Member question:  Lichen Sclerosis, decreased sensation and libido – I discuss two types of desire – spontaneous and responsive and three options pharmacologically for low desire. A couple options for if you "want to want": testosterone, Addyi and Vyleesi. Pneuma for penile girthiness  - if you want to be a shower. The Orgasm Gap - as written by men Testosterone is not associated with increased cardiovascular risk and associated decreased risk of breast cancer. P Agrawal and others, Testosterone Therapy in Females Is Not Associated with Increased Cardiovascular Risk – A US Claims Database Analysis, The Journal of Sexual Medicine, Volume 20, Issue Supplement_1, May 2023, qdad060.014, https://doi.org/10.1093/jsxmed/qdad060.014   Sexual Boredom in long term relationships contributes to low desire. L De Oliveira and others, (055) Sexual Boredom and Sexual Desire in Men and Women in Long-term Relationships: A Latent Profile Analysis, The Journal of Sexual Medicine, Volume 20, Issue Supplement_1, May 2023, qdad060.053, https://doi.org/10.1093/jsxmed/qdad060.053   An obituary of Jaqueline Gold Our Podcast Sponsor is Firmtech – use code “NOTBROKEN” FirmTech’s rings help improve performance and sexual experience for all men not just those with ED. ⁠https://myfirmtech.com/⁠ Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership

You Are More Than Just Your Breast Cancer - Hormones and Breast Cancer   Dr. Corinne Menn is a board certified OBGYN and North American Menopause Society Certified Menopause Practitioner. She has a special interest in areas often neglected in women's health: Perimenopause and menopause, the unique needs of female cancer survivors and those at high risk for breast cancer.    Dr. Menn tells us her story of breast cancer dx at age 28, going through menopause three times and is now a pro-hormone educator.   Dr. Menn discusses taking systemic hormones and her journey and how it has changed her life.   Why are doctors and patients so afraid of hormones?   Doctors are so risk adverse – but let’s talk about the risks of not treating menopause.   The myth that estrogen causes cancer.   How Tamoxifen works.   Breast cancer nomenclature – estrogen positive – this doesn’t mean estrogen caused the cancer – we clarify.   The nuance of being overweight and risk of breast cancer.   The number one killer of women with history of breast cancer is heart disease.   Safety of systemic hormone replacement therapy in breast cancer survivors Article in Breast Cancer Research and Treatment · January 2022 – Dr Bluming -       "Twenty-five studies of HRT after a breast cancer diagnosis, published between 1980 and 2013, are discussed, as are the 20 reviews of those studies published between 1994 and 2021. Only 1 of the 25 studies, the HABITS trial, demonstrated an increased risk of recurrence, which was limited to local or contralateral, and not distant, recurrence. None of the studies, including HABITS, reported increased breast cancer mortality associated with HRT. Even in the HABITS trial, the absolute increase in the number of women who had a recurrence (localized only) associated with HRT administration was 22. It is on the basis of these 22 patients that HRT, with its demonstrated benefits for so many aspects of women's health, is being denied to millions of breast cancer survivors around the world."   The problem with the HABITS trial.   Why are we scaring women so much about breast cancer?   Who is the right breast cancer survivor to start hormones? A good candidate?   Are we overtreating with aromatase inhibitors? Podcast partnership today: Always Discreet https://www.instagram.com/alwaysdiscreet/   Bluming AZ. Hormone Replacement Therapy After Breast Cancer: It Is Time. Cancer J. 2022 May-Jun 01;28(3):183-190.   Young Survival Coalition https://youngsurvival.org/   Vaginal Estrogen for people with a history of breast cancer: https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2021/12/treatment-of-urogenital-symptoms-in-individuals-with-a-history-of-estrogen-dependent-breast-cancer   Dr. Menn is an Alloy Health Medical Advisor and Prescriber www.myalloy.com http://www.drmenn.com/ https://www.instagram.com/drmennobgyn https://www.tiktok.com/@drmennobgyn https://www.facebook.com/drmenn

I went to the 2023 American Urologic Association's National Conference. Here are some top takeaways and thoughts. So much on this week’s podcast! Low hormones in men and women — can increase risk for cardiovascular disease Women have a decreased risk of heart attack and stroke when started on hormones in the safety window of menopause (first 10 years) The Traverse study paper coming out in two months - can’t wait! Testosterone is not a gendered hormone All bones need testosterone Women in early menopause should be on hormones at least until natural age of menopause to decrease risk of cardiovascular disease, osteoporosis (NAMS guidelines and this indication has FDA approval). Equality in healthcare Three new oral testosterone pills on the market for men, not for women We need to focus on brains and bones health in women just as much as we do for men Treat women the same in healthcare Did you know the UK is requiring doctors to talk to their patients at age 50 about menopause? Amazing! If hormones are so dangerous, why don’t we stop estrogen in trans women after the age of 50 - a thought exercise on how we think about giving hormones to all bodies - Is staying on hormones during menopause gender affirming care? Oral DHEA supplements — what’s the deal? Bulkamid — urethral filler for stress incontinence ECoin training Prolapse repair in premenopausal women Should we offer it or no? Male infertility is associated with shorter life expectancy Marijuana affect sperm Using testosterone for maintenance of vaginal health Michael Pearlman balance scale of desire More about Addyi (filbanserin) Importance of elastin and collagen Very small percentage of women have cervical orgasms - but it matters. New technology that @mysteryvibe is releasing to help with period cramps

Feeling Broken In The Bedroom? What You Need To Know About Your Sexual Health - With Dr. Kelly Casperson This is an interview I did with Lesley McShane for her podcast “Redesigning Midlife” and it was just such a good interview I asked her if I could share it again.  1. Basics:  a. Menopause means it’s been one year and one day since your last period. b. The average age of menopause is around 51. and c. for ten years prior to menopause, women go through peri-menopause, where hormones are doing a reverse puberty. 2.  A lot of women stop or have pain during penetrative intercourse during this time due to a decrease in natural lubricant and collagen, but this can be easily treated. 3. Even if you don't have menopause symptoms, if you are over the age of approximately 51, you have gone through it. 4. The most sexually satisfied people aren’t young people, it is people in their 50s, 60s, 70s. 5. Great sex is not a passive thing. It’s an active process, just like someone that is physically fit. It has to be prioritized. 6. Use of lube increases your success of orgasm by 70-80%. Silicone based lube is best because you don’t absorb it like you do the water based. 7. There is no “how long” should I use Vaginal Estrogen cream. The use of it is like using sunscreen or wearing a seat belt. 8. You don’t need a “sex drive”. We do things because they are awesome.  If you aren’t having awesome sex, don’t wonder why you don’t desire it. 9. We feel entitled to a spontaneous sex drive that has been sold to us by media. And when we don’t achieve that, we end up feeling broken. 10. Putting something in the vagina only leads to female orgasm 30% of the time so special focus need to be paid to the female body. Your largest sex organ is your brain. 11. Don’t sit passively by waiting for spontaneous desire to happen. Get dressed up and go to the party even if you don’t think you want to. Chances are you’ll have a good time once you get there. 12. Control of stress and cortisol levels in our bodies will help us desire more intimacy. 13. If there is a desire mis-match in your relationship, normalize it by talking about it. 14. Communication with our partner about menopausal symptoms and what we are going through is important to our relationship. 15. Get educated on hormone replacement therapy as an option. When women start thinking about how they want to live as they get older and get educated, then they see how beneficial HRT could be for them. 16. Women between the age of 50-60 that are on hormone therapy live 3-4 years longer than women in the same age group not on hormone therapy. 17. For our young adult children that are starting their own sexual lives, the biggest thing they need to know from the start is about consent. 18. They need to be aware of is orgasmic equality. 19.We have to educate our girls that pleasure is for everybody.  Lesley McShane's podcast: https://podcasts.apple.com/us/podcast/redesigning-midlife-workout-motivation-over-50-weight/id1549596974 Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership

Better Sex Through Mindfulness – Dr. Lori Brotto  Dr. Lori Brotto is a psychologist and Director, UBC Sexual Health Laboratory Canada Research Chair in Women’s Sexual Health Professor, Department of Obstetrics & Gynaecology, UBC Executive Director, Women’s Health Research Institute  “Sex is not just a deficiency in a hormone” – KJC Dr. Brotto tells us how she started her sex research career by studying rats. Do stressed out rats want sex? “Stress is antisexual” – Dr. Brotto “So many people don’t even know that they are stressed.” - KJC Dr. Casperson tells her story about finding mindfulness How Dr. Brotto discovered mindfulness for helping manage pain, anxiety, and desire Mindfulness During sex. How anxiety and depression affects our sexuality. And mindfulness can help! We talk about medications for low desire in women. Filbanserin specifically. Beliefs are key!  We discuss the role of beliefs on our sex life. Mindfulness helps us “see” our beliefs more. Anorgasmia – how common it is and what is the most common cause. How to suss out asexuality versus low desire.  Obligatory sex – how to navigate discrepant desire. The myth of penis and vagina sex and why it excludes so many people. Mindfulness for sexuality after prostate cancer. The role of communication with your partner. Do they even want your erect penis? https://www.loribrotto.com/ Better Sex Through Mindfulness https://amzn.to/42bchpj Better Sex Through Mindfulness Workbook: https://amzn.to/42abTYc https://www.instagram.com/drloribrotto/ https://www.cancersexnetwork.org/ https://www.drannekatz.com/   Did you get the You Are Not Broken Book Yet? https://amzn.to/3p18DfK   Join my membership to get these episodes ASAP when they are created and without advertisement and even listen live to the interviews and episodes. www.kellycaspersonmd.com/membership