell.
This is what I say when womencome to see me.
I say if I had something thatdecreased the chance of you
getting another UTI by 50% to60%, would you be interested in
that?
And universally they say,yeahame this, why don't we say
what can we do to decrease thechance of a next one?
And then they're like, okay,that's not a narrative they
(06:10):
thought they had right.
So vaginal estrogen what it doesis it repopulates lactobacillus
.
That's a microbiome.
Microbiomes are hot topicsright now, right, gut microbiome
, skin microbiome, vaginalmicrobiome.
So you need a healthy vaginalmicrobiome, skin microbiome, you
know vaginal microbiome.
So you need a healthy vaginalmicrobiome, which means estrogen
, right?
So as you lose your estrogen,the microbiome changes and when
(06:32):
the microbiome changes, thevagina becomes less acidic and
the acidity produced by thelactobacillus, which is your
healthy microbiome, that's whatprevents the poop bugs from
walking up, going past the yardinto the pee, right.
And so it's like healthy vaginaactually is a barrier to keep
the gut microbiome where itbelongs, so it doesn't start
(06:54):
going up into the front side andthat's a bladder infection.
It's a natural prevention yeahyeah yeah, our bodies are smart,
man, our bodies are super smartand and I like thinking about
it that way because, well, itfeels good.
But then for women to be likewe're just giving you back
something that you always hadright and that was protecting
you, just like we'd give youback insulin or we'd give you
(07:14):
back thyroid, we'd give you backsomething that you're just body
, you outlived it, and so thatkind of helps them understand,
because if a woman doesn'tunderstand, she's a lot less
likely to go forward with thetreatment.
And the other thing that theydon't understand because they
don't understand that menopauseis forever right.
When those ovarian folliclesstop, they don't start again is
(07:35):
that?
Yes, you have to use thevaginal estrogen in order for it
to work.
It's like sunscreen, right,that doesn't matter.
If you used sunscreen lastAugust, you still got to use it.
Sonya (07:46):
I love it.
It's a great analogy.
Yeah, and I know I'm guilty offorgetting to use my vaginal
estrogen every week or every fewdays.
It's funny, right?
I have to remind myself.
Yeah.
Kelly (07:56):
We get kind of entitled.
Women are like I don't want tohave to use it and I'm like you
put a seatbelt on every time youget in the car.
Do you floss all the time?
You put sunscreen on all thetime.
Do you put your glasses onevery time you read?
You forget we do things all thetime.
You've got to incorporate a newthing into your system, unless
(08:17):
you want to live with lowhormones, but then that has
consequences.
Sonya (08:22):
It does.
Yeah, Now, while we're on thetopic of vaginal estrogen,
there's a couple of things thatI want to do to clarify for me I
would imagine anyone that'slistening or anybody new that's
listening I am an estrogenpositive breast cancer survivor.
Now there is this.
I want to say myth, but it'seven more than that, because I
hear stories over and over again, Like yesterday I read of a
(08:43):
woman who was denied vaginalestrogen because she was an
estrogen positive breast cancersurvivor.
Kelly (08:49):
Now, that's not right, is it?
No, you're right, that's notright yeah.
Sonya (08:53):
Yeah, I love that.
Can we record that so I canreplay that to my husband later?
Kelly (09:03):
Yeah, I mean, we have it in America if it's useful for
people who don't live in America.
I don't know how much weight itcarries, but our ACOG, which is
basically the Society ofObstetrics and Gynecologists,
has a position paper online thatI encourage women to print out
and bring to their doctors,because we, so many women think
that, well, the doctor must know.
And I have to tell you, inregards to menopause and
hormones, the doctor doesn'talways know.
We have two generations, that'sworldwide.
(09:23):
We have two generations oftrainees that didn't get trained
after the Women's HealthInitiative happened in 2002.
So now we're 23 years afterright.
So don't assume that becausethey say you can't have it, that
that's actually based inscience.
Many, many, many studies on thesafety of vaginal estrogen with
breast cancer survivors and Iwas like I mean, I'm a urologist
(09:44):
so I always compare it to men.
I could call prostate cancertestosterone-positive prostate
cancer.
We don't call it that right.
So I think that it contributesto the stigma that a hormone
that your body naturally makesis trying to kill you, and the
better way to think about it isthat hormones are like food.
Food doesn't cause monsters,but if you have a monster, you
(10:05):
got to get rid of the food youdon't want to feed the monster
in your house.
Right, treat the monster, thenyou can bring back some food.
And vaginal estrogen is so lowdose that it doesn't go into
your bloodstream.
It doesn't make youpremenopausal again.
We'll say that it's just suchlow dose that if you draw your
blood you're still in thepostmenopausal range.
(10:25):
Right, it's incredibly low dose.
So the fear?
Fear comes from lack ofeducation.
You educate women.
They understand things.
There still might be 22 yearsof fear in the zeitgeist and
ether right that they and theirsister and their neighbor and
all these other people that likewant to kind of they.
Of course they love her right.
(10:45):
But it's like if the people wholove you aren't educated,
they're going to contribute tothrowing the fear on you as well
.
Sonya (10:51):
Yeah, absolutely.
And the other area, when we'retalking about vaginal estrogen
and I know I actually did apodcast episode with this
recently with my good friend JoeWicks and we were talking about
the significant campaign that'sunderway in the US to remove
the black box warning so can youjust talk us through that a
little bit as well?
Kelly (11:09):
Yeah, does Australia have the boxed warning on it?
Yeah, we do.
Yeah, you do.
Yeah, canada has it too.
So after the Women's HealthInitiative, our FDA so that's
our Food and Drug Administrationbasically said we need to warn
everybody about the bad thingsthat the WHI found and they put
a very scary label.
We call it the boxed warning.
It's like the highest scarylabel that a medication can have
(11:30):
, short of it just beingwithdrawn as a medication, and
it basically says stroke, bloodclot, heart attacks, probably, I
think liver disease is on there, the cancer is on there, but
the most concerning one to me.
I mean, they're all concerningbecause they're all wrong, but
is that?
It says probable dementia, andfor anybody who knows words,
probable means more thanpossible.
Yeah, right, so it's like crazystrong wording.
(11:58):
None of it's correct with thecurrent medications that we
commonly use.
Most menopause experts think theboxed warning should come off
of systemic estradiol as well,because that doesn't cause any
of these things either.
In addition, it might actuallydecrease your risk of dementia
and decrease.
It might actually do theopposite of what.
The warning is not just neutral.
So most people think that alsoneeds to come off.
But the very low hanging fruitis the vaginal estrogen because
(12:21):
it's not systemic.
It's incredibly safe.
Studies after studies afterstudies have been shown the
safety and efficacy of thismedication.
A good example is like asteroid, right?
So like a steroid cream thatyou put on your hand because you
got to be touched some plantoutside is different than you
swallowing high doses ofsteroids.
Right, they're both calledsteroids, but the risks are
(12:44):
different.
And so to take estrogen andthrow a warning on every single
dose route type of estrogen,that's just simply not how the
world works.
My friend actually published astudy last year and they said
even if a woman is lucky enoughto get a vaginal estrogen
prescription, 23% will still notuse it because she reads the
(13:09):
warning label.
And if the doctor isn't like,well, if you're a label reader,
you're going to read this andit's wrong, right?
So, and everybody, I see Ipreemptive and I'm like and I'm
sorry because that means youhave to decide between me and
the FDA and that's a crappyposition to be put in.
But you know, the big petitionnow is like, people want truth.
They want truth from governmentlabels.
(13:29):
I always joke like the othergovernment label that we were
talking about changing inAmerica recently is the alcohol
warning.
So the alcohol warning saysdon't use if you're pregnant and
don't operate heavy machinery.
And I'm like that's a verytoxic chemical that's associated
with seven different cancers,right.
And they're like don't operatebulldozers with it.
(13:51):
It doesn't apply to most people.
So that's that governmentwording.
And then you've got thisvaginal estrogen on like a
product so safe.
It's over the counter in the UK, it's over the counter in
multiple countries, right, Iknow that's what I was going to
say.
Sonya (14:03):
There are countries where they have now provided
availability for it over thecounter from a pharmacist.
Kelly (14:08):
Yeah, uk happened, maybe 23.
That happened.
Finland's over the counter, Ithink Israel's over the counter,
multiple countries, it's overthe counter Probably over the
counter in Mexico.
Sonya (14:19):
And just going back to one of the things that you were
talking about, with thepercentage of women that choose,
then, not to use it once theyget at home, because they read
the warning I'm not sure if itwas through you or someone else
shared a story recently wherethe woman that took it home she
knew that it was safe to use buther husband happened to pick up
the packaging and read it andsaid I don't want you to use
this.
But I think it also goes intowhat we were talking about
before, and that is, you know,the people that love us the most
(14:41):
often try to keep us safe, andthey're not necessarily coming
from a place of education andinformation, but that's exactly
right, yeah, yeah, hey.
Kelly (14:51):
That's exactly right, yeah, yeah, hey.
If everybody wants to keepeverybody safe, like some people
die when they take Viagra, whatso do we tell everybody not to
take Viagra?
No, no, we do not.
Sonya (14:57):
No, we do not, and that gets pretty much encouraged.
Kelly (14:59):
Yes, so you know, I always say check our bias yeah.
Sonya (15:03):
Great point.
Check our bias.
Yeah, I like that very much,kelly Kelly, one of the other
areas I wanted to talk to you alittle bit about was
testosterone.
It is something that can bereally controversial,
particularly here in Australia.
Kelly (15:15):
You guys like making mountains out of molehills.
I'm learning.
Sonya (15:20):
Not all of us.
Not all of us.
Thank you for the clarification, but yes, there is a bit of
conjecture and gatekeeping andpushback around the use of
testosterone.
So I'm really keen to hear asyou know a urologist and
somebody that does see male andfemale patients, you know, I
know where you sit on this, butI'd love for you to just kind of
explain to everybody listeningyour thoughts on the use of
(15:42):
testosterone.
Kelly (15:43):
Yeah, so it's kind of like.
It's kind of like GSM, like youhave to step back two, two or
three paces because ifsomebody's, like Dr Casperson,
just thinks all women should goon testosterone, I was like,
well, no, and you know, a lot ofwomen don't even know that
testosterone is in our bodies,and so it's.
I always now like try to stepback and be like okay, just so
people, so people can catch up.
(16:03):
Testosterone is in all bodiesfour times the amount of
estrogen in our bodies, right,so ovaries make testosterone.
We just have 10 to 20 timesless than men.
Like men make tons oftestosterone.
We make more testosterone thanestrogen.
Right, but if people don't havethat understanding first, then
they are very confused as to whywe're talking about giving a
(16:24):
male hormone to women, becausethey don't know that it's an
every body hormone.
So I always lead with that,because now people are like
they're a little bit more opento be like holy crap, are you
telling me, ovaries make fourtimes the amount of testosterone
and estrogen?
We don't even talk aboutreplacing it?
No, we rarely talk aboutreplacing it.
But testosterone receptors areeverywhere in our body, right,
(16:46):
you give women testosterone.
Their clitoral artery has moreblood flow in it, like.
We've measured this right.
It's cool stuff.
That is very cool stuff.
It's super cool stuff, liketestosterone helps men with
erections.
Testosterone helps women witherections right, we all have the
same body parts, so what'sinteresting about it is, in the
sexual health studies,testosterone actually helps all
(17:08):
domains of female sexual health,so lubrication, arousal, orgasm
, desire and overall sense ofwell-being in regards to their
sex life.
That's very important.
In addition, we've got data thatit's good for libido.
It's not great for libidobecause libido is incredibly
complicated.
This woman was like I've beenon testosterone for a year and I
still have low libido.
Libido is incrediblycomplicated.
(17:28):
This woman was like I've beenon testosterone for a year and I
still have low libido, and I'mlike libido is incredibly
complicated, right.
It's like how's yourrelationship?
How's your stress?
Are you sleeping?
How's work, right?
Do you have a newborn at home?
Right?
All of these things affectlibido.
So the other thing to note,though, is libido is a mood,
right.
Where is libido located in yourbody?
(17:50):
Your libido is not located inyour heart or your armpit.
It's in your brain.
Thus proving that and we've got, you know, mri studies showing
testosterone in the brain andhow testosterone helps nerve
cells and helps myelin and helpsmitochondria.
We've got tons of basic scienceon testosterone and cell
function, mitochondrial health.
Your body works better with it.
(18:11):
Now what the problem is is wedon't have many people actually
studying it currently in femalebodies, especially in
postmenopausal female bodies,right?
So it's like it's crazy that50% of the population isn't
being studied on something theymake four times the amount of
than estrogen.
I mean this doesn't pisseverybody off.
That's pretty mind-blowing.
(18:31):
It's pretty mind-blowing.
In addition, we've been givingwomen testosterone for 80 years,
right Started in the 1940s.
We're giving it for multiplegynecologic reasons.
We've got good data that againhas gotten forgotten because of
the WHI.
Whi happened everybody didn'twant to talk about hormones.
Good data, randomized,controlled data in surgical
(18:52):
menopause because surgicalmenopause is removal of ovaries
your ovaries actually make alittle bit of testosterone still
after your period stop, right.
So it is a myth that, like yourtestosterone falls off a cliff
with menopause.
That's not how it happens.
But especially for surgicalmenopause, not all studies, but
some say estrogen plustestosterone is much better
because you're actuallyreplacing better what the ovary
(19:14):
had than estrogen alone.
And we did have a female dosetestosterone patch in Europe.
It was for surgical menopauseonly, so you had to have removal
of ovaries Got taken off themarket, not because it was
unsafe, not because it didn'twork, but because it just didn't
sell enough, probably becauseit was limited to surgical
(19:35):
menopause and doctors justdidn't know about it.
And doctors were crappy athelping women with their sex
lives, right.
So, like all of these reasonsto be like they've been trying
In America, a patch went up toour FDA just about two years
after the WHI Didn't getapproved.
Not because it didn't work, butbecause two years after the WHI,
(19:55):
everybody's still thinkinghormones are going to kill
everybody.
So the FDA said we want fiveyears of safety data.
Now for men to get an FDAapproved testosterone product of
which we have two dozen theyneeded six months safety data.
Five-year placebo-controlledsafety data trial is about a
billion dollars.
So for anybody to be like, well, we don't have an FDA-approved
(20:16):
female dose, that must mean itdoesn't work or that must mean
it's bad.
It's like no, this is money ona hormone which is actually very
cheap.
So there's not a lot of moneyto be made.
So who's going to pony up abillion dollars to sell a
generic medication?
Zero people.
Sonya (20:30):
And be made.
So who's going to pony up abillion dollars to sell?
Kelly (20:32):
a generic medication.
Yeah, zero people.
And we're lucky, in australiawe do have a female you have
androfen?
Sonya (20:35):
we have androfen.
However, it is very expensive.
It is not on our pbs, so but Iuse testogel, which is the men's
sachet and I just use a tenthof it roughly every day and and
that costs me something like $5or $10 a month or something you
know it's huge.
I mean how?
Kelly (20:54):
crazy is it that a smaller dose is more expensive
and that's what I say aboutAmerica too of like, because the
FDA approved product for womenis coming.
This is not a never Like.
The demand is gaining force.
I mean, even just if you justlook at how many women are in
surgical menopause, like it'snot a small amount, right.
So even if they went for thatniche.
(21:14):
But I'm like, listen, if you'regoing to put it in a pink box
and make it cost $500, I'm stillgoing to do what I'm doing now.
But just having the validationof it is going to expand the
conversation all the more, soI'm looking forward to it.
Sonya (21:33):
I'm totally an advocate of it.
Kelly (21:33):
Do you guys have compounding?
Can you compound in Australia?
Yeah, we do have compounding.
Do people compound?
Sonya (21:36):
female testosterone there .
I don't know about testosterone.
I know that there's a lot ofcompounding of progesterone and
estrogen.
I don't know so much abouttestosterone.
Kelly (21:44):
Yeah because we do a lot of compounding here.
Because the other thing abouttestosterone here I don't know
where it is with you guys isbecause of the Olympic doping
scandals of the 80s, ourCongress passed something called
the Anti-Doping Act in 1991,which, through testosterone, is
the only natural hormone thatour body makes in with all these
synthetic, you know, anabolicdoping steroids, and so it's
(22:09):
classified like ketamine andTylenol with codeine in America.
So there's a lot more hurdlesto getting it.
You have to all the barriers.
So that's the other thing we'reworking on is like not only is
there the gender bias, but it'sactually kind of stereotyped as
a dangerous product because it'syeah, because it's on this more
highly, highly.
So we're working on trying toget that deregulated yeah,
(22:31):
that's interesting, kelly.
Sonya (22:33):
One of the other reasons why we're talking today and you
know, doing a bit of a refresheron who you are and what you do
is you are coming to australiain a matter of weeks for the so
hot right now event in sydney atthe.
I'm very excited to be hot insydney.
Yeah, well, I can tell you itis february right now it is be
hot in Sydney.
Kelly (22:49):
Yeah, well, I can tell you, it is February right now.
Sonya (22:51):
It is very hot in Sydney, but yeah, so they definitely
nailed the theming of that event.
And it's funny.
I was chatting recently, oractually like last week, with
Louise Newsome Dr Louise Newsome, who is also coming out.
Kelly (23:04):
We love her.
Sonya (23:05):
We do love her and she's also, you know, regardless of
being just so super brilliant atwhat she does, she is one of
the nicest people I think I'veever met.
Yes, she's just gorgeous andsmart and charming.
Kelly (23:17):
She's everything.
She really is All the thingsand clever and gives the best
hugs.
Sonya (23:23):
If you haven't had a Louise Newsom hug, you are in
for something she's a goodhugger.
That's awesome, so I'm lookingforward to lots of hugs from
lots of amazing, clever womenlike yourself and Louise in a
few weeks.
What can anyone that is luckyenough to be attending the event
or has purchased a ticket tothe live stream as well now yeah
, they just announced livestream, which is very cool it
(23:46):
really is.
But what can, what can everyonekind of expect to hear from you
know yourself when you're outhere, other than, oh my god,
it's so good to be hot, I knowI'm just wanting, I'm just
hoping to be warm for anybodywho doesn't know?
Kelly (23:57):
america is a little chilly right now.
Um so I give my my sydney Housetalk, so these are my tasks.
The tasks are threefold Generalurinary syndrome and menopause,
the safety of vaginal estrogenand then the role of sex
testosterone and empowerment,and that's wrapped up into 20
minutes.
Sonya (24:17):
Beautiful and that's good , because we just hit the nail
on all of those ourselves.
Kelly (24:20):
Yeah, yeah yeah, we just talked about it, so I should be
able to talk about that for 20minutes.
Sonya (24:29):
I'll let the organizers know all of who I'm very lucky
to call close friends, that youknow.
I just gave you a little bit ofa warm up.
Kelly (24:32):
Good, I know it's going to be super fantastic.
It really is, the talk's beenwritten Now I'm working on
embodying it.
We're doing so.
There's a the day before.
Nope Medical conference is theday after.
(24:52):
Thank you very much.
And then, for people who can'tmake it to Sydney because it's
sold out or you just want to seeme, I'll be up in Newcastle.
I'm getting my Australian daysMonday night.
I was going to say it must beduring the week on the Monday
night, monday after Okay, yeah,because the medical conference
is the Sunday, so so hot.
Sonya (25:00):
Right now is Saturday.
Kelly (25:00):
Saturday.
Sonya (25:01):
Medical conference is Sunday and then you're heading
up to Newcastle, which is ourcentral coast, from where I am
in Sydney for the event withShauna Watts and the team up
there, which is really exciting.
Kelly (25:11):
And I just, I really want to see a koala.
Well, you'll find a koala.
Sonya (25:14):
Not that they're hanging out on the side of the road, but
look, I'll take you to TarongaZoo and we'll definitely find
you a koala.
The only thing you have towatch out for is they pee on you
out of fear out of spite, likewhat's the don't know, but it
seems to be a common thing.
Kelly (25:30):
They also have chlamydia.
Oh, I know, that's what I'veheard.
Sonya (25:32):
Yeah, yeah, precious thing they are also very cute
and cuddly.
So, oh, best thing ever, yes,no guarantee to find you I wish,
I mean if I could, I have.
Kelly (25:40):
I have children and a day job, otherwise I would make it
a longer trip.
But I've been to brisbane.
I've been to the Gold Coast,the insane beauty of Australian
beaches I've been around.
I've been to Thailand.
I've been to some nice beaches,australian beaches.
There is no competition in theworld as far as I've been to.
Sonya (25:59):
Very hard to beat.
Very hard to beat, and assomeone who lives on the beaches
in Sydney and does a lot oftravel overseas and been to some
amazing beaches as well, butalways come home and go.
We really do, yeah, nailed it.
We really do.
Uh, yeah, we're really lucky.
Kelly, thank you so much foryour time you're very welcome as
I said, really excited to haveyou out here soon.
(26:21):
Anybody that hasn't got theirticket to the opera house event
in particular, there is a livestream available now.
How cool is that.
Yep.
Kelly (26:31):
Like everybody, everybody who's anybody in the menopause
world and the menopause.
They're incredible women.
They're like this is a group Iget to speak for myself because
I'm just part of it, but likefeeling blessed of it.
But like feeling blessed, butlike these are women who are
just willing to stick theirnecks out there for the goodness
of women and for the goodnessof women to get treated and
(26:52):
start feeling more likethemselves.
And, you know, grab the bull bythe horn and we've got years
left.
We should feel decent for it.
And so, like, the women who aretruly the advocates for this
are incredible people.
Sonya (27:04):
Yeah, I 100% agree and, regardless of the negativity
that sometimes comes with theterritory of being an outspoken,
putting yourself out therefighting the good fight, that's
what cuts through in the end andyou have to keep it.
That's the thing thatfrustrates me the most when I do
hear any negativity that doescome you know your way, or the
(27:24):
whole menopause-y way.
Kelly (27:29):
You know you are all just doing it for the greater good
of the women that deserve it.
That's just so crazy about thehate right?
Really, we just want to helpwomen.
Sonya (27:35):
Really it does not make sense.
Kelly (27:37):
It's crazy, it's so incredibly frustrating.
This is the deal.
There are a lot of people whohave vested interests in status
quo, whether that means they'remaking money from it or they
have power in it.
For whatever reason, there is avested interest in the status
quo, and I think that's what wesee, because we're literally
(27:59):
like dude, we're just tellingyou what women are telling us
from us taking care of them inthe clinic, right, we're not
making anything up and somepeople don't want to hear it.
Sonya (28:09):
I shared a quote recently with my good friend, dr Kerry
Cashel, because I saw it andimmediately thought of her and
it's relevant to everyone in themenopause, and that is, if your
voice held no power, theywouldn't try to silence you.
And that's from Ruth BaderGinsburg.
Kelly (28:26):
Oh, thank you for that.
Sonya (28:28):
Yeah.
Kelly (28:29):
Yeah, I love it, my other , my other one recently, I don't
know I'm not sure if this is aquotable one, but it's a
different vein.
But also helpful is like peoplewho hate on you actually
probably hate themselves worse.
That's a good one, Right?
So you're like yeah, sorry, Gosit on that for a while.
Yeah, you know, like that's thething, Like if you truly have
(28:51):
time to hate or pick on peoplelike we don't have time for that
, we have so many people to help.
Like, just going back to GSM,right, Generally that's 50 to
80% of women.
We have data that maybe 5% ofwomen are on vaginal estrogen.
Sonya (29:05):
Yeah, right, and I know there's a lot of talk as well
about you know, particularlywhen we're talking about vaginal
estrogen before, but that isthat you know there are women of
the generations ahead of usthat are in nursing homes that
should be having this as just apart of their general care.
Kelly (29:19):
Why is it not given to you on admission?
You know, I actually heard froma nursing aide messaged me
today or yesterday and she'slike me and my coworkers are
taking care of all these frail95-year-olds who just get
urinary tract infection after ayear.
She's like zero of them are onestrogen and so they're trying
to figure out how to advocatefor the 95-year-olds because
(29:41):
they're like this will kill you,right, a UTI will kill you.
And the prevention 50% decreasedrisk like there's nothing
better than that.
It's fantastic and it's suchlow hanging fruit.
So yeah, we've got a lot ofwork to do.
That's why we're like I can'tget distracted.
Responding to the people whothink that we should be doing
(30:01):
our advocacy a certain way ornot.
A certain way is like listen,I'm a Gen X.
I kind of had the like thoughtthat the world would be perfect
and good, right Like.
Remember growing up in like theeighties and nineties, and
we're like we solved the war,you know, everything's good now
because all the adults are incharge.
And now, like we're, the adultsare like oh dude, we got some
(30:24):
shit to do.
Sonya (30:24):
Still, we do.
And how often do we feel likewe're progressing and then we
just get knocked back a fewsteps and it's like, yeah, I
mean big change doesn't happenovernight, but even just you
know, going back to thebeginning of like, how different
even three years has been yeahright, like we're talking about.
Kelly (30:41):
We're talking about sex way more than we were three
years ago.
We're talking abouttestosterone.
I was the crazy person who waslike I think isn't it weird that
these people aren't having anyorgasms, but they're sleeping
with the people who are havingorgasms all the time.
Isn't this really weird?
And now testosterone what's,three years from now, going be?
Sonya (31:05):
yeah, it's gonna be super exciting it is super exciting
and that's where I get superexcited is the thought of the
generations that are comingthrough behind us.
You know, not even thegenerations that are like our
kids generations, but like theliteral decade behind us that
are coming through.
Kelly (31:19):
Yeah, I mean, I think about I think about that all the
time because I was at this, youknow, thought leader, thought
leader space, we'll say inAmerica.
And here I am being all radicalof like sex equality and
testosterone's in everybody, andlike I'm thinking I'm this
crazy radical, right, and I'msitting listening to these women
on stage, phds in science, andthey're like what if menopause
(31:41):
is optional?
Mm-hmm.
Sonya (31:43):
Now, that's coming out of one of the research centers in
California, isn't it?
Kelly (31:47):
Yeah.
But that's when you're like,okay, here we are being, like
people need their hormones.
It's like, dude, 10, 15 yearsfrom now.
It's like eyeglasses for theovaries, right, just figure out
what keeps the follicles going.
And menopause is optional.
And so it's like we're going tolook back on now and be like,
oh my God, we people didn't.
(32:08):
Are you kidding me?
People didn't want to be onhormones.
Now we just don't let ourovaries fade away.
Right, it's going to be sodifferent?
Sonya (32:15):
Yeah, it's the Buck Institute, just kidding, thank
you.
Kelly (32:19):
So to me I'm like you know.
Here we are thinking we're,we're rat, like people are
hating on us for being too boldand too radical.
And I'm like girlfriend in 15years we're just gonna take,
take something that's gonna keepthe follicles.
Making our own hormones likeprescription hormones will be a
thing of the past yeah, bring iton, kelly.
Sonya (32:37):
Thank you so much for your time.
I cannot wait to see you andgive you a great big hug when
you're here in sydney thank you.
Kelly (32:42):
I hope to be wearing less clothes when I see you.
Sonya (32:45):
I was finding a really diplomatic way to say that, but
it just didn't come to me.
I'll take the heat.
Kelly (32:51):
Thanks, kelly, thank you.
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