RE-RUN - Vaginal Health, Sexual Pleasure, and Wellness Beyond Your 40s with Dr. Kelly Casperson

24:47I'm like, well, here's my problem. I know both of us are like dragging

24:50Dr. Kelly Casperson:our podcast just created for the, for the host to like help themselves. I mean, come on. That's what we're all doing. So, okay. The overactive bladder. I did not know that was a symptom of perimenopause. And let me tell you, I've gone to the urologist and he had me on the anti-coli... What are the... Oh, the anti-coliologics. Those are nasty drugs. Yes. By the way. I'm so annoyed. I was on it for like three years. And then my new urologist, because this guy like bounced. announced he was like oh no you can't be on that like you don't go on that long term and I had no idea so now I'm like well why am I peeing all the time freaking vaginal estrogen what's wrong with your urologist I'm allowed to say that because I'm a urologist yes exactly and I'm also allowed to say that because I was literally in Denver Colorado last spring looking at how brown it was telling the Rocky Mountain Urologic Society that vaginal estrogen is equivalent to anticholinergics like we literally have that published data the problem with that data is it's hiding in the menopause journal and urologists besides me don't read that but i was literally in denver last year telling the colorado urologist that vaginal estrogen is equivalent to the nasty medications they put you on my he's fired he's he is i have an amazing urologist near boulder who's a female that you can go see her name is dr carolyn franziak go see her she's amazing Oh, I'm seeing her as soon as I get off this call.

26:19This is like that information. Help me help you. So overactive bladder and incontinence, incontinence just means bladder

26:30Dr. Kelly Casperson:leakage. Okay. That's what I wanted to know the difference. So, so many women always complain about if they sneeze, if they jog, they're running, they're jumping, you know, anything that your pee just comes out. So what - Yeah, let's talk about that because that's super important and very common. So leaking when you cough, sneeze, laugh, trampoline, double under exercise, right? It's called stress incontinence. People think that means it's because you're stressed. It's not because you're stressed. Stress means a force. So it's a force on the bladder, force on the pelvis, right? So running, jumping, coughing, sneezing, all of that will push urine out of the pelvis.

27:11Dr. Kelly Casperson:Happens with aging, decreased collagen, decreased hormones, decreased muscle strength. Also putting any sort of baby through a vagina once or multiple times can increase. So there's many reasons that it happens. Vaginal estrogen may or may not help. Doesn't help everybody with that. I've seen some women on systemic testosterone get helped with that. I'm not saying that's why we should use systemic testosterone. It's another podcast episode. but sometimes systemic hormones do help. Pelvic floor physical therapy can help greatly. They're awesome. And the traditional surgery was a sling. It's called a mid-urethral sling.

27:52Dr. Kelly Casperson:It's been around for 20 years. I've done plenty of them. It's a great surgery, but I'm giving you a 3 % risk of mesh complications for your life because I'm putting a permanent piece of mesh in there. I will now offer you the best new things since sliced bread, which I went in very skeptical and cynical because I'm not the youngest urologist anymore. It's called Bulcomid, B-U-L-K-M-I-D. You know how women get fillers for their face to make their cheeks and their lips more full? It's filler for your urethra. Oh, my gosh. And it decreases stress incontinence by like 50 to 80 percent. It's a three minute procedure.

28:33Dr. Kelly Casperson:There's no downtime. I'm like a walking billboard. This is phenomenal. It's like you can exercise the next day. You can have sex the next day. If you have a sling, you can't have, you know, put anything in your vagina for six weeks and you can't exercise. Like downtime is a big deal for busy women. Bulk of mid, no downtime. Just the day you're having the procedure. I have you pee before you leave my surgery center because I want to make sure you're not, you know, have it blocked. And it's not permanent like a mesh sling is, but the benefit is you don't have any risks of things being permanent in your body.

29:02Dr. Kelly Casperson:And so you just call me and you just tell me when it wears off and we give you more. Insurance covers it. This is a no-brainer. It's a no-brainer. Nobody knows about Bulcomid yet. It's been in Europe for over seven years. It's been in America for about two to three years. I went, I'm telling you, believe me, I went in cynical. I'm like, slings are pretty awesome. Why am I going to do something that's not maybe doesn't like like I went in fit with a scientist mind I'm like I don't know about this if women tell me they don't like it I'm not gonna do it like that's how I went in and now I'm like these are the happiest freaking women they like bring me houseplants as thank you gifts one woman came in with no underwear on to just to show me she can wear no underwear now she doesn't I love it.

29:50Dr. Kelly Casperson:Like these are happy women because it like is hardly a surgery. I give you a little IV anesthesia because if you're going to put a needle in my urethra, I'd like a little IV anesthesia. Like no breathing tube, no incisions, no stitches. Like this is filler for your urethra for stress incontinence and insurance covers it. I can't take it. And I feel like women don't care about going and getting something done again because they're used to getting the Botox or getting, you know, you go and get your teeth cleaned. How often? I don't know. I just feel like that's. I agree. When I was starting to do this procedure, I had a woman come back at a year.

30:33Dr. Kelly Casperson:She's like, yep, we're off. And I'm like, listen, let me ask you, would you rather come back and see me once a year for this or would you rather me give you a sling? Right. Yeah. and she's like this once a year hands down keep the mesh out of my body and i'm like the women are speaking man they know what they want we've got we've got options they know they want the bulk amid it's very rare that i see a woman and do a sling now it's usually like do a bulk amid if it's what if it didn't meet your expectations let's do it again so you get two bulk amidst before you've bought yourself a sling and i've probably done 200 to 250 bulk amid in the last like two and a half years and I've put slings in four of those people.

31:17It's a great outcome. This is amazing. And so it doesn't always come down to like not having a strong pelvic floor.

31:26Dr. Kelly Casperson:Not always. No, the control of urine is actually quite complicated, right? So it's like the integrity of your urethra, how you, so integrity of the urethra collagen and hormones, right estrogen uh really helps the mucosa the collagen the blood blood just keeps things plump so it doesn't atrophy um so estrogen hormones also the descent of the urethra where it rides underneath your pubic bone it can get pushed down a little bit by having a baby age all that stuff and then the muscles of the pelvic floor so it's not just you know i agree with the pelvic floor physical therapists try it it's non-invasive they can help it makes a world of difference but if it helped everybody, I would be out of a job in that department.

32:12Dr. Kelly Casperson:And I'm telling you, I'm not. Yeah. Do you do vaginal reconstruction surgery? Yeah. For prolapse? Yeah. Yeah. Or just anything if a woman comes. I don't do, I cringe. I get very, I'm very, I'm a protective person. I get very protective of my women and I get very cringey anytime people are like tightening rejuvenation. Like those words me nothing and you're playing on the insecurities of women because they don't know if their vulva and vagina is normal. And like, I think there's a huge market for preying on women's insecurities about their genitals. So I do nothing like that. For me, it's like, dude, I had a baby.

32:53Dr. Kelly Casperson:I haven't been on my hormones. This tennis ball's falling out and I can't exercise. I'm like, fix it if you want to fix it. Absolutely. So I do a lot of pelvic surgeries, a lot of vaginal surgeries, but anybody who's got a website about rejuvenation and tightening what the fuck is tightening okay well we like so we to me i'm like you do people come to see me because sex is painful because it's too tight because they don't have estrogen so to me i'm like anybody who's branding vaginal tightening is i don't know a predator okay well we read how you said there are three things i know and I have done two of them.

33:36The PRP, the vaginal tightness and the overactive bladder, which I've done that. So I guess I covered all of them.

33:45Dr. Kelly Casperson:Oh, the anticholinergics for overactive bladder. Yeah. So between Haley and I, we have covered them all, but her and I both have done PRP in the cloders. Can you please tell us why we shouldn't do either of them? Listen, if women want to spend their, women can spend their money however they want to spend their money. Like I'm not here to tell people not to, they can bedazzle their armpits on for as much as I care. But where I have a problem is when women are sold something for something that doesn't either solve their problem. Right. That's my big issue of like, you know, take sexual desire for example sexual desire is quite complicated it's biopsychosocial there's a great ted talk on it but it's like desire is complex right like it's your relationship it's how you view your body image it's your hormones it's how good the sex is to begin with like desire is really complex and when a woman is sold like come get these proprietary injections to improve desire, I know that's bullshit.

34:57Yeah.

34:57Dr. Kelly Casperson:Because it will not affect everybody's desire because desire is complex. Yeah. Right. And by the way, it's thousands of dollars. Insurance doesn't cover it. And you have to keep doing it if it does work. Yeah. So even for a woman who's like, it worked great. It's like, okay, well, just wait for it. Like, have you budgeted for this plan? Right? Totally. I always joke, like, women shouldn't have to remortgage their house to take care of their health. No. Yeah. That's such a good point though, about the desire. It is like, we're missing that point. And in your Ted talk, I feel like one of the most important things you said too, is your biggest sex organ is your brain.

35:38And it's, isn't that what you said today? I want to repeat it correctly. And I just think how you're exactly right.

35:48Dr. Kelly Casperson:totally i mean if i think if i think my body's a disaster it's failed me i'm worried about leaking i'm checking in on my thighs all the time like my experience of my sexual life is going to be very different than if i came in being like this is what i'm showing up with today and let's try to have a good time yeah which is even different than fuck yeah look at me yeah this is awesome I am hot. Right? Because I think we're always trying to get to neutral. Yeah. And it's like, what if we were profoundly radical and tried to get to freaking awesome? I'm obsessed with you. There's a book on that. There's a book called - This is our best podcast already.

36:28I'm not going to help.

36:30Dr. Kelly Casperson:There's a, for people who are interested in that work to get like, there's this book called The Body Is Not An Apology by I think Sonia Renee Taylor, if I'm getting it right, it's like over on my bookshelf. but um she's like why the hell are we striving for neutral so good and it's like as soon as she says you're like oh right we've put the bar real low yeah yeah well okay this is like since i'm sharing everything like when i see these things advertised you're right like i go down and look and i'm like i don't know if if i'm normal like how do you know no because your body parts have been banned on the internet.

37:11Like the only body parts we see are photoshopped or video shopped

37:18Dr. Kelly Casperson:or surgically augmented. It's very hard for people to go and to see if they, if like, how does my chin compare? Like you can go see a whole bunch of different chins, right? Yeah. But like, it's profoundly important to know that people sit within the bell curve. And if they don't that, you know, we can do something about it. And even if you don't sit within the bell curve, you can have an amazing sex life anyways, if it's not, you know, a broken thing. I saw this woman, older woman, she came in with her, I think he was her husband. We were doing a pelvic exam for, like, I don't even remember what it was for.

37:54Dr. Kelly Casperson:And she was like, I'm so sorry. I'm so sorry. I'm so ashamed. And, and I'm like, oh, you know, tell me about that. And she's like, my earlier husband, like before the before husband had told her that she had a profoundly abnormal labia and vulva and it hit but i think it was a little more derogatory of a term i made it medical but like derogatory term about how horrific her external genitalia were and i was like listen i'm gonna do you a favor i look at like 15 vulvas a day i have a lot of vulva knowledge in my brain i'm just gonna tell you where you are on the bell curve yeah she's like okay like i wanted to keep it like super neutral.

38:34Dr. Kelly Casperson:I'm like, I'm just going to tell you how average you are. I did her exam and I'm like, you're like so average, you're unforgettable. Like I can't actually remember her vulva now. Right. I'm like, you're just like average, normal bell curve, nothing remarkable. And her husband looked at her and he's like, see, honey, I told you. And I'm like, you get to release this asshole from your brain now. But again, going back to sex ed, like she took that one guy's advice. He wasn't, he had, how many of all was had that guy looked at? Right. And taken him as what her body was. That is so sad. Anyways, I don't remember the point of that story, but like women are hiding in shame because they don't know if they're normal or not.

39:21That's the point. Yes. That's the point. Well, all of, you know, we're at this age where when we are with our friends, we're talking, we end up talking about all of these different things. And a lot of my friends have said that they feel like their vagina has aged, like it's not looking the same and they, and sometimes functioning the same. and they do want it to function like it did, but also look younger. And I never even thought about that until I started having conversations about it and I'm at an older age, but what do you think is the best advice for people that feel that way?

40:08Dr. Kelly Casperson:Yeah. So, I mean, again, this whole thing is biopsychosocial, right? It's like, why do you want to change your body part? Oh, because society told you younger is better. Okay. Interesting. So there might not actually be anything wrong with the body part. You're just succumbing to... And by the way, we wear clothes like 99 % of the time. Like society's literally not... I understand the face so much more because it's your billboard, right? But it's like, dude, literally maybe a couple of people are looking at your vulva and ideally they're having a hell of a good time with it and not trying to judge your like your anatomical age by it yeah right that's why i love these conversations because like you just take somebody's concern and you just freaking blow it out of the water by being like is anybody asking how old you are and you're like hold on let me check my vulva yeah and what's funny is yeah we'll say well did your husband seeming like are there any complaints it's like no he'd be all over every day yeah so i'm like okay this is my advice number one nothing prevents us from aging except for death yeah so true you like nothing is stopping the clock and you spend your whole life wishing you were a different age or your body looked different you at the on your deathbed you kind of wish you didn't do that like enjoy the time you had right but number two save your money, go get yourself some phenomenal, good hormone healthcare.

41:41Dr. Kelly Casperson:Because I would agree, our vulvas do change with age. We lose volume, we lose elasticity, and a$20 bottle of vaginal estrogen does a world of difference. And we should be putting it on our clitoris, we should be putting it on our labia minora. And that six o 'clock entrance to the vagina is nasty. It gets tight. And that's the first part that starts hurting when people start complaining of dryness or pain with sex. So when I see people being like, get tighter, I'm like, dude, just give it, give yourself five years with no hormones and you'll be tight to the point that you hate sex. So like, I don't think that tightness should be a branding thing at all.

42:19Dr. Kelly Casperson:It makes no sense to me. If you want to work on tightness, like get a good pelvic floor physical therapist, get your muscles toned. Right. So pelvic floor physical therapy and then vaginal estrogen, but don't remortgage the house or break like go out to dinner or go on vacation with the amount of money that people are taking from women preying on their insecurity that their vulva doesn't look 20 like your partner doesn't care they probably just want more sex what are we trying but when all you see online is like the plastic surgery images of this is what how i can change a vulva you start thinking that's necessary it is completely not necessary to a great sex life.

43:01Dr. Kelly Casperson:So true. Spend your money on good vibrators for sure. That's what I thought you were going to say when you said hormones, I was like, we're having the vibrator conversation. Oh, invest in some good vibrators. Like a$20 vibrator is kind of a piece of crap. Yeah. In my opinion. This is, this is the best. Okay. The pelvic floor physical therapist. I went because I had a lot of issues with my, my last, my third child birth. I didn't know what that entailed. And when I went in there, I was like, well, that was personal. And for people, I want to address that, right? Cause I see a lot of women say, I don't want to go because I'm worried about an internal exam, stuff like that.

43:49Dr. Kelly Casperson:And I'm like, you need to communicate that to them. You need to tell them your boundaries, whether you've had a history of trauma, you don't have to tell them the details, but I fully respect it. If a woman is not ready to get naked and have some fingers in her for, you know, checking out her hip joint on the first date, I get it. And physical therapists can do a lot without going inside of you. They're very talented people. They're better than doctors are at assessing pelvic floor muscles and inside the vagina is the way to do that, but they can do a lot without doing that. And you can also get to know them.

44:27Dr. Kelly Casperson:Is this a good fit? Are we aligned in what the plan is? Do I feel good showing up here? Right? You don't have to rush into the internal exam, but you got to communicate it. You can't be like, well, here I go. And then be like, I wish I didn't. I wish we didn't do that. Address that, bring that up on the front end would be my advice. That's good advice. I just didn't know what I was getting into. I mean, the lady was amazing, but I was just like, she's like okay so this is what's happening i was like oh well i thought i was coming in here for a hamstring or something where are we going with this you learn a lot but with i mean they they're incredibly talented there is like not a pelvic floor physical therapist that i haven't liked yet they're invaluable people i mean it's so silly our health care system right like i'm a surgeon.

45:17Dr. Kelly Casperson:People come to me, first of all, not wanting surgery. And then I'm like, you know, I'm a surgeon. And they're like, no, I didn't know that. And I'm like, okay, well Google, but you can go to physical therapy first. The surgeon doesn't have to be your first stop. Right. And so many good pelvic floor physical therapists will tell you though, they'll be like, go see a doctor, get on vaginal estrogen. Like they know the importance of hormones in pelvic health. So we're all, it's all just kind of like a mutual love fest that like, we love them. They love us because we all do a different part to help, help a woman.

45:52So besides the estrogen, what is another essential hormone that you feel like is really helpful for women? Testosterone and progesterone? Yeah.

46:07Dr. Kelly Casperson:So there's three, I mean, there's three hormones that we can buy, right? Like that we have pharmacy that we've created our bodies. Well, I mean, besides the other hormones of like insulin, thyroid, you know, all those things, but we're talking like perimenopause, menopause hormones. And to call these sex hormones is a complete misnomer. Like, yes, our gonads make most of them, but like they work in your brain, they work in your heart, they help with insulin resistance. Like the fact that we've labeled them sex hormones is actually like a dismissal of their importance. They're vitally important for our entire body.

46:45Dr. Kelly Casperson:But again, we didn't get taught that. But so we have many hormones within the like, there's many types of estrogen, there's several types of androgens, like all of these different things, but we have three that like money can buy money can buy testosterone progesterone estrogen our ovaries make testosterone which then gets converted into estrogen so it's actually wrong to say ovaries make estrogen because you're missing out you're missing out the fact that like you we actually have more testosterone in our bodies than estrogen because we make testosterone to make some estrogen it, which is, I didn't even get taught that in medical school.

47:26Dr. Kelly Casperson:Like it's insulting how little we know about our bodies. But so to me in perimenopause and menopause, those are the three options on the table. And I think they're all important and they all do different things. And if you see somebody for hormones and they don't talk about all three of those things, then I wouldn't say they're comprehensive. If they're only, I like put this on Instagram the other day. I'm like, if your only option for a woman is a pellet of one type, you're a one trick pony. You're not actually a hormone expert. I loved when you said that. Well, I loved when you said the pharmacists are assholes.

48:07I was like, yeah, so let's talk about that. The testosterone and the lack of how hard it is to get from insurance.

48:18Dr. Kelly Casperson:It's embarrassing. And the reason why it's embarrassing is because I know, I trust, and I believe that in the future it's going to be better. I know that. I know there is a world where we have good access to this. And so I'm like, oh, my God, I'm part of the generation where it's embarrassing. Yeah. But we have to help get it there, right? Yeah. So ovaries make testosterone. All people have testosterone. Men just have more of it. Right? Like people need to know that because otherwise I come in looking like this crazy person who's like testosterone for women. And they're like, right? So you got to like go back to the education first.

49:01Dr. Kelly Casperson:But the FDA has about 20 different products for testosterone for men. We have zero for women. The FDA has said we want five more years of safety data for testosterone for women, more safety data than we have for men. The additional problem, because of the Olympic doping scandals of the 70s and 80s, our legislature got a little pissed that people were doping. So they put in the federal act that all of these synthetic androgens are now banned substances. And on that list was one naturally occurring hormone called testosterone. People do not overdose on testosterone. Like they do not do it. They might become, they might have, grow some more hair and get angry.

49:48Dr. Kelly Casperson:Like there's side effects, but like too much testosterone doesn't kill a person. But it's on this list of banned substances, including fentanyl and oxycodone. What that does is it prevents access because now we've labeled it as unsafe instead of something your body naturally makes. Right. So we've got two problems. We do not have a female dosed product approved by the FDA. That means insurance won't cover it and you have to dose it appropriately. And it's actually difficult to do. The other problem is now it's on a DEA list. Your name goes on a register of being somebody who has a controlled substance.

50:23Dr. Kelly Casperson:Stop it. No, legit. Yeah. California has its own list because they want to know everybody who's taken oxycodone and fentanyl and oh, testosterone's on that list. And you have to see a doctor every six months for your prescription instead of every year because it's on that list. And it also carries the stigma of doctors being like, that's unsafe. That's a steroid. Of course, it's a steroid, but so is cholesterol. Something being a steroid means nothing. um so yeah we've got a lot of barriers to testosterone but let me tell you there is nothing like testosterone appropriately dosed in a woman in midlife where she comes back to see me and she says i'm back oh i just got the chills i feel more like myself and i'm like at the end of the day, if my job as a doctor isn't to make you feel more like yourself, what are we doing?

51:23You know, like there is something profoundly better about women when they are on testosterone,

51:29Dr. Kelly Casperson:they come back and they're like, I can think faster. I'm quicker. I have more energy. I can recover better from the gym. I'm more, I just had a woman, she's like, I'm more interested in the world again. You're never going to get an FDA approval for something that makes you more interested in the world, right? Like it's these, but it's these stories that come back. The other bullshit about testosterone for women is that the main global consensus on it is for low desire. Why is the only legitimate reason for you to be on a hormone for you to sleep with somebody else? Good point. All messed up. It's so messed up.

52:07Dr. Kelly Casperson:I didn't even think about that. Like my male brother pointed that out to me. He's like, Kelly, isn't it kind of weird that like the only reason for women to take testosterone is to like sleep with dudes and i'm like yes bro yes yes bro thanks for putting that out to me gosh and i don't want to be on any anyone's list any government you are if you take testosterone like america's most wanted it makes it sound like you're doing something dangerous and so in a woman's body the testosterone she has in her 20s is about 40 to 50 percent higher than the testosterone she has in her forties. Testosterone starts going down much early.

52:49Dr. Kelly Casperson:We kind of think of menopause as like, and on Tuesday, the ovaries stopped and then everything fell off a cliff, right? That's not how it works. For testosterone, it's a much slower decline, but it starts earlier, but you're still going to make some testosterone even after the periods are done, right? So, testosterone is kind of like slow, but early, but you can keep making some. Estrogen is like in perimenopause, it's like up, down, up, down, super up, way down, up, down. Here's a period. Now you're not going to have one for a while. So estrogen is like spastic, right? And then progesterone can kind of, it's kind of doing its own thing.

53:25Dr. Kelly Casperson:Nobody's really paid it. It's like the, it's like the stepbrother that like doesn't, doesn't come out of his room much. Like we haven't really looked at progesterone very much, but so, but progesterone profoundly important for mood and sleep. I think we need more research, especially in perimenopause. But so to say for a woman who's still, she's perimenopause, she still has her periods, maybe her energy's low, maybe her sexual desire's low. To me, I'm like, I'm checking that woman's testosterone way before I'm telling her to go get PRP in her clitoris or lasers or anything else is like there's things happening in your body.

54:03Dr. Kelly Casperson:Let's optimize them. And by the way, it's pretty damn cheap. So, but I mean, it all comes back to education. The more we know, the less we're going to fall victim to people who just want to make money off of us. Yeah. Okay. So with testosterone, when it's low for, for certain women, I just had a conversation about this this week, that can affect your ability to grow muscle. Yes. So I have some clients. I mean, I only work with people 40 plus and I, most of them are in their fifties and they're post-metapausal. And when they, again, different conversation, but when they come in, they're like, well, I don't want to get bulky.

54:43And I'm like, do you know how hard I try? I'm like, do you know how many women that like, we'll talk to them when they're passed out on the floor, just because they're trying to maintain their muscle that they have.

54:57Dr. Kelly Casperson:Dude, and the role of muscle in longevity, the role of muscle in insulin resistance, the role of muscle in bone health, the role of muscle in preventing falls. I'm telling you, if you want to do anything to help out your 72-year-old future self, lift the weights. Please. Preaching to the choir. But it's like, dude, muscles are so important. Yeah. I just saw a lady, she was 60. She just came back four months. So sometimes taking testosterone, especially when it's appropriately dosed and we can go into that, but she's about four months in, she's like, I'm noticing now my lean body mass. Right. But an appropriately dosed hormones, like it's going to get you there slowly.

55:39Dr. Kelly Casperson:Not like four months is slow. Right. She spent, she spent 10 years without the damn stuff. But you know, to be like, yeah, I think all testosterone is important in wound healing, right? Orthopedic is looking like the orthopedic world is looking at, they did a study where they gave dudes super high testosterone, like way more than standard replacement before hip replacements. And they actually did better. No way. I know it was a little unorthodox, but like people are, you know, I think we are under because of the stigma and all the other things that we're calling these things sex hormones we're under researching the role of hormones in healing and lean body mass certainly we know how important it is for bone protection and in women your bone loss starts before your periods end everyone's like oh that happens after your periods end it's like no no this starts before because remember the the hormones are already doing their thing before the period stop.

56:39Dr. Kelly Casperson:It's profoundly important. I am. I am. I'm getting blood work done. I'm giving you a standing ovation. I don't want it to end. I'm super sensitive of your time and our hours. But holy, like my brain is just running with all of these conversations that I mean, I love what you're doing, Kelly. I love how I love your personality. Number one, I mean that alone outside of all of the education and knowledge that you're sharing, but like, it's just on the opposite side to wrap up. Like I see women all the time that are just like shamed about weight or the fact that they don't have as much lean body mass and all of these things.

57:29And I'm just like, why are we making our lives miserable when it's just hard? I mean, and a lot of that comes from biopsychosocial and it's just, it makes me so sad when women are just like, kind of told that after midlife, like, well, why do you care that much about your body or about your sex or about, you know, anything? It's just, it's very disheartening.

57:58Dr. Kelly Casperson:And I've thought about this. These are things I think about a lot. So we're like, oh, society tells women all these things. And it's like, we just lay down and fucking accept that. And it's like, no, no, you get to decide. You control the narrative. You tell people how to treat you. You tell people what the women are like at this age. I'm so sick of this laying down and taking it attitude of like, do you not realize your power? We have immense power. Freaking use it. Yes. Amen to that. And I think the older we get, the better we get. I don't think it's the opposite. Yeah. I mean, you just look, you know, and I'm so inspired by the thing of like, you know, Martha Stewart didn't make her first million I'm making this up because I haven't looked recently, but like women kick it into gear in midlife.

58:56Dr. Kelly Casperson:For anyone to be like, oh, they told me that this is just blah, blah, blah. It's like, no, no, no. This is when you can kick it into gear if that's what you want to do. You don't have to do that. Right. But it's like you write the narrative because we have the immense privilege of living long. And we've never lived this long before on a global scale. We are literally making it up what aging looks like. All this is just a big grand experiment for the next generation, right? We're trying to help out our kids. Yeah. What you are doing. I think it's an amazing moment right now in midlife for women.

59:33Dr. Kelly Casperson:And I'm so happy to be part of the conversation. Yes. That is the perfect way to end. Really quick. Can people see you online? Do you do telehealth or are you full? It's a good question. So I practice in Washington State. I currently only have a Washington State license. So what that means is you must be, and the bullshit of the world, right? Like, do you think healthcare is any different in North Carolina than Washington State? No. No. But state regulations, I mean, don't blame the doctors for this is what I'm saying. State regulations say that the person has to be in the state where the doctor is licensed, which makes, again, arcane state rules.

1:00:15Dr. Kelly Casperson:But I'm already booked out for months and months and months taking care of Washingtonians. So I'm like, I have no incentive to get other state licenses because I'm like, I got 9 million people in this state. 50 % of them are female, right? So the point is I take care of Washington state people or people who fly in right now. I have no problem with you flying in. but oh i'm flying in i'm gonna get on your no to me i'm like i'm like you're in boulder you have resources i will get you the people yeah yeah okay what about you up with dr carolyn franziak you will say you know me i will help with her taking taking care of you we will get all the women all the bulk of med in boulder in colorado and uh it'll be we'll help all the people done and done all right so your instagram is that the best place for people to get a hold of you or follow you.

1:01:07Dr. Kelly Casperson:So either Instagram, cause I love it, but it gets a little busy on there, you know? So you can always send me an email info at kellycaspersonmd.com. That's through my website, which is kellycaspersonmd.com. My baby of babies is the podcast. You are not broken. I love it. That's the long form, right? Cause like you have to hear these things a couple of times to like understand hormones and like the pelvis and how it works. So I, that I love a lot. Like podcasting is my favorite thing so you're not broken and then the book is being re-released september 10th um so it's for pre-sale on amazon right now if you didn't get the book before it's now taken down and re-releasing september 10th which is you are not broken stop shooting all over your sex life okay we're we're coming back on in september when you're slammed exactly 9 million.

1:02:01Everyone has like 9 million Instagram lives. Oh, I'm already pre-booking. So we want to pre-book you now. Because this is amazing. And we're making everyone buy the book. I'm going to pre-buy the pre-sell right now on Amazon because I just think you're fabulous. And we are so grateful for your time and for everything that you're doing to serve women. So thank you so much for that. And we look forward to your book launch.

1:02:28Dr. Kelly Casperson:Yeah. Thank you so much. Thank you guys so much for having me. Thanks for listening, everyone. If you enjoyed this episode, please consider giving us a five-star rating and sharing the body pod with your friends. Until next time.

1:02:53Thank you.