392. When in Menopause: Advocacy, Policy, and the Power of Speaking Up

0:00Jennifer Weiss-Wolf: This 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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1:05Jennifer Weiss-Wolf: 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. I have my friend Jennifer Weiswolf on today. Welcome.

1:24Dr. Casperson: I'm so glad to be here with you.

1:27Jennifer Weiss-Wolf: Yay. Before we get started, I want to remind people that you can get CME if you're a healthcare professional on the Pinnacle Podcast Network for listening to stuff like this and advocacy. So get credit for it. Besides the fact that we're entertaining to listen to.

1:40Dr. Casperson: Maybe people can get CLE too. Maybe the lawyers can, you know, cash in too. We'll see. Totally. They should. They should.

1:48Jennifer Weiss-Wolf: Okay. So you are a lawyer. you work in New York City and super adorbs at the Senate hearing. I'm just going to jump in. You had students who came and like came to support you. And it was the cutest thing.

2:01Dr. Casperson: Where do we start? Well, why don't we start with just like, like where I'm sitting right now. So I'm sitting in New York City right now and all the way across the country from you. And I by day, I run a women's leadership center at the law school at NYU. And yes, indeed, while we were at the senate together last week uh nyu dc had a bunch of their their students come i almost called them kids but they're college students and they were awesome they were so so so so sweet that

2:31Jennifer Weiss-Wolf: they came to to see it i feel like it was at a new york event i actually think it might have been

2:37Dr. Casperson: in austin texas like we might have met at one of the south by southwest we meet at south by southwest

2:44Jennifer Weiss-Wolf: well i mean is this such a first world problem it's like but i think it was in austin um

2:49Dr. Casperson: So you've been, obviously, this has been your whole career. I am a newcomer in the space of menopause. And I've been focused, I started by focusing on menstruation and related policy, probably about 11 years ago. But my whole career has been focused on women's health and women's rights, reproductive health and rights. But menopause and thinking about and focusing on policy reforms and menopause is newish and newer to me. So I would say my brain started spinning here in around 2020. And I think I really started meeting doctors and advocates and leaders in earnest, probably in like 2022, 2023.

3:29Jennifer Weiss-Wolf: Did the change happen because of your menopause experience, your friends going through that, realizing, oh, it's not just good once we figure out menstruation. Like what was the shift? Is it just like growth in your career?

3:42Dr. Casperson: And that kind of feels like that's like a weird admission. My menopause experience generally was, I think, kind of nondescript. I think if I had known more about menopause, there would have been more to describe. But because I was so unaware of what I was going through, it's not like in hindsight, I mean, I don't know what I would have fixed or if I would have been gaslit or what would have happened. So I had symptoms. I had disruptions, but I did what most people do, which was just muscled through it because I didn't even know enough to ask. I never knew. I never connected the dots on any of it.

4:23Dr. Casperson: But I didn't come to talking about menopause because I wanted to fix that. The reason is actually a little less noble, but I'll share it anyway. I really enjoyed doing menstruation-focused advocacy. It truly changed my life. It gave me this alter ego. I found new community, new friends, new confidence in myself, new beliefs in what strategies could work to make change. So all of that I attribute and credit to having really stumbled into wanting to be a menstruation-focused warrior. in 2020 when I was became aware that the changes I was going through were in fact menopause a friend asked me the question what's the state of play for menopause policy and I was just very flip I was like I don't know and she said I would think you would want to know and it was that question that changed everything I was like you're right I would think I want to know but I'll add to it I just said the number 2020 it was 2020 in the middle of the pandemic the height of the pandemic And to be very, very honest, I was also bored and antsy and frustrated and dying to get out of my house and dying to escape myself because the world was so miserable then.

5:36Dr. Casperson: So it also felt like having a new mission and a new focus and a new project would give me something to get up in the morning for. So that's the real story.

5:46Jennifer Weiss-Wolf: That is phenomenal. um I remember you know med school residency probably even college like you'd go to these free lunch seminars and they'd be people would be like get involved get involved be an advocate get involved and like I would go for the free food and I was like at the end of the day I think in like flow charts I'm a surgeon I think very like linear and black and white and I was always left very confused as to like, what is advocacy? How do you advocate? Like, I was always like, I don't get it. I don't understand. How do you actually do this? I understood the importance, but I didn't understand the like how.

6:25Jennifer Weiss-Wolf: And now that I look at my career, I'm like, dude, like that's probably the first it's like Kelly Kasperson, MD urologist advocate.

6:32Dr. Casperson: You've been an advocate all along. Right. But like, I wasn't like, well, I should advocate.

6:37Jennifer Weiss-Wolf: I just looked back and was like, oh, this is what advocating is.

6:43Dr. Casperson: And it could be so many different things to so many different people, which is really why I wrote this book. I call myself an advocate all the time. And I realize most people don't. And most people probably want to at some level, even if they think words like public policy or politics, you know, makes them their eyes glaze over or makes them want to crawl under a rock. The truth of the matter is, is change making happens by all the time, by everybody in so many different ways. So the point of this book, this book that I wrote, What in Menopause, A User's Manual on Citizens Guide, I'm wearing my t-shirt, is, it's not just about how to make change for menopause, although that's the, you know, that's the meeting place.

7:27Dr. Casperson: That's what brings you to the book. But it's really about what it means to be an advocate and how to how to wear that title, with confidence and pride. I describe advocacy itself as a choose your own adventure book. Did you read those when you were a kid? Absolutely. We all did, right? 100%. And that's what it is. It's not one roadmap. It's not one set of skills. It's not one set of gifts. It's not one set of ideas or vision. We all bring different things to bear. I learned that so explicitly when I was doing menstruation focused advocacy, because I'm, again, I'm really like bizarrely interested in legislative language and cost benefit analyses and all the things that make most people, you know, probably, you know, fall asleep within hearing those words.

8:15Dr. Casperson: But I was surrounded by people who didn't care about that, but cared about the same outcomes that I cared about, you know, dignified menstruation for all equitable access to everything in life that makes you able to exist as a citizen and as a civic player, including menstrual products. And because we all believe that we all approached it with our own gifts and strengths. So I worked with athletes, I worked with artists, I worked with innovators, I worked with kids, I worked with people who had all kinds of different talents. And when you put all that together, you know what you got? movement.

8:52I love it.

8:53Jennifer Weiss-Wolf: Are you surprised looking back or looking at the current? I mean, you and I have had a hell of a week on the Hill. Are you surprised by the speed of this? Are you surprised by the overwhelming positivity of this? Like what shocked you the most about this?

9:08Dr. Casperson: I'm going to answer like a lawyer, so I'm going to say yes and no. Period advocacy also happened really fast. It was similarly bipartisan, the way we've seen it now in the menopause space. And a lot of it happened in state legislatures. So I would say that part is super analogous. And that was honestly what gave me the confidence to say, hey, I really want to tackle menopause too. I've learned a lot about what it takes to move the needle on an issue that people like were squeamish about talking about. But then once they started, discovered that the policy reforms were totally doable and we could win a lot and we can win fast and we could even, you know, bridge the divide and work across the aisle because where we might disagree, you know, the political parties or people might disagree on some aspects or issues about women's health.

10:00Dr. Casperson: And it doesn't mean I'm compromising just because I will work with people with whom I disagree on many other things. But where there was, you know, overlap and commitment to this one piece, we made change happen. We made it happen fast. So I did come to this with that level of expectation. I was surprised truly, when I started meeting y 'all and learning from the doctors around me, that getting into menopause solutions was going to be way harder than menstruation solutions. And the thing that I didn't account for is that the science here has been both neglected and, what would be the right word for it?

10:49Dr. Casperson: It's been neglected on the macro level, you know, in terms of NIH funding and real public commitment to women's health and women's lives. But that doesn't mean it's been neglected on the ground. And that doesn't just mean activism or advocacy, but that there is real research that's been happening. And we can focus on what it looks like to accumulate that or look at it cumulatively to hopefully fill the gaps that have been left by the big macro, you know, refusal to, to invest. So I'm giving a really like long winded answer. But the thing that surprised me, I think the most was that it's like an onion, it's gonna be a lot of layers to peel back to get to solutions, because there is not just one gap or one ball dropped or one misstep or one unanswered question.

11:45Dr. Casperson: They all touch each other, they all trigger each other, they're all intertwined with each other, there There was not going to be a linear path forward, and it was going to take some patience and the ability to learn to speak in multiple truths to be able to get to the core of what we wanted to get to.

12:02Jennifer Weiss-Wolf: 100%. I think this speaks to, number one, the people who know how to get things done understand you have to work with people that maybe wouldn't work with them to get other things done. Or you might disagree with them on other things, right? That doesn't mean we can't work with each other to get certain things done. And that's been overwhelming, especially, you know, with the social media world. How can you work with that person? How could you be on stage with that person? And I'm like, I have an agenda to get things done for the American people and, you know, women worldwide. We're going to work with whoever supports us.

12:32Jennifer Weiss-Wolf: And, you know, today, for example, there was a four hour meeting with HHS and the AUA. And we're talking about what do we do to advance vaginal estrogen, which is like the lowest hanging fruit. Everybody who knows knows vaginal estrogen is safe, effective, saves deaths. We had an amazing USA Today article out yesterday on vaginal estrogen.

12:53Dr. Casperson: Laura Trujillo, shout out.

12:54Jennifer Weiss-Wolf: Yay, phenomenal. Anytime I can scream Dr. Elsie Day's paper on vaginal estrogen preventing deaths, I love screaming. That is a completely neglected science paper that came out. But my other point is here we are, HHS and the AOA. We've got government coming together with medical societies. How do we advance this? And I'm like, listen, you guys, we can't say vagina on social media. We violate terms and conditions, especially the small creators, right? Like the bigger creators, we've got a little bit of clout because we got a lot of eyeballs. But small creators, vulva, vagina, clitoris, sex, you know, we call it intimacy on social media.

13:34Jennifer Weiss-Wolf: But it's like every piece matters because how do you get a C change when you can't say vagina? And it's called vaginal estrogen, right? So we actually talked about that. We're like, listen, we've got a branding problem. We need to call this sepsis prevention cream.

13:54Dr. Casperson: And if we call it sepsis prevention cream, we can say that on Meta.

13:57Jennifer Weiss-Wolf: This 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.

14:35Jennifer Weiss-Wolf: 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. This is your time. Demand more. Visit ExploreWorldwide.com And don't just travel, explore. 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.

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16:30Dr. Casperson: Well, and you know what comes with that, too? And again, this is this is among my lessons from menstruation focused work is it's not just that we're going to solve one problem together, but we're going to actually learn to listen to each other a little bit. And so one of the experiences I had was a bunch of years ago, I think it was in 2017, I was working with legislators in the state of Illinois, as they were endeavoring to end the sales tax on menstrual products in their state, aka the tampon tax. And it was Republican led legislature and Republican in the state house and governor as governor.

17:06Dr. Casperson: And they, so they succeeded in passing the legislation and the governor signed it. But what the really interesting thing that happened was, is the House, the floor leader of the House, who was a Republican man from downstate, like not a Chicago guy, but like heartland, you know, real deal. We just kind of developed a nice friendship. And he told me that talking about this issue with their constituents was kind of like game changing for them. They'd never really like thought about engaged at that level. They never thought about the affordability of menstrual products before. They never listened to people or women, especially on that level.

17:46Dr. Casperson: And he said it opened new doors. And they went on to expand their state's Equal Pay Act in Illinois, and then to become the 37th of 38 states to ratify the Federal Equal Rights Amendment. Whole conversation for another day why we don't have sex equality in the U.S. Constitution still. But Illinois was part of making the national effort to change that by voting for that ratification with Republican support. And he's explicitly credited talking about menstruation, which they had never done before with their constituents, as part of how they were able to see other policies differently. And he went on record and wrote about that with me.

18:26Dr. Casperson: We wrote an op-ed together for Newsweek. It was like a little bit of like a sketch, comedy sketch. I'm a heartland Republican and I'm a pro-choice New Yorker. And this is why we agree. and this is why we agree. But it was really meaningful. And I still throw that op-ed out there when people need to see what it means to work across the aisle.

18:45Jennifer Weiss-Wolf: I love that. I want to give people practical solutions. People say, what can I do? What can I do? What can I do? And I've started saying on Instagram, like, please don't bitch to me on Instagram. I hear people's stories all the time. But it's like, in order to enact change, my best short advice is write to your legislature, state and federal. That, I think, has made a big difference. Look at let's talk menopause in the unboxing. Right. Look at what's happening. The people who have commented on the FDA comment section for testosterone. That's why we got a female testosterone day at the FDA. Right.

19:20Jennifer Weiss-Wolf: It's really do speak up. Bitching doesn't change like writing letters changes things.

19:27Dr. Casperson: Well, you know, so this is the whole point of the book to own citizens guide is filled with all of these things, with scripts, with how-to lists, with checklists about how to be part of the movement for that kind of change, for systemic change, for the changes that come from the rules and the laws by which we live. And that's a really, really important way to advocate. And the FDA open comments issue, like opportunity, is a really, really good example. It's not even as scary as calling your legislator and being like, oh my God, somebody's going to answer the phone and I'm going to have to talk to them.

20:00Dr. Casperson: Like it's as simple sometimes as filling a form or sending it, you know, uploading a document. But I think going back to the choose your own adventure for people who don't think in terms of, you know, rules and laws, but think about other ways they use their voice, not to bitch, but to educate and to bring along and to mobilize. There are so many ways to do so. And you don't have to be a Dr. Kelly Kasperson with half a million followers on Instagram. I don't know your TikTok because I don't go on TikTok, nor do you have to have a law degree, you know, or an office in Washington Square Park. You can use your voice in so many ways.

20:39Dr. Casperson: And honestly, it could be your singing voice. It could be your yelling voice. It could be your typing voice. There are so many ways to create community, make people feel less alone and inspire other people to also be change agents. That's what being an advocate is. It's also being a leader, quite frankly, a lot of people maybe don't see themselves as leaders. They see themselves as somebody who has, you know, had a bad experience themselves, wants to make sure it's different for their daughter or their granddaughter. I'm just here to tell you, you're being a leader when you speak out that way.

21:10Jennifer Weiss-Wolf: I love it. I think even going back to like calling our body parts by their anatomical names.

21:15Dr. Casperson: And teaching our kids to do so too.

21:17Jennifer Weiss-Wolf: Teaching our kids to do so too. And I think a lot of people think of this like all or nothing of like, well, I don't have, you know, 300 ,000 on Instagram. It's like, none of us started out there.

21:28Dr. Casperson: I don't have even close to it. I'm just like, I'm like a hobbyist on Instagram. Mostly you'll see pictures of my cats and my kids and some menopause content. But yeah, there's the world goes around with lots of different, you know, skills and lots of different brains and lots of different energies. And all I can say is that's what movements are all about. When we talk about what we're doing right now in menopause, I will say I don't know that we've quite brought ourselves to like movement status. I don't, I feel like we're

22:00Jennifer Weiss-Wolf: still a lot of - I'm going to hear you out before I challenge you on that. Okay.

22:04Dr. Casperson: Tell me more. I don't know when a movement becomes solidified as a movement. When I think about, you know, the fights for voting rights and civil rights and racial justice in this country, in the menstruation space, I know that for a long time, we, we, we, like, it felt like movement energy, but I don't know that there was a shared sense of how we were driving forward. And I think in part, from my perspective as somebody who's always been in nonprofit spaces, it was really strange to partner with companies and private sector players because I had never done that before. So I'm feeling my way through that still now in the menopause space.

22:48Dr. Casperson: And I think that we have all the makings of a movement and that we have so many bold ideas and so many brilliant people doing all the work that's gotten us where we are, that there is all this movement on Capitol Hill, there's movement in federal agencies, there's movement in Congress, there's movement in state legislatures, and that's the policy stuff. That's not even everything that's happening as we think about what makes change. I guess I'm still envisioning what it looks like Like, not when people are walking in lockstep, but that there's real communication across disciplines and ideologies to see that change occur.

23:38Dr. Casperson: I had talked to somebody who's going to be funding in this space, and she had made a comment to me that she saw this as a fractured field. and I said I don't think it's fractured at all I think it's really organic and so there's a lot happening and there's no one orchestrating and there's no leader and so I'm giving you a lot of ideas versus like a full analysis movements don't require leaders or single leaders either but I think we have the recipe here I just think we're still working on cooking it and that's a good healthy thing that's not a critique at all and that's better to me than a fractured movement versus an organic, you know, array of players still stirring the pot.

24:22Yep.

24:23Jennifer Weiss-Wolf: I appreciate your thoughts. My thought is you don't always identify a movement until it's either A, done, or B, you can actually look back and be like, oh, yeah, okay, we're here now because this is what started. It's a retrospective.

24:36Dr. Casperson: Right.

24:37Jennifer Weiss-Wolf: You know, like when Rosa Parks didn't sit in the back of the bus where she's like, here, I don't see a movement. Right.

24:42Dr. Casperson: Nobody was writing positive headlines how the movement succeeded in something.

24:46Jennifer Weiss-Wolf: the women's right movement, the civil rights movement, the, you know, HIV medicine movement, you only see it in retrospect and be like, oh, X, Y, and Z happened. And to me, I'm like, oh, God, we have come so far so fast. I feel people are like, you've been in this thing this whole time. And I'm like, you realize this whole time started four years ago, right? But it just still seems so big and that we've moved so fast. But I'm like, dude, when you've got a Senate hearing on aging with, you know, Republican Rick Scott and Democrat Gillibrand. And it's like it is bipartisan. I mean, to me, I'm like, this is Gen X women in their 50s changing the nation.

25:28Dr. Casperson: Well, that I agree. And I and I I totally appreciate the idea that sometimes things aren't defined until until after there's some exclamation point that forces everybody to look look at it or look back at it. And I do think we have all the ingredients, all the right ingredients. And, you know, it's super clear that whatever we're doing is effective and that people are listening and that people who have the power to make decisions are listening. So we're exactly where we should be. I guess that the statement I made even about thinking about what it looks like to be a movement wasn't intended at all to like create an opportunity for something different.

26:11Dr. Casperson: It was just to reflect on where we're going and how we're going to all join forces to make the most of this moment. In the research I did for my book, I'm really, really interested in the media. The media completely intrigues me. It motivates me. I probably should have been a journalist, not a lawyer. People often think I am a journalist just because I do a lot of op-ed and public writing, but I'm not, I have no training in journalism. But the media to me tells so much of the story of where we've been and where we're going and has so much power to do so. So I looked at two distinct periods in American history and how menopause was talked about in the media in writing my book.

26:53Dr. Casperson: I looked at the 1960s and into the seventies after estrogen really became popularized. and there was, you know, a lot of discussion about who was being popularized for, for women's health benefits or for men's sexual, you know, pleasure, the Robert Wilson style, you know, this is why we need estrogen, feminine forever, and also how to ensure safety during that time when still it wasn't fully known how the hormones were affecting us and, you know, And little course corrects had to be made pretty quickly, right, in the 1970s, even into the early 1980s, adding progesterone to the recipe. And that's where the original FDA labeling came from.

27:39Dr. Casperson: It was a Ralph Nader campaign. And it was feminists with Nader saying we needed more protection from big pharma. The next period of time where menopause was really, really popular in the public discourse was in the early 1990s. In 1992, a record number of women, also they weren't Gen X, but they were our age at the time. They were boomer women, 50s, early 50s, swept into Congress and political office around the country. It was called The Year of the Woman. I found this amazing op-ed from The New York Times in October 1992 called Mighty Menopause. And if you read it, you would think it was written yesterday about, you know, what it means to reclaim your hormonal self and hormonal power and what that's going to do and say about government and politics and policy in this country.

28:28Dr. Casperson: And that is what got us the WHI in 1993 and the hugest infusion of funds that had ever gone into women's health and menopausal health. And that was all amazing, actually. Those were two really big, pivotal moments. We know where the WHI brought us and how much that is part of what this third kind of renaissance is. And the thing I think about a lot is 1960s and the 1990s each ended up being, in retrospect, not quite a movement, but one step forward, two steps back, five steps back, especially from the 90s to 2002. What do we do this time to make sure that we are 100 steps forward and zero steps back?

29:11Jennifer Weiss-Wolf: I think that's the power of social media. I mean, if you look at the 60s and the 90s and in 2002, doctors couldn't say, hey, this publication's not that bad. Hey, breast cancer wasn't statistically significant, right? Like there's so many voices that now can speak truth.

29:30Dr. Casperson: And going to media is like, media was controlled by the few and the mighty.

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32:37Dr. Casperson: Okay, so I agree with that 5000%.

32:39Jennifer Weiss-Wolf: And interestingly, even though I'm not a social media model or somebody who actually knows how to use it at all.

32:46Dr. Casperson: But I am so grateful for that democratization aspect, even though and we can maybe talk about this too, it also poses risks and it poses, you know, different ways that people end up communicating with each other that could, you know, turn off or redirect or confuse every day. people. But that said, if you look at also most of the news coverage in the 1990s, Jane Brody, the New York Times health reporter at the time, was really the main voice and journalist, at least at that newspaper. And that's a very big influential newspaper guiding the discourse. And she had very, very specific and ardent views about the role of hormones.

33:33Dr. Casperson: So she was definitely a voice for slowing down and caution and was a critic and was a skeptic. And in hindsight, I wonder how much of that actually was part of what led to that 2002 announcement, the idea that there was a waiting and welcome media audience for this controversial message that they were going to land at a press conference.

34:02Jennifer Weiss-Wolf: Yeah. I mean, if I if you look at the 1990s and the gain in equality that women got in the 1990s, it was a massive ascent.

34:12Dr. Casperson: Massive. The 90s were massive. It's enough to make you think this was on purpose. Thank you for reading my mind. Yeah.

34:18Jennifer Weiss-Wolf: No, it is. Yeah. Because I'm like the WHI quite possibly and I got I need an investigative reporter to like do this. But the WHI possibly was a backlash to the gain in power that the women had obtained in the 1990s. Like 92, you were the woman. There it was. Yeah. And one decade later, we just put a lid on the women and with taking the hormones away. I figured this out a couple of years ago at the beginning of this advocacy journey is how do you best control women? Make them afraid. If you can And also distract them. Make them have to work really hard. Yes. And then you look at rates of depression, cardiovascular disease, all the things.

35:02Jennifer Weiss-Wolf: And it's like being sick pulls you out of the workforce like nothing else. Right. And so you look at the gains of the 1990s and you just have to wonder, was the WHI trying to put a lid on something?

35:14Dr. Casperson: So I'm going to buy into the conspiracy theory right now and say that what is really interesting too, if you look at sort of generational behavior, that was geared at baby boomers. They were the generation who was that age at the time. And they were the people who, they were the women who were taking power. Fast forward to 2026. I feel like Gen X women like us are this kind of sleeping giant. People have zero expectations of us. They've done a pretty good job of ignoring us, blowing us off. We've existed quite well. Which we've always thrived on. Right. I would say that's actually what's fueled us.

35:57Dr. Casperson: So here we are saying, all right, the rules no longer apply because we've never been people who've been able to have to play by the rules. We were at home alone with our house key, watching cartoons in the afternoon, not telling our parents anything we were doing. We had no rules. And when you think about millennials and the sort of higher maintenance, sorry, millennials, I'm just going to say that they were raised by a different generation than us who gave them much more to aspire to perhaps and much to believe they were capable and deserving of more than the generation who was perennially ignored.

36:34Dr. Casperson: Look at what power there is and that combination of perspectives and skills we each have as a generation because of that. I think that our Gen X creativity and ability to, you know, take care of our idling selves combined with millennials, you know, get aheadness and you deserve this could actually tear this all down.

36:58Jennifer Weiss-Wolf: Completely. This is what I say when I'm public speaking is like we've got the wave of the health care system crashing up against the wave of the millennials right now. And the millennials are going to win because the millennials think I've got a great idea. I'm watching the boomers. I'm watching the Gen X. What if we don't suffer? How about we prevent hot flashes? How about we prevent our labia from going away? How about we prevent pain with sex? How about we like the, and so the healthcare system's not set up for prevention, but when you've got 50 % of people with ovarian decline saying, why would we suffer first?

37:33Jennifer Weiss-Wolf: Yeah. They're going to push in the era of preventative health. I think they're coming out with solutions.

37:39Dr. Casperson: When you push in the area of preventative health, that has ripple effects too, right? One of the things that I was asked about by Senator Kim from New Jersey was the pros and cons of workplace policy. Yeah, dude, let's talk about that because your answer was paradigm speaks exactly to what you're talking about. We've said these stats about how the economy is suffering when women in menopause don't have support in the workplace. And he hears this from women he knows. And the answer is that, so there's numbers to show that, there's stories to show that. So to those things, I say, I've almost never seen a benefit or an accommodation that looks useful to me.

38:27Dr. Casperson: Menopause solutions, right? People work in all different ways. Not everybody goes to an office. Some people, you know, sit behind the wheel of a bus and people stand in front of a classroom. Some people work in a coffee shop and, you know, on their phone and on their computer all the time. And then add to that, we're not just talking about what happens while you're in the transition to menopause, but all the ways that if you aren't thinking preventatively, you're not setting yourself up for long term health. So it's not just that I need help today. You don't just need a fan, Jennifer?

39:00Jennifer Weiss-Wolf: I have a cooling room.

39:01Dr. Casperson: You can see I'm kind of in a sunny room right now. It's a little warm. So the combination of really no package of benefits covers what is needed for menopause, not to mention that women are not a monolith in this way and the menopause experience plays out differently for everyone for all kinds of different reasons. But putting a pin in that even, even if there were perfect solutions and were perfect reforms, here's where I see the hugest rub. In this country, at this moment, we do not have anything resembling protection from discrimination on the basis of menopause in any of our anti-discrimination laws.

39:46Jennifer Weiss-Wolf: Do we have anti-discrimination for aging, ageism?

39:50Dr. Casperson: Yeah, there's aging, yes. And there's even a bill that's been introduced about older workers It hasn't been passed, but it's been introduced. There's the Americans with Disabilities Act. There's the Pregnant Workers Fairness Act. There's the Pregnancy Discrimination Act. So there's a host of ways that the ways our reproductive and bodily systems work, have some forms of protection. There's opportunities, perhaps, to fit menopause into some of the laws I just named and probably some others, too. But the problem is, is it's not clear. It's not been done. And it's been attempted a few times, not successfully.

40:31Dr. Casperson: And I think that's also because lawyers and judges themselves are not adequately educated on menopause so that they're the correct or proper experts to be figuring out how to make, how to thread this needle. But all of which is to say is without that protection, I would not feel comfortable telling any employee that they should march into their HR office and demand menopause benefits or announce to their HR department that they're taking advantage of menopause benefits because the second they get kicked off that project or demoted or worse, there is no law to protect them, even if those benefits were offered.

41:08Dr. Casperson: There are people, lots of people in our space too, in the menopause space who say, I wouldn't ever want to argue for accommodations like that, because I wouldn't want to give people another reason to not want to promote women or not older women or to discriminate against them or otherwise marginalize them. To that, you know, I think we owe it to ourselves to make these fights. If people said that about pregnancy, if people said that about other aspects of our health and lives, that, you know, fighting for that protection was only going to remind them that we exist and that they can, you know, use that against us, I'd say, no, I actually want to have the bigger fight, but I want to have the bigger fight with all the right tools and all the right weapons and tools and weapons.

41:53Dr. Casperson: So I would like us to get all the smart lawyers together and think about how to create a really, really robust anti-discrimination law. I don't still think that most benefits and accommodations I've seen floated are probably that much worth fighting for. Yeah.

42:12Jennifer Weiss-Wolf: So I'll pick on Washington State just because I'm intimately, I live here. So the governor passed basically our version of the menopause legislation. One thing that was very interesting on Capitol Hill last week, talking to HHS, talking to senators, they know that prior authorizations for insurance for generic FDA approved, generic FDA approved, there's no lower hanging fruit than these medications, is a massive barrier to access. And so to me, I'm like, listen, we can you can governor governor menopause bill all day long. But when this is at the end of the day, symptoms happening because of low hormones and then you can't access low hormones, a fan doesn't do you any good.

42:59Jennifer Weiss-Wolf: By the way, that hot flashes are actually a signal of your brain not doing well and heart potential heart disease. So to me, I'm like to pun intended, blow it off with a fan humor. So I actually then met with the governor's office and I was like, what about the prior authorizations? What about health access? What about women, their rightful worry of being discriminated against because they're of an age where a hot flash might happen? You know, and my gut feeling on that was they don't really know what menopause is. Right.

43:34Dr. Casperson: Yeah, it feels like a low hanging fruit for them to say, oh, workplace seems kind of non-controversial and easy. His executive order was like, it didn't really do anything for what it's worth. It like called for a study, but it was a waste of a microphone moment because he got a lot of publicity for it. And it would have been so much more useful if he was saying something interesting and important. But that was to me just like a lot of filler.

43:59Jennifer Weiss-Wolf: Yeah, I mean, you know, Washington State is we were number one in business and now we're number 11. Like we're businesses are fleeing the state and to not be business friendly and to say business has to take all this on when the health care system isn't supporting the businesses. I put my pro-business brain on this. It's like not every business is a Fortune 500 company, right? And so it's like, are we putting the weight of this problem on businesses instead of the healthcare, the insurance companies, again, prior authorizations for generic FDA approved medications? It is a big whale and we try to take a bite of it at a time, I suppose.

44:38Dr. Casperson: But the other thing I'll say, and this goes to Fortune 500 companies or even small business owners, any CEO or business owner or private sector leader or philanthropist or, you know, investor who thinks that it's important to ensure that women in the workforce, especially menopausal women and midlife and older women are supported. What they really should do is put all of that influence and energy and funding into the things we need, which are the research, the reforms to practice, like prior authorization and reimbursements and education and training. Like that's where if they invest in all of those things, guess what?

45:22Dr. Casperson: We'll be healthier. We won't be showing up to work compromised.

45:25Jennifer Weiss-Wolf: Yeah, absolutely. I thought that the Senate hearing was very interesting because you think about aging and you can hit how many topics on that. And we had four amazing speakers, three physicians and you, and every single one was hormones.

45:42Dr. Casperson: Hormones, hormones, hormones, hormones.

45:43Jennifer Weiss-Wolf: Outside the box thinking on hormones too, including testosterone and including longevity. We know we have the data that women between the ages of 50 and 60 who are on hormone therapy live longer. And so to me, I'm like, it's absolutely the right conversation to have. And I was struck by how that's what all the experts came to them with was like, this is hormone access to keep people healthy, to keep them functioning. This is what we need to be talking about. And even 10 years ago, a Senate hearing on aging probably wouldn't have been for people being like hormone access.

46:17Dr. Casperson: Yeah, I thought it was a really interesting array of speakers, too. I was a little nervous. I was a non-doctor. And there was an original WHI investigator on the panel, too. And I thought her points to research and filling gaps that was really was important. I thought the two practicing physicians who I guess sat on either side of me, I really appreciated their perspectives. One of the doctors was the Republicans' witness. Gillibrand picked three of the witnesses and Senator Scott picked one. We had no opportunity to engage with each other before. We saw each of the others' written testimony probably the night before the hearing.

46:58Dr. Casperson: And I actually thought the four puzzle pieces worked together really well. And the role that I play in this, and I was really grateful to have to play that role, because I play it often like behind the scenes when I'm talking with you all or on our text exchange or in the writing that I do. I listen to what all the doctors say and I translate it into what are the what are the possible, feasible, best policies these can be turned into? And that's the very distinct part I play here. And no one should ever take medical advice from me or even rely on what I have to say about hormones, quite frankly, because all I'm doing is listening to what is said to me and saying, okay, well, these are the policies that can help us have access to what we deserve, the information that we need, fill the gaps that are left open, and ensure people are able to stay, be as healthy as possible during this time and set themselves up for a healthy future.

48:02Dr. Casperson: I felt the need to keep reminding everyone I wasn't a doctor. I don't know why I was feeling a little bit like self-conscious. So I probably said it more times than was necessary. And it was the kind of thing that as soon as you say to somebody like, you know, don't talk about elephants, all they will say is like something about an elephant. So Senator Gillibrand at one point asked me a question and referred to me as Dr. Weisswolf, which of course, you know, I laughed and said, no, no, not a doctor. And then so she corrected and she said, oh, smart woman, weiswold. So I have to say my husband saved that little two second clip like out of the thing.

48:35Dr. Casperson: So now it's played for the family text. Whenever there's a debate or disagreement about something, I just play the Senate records calls me smart woman, weiswold. So my family's now put in their place.

48:46Jennifer Weiss-Wolf: So to wrap it up, I want you to speak to two different people who I know listen to this podcast. The first one is the busy clinician. These people are seeing 27 patients a day. They are bombarded with prior authorizations, notes, corrections, text messages, portal requests from their patients. How the hell? They don't know how to advocate. They don't know how to try to make this better. Give them little teeny bites of like how they feel like they can do more without adding more to their plate.

49:15Dr. Casperson: As you listed all those things, that sort of made me feel guilty as the patient who's always filling their portal with questions and comments and even links to things that I found interesting. I guess they don't really like that. It's not that they don't like it, it's that they're overwhelmed by it, right? I'm going to do this clinician focused, although this could apply to anybody who, you know, feels overwhelmed this way, is to use the platform that you have. So if you're seeing 27 patients a day, that's 27 people who actually get to have exposure to what you know and what your thinking. You could put my book in your office.

49:47Dr. Casperson: You could put other people's books, your book in your office. You could have a page where somebody on your staff at least posts links to things that you think are important or interesting that they should know. You can really use the way you see patients as a way to mobilize the people who come in your office every day. Yes, I love that.

50:07Jennifer Weiss-Wolf: Don't underestimate the advocacy you're already doing.

50:11Dr. Casperson: My doctor told me, I mean, because I yammer about all this stuff every time that I go in and show it in my book and everything. And he said he ordered it. He ordered it also for his wife. He can't wait to pass it around the office. Like, it was just a little exchange. But now he sees that he could use his credibility and his access to the people he's with to help make a statement.

50:36Jennifer Weiss-Wolf: That's it. I love it. I got started on my soapbox in my clinic. It was just vaginal estrogen, vaginal estrogen, vaginal estrogen, vaginal estrogen.

50:45Dr. Casperson: And like that turned into. You can say that 10 times fast, which most people probably can't.

50:49Jennifer Weiss-Wolf: I know. So that's how I got started is just like me on repeat being like, this is literally life changing. This will literally change the course of the recurrent UTIs you have. It'll change the course of your sex life. Like that was, it just kept being on so repeat in clinic. And then I realized, oh, this is bigger than my clinic.

51:08Dr. Casperson: and I've got to do more.

51:10Jennifer Weiss-Wolf: 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.

51:48Jennifer Weiss-Wolf: 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.

52:27Jennifer Weiss-Wolf: If you've been wondering whether your hormones could be contributing to the way you feel, visit joyandblokes.com slash not broken and use code not broken for 65 % off labs and 20 % off treatment. That's J-O-I and B-L-O-K-E-S.com backslash not broken code not broken. Okay. So thank you for talking to the clinicians. Final thing, the general population, the people who feel like nobody listens, the people who feel like, like just bitching in the corner. What do we tell them?

53:05Dr. Casperson: It's like the flip side of the coin. Once you start talking about this issue, you can't stop. There's something really like infectious and addictive about it. It's so fascinating. It's really, I mean, it's truly interesting to understand the history, to understand the politics. It's popular stuff. Like you could read about it in People magazine and and like Vogue magazine. And again, the community is everything. I love talking to other people about that. The very first thing I'm doing is a party in my gym. And we're going to do, I go to a bar class, and they're going to do a mini class that's on like musculoskeletal and balance issues, like things that we think about as we if we want to age well.

53:46Dr. Casperson: So it's going to be a mini class focused on those things, both talking about it and exercises. And then we'll all just be sitting on the floor in our leggings and our bar socks. And I'm going to talk about the book. And I feel like that is going to be just as impactful an event as sitting in a big theater, you know, with muckety mucks, who I can't wait to talk to my own gym community and then see them in class every day thereafter, and have them know we share this idea. And we can share anything that's going on in our lives, even if it's in a quick passing. That's, that's what community is. And And quite frankly, advocacy doesn't exist without community.

54:21Jennifer Weiss-Wolf: Agreed. Yeah. To me, I'd be like, get in your churches, get in your schools, get in your libraries. Everywhere.

54:26Dr. Casperson: Your PTA, your book group. Your jam. All the things. Your library.

54:29Jennifer Weiss-Wolf: Totally.

54:30Dr. Casperson: That's how we change.

54:31Jennifer Weiss-Wolf: That's how we empower women. Because I mean, I think at the end of the day when I zoom out, I'm like, yes, this is, you know, you might see my platform only as hormones, but I'm like, this is women feeling good, which will change the world in a completely different way compared to a whole bunch of women not feeling good and being empowered to advocate and see the change and having the energy to do what they want to do. Like, that's the big vision of this, even though we're like, oh, estrogen patches, blah, blah, blah. We're like, it's part of this bigger sea change of women creating a world they want to be part of.

55:07Dr. Casperson: I think we've been seeing it a lot. We've certainly been seeing it in force in this space. But I think especially this year, as we think about the state of our government and American democracy. We've been seeing women and older women really at the forefront of a lot of action. A lot of the skills and ways of mobilizing and just existing that we're good at, and without being too stereotypical, whether it includes like driving a carpool or, you know, managing a household or, you know, helping our kids get through their lives in their days, a lot of that translates, you know, explicitly to what it looks like to mobilize for our democracy right now.

55:52Dr. Casperson: And many of the ways that we're having to push back against the overreach of our government. So I'm actually counting on us to be the, you know, the, the, the cavalry who's coming to save us.

56:04Jennifer Weiss-Wolf: I love it. I love it. I love it. Thank you so much for coming on the book. Gwen in Menopause is out in October.

56:11Dr. Casperson: It's out now if you're watching this right now. Yes, exactly.

56:15Jennifer Weiss-Wolf: Thank you for your work on the hill with me. And until we meet in person again, thank you for your friendship.

56:23Dr. Casperson: Until we're on one of the coasts or somewhere in between. Texas.

56:26Jennifer Weiss-Wolf: Maybe it'll be Chicago. Who knows? All right, everybody. Thank you so much, Jennifer. Bye-bye. 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. And thank you. For courses, books, and my monthly membership, and the Casperson Clinic information, visit kellycaspersonmd.com. This podcast and all content from Dr. Kelly Casperson is intended for educational and informational purposes only. And this is not a substitute for individual medical, coaching, or psychological advice, diagnosis, or treatment.

57:09Jennifer Weiss-Wolf: 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.