386. Nuances and Myths of Menopause with Dr. Shepherd

0:00This podcast is sponsored by Explore Worldwide. One of the themes that keeps coming up in my conversations is that it's okay to want more. More joy, more connection, a better experience. And thanks to our sponsor, Explore Worldwide, you can get so much more when you travel. All of Explore's adventures are 100 % human-made. Their tour leaders have actually stayed at that family-run guest house that isn't even online. They've eaten at the neighborhood restaurant the locals love and know the trail you'd never find on your own. Your vacation should feel uniquely yours, not like it was generated from the same prompt everyone else entered.

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1:05Welcome 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. I have the amazing Dr. Jessica Shepard on a long time coming. Thank you for being here. Oh, I'm so excited to be here. I think we've been planning this for 87 years now. Yeah, yeah. Full on 87 years. I'm like, I'm fully convinced that you are AI because you're everywhere. And like all of us in the menopause group, we're all like, how are you everywhere?

1:41And we're like, you're everywhere. And I'm like, but I think Jessica's AI at this point. I have a clone. I will admit it. I have a clone. You have like somebody on the East Coast, somebody's on the West Coast. We've got multiple Dr. Shepard's covering the universe. It's fun. It just is something that has exploded. And then you're like, let's do it. Yeah. You know, it's very interesting. Give me your opinion. So menopause blew up. Sexual health has kind of always been there. It gets a little hot. It goes quiet. It gets a little hot. It goes quiet. Menopause blew up. I thought perimenopause was going to be bigger than menopause.

2:19I'm feeling like menopause was still bigger than perimenopause. as far as the zeitgeist. What's your pulse on the trends right now? I think menopause will always be that gateway drug, right? So it's always the entry point because it's been around for so long. I will say perimenopause creates this context of women who are trying not to be in it, right? So you have the people who are like, oh, that could be me. And people are like, holy hell, I don't need that to be me. So they're like scurrying away from it. And I'm like, no, no, no, it's catching up to you. Do you see it behind you? you look back behind you, it's closer.

2:54You want to know what's coming, right? No, you don't. You don't want to know what's coming. Okay. Call me when it's here and then we'll deal with the crisis. Yeah, exactly. Whereas like menopause, you're like, you're in menopause, you're in menopause. There's no running away from menopause. The period stopped three years ago. But you're saying the perimenopause people are like, not me though. Yeah. Menopause is acceptance. That's the phase where you're like, you know what? Here it is. Sitting on my lap and I can see it. Perimenopause is like, I'm going to maybe go through door number three and hope that it's not there.

3:25Is there enough ashwagandha in the world to prevent menopause? Keep it coming. If I sleep nine hours a night, will I avoid menopause? They think so, but you will not. Don't smoke cigarettes. That helps ovaries live longer. Mm-hmm. It's simple things, right? I know. When we were talking about what did I and the great Dr. Jessica Shepard want to talk to today, She's like, the basics, which are the most important things. And I'm like, yes, that's, I'm like, God damn it, nutrition again. God, nutrition again. I feel like it's from Sound of Music that started at the very beginning. It's a very good place to start.

4:05Well, I mean, you and I exist in a bubble. And we both know you step a half a foot outside of the bubble. And people are like, I never went through menopause. Or like, my doctor said I can't have hormones because I still have a period. or what do you mean my dry vagina at age 72 is because of no hormones? You're like, I have something to tell you. I'm going to hold your hand while I say it. But yes, it's like going back out into the vortex where you thought you were out of the tornado, and then you realize just how many women are unaware of this transition in their life. And so you're like, oh, yes, I have to keep saying the thing.

4:47So it's a message that will never die. It will always be with us. Which is why we have four Jessica Shepherds currently circulating the planet Earth to get the freaking work done. 80 million women over the age of 40. Yeah. 50 million women in midlife, nearly all in the workforce. I just did this. It's incredible, the sheer number of this. Let's talk about that for a second. Number one, the women in the workforce. Number two, our buying power. We got more money now than we have when we were 23. Let me tell you. And it's a beautiful thing, I tell you. It's a beautiful thing. This is very interesting to me.

5:23And I know that you like philosophy like I do. So you have half of the internet being like, nobody's paying attention to women. We have no funding. There's no research. Women have never been in research. Nobody's paying attention to the women. We need more women this, blah, blah, blah, blah. That's half of the internet. And then the other half of the internet is like, stop preying on the women. We don't need all this shit for women. Why do we have shit for women? You're just taking money from the women because you made shit for women. I think we need like a camp, a summer camp where we're like, we need more for women and it's okay.

5:54Full stop. Yes. I'm like, you can't have, we're ignoring women and then stop trying to make solutions for women. But women have to buy the solutions that we have to buy food and gas and solutions and all the things. And it's just, it's just like, it's just a lot of yelling and absolutely no common sense. it's a lot of yelling and I feel that we have been taught to do that like always have opposing sides and you have to be on one of them I'm like there's a lot of gray area here and it's okay to live in that gray and you don't have to join one or the other you can do both you can actually have both of those at the same time maybe I don't want to partake in what's around for women that's your choice but guess what we still do need at the end of the day more for women I mean that has been seen in study after study after study how women have been left out.

6:46So we do need more. That is that is the statistic. End sentence. Yes, totally. Thank you for that. And that's what I like about you because like at every time you're on stage and we got to do the wonderful NPR event together, which is always so, so fun, is like you are just this like cool, calm voice of God. Well, Jesus voice trains me tonight. what is his retainer really it's just like this calming voice and i'm like oh that's the tone okay good we're gonna go with that this is what everybody needs obviously um were we talking about sex on npr what were we talking were we talking about menopause i forget talking about sex and the misconception around it and why women don't know more about their own bodies and it's not of been reproductive.

7:34You know, I think that we align sexual with reproduction and I wish that we would stop. That's what eighth grade taught us. Mind you, a fear-mongering way, like don't do this because this is the outcome. So then you get to an age where you're like, now you're allowed to do it and we expect that as the outcome. You're like, well, great. Thank you so much for the starter notes that were not helpful at all. That got me nowhere. Then you also see women being like, well, if you're not having sex to have babies, why are you having sex. I'm like, do you want the list? The clitoris exists. End of sentence, period.

8:09Not necessary for any reproduction. Babies are not made from clitoris. It is a good thing to have. Yeah. It's a wonderful thing to have and completely ignored. Again, we hear us do a podcast episode of like things the internet says that like bothers me. What does Dr. Jessica think? When people are like, we need to tell people that the clitoris just got rediscovered. again. And I'm like, God damn it. I'm just telling you that like, if we looked at it with the microscope, the clutter says like, guys, I've always been here. I've always been here. I never left. We've always been here. We got discovered in the 1980s.

8:45We got to rediscovered again in the 1930s. They discovered at the end of the 1800s. Like it keeps getting discovered and lost and discovered and lost. And I'm like, can it just be here? And can we stop like screaming that we just rediscovered it? Like it was a hubble would just always be here. It's the voice in the back. It's like, guys, I'm not going anywhere. You keep trying to bring me back up, but I've been here. And like lovely women who are like, I know it's been here the whole time. Like, I've been having a fun time. This is not a rediscovery. They're like, no, no. Yeah. They're like, where have you been?

9:17You just decided to yell on the internet that I've been rediscovered again. Like, slow news day. The clitoris has been rediscovered again. A National Geographic that's like resurfaced from the 80s is back in 2002, then back in 2026. You know, they just bring up like the topic every 20 years or so. Like, you know what women need to know today? The clitoris is back. The 2026 version of it. Yeah, totally. I mean, I do find it so humorous, though, that like they just discovered snake clitorises. And it was female scientists who discovered the snake clitoris. And like snakes have two clitorises or there's something.

9:53But it's like other animals also have clitorises, not even mammals. That is pretty interesting. This thing's been preserved through, what's the word? Phylogy? Now we're coming up with all sorts of terms. Oh my, phylogeny? I don't know, genus and species? So here's an interesting thing about the NPR talk. So I probably scared the poor researcher. So she met with me beforehand and I'm like, listen, and this was Epstein Central. week. And so Epstein, very centric. And I'm like, you need to talk. And this is what I told her. I'm like, you should open by saying sex is being used against women. Sex is violence.

10:36There are many people harmed. There are many people traumatized. And let's try to right the wrongs. But acknowledge up front that this is a very traumatizing topic, especially right now, because Epstein's all over the news. And she's like, well, maybe we don't mention that up front. And you're like, how about we do? And I'm like, how about we do? Anyways, you were there. We did not mention that up front. I just think if we don't acknowledge the profound harm that sex has done to people, disproportionately, young people, female people, and then we're like, everybody deserves pleasure and an orgasm.

11:15And we're just like, if we just dismiss this dark side of it, it's sex is a weapon. it's been marketed as a weapon and in that against women. And so there is this underlying tone of, again, very patriarchal in the sense of we will use it to, as control, power, and as a weapon. And many times women have not been able to find their way out of the toxicity of it. So there is a lot behind it. Unfortunately, it's trying to find the good of it in a world of chaotic, weaponized sex. Yeah. And to be like, making it your own, a woman's own, her choice, her advocacy, her pleasure is part of this profound acknowledgement of if she doesn't try to take that on or make it hers, what hope does she have?

12:14Because everybody else isn't being helpful. At all. And I think that's some of the framework of where a lot of the work that you and I and the menopause are doing in mid-age is also very hard because it fundamentally goes against what we were taught as teens. And so you're actually trying to change this, like these neurons firing that for so long have been told one certain thing, whether it has to do with puberty, whether it has to do with your period and how evil and bad it is, whether it's sex and how you enter in that world and how you're taught in eighth grade on a video or even fifth grade.

12:50you're going against all of that in a moment when your hormones are already chaotic and then also wherever you are in a relationship and what you've been told up until that point we are going against that and so it seems very suspicious initially i think that women are like wait what did you just say this podcast is sponsored by jones road i like to take care of my skin but i don't like the whole cover-up makeup routine. I like things fast and fresh. So when I found Jones Road Beauty's Miracle Balm, it genuinely fit the bill for my lifestyle and skin. You see, it doesn't mask your skin, it enhances it.

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14:43All of Explore's adventures are 100 % human-made. Their tour leaders have actually stayed at that family-run guest house that isn't even online. They've eaten at the neighborhood restaurant the locals love and know the trail you'd never find on your own. Your vacation should feel uniquely yours, not like it was generated from the same prompt everyone else entered. That's the difference a human touch makes. Explore Worldwide's trips are created by real destination experts and led by tour leaders who actually know the places they recommend. They handle everything so you can relax, stay curious, and experience something genuinely memorable.

15:22This is your time. Demand more. Visit ExploreWorldwide.com. And don't just travel. Explore. Yep. I agree. I think about this in the healthcare system. because it comes down to fundamentally how we think about women, women's bodily autonomy, women's decisions to have agency, women's decisions to try to deal with something before it gets bad enough, the physician's power of I decide when it's bad enough, I decide when you get this or not, I decide risk benefit. And I know I'm oversimplifying, but man, in a 10-minute doctor's appointment, how the hell do you do anything but try to have that control?

16:01You know, when people are like, take hormones preventatively, don't do it unless you're suffering enough for severe hot flashes. And we're arguing about it. I'm like, what's underneath that is the fundamental belief of the right of the woman to decide for herself when she wants to choose these things. We've never really had that freedom, especially, you know, now as we're in mid-age to have actual autonomy. And we have made steps and strides. And then we take 80 steps back, you know, that even when we're thinking of, what was that 2019, 2020, or maybe it was a little bit later when we had the abortion, the whole conundrum with abortion, that again is a fundamental, look how long it took to get to the point to allow women to say, oh, I want to make a decision for myself and then snatching it from her.

16:55And so it's like this secrecy of you feel violated, but you don't know who to talk to. Or you feel you want to make a decision for yourself, but you're like, but if I speak out, then everyone's going to say something is wrong with what I'm saying and I'm not allowed. And so it's permission. It's permission for women to just even have the thought and have the thought then become something that they're going to verbalize and then take action. I love it. I was recently on a panel. Somebody asked, it was a physician asking about an 84-year-old patient. They can't have hormones because of their age, right?

17:26And I'm like, what man do we ever say is too young or too old for anything? Give me a man's condition because I'm still trying to like process. What man's condition do we tell him that he's too young or too old for? I've got an 89-year-old on testosterone and Viagra, right? Because his quality of life, that's what he wants to do. It's not without risk-benefit discussion, but I don't say 88, sorry. 88 was the cutoff, right? And with women, especially with hormones, when we're like this age 60, which is completely arbitrary. We've got the healthy cell hypothesis and the timing hypothesis, meaning the healthier the cell is when you start.

18:05But the cell doesn't know like I'm 60 and one month versus 59 and 11 months, right? Like the actual 60-ness of it is arbitrary. 10 years post, made up by a human, could have been eight, could have been 12, could have been 11, right? Arbitrary. You know, the other thing is as you bring that up, when they had these studies, one, fundamentally, they were obviously different hormones that they were using. But where we have gotten, even in the last 20 years, in just innovation and science, in quality of life, how people take care of their health, what people are exposed to as far as, oh, I can do this in order to further my health, has changed the game in genomics, in just what our body's even able to do.

18:48So that is the goal is to push further and say, wow, we're now able to do this, which we weren't even able to do 20 years ago or 20 years before that. So the fact that we're limiting ourselves to a very archaic version of what, one, we can do by choice, but then also what our body is able to do and able to capacitate is almost like a slap in the face. The other very interesting thing that you see a lot on the internet is like, well, menopause isn't a disease, so doctors shouldn't deal with it. And like, the idea of what a disease is, is changing all the time. Homosexuality used to be a disease in the DSM-3.

19:27It's no longer, just a profound example. It's so interesting that that was even in the DSM. and things that are in the dsm people disagree on if they're a disease or not so like the concept of disease is ever changing the concept of codes for a disease is actually an insurance reimbursement thing but what's fascinating about this culturally is that physicians aren't allowed to be involved unless it's a disease which then is defined by a human made decision right and so it's like we've made up what a disease is. It's fluid at best. Some things aren't, but some things are fluid. It may have made a construct.

20:07And so what we've done is we've said, physicians are only here to take care of disease, not anything else, which fundamentally clashes with doctors are here to keep you as healthy as possible so you don't get a disease. And so it's like this view of what's the role of the doctor, which I think, especially in 2026 with AI coming down the pipeline, fast is we're starting to wrestle with this a little bit. It is so offensive that that is even a statement, because that would mean that we don't care about you while you're well, but we'll only take care of you in the instance that you're ill. So I don't know where that frame of mind comes from.

20:48We've done a poor job, I will say, at not allowing people to teach themselves or help them learn how to stay their healthiest version of themselves for the longest amount of time. Yeah, I can say that there's some contribution there. But to say that a physician is only going to watch you, care for you, even be interested in you until you have a disease is so offensive. Agreed. And how many perimenopausal women have said to you, my doctor said I'm not sick enough, I don't have diabetes yet. My A1C is not high enough. X, Y, and Z. And we've legitimately turned healthcare into what insurance will pay for or not.

21:29Let's talk about, I'm going to call out Function Health, not to pick on them, to say what a massive success because of the failure of healthcare, right? So Function Health, valued at$2 billion. Beautiful website. They check labs. They kind of interpret a little bit, but there's not like a doctor that interprets it, right? So At best, they check labs. $2 billion industry because healthcare sucks. You know, they people come to see me and I'm like, any other labs you would like checked? And they're like blown away by the question. And I'm like, this is your body. I can't make insurance pay for it or not.

22:02That's kind of up to you and your insurance. But this is your body. I believe you have a right to that information. And with that information, then you guys can do... I can always say to my patients, I'm the Sherpa of your wellness journey. I can guide you along these paths, which are really going to be helpful. In the end, ultimately you get to choose your own adventure. But my goal is to guide you along a variety of different ways in order to get you the outcome that you're looking for. So if I can't do that, I need information. And that's the information that's so long we've like gatekeeped until you show up with the symptom.

22:42Then we'll let you get a lab. I mean, to take it one step further, insurance will cover a GLP-1 until your BMI is under 30 and then they cut you off as if, again, BMI is made up. Right? Like, it's an equation we decided upon. Which isn't even that great of an equation. It's horrible, actually. Not great is me being kind to the BMI. But that's the crazy thing is like, okay, you just got somebody underneath a BMI of 30, which is a crappy equation to begin with. And now you cut them off? You want them to get sick again? Yeah. Oh, and also, we're not going to give you any tools or resources. But peace out.

23:21Good luck with that. Insane. The life journey of everyone requires good foundation. And we have not done a good job with providing foundational pieces that people can go back to over and over and over again. And the complexity of what we know, will I say that we know an astounding amount more of information when it comes to the human body or disease progression or how the body responds physiologically? Absolutely. But does that mean that there's no value for fundamentally helping patients with good foundation? And that's what we've missed. That's the gap right there. And so it's just like waiting, waiting, You know, what was that?

24:02It was on Price is Right. Do you remember the game where the yodeler would go up the mountain? And then you have to like get the right price. And if you don't, he like falls off. You may be in perimenopause if you remember The Price is Right with the yodeler. There are going to be people who would be like, oh my gosh, that was one of my favorite games. Where you're like, don't get the price wrong. Plinko? Oh my gosh. I was really good at that. Even though I've never been on that show, I knew where you're supposed to place the chip. It's like to the right thing. We are the latchkey kids of the late 80s.

24:34Yeah. Complete squirrel. Where were we going with that? Price of right? Oh, yeah. So here's my question. So why does everybody moan and groan every time we're like, sleep, no alcohol, walk, lift some weights, chew some vegetables? Like people are like, they're so groany about really the 80 % that matters. because we live in a society as well that has presented things that feel much better right so we're going on emotion we're going on the emotion of i want to go out and eat this and drink this but not fundamentally having something to default back to it's that everyone's here for fun everyone we are just going to live our lives in the best way but when you get a disease someone is there again to catch you the yodeler going off we're the person who's like hey i got you but that's not how it should go.

25:29People argue our, you know, our life expectancy now as a society, yes, we have vaccines and we have antibiotics and we have clean drinking water and we have trauma care and we have cancer care, but we have been able to keep heart disease alive at an, you know, as surgeons, you know, we talk about with this with the anesthesiologists all the time of like, we're so successful at heart disease now that we have like pretty sick people that are still alive. But we need to move that needle on like, how about we don't get heart disease? Maybe we get heart disease 10 years later. Maybe we get dementia 10 years later.

26:06And that's the boring stuff. That's, it's possible it's throwing out an estrogen patch at age 51 instead of age 58. And going for a walk, movement, you know, sleeping well. I often think, and I didn't think this in, you know, things you question about your training once you're out. and I can't prove this. I haven't been able to prove it. I think that the alcohol industry's paid off. Like why? Why? And this is what we were trained. We were trained this in medical school. We were trained this in residency. No drugs, alcohol in moderation. No drugs, alcohol in moderation. Alcohol, cage. This podcast is sponsored by Addy.

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29:27Oh, I used to ask them because I was like, oh, this is so phenomenal. Beer in the shower at 8am. No, you don't. Oh, okay. Keep drinking. As long as it's past 11 a.m., you're good. Right. Is it happy hour somewhere? So that's like, and now, you know, I'm almost five years out not drinking. Anybody who struggles with depression and anxiety, take the fucking depressant out of your life, right? And so anybody who can't sleep, anybody who wants to drop 10 pounds, take this out of your life. But the medical profession, no drugs, alcohol in moderation. And I'm like, are you paid off by big alcohol? Like, where did this come from?

30:07I think society has really created, it's a buffer, right? So it's a buffer of how do we have something that's still, quote unquote, because it's a narrative of fun, right? Without being over the top, because we have the disease and pathology of it, which obviously we don't want anyone to go over there, even though we're still allowing you access. And I think it has to do with basically we're a country that makes money off of alcohol. A lot. A lot of money. And so in order to fight that, that goes against a little bit of the infrastructure of how we build our societies, especially in a westernized world, where it is of convenience and of leisure and luxury.

30:47Right. And don't take my cheap joy away. But it kind of plays into the narrative thinking about it now. If a doctor's domain is only when it's pathology, only when it's a disease, only when it's cage criteria, right? Versus like if a doctor's true job is to help you be the healthiest, optimized is kind of a loaded word, but healthiest version of yourself, no alcohol really is the extension of that instead of, but it's so much of medicines like alcohol when it's a problem. And I think that keeps a lot of people drinking because they're like, well, I don't have a problem. I can just keep doing this, right?

31:21And you're like, well, yeah, but the 10 pounds you can't lose and the fatty liver and the anxiety and the poor sleep and all of the stuff. And the funny thing is, as you say that, it's that whole bodily system of one creates the other and then it just creates this whole cogwheel effect is the reverse of that, that the ability for midlife women to have the reverse of that cycle is actually hormones when you think about it, right? And somehow we've created the reverse cycle of people not wanting to do it for fear. But we will promote another cycle in toxicity of alcohol and food and what types of food and illicit drugs.

32:02And that one's okay. But the one that actually is going to help you in being the best version of yourself as you termed it is hormones. But we've created the other side of the structure to that. that's really fascinating so there's a now deceased comedian and he goes you have to ask your doctor before you exercise before you change your diet like everything says ask your doctor before you exercise before you change your diet ask your doctor he's like you're not asking your doctor when you go out on the bender when you sleep with somebody unprotected when you're going to do the drugs nobody says ask your doctor before any of that shit and arguably that's the worst thing for you.

32:41I know. They're like, but don't ask for advice on that. Just go ahead and do it. But those other things actually might be... Don't go on a treadmill before checking with your doctor, but feel free to drink the fifth of whiskey. You don't have to check with your doctor before that one. You know, it's only the comedian who can bring that out of like, oh, that's right. Why are the healthy things, the barriers, check with your doctor and the unhealthy things, everybody's like, have a great night. I'm going to use that with my patients when they're asking me, you know, 101 questions about hormones.

33:11It's just being like, think about it this way. I think that just brings so much clarity to it. It's so good. I think, you know, as a culture, we're kind of effed up in regards to diet and nutrition and especially women being small. And then I see like in perimenopause and menopause, it just backfires because now we're trying to be small, but not have osteoporosis. Then this whole like, don't get bulky, which God, the men wish they could get bulky and they've got testosterone at 800 you know like all this big myth of like what worked for us in the 1990s and what hollywood's actively portraying by the way is frailty masked as beauty and when you get into like you know how do how do you oppress a people keep them weak is like it gets kind of dark they're like well take away your muscle mass and your bone mineral density.

34:04And your energy. Let's take away your energy. But we still want you to perform it, you know, very high levels of production. And it's fascinating when you think of how the body starts to deteriorate. Because I always say that there's an aging component. Everyone's going to age. And then it's compounded with some of the factors that you see throughout that hormone decline in perimenopause or midlife. Because women have an average reduction of like 10 % in bone mineral density. And then their muscle mass as well. But they don't know this until it's too late, obviously. These are the moments in where I'm like, this is what we're creating as this foundation so that when you're older, we didn't miss out on that time.

34:44We didn't miss out on that time. And time is that one thing that is like your currency that you get to strengthen or weaken. That's your currency. I love it. And the other thing I'm picking on the internet today because I'm in a mood, but the internet's like don't scare the women don't scare them don't tell them that they're going to get frail don't tell them that they're going to break a hip what are we supposed to tell them do you want us to tell them after they broke a hip and be like well i saw that coming and they're like you did why didn't you tell us right like well i didn't want to scare you no but i think it's a very patriarchal but like it's a very why are we afraid of telling adults what happens to bodies when bodies aren't maintained?

35:27I think we have a system that's already set up for it's here when it breaks, but I'm also not going to give you the information prior to it breaking. That is a business model. If you wanted to look at it like just from a business standpoint, that is a very strong business model in where if everyone started to make these small changes and maybe the age of 75, say, we started to have a reduction of inpatients. We had a reduction of falls. We had a reduction of people in ICU and in long-term care facilities. What would happen to those businesses? They would fundamentally fail. And so there is this notion, and it may be subconscious because, you know, I'm not going to go out and say that people want the worst for people, but to be in not preventative mode and only in the solution base of when you get there actually is kind of limiting what people can do for themselves.

36:25And it's a business model. But you know, no one's going to say the thing, but I just said it. Even though I just said it. I know, I know. It's true. I mean, I think my big one is dementia, right? So right now, just because I like to pick on big stuff. But so right now in Australia, dementia is the number one killer of women. In the UK, if it's not there, it's very close. So America's next, except for we're really good at killing ourselves way younger. So like we've got competing, oh, ours isn't dementia, but yeah, we're good at dying younger. So that's why. But if we don't watch out, it'll soon be the number one killer of women in America.

37:03It's coming, right? And so you're like, okay, that's big. That's number one killer. That's big, especially that would do heart disease, right? If we know hormones, and I'm including testosterone in this, are neurohormones that help glial cells, that help astrocytes, that help myelin sheaths, that help dopamine, that help serotonin, that help depression, sleep, and it help inflammation, that help, I'm going to keep going because I know all this stuff, that help glucose metabolism of the brain. We know all of that. And then here we are yelling on the internet being like, we don't have a 20-year randomized placebo-controlled trial knowing if it prevents dementia or not.

37:43That's true. That's true. But the big elephant's coming across the sea. It's already in Australia. It's headed in the UK. The big elephant's coming here right now. And we actually have a chance to do something where we have biologic proof that it does this. We just don't have the big 20-year randomized placebo control trial. But this is why you and I, and others as well, are willing to, quote unquote, as people term it, scare women by giving them the facts and the data and what's able to be done in a preventative way, it to me is very enlightening. Whether it's heavy or not, at some point you have to let that sit and say, now what do I want to do with that information?

38:22And am I going to let it scare me or am I going to take action and actually be preventative? And I think from what I've seen, as much as we speak and are on podcasts and stages, is women really are starting to understand their lives in a different way. And it's like the veil is being removed of for so long what was there in order to weaponize and scare women gives them more ability to say no more. And so it required steady steps of things happening, whether it's political, whether it was, you know, scandals being revealed and people being like, wait, what is going on? Is pulling away those curtains and being like, here's the shit show.

39:03Here it is. Yeah. Anger. And again, right, women aren't supposed to be angry. so you're not even like allowed to have the emotion that drives the change to make the world a better place a safer place a healthier place what do you so i've like i've spent way too much time saying what i hate about the online health space right now so i'm going to kick it over to you what are you loving what are you hating what are you seeing we're just going to keep the philosophy of this episode going? I think what I love seeing is, for example, going into big settings where women are congregated, right? So if that's a conference, a summit, a retreat, is seeing the buy-in.

39:46I think the buy-in is important of women because one, we're based on community. Women love community. And also the anger. The anger is not a bad emotion. Anger actually means that you still care. You still care. And now you're going to do something about it. And the more that we have women saying, I want more, I don't want any more of this, is where we start to see those small changes. And it's only a matter of time before this becomes something of the norm, right? So you have to go through that transition, gross kind of people saying the mean things and I'm angry. And then eventually we will get some more.

40:26So I am very delighted to see finally some anger. Anger can get us somewhere. What I don't love seeing is, and we mentioned it earlier, is the pitting against each other. Because I said this, I'm all right. And because you said this, you're all wrong. That is kind of like now we're on three wheels again on this car and we're not going very fast with it. Is how can we have still gray area? in, I always say this when I'm speaking on stages, we were taught as women, and we could go back to sex, sexual health is that you can either be a nun or a whore. That's it. Those are your only choices. And there's no gray area.

41:07And the same thing goes with when we get to choose how we want to show up, you only have like two choices. And that's what we're kind of seeing combated now in the midlife phase of hormones and do we do testosterone? Why is estrogen bad? Is the all or nothing. And I don't love seeing that. The distilling down or oversimplification, which then loses a lot of it. You know, I see what's the perfect estrogen patch dose? What's the exact testosterone lab value, right? What's the right order to start things in? It can be distilled down of what's actually a very nuanced, complicated, you know, you presenting with your perimenopause is a very different story than her presenting with her perimenopause and what we might decide to do first.

41:54So I think that oversimplification, I think this, I've been thinking a lot about the hate on the physicians for starting companies. Like you're allowed to pay multiple six figures for your education, but let the non-experts create the companies and create the solutions. Like that's the either or of like, yeah, but doctors can't create businesses and solutions. It's like, fuck yeah, they can. And furthermore, who better to create the solutions and the companies than the experts who spent a decade understanding the human body? But it's like the whole like, yeah, but you can just be an advisor. You know, it's like, it's all this like dismissal of your expertise or your expertise only should be used in the right way.

42:46And I'm like, oh, well, you're going to continue to have a bunch of bullshit products on the market then if you're not going to let the experts in. We were only allowed, you know, very historically to be meek and humble and we don't ask for much and we're only givers and we are only of service, right? And in that has obviously for centuries now become evolution of society is still this very nomadic kind of vision of what a doctor should be and can do and how they can be also in society in a very big way, just like everyone else is. And I think it's taken time and it will take more time because obviously we hear a lot of, you know, kind of bad press when it comes to physicians being just as important or just as big and loud as industry, we will get there.

43:39But I agree with you that the people who actually value the human the most comes from the training that we've had, but also the understanding. Like we literally know the nuance and physiology and pathology of how a body functions. So who would be better than us to do that? Yeah. I'm saying that with like my full chest. I'm like, yes, we have to say more of that and being like willing to stand in that and be like, no, I am the best person to give this advice. Thank you so much. Yeah, yeah. And I think the other dismissal just in the doctor world is like that the people who do the research are somehow more knowledgeable than the people who spent 20 years seeing patients.

44:17And again, I'm even describing it binary. It's the researchers see patients and people who say patients do research, all this thing. But we've put, it's very interesting. If you go back and look at the definition of evidence-based medicine. It is available research combined with patient desires combined with clinician expertise. It is literally three circles in a Venn diagram. And in the middle of that is evidence-based medicine. And especially on the internet, we do this whole like, well, we don't have a placebo randomized control trial. So all bets are fucking off because that's, we don't have evidence-based medicine.

44:53And it's like evidence-based medicine is clinician experience. Somebody who's seen like the amount of people that you and I have seen age, just the expertise of like, when you come to see me, know that I've been studying 80 year olds for two decades. Yeah. And I'm profoundly curious of how do I get this there? Best case scenario. And it's like, that's not a randomized placebo. That's incredible expertise. And we've dismissed clinician expertise? Oh, absolutely. I would say one thing, you know, 20 years in practice, I don't see as many patients now as I used to. You know, when I first started in the first 15 years, I would say.

45:34You need to make more clones. I know I need to make more clones. Working on it, working on the clinical clone is when I tell you the experience of seeing patients over and over and over and over again from different backgrounds, from different countries, from that experience, you can never replicate. You can never put into an AI chat GPT and expect the best answer. I think experience probably is of that kind of coalition that you just said of evidence-based medicine is one of the most important parts of them. Yeah, totally. I think like, again, this is moving so fast. I'm actually giving the keynote at the Washington State Medical Association and it's about medical misinformation.

46:17Phenomenal, right? And I was asked to give this like months ago And even just in these months, because here we are like, well, we don't want physicians to be too successful in speaking because they're just supposed to be in the clinic seeing 40 people a day. But now we've got the non-doctors who are the experts, right? Those people, okay. Well, okay, so these people were the problem. Now these people are the problem for medical information. Don't forget the doctors in the clinic who don't know that vaginal estrogen isn't safe, right? So there's medical misinformation in the clinic. but even in this couple of months since I've been asked to give this talk now we have ai and we have ai on instagram looking like a human telling you something yes I've seen those oh it's it's real looking and now we've got a one to my knowledge some people tell me three companies that are authorized one's at one's a california company authorized in the state of utah to prescribe prescribe psych meds, AI, no physicians.

47:17No, stop. That's happening. That's scary talk there. And so to me, I'm like, oh, you thought the doctor social media people were the problem. And then we thought the non-doctor social media people were the problem. But now we've got AI on social media. We still have the doctors in the clinic that are the problem. But now we've got AI prescribing. That's the problem. It's like... That's crazy. It's moving so fast. And this is why we have to keep being the mean ones who are creating the fear and telling people about the scary parts. I was like, because unless they know, there's going to be a massive shift of, you know, and I never like to put all the blame on a patient.

47:54Actually, no one is one person's blame. But if they don't know, they can't make better decisions. So I will continue to stand on my soapbox and give the information that may be controversial or maybe someone, you know, people will still have bad outcomes regardless. That just goes all through any type of medicine. Walking across the street can have a bad outcome, just so you know. But if we are not able to give really good information that is evidence-based, that really has kind of applicable manner for each person who walks through this, you said it before, No one walks in with the same kind of template of perimenopause.

48:35But what would be the better version of that? Going to AI and assuming that they're going to know what that is? It's only as good as who's fed it. And if doctors aren't in that discussion, you know, running the companies, being active leaders. And I think like philosophically, this is coming nearly full circle of what's the role of the doctor. If AI can prescribe medications, what is the role of the doctor? And I think ultimately this doctor-patient relationship, it's holy, it's precious. It's been nearly erased in the 10 years of employed 10-minute phone calls. And I think, you know, the concierge were like, I want an hour.

49:17It's not novel. It's called 30 years ago, right? Bringing back this doctor-patient relationship. And at the end of the day, AI can't hold your hand. It's like retro. It's like literally we're going back to headbands and neon.

49:32Acid wash jeans. Yeah, we're bringing back an actual doctor-patient relationship. I know. Actually, for one solid day, I thought I had invented something new. And then I was like, oh, it's called a doctor-patient relationship. There's actually a word for this because it used to be a thing. I'm just going to want to do that now. And I think I would say that most people are actually trying to get that back for themselves. I have seen a lot more people who are saying, I just need someone to talk to. Yes. But humans can be like, let's learn together. Let's figure this out together. Let's, you know, there is a role.

50:08And I think there's kind of a reckoning coming of like, at the end of the day, who's got your back? And what do you want? Do you want somebody who can just prescribe a medication? Or do you want somebody who can listen and be there? That's why community is so important. I mean, going back to, again, the basics of when we look at centenarians and what are the biggest parts of how they thrive and what contributes to their longevity is literally community. I love it. Someone to talk to, someone to be able to hold their hand and saying, I'm going through a hard time. Someone to say, I don't even know what to do, but maybe not even giving them the answer, but community.

50:42I love it. And wrapping it up, what are you excited for? Like what's coming down the pipeline where you're like, this might move things? Yeah. Yeah, I think technology actually has a place in health and wellness. Do I think that we are doing it the best we can right now? No. Do I think that the advent of technology and how we man our health, the N of one, like what's going on with me, what is my specific data? I think where we're not holding hands the best we can is, again, that community. So that fostering of the doctor-patient relationship. And there's stuff on the physician side and the healthcare practitioner side that we have to do a better job at is understanding technology, right?

51:22But technology is going, like you said, super fast. But we have to find a way to have an alliance between how does that impact the individual? Who is going to fill in that gap? And that's where we are. We've always been the one to fill in the gap. We just need to do a better job at it from both sides. Oh, frankly, I love it. Like I love, I was telling somebody like I'm a luxury white t-shirt. Meaning like I am getting very good at the basics. Like listening, what are your goals? What do you want to do? I've got a whole menu of options. What do you want to do? We've got all these different and I'm like, I'm a luxury t-shirt at this point.

52:04Like I'm not here for all the bells and whistles, but I want to do the basics really good. And that's not for everybody. Some people want the latest in all the things. But to me, I'm like, God, I just like being really good at the basics. It's very fulfilling to me. I love that luxury white t-shirt. I think, you know, I always said that I'm a Sherpa. I am a Sherpa in stilettos because I, you know, I have to do it high fashion. So I'm a Sherpa in stilettos. Oh, I love it so much. I always love it when our paths Cross, whether on the stage or NPR or the You Are Not Broken podcast. Tell people where they can find you.

52:39Yes, you can find me on Instagram. It's probably my best bet, Jessica Shepard, MD. And then also my community of Modern Menno. We're again, going to community and the basics is where I have that fundamental community feel at Modern Menno. I love that. Thank you for doing that. It's more important now in this. I was just doing a podcast. Somebody said like 50 % of people are lonely. 50 or 60. It's not a minority at this point. So thank you so much for doing that. And we should do this more often. It's so fun to talk philosophy and medicine. Yeah. Awesome. Thanks for your time. All right. 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.

53:24That support is how this information reaches more people. 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.

54:04Thanks for being here. And remember, you are not broken.