381. Cancer, Sex and Hormones with Oncologist and Sex Therapist Dr. Bosserman

0:03Dr. Linda Bosserman: Welcome to You Are Not Broken, the podcast that challenges everything we've been taught about midlife, hormones, and sexuality. I'm Dr. Kelly Kasperson, board-certified urologist, author, and a leading voice in women's sexual and hormone health. Enjoy the show. Hey, everybody. Welcome back to the You Are Not Broken podcast. We are going to have a fiery, feisty, fantastic conversation today because I met at the Ish-Wish conference in February 2026, Dr. Linda Bosserman, MD, PhD. And the reason I was attracted to you is, I don't even remember what they were presenting, but you stood up at the end and you were basically schooling them, I think on the difference between progesterone and progestin, if it was not the difference between oral conjugated equine estrogens versus estrovibe.

0:46Dr. Linda Bosserman: It was something like that, which if you know, you know, and if you don't know, you don't know. But I was like, okay, That's a sign that a person knows something about hormones. And I was like, who is she? I must meet her. And now we've written two editorials already together. Watch out, world. Welcome to the podcast. Thank you so much. It's such a pleasure to get to know you. I've learned so much from your podcast and I'm happy to share and really work to get information out so people can make better choices and have better health. This is just so important to people. So you are a practicing oncologist.

1:20Yes, I am a board-certified medical oncologist, full professor at City of Hope National Cancer Center. I don't speak for City of Hope in my podcast or private work, but I teach and lecture and I have a clinic two days a week only for patients who have had cancer and sexual or menopause or endopause side effects. Actually, I'm only seeing women now because I'm booked through August. There's not enough practitioners with knowledge. And then I'm writing and publishing. And after 40 years, really as a breast medical oncologist and value-based specialist, instead of drinking during COVID, I went back and got a PhD in sex therapy because seemed like a good thing to do.

1:58Actually, my partner's a therapist and a couple's therapist, and he wanted to do it.

2:02Dr. Linda Bosserman: So we did it together. You're like, I can do this as good as you can. Yeah. Well, I mean, more than a second, I think we want to put the bio in biopsychosocial. You can do all the cognitive behavioral therapy you want, but if your vagina's raw, you don't want sex. I'm the bio person who's like, I can make your vagina and pelvis perfect. I can give you erections. I can do all those things. But if you think sex is dirty, it's too much work, you don't like your partner, your perfect pelvis isn't going to have great sex. Exactly. Exactly. I have a woman who had never had great sex, has an idiot for a husband, went and had all her hormones optimized and testosterone and said, oh, that's an orgasm.

2:38That's why people have sex. Where are all those toys you taught me about? Because my husband's still an idiot. So, you know, it's like, you do have to go where the patients are.

2:49Dr. Linda Bosserman: Yeah. You got to pull all levers, not usually at the same time, because it can be a bumpy ride, but all levers must be pulled. And it's important to have people understand. I think in the, and correct me if I'm wrong, but we're seeing this in the sex therapy world now, but we saw it in the past. Erections were just all in your head. Women's desire is just all in their head. We're kind of seeing this like anti-medicine belief system, like we need hormones to have good sex. And again, you know, one of my greatest failures many, many years ago in practice was a guy with cancer everywhere in his body.

3:22He said he wanted to have sex again before he died and I optimized his testosterone. He came back so happy and his wife sat there and said, what did you do? I've always hated sex. And here I'm thinking I'm doing a good job and I have failed.

3:36Dr. Linda Bosserman: Yeah. No, you got to ask what, you got to ask who's treating the partner. Exactly. And so many women do not know that when they start menopause, they often already have atrophy. They're often losing their testosterone. So I say by 40 or 50, lots of women say, I don't know why men want sex. I'd rather read a book. You give them optimized hormones, testosterone, estradiol, and they're like, get over here. Let's have fun. It changes everything about the relationship, the intimacy. Let's talk about late breaking news. It won't be late breaking by the time the podcast comes up, But late breaking news, literally this morning, the FDA put out a press release saying we want to help men more with testosterone.

4:18Dr. Linda Bosserman: So we're looking for companies who want to come forward and try to get testosterone FDA approved for low libido in men. Well, I mean, one in five men lose their testosterone from 40 on. So it is an issue. It leads to metabolic dysfunction, diabetes. But they have all the products they can use now. it's just not covered by insurance. And I've seen insurance clamping down on not covering except for I was born that way, which is absurd. Yeah. And to clarify that for people, so currently the FDA approved indication for testosterone for men is primary hypogonadism, meaning I was born without the ability to make enough testosterone.

4:57Dr. Linda Bosserman: So about two thirds of men in the United States of America do take testosterone off label. So what you're talking about is especially in the state of California, insurance companies... Give me a break too. A vial of injectable testosterone is$10, right? Is this where the cost savings are coming from? But they're clamping down on the men saying, you actually don't have primary hypogonadism. So even men, I say even men because women have way worse... Everybody's yelling at their speaker right now at us because they're like, women have nothing. And I want to acknowledge that. But a lot of men take it off-label or for a reason that's not actually indicated.

5:32Dr. Linda Bosserman: But I would argue the FDA should get it approved for secondary hypogonadism, not low libido, because most private insurances have a sexual health rider on them. And people are like, it doesn't really matter for men because Viagra is cheap, cash, right? And so is testosterone. I would argue it's the wrong indication. If you wanted to expand access, secondary hypogonadism is the right indication. And where the hell is the female testosterone? Right. And if we get it based on the last studies that went to the FDA at 10 milligrams per day, which, you know, female dose testosterone, I consider 2.5 to 10 milligrams a day.

6:08I have a woman on 60. I have one 20. I have one one. But in general, you start low, you go slow, you see how that woman does. She gets to decide. I tell everybody the only important person in the room on a consult is the woman. How does she do with this drug? I was on a website with very conservative doctors saying, you know, we have to control testosterone in women. They might overuse it. I'm like, where? Women don't want more than what works for them as a balance. And, you know, women don't generally want libido off the ceiling where they can't go to work.

6:44Dr. Linda Bosserman: Out of control libido is now unpleasant for the majority of people who have it. They don't want it. They want just enough. Yes. And then it's not just libido. It's I got myself back. Or a woman said last week, the world is now in color again. Where's the patient reported outcome for that? You know, I have myself back. The first time a woman said to me, she was even more specific. She's like, you know, that scene in The Wizard of Oz, when Dorothy goes from black and white to technicolor, that's my brain on testosterone. I love it. I had a woman who biologically had a larger clitoris and labia in the past.

7:18And it came back and the gynecologist was horrified, told her she should stop. She goes, this is my normal body. And then she told me, I don't care if I die five years sooner. I am alive and well, and I want every day of quality for the life I have. And yet there's no evidence it does anything but make you live longer and better.

7:37Dr. Linda Bosserman: Well, here's my question, because I'm just going to harp on the FDA for a hot second for libido. So the intrinsic patch went up, 300 microgram patch a day, four-year safety data, went up in 2004, did not get FDA approved. The indication attempted was for low libido, did not get FDA approved because the fear of hormones in 2004 because the Women's Health Initiative. So we have four years of safety data that did not get FDA approved for low libido. And now the FDA wants to jump to, are they going to have four years of safety data? Are they going to make them go through the same hoops? At what point do we have a gender discrimination issue here?

8:13Oh, it's unquestionable gender discrimination in funding, in research, in priorities for women health. And women are going to have to get together and lobby for this. But we could lobby first to re-review that data. And when you think about it, the lie that happened was the idea that was completely disbunked by the Women's Health Study. Even horse urine estrogen, conjugated equine estrogen over 20 years lowers breast cancer risk 23%. So the people that worry that testosterone has some conversion to estrogen and therefore it must cause breast cancer, do not know the data either from the Women's Health Study or all of Glazer's study at high doses showing it lowers breast cancer risk 40 to 50%.

8:56So we have to go back. I think they could reevaluate the data they have if that company was willing.

9:03Dr. Linda Bosserman: And that was Procter & Gamble. I'm pretty sure. So let's talk about Rebecca Glazer's data. A large amount of women, this is testosterone pellets versus a national SEER database standard. So your standard rate of breast cancer, because the critics will say it wasn't testosterone versus placebo in a group of women. It was testosterone versus baseline SEER database, expected amount of cancer in a population. Yes. And the Million Women's Study, you could look at any large database against it and it's significantly less. It's like 30 to 40 % less breast cancer. Why are we not screaming this from the rafters?

9:41Dr. Linda Bosserman: Why do we not have NIH grants trying to replicate this to check it? Like if people are like, they're poo-pooing it, I'm like, check it then. Right. Well, I have found in my lecturing now in the academic spheres and different, really getting things published is that people do not know that estradiol does not cause breast cancer. The only association with increased breast cancer risk is synthetic high-dose progestins, like in that one arm of the Women's Health Study, like in other studies. And it's one in a thousand, like being obese or drinking alcohol every day. It's not zero, but there's less with estradiol long-term in studies now with women with BRCA1-2, women who get pregnant and have thousands of micrograms of estradiol in their blood for months don't have an increased risk.

10:32So we're going to have to get over this confirmation bias that estrogen...

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13:34The estrogen receptor is not on-off. It does 50 things. And it's often anti-proliferative. There's three different parts of the receptor. So it's not estrogen increases, blockers decrease. That's our problem we have to address with science. And I've been working on a paper showing all these mechanisms.

13:53Dr. Linda Bosserman: I think that's key because people think, they call them hormone blockers or estrogen blockers. So you think it works by blocking the estrogen receptor, but it has, I mean, look at tamoxifen. How many different ways does tamoxifen work, right? It works in tons of different ways. And once a person was telling me very recently that they think there might be like an anti-mass cell, like an anti-inflammatory nature to, I think, at least the aromatase inhibitors of like, these things are working in ways other than preventing the big, bad estradiol from like putting a stake in the breast and causing cancer.

14:25Right. Because do we ever measure estradiol? No. And tamoxifen, the average estradiol level runs 95. It does not run low. In AIs, it will be very low or ovarian suppression. But we don't know that that has any association with the actual benefit to breast cancer. Breast cells have the most aromatase. Maybe it's helping the breast cell. That doesn't mean you can't give estrogen back, progesterone back, certainly testosterone, because if you believe it converts, which it really doesn't have a lot of high conversion by blood tests, it will not on aromatase inhibitors. So the minimum for women on AIs to me is vaginal estrogen for healing and then strong consideration of testosterone, not really always for libido, but for brain fog, memory loss, energy, all the depression, anxiety, the tortures of aromatase inhibitors.

15:20Dr. Linda Bosserman: Let's talk about that a little bit because I know you and I know, but for the general population, It'll piss me off to no end for people to say testosterone is only indicated for libido. And again, going back to the FDA, like FDA, really? Your second indication for men is going to be effing sex drive? Like there's so many different, like how about prevention of diabetes, which it does. Putting it on libido, number one, decreases how complex libido is. Libido is not an on-off switch directly correlated to testosterone number. It just isn't, right? But when people say, well, you can't have this because it's only for libido or it's only indication is for libido.

15:58Dr. Linda Bosserman: I'm like, that just tells me you don't know how the brain works. It lights up the brain. It's so important for so many of those neurocells. That and estradiol, they help neurodegeneration, neurofunction. And you just ask a woman who has word finding and brain fog. It can be remarkable to go on testosterone and they get their life back. Yeah, but Linda, then we would have to listen to women and then we would have to believe them. Yes, yes. Well, that is the problem. And I really want to call out to all our colleagues who are dying in factory clinics. They're working 12 hours a day. They're dictating hours and they just have to stay in their lane, which is why I say we have breast cancer blinders.

16:43This is what we do for breast cancer. We don't care if your risk is super high or super low. We have to customize, but they don't have time. Well, there's no time for curiosity when you're being worked to death, right?

16:55Dr. Linda Bosserman: Like we all know this. Curiosity goes out the door listening to somebody going off label. The other thing with the factory clinics, because let's just pick on them since we're here, is so many people are afraid of losing their job because of prescribing off label. And it's really weird because 60 % of the medications in this country are prescribed off label. But especially for women in breast cancer, people are, they're worried about litigation. They're worried about losing their job. And I don't want to downplay that. That fear is real. But you're like, 60 % of the medications in this country are prescribed off-label.

17:28Dr. Linda Bosserman: Why are you so rigid on this one issue? Right. And I think when I talk to my colleagues, it's because they don't know the data. They're like, okay, tell me this. I don't know this. When I talked to our endocrine department, an academic department with 40 people, including some outsiders who were visiting you there, like, we don't know this data synthesized like you have it. Tell me every study in women of estradiol, CEE, progestin, progesterone, synthesizing graphs and charts that I've worked on for six years, and we don't know the data in women and we've not parsed it. And that's why I think the publication that Dr.

18:07Dazan and I did in JCO two weeks ago was so important because when I sent the editorial in this, it will, well, you're so far ahead, show us the science. So I wrote a month of science. They said, that's great, cut it in half. So half of it's on the floor. And the charts are there. What did habit study really show in women with breast cancer? And somebody stood up at ASCO two years ago and I was embarrassed for them because they said, we can't give hormone therapy to women with hormone positive breast cancer because of the habit study, which was a two and a half year study. they followed up of synthetic high-dose progestin in 72 % of the patients.

18:48At the same time, the Stockholm study used the same conjugated estrogen with minimal progesterone, none or low dose, and had no breast cancer risk.

18:59Dr. Linda Bosserman: And that's published up to 11 years follow-up on Stockholm. Yes, exactly. And when you do a meta-analysis, there's no increased risk. And that's where the Poggio meta-analysis is a tragedy of publication. That's a piece of bullshit and should be blamed on the editors and the reviewers for accepting it. And the reason is, and then let's break it down for the people who need to catch up, they threw in a paper with tibolone. And tibolone is a synthetic, which you can't, even if you wanted to give a patient tibolone, which you shouldn't because you don't know anything, you can't get it in America.

19:31Dr. Linda Bosserman: It's not even available in America. The FDA declined it. It was way too toxic with clots and it caused breast cancer. There were like 3 ,400 people in that study. It was such a big study and it's such bad outcomes. The RFDA said, don't ever think of using it. And the two trials that actually had menopausal hormone therapy at that time are the only relevant randomized controlled trials. And they were much smaller, you know, 300, 300 range of women who entered. And then they were stopped early for misunderstandings. Remember the original women's health study of conjugated estrogen alone or conjugated estrogen with synthetic toxic medroxyprogesterone.

20:12The paper in 2002 actually said the risk of breast cancer almost met statistical significance, meaning it was not significant.

20:23Dr. Linda Bosserman: It was not significant, my friends, but the media took it. Let's talk about the media for one hot second. So there was just another journal article published in the Menopause Journal in February. And I did an immediate Instagram post because I said, watch this paper. It's going to be used against you. It was a database study looking at air quotes hormones. And nowhere in the study, they actually say what hormones meant. We don't know dose. We don't know route. We don't know type. We don't know anything. The relative risk of stroke is greater than cigarettes by massive quantities, like eight times.

21:00Dr. Linda Bosserman: So the relative risk itself is a warning of like, this data seems a little fishy, right? And so I said, watch it. This is going to be used against you. So that was February. And then what happened in March was Medscape, which is a big online kind of news of the medicine focusing on doctors, basically says, headlines, hormone therapy increases risk of cancer and strokes. In women over 65, when started. In women over 65. And I'm like, there it is. And so you and I wrote a letter to the Menopause Journal, basically saying, please try to do better. And then I actually did a video with Dr. Rubin for Medscape saying, do not believe clickbait headlines.

21:43Dr. Linda Bosserman: And furthermore, Medscape do better. Because you're supposed to be known for good medical interpretation. This podcast is sponsored by Addy. Let's stop pretending low libido isn't a big deal. If it's bothering you, it's worth paying attention to. Meet Addi. Addi is a non-hormonal FDA-approved option for women under 65 with bothersome low libido. Although the exact way Addi works is unknown, it's believed to work on brain chemistry, is taken once daily at bedtime, and it works over time. Addi, flabanserin, is a prescription medication for women under 65 with hypoactive low sexual desire disorder that is distressing to them, known as HSDD.

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22:56Dr. Linda Bosserman: Learn more at ADDYI.com, including important warnings. Visit ADDY.com and complete an online telehealth visit today. With commercial insurance coverage, ADDY is as little as$20 a month. Eligible patients only. Restrictions apply. Visit ADDY.com, ADDYI.com. Well, they have a million MD subscribers. They have a million MD subscribers. It's a travesty. Dude, there's a million physicians in America. That's as many physicians as there is in America. It's a big platform. Do better. As I studied for my dissertation and read thousands of articles, I was shocked at how sloppy our medical literature is.

23:37And everybody needs to be on alert. First of all, things get spun by the PR department to sell a drug. That's just reality. but second of all it's not uncommon to say progesterone causes something when the drug

23:51Dr. Linda Bosserman: was a synthetic progestin over and over and over again and then estrogen mixes oral estradiol or transdermal and conjugated and the people the guidelines to this day say that oral estrogens increase the risk of clotting therefore you should all have transdermal and that is not evidence-based Conjugated equine estrogen, yes, increases the risk of clotting 17 per 10 ,000 women in year one. Less than pregnancy, less than birth control. Yes, but more than the population baseline of like 6 to 12 per 10 ,000. Remember, we all have a risk of something in the population. That doesn't mean giving something causes it.

24:35If you look at transdermal, it has the exact same risk as oral estradiol. And oral estradiol has some of the longest randomized controlled trials in DOPS, where they gave two milligrams of oral estradiol for 10 years in a row. And no increased breast cancer risk, no increased clot risk, 52 % cardiovascular disease risk and mortality.

24:59Dr. Linda Bosserman: Thank you for bringing up the DOPS trial. We don't talk about that enough. The other very interesting thing is the Iron Curtain of 2002. too. People ignore any published data prior to the WHI as if it doesn't exist. And I'm like, some of the best hormone data was done in the 90s. Great hormone paper data from the 90s. I went on this rant like a week ago because people are like, there's no data. And I'm like, you not knowing the data is different than there's no data. Don't confuse the two. Yeah. Dr. Hodes has become one of my heroes. I'm going to go have lunch with him. Right here in my backyard at USC, chief of cardiology, 35, 40 years of careful research in women's hormone management showing oral estradiol is the best at reducing plaque in the arteries by the carotid interval medial thickness, stopping early bone loss, and improving overall survival three to five years and reducing cardiovascular death rate.

26:01Our number one cause of death in all women, breast cancer or not, is cardiovascular. And there's not one study with statins showing improved survival in women as a primary therapy. There's no study of statins showing improved survival in any study in women as primary therapy. Right. Primary therapy, meaning prior to having a heart attack,

26:24Dr. Linda Bosserman: there is data that says it does decrease risk of cardiovascular event, but we don't have any survival data. Except with estradiol. I was literally on a stage last night in Seattle and it was like a longevity style forum. And it was great. And the panelists were doing very great when being thrown like, what about urolithin A? And what about creatine? And what about, because everybody wants one damn thing to make them live forever. Like what's the one damn thing to put my money into? And so one of the panelists looped estradiol in with all these supplements. And I took the mic after him and I was like, hold on, will you pull estradiol out of that group?

27:05Dr. Linda Bosserman: And I'm like, if men had a drug or supplement that they could take between the ages of 50 and 60 that helped them live two to three years longer, they would all be on it. And women have that drug. It's called estradiol. And we have the data and the studies to show two to three years improved years survival. That's what decreased mortality means? Survival. Nobody, if there was a drug that made you live two to three years longer, they would have four Super Bowl ads. Yeah. And you feel better. What's wrong with feeling better? You know? Yeah. Jeez Louise, it's two bonus. Let me go back. I want to circle back to alpha and beta receptors of estrogens.

27:42Dr. Linda Bosserman: And some people get a little, again, in the estradiol causes cancer camp, they think it's because of the beta receptors in the breast. And so people get a little specific about that? And like, can we break that down? There are so many receptors. There's GPER. They all do different things in different milieu. And we don't know what that is. We don't know why women get breast cancer. Let's get the research to find out that. Can we be honest about that? Like everybody just wants to blame her goddamn family. Mm-hmm. You know, genetic mutations are, you know, less than 5 % and we're learning more, but that doesn't mean you're going to get it.

28:23The question is, why don't all women? And then look at the latest Casapopolis study published in December. You know, they had the guts to give women with high risk BRCA1 or 2 mutations who would have their ovaries out because we can't find ovary cancer early, but they hadn't had their breasts chopped off. And they gave them estrogen and they lowered the risk 63 % in five and a half years.

28:50Dr. Linda Bosserman: And is this the same paper with the Duovie arm? There was no breast cancer. That's a signal and should be studied more. Yes. And why not do it with estradiol? Yeah. Why do it with Premarin? Right. Do you think most oncologists know that estrogen doesn't cause breast cancer? No, but they're learning. The unbelievable 40 years of my last career is every new drug, every month, two or three new drugs. We are grateful, right? We have HER2 now. We have HER2 blockers. We have people getting treatment that's more and more specific without even chemotherapy. We're learning more and more and more about the subtypes and the triple negative and immunotherapy.

29:30They are spending all their time on what the next treatment is and how to explain it to patients. Estertin doesn't cross their education unless we really start bringing it to attention through centers, education and publications and women pushing back. But sadly, what I see is that they're so overwhelmed. I've heard the doors are slammed. They're told no, the charts are thrown down, the eyes are rolled, and women have the right to ask their questions and have individual personalized discussion and make their own choice on what they want to do for their health and their risk reduction and their overall health benefits.

30:12And that's not being respected because people are so overwhelmed in their medical practice.

30:18Dr. Linda Bosserman: Yep. I need to say it because I think sometimes I go without saying. We're not blaming the doctors. We're blaming the system and the lack of good education. There was an education void for two decades. the doctors who knew from the 90s don't practice anymore you actually saw estrogen and hormone prescriptions go down after 2010 and people are like why did that happen and it's like because all the people who worked in the 90s who knew better retired so it actually got worse so a cool thing happened at harvard at the for people who haven't heard of this it's called whams it's the women's health menopause harvard conference and it's already scheduled for 2027 go get educated It's 65 CMEs.

30:58Dr. Linda Bosserman: Oh my Lord. It's amazing. Two Harvard oncologists are on stage with a OB-GYN. She herself had breast cancer. It was Dr. Corinne Min. And all three said, okay, and a woman who's been treated, adequately treated for breast cancer, she deserves a risk benefit discussion about hormones. That wouldn't have happened even two years ago, that comment. And the NCCN guidelines just got updated. Finally, right? It still sounds scary to me. I literally, I logged on to the NCCN because they told me the NCCN guidelines got updated on this. And so I wanted to look at it before we actually met. And so I still think it's scary, but the latest NCCN update was February, 2026.

31:42Dr. Linda Bosserman: And it says, relatively contraindicated for hormones after breast cancer, relatively contraindicated and use caution in genetic cancer risk. Not evidence-based. So I put that up when I speak and a big X, not evidence-based. Just like they said that different vaginal low-dose, non-absorbed vaginal products have a preference. You can use a ring, you can use cream, you can use a tablet, you can use a suppository. And so many women on aromatase inhibitor have such daily deprivation of estrogen to their vital vulva, urethra, clitoris, the opening to the vagina, which is your retral tissue, the vagina, they need it four or five times a week.

32:25Twice a week is not enough.

32:27Dr. Linda Bosserman: Yes, twice a week is maintenance dose for people without symptoms, not treatment dose. But I've had doctors, I've had a major professor at a university going, that is just too dangerous. I go, what's the dose of the ring? The ring is 52 micrograms a week, 7.5 per day, 90 days, 52 a week. So we have safety data. So you can use your five suppositories if you can get your insurance company to cover them. They dole it out like it's morphine. It's ridiculous. This is generic, cheap stuff, right? And even then, the poor patients are having trouble with generics. I had a patient yesterday, depending on some of these tablet packages and the generic, you try to open them, the whole thing flies apart.

33:09Some of them are so poorly made. And just like, I don't know if you've seen progesterone, Several of my patients recently have had trouble with micronized progesterone. And they said there's a generic, this orange, and it doesn't work the same as the white one.

33:25Dr. Linda Bosserman: I've seen that too. And they'll just switch it at the pharmacy. And then they're like, I'm awake on this stuff. And the other stuff made me sleep. And so I looked into it. And I looked into it specifically with the patches. Because women now with the patch shortages, and we're swapping out the different brands, like, first of all, they stick differently. And, you know, all these things. Women tend to have a preferred type that's been working for them, right? But the generics are allowed to just be swapped out at a pharmacy. And there's actually published data on this, that generics can be within like a 20 % margin of difference, which is not zero when it comes to hormone distribution.

34:01Dr. Linda Bosserman: And so women are like, this one doesn't work as well. And people are like, well, take what you can get. And I'm like, you might need a higher dose on a different brand. But that's real and that's published. And we've never talked about that on the podcast. So I'm glad we got to bring that up. Yeah, and transdermal itself can have very variable absorption in different women. For some women, it's great. For some, it's probably the only reason to check a hormone level. The level doesn't tell us how to treat women. You ask them how their symptoms are. But if you think they're not responding and you're not getting a good level, but you know, perimenopause can be high tomorrow and zero the next day.

34:35So that doesn't guide us. But if you're looking at whether the patch is efficacious and being absorbed, there can be a reason to check a level then.

34:43Dr. Linda Bosserman: Yep. Let's talk about that because I hate the black and white thinking of with a 0.075 patch and higher, you need 200 of progesterone versus you need 100 for the lower ones. And I'm like, I can give somebody a 0.375 patch and get a serum level that I can't get with a 0.075 in somebody else. And you're telling me the dose is what you're deciding progesterone on? I mean, it actually makes no sense, right? No, because small amounts of progesterone will control the uterus issue. The issue with progesterone is what helps you sleep and sleep well, what helps mood, calmness, bone health. I mean, my own, when I adjusted my hormones to add, you know, get away from my doctor who gave me transdermal, which is useless.

35:28It's a 21 carbon molecule. It's not absorbed. After I trained, I got smarter. and that in testosterone, my density went up 2.3 % in two years.

35:39Dr. Linda Bosserman: Your bone density went up by adjusting your progesterone and your testosterone. And my testosterone. I had been on estradiol for years. Is that amazing? Women get told all the time that we don't have enough data. And I'm like, that irritates me because I'm like, not enough data doesn't mean it doesn't do what we know. The bone has progesterone receptors. The bone has androgen receptors. Testosterone helps osteoblasts function. Not having studied women in their bones doesn't make the actual biological knowledge go away. Yes, and the same with progesterone. Muscle strength, testosterone, progesterone.

36:14So it's in so many parts of our body, but you ask a woman, does 100 milligram work for you? Does 200, 300, 400? 20 % of women get on and say, I hate it. Okay, I don't know why. If we have to have it, we try to figure out a lower dose or a vaginal dose or compound it or try a different one. But most of them are like, oh my gosh, I've never slept so well.

36:38Dr. Linda Bosserman: I just got a woman off of her nightly Tylenol PM. I was talking to a sleep doctor last night again at this longevity thing. And I'm like, I pride myself in getting people off of THC gummies, Tylenol PM, Trazodone. And she said, she's like, that is not sleep. That is sedation. and it is biologically incredibly different in the brain. Like the brain is not getting what it needs when it's sedated. It's a very different thing than when it's sleeping. Yes, I saw someone yesterday on trazodone. I think trazodone is one of the safer long-term, but if we can taper off and do what the body was built to function on, that's what we're talking about here.

37:17We're talking about losing it because I just say we're a species like every else. We're here to procreate. We don't have to. But after we procreate, we're biologically irrelevant, but not to ourselves. If you want to maintain a healthy, long life, you have to do what kept your body optimum in our 20s and 30s. Testosterone, estradiol, progesterone, get your thyroid, make sure it's normal. Take your vitamin D. It's a hormone. Exercise, stress, diet, minimize toxicities. The things we know there's evidence for. But that will make us live better.

37:55Dr. Linda Bosserman: Women are living longer, but not better. My mother-in-law just broke her hip last week. Oh, I'm so sorry. No hormones, no exercise. Curbs will kill you. And I think that's the perspective the general population doesn't get about the perspective that doctors, nurse practitioners, clinicians, like we put in the reps of seeing how people age. Yes. And we're like, listen, do you want to benefit from my experience? So it's two people, the people over age 90 in the people who've been married for 50 years. Whenever I get them into my clinic, I'm like, tell me your secret. And I've got 20 years of those people telling me their secrets.

38:31Dr. Linda Bosserman: And I'm like, that's valuable. Yeah, and I'll never forget, I was in Boston for five years in my fellowship training. We saw so many women in nursing homes who had had 10 kids, no calcium, no hormone replacement, bedridden. Perfectly functional women whose bodies no longer worked and they were just waiting to die. That is not how people want to live. And I think that's the perspective that your average non-medical 50-year-old doesn't get. Is they're like, I feel fine. Why should I do this? And I'm like, you have to borrow the belief and the knowledge of somebody who's like, listen, when you want to keep traveling to see family, do you want to be the person that has to wait for the freaking wheelchair at the airline?

39:17Dr. Linda Bosserman: Like those people can't walk because of frailty. Lots of people can't walk for other reasons, but like we don't have to let frailty be the reason why we can't walk. I look at it as kind of like a level, you know, after you do a full assessment, the first thing is everyone can take vaginal estradiol to heal locally. It won't heal everybody. And I see all kinds of things on the internet being sold, but the second is testosterone. That is the other missing piece, whether it's local or systemic, that heals the rest of it, right? And then you have systemic testosterone. and you've got systemic progesterone and systemic estradiol.

39:52These are these steps. And so working with women, what are their priority? What are their treatments, especially if they're on breast cancer treatment? You know, I want them to optimize that. But you know, people in the middle of chemotherapy generally not worried about their sex life. They're trying to stay awake to, you know, get through the day, right? But when they recover, the devastation to intimacy and And the amount of men who feel that they're not loved because their partner no longer desires them, finds them sexy, feels sexy themselves. You know, it's duty sex at best. That's not what men want on the whole.

40:29They don't want to hurt their partner. And we're not helping them unless we guide them in bio and psycho and social.

40:37Dr. Linda Bosserman: Yeah, I absolutely love it. So knowing what you know, knowing what I know about recurrence risk with systemic natural hormones after complete treatment for breast cancer. And we can get NICHI if you want. We can completely neglect the ovarian cancer survivors and the uterine cancer survivors here. So we need to loop them in. But knowing what we know, two things. Knowing what we know about the recurrence risk with natural hormones, which is pretty much close to zero. Yes. And then knowing what we know about breast cancer with hormone positive breast cancer being an absolute asshole and coming back at 15 years, 18 years, how do we, with the average human brain that wants to blame something, if you're on hormones, and my question is, how do you counsel these people?

41:20Dr. Linda Bosserman: So you've decided you're going on hormones because it doesn't increase the risk. And then damn it, 12 years in, we got a recurrence. We're going to blame the hormones. And now we're going to tell all of our friends and family, or they're going to tell us it's your fault for taking it. That's the problem with breast cancer is it comes back so late. And then we want to associate, maybe we've been on hormones because we thought it was best for us. Like that's the difficulty of it. So how do you as a physician counsel people to be like, breast cancer can come back late. And that's what's so awful about it.

41:52Right. Except there's no evidence that estradiol, testosterone, or progesterone does anything but potentially lower the risk in people. If it can lower breast cancer risk and BRCA1 too, if long-term testosterone can lower risk, you will feel better and be better for the time you have. your cancer might come back. I might get breast cancer tomorrow. I've been on hormone therapy since my 40s. I'm 71. So, you know, I would not go off, but I know the data, right? I would say there's a whole body this cancer is happening in. We know inflammation increases risk, obesity, and probably esterone and toxic estrogens.

42:31Dr. Linda Bosserman: How about just not exercising? Like if you take hormones, which make you feel better and you make your joints not hurt and lets you sleep, then you can exercise, which is phenomenal for longevity. Yes. So these are the things that go with it. Sleep is essential to recovery too. So we can't measure all of these in a population and say, oh, everything went well. They had a lower risk. They didn't exercise. They didn't sleep well. They were stressed all the time, overweight, diabetic, had recurrence. We know all those things increase risk. So I think all we can do is be as healthy as possible. And I tell people, you might get a recurrence, but you'll live well along the way and reduce your cardiovascular risk, which is the greatest.

43:13And you will be healthier for all the other things that happen. And I really work with women with breast cancer on metabolism and getting the weight off so many women. Obesity is such an issue in our society. We are not here to shame anybody. And now we have treatments that can help women take control. And you're looking at 8 % to 30 % less breast cancer risk. Yesterday, less psoriatic arthritis, less cardiovascular disease.

43:41Dr. Linda Bosserman: Is that a normal weight or is that GLP-1 data? GLP-1 data, that it's lowering risk. I think Eric Topol had a nice chart today on his summary. We just keep learning more things. Yeah, he's super pro-GLP-1. His book, Super Agers, is a great read for anybody who wants more on that. Yeah, my own partner had diabetes for 17 years. And then, you know, you become partnered with a doctor and you whiff yourself into shape. You know, he's lost 45 pounds. The last five on GLP-1 got off insulin, metformin, glipazide, blood sugars are good. Creatinine came down. At 79, they told him the creatinine can't get better.

44:17The creatinine got better because health is so important and low blood sugar and metabolic control. That's amazing. Interesting.

44:26Dr. Linda Bosserman: Are you doing this in your cancer center? Not you, but like people, are people having the GLP-1 conversation with breast cancer survivors or cancer survivors in general, colon cancer, et cetera? Yes, they are having it. And again, the issue has been coverage, right? You have a woman with a BMI over 30 who qualifies and she gets below 30 and they cut her off. That makes no sense. No sense. The cost is crazy. You can do it$5 worth of profit and they're still charging even $250,$500 a month. It's scandalous. We need to bring the price down. But for individual people, it can be remarkable in giving them metabolic control.

45:05So you can follow a keto diet, less carbs, healthy fruits and vegetables, healthy proteins, get rid of processed food. It is absolutely a game changer. And again, I think we don't need it for those who are looking at size zero and are shrinking away. I think there's a limit to whether we need it. I'm a big keto person. I got to my high school weight, lost to 20 pounds, really very much a low carbohydrate person because it works for us as it, you know, in our busy life and choices. So I think, you know, with this full Mediterranean or Mediterranean keto, and then do you need a GLP-1? Because we're looking at your overall health, hormone optimization, also thyroid.

45:45Thyroid Hashimoto's has a significant mortality risk. And my 42 year old was born and I got Hashimoto's. And I followed my doctor's advice for years and took my Synthroid. And then they got generics. And every 90 days, the damn level would go up and down with the different generic. Then I went to brand. Then I took training. And then I switched to desiccated thyroid. I've been warm for the first time in 15 years. I don't have shivering chills all the time on airplanes and three coats out of the shower. It's so interesting. And my life is much better. But my latest health plan wants to have you go back to Synthroid.

46:22or take the cytomo with it. It's desiccated two to one in randomized clinical trials. People prefer desiccated and the doctors don't know it and they're all prescribing Synthroid. It's just, come on people. It's the same cost. There's NP thyroid or armor, whatever's covered. People have a different experience with it. Let them validate their experience. Yeah, I love that.

46:47Dr. Linda Bosserman: Let's loop back to the endometrial cancer people and the ovarian cancer people because I see a lot of uterine cancers, endometrial cancer. I know that there's rare sarcomas that get a little niche-y, but let's talk about your all-American endometrial cancer. I've been told I can never have hormones again. How do you counsel them? Yeah, so again, there's no evidence of increased recurrence risk. If you've got a stage one or two, we know the vaginal low-dose estradiol has been looked at in small studies. We don't have the 50 ,000 women years of trial data we have in breast cancer, but we know it's not absorbed.

47:25So again, raw vagina versus healing and multiple urinary tract infections and misery, we need to heal women with vaginal estradiol. Whether they go on systemic, it really depends on the recurrence risk and their priorities. So if you have a stage three or four with a 60 % recurrence risk, and I go on open evidence now. I put in the information, the age, the tumor, what treatment they got, and I bring up the clinical trial data to specifically say for each woman, what is your recurrence risk? And then if, you know, many of the estrogen, the endometrial cancers are hormone positive. And so doctors are very concerned that estrogen might stimulate it.

48:05We don't have any data that it does, but they believe it could stimulate it unopposed. So can you give progesterone? Testosterone can treat vasomotor symptoms. So can progesterone. So can we optimize without using estradiol? What are their other risks? What are their symptoms? What are their preferences? So it's not a no, but in higher risk disease, it's with caution. Certainly local treatment. Certainly I'm not worried about testosterone. You can check the estradiol level. It rarely raises and you can get rid of a lot of symptoms. So they still should come for a consultation. Ovary cancer, all the guidelines say you can replace.

48:46And we rip out the ovaries. We ought to wake up with a patch or a pill and treatment. And they ought to include testosterone because they just ripped out women's ovaries early and they lost their testosterone. And they're like, well, let me know how you're doing. You know they're going to do badly.

49:02Dr. Linda Bosserman: I had a woman. I had a woman who had a a hysterectomy in the hospital, woke up the next day, hot flashes, night sweats, didn't sleep, like immediate surgical menopause. This woman was having a period on her way into the operating room and then they removed her ovaries and uterus, right? So immediate surgical menopause, she's got all the vasomotor symptoms. They say, oh, that's you just processing your anesthesia. And then on her follow-up, she's like, I'd like a referral to Casperson. And they said, well, you know, she's going to talk to you about hormones. and she's like, yeah, that's why I want to go to Casper's.

49:33Dr. Linda Bosserman: She's like, yeah, I know. That's why I want to go because I didn't wake up with an estrogen patch on. You know, it's interesting going back to the data of like, people are saying, oh, you know, there's no data in testosterone. It's only for libido. All this stupid shit we say. There's phenomenal surgical menopause testosterone replacement data from the 80s, from the 90s. And then it stopped. It all stopped. But it's like the gynecologist knew that when you took out ovaries in the 80s and 90s and you gave testosterone, people did better. Right. But they don't know how to use it. They do not know how to use it.

50:10Dr. Linda Bosserman: But I'm like old Scrooge who's like, don't forget the original studies. Yeah. Well, I guess one of the advantages of electronic records, which has all the torture that you can imagine, is building statements. So I've taken the time to build loads of statements in Epic, the United States electronic record in most systems. and I actually put science data in each note. I put a lot of science data and then I emailed the patients the papers. They want them. And what's interesting is I actually heard back from patients who said, the doctor said I could come see you because testosterone has a lot of benefits.

50:42They've been reading your notes. So they are reading my very detailed. I talk about vaginal, I talk about testosterone and all the benefits and the 36 randomized trials of 8 ,000 women that have been summarized. There's so much data out there, but I'm just trying to share it with doctors. So even if they're overwhelmed, I want them to say, you deserve a consult. I'm not the expert. Please go see someone. That's good enough.

51:14Dr. Linda Bosserman: I love it. And absolutely, yes. I'm still worried because there was just a very recent paper published by somebody whose agenda is anti-hormone. And it said, we don't have enough data. It called into doubt and question vaginal estrogen after breast cancer, saying we don't have enough data. We don't know if we need uterine. Like called out all of that. And I'm like, you're putting back in publication what we've worked so... I mean, the boxed warning just came off in November. But like people don't understand. We have over 50 ,000 breast cancer women studied with vaginal estrogen. We have overwhelming support for this.

51:53Yeah.

51:54Dr. Linda Bosserman: And we have the gold standard. Gold standard systematic review meta-analysis, including with aromatase inhibitor. Yeah. So it's like, again, I'm calling out the journal articles and the reviewers to be like, you are allowing this to be published still. Basically calling into doubt, do we actually know enough? And it's like, how many things do we study? 50 ,000 people. Like, that's pretty big. Yeah. And you and I just sent, we just sent last week an article they haven't rejected yet. a major journal said we we need to teach menopausal hormone therapy now but it also had three major errors that you and i called out and i hope it published to enhance that basically they said well you know it can cause breast cancer no only in synthetic progestin let's be very specific it said testosterone was kind of an afterthought and you and i really detailed the publications that benefit and it said that vaginal low dose estradiol for women with breast cancer was theoretical.

52:51How did that pass inspection by reviewers and editors in this day and age? And I can only say reviewing is a thankless job. It takes hours to review a paper and to really respectfully comment and make suggestions to make it better or reject it because it really isn't accurate as that menopause paper should have been rejected. It was not clinically relevant, had data without any information in it, and it made false claims.

53:22Dr. Linda Bosserman: It had relative risks above and beyond smoking and arsenic and guns, basically. Like, it was so unrealistic in just the reading of it. But a lot of people don't know that. They don't know. But reviewers should. Reviewers to a journal should. Well, you know, I go back in my medical training. I remember they said we should calculate the statistics in every paper ourselves. And that was absurd in 1970. and it's more absurd now. But I have to say that when I went through my 80 hours of bioidentical training, it was drilled into us the quality of papers, reviewing 80 hours of the medical literature.

53:59And Neil Razier is just a gifted instructor at Worldlink, I have to call that out. And he taught us database, right? And so we have these criteria, there's grade criteria, there's all kinds of criteria to look at a paper. And when it starts out saying we looked at a database that wasn't a prospective study. And then it had some hormones. We don't know what hormones, how long, which ones. And this is what we found. I mean, even that paper said there's limitations, but then they...

54:27Dr. Linda Bosserman: This podcast is sponsored by Joy and Blokes. One thing I've always believed, if I'm helping one person with their sexual health, I always have to think about who's on the other side of that relationship because intimacy doesn't happen in isolation. And I've said this for years, if I'm prescribing a blue pill for a man, what about his partner? Are they dealing with pain during sex, low libido, hormonal changes? Are they both healthy enough to enjoy their relationship they're trying to build together? I see it with women and their health all the time too. She starts optimizing her hormones, more energy, better sleep, the brain fog lifts, libido comes back, and the next thing I hear is, now my husband needs help too.

55:05Dr. Linda Bosserman: That's one of the reasons I like Joy and Blokes. They care for both women and men, connecting patients with licensed clinicians for personalized hormone optimization when it's clinically appropriate. And they publish peer-reviewed research on outcomes, real improvements in energy, mood, mental clarity, sexual function, and quality of life. Whether you're navigating perimenopause, menopause, low testosterone, or simply wondering why you don't feel like yourself anymore, the first step is understanding what's going on with your body. If you started feeling better because you've taken care of your own health, maybe it's worth asking whether your partner could benefit from doing the same.

55:44Dr. Linda Bosserman: If you've been wondering whether your hormones could be contributing to the way you feel, visit joyandblokes.com slash notbroken and use code notbroken for 65 % off labs and 20 % off treatment. That's J-O-I and B-L-O-K-E-S dot com backslash notbroken. Code notbroken. I said there was a finding and that was picked up as if it was clinically relevant. That type of paper is potentially hypothesis generating, but it contradicts the Medicare study, contradicts the Menopause Society guidelines of the journal it represents. And it should not have been published or should have been published with a commentary for clinicians so it wouldn't have been picked up by Medscape and then false information echoed.

56:34once again.

56:35Dr. Linda Bosserman: I couldn't say it better. Let's wrap up by talking about your PhD in sex therapy. What did you learn in doing that work? How do you use that every day? And should I become a sex therapist? Yeah, I mean, I think, you know, first of all, in America, we don't talk about sex. We don't empower our children to understand their body, that sex is normal. It's a drive. I remember my son at one point, my younger son and his girlfriend wanted to be abstinent in their teens. I go, that's a great idea. I respect that. But if you want to be abstinent, you probably shouldn't be necking for hours because we are made to have sex.

57:07It feels good and it's a natural drive. So if you choose not to be aware of how your body works. And, you know, I, at the time the woman said, I thought that was just a lot of information. And later she said, why doesn't every parent tell their kids how their body works? Right? So that's number one. Number two, if you do counseling with women, there's women that don't know their body parts. I explained to a woman, And, you know, what the bite of the little vagina with the clitoris and the urethra and the vagina opening. And they don't know their body parts. I had a woman who said, you know, she tried to get together with somebody in an older age and he had ED and she told him, it's your problem.

57:45I go, it's a partnership. It's pleasure. It's not a performance. And she knew nothing. Right. So we have to start where our patients are. But I learned a lot. I mean, going through a formal PhD, I really wrote physiology and really worked on medical issues because I'm the bio part. But I trained with therapists and they were gifted. I learned so much from them. And I have to say my guilty pleasure has been romance novel reading for many years. So there wasn't a genre I hadn't read about. So when some people are shocked by things, I'm like, oh, I read about that. I know all about that. So again, we're not here to judge anybody.

58:20I am not a BDSM expert, nor will I be. But I know experts if that's your thing, right? We're not here to judge people. Consent. You know, one of the big questions people ask is, can you do some outrageous things? And the answer is not without consent. And of course, children cannot give consent. Animals cannot give consent, right? Consent is so important. So lots of things you learn, but also all the range of physiology, medical issues. It was really great training. And my partner is a therapist, is specialized in couples. and most couples come to therapy seven years too late. There's already so much buildup.

58:58Is there data on that? Yes, there is. Yeah, published data. Seven years. I need to send it to you because it's part of his PhD.

59:03Dr. Linda Bosserman: Oh, please do. Because I'm always like, as a urologist, they're always like, women wait eight years to go see a doctor about bladder leakage. And so I've been looking for a similar stat for sex issues. Okay, so I will get that because they come. And then oftentimes they're just so much hurt, right? Women are not getting their needs met. Men aren't getting their needs met. It's always like my favorite couple book is still His Needs, Her Needs, and Affair-Proof Marriage. It's a non-blame analysis of we have needs. If our needs are being met, our relationship probably works pretty well. If the needs, our top needs are not being met, these people have been married 40 years.

59:42It's their 20th republishing. It's great case studies.

59:46Dr. Linda Bosserman: William F. Harley Jr. His Needs, Her Needs, Building an Affair-Proof Marriage. Over 2 million copies sold. Thank you. First published in 1986. Yep. Great stories, again, about needs and understanding each other. And then people can work it out if they want to. Sometimes the hurts have been too great. They can learn to part as friends. But if you want to rebuild a relationship, you've got to have a healthy body. Because when you're on healthy hormones, you hug your partner, you start to feel good. So as you know, we have the libido of I'm thinking about sex now or all the time versus, okay, you could talk me into it, right?

1:00:26I start to, you know, Emily Nagoski has a fabulous 10 minutes TED talk, sex and long-term marriages about getting together, that hug, that oxytocin, thank you for doing life with me, right? And that can lead to pleasurable sex with your partner, whatever that is. And we have to get to play. It is not performance. And especially as people get older, things work or don't work in this way or that way. And toys are essential. And I have to say, I have one couple who came on, they were very unsure what this consult was about from a sex therapist, hormone doc at a cancer center. And I said, I don't want to hear anything you don't want to talk to me about.

1:01:06And first we realized that he was told he only could get a penile prosthesis and I go, well, you're on two medicines that cause ED. How about if we stop those first, right? And then, you know, just basic medical care. And then they came back and then we've talked about last discussion was toys. They'd never heard of this, never been in a shop. I said, what would this be comfortable to talk about, right? Because vibration really helps blood flow, sensation. It can add to a relationship on your own or with a partner, but you have to ask the question if you're willing to look at it. And as a sex therapist, you're trained in everything.

1:01:43Pelvic floor therapy, healing of the pelvic floor, right? Psycho-struck, bladder leakage, right? Nobody wants to have sex and be peeing. So let's get healed and see a urologist, a pelvic floor specialist. So it all goes together. So it was exciting training.

1:01:59Dr. Linda Bosserman: I'm so excited that you stood up at the mic to be all pedantic about hormone types because it freaking matters. And And then now I have you as a friend. I'm so grateful. And we're going to keep writing and holding people accountable and teaching. Absolutely. I was thinking, I did this before the last menopause society meeting is like, there needs to be some rules. These are my, like, Kasperson's rules of the menopause society meeting. If you say hormones, you must say what type? If you say hormones, you must say what route? This is how I describe it. Hormones is a big tent. There are many, many things in the tent.

1:02:34Dr. Linda Bosserman: You can't say, I can't have any of the tent. It's simply too big. So that was my, like, I think at the beginning of the Menopause Society meeting, they should be like, I solemnly swear that I will not overgeneralize and I will be specific when I use the word hormones. And the lack of data does not mean things don't work. So yes, we're 23 years behind in clinical trials. It would give us a lot more information. but how are we getting trials of customized testosterone dose, estradiol dose, progesterone dose, and information on women? We're going to have to do a database, electronic record, interesting consent, develop a better patient reported outcome tool that would be effective and useful.

1:03:18There's so much work to be done, but only together can we figure out how to get more information and improve women's long-term health. Get FDA to stop the Schedule 3 restrictions on testosterone for men and women and get a female dose product approved or have the health plans cover compounded or men's test them if you want to use male dose and adjust it for female levels.

1:03:46Dr. Linda Bosserman: You're a woman after my own heart. All of those things. The only thing I would add is women need to, they've been taught to be passive. They've been taught to accept what the answer is. Them learning how to advocate, seek a second opinion, ask questions. Know that adjustment takes time, that this is not one size fits all, that your quality of life matters. And there is no such thing as too old or too young. And we don't too old or too young men. Like they don't even realize. I'm like, there's no too old or too young. Your driver's license age doesn't matter in this discussion. It doesn't for men, so it shouldn't for women.

1:04:27And I think that advocacy piece just adds in to the to-do list.

1:04:32Dr. Linda Bosserman: Thus the podcast. Yes. As I say, we can only do better. That's why we show up to work, because we can only make it better. I love that. Thank you so much for coming on the podcast. I hope it's not our last time. I mean, obviously, we're going to keep working together and doing cool things. Thank you so much for having me. It was such a pleasure. Absolutely. Till next time. If you found this episode funny, helpful, insightful, please take a moment to follow, rate, and share the You Are Not Broken podcast with someone who might need this conversation too. That support is how this information reaches more people.

1:05:05Dr. Linda Bosserman: And thank you. For courses, books, and my monthly membership and the Kasperson Clinic information, visit kellykaspersonmd.com. This podcast and all content from Dr. Kelly Kasperson is intended for educational and informational purposes only, and this is not a substitute for individual medical, coaching, or psychological advice, diagnosis, or treatment. Always seek the guidance of your qualified healthcare professional with any questions you may have regarding your health. Never disregard or delay medical advice because of something you've heard on this or other podcasts. Thanks for being here, and remember, you are not broken.