771_Dr. Kelly Casperson_AD FREE
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[00:00:00] JJ Virgin: I am JJ Virgin, PhD Dropout, sorry, mom turned four time New York Times bestselling author. I’m a certified nutrition specialist, fitness Hall of Famer, and I speak at health conferences and trainings around the globe, but I’m driven, most of all by my insatiable curiosity and love of science to keep asking questions, digging for answers, and sharing the information that I uncover.

[00:00:31] JJ Virgin: With as many people as I can, and that’s where you come in. That’s why I created the Well Beyond 40 podcasts to synthesize and simplify the science of health into actionable strategies to help you thrive. In each episode, we’ll talk about what’s working in the world of wellness, from personalized nutrition and healing your metabolism to powerful aging and prescriptive fitness.

[00:00:56] JJ Virgin: Join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out at 100. Don’t miss an episode. Subscribe [email protected] to start unlocking your healthiest, most energetic self. I have been waiting for this guest. Gosh, for six months, 12 months, a while, and what I can tell you, I will promise you is she is worth the wait.

[00:01:29] JJ Virgin: I’ve got Dr. Kelly Casperson with me today. She is a board certified urologic surgeon, renowned public speaker, sex educator, and host of the top ranking podcast. You are not broken. She also has her book out. You are not broken, and you are just gonna love her. I knew I would. But she just is, she’s fun. She’s super smart, and she goes there, she goes into all the subjects that it’s hard to, it’s hard to get straight answers to.

[00:02:00] JJ Virgin: So we are gonna be going deep into hormones, especially testosterone. We’ll be talking about sex, we’ll be talking about sexual desire, all the things, and you’re going to understand why she has just dedicated her life to this now, and she’s on a mission. So love this conversation. I’m excited to share it with you as well.

[00:02:22] JJ Virgin: I will put all of her information. She’s got a great Instagram and again, her, um, book and her podcast. She also has an incredible clinic in Washington State. I’ll put all of [email protected] slash Dr. Kelly and that. Spelled K-E-L-L-Y and stay with me. I’ll be right back with Dr. Kelly Casperson.

[00:02:55] JJ Virgin: Dr. Kelly Caspersen, welcome to Well Beyond 40. Thank you for having me. Well, I’ve been waiting and waiting and waiting, but I know this will be worth the wait. And you just said something off. Uh, before we turn on the recording, I got so excited. I got a little flustered, and I’d like to just start with this when I said, what would you like to make sure everybody knows and, and you said

[00:03:17] Dr. Kelly Casperson: that I wanna tell women that they aren’t broken.

[00:03:20] Dr. Kelly Casperson: And what do you mean by that? Um, so because of our lack of education and our lack of education about not only adult sex education, but our body’s hormones, perimenopause, menopause, like what happens in our bodies, most women will think it’s just them. It’s my problem, it’s my flaw. I need to be better. I should have been different.

[00:03:42] Dr. Kelly Casperson: I blah, blah, blah, blah, blah. And it’s like, no, you’re not broken. You just didn’t get an education. And that shows the power of how far education can go in making you feel like, oh, this is part of owning a human body with whatever that might be, is like, don’t internalize it as a personality flaw. It’s not a psychological disorder, it’s not a psych.

[00:04:05] Dr. Kelly Casperson: I mean, I get, I go to the dentist and I’m, I always feel very broken at the dentist. Like I, if I’m just like a better person, the dentist would go. So I’m like, I get it. Like it’s probably just brains, you know? But it’s like truly the lack of decent education is what gets us feeling so crappy in the first place.

[00:04:22] JJ Virgin: And I am, I see it every day. And the crazy part is, I mean, my friends are all in health space in one way or the other. And literally one of my girlfriends who runs a big institute. It said to me, I saw her after not seeing her in person for a year, and she looked completely like, she looked so different.

[00:04:44] JJ Virgin: And I go, what’s going on? She goes, oh, you know, I’ve just been so stressed and I don’t know what’s, I’m not sleeping well. I’m just stressed. I think it’s the mood. I, I go, how old are you? She goes, 48. I go, this is not stress, sweetheart. Yeah. I go here, have one of my estrogen patches. Yes, yes. We

[00:05:03] Dr. Kelly Casperson: share with friends.

[00:05:04] Dr. Kelly Casperson: We’re like, we’re like, literally we, I just got back from a trip to Australia with a bunch of people our age and we’re like. Who needs progesterone to sleep? You need some? I got extra. We brought extra progesterone.

[00:05:14] JJ Virgin: You have to sleep. I know. It’s so funny. It’s like, what do you got in that stash? When I was, um, 49, my 16-year-old son got hit by a car and, and this story’s, I’ve told this story so many times, so I can tell it a little bit like this and not be, you know, sobbing.

[00:05:31] JJ Virgin: But he got hit by a car left for dead in the street, and I am literally in the hospital with him for four and a half months. But I’m in the hospital and one of my girlfriends comes in and she’s like, here, you know, a doc? She’s got thyroid support, adrenal support, she’s got progesterone, she’s got estro.

[00:05:47] JJ Virgin: I’m like, what do you need? I’m like, oh, thank God. You know?

[00:05:50] Dr. Kelly Casperson: Totally. I mean, if only we could reframe, right? Like all this, like women giving to others and helping others is like, you don’t under like, taking care of your mothership is the best thing you can do for other people. And it’s like, that’s a reframe that’s due.

[00:06:04] JJ Virgin: No kidding. Why are we not like. It’s not even, we’re not number one on our to-do list. I see. Quite often we didn’t even make it onto the to-do list. It’s like, hello? Yeah. Yeah. Or like, or like, we’re like the whipping

[00:06:18] Dr. Kelly Casperson: boy for ourselves. Right. Like everything else. And then we’re like, I forgot to eat today and I haven’t exercised and Oh, shoot.

[00:06:26] Dr. Kelly Casperson: Oh, that, that

[00:06:27] JJ Virgin: exercise. Oh, that piece. I mean,

[00:06:28] Dr. Kelly Casperson: I, I, I, I, I am Gil. If I could just exist on coffee, like I would, you know, like I, I’m exactly, I’m guilt favorite. I’m guilty. It also,

[00:06:37] JJ Virgin: yes, but we, but we try, that was when, when my son was in the hospital, I went, you know what? I am going to allow myself to have as much coffee as I want.

[00:06:49] JJ Virgin: Yes. That is my one thing that I’m gonna let myself do. You can have as much coffee, you have carte blanche to have as much coffee as you want.

[00:06:56] Dr. Kelly Casperson: I was, I was like, this is the power of marketing. The other day a friend of mine was like. Hey, do you want some plant-based energy? And I’m like, you mean you mean caffeine?

[00:07:07] Dr. Kelly Casperson: Oh my gosh. I’m like, they figured out a new way to market caffeine. It’s plant-based energy, you know?

[00:07:13] JJ Virgin: There you go. That’s great. Get my plants in, drinking my coffee. Well, let’s, I’d, I’d love to start with busting, just a couple myths ’cause they’re just, you’re a urologist so you’re in a unique position.

[00:07:26] JJ Virgin: ’cause you’re a urologist now, you’re also, uh, certified. Now. What are they calling? ’cause I, I’m still blown away that OBGYNs. Aren’t trained in menopause, like I still had to get over that piece of it. That seems so strange,

[00:07:39] Dr. Kelly Casperson: but I mean like, it’s not in all, this is me being loving on the OB GYNs, there’s 22,000 of them in America.

[00:07:48] Dr. Kelly Casperson: There used to be over 40,000 of them. It’s a shitty job and they’re leaving. Okay, so we’ve got 20,000 ob GYNs in America. We have 80 million women over the age of 40. Yeah.

[00:07:58] JJ Virgin: Hmm. There’s a little, like even if they,

[00:07:59] Dr. Kelly Casperson: let’s say they were all trained in menopause. That’s not enough.

[00:08:03] JJ Virgin: And is it just a shitty job and they’re leaving because you have to get up in the middle of the night to deliver babies.

[00:08:09] JJ Virgin: That’s one of the shitness. And why wouldn’t there be OBGYNs and then geo, like you would think you would just have lifespans, like you can decide which part of gynecology you wanna specialize in.

[00:08:20] Dr. Kelly Casperson: Yeah. Well they, they, I mean, it’s all made up, right? So, so medicine’s traditionally a male dominated, we all learn from all the men who, by the way, were on cocaine at Johns Hopkins when they invented surgery.

[00:08:31] Dr. Kelly Casperson: Like it’s a, it’s a, it’s a long varied history, but they actually threw delivering babies and gynecologic surgery into one re like that was created at one point. And they have never uncreated that. Huh? But one could argue, like, don’t you think delivering babies might be a whole separate gig to like surgery in the pelvis?

[00:08:51] Dr. Kelly Casperson: Yeah. So there, so some of the thought leaders in gynecology are like, it probably hampers us because then we have. 22,000 people should not be in charge of taking care of half of the population. It’s complete medicine bias that we say like, oh, those are the women’s doctors as if assuming the rest are the men’s doctors.

[00:09:11] Dr. Kelly Casperson: Right? Like it’s absolutely insane. And people are always like, you know, ob gyn for hormones and it’s like internal medicine, cardiology, family medicine, urology, dermatology. They should all know what happens in menopause. ’cause this is 50% of the population. This is not like an air quotes, rare woman’s issue,

[00:09:29] JJ Virgin: right?

[00:09:29] JJ Virgin: I think of just even the psychiatrists, oh my god, psychiatry. Think a hundred percent. And Cardi like obviously cardiologist, psychiatrists, orthopedic surgeons, definitely Ortho. Shout out Dr. Vonda Wright. We love shout out. We love Dr. Vonda Wright. I just got to spend a week with her in Australia. You know, I still think even, you know, as an exercise physiologist, I was telling her I had these women coming in in their late forties and I did with frozen shoulder.

[00:09:54] JJ Virgin: I had no clue what the heck was going on. Like, and then when I read her thing about musculoskeletal syndrome of menopause, I’m like, oh, that’s what it was. But now you’re unique and you know, when we look at how many women address, how many, how many doctors are there addressing menopause? And I would be biased.

[00:10:13] JJ Virgin: I would prefer to go to a woman because I want to go through some to someone who gets what’s going on with me. Um, then we get into urology, which I would think it would get even smaller, like in terms of women urologists and women urologists treating women. 1000, 1000 in America, one other one. Um. Yeah.

[00:10:32] JJ Virgin: And then you get into a urologist who also has a specialization in menopause. You probably are the unicorn, I’m assuming. Yeah.

[00:10:39] Dr. Kelly Casperson: There’s a, there’s about, I mean, it’s amazing that the female urologist of, of which there’s a thousand of us, um, just kind of this very cool niche of like menopause and sex med.

[00:10:50] Dr. Kelly Casperson: And there, there’s a de a decent dozen for how many people are in America? 330 million. Wow. But yeah, I’m, I’m by no means the only one. Um, but it’s a pretty, it’s a pretty small niche, the Venn diagram,

[00:11:07] JJ Virgin: menopause, urology, and I mean, when we start to talk about sexual medicine, then it’s a whole other thing.

[00:11:14] JJ Virgin: You know?

[00:11:15] Dr. Kelly Casperson: Yep.

[00:11:15] JJ Virgin: I

[00:11:15] Dr. Kelly Casperson: mean, so, yeah. And by the way, we all got here because of sex. Like it’s actually a huge issue. Like Right. Like how come doctors aren’t good at talking about sex? We didn’t get talked that either. Well, are you taught

[00:11:26] JJ Virgin: that one in medical school?

[00:11:28] Dr. Kelly Casperson: No, the data actually shows we, uh, medical schools are teaching less now than they even were like 10 years ago.

[00:11:34] Dr. Kelly Casperson: There’s just so, and the argument is there’s so much to teach, but my, my argument is everybody has sex except for some people. But we all got here because of sex and. I mean, erectile dysfunction, 40% by age 40. Genital urinary syndrome menopause, 50 to 80% of women. Uh, the data is shitty, but the decent data, 70% of marriages break up because of intimacy issues.

[00:11:59] Dr. Kelly Casperson: 70% breakup ’cause of intimacy issues. Yeah. Tough. Nobody’s, nobody’s like at the courthouse being like, why exactly does this end? Right? Like, so the data is a little crappy. Yeah. But from like me pulling together as much different and you know, I’ve got friends who are divorce lawyers and they’re like, Kelly, it’s untreated menopause okay’s, untreated menopause.

[00:12:19] JJ Virgin: So I think of just when I was dating and I was onm match.com. And you could read these men’s profiles and you went, oh, not having sex, not having sex, not like it was your, how could you tell? You can just, you know, you’re reading, you’re like, I about meh do com. I don’t remember

[00:12:36] Dr. Kelly Casperson: telling that.

[00:12:36] JJ Virgin: Women who are frigid and you know, women who are like, don’t.

[00:12:39] JJ Virgin: And I’m like, oh, oh, anger. Oh,

[00:12:43] Dr. Kelly Casperson: oh, no. Smart now, now people would say, swipe what? Whatever way you’re supposed to swipe. Yeah.

[00:12:48] JJ Virgin: It it, I mean, I was like reading through going, okay, this wo this man does not want a woman who doesn’t wanna work, who wants to be taken care of and doesn’t wanna have sex. Like it was like boom, boom, boom, boom, boom, boom.

[00:12:58] JJ Virgin: You could just read it through all of them, like, wow. Huh. Interesting. Very interesting. Okay, well let’s dig into just like some of the myths around sexual health and you know why, you know, I mean, there’s, there’s, it’s just no one’s talking about it. I don’t even know if you had an issue, like you went to your primary care doctor.

[00:13:18] JJ Virgin: I don’t know what they would tell you to do. Good

[00:13:20] Dr. Kelly Casperson: luck.

[00:13:21] JJ Virgin: You know,

[00:13:23] Dr. Kelly Casperson: like, and I, I mean, I come by my, I come by my, my words very honestly of like, listen, I was a shitty menopause sex med doctor at one point too, right? Like, I didn’t get taught this. This is all like deep, deep curiosity, love. And like a little bit of being pissed that there is data and nobody knows it.

[00:13:48] JJ Virgin: So what, so someone, I would assume that a lot of the struggles with women and sex start to, well, no, I wouldn’t assume this because then we have women who have just given birth and they’re tired. Then you have women who are now small kids and they’re working their asses off and they’re stressed out.

[00:14:03] JJ Virgin: Then it’s all

[00:14:04] Dr. Kelly Casperson: of ‘

[00:14:04] JJ Virgin: em. It’s the 20-year-old whose

[00:14:06] Dr. Kelly Casperson: shitty 19-year-old boyfriend tells ’em they’re not supposed to use lube and start, and they start having sex just by putting a rock hard penis in a vagina. Like that’s not good sex. Right. So it’s like it’s, I I think especially like the Gen Xers, we all are very hopeful that like the generations coming up behind us are doing better, but it’s like, dude, they were raised on porn.

[00:14:27] Dr. Kelly Casperson: That’s not normal. Getting worse.

[00:14:29] JJ Virgin: It’s worse. Like where would you learn how to, where would you learn what a normal sex life is? What, and, and you know, I’m looking at more from a health standpoint, like, you know, I’ve always heard about how great it is for men’s health. I’m sure it must be the same for women’s as it is for men’s.

[00:14:46] JJ Virgin: There’s

[00:14:46] Dr. Kelly Casperson: less, there’s less data, but you wouldn’t think we’re not special, right? Like, men who are sexually active, the data is that they do live longer. Um, and, and probably multi-variable, like it’s cardiovascular fitness, right? It’s a loving, it’s a loving relationship. You know, you probably have a better diet because you’re eating meals with people, right?

[00:15:03] Dr. Kelly Casperson: So there’s probably multi-layers to the, to the data that men who are sexually active live longer. But, um, it’s not as researched in women, but dude, an an orgasm’s an orgasm, like, yeah, but I mean the, the sex ed, I mean, I always say like, if at best you got a disease and pregnancy prevention plan, right?

[00:15:26] Dr. Kelly Casperson: That’s what schooling might do. If you didn’t have a mom who cared. You didn’t get much of a sex education. I got

[00:15:35] JJ Virgin: a

[00:15:35] Dr. Kelly Casperson: book.

[00:15:36] JJ Virgin: Good. I got a book of, of paper doll things like, and that was Paper Doll Man, putting penis into paper. Doll Woman. Okay. Egg. Like that’s what I got. That’s, I remember, I remember a book.

[00:15:51] Dr. Kelly Casperson: It was the wonderful way that Babies are made.

[00:15:53] Dr. Kelly Casperson: There may have been a stork, there may have been Jesus. Like there were mul, there were many players in the game. I don’t quite a, but I remember the title

[00:16:03] JJ Virgin: Stork, where the Stork ever came from. But yeah,

[00:16:06] Dr. Kelly Casperson: there’s a new book called, it’s Not About the Stork. I, when people are like looking for, for resources for their young children.

[00:16:13] Dr. Kelly Casperson: Um, it’s called this, not About the Stork, which is pretty good.

[00:16:16] JJ Virgin: Well, what about resources for the, like, you know, the woman who wants to know what’s normal, what is a good sex life for them? What is normal for them? Like where is that information?

[00:16:27] Dr. Kelly Casperson: Yeah, so I, so I would get two, two recommend. First of all, I would start with my book because my book is like, I’m assuming this woman got crappy sex ed.

[00:16:36] Dr. Kelly Casperson: ’cause that’s America 1 0 1. So my book is literally like female body clitoris is important. Responsive desire is pretty darn normal. This is what happens with menopause. So it’s really kind of like a, a health-based sex ed book. And then you have to ask like. Once you figure all that out, what do you do to truly have an exceptional sex life?

[00:16:56] Dr. Kelly Casperson: Right? Because I joke like we’re spending so much time just getting people outta the gutter with the sexual dysfunction that you’re like, what do you have to offer? The people who are like, it’s pretty good. Like can it be better? Like where do those people go? Right. Um, Dr. Emily, Jamie, A-J-A-M-E-A, just wrote a book called Anatomy of Desire, if you’ve ever heard of like the flow state and the research on being in a flow state.

[00:17:19] Dr. Kelly Casperson: So she basically takes that theory and applies it to sex. And to be like, you have to have it be a little bit challenging. You have to actually have meaning to it. You have to be intentional about it. You have to practice it, right? So it’s like all these things that create flow state to actually make truly exceptional sex.

[00:17:37] Dr. Kelly Casperson: Once you’re in the like, okay, I’ve got an orgasm happening. Most of the time it’s not painful. I can communicate with my partner about it. Like the 1 0 1 class. Once you’ve got that under your belt.

[00:17:49] JJ Virgin: So you mentioned something that I don’t think is wildly known, and I wanna define this term. ’cause you talked about responsive desire.

[00:17:57] JJ Virgin: Mm-hmm. What does that mean?

[00:17:59] Dr. Kelly Casperson: So people think of sexual desire, and this is going all the way back to Freud. So Freud said this, Hollywood movies say this, that your sexual desire is petitive, and I love that word, but petitive means appetite driven. So if you are hungry, you get hungrier. If you’re thirsty, you get more thirsty.

[00:18:17] Dr. Kelly Casperson: If you’re tired, you get more tired, right? It’s like this drive for these body needs. For many people, you don’t want sex. The less you have it. So. Freud said, oh, the sex drive is like that for everybody. No. Especially if you happen to be a female body with a stressful work life with a long-term relationship where your brain’s not saying, this is novel, this is new.

[00:18:38] Dr. Kelly Casperson: What’s Friday night gonna be like? Right. So spontaneous desire is, I’m going out seeking it, I just want it sitting on the couch. Not most people’s lived experiences. And then responsive desire is, I am now in a sexual context, or I’m going to choose to put myself in a sexual context, become sexually aroused now I want it.

[00:19:00] Dr. Kelly Casperson: So I want it during, I might want it after. How many people after are like, oh my God, that was so good. I totally forget how good that is. Remind let’s remind me to do that again. ’cause that was so good. That’s desiring sex after you had it,

[00:19:12] JJ Virgin: right? You’re, you’re so spot on though. I’m thinking of, um, you know, one of my friends who literally hasn’t had sex for last I checked five years, so it’s even longer now.

[00:19:22] JJ Virgin: And it, I think. It’s like she could care less now. Yeah. That’s normal.

[00:19:27] Dr. Kelly Casperson: And so for when people feel they’re broken, but I’m like, that’s normal. Especially if you’re post menopause and you have like no hormones telling you to like, Hey, you have an egg. You have an egg that you just released. Would you like to fertilize this?

[00:19:38] Dr. Kelly Casperson: Right. You don’t have that happening. Yeah. Um, and so many people are sitting, and this is, it’s the same thing with exercise, and it’s the same thing with, for me at least, eating vegetables is like. If I just sit around on the couch waiting for the desire to eat my five fruits and vegetables a day and to get my cardio in, like, I’m gonna be waiting a while instead of like, I’m gonna prioritize putting myself in an exercise mindset, uh, you know, chopping the vegetables and then you’re like, oh, I love it when I’m doing it and I love it after I ate the salad.

[00:20:09] Dr. Kelly Casperson: Right? Like, sex is not exceptional. It’s just like all those other things, but like, don’t wait around to exercise. ’cause for most people, they’re like, most Olympic athletes don’t have a spontaneous desire to exercise.

[00:20:19] JJ Virgin: This is such good information because I, when I heard this first, the first info about responsive desire, I go, oh.

[00:20:26] JJ Virgin: ’cause the way it’s presented in me is that men are very easily aroused women. It’s like, takes quite a while to get things going. Mm-hmm. And then this idea that. You know, it’s, it’s like exercise or anything else where literally you don’t wake up and go, I can’t wait to go do that. Like, I would love to do some high intensity interval training.

[00:20:48] JJ Virgin: Exactly. No, I freaking every minute. I really

[00:20:49] Dr. Kelly Casperson: wanna get my fiber in first today.

[00:20:52] JJ Virgin: Yeah, that’s it. Amen. No, forget. I forget the big rib eye with the salt. No, I’m going to eat those brussel sprouts, right? Yep. Yeah, it’s, so what does someone do then? You know, you’re in a relationship, you understand the importance of it, you feel great afterwards.

[00:21:08] JJ Virgin: How do you get yourself going? Put yourself

[00:21:11] Dr. Kelly Casperson: in this, in the space reserve time for it. I mean, you think even like a hundred years ago, right? What was like the most thrilling thing that humans could do? Probably have sex, right? Like the occasional alcoholic beverage, but pretty rare. Um, there was no Netflix, there was rare ice cream.

[00:21:28] Dr. Kelly Casperson: Like there was nothing else that was competing with your dopamine. So like, sex was the thrill. And now you’re like, dude, there’s easier ways to get your dopamine going. Way easier ways. And so to me, I’m like, it’s, it’s no wonder that at the end of a long day, you’d rather sit on the couch, eat, eat Haagen-Dazs and chill on Netflix.

[00:21:49] Dr. Kelly Casperson: Like it’s easier dopamine, right? But, okay. So we’re in a committed relationship. We understand sex is good for our bond. We both wanna prioritize it. Great. What’s the time that works best for you in the week? Is it Sunday afternoons? Is it Friday mornings, go spend the time and not, and the only critics, the only critics of the schedule sex view are the people who they don’t want it to be like, and you have to have an orgasm and you have to, it has to take 20 minutes.

[00:22:16] Dr. Kelly Casperson: And it like, no goals, just some, just some connected naked time. Uh, prioritize, nonsexual touch during the week. Like the more connected you are, non sexually, the lot easier that intimacy is going to be. Great data on that. But yeah, I think I, it’s our, it’s our petulant desire to spontaneously want sex in a world that’s filled with like stress exhaustion and easier dopamine.

[00:22:43] Dr. Kelly Casperson: It’s like, no, it’s not how it works.

[00:22:46] JJ Virgin: It’s interesting ’cause you schedule everything else.

[00:22:48] Dr. Kelly Casperson: It’s like you schedule every, would you work out as much as you were? If you didn’t, you have to put it in your schedule. You have to prioritize it. You have say, exercise is important to me,

[00:22:57] JJ Virgin: otherwise it

[00:22:58] Dr. Kelly Casperson: won’t happen.

[00:23:00] JJ Virgin: And I would view this then, like I’m starting to really think of sex along the same lines as getting good sleep, getting in your resistance training, doing your HIIT training, getting your steps in, getting your sex. Like all, I put them all together. I. Yeah. Is that a crazy idea here?

[00:23:18] Dr. Kelly Casperson: No, I like it. The only thing I don’t like is when you put, I mean, sex is magical.

[00:23:25] Dr. Kelly Casperson: It’s, it’s spiritual. It’s like, it’s so precious that when you, not you, but like when one is like, and eight fruits and vegetables and don’t forget to floss first and like when you put sex in with kind of a rote, you lose the like, magic of what sex can be. But yes, in the like, hey, if you want a sex life, you’ve gotta prioritize a sex life.

[00:23:46] Dr. Kelly Casperson: Don’t be entitled to have something for free. Um, there’s this great book called Magnificent Sex by Peggy Klein Platt. She’s a PhD and she basically like put up advertisements and she’s like. Who thinks they’re really good at sex, let’s chat. And then she like interviewed them to figure it out. Nowhere in any of these, like self purported sexual experts were they like spontaneous desire is why I have an amazing sex life.

[00:24:11] Dr. Kelly Casperson: Like it’s not in the top five criteria. So I think so many people, women especially probably ’cause I just talked to them more, they’re like, I just don’t have sexual desire. So two things. Number one, are you prioritizing it? But number two, are you having sex worth desiring? And I think that’s a very important issue when you just look at the orgasm gap in heterosexual relationships nationwide, which is not getting better with time women.

[00:24:36] Dr. Kelly Casperson: What is

[00:24:36] JJ Virgin: that orgasm gap? What is it?

[00:24:37] Dr. Kelly Casperson: Orgasm gap is the rate of, so take a couple Uhhuh, we got heterosexual, we got same sex male, same sex, female, or is like the traditional research ones. How often does each person have an orgasm as a marker for sexual satisfaction? Basically? So the person with the highest amount of orgasm is the heterosexual male clocking in mid nineties.

[00:24:58] Dr. Kelly Casperson: The paired with the person. Interestingly enough, with the least amount of orgasms, the heterosexual female clocking in around 60% of the time, that’s with a loving partnered relationship, hookup sex 7% of the time. Wow. Yeah. What the hell are we, what the hell are we doing that for? I even do

[00:25:15] JJ Virgin: that. Then

[00:25:15] Dr. Kelly Casperson: why would you do that?

[00:25:18] Dr. Kelly Casperson: Yeah. And then they just feel like they’re broken and it’s like, no, you’re existing in a, in a, in a con sign where like one person’s orgasm is way more prioritized. So in me learning about desire types, you know, and talking to desire experts, I’m like, okay, but you’re assuming women are having sex worth desiring.

[00:25:37] Dr. Kelly Casperson: And they’re like, yes, we are assuming that. And I’m like, you can’t assume that. Like the data does not support women are having sex worth desiring. Like, I can’t make you like melted ice cream. I can’t make you like mushy broccoli. Like if it doesn’t give you an inherent reward, that’s not how dopamine works.

[00:25:55] JJ Virgin: Yeah. Interesting. So let’s put this together now with, you know, shifting hormones, which I would just imagine compounds the issue.

[00:26:05] Dr. Kelly Casperson: Mm-hmm.

[00:26:06] JJ Virgin: So you talk a lot about testosterone. Let’s, I’d love to dig into that. What you, you know, how you got into the whole testosterone thing, what you see for women with testosterone, because I still am blown away by the fact that we don’t get testosterone covered by insurance.

[00:26:24] JJ Virgin: You know, it’s our most abundant sex hormone. And yet, like, it’s just crazy. The world’s crazy, my friend,

[00:26:33] Dr. Kelly Casperson: like, the world doesn’t make sense. And, but we can work with that. Right? And we’re working to change things. So yeah, I mean, thank you for bringing that up. Like we gotta talk about the facts first, because otherwise I’m like this crazy person telling women to go on testosterone and they’re like, why does she want us all to turn into men if they don’t have the knowledge that ovaries make testosterone.

[00:26:54] Dr. Kelly Casperson: So do our ag adrenal glands. So does our brain, right? We do peripheral conversion of testosterone. We have about four times the amount of testosterone than estrogen when we’re in our cycling periods of life. That means, because then people will be like, well, all your testosterone just converts to estrogen.

[00:27:09] Dr. Kelly Casperson: No, it doesn’t. Only about 25% of it does. We have testosterone receptors everywhere. An absence of evidence does not mean evidence of absence as far as research goes. People are like, we don’t have enough evidence. I’m like, yeah, because we prioritize male research. We don’t even know this is in our bodies.

[00:27:27] Dr. Kelly Casperson: There’s no funding for a generic hormone that can’t be patented.

[00:27:33] JJ Virgin: So, no, nobody’s doing research on this. Well, we have the, and this drives me a little bit nuts, and I understand the need for double-blind placebo controlled randomized trials. I understand it, but I also know that we have mechanisms of action and physiology.

[00:27:47] Dr. Kelly Casperson: Thank you. Most people. And then, and here’s the other like, just to put the nail in the coffin of like any woman who’s waiting around for 20 more years of testosterone research. Yeah. Fun. You’ll be deaf. We do, we do high blood pressure medication research on men, and then give women the high blood pressure medications.

[00:28:02] Dr. Kelly Casperson: We do high cholesterol studies on men and then give women the cholesterol meds. We do depression studies on men, and then give women the depression meds. You know, how much medi, how much research we have on testosterone in men, A crap ton. So you’re telling me that’s the only thing, the thing that’s physiologic in our body.

[00:28:20] Dr. Kelly Casperson: That’s the only thing we’re not gonna extrapolate to women. It makes no sense. Yeah, it doesn’t make any sense. I mean, the, the data on the, the testosterone is a brain neuro hormone. The fact that we’ve labeled them sex hormones hurts us because sex is extra, sex is not necessary. Like all the dismissive things that come with labeling them sex hormones, they’re called sex hormones ’cause they’re initially discovered in testicles and ovaries.

[00:28:46] Dr. Kelly Casperson: Right. But it doesn’t describe all their functions like they protect your myelin. Women have less neurologic diseases when they take estrogen post menopause. Like these are brain and neuroprotective hormones. So calling them and dismissing them as sex hormones is static. So what

[00:29:04] JJ Virgin: would you call, call them

[00:29:06] Dr. Kelly Casperson: neuro hormones.

[00:29:07] JJ Virgin: Neuro home. That’s, that’s fantastic.

[00:29:10] Dr. Kelly Casperson: Because it, in the, the data on low testosterone for depression and dementia in men is legitimate and scary. Like to the, if like you have a man with low testosterone and you don’t treat him his risk of like bone health, mental health, dementia, diabetes, like it’s legitimate.

[00:29:31] Dr. Kelly Casperson: And so to say, well, but why are we choosing this whole natural shit we throw on women is insane because we can’t handle the fact that we never used to live this long. Like living to 84 is not natural as a population. Right. And, and nobody ever tells a man like, oh yeah, I’m sorry. You have low testosterone and erectile dysfunction.

[00:29:54] Dr. Kelly Casperson: It’s natural. Have you tried like. Have you tried some meditation retreats? Like we just, we don’t hold men and women to the same standards as far as judging what they’re supposed to do with their body. And to me, this is a gender equality issue.

[00:30:08] JJ Virgin: Yeah, that sounds, that sounds like it. I mean, the first thing you think of, like my husband at low testosterone, it actually came out, he’d had low testosterone.

[00:30:19] JJ Virgin: We went and did DEXA scans when I was prepping for my 60th birthday blast and discovered that it, thankfully the DEXA discovered it. I didn’t have to tell him, uh, that he was a skinny fat. Totally normal weight obesity for, you know, 25% body fat for an athletic male.

[00:30:37] Dr. Kelly Casperson: Mm-hmm.

[00:30:38] JJ Virgin: And I did my side of the equation with him of a protein, kicked his strength training into gear, creatine, and then he added in the side with testosterone and a couple peptides and dropped to 10% literally in eight months.

[00:30:52] JJ Virgin: Put on 24 pounds of muscle drop, 27 pounds of fat. Wow. Which never would’ve happened. I mean, I look at it, I go, yeah, I’m good. I’m not that good. That was testosterone. Like I might’ve gotten, you know, 10 pounds, never that much. Like, are you kidding? It’s not gonna happen. But what a dramatic difference and every aspect of his life does he feel better.

[00:31:11] JJ Virgin: Oh yeah. Yeah. I mean, remarkably like he looks better now than he’s ever looked in his life, but he also had like a dad who died of heart disease. I was watching all these things going uhoh, we gotta go do something about this. I was fortunate early on, like as I was going through starting into perimenopause, my doc, Dr.

[00:31:29] JJ Virgin: Allen Christensen actually put me, testosterone was one of the first things he did with me.

[00:31:34] Dr. Kelly Casperson: That’s rare and amazing.

[00:31:36] JJ Virgin: Yeah, I, I mean, shout out the

[00:31:38] Dr. Kelly Casperson: data. Shout out for sure. I mean, the data in perimenopause we’re behind on treating menopause. Like that’s a whole podcast. But the perimenopause, I mean, our biggest rate of bone loss is the two years before your period ends.

[00:31:52] Dr. Kelly Casperson: This is

[00:31:53] JJ Virgin: how the hell, this is such an important statement. Does having, how the hell do you know when your period’s gonna end? Right? Like, you don’t No. These things are going wonky. Yeah. Like, you know, so I was lucky, Kelly, ’cause I was, um, teaching this course called Overcoming Weight Loss Resistance to Doctors.

[00:32:09] JJ Virgin: And one of the places that I said you would get weight loss resistance. Is it when you started to get into peri, when you saw any disruption? First I had a thyroid one, and then it was like anything disrupting testosterone, estrogen, progesterone. So when I, when I had little symptoms, I was like, uhoh. And so, and I had great buddies who were in the, the business who were are, who were way ahead of their time because this was, what, 15 years ago?

[00:32:35] JJ Virgin: That’s way like,

[00:32:36] Dr. Kelly Casperson: I’m ahead of, I’m ahead of the time. And that was way ahead of the time.

[00:32:39] JJ Virgin: I was ne I might have been three months when it first started before I went on hormones. I was, I’ve always been on. So

[00:32:46] Dr. Kelly Casperson: I think the future is starting hormones in peri, wh why are we waiting for women to suffer?

[00:32:52] JJ Virgin: Yeah.

[00:32:52] JJ Virgin: No,

[00:32:52] Dr. Kelly Casperson: why are we waiting for you to have disease?

[00:32:55] JJ Virgin: You know, it’s.

[00:32:56] Dr. Kelly Casperson: Why wouldn’t we start treating in perimenopause

[00:32:58] JJ Virgin: and wouldn’t you see it right away in their fasting insulin and their, you know, H-S-C-R-P And then if you were doing a dset, I don’t know, maybe not at 65, but do a baseline one and then start to do it, you know?

[00:33:11] JJ Virgin: Yeah.

[00:33:12] Dr. Kelly Casperson: I

[00:33:12] JJ Virgin: mean that’s a whole bizarre DEXA at 65 is

[00:33:15] Dr. Kelly Casperson: nuts. I was just in Australia, DEXA is is at starting at age 70 in Australia. 70. 70. Whatcha gonna do at that point? What’s the point that egg is fried? Just feel how strong your bones are before you go in the grave. Like, what’s the point? So, wow. Yeah, that’s very bad.

[00:33:30] Dr. Kelly Casperson: And it’s not even expensive. No, they’re cheap. You can get a cash, cash dexa, usually a hundred, around a hundred dollars in America. Now, unfortunately,

[00:33:37] JJ Virgin: most people are now doing them for body comp. But I mean, think if you had a baseline, like I got a baseline in my thirties, but think if you even did one in your teens, then your twenties, then your thirties, you could catch it and then in your forties and the minute you started to see any kind of hormonal stuff you would start to treat.

[00:33:54] JJ Virgin: So

[00:33:54] Dr. Kelly Casperson: yeah, the, the fact that we’re not treating women’s bones estrogen’s, f FDA a, approved for the prevention of osteoporosis, first of all, like for people who think they need permission from the FDA is a whole, which that’s, that’s a whole podcast episode. But we actually do have permission for prevent primary prevention of osteoporosis with estrogen, which is very exciting.

[00:34:14] Dr. Kelly Casperson: Um. The, I mean, this is how I explain it to people. The body is smart. The body needs hormones. So what’s the female body doing? Why are we seeing glucose go up? Why are we seeing cholesterol go up? Well, cholesterol is a precursor to testosterone and estrogen and progesterone. So our body’s actually trying poorly.

[00:34:36] Dr. Kelly Casperson: These are compensatory, not so great mechanisms, but cholesterol goes up because these we’re trying to get some hormones in our body. And then insulin resistance are the are fat de, so a lot of people will say, you don’t always gain weight, but at least your fat distribution, right? Your body masses changes.

[00:34:52] Dr. Kelly Casperson: My mom called

[00:34:53] JJ Virgin: it shifting sands.

[00:34:54] Dr. Kelly Casperson: Shifting sands. I like it. It’s like, oh, I do not want that. Shifting sands. So adipose tissue, poorly inflammatory, makes estrogen. And so it’s like the body’s actually kind of smart trying to eek out some neuro hormones when the ovaries have outlived their life. I just like thinking about it that way because it helps it make sense as other women are like, why is this happening?

[00:35:18] Dr. Kelly Casperson: It’s like it’s happening for a reason.

[00:35:20] JJ Virgin: Yeah, makes sense.

[00:35:20] Dr. Kelly Casperson: None of this is, is different. Once you, going back to what you said, once you understand physiology, once you understand cellular mechanisms, once you understand that cholesterol is a precursor to neural these neural hormones, it’s not confusing anymore.

[00:35:35] JJ Virgin: So how would you treat someone walking in then as they’re starting to go through all of this? What would you be looking at? What point would you start to treat them with hormones? Where does testosterone fit in?

[00:35:49] Dr. Kelly Casperson: Yeah, well, it,

[00:35:51] JJ Virgin: it, it’s all individualized, right? I know. I know. It’s the end of one so people can start to think.

[00:35:56] JJ Virgin: I think just that explanation. So great for people to realize, you know, your body is telling you these things. And yeah, and, and I love that you said, you know, that whole natural thing. ’cause I literally had a, a woman crying. I was doing a talk and she came up afterwards. She goes, I’m doing all the things you’re saying, you know, but I wanna approach this naturally.

[00:36:15] JJ Virgin: So I’m not doing hormones. She’s absolutely miserable. I’m like, well.

[00:36:20] Dr. Kelly Casperson: I was doing a talk. You not

[00:36:21] JJ Virgin: saying that about insulin.

[00:36:22] Dr. Kelly Casperson: I know, I know. Or eyeglasses. I’m trying to just see naturally. So I’m not gonna use eyeglasses. Like, okay. Um, I did this talk in Texas and this woman literally redid her kitchen to make a cabinet to hold all of her supplements.

[00:36:37] Dr. Kelly Casperson: That’s how like into it she was, her and her partner hadn’t had sex in years because it was so damn painful from her genital urinary syndrome of menopause untreated with low estrogen. And I was like, a $14 tube of vaginal estrogen can fix this for you. And you remodeled your kitchen for all of your expensive supplements that aren’t helping.

[00:36:58] Dr. Kelly Casperson: And I’m like, just use the vaginal like, and then the source. Yeah. And then you’re like, um, vaginal estrogen is over the counter in multiple countries and they’re like, oh. Like, somehow that makes it more safe to use or something. Um. But yeah, like the, the myth of natural, it’s, I mean, it’s called the naturalistic fallacy, right?

[00:37:16] Dr. Kelly Casperson: Like this is a well-developed theory of just because something’s natural, it’s therefore inherently better. Wow. Like that’s made up. Naturalistic fallacy is a common brain thought error.

[00:37:27] JJ Virgin: And why is it that progesterone, this is never made sense to me. Why do we have progesterone over the counter? And I guess in some places I actually have been ordering estradiol cream that I’ve been using on my,

[00:37:38] Dr. Kelly Casperson: yeah, I mean, the problem is just not knowing because in America, supplements are unregulated that a lot of the progesterone creams on Amazon don’t actually have two problems, might not actually have progesterone in them, and they might not have the dose.

[00:37:51] Dr. Kelly Casperson: If you need to protect the uterus, that’s actually medically required. So that’s the buyer beware on over the counter. But yeah, it’s all made up. For instance, dheas over the counter in America, it’s a prescription in Canada, Mexico’s over the counter, or in Mexico, testosterone’s over the counter. You can get it at the airport.

[00:38:07] Dr. Kelly Casperson: Wow. Like, uh, Viagra and Cialis are over the counter in the uk. Vaginal estrogen’s over the counter in the uk. Like it’s all made up. Uh, estrogen used to be in face creams in America in the 1950s before they decided that it needed to be a prescription. So, like, it’s all made up, my friend.

[00:38:26] JJ Virgin: That’s great. Okay, let’s go back over to testosterone.

[00:38:30] JJ Virgin: So testosterone for women.

[00:38:32] Dr. Kelly Casperson: Yes.

[00:38:33] JJ Virgin: Um, how, like, what, what should they be looking at if they’re looking at labs with their doctor? What, you know, how, with things like TSH and free T three and all these, the, the norms, what we see as the mm-hmm. The levels out there are pathetic. Yes. Is it the same when you start to look at testosterone for women?

[00:38:54] JJ Virgin: I would, yes. Okay.

[00:38:55] Dr. Kelly Casperson: Yes. So in America. We have two major lab companies. We have LabCorp and Quest, and there are many other labs. So remember, each lab, Tori has different reference ranges that they use to say normal. And I, I I, I can often explain this better when I talk about men’s testosterone. So men’s testosterone, I just, for conversation normal is 300 to about 900 or a thousand massive range.

[00:39:24] Dr. Kelly Casperson: Yeah. ’cause they just studied a whole bunch of men and they said this is the 95% of people will fall within this distribution. Now show me a 52-year-old man with a testosterone of 3 0 2. Who feels normal? That was Mike. Tim. Yeah. So, so even in men, so people are like, why are women so weird? It’s like, no, it’s the same in men with testosterone, right?

[00:39:43] Dr. Kelly Casperson: So just because you are within the normal distribution. Now the problem is when your insurance won’t cover your testosterone, this is still men because you’re three 20. But you’ve got all the signs and symptoms of low testosterone, right? But then we have age adjusted testosterone for the experts and men.

[00:39:59] Dr. Kelly Casperson: So same thing with women. Huge range for, I think Quest, it goes down to like seven to 42 is considered normal. And again, these are American values for the uk, for Australia, you’ve got a convert. The numbers that I’m saying. Um, most of the data for low libido shows improvement in higher physiologic numbers.

[00:40:23] Dr. Kelly Casperson: So I like to say high double digits, low triple digits. For where, where a woman’s usually like, oh my gosh, I feel so much better.

[00:40:32] JJ Virgin: So what would that look like in terms of like 70 to a hundred? Something like that? Yeah.

[00:40:36] Dr. Kelly Casperson: But again, it’s individualized, you know? And I, I never on Instagram, because people are like, what’s a, what’s your, I know They’re like, Nope.

[00:40:43] Dr. Kelly Casperson: Not tell. Nope. What’s a good number? Because then you’re chasing a number. Yeah. And a good clinician knows it’s about how do you feel? What are your side effects? Like a woman might have side effects at a testosterone, A 95 and another one has a testosterone, a one 50 with no side effects. Right? So it’s really individualized medicine.

[00:41:01] Dr. Kelly Casperson: But you can, you know, argue, you can bring in the international guidelines on low sexual desire and testosterone. You can bring that to your doctor. You can say that most papers show an improvement in high physiologic for women. Um. You know the, because medicine is so awful at treating hormones in women, women are suffering.

[00:41:20] Dr. Kelly Casperson: So they do go to the places that make money off of pellets. So they don’t offer you, they don’t offer you the, like, normal physiologic treatment first you get very high, high levels, which is low male levels. Um, some women love it. Yeah. Talk

[00:41:34] JJ Virgin: about the pellets because that Yeah, the, the pellet thing to me drives me nuts.

[00:41:38] JJ Virgin: ’cause you’ve got a pellet. How do you adjust the dose once you have a pellet in, you

[00:41:42] Dr. Kelly Casperson: don’t.

[00:41:42] JJ Virgin: Right. So you just wait

[00:41:43] Dr. Kelly Casperson: for it to wear off. Um, so it’s the most invasive and it’s the most expensive. And if you’re lucky and blessed, you’re gonna live 40 years past menopause, right? Like, so to me, I’m like, you should never remortgage your house to pay for your hormones.

[00:41:55] Dr. Kelly Casperson: Um, and it tends to be the highest dose. And people who I would call, they call ’em pellet pushers, but the people who sell pellets don’t tend to offer any other options. And so to me I’m like, that’s a one trick pony, not, not a comprehensive menopause specialist.

[00:42:13] JJ Virgin: Are there certain forms that you find are the easiest or most reliable, or is it different for Yeah,

[00:42:22] Dr. Kelly Casperson: what I tend to do, again ’cause it’s easy and most reliable, is I have a good relationship with my local compounding pharmacy.

[00:42:27] Dr. Kelly Casperson: And I compound a five milligram cream. One pump is five milligrams because then it’s idiot proof, it’s one pump of cream. Um, the only country with a current government approved testosterone product for women is Australia. And that’s. A pump of cream. That’s how they do it. You can basically microdose the male gel in this country.

[00:42:48] Dr. Kelly Casperson: The biggest problem with that is number one, insurance coverage. It’s dirt cheap. You don’t need insurance coverage, but it’s dirt cheap. But then the pharmacists are actually kind of jerks to women. Do you know what you’re doing? Are you trying to transition like lots of invasive questions when my women went to the pharmacy and so I’m like, I don’t wanna deal with you guys.

[00:43:09] Dr. Kelly Casperson: Wow. A woman shouldn’t have to dece defend her healthcare. So I tend to compound. Wow. Or you can, if, if you want the male dose to microdose, uh, have it delivered from Amazon, then you’re not gonna have to deal with a, a phar because pharmacists

[00:43:20] JJ Virgin: didn’t get trained well, that’s the dosage on it, doesn’t it, of the microdosing.

[00:43:23] JJ Virgin: So why would they even con. I’m assuming it’s

[00:43:27] Dr. Kelly Casperson: a, well, wow, that’s a good question. So in America, because testosterone is a scheduled two, medication scheduled, three in New York, scheduled two me, so same level of ketamine and Tylenol with codeine. ’cause it’s restricted because of Congress from the 1991 Anti-Doping Act ’cause of the Olympic doping scandals having nothing to do with the risks of healthy physiologic testosterone.

[00:43:49] Dr. Kelly Casperson: Testosterone got labeled that. So because of that you can only do a three month supply at once. So if you microdose and actually put that dosing on the box, that’s greater than three months. Oh, got it. So a pharmacist can say, I won’t dispense this ’cause I’ll be breaking the law. And they’ll also say, um, I don’t wanna break the box ’cause they lose money.

[00:44:09] Dr. Kelly Casperson: Right. So it’s act, it’s, it’s tricky jj

[00:44:13] JJ Virgin: Wow. And what, how would someone, what should someone feel. Because one of my favorite books I ever read was Uzi Reese’s, um, book where he went through like all the different hormones and how you would feel, you know, at the right amount, how you would feel deficient, how you feel, you know, if you had too much with someone, a woman going on testosterone, how would they know that they’re kind of where they need to be?

[00:44:39] Dr. Kelly Casperson: The most common sign is I feel like myself again. Now that’s very hard to research, but they actually have done it. The not feeling like myself, not NFLM, um, has actually been researched and in perimenopause menopause transition, about 40% of women say they don’t feel like themselves and it’s legitimate.

[00:45:02] Dr. Kelly Casperson: But you’re never gonna get anything FDA approved for not feeling like yourself

[00:45:06] JJ Virgin: percent. I would think it’s much higher than that. I, well, that’s like one study and one questionnaire. Okay. I was like, who, who feels like themselves going through Right. Perimenopause, let’s say. But I would say, I

[00:45:15] Dr. Kelly Casperson: mean, I always joke and I’m like the, the most legitimate reason for testosterone in females in America currently is hypoactive low sexual desire disorder or low libido.

[00:45:25] Dr. Kelly Casperson: Right? But no woman ever comes back and says, the only thing that’s better is my libido. Like that does, because that’s not how libido works, and that’s not how the brain works, right? So most women will say, I feel like myself, I have more energy. I don’t hit the wall at 3:00 PM I’m not searching for coffee at 3:00 PM I just feel like getting more stuff done.

[00:45:47] Dr. Kelly Casperson: I’m finally making gains at the gym that I, I’ve been working my ass off and not making any gains. Um, I’m more curious about the world, the world’s in technicolor and not black and white anymore. My husband says, I’m asking more questions. Like it’s all of these like non-scientific, non-medical terms for her being like, life is better.

[00:46:07] Dr. Kelly Casperson: I just know it’s better.

[00:46:09] JJ Virgin: As opposed to them being on estrogen and cycling progesterone. Like let’s say someone gets on hormone replacement therapy. I know, I’m, I’m asking you the collective rather than the N of one. But just, just kind of here you’re like, bear with

[00:46:25] Dr. Kelly Casperson: me.

[00:46:25] JJ Virgin: Okay, bear with me with this. So, so a woman, ’cause you know.

[00:46:31] JJ Virgin: Typically there are a lot of doctors out there not prescribing testosterone. They’re prescribing estrogen and you know, either steady state or cycling progesterone. And would a woman be able to feel like themselves enough with those two, or is it gonna be the testosterone that’s is when you talked about I feel like myself again, was it the combination of the three?

[00:46:54] JJ Virgin: Is it the testosterone? Could they do it without the testosterone? What’s the story? And I know I’m violating the rules here. I’m aware,

[00:47:02] Dr. Kelly Casperson: I’m like, how do I answer this without saying It depends this,

[00:47:06] JJ Virgin: this is why I’m just thinking that there are so many women out there who are at least now. Have, have recovered from the Women’s Health Initiative are realizing that by going on hormone therapy, they’re reducing their risk of heart disease, osteoporosis, uh, dementia, all of the things, and having better quality of life, but they’re just doing estrogen and progesterone.

[00:47:30] JJ Virgin: Mm-hmm. And not, or if they are doing testosterone, not doing enough.

[00:47:35] Dr. Kelly Casperson: Right. Yeah, yeah, yeah. Um. It, it’s, man, it’s taken us 22 years after the WHI to get 5% of American women on, on estrogen.

[00:47:44] JJ Virgin: That just pisses me off. Right?

[00:47:45] Dr. Kelly Casperson: Like, so to me I’m like, it’s a big ass to tomorrow have everybody on testosterone. But I thi I do think it’s different for everybody.

[00:47:52] Dr. Kelly Casperson: I mean, some people like they’re sleep, they’re hot flashes, they’re heart palpitations. You give them estrogen and they’re like, oh my God, I’m so much better. You know? So it’s like the one thing isn’t the the best for everybody. Uh, there’s some people testosterone doesn’t work well with, like, there’s some people estrogen doesn’t work well with.

[00:48:10] Dr. Kelly Casperson: And so I, you know, I think where people like to get me in trouble, not really, but like when I’m like, this is all you need is these three simple hormones, and then you don’t need to eat protein or get your sleep or work on stress or lift weights, you know? And it’s like, no, you have to do all the things.

[00:48:27] JJ Virgin: Yeah, this will help you feel like doing all the things again, this will help you feel like, you know, and it’s the same

[00:48:32] Dr. Kelly Casperson: with men. Like men. They’re like, man, I’m gaining weight. I have no energy. And you’re like, just go to the gym, dude. It’s like, give them the testosterone. Yeah. So they actually have the energy to get to the gym and then they can do that too.

[00:48:43] JJ Virgin: Yeah. Like watching my husband now take his testosterone from 300 to 900 and all of a sudden he’s way more motivated at the gym and can recover

[00:48:53] Dr. Kelly Casperson: by the way. Yeah, yeah, yeah. He’s not wiped out after.

[00:48:55] JJ Virgin: After. Yeah. So, so testosterone, the biggest thing you’d be looking for as you’re dosing it is really libido ish stuff and feeling kind of back in your body.

[00:49:06] Dr. Kelly Casperson: Yeah, I mean, I, I, I ask women and, and the other, I think important thing about. Hormones and your doctor is like, this is your choice. I, it drives me. It irritates me to no end. When people are like, my doctor said I need to blah, blah, blah, is like, what do you want? Right? Like, this is your choice. This is a 40 year career post menopause.

[00:49:27] Dr. Kelly Casperson: You’re choosing hormones. Why do you wanna be doing it? It’s not anybody else’s fault that you’re on hormones, right? Like you are choosing it. And so I really care about the empowered woman that way. She wants to try testosterone. She’s gonna tell me if it’s helping her or not. Like none of this. I, at the end of the day, I’m like, I don’t care if you take hormones or not.

[00:49:46] Dr. Kelly Casperson: But I, I was having this brunch with this with a friend, and she’s like, so what do you want? And I’m like, I want women to be educated, to be knowledgeable about their bodies and to advocate for what they want. At the end of the day, I don’t care if you use vaginal estrogen, but life’s better with vaginal estrogen.

[00:50:04] Dr. Kelly Casperson: Right. Like, just have the knowledge.

[00:50:07] JJ Virgin: So I’m, I wanna go over to vaginal estrogen one moment more with testosterone. Mm-hmm. Because my guess out there is that women who are using it aren’t using a high enough dose. So likely.

[00:50:21] Dr. Kelly Casperson: Yeah. Well, I mean, I, but then you have the pellet pushers where they’re using way too high of a dose.

[00:50:26] Dr. Kelly Casperson: So I think it’s both, you know, there are women like, oh my God, my hair fell out and my voice changed and I got acne. And it’s like possibly too high of a dose, you know? And then the other women, the other thing I see a lot is because so many doctors don’t know that, like the reference ranges aren’t.

[00:50:44] Dr. Kelly Casperson: Optimal is, they’ll be like, my doctor says my, my testosterone lab was normal, or it went up to 40 on testosterone, but I didn’t feel anything. It’s like they don’t know the nuance of like, yeah. Women start really getting symptom improvement in the higher double digits. And I tell my women, I’m like, listen, your lab value says high on testosterone.

[00:51:04] Dr. Kelly Casperson: Now you need to know that because if you have somebody come and look at that and tell you that your testosterone’s high and freak out about it, like you need to be educated enough to be like, I’m aware. It’s where I feel best. I’m choosing to be on the testosterone. Like give them the empowerment so somebody doesn’t sweep in and review your labs a year from now and be like, oh my god.

[00:51:24] Dr. Kelly Casperson: You know, like where, why women are happy on testosterone, their labs say hi.

[00:51:29] JJ Virgin: I think this is really, I mean we’ve, we’ve talked a lot on this show about lab values in general and that we are not normalizing to the normals because Right. You know? Yeah. You’ll be then in the average and that is not where we wanna be.

[00:51:46] JJ Virgin: So,

[00:51:46] Dr. Kelly Casperson: and I think the other thing with labs is. People read labs like they’re infallible. Like there can be false positives, there can be false negatives. And especially with hormones like did you dose your testosterone cream two hours before you got your labs done, or eight hours before you got your labs done?

[00:52:01] Dr. Kelly Casperson: Like, you’re gonna have different lab values. We’re not, like bodies aren’t steady state ever. And so to pick one lab, and that’s why labs are so crappy in perimenopause, is people are like, that’s what Tuesday at 8:00 AM was right. But that’s not how Thursday at 2:00 PM was. And and it doesn’t represent how you’re feeling overall.

[00:52:23] Dr. Kelly Casperson: And at the end of the day, it’s like, how do you feel? What are your goals? Can hormones help get you there? Yes, we can do it safely. We should be able to do it cheaply. ’cause this is 40 year, 40 year lifespan.

[00:52:34] JJ Virgin: Yeah. Makes a ton of sense. All right, let’s, let’s talk vaginal estrogen

[00:52:37] Dr. Kelly Casperson: skincare for down there. I just gave a talk at the Sydney Opera House at basically like normalizing, like.

[00:52:45] Dr. Kelly Casperson: I looked this up. Face skincare, $96 billion Industry. And then people are like, I don’t wanna put anything on my vagina ’cause it’s not natural. And I’m like $96 billion up here. My friends. Yeah. What all

[00:52:59] JJ Virgin: are you putting up there?

[00:53:00] Dr. Kelly Casperson: That’s a whole lot of stuff that’s not natural. Yeah. Yeah. Most of it’s like doesn’t do anything.

[00:53:06] Dr. Kelly Casperson: You know, you like the, you like the packaging but like vaginal estrogen is like just putting back the hormones that were always there. Keeping things functioning well. And again it goes back to miseducation of like if all you think menopause is, is a hot flash and no periods and now menopause is done ’cause the hot flashes are done of like, you don’t understand that every single tissue in your body functions mitochondria function because of hormones all over your body and your bladder gets affected.

[00:53:35] Dr. Kelly Casperson: Your clitoris, your labia, your, it’s, it’s crazy to me that women spend money cutting off their labia and then post menopause freak out ’cause their labia goes away ’cause there’s no hormones. And I’m like. Do you want it? You don’t want it either way.

[00:53:56] JJ Virgin: Okay, so over to topical j d’s like, whoa, Kelly. I was like, wait. Cutting off their labia. Pre like,

[00:54:04] Dr. Kelly Casperson: oh, well, the cosmetic, like the co, the cosmetic people who are preying on women’s lack of knowledge of what normal body anatomy is.

[00:54:13] JJ Virgin: Well, how would we even drives me nuts like. It is not like we go out and look at them.

[00:54:17] JJ Virgin: So you can’t, you know, I mean, you know, it’s not, they’re considered, they’re considered vulgar, so on the internet, so don’t know what it really supposed to look like. You just know what yours looks like. And Barbies, that’s normal. And Barbie, Barbie doesn’t have any genitalia don’t happen.

[00:54:35] Dr. Kelly Casperson: Yeah.

[00:54:35] JJ Virgin: She also had a waist that I figure if I got rid of a couple ribs on each side, I could potentially even come close.

[00:54:43] JJ Virgin: But I didn’t eat anything ever again. Um, I’ve gotten those bodies where you can literally put your pants on and pull them all the way down and never have to unbutton them. So I was like, okay, so. Yeah, that waist curve is not mine. Alright, so back over to vaginal estrogen. So go back to

[00:55:00] Dr. Kelly Casperson: vaginal estrogen.

[00:55:01] Dr. Kelly Casperson: Um, it’s, it’s over the counter in multiple countries. I don’t think we’re gonna get that here. America.

[00:55:06] JJ Virgin: And is that estradiol? That’s over the counter. Vaginal estrogen.

[00:55:07] Dr. Kelly Casperson: Vaginal estradiol. So it’s all about dosing, right? So people are very confused about dosing. So vaginal estrogen is low dose estradiol.

[00:55:17] Dr. Kelly Casperson: There, there’s also a premarin, but most commonly estrodiol, which is your body’s natural es estrogen. And, um, it’s dosed low enough that it’s not gonna put you above menopausal blood values if you check where to check your blood. It’s like literally skincare and it helps everything that comes in contact with.

[00:55:35] Dr. Kelly Casperson: So vagina and bladder share a wall, which is why it helps the bladder. Helps with getting up at night to pee, decreases urinary tract infections by 60 to 50 to 60%. Nothing works better. That

[00:55:46] JJ Virgin: is so huge ’cause this is such a thing.

[00:55:48] Dr. Kelly Casperson: Huge. Yeah, if you, if you start getting urinary tract infections recurrent and you’re 46, that might be a nice hint that you’re in perimenopause, right?

[00:55:58] Dr. Kelly Casperson: Like you’re so, and to explain it to people, you need estrogen to help support the lactobacillus, which is your natural microbiome of the vagina. Lactobacillus makes an acidic vagina. The acidic vagina is what prevents the poop bugs from traveling up to the bladder area. Your estrogen goes away, your lactobacillus die off.

[00:56:20] Dr. Kelly Casperson: The acidity of your vagina changes. Now you’re more prone to re your recurrent UTIs. Like going back to what you said, it all makes sense once you understand physiology.

[00:56:31] JJ Virgin: So why wouldn’t this just be standard of care then to be doing vaginal estradiol as part of the part of your per,

[00:56:42] Dr. Kelly Casperson: well, I, I mean, the experts think it should be, I’m like, mammogram, colonoscopy, vaginal, estrogen, age 50, like.

[00:56:48] Dr. Kelly Casperson: So, and you floss, you wear seat belts. We use vaginal estrogen,

[00:56:52] JJ Virgin: but I will tell you, I’ve been around a lot of, of, lot of hormone docs for years and just started hearing about it.

[00:57:00] Dr. Kelly Casperson: So not maybe they, maybe they don’t care about your sex life. I, I mean, again, it’s like I’m a urologist, right? So like my lens is like, I give 10 times the dose of testosterone to men every Tuesday and I look at labias and vaginas and painful sex and recurrent UTIs every single day.

[00:57:17] Dr. Kelly Casperson: So it’s like that my world in the perimenopause menopause really does revolve around like, how do we take care of the men? What’s the pelvis doing? Like my lens is just different.

[00:57:25] JJ Virgin: It just seems like if someone’s coming in for a UTI, who’s perimenopausal and up, that this should be part of their standard of care.

[00:57:34] Dr. Kelly Casperson: A hundred percent the American, the American Urologic Association gives it a category B rating, which is pretty good evidence for prevention of UTI. And they’re coming out with new guidelines. I haven’t seen them yet. My hope is that they’re gonna be even stronger. But emergency department doctors who know this, when a woman comes in with UTIs, they’ll send them out with vaginal estrogen prescription.

[00:57:56] Dr. Kelly Casperson: A friend did a study looking at Medicare. So if Medicare just mailed everybody 65 and older with a vagina, vaginal estrogen, and they used it, it would save Medicare billions of dollars a year. Just. In decrease urinary tract infection costs.

[00:58:13] JJ Virgin: Holy smokes. Well, I will tell you full disclosure, like I’ve had a couple UTIs over the years and no one has ever recommended this.

[00:58:21] JJ Virgin: I, I, I, the only reason I knew about it was I heard you on a podcast talking about it, and I’m like, what the hell? Why have I never heard about this? Yeah.

[00:58:31] Dr. Kelly Casperson: Well, I, most people don’t care about the pelvis and female sex. Well, I’ve had

[00:58:37] JJ Virgin: like, you know, I’m around like really amazing docs. I just, this has to get out there like this.

[00:58:43] JJ Virgin: Yeah. It’s has to get out there. I mean, the lack of,

[00:58:46] Dr. Kelly Casperson: the lack of curiosity about why UTIs go up in midlife,

[00:58:50] JJ Virgin: right? Like, could it be because of the, I mean, gotta be estrogen went down, whatever, you know. Yeah. Or testosterone or whatever. So something dropped and your hormones dropped. So it makes complete sense.

[00:59:03] JJ Virgin: Um, you know, I was using it on my face, so I was like, oh. Yeah. Okay. You know? Totally. All right.

[00:59:10] Dr. Kelly Casperson: Yeah. So I, a lot of people will use their vaginal estrogen on product, on their face. I think it’s a little thick, you know, it might be nice for like crow’s feet spot treatment. I compound estriol, which is another low potency just for skincare.

[00:59:24] Dr. Kelly Casperson: And I didn’t tell anybody that I was using it and that I kid you not, like two to three months after I started using it, people are like, oh my god, your skin, oh my god, your skin’s so amazing. And I was like, are you kidding me? Like, you use estriol on your face. I use estriol on my face. It’s just a lower potency.

[00:59:42] Dr. Kelly Casperson: The, the risk of systemic absorption, super low. Like, it’s just a very safe way of being like estrogen’s getting, and again, for PE to explain to people estrogen’s incredibly important with, for collagen. Collagen’s where our moisture and our kind of like the softness, like the resilience of the skin comes from and, uh, in America, before estrogen became a prescription over the counter face creams in the fifties had estrogen in it.

[01:00:07] Dr. Kelly Casperson: Wow. It’s not a mystery that estrogen helps skin so.

[01:00:12] JJ Virgin: Yeah, I had a girlfriend years ago, this was probably 20 years ago. She was way ahead of her time, who was like working with a compounding pharmacist, getting, and she was my age, so she was in her forties doing estrogen creams back then for her face with a compounding pharmacist.

[01:00:29] JJ Virgin: I wish I’d listened to her again. She was a, she was ahead of her time. She was an eastern European gal, like very into longevity stuff. And I’m like, I love it. She listened to everything she said.

[01:00:38] Dr. Kelly Casperson: I went, I went to my dermatologist. She’s like, what are you doing? And I’m like, estriol, Trein and sunscreen. And she’s like, that’s literally just what you need to do.

[01:00:48] Dr. Kelly Casperson: Like that’s your, that you don’t have to do many other things. Like those things all actually work.

[01:00:55] JJ Virgin: You heard it. There’s the tricycle. There you go. From the urologist skincare, from UR Skincare, wrecks.

[01:01:00] Dr. Kelly Casperson: Hey, it works for

[01:01:01] JJ Virgin: me.

[01:01:01] Dr. Kelly Casperson: Like,

[01:01:04] JJ Virgin: well, you have a great podcast and a great book and they’re easy to find ’cause they’re all the same name.

[01:01:09] JJ Virgin: You are not broken. So I’m going to put those in the show notes. Um, one last word because we really didn’t touch on it. I guess we should touch a little bit on progesterone. Mm-hmm. My least favorite hormone. I know most people love progesterone. I’m the person who gets pregnant and gains like 12 pounds in a week and cries and breaks out systemic acne, cystic acne and like progesterone is, is just so awful for me.

[01:01:35] JJ Virgin: Mm-hmm. But for, but we do need it. So can we just address that one real quick so we don’t have someone saying, I’m just gonna use estrogen.

[01:01:43] Dr. Kelly Casperson: Yeah. So if you, I actually just did an Instagram on this to clear it up. So if you have a uterus and you take systemic estrogen, meaning it goes in your body and in your bloodstream, not vaginal, not face stuff like systemic estrogen, you must take the dual of both estrogen and progesterone because the uterus needs both to stay healthy.

[01:02:04] Dr. Kelly Casperson: That’s that rule. So people took that and said, you don’t need progesterone if you don’t have a uterus. Well, progesterone, especially the oral form of micronized progesterone, it converts in the liver to gaba the neurotransmitters in the brain. It’s great for sleep, it’s great for anxiety, it’s great for like, it’s kind of like the calming mellowing hormone.

[01:02:24] Dr. Kelly Casperson: And if, again, not for everybody, but so we’re, I think we’re finally getting to a point where people with hysterectomies are like, Hey, can I try this? Is it safe? It is incredibly safe. Tons of studies saying it’s breast protective. Certainly not harmful. Like the, I think we are under likely undertreating and what’s currently available in America, which is an oral micronized progesterone.

[01:02:47] Dr. Kelly Casperson: It’s short acting. It’s a big dose that’s then gone. I would love a longer acting one that didn’t just hit people with a huge progesterone dose. Um. Again, it’s not gonna happen. ’cause these are cheap medications. You can’t make a lot of money off of ’em. But I do compounding pharmacists do a slow release progesterone.

[01:03:06] Dr. Kelly Casperson: Yes. You can get a compounded slow release progesterone. Huh. And that’s what people who, you know, they say they’re progesterone intolerant, but you’re like, is it possible your body doesn’t like this big dump? And then have it be gone. Some people want the progesterone effects all day long. Right. Or to not take it right before bed.

[01:03:21] Dr. Kelly Casperson: So we don’t have an FD approved formula. I, I’m not holding my breath for one, but when people say, you know, they don’t tolerate it, I always wonder like, is it the formula? What’s, what’s happening?

[01:03:33] JJ Virgin: I literally break out in cystic acne, but I do low dose five, five to seven days a month even though I do not have a uterus.

[01:03:42] JJ Virgin: Ah. So I still do.

[01:03:43] Dr. Kelly Casperson: Yeah.

[01:03:43] JJ Virgin: Um, especially if I’m like having trouble sleeping. I’m like, boom. So yeah, it is, it is great for that. I mean, like

[01:03:51] Dr. Kelly Casperson: your, your people probably know this, but like sleep is everything.

[01:03:56] JJ Virgin: We can always go on a sleep rant. ’cause I feel like everybody can always continue to hear this one.

[01:04:01] Dr. Kelly Casperson: Yes.

[01:04:02] Dr. Kelly Casperson: Like, okay mom.

[01:04:06] JJ Virgin: I’m like the total sleep freak. Like, I will not steal from my sleep. I’m, oh, I’ve got the whoop on

[01:04:12] Dr. Kelly Casperson: now. And so now I’m like a little bit sleep. I’m like, what happened to my REM sleep last night? Was it the, was it the late night ice cream? I don’t know. Hmm.

[01:04:20] JJ Virgin: Let’s put it together. Yeah. I know for a while I was doing Aura plus apple and picking the best one and I go, I really can.

[01:04:27] JJ Virgin: You know, I’m gonna have to just pick one and go with it there. Yeah. But, uh, it’s fun. Super. We’ve been playing around with it. Super. Mm-hmm. The one thing I know for sure is alcohol does nothing good on that. Different alcohol is not our friends. No, don’t, not our friends. I know, I, I was, I was, uh, when we both were on that how-to menopause, big book launch party and it was like, that was the, we had to break up with wine.

[01:04:53] Dr. Kelly Casperson: We, you know, we’ve had a, most people have had a good run.

[01:04:55] JJ Virgin: Yeah, we had a good run. I grew up outside of Napa, so we literally used to go wine tasting in our teens. We’d skip school ’cause they didn’t card. Imagine that like, you know, you’re in your senior year of high school, you could go to Opus One and they would give you wine and not carve for free.

[01:05:15] JJ Virgin: That is wild. It was fabulous. Those were the days.

[01:05:18] Dr. Kelly Casperson: Those were the days, yeah. I mean, I told people like, Hey, most of us have had a full career with alcohol. Like, we can be done with it now. We can just decide. Yeah,

[01:05:25] JJ Virgin: it’s, it actually was good because I did it when like I. Didn’t really, you know, I didn’t need to sleep as much, I guess,

[01:05:32] Dr. Kelly Casperson: right?

[01:05:32] Dr. Kelly Casperson: Yeah. Yeah. You’re like, thank God I gave up that habit before it got worse.

[01:05:36] JJ Virgin: God. Well, it’s been amazing. I knew it would be, and again, I’m gonna put everything, I’ll put your podcast, Instagram, uh, book. I’ll link all of [email protected] slash Dr. Kelly. Um, just for anybody listening right now, Instagram handle is Dr.

[01:05:56] JJ Virgin: Kelly Casper Kelly, it’s

[01:05:57] Dr. Kelly Casperson: Kelly Casperson, md. Aha.

[01:06:00] JJ Virgin: And what about the website’s?

[01:06:01] Dr. Kelly Casperson: Kelly casperson md.com. New books coming out in September called The Menopause Moment. It’s gonna be a very prohormone book ’cause I just feel like the world needs a prohormone book.

[01:06:11] JJ Virgin: I am. Absolutely as prohormone as it gets. But I’ve been, again, I feel so blessed that I, you are like, I, I’m a unicorn with this whole thing and you

[01:06:21] Dr. Kelly Casperson: are,

[01:06:22] JJ Virgin: you know,

[01:06:23] Dr. Kelly Casperson: to be celebrated.

[01:06:24] JJ Virgin: Oh, thank God. But I feel really sad for the forgotten crew that are about 10 years older than me that are, the

[01:06:32] Dr. Kelly Casperson: boomers are pissed

[01:06:34] JJ Virgin: and they should be.

[01:06:35] Dr. Kelly Casperson: The boomers who have, have knowledge are like, most people don’t know, but we, when we are gonna start looking at health disparities over women, we have this data.

[01:06:45] Dr. Kelly Casperson: We have data on women. This is published last year, I believe. Women who are 65 who’ve stayed on their hormones versus those who’ve never been on hormones, less of most chronic diseases.

[01:06:58] JJ Virgin: Yeah. I mean, I’m like, I have nothing except all the dumb stuff I did in my twenties to my joints, broke a foot, blew out a knee.

[01:07:06] JJ Virgin: Like the dumb stuff I did that just, that’s just living. Other than that, like,

[01:07:12] Dr. Kelly Casperson: and

[01:07:12] JJ Virgin: you know, I credit it to

[01:07:13] Dr. Kelly Casperson: having, but you’re, I mean, like, but you’re, you’re protecting those joints

[01:07:17] JJ Virgin: Oh, yeah. With the hormones. Yeah. And working, working out and eating, right, yeah. And sleeping well and sunning and all the stuff,

[01:07:25] Dr. Kelly Casperson: and remembering to prioritize sex.

[01:07:28] Dr. Kelly Casperson: Oh, yeah.

[01:07:29] JJ Virgin: And my husband will love you. It works.

[01:07:32] Dr. Kelly Casperson: I mean, you know, and people are like, you know, why do you do it? Why do you keep showing up? Blah, blah, blah, blah, blah. And I’m like, listen, I save marriages. Like, which means I’m saving women’s wealth. You know, like it’s, it’s a big deal. And, uh, I’ll keep showing up.

[01:07:48] JJ Virgin: Well, you’re saving families. Like when you do that, like the, the ripple effect of all of this is so big.

[01:07:53] Dr. Kelly Casperson: Yeah.

[01:07:54] JJ Virgin: You know, so it’s, it’s massive. And I didn’t realize that sex was, you always hear it’s sex. It’s what? Sex kids and money.

[01:08:02] Dr. Kelly Casperson: Yeah.

[01:08:03] JJ Virgin: It looks like you can overcome. It’s looking from

[01:08:05] Dr. Kelly Casperson: the data. Again, it’s hard data.

[01:08:07] Dr. Kelly Casperson: ’cause nobody’s like, why did this end ultimately, was it the soft dick or the dry vagina? Like we, we don’t have great data going into it, but from what we can tell intimacy. Lack of intimacy. Yeah. And you stop having sex, then you stop hugging, then you stop holding hands, then you stop having dinner, then you stop going to bed at the same time.

[01:08:25] Dr. Kelly Casperson: Like it’s just, and I always, I wanna be careful. I’m not here to say everybody has to have sex. Like, I, I just want you to be educated about it. And if you, if it’s important to you to understand, you have to prioritize it. Like, that’s all I want. Yeah. That’s it.

[01:08:41] JJ Virgin: Thank you. Thanks for having me. Appreciate it.

[01:08:44] JJ Virgin: We’ll have you back with the book too. Sounds good. Awesome. Thank you. You’re welcome.

[01:08:52] JJ Virgin: Be sure to join me next time for more tools, tips, and techniques you can incorporate into everyday life to ensure you look and feel great and are built to last. Check me out on Instagram, Facebook, and my website, jj virgin.com. And make sure to follow my podcast at, subscribe to jj.com so you don’t miss a single episode.

[01:09:15] JJ Virgin: And hey, if you’re loving what you hear, don’t forget to leave a review. Your reviews make a big difference in helping me reach more incredible women just like you, to spread the word about aging powerfully after 40. Thanks for tuning in and I’ll catch you on the next episode.

[01:09:41] JJ Virgin: Hey, JJ here, and just a reminder that the Well Beyond 40 podcast offers health, wellness, fitness, and nutritional information that’s designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment.

[01:09:58] JJ Virgin: If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Make sure that you do not disregard, avoid, or delay obtaining medical or health related advice from your healthcare professional because of something you may have heard on the show or read in our show notes, the use of any information provided on the show is solely at your own risk.

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