140. Dr. Kelly Casperson: The Hormone Truth About Women's Longevity

Most women are taught that aging means decline, less energy, less strength, and less desire. What if the real problem has never been age itself, but untreated hormone loss and outdated medical narratives. In this episode of Extend, we sit down with Dr. Kelly Casperson, urologist, hormone expert, and leading voice in women's sexual health, to uncover how hormones shape longevity, muscle, brain health, and quality of life across midlife and beyond. We break down why estrogen, progesterone, and testosterone matter far beyond symptom relief, how the WHI was misinterpreted, and why modern hormone therapy changes the trajectory of aging. We also explore how mindset, muscle preservation, vaginal estrogen, blood flow, wearables, and responsive desire redefine what healthy aging and sexual health can look like for women in their 40s, 50s, and beyond. Dr. Kelly Casperson is a board certified urologist, author of You Are Not Broken and The Menopause Moment, and host of the You Are Not Broken podcast. Through clinical care, education, and media, she helps women reclaim agency over their hormones, sexuality, and long term health with science driven, compassionate guidance. What We Discuss: (02:22) Why aging is driven by hormone and muscle loss, not age (05:30) How mindset shapes longevity, vitality, and sexual health (08:15) Why estrogen, progesterone, and testosterone affect the entire body (12:40) The WHI study, fear based medicine, and what the data actually shows (18:20) Muscle, hormones, and their role in bone, brain, and metabolic health (23:40) Perimenopause, menopause, and why symptoms are often dismissed (30:10) Vaginal estrogen, pelvic health, and preventing long term decline (36:50) Wearables, biomarkers, and how data empowers better decisions (42:30) Exercise, blood flow, and preserving sexual function with age (48:15) Responsive desire, desire mismatch, and the orgasm gap (55:40) Why sexual health is biopsychosocial, not just hormonal (01:02:20) How education, communication, and prevention redefine women's longevity Thank You to Our Sponsors: IM8: Try IM8 today with a 30-day money back guarantee. You can get 10% off your first order with code DRSHAH at https://im8health.com/discount/DRSHAH. Nexthealth: NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram:https://www.instagram.com/darshanshahmd/ Learn more about Dr. Kelly Casperson: Website: https://kellycaspersonmd.com/ https://kellycaspersonmd.com/?utm_source=chatgpt.com Podcast: https://kellycaspersonmd.com/you-are-not-broken-podcast/ https://kellycaspersonmd.com/you-are-not-broken-podcast/?utm_source=chatgpt.com Instagram: https://www.instagram.com/kellycaspersonmd/ https://www.instagram.com/kellycaspersonmd/?utm_source=chatgpt.com Facebook: https://www.facebook.com/youarentbroken/ https://www.facebook.com/youarentbroken/?utm_source=chatgpt.com YouTube: https://www.youtube.com/@kellycaspersonmd

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease and, most importantly, extend your health span.

• 0:48Dr. Darshan Shah?

  What if your low libido isn't a problem to fix, but your body is sending you an important signal about your hormones and your health? For decades, women have been told that loss of desire is all in their heads, or worse, just part of getting older. But what if the real issue is biological and completely curable? In this episode of Extend, I'm going to be sitting down with Dr. Kelly Casperson. She's an MD urologist, a sex educator, and author of You Are Not Broken, and the upcoming book, The Menopause Moment. As one of only 10% of urologists who are female, Dr. Kelly brings a rare perspective on female sexual health and hormones.

• 1:32Dr. Darshan Shah?

  We break down why perimenopause and menopause are hormone crises affecting brain, bone, heart, and sexual function. You'll learn why estrogen loss causes physical changes that make sex painful, and testosterone drives desire and energy. We'll learn why vaginal estrogen and HRT are evidence-based treatments, and how to talk to your doctor without getting dismissed. If you've ever felt broken or blamed about your sex life or body in midlife, this conversation will change how you understand what's really happening and give you the tools you need to take action.

• 2:12Dr. Darshan Shah?

  Kelly, so excited to have you on the podcast.

• 2:14Speaker 01

  Thanks for having me.

• 2:15Dr. Darshan Shah?

  Yeah, this is amazing. So you just got off the stage with Jane Fonda.

• 2:19Speaker 01

  I just got off the stage with Jane Fonda.

• 2:20Dr. Darshan Shah?

  What was that like?

• 2:21Speaker 01

  Surreal. Like I knew she was an icon, right? Like I knew, and then I was there and I was like, oh no, the icon's for real.

• 2:30Dr. Darshan Shah?

  There's a reason she's an icon.

• 2:31Speaker 01

  There's a reason she's an icon. And you hear the story and like, the thing, the one thing that struck me the most is she's like, "Yeah, when I started my fitness business company, I was like 45 or maybe I was 48." And I was like, "That's right. We have a ton of time." And you were born, and she's like, "You're not too old."

• 2:48Dr. Darshan Shah?

  Yeah.

• 2:48Speaker 01

  Right? It's like, you don't even remember when you like changed the world with your fitness company, right? Like, and not because her memory's poor, her memory is very sharp.

• 2:56Dr. Darshan Shah?

  Yeah, she's super sharp.

• 2:57Speaker 01

  Right? But you're like, "That was one of those things that happened that decade." And she's like, "In the 70s, in the 60s, in the 80s." And you're just like, "Wow."

• 3:03Dr. Darshan Shah?

  And I went to medical school, you know, in the 80s. And I remember like, growing up with Jane Fonda, like she was always, she was one of the first fitness influencers, right?

• 3:12Speaker 01

  Yeah.

• 3:13Dr. Darshan Shah?

  Everywhere, on TV, and I had videos, tapes, when those were the thing.

• 3:18Speaker 01

  Yeah.

• 3:18Dr. Darshan Shah?

  People probably listening don't even know what a videotape is.

• 3:20Speaker 01

  Yeah, totally. No, totally iconic, very funny.

• 3:24Dr. Darshan Shah?

  Yeah.

• 3:24Speaker 01

  Very sharp. And we had a great talk and I did like an hour long panel with her. And then when I gave my keynote, I followed her and I'm like, "I am following Jane Fonda."

• 3:32Dr. Darshan Shah?

  Yeah.

• 3:33Speaker 01

  On stage.

• 3:33Dr. Darshan Shah?

  Pretty incredible.

• 3:34Speaker 01

  Incredible.

• 3:35Dr. Darshan Shah?

  Well, you deserve it. I mean, you are also an icon in the field of women's health.

• 3:39Speaker 01

  Thank you.

• 3:39Dr. Darshan Shah?

  And I'm so excited to have you, have you here. So she's 88 years old.

• 3:43Speaker 01

  She's 88 years old.

• 3:44Dr. Darshan Shah?

  Yeah.

• 3:44Speaker 01

  Her Wikipedia page takes about 45 minutes to read. I know from experience.

• 3:51Speaker 01

  It's a long life.

• 3:52Dr. Darshan Shah?

  And you know what's really cool about that too is like, she was in her 40s when she started her fitness company. And like a lot of people I meet right now in their 40s, they feel like now they're on the decline.

• 4:01Speaker 01

  Isn't that insane?

• 4:02Dr. Darshan Shah?

  And you look at people like Jane and it's like, you're just, you can't be just getting started.

• 4:05Speaker 01

  Life expectancy is never been longer.

• 4:07Dr. Darshan Shah?

  Right.

• 4:08Speaker 01

  And we're like, "Well, it's over, you know."

• 4:09Dr. Darshan Shah?

  I know. Why? Why do we do that?

• 4:11Speaker 01

  I don't know. Well, our society puts a lot of weight on youth.

• 4:14Dr. Darshan Shah?

  Yeah.

• 4:15Speaker 01

  Right. And a lot of weight of like, a lot of weight on like, well, you weren't first and other people did it before. Like, there's a lot of like age shame happening, right? Like, I saw, I saw a patient, I see a lot of people for sexual health and hormone health. And I saw this couple and they're in their seventies and they're having the best sex of their lives, been married for four years. They needed some help. They'd had some pharmaceutical help, but like, they're like, this is the best, right? Literally, like, that same morning, a married couple in their forties came in and they're like, "Well, doc, if you just tell us that we're too old for this to be good anymore, like, I said, we'll just, we'll believe that, we'll take that." Like, and I was like, I had some seventy-three-year-olds in here earlier today who are having the best sex of their life, right? And I'm like, I've got forty-year-olds who are like, "Well, if you say it's over, I guess it's over."

• 4:59Speaker 01

  Yeah, yeah. It's like the perspective, right? It's like you have Jane Fonda, who's at eighty-eight, is like, "Exercise every day. I know that's the key to my success."

• 5:06Dr. Darshan Shah?

  Yep.

• 5:07Speaker 01

  Like, "Keep learning new things. Have it, surround yourself with people who love you," right? And I'm like, taking notes before I go on stage. It's like, a lot of it's mindset.

• 5:15Dr. Darshan Shah?

  Yeah, a lot of it. I mean, I would venture to say it's almost all mindset.

• 5:20Speaker 01

  It might all be mindset and a little bit of hormones and a little bit of muscle. Yeah.

• 5:24Dr. Darshan Shah?

  Exactly. Like, if you really boil it down, like, you know, you and I have been doing this stuff for a long time, and you look at age-related decline, it really is just a decline in muscle and decline in hormones.

• 5:35Speaker 01

  Yeah.

• 5:35Dr. Darshan Shah?

  Right? I think everything else is, comes from that. Like, all the other aging, the frailty, the bone issue, you know, Vonda is, and we're very good friends with Vonda, right? Do, like, and we were just talking to Luisa, who talks about the brain. All of it, all of that sequela, I would say, of aging comes from loss of muscle and loss of hormones.

• 5:56Speaker 01

  Yeah. Well, I completely agree. And, you know, and especially in medicine, we're so organ-centric. Like, these are the liver guys, that's the brain lady, this is the glucose person. And it's like, you guys, it's all a unit, right? And the unit affects each other. It's like hormones, you know, hormones get so stereotyped of like, they're just for hot flashes, or they're just for libido. And it's like, it goes everywhere and it affects everything.

• 6:17Dr. Darshan Shah?

  It really, really does. So I'm so curious about you, though, as a person. You know, you're, you and I both trained in Minnesota at some points in our lives. When you go through medical training in Minnesota, like you really put your time in because it is not.

• 6:30Speaker 01

  Minnesota is a land of overachievers.

• 6:32Dr. Darshan Shah?

  Exactly.

• 6:32Speaker 01

  And it also has the weather for overachieving because like, what else are you gonna do in in January? It's like, unless you play ice hockey. Like, you're in the library studying.

• 6:43Dr. Darshan Shah?

  Right.

• 6:43Speaker 01

  You know, so it's like the most educated or the most advanced degree state in the nation.

• 6:48Dr. Darshan Shah?

  Yeah.

• 6:48Speaker 01

  And it's like, you're, you're competing with like, very smart people in Minnesota.

• 6:52Dr. Darshan Shah?

  Exactly. You know, I trained in the Mayo Clinic and when I first got there, my first day of training, I'm like, why is this massive, incredible hospital, the smartest people in the world out here? And then my first winter, I figured out why. It's because during the winter, there's nothing else to do except for learn and work and just be in it to win it.

• 7:11Speaker 01

  Yep.

• 7:11Dr. Darshan Shah?

  And so I get it.

• 7:12Speaker 01

  Yeah, yeah, yeah. And there's a work ethic, I think, in the Minnesota people as well of like, it's just expected of you.

• 7:19Dr. Darshan Shah?

  Yeah.

• 7:19Speaker 01

  I actually interviewed for residency on the East Coast at a place and they're like, oh, you're from Minnesota. And they said, you will find we don't work as hard here. And I was like, oh, the reputation, the reputation travels.

• 7:31Dr. Darshan Shah?

  Yeah, it definitely does, definitely. So you're a urologist. I mean, that's intense training, a lot of surgical training.

• 7:38Speaker 01

  Yep.

• 7:38Dr. Darshan Shah?

  And I'm just wondering, when was the moment that you decided to just really hone in and focus in on women's sexual health and hormone health?

• 7:47Speaker 01

  Yeah.

• 7:47Dr. Darshan Shah?

  Because, you know, I mean, you, you'd spend a lot of time learning how to do urological surgery, et cetera, et cetera. So was there a defining moment or like a career path change? Yeah, tell us about that.

• 7:56Speaker 01

  Totally. So as a general urologist, for any listener that doesn't know, urologist is a surgical subspecialty of the genital urinary organs. So starting from the top, adrenals, kidneys, ureter, bladder, urethra, and stereotypically male genitalia and male quality of life, right? Testosterone, Viagra, et cetera. So that's the urologist. And so I fell in love with urology. Nothing beat urology, urology. Urologists are funny.

• 8:19Dr. Darshan Shah?

  Yeah.

• 8:20Speaker 01

  They, you have to, you have to not take things too seriously when you work in the pelvis, right? So I was a general urologist, tended to see more women because there are so few female urologists, so the patients just gravitate towards me. So really liked female urology, bladder leakage, pelvic organ prolapse is a lot of my work. And still nothing better than a distal ureteroscopy, though. That's my favorite surgery. So in residency, I had an attending tell me, watch out for the seven year itch. Whether that's your marriage or your job, something happens at seven years. You get a little bored, you might get a little complacent, seven year itch. And at seven years, I was kind of bored. And I was like, why did I do all this training to just see recurrent urinary tract infections 27 times a day and say the exact same thing?

• 9:04Speaker 01

  Right? And am I, am I making a difference? And I actually told one of my partners, I'm like, I'm bored. And so I now believe, looking back, I'm like, I now believe the universe was like, she's ready. And the universe delivered to me, one of my patients, who I was already very bonded with and very much, I loved her. We had treated her for invasive bladder cancer, very big surgery. Got her through that, got to know her family, know her husband. And that day in clinic, seven years into my private practice career, she was crying in my office. She was crying in my office because of her sexless marriage. And I'm handing her a box of Kleenex and everything from residency that I was told came up. Women are difficult. They take too much time.

• 9:47Dr. Darshan Shah?

  Oh, my gosh.

• 9:47Speaker 01

  We don't know about, they're too complex. We don't know how to help them. And don't worry, the gynecologists are taking care of them anyways. These are things I'm, and like, people are blown away by it. But like, you know, the indoctrination of medicine, like, I was young, I was told that. And you're like, okay, like, that's, I was told to do a fellowship so I didn't have to deal with women.

• 10:05Dr. Darshan Shah?

  Oh, my gosh.

• 10:06Speaker 01

  That is what I was told.

• 10:07Dr. Darshan Shah?

  Wow.

• 10:07Speaker 01

  Yeah. So all of that came up.

• 10:09Dr. Darshan Shah?

  So much gaslighting in the medical space.

• 10:11Speaker 01

  It's wild. Like, I tell this story and I'm like, no, no, that was my reality. Like, that was the area we grew up in.

• 10:16Dr. Darshan Shah?

  And you know, I can corroborate that because I remember doing my OB-GYN fellowship and talking to some of the attendings. And they're like, you don't want to do this if you can't deal with hormonal, emotional issues. Like, what do you mean? And, you know, it's the same kind of thing. It's like, you know, prepare yourself, you know, for...

• 10:35Speaker 01

  And what, I'm much older and wiser now. What I think they're saying now, if I look at it in a, in a kind way... Our system isn't set up for women.

• 10:45Dr. Darshan Shah?

  Right.

• 10:46Speaker 01

  So women became the problem. Right? It's like, women aren't the problem. The system's not set up for them.

• 10:51Dr. Darshan Shah?

  Right.

• 10:51Speaker 01

  So here's my patient. Everything's going through my brain. I'm handing her the box of Kleenex. And I thought, I don't know how to help her.

• 10:58Dr. Darshan Shah?

  Wow.

• 10:59Speaker 01

  But I take care of men with sexual health problems, which begs the question, who's taking care of the people who are supposed to be sleeping with the people that I'm giving testosterone and Viagra to?

• 11:09Dr. Darshan Shah?

  Yes.

• 11:10Speaker 01

  And that started, basically, a year-long educational journey for me. Great opportunity, because I was bored. Right? Fantastic time to learn something new. So started going to the conferences, Ishwish Conference, International Society for the Study of Women's Sexual Health, for people who don't know what that is. Started reading the journals. Started talking to all the sex therapists. Started figuring out, you know, hormones. And then I was like, I can't change the world? I was starting to realize how big of a problem this was. I can't change the world just by being in my clinic and seeing people in my town. This is too big.

• 11:42Dr. Darshan Shah?

  Yeah.

• 11:42Speaker 01

  Like, I had realized it. And so a voice in my head was like, you need to talk. You need to talk. You need to share your knowledge. You need to talk. And I was like, this voice is very annoying. But it wouldn't go away. And this was, you know, seven years ago now. And I was starting to listen to podcasts. And I was like, well, I like podcasts. Maybe we should do a podcast about women's sexual health. And I'll teach adults about women's sexual health. And I was like, ah, but I didn't do a fellowship in this. There's one, at the time, there was one fellowship, one spot in America.

• 12:12Dr. Darshan Shah?

  You're kidding.

• 12:12Speaker 01

  One spot. Now there's two spots.

• 12:15Dr. Darshan Shah?

  It's still only two spots?

• 12:16Speaker 01

  For female sexual health, yeah.

• 12:18Dr. Darshan Shah?

  Wow.

• 12:18Speaker 01

  One's by a gynecologist, one's by a urologist. And so I'm like, I didn't do the fellowship, though. Maybe I don't know enough. And so I was wait, I was actually waiting for somebody to give me permission to be like, Kelly, you know enough now. Right?

• 12:29Dr. Darshan Shah?

  Yeah.

• 12:29Speaker 01

  And I got out of the shower one day. And like, lightning strikes. And the only permission you need is your own.

• 12:36Dr. Darshan Shah?

  Yes.

• 12:37Speaker 01

  And I was like, okay, start the podcast. So I started the podcast, it's called You Are Not Broken. And the reason it's called You Are Not Broken is because women kept coming in and being like, I don't have an orgasm with penetration. And I'm like, well, you're not broken. Only 30% of women do. The clitoris is actually the organ of pleasure. Another woman would come in and be like, I've never had an orgasm. And I'm like, well, you're not broken. 10% of women have never had an orgasm. Not because our bodies don't work, but because of the way we shame women about touching their body, learning about their body. Boys get to learn about their body. They have to hold their penis to pee.

• 13:08Dr. Darshan Shah?

  Yeah.

• 13:08Speaker 01

  Right?

• 13:09Dr. Darshan Shah?

  Yeah.

• 13:09Speaker 01

  So, boys get to touch their genitals.

• 13:12Dr. Darshan Shah?

  Right.

• 13:12Speaker 01

  In a very socially acceptable way. They understand their body more. Women are told not to touch their body. Right? So, you're not broken. You just didn't get the education. And I think so much can be fixed by just a little bit of education.

• 13:24Dr. Darshan Shah?

  Absolutely.

• 13:25Speaker 01

  And so the podcast started for sexual health and then morphed also into hormones because they're like, you know what happens to your sex life with menopause? And I'm like, no, moving on. And then the next one, you know what happens to your sex life with menopause? You know what happens to your sex life with menopause? And I'm like, what the heck happens to your sex life with menopause? Let's go down that.

• 13:42Dr. Darshan Shah?

  Yeah.

• 13:42Speaker 01

  Let's go down that aisle. Right? And I'm like, I'm staring down the barrel. Like, let's learn about this. Right? And so I'm like, oh, estrogen is essential for blood flow and moisture and to decrease pain. Oh, testosterone. We've got, we've got international guidelines on female testosterone for low desire. Oh, my gosh. And plus, I give 10 times the dose to men every day. I'm not, I'm not afraid of testosterone. Right? And so started learning about hormones and, oh my gosh, why are we afraid of them? What the heck was the WHI?

• 14:08Dr. Darshan Shah?

  Right.

• 14:09Speaker 01

  And just kept peeling off the layers of the onion.

• 14:12Dr. Darshan Shah?

  So interesting.

• 14:13Speaker 01

  At a time when this was getting really big.

• 14:16Dr. Darshan Shah?

  Right.

• 14:16Speaker 01

  So to me, I'm like, man, I caught the wave of sexual health. I caught the wave of menopause.

• 14:22Dr. Darshan Shah?

  Yeah.

• 14:22Speaker 01

  You know, and now I'm like, oh, yeah, international, international expert on this because a patient changed my life.

• 14:28Dr. Darshan Shah?

  One patient, yeah.

• 14:29Speaker 01

  One patient.

• 14:30Dr. Darshan Shah?

  Incredible story.

• 14:30Speaker 01

  Changed my life.

• 14:31Dr. Darshan Shah?

  Well, I mean, and kudos to you too, because you actually listened and you did more than what, you know, unfortunately, like, we only have sometimes 15, 20 minutes with our patients. So.

• 14:40Speaker 01

  Yep.

• 14:40Dr. Darshan Shah?

  It's really easy to just move on to the next thing, write a referral to somebody, like, you should talk to your OB GYN about this. And you actually paid attention and you listened and you. Didn't know something and you realize it and you admitted it to yourself and you went out there and learned about it.

• 14:54Speaker 01

  Yes.

• 14:54Dr. Darshan Shah?

  And I think that's critical and I wish so many more physicians would do this because so many physicians are stuck in the mentality of hormone replacement therapy is something that you have to protect yourself against more than anything, you know?

• 15:08Speaker 01

  Yeah, I mean, I think two things. I think the traditional medical system curiosity is not available anymore. You need time for curiosity. You need space for curiosity to learn things, right? So I'm like, the traditional medical system is not set up for people to be like, I don't know, let's figure this out. And then number two, I was taught in medical school is 50% of what we teach you will be wrong.

• 15:29Dr. Darshan Shah?

  Yeah.

• 15:30Speaker 01

  But we don't know what that 50% is, right? And in that sense of like, stay humble, man.

• 15:35Dr. Darshan Shah?

  Yeah.

• 15:35Speaker 01

  Like, stay humble. We don't know. Things are always changing. And I see that a lot of like, tell me exactly the dose and exactly the lab and exactly this, like, we're still figuring it out.

• 15:45Dr. Darshan Shah?

  Right.

• 15:46Speaker 01

  But a lot has happened between you learning in med school that hormones are dangerous and 2026.

• 15:51Dr. Darshan Shah?

  Yeah, exactly. In, you know, to compound the problem too, the speed of dispersion of medical knowledge is so slow.

• 16:00Speaker 01

  Yeah. And the speed of new knowledge, it's like, did you read about this? It's like the rate of change or knowledge gained right now in medical publications alone is like a whole new textbook.

• 16:13Dr. Darshan Shah?

  Exactly.

• 16:13Speaker 01

  Like yearly, like it's insane, the knowledge to stay up on top of it.

• 16:17Dr. Darshan Shah?

  Right, right. And so it's so hard for the average physician to keep up with it. And then it's so, you know, medical schools are still stuck back in what they were teaching people maybe 20 years ago. And so you have all these new physicians that are going out there. And I just talked to a brand new physician, like, I think this was like six months ago, just graduated from a family practice residency, okay, going out there, talking about hormone replacement therapy. And even this new physician told me that hormone replacement therapy, there's a risk of cancers, you have to be very careful. I was so sad to hear this. Exactly.

• 16:53Speaker 01

  Bummer.

• 16:53Dr. Darshan Shah?

  I was so sad to hear this. And, you know, the prevailing kind of thought process there. You might get sued if you give someone hormone replacement therapy if they develop a cancer. So it's probably in your best interest not to do this. I want to send him to an endocrinologist.

• 17:07Speaker 01

  Yeah, yeah. Which there's plenty of endocrinologists sitting around with nothing to do, waiting to take care of 50% of the population. If you look at female hormones. The other thing that's crazy about it and me kind of learning and to me, I'm like, listen, I'll admit that maybe I, maybe I am weird. Maybe it is weird that I like reading medical journals and but like I'm obsessed with this topic now, right? Like there's, I'm obsessed with it. And what's so crazy is the initial WHI study from 2002, published in JAMA, is open access and free on the internet.

• 17:37Dr. Darshan Shah?

  It is, right?

• 17:38Speaker 01

  Anybody can read that the cancer was not statistically significant. You can read that at any time right now.

• 17:43Dr. Darshan Shah?

  What?

• 17:44Speaker 01

  Right? So to me, for people just to be like, it's in the zeitgeist, it's just in the ether.

• 17:48Dr. Darshan Shah?

  Yeah.

• 17:48Speaker 01

  But it's that fear and truthfully, when I talked to women, I was talking to women today about it. I was like, what's the best way to control a woman?

• 17:55Dr. Darshan Shah?

  Yeah, fear.

• 17:56Speaker 01

  Keep her afraid.

• 17:57Dr. Darshan Shah?

  Keep her afraid.

• 17:57Speaker 01

  Keep her afraid. What better way than to keep her afraid of something her body naturally makes?

• 18:02Dr. Darshan Shah?

  Right.

• 18:03Speaker 01

  Right? And once you see that, you're like, oh, my Lord.

• 18:05Dr. Darshan Shah?

  Wow.

• 18:06Speaker 01

  Right? And it's like that fear that we're trying now that we're 20 some years past the WHI is like that fear. We're still, it's so ingrained, it's so in the zeitgeist, it's so in the ether. But I asked women, like, where did you hear that from? Like, are they, are they going to quote me a 2002 JAMA paper?

• 18:21Dr. Darshan Shah?

  Right.

• 18:22Speaker 01

  Right? Where'd you hear that from? They don't know. It's just, it just is.

• 18:25Dr. Darshan Shah?

  It's just is, right?

• 18:26Speaker 01

  There's gravity and there's one moon and it just is.

• 18:29Dr. Darshan Shah?

  Exactly.

• 18:30Speaker 01

  And to me, I'm like, is nobody curious about where that came from?

• 18:33Dr. Darshan Shah?

  Right, right. Exactly. I wonder that too. And you know, just this year now, we're finally living in a time where there's mainstream media attention to that not being a study that we should be hanging our hat on anymore. And you know, finally, there's some momentum, especially with podcasts, the work you're doing.

• 18:50Speaker 01

  Yep.

• 18:51Dr. Darshan Shah?

  But it just, you know, I speak all over the nation and I just got back from Tulsa, Oklahoma. And someone asked me in the audience, I heard estrogen replacement therapy causes cancer. Is that not true? And you know, it made me boil up a little bit inside because I was like, oh, no, it's not true. And then I explained to W H I, the misinterpretation of it, et cetera, the new studies. And I think, you know, we just got to do the best we can, which is what you're doing, spreading this knowledge to, to me, it's almost like any man or woman that comes to our clinic, we have to almost find a reason to not put them on hormone replacement therapy.

• 19:26Speaker 01

  Yep.

• 19:26Dr. Darshan Shah?

  Right? There's, it is, and you and I were talking about this earlier, is that aging really is due to two things, is loss of muscle and loss of hormones, for the most part, right? And if you can mitigate both of those, there's a chance that you're going to age like Jane Fonda did.

• 19:40Speaker 01

  Yes.

• 19:40Dr. Darshan Shah?

  Eighty eight years old and still sharper and stronger than people half her age, probably.

• 19:45Speaker 01

  Yeah, yeah. And I think, you know, people, people don't understand their own power in the control of the health. And, and there's probably many reasons to blame for that. But I think one of them, give me, give me your opinion, but it's like, this, this gene theory kind of messed us up because we're like, well, you know, it's just your genes. It's just your genes. You can't pick your parents. And it kind of took away this agency of like, and now the experts know, like, genes are really not everything. You have genes, you have genes for cancer and never get cancer. And people do not know that. Right? And it's like, you, there's this lack of agency because we're like, well, it's just genetics.

• 20:21Dr. Darshan Shah?

  Yeah. I am so with you on that. And it was another one of those media frenzies that turned out to be nothing. But it turned out to be worse than nothing. Because like you said, it gave people an excuse, but it also took their power away to, like, obesity became a genetic thing for many, many years. And, you know, it's, obviously, there's components to it, but you can fight through that. And to your, also to your, you know, point there, Alzheimer's disease, this APOE gene.

• 20:52Speaker 01

  Yep.

• 20:52Dr. Darshan Shah?

  And how, you know, if my mom had it, and I have family members with it, probably going to get it. It just, it just is what it is. And the reality is, we know that's not the truth.

• 21:01Speaker 01

  Yeah, exactly.

• 21:03Dr. Darshan Shah?

  You can protect against this.

• 21:03Speaker 01

  Yeah, totally. And genes aren't everything. But I think the like, genes, you know, remember, I remember the couch I was sitting on when the news announced, we have mapped. The human genome, like it was such a big deal like we're gonna cure everything now.

• 21:16Dr. Darshan Shah?

  Yeah.

• 21:17Speaker 01

  We know everything now and here we are like, uh, genes aren't everything like it's I'm glad we are doing all this work, but it's not everything. But so many people are like, well, it's just my genes.

• 21:27Dr. Darshan Shah?

  Yeah. How do you feel about the current kind of sphere of knowledge out there in medicine right now? How's how are you feeling about it? Like what we're learning now, what we know now? Do you feel optimistic?

• 21:39Speaker 01

  Yeah, I mean, it's a wild, crazy time right now, right? Cause I mean, just let's just do the math for a second. In America alone, we have 80 million women over the age of 40, 1 million physicians of those. Because again, this is the other damning thing we did. There's one type of doctor that takes care of women.

• 21:55Dr. Darshan Shah?

  Yeah, yeah.

• 21:56Speaker 01

  And there's 35,000 of them, right? OB GYNs for anybody who wasn't tracking that. But to tell 50% of the population, there's one type of doctor for you to go to for everything is immense bullshit.

• 22:07Dr. Darshan Shah?

  Yeah.

• 22:07Speaker 01

  Like the numbers don't matter. So because everybody's so upset at the OB GYNs of like, they don't know anything about hormones, they don't know blah, blah, blah. I'm like, why are you putting all of, why are you putting 50% of the population on one type of doctor?

• 22:17Dr. Darshan Shah?

  And there's only 35,000 and but half of them are delivering babies all the time.

• 22:21Speaker 01

  As I said on stage today, I'm like, babies cause bleeding, they get stuck in vaginal canals. Like OB GYNs are busy, give them space, right? And we and we know we do not have enough OB GYNs for our population and it is getting more dire. So this basic math, you're like, okay, 80 million women over the age of 40, 100% of them will outlive their hormones.

• 22:42Dr. Darshan Shah?

  Yeah.

• 22:42Speaker 01

  What are we gonna do? Right? The math doesn't math. And so I think all of these things that are happening of like, I call it mass transit, which is the online telehealth companies of like, we need mass transit. The numbers can't math, even if you just do 10 minute appointments, we need mass transit.

• 22:57Dr. Darshan Shah?

  Yeah.

• 22:58Speaker 01

  So and AI.

• 22:59Dr. Darshan Shah?

  Exactly.

• 23:00Speaker 01

  And how do you scale a brain? How do we scale your brain with your knowledge of longevity and what's fresh and what's new? How do we scale that?

• 23:07Dr. Darshan Shah?

  Yeah.

• 23:07Speaker 01

  Right? Cause we, how many people can only one person see?

• 23:10Dr. Darshan Shah?

  Absolutely.

• 23:11Speaker 01

  So it's AI, it's mass transit. And there's something that we've lost that I think is precious and it's called the doctor patient relationship.

• 23:17Dr. Darshan Shah?

  Yes.

• 23:18Speaker 01

  And there will always be a role for caring, compassionate. Passion, the expert who helps interpret. But I think the role, and you're seeing it right now, like the role of the doctor as the person with all the information, that's going away. Because the doctor used to have the medical library, right? That's all they had, but nobody else had that.

• 23:39Dr. Darshan Shah?

  Exactly.

• 23:39Speaker 01

  Everybody has AI.

• 23:41Dr. Darshan Shah?

  Right.

• 23:41Speaker 01

  Everybody has a cellphone, right? Not, not everything on that's true. But doctor, how do I navigate all of this?

• 23:48Dr. Darshan Shah?

  Right, now I have the information.

• 23:49Speaker 01

  I can get all the information. I can go home in a relaxed environment and do tons of research on this. Right? And so it's, it's a power dynamic that's shifting. And I think some physicians are like, what's our role? Oh, my gosh. Elon Musk, I think, said, we don't need to go to medical school anymore.

• 24:03Dr. Darshan Shah?

  He said that a couple of weeks ago.

• 24:04Speaker 01

  Yep. But my God, do you want somebody to hold your hand through all of this when, when shit's hitting the fan? Yeah. So I think there is a role for that. And there will always be, you know, we call them normal Barbies and weird Barbies. Of like, normal Barbie, you don't need as much. If you're a weird Barbie, you might need a different level of care. Right? And so, like, to me, I don't think it's all doom and gloom.

• 24:24Dr. Darshan Shah?

  No.

• 24:25Speaker 01

  I mean, I'm having the time of my life as a physician right now.

• 24:28Dr. Darshan Shah?

  I agree.

• 24:28Speaker 01

  Like, I am so glad I went to medical school. I'm so glad I knew what I, what I know now. And so, wow, it's changing. But it's not going to be one size fits all.

• 24:38Dr. Darshan Shah?

  I agree with you. And you know, the other thing, other component of this, I think is really transformative, is people finally are not gate-kept from the data of their own body.

• 24:49Speaker 01

  Yes.

• 24:49Dr. Darshan Shah?

  Right? They can get their own blood biomarkers done.

• 24:52Speaker 01

  Yep.

• 24:52Dr. Darshan Shah?

  They can do it themselves without even having to request the doctor to order them.

• 24:55Speaker 01

  Yep.

• 24:56Dr. Darshan Shah?

  That's how it was 10 years ago. You had to ask your doctor for this.

• 24:59Speaker 01

  I think it's fascinating.

• 25:00Dr. Darshan Shah?

  I do.

• 25:01Speaker 01

  So I was talking, again, I was talking to very intelligent, well-connected women. And I'm like, okay, there's a company, we don't need to name names, but there's a company. All it does is labs. It won't interpret them for you. It won't help you know what to do with them. It just checks labs. It's worth $2 billion.

• 25:18Dr. Darshan Shah?

  Right.

• 25:19Speaker 01

  Right? Like, that's the, that's what's been missing? Because people go to their doctor and they say, can I check my labs? Can I check ApoB? Can I check blah, blah, blah? And the doctor says, no. And we, there's, they're not at gatekeepers anymore. And I'm like, that's your health. That's your body. You should have access to that. You might want somebody to help you interpret it.

• 25:36Dr. Darshan Shah?

  Right.

• 25:37Speaker 01

  Right?

• 25:37Dr. Darshan Shah?

  Or hold your hand through, what do you prioritize? What's the?

• 25:40Speaker 01

  Yeah.

• 25:40Dr. Darshan Shah?

  What should you be looking out for? What is optimal? Then, you know, I, I think like with the access that we have to our own data right now, doctors are gonna now be held to a higher standard because the patients know what this data means.

• 25:54Speaker 01

  Yes.

• 25:54Dr. Darshan Shah?

  But it's, I love it because all of my patients have their data.

• 25:57Speaker 01

  Yep.

• 25:57Dr. Darshan Shah?

  Right? And they hold me to a higher standard. And then I can be more of a guide and a confidant and like you said, an empathic ear to listen to them.

• 26:07Speaker 01

  Yep.

• 26:07Dr. Darshan Shah?

  And I love my role so much better now.

• 26:10Speaker 01

  Yeah.

• 26:10Dr. Darshan Shah?

  You know?

• 26:10Speaker 01

  Yeah.

• 26:11Dr. Darshan Shah?

  So I, I don't know. I'm excited about it as well.

• 26:13Speaker 01

  Totally. I think a lot of people think that labs are, I say god, but labs are god. Labs are the commandments. Labs are the bible, whatever you wanna call it. Because they're like, what exact lab value should this be? What exact lab value should that be? And I'm like, what are your goals?

• 26:26Dr. Darshan Shah?

  No.

• 26:26Speaker 01

  And do you have side effects when you're trying to get those goals? Right? And they're like, oh.

• 26:30Dr. Darshan Shah?

  Yeah.

• 26:30Speaker 01

  And so especially when it comes to testosterone, for example.

• 26:33Dr. Darshan Shah?

  Yes.

• 26:33Speaker 01

  What exactly should the right testosterone be for a woman? And I'm like, three things matter to me and my patients. What are your goals? How do you feel on it? Do you have any side effects? And what are your lab values in that order?

• 26:44Dr. Darshan Shah?

  Mm-hmm.

• 26:45Speaker 01

  Right? And they're like, oh. Cause you know, people are learning on the internet and they, we like concrete things. Right? But you need that expert to be like, some people have side effects when they're at that level.

• 26:55Dr. Darshan Shah?

  Hundred percent.

• 26:56Speaker 01

  The labs aren't everything. Help interpreting them is what our role's gonna be now.

• 26:59Dr. Darshan Shah?

  Yeah.

• 27:00Speaker 01

  But not access to them. Those companies have been created. They're doing very well.

• 27:03Dr. Darshan Shah?

  Exactly.

• 27:04Speaker 01

  Yeah.

• 27:04Dr. Darshan Shah?

  And guess what? Every individual's biology is completely different. So what's the best testosterone level for you is gonna be different than your own sister. This is gonna be different than what your mother's testosterone was.

• 27:14Speaker 01

  Yeah.

• 27:14Dr. Darshan Shah?

  Right? And so it's, it's different for every individual completely. And so we don't know what is the optimal one for you. And we have to use, what are your goals? What are the side effects? And then what is the level?

• 27:25Speaker 01

  Yep.

• 27:25Dr. Darshan Shah?

  As kind of like. Like our guiding principle to optimizing any piece of blood work.

• 27:30Speaker 01

  Yeah.

• 27:30Dr. Darshan Shah?

  Right? So, yeah, I love that. I love that model. The other thing that we have now is wearable devices too, which are giving you constant feedback.

• 27:37Speaker 01

  I have a whoop up. So it's very interesting. When I do public speaking, I'm like zone four, zone five. Yeah, I'm working out on the stage. Yeah. Yeah. And they actually have a thing. You can record your activity and there's a public speaking thing.

• 27:48Dr. Darshan Shah?

  There is. I didn't know that.

• 27:50Speaker 01

  Yeah. So now I'm like, public speaking.

• 27:51Dr. Darshan Shah?

  I just got a whoop and I also wear an Oura ring. I'm going to wear both. I feel like they're both such great pieces of, first of all, they're great. They're great to wear. So you have your own data, but they're also, I think the companies have done a really good job of really getting the data as accurate as possible.

• 28:06Speaker 01

  I want to see a little bit more female focused.

• 28:08Dr. Darshan Shah?

  Yes.

• 28:08Speaker 01

  We can't just take male data and tell a woman that this is what things are supposed to be. So I would like them to be, and I think they're headed in that direction. But I call mine my gentle parent. Because I'm like, I know I should go to bed. I should go to bed. Right? Like it's like gently guides me to be like, I know that I should put in a little bit more extra, a couple more steps. But to me, it doesn't stress me out. It's more a guy, like, don't forget that stuff. Right? Especially when you're traveling.

• 28:33Dr. Darshan Shah?

  Exactly.

• 28:33Speaker 01

  Right? Of like, get your sleep. Otherwise it will mess with you.

• 28:36Dr. Darshan Shah?

  The travels were really kills me.

• 28:38Speaker 01

  Yeah.

• 28:38Dr. Darshan Shah?

  I really use the guide when I'm traveling. So can you, can I push you on that a little bit? How should wearable companies think about women and how to use the data a little bit differently? Like, what are, do you have any specific examples?

• 28:50Speaker 01

  Yeah. I mean, this is just talking to friends who are in the space and are trying to design this stuff of like, how does heart rate variability change when you throw on an estrogen patch versus not having an estrogen patch on? Estrogen, estrogen influences heart rate variability, right? That would be fantastic data to have. How does sleep change? What do, what do women need to sleep versus men need to sleep? So to me, I'm like, ah, we're not all Toyotas that came out of the same factory. So it's like, if, if we tried to put everybody's factory settings to the Toyotas, well, we've got some Ferraris over here.

• 29:19Dr. Darshan Shah?

  Right.

• 29:19Speaker 01

  But we should probably pay attention to the Ferraris and Ferraris on hormones, Ferraris off hormones. Women are the Ferraris in this scenario, in case anybody, because we create life. So yeah, to me, the the experts are like a lot of the data for the whoop and the Oura ring are built on male.

• 29:35Dr. Darshan Shah?

  Right.

• 29:36Speaker 01

  And so to me, I'm like, the people who will start and to me, I'm like, the market's huge. Like, you start saying you've got female data to track and like, you've done that, like, that's good for your brand.

• 29:46Dr. Darshan Shah?

  Yeah. And also, there's probably an opportunity in how the data changes throughout the cycle of the month as well, right? And so HRV should probably be interpreted differently at some some weeks of the month versus other.

• 29:57Speaker 01

  Right. Are you stressed or do you have low estrogen?

• 29:59Dr. Darshan Shah?

  Yeah.

• 29:59Speaker 01

  Right? Like, we don't know. And can we can we figure that out? What else can we use? Respiratory rate? Like, I don't know. That's how well you're sleeping. So.

• 30:11Dr. Darshan Shah?

  Hi, Dr. Shaw here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30 year old people with cells that look like they're pushing retirement. And I've also seen 60 year olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones and they have limited cellphone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IMA. IMA powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity.

• 30:56Dr. Darshan Shah?

  I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection. The clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IMA actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IMA had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power. Power your health. Most people are aging twice as fast as they should, unfortunately.

• 31:42Dr. Darshan Shah?

  You don't have to be one of them. Try IMAID. I actually have a discount secured for you if you go to drshah.com/ima or go to imadehealth.com/discount/drsah and you can get 20% off with my discount code, Dr. Shah. You can also find the link below.

• 32:02Dr. Darshan Shah?

  I'm really also excited about these continuous monitors that put a filament in through our skin, like the continuous glucose monitor.

• 32:08Speaker 01

  Yeah.

• 32:09Dr. Darshan Shah?

  There's a lot coming out. I'm talking to some of the CEOs and the researchers of these companies that they're going to be adding cortisol.

• 32:16Speaker 01

  Yep.

• 32:16Dr. Darshan Shah?

  They're going to be adding lactate, maybe hormones.

• 32:19Speaker 01

  I think hormones are coming.

• 32:20Dr. Darshan Shah?

  Yeah.

• 32:20Speaker 01

  I think hormones are coming.

• 32:22Dr. Darshan Shah?

  I mean, that's going to be a game changer.

• 32:23Speaker 01

  Yeah, yeah. The data's in your hands. I mean, especially for the perimenopausal women, because it's zone of chaos.

• 32:28Dr. Darshan Shah?

  Yes.

• 32:28Speaker 01

  Right? And to know like, oh, wow. Okay, estradiol's 350 right now.

• 32:33Dr. Darshan Shah?

  Right.

• 32:33Speaker 01

  Let's prioritize sleep. Maybe, do I need to exercise? Like, what do I need to new? Or even just a validation of like, oh, that's why I'm off. Right? Like, all of that is just, it's again, gentle parent, right?

• 32:44Dr. Darshan Shah?

  Exactly.

• 32:45Speaker 01

  Like, hey, you might, you might have a loop cycle right now. Like, what do we need to do to make you feel better?

• 32:49Dr. Darshan Shah?

  Right, right, right. Yeah. And we're such an incredible time with all these converging technologies and AI being there as well.

• 32:55Speaker 01

  Yeah.

• 32:55Dr. Darshan Shah?

  I'm super excited about it.

• 32:57Speaker 01

  Yeah.

• 32:57Dr. Darshan Shah?

  So let's go, you know, you're one of the foremost hormone experts in the world, right? And so I'm sure you've synthesized thousands of patients' worth of data and your experience of the conversations that you've had. And so if a woman were to come to you today, 2026, and she is right now perimenopausal, what should she do? Like, she's experiencing some symptoms, maybe hot flashes, maybe brain fog.

• 33:20Speaker 01

  Yeah.

• 33:20Dr. Darshan Shah?

  Weight gain. Give her some advice from you that she, that she can then take and put into her own protocol moving forward.

• 33:28Speaker 01

  Yeah.

• 33:29Dr. Darshan Shah?

  How should she, where should she go?

• 33:30Speaker 01

  So the first thing is basic education, because body literacy is crappy for everybody. So what is perimenopause? Do you know what it is, right? What's happening to you? And validating that her symptoms are real. So many people get dismissed, right? Of like, I think I'm the crazy one because they said, especially the, all my lab values are fine, in air quotes, right? Like, those people get very dismissed. And again, lab values are not written in stone, right? That was Tuesday at 10 a.m. That is not the whole week.

• 33:59Dr. Darshan Shah?

  Exactly.

• 33:59Speaker 01

  Right, so it's really validating what's your understanding of this? Do you know what's going on? You know, anything about your mom? Did that go well? Do you know when she went through menopause? Just to kind of get the story of it. And then what's your goal? Right, because again, I don't, this is not cookie cutter. This is not one side. Some people, hot flashes, some people sleep, some people sex drive. Some people, I want to preserve bone mass because my mom just broke her hip. Right, so what's everybody's priority? And then the basics of like, are you sleeping? Do you exercise? Are you drinking every day? Why are we, why are we still drinking every day? We drink ounces of water, not alcohol. Right, and so I had a perimenopausal woman. She came in, had a bladder cancer scare. Low grade, non-invasive, cured the bladder cancer. And I'm like, well, of course you don't smoke cigarettes. Like, I'm kind of assuming, right?

• 34:42Speaker 01

  Because I'm like, and she's like, um, does a bong every day count? And I'm like, honey, we count ounces of protein, grams of protein, ounces of water at this stage. We don't do bong hits anymore. And her husband's like, thank you. Right, so it's like, go back to the basics of how are you treating the Ferrari?

• 35:00Dr. Darshan Shah?

  Right.

• 35:00Speaker 01

  Are you hitting it up against the curve every day? Right? And that really does move the needle on how you feel, right? Exercise, exercise is fantastic for helping out basal motor symptoms and perimenopausal symptoms and all that stuff. So to answer your question is like, basics first.

• 35:16Dr. Darshan Shah?

  Right.

• 35:17Speaker 01

  We're Americans, we want quick, fast fixes.

• 35:19Dr. Darshan Shah?

  Yes.

• 35:20Speaker 01

  Right, just give me the right testosterone level of like, if you don't do the basics.

• 35:24Dr. Darshan Shah?

  Right.

• 35:25Speaker 01

  You're gonna be like, these hormones don't work.

• 35:26Dr. Darshan Shah?

  Yeah, yeah, exactly. I say that all the time, like, you know, it's a pyramid and you have to build the base first. Otherwise, the rest of it just comes crashing down every time you try to do anything.

• 35:36Speaker 01

  Yeah.

• 35:36Dr. Darshan Shah?

  And so those bases are exactly what you said. Exercise, nutrition as an intervention and sleep as an intervention. How should a woman in her 40s think about an exercise routine? What would be the optimal exercise routine for that, for that woman?

• 35:50Speaker 01

  Yeah. What do you like to do?

• 35:52Dr. Darshan Shah?

  Oh.

• 35:52Speaker 01

  Right? Because you're like, I've, I've done all the research and this is exactly what you, do you like doing it? Right? I think you can learn to like things. Like I, I was like, I need some more zone five, four, five. All, let's start spinning. And I was like, I did not like this for a while. But now I'm like, I like it. Like I guess I, I truly believe you can start to like things that you, you haven't done before. But it's like, just move the body. I think mobility, like yoga, stretching, mobility, range of motion exercises. Nobody talks about that. I'm sure Dr. Wright does because she's amazing. But it's like, just the feeling of your body moving. And to me, I'm like getting out all those like cracks and kinks and everything every day. Like feels very good.

• 36:30Dr. Darshan Shah?

  Yes.

• 36:30Speaker 01

  And just kind of getting into your body. So to me, I'm like, are you exercising at all?

• 36:33Dr. Darshan Shah?

  Uh huh.

• 36:34Speaker 01

  Because if she's not, you're not going to be like, okay, you need zone four and five, and this much zone two, and lift heavy. Like if she hasn't done that, it's very overwhelming and it's not sustainable.

• 36:44Dr. Darshan Shah?

  Sure.

• 36:44Speaker 01

  Uh, I mean, low hanging fruit is walking.

• 36:46Dr. Darshan Shah?

  Yeah.

• 36:47Speaker 01

  Walk, walk, walk, walk. Like get the steps in. So you gotta meet people where they are. You can give them data, but if they're not going to do it.

• 36:53Dr. Darshan Shah?

  Right, right. Exactly. You know, in my practice, what I find when I talk to specifically women, let's just focus on women, is that there is a huge percentage of them, maybe 40% that are not doing any exercise. You know, I look at their phone and they're getting two to 3,000 steps in a day.

• 37:10Speaker 01

  Yep.

• 37:10Dr. Darshan Shah?

  And all of this advice is absolutely critical. Got to get moving, right? But then I also have a big percentage of women, I would say 30, 40% of women are also going to the gym. And they, you know, they're not overweight. They're going to the gym. They're spending three to four hours in the gym a week just on the treadmill. All they do is run.

• 37:30Speaker 01

  Mm hmm.

• 37:31Dr. Darshan Shah?

  And they're really focused on calories and maintaining their weight. And the running feels good. It's like an endorphin hit to them.

• 37:36Speaker 01

  It could be a stress relief.

• 37:37Dr. Darshan Shah?

  Yeah, it is a stress relief for them too. And so, you know, I, I, one of the things I try to prioritize with those particular women is changing it up a little bit though. Adding some strength training in, adding some yoga, mobility exercises in as well. Is that something that you believe in?

• 37:51Speaker 01

  Oh my God, yeah.

• 37:52Dr. Darshan Shah?

  Women should be adding strength?

• 37:53Speaker 01

  Women in their 40s and 50s, we grew up in the 90s.

• 37:56Dr. Darshan Shah?

  Yes.

• 37:56Speaker 01

  Skinny is best.

• 37:58Dr. Darshan Shah?

  No.

• 37:58Speaker 01

  Skinny is better. Not eating is good. Right? And so it's like to explain to people, we exist within a culture.

• 38:07Dr. Darshan Shah?

  Yes.

• 38:08Speaker 01

  And if the culture tells women, and we were seeing this again, women are getting skinny again.

• 38:12Dr. Darshan Shah?

  Yeah.

• 38:12Speaker 01

  If we exist in a culture that says thin is beautiful, well, I've been told like muscles make me bulky. I don't even know what does bulky look like. And frankly, the guys are like, we wish, we wish lifting weights made us bulky. Right? The guys are like, I wish.

• 38:25Dr. Darshan Shah?

  Yeah.

• 38:26Speaker 01

  And so you, but you have to like undo this societal beauty perfection culture. Like there's so much, let alone that you're women in their seventies. They had it worse, man. They didn't, they didn't have sports.

• 38:40Dr. Darshan Shah?

  Yeah.

• 38:41Speaker 01

  Right? And so I see my seventy year olds, I call them my pissed, my pissed advocacy boomers. Cause they're like, we didn't get hormones. Our friends are breaking their hip. I want mine. I'm a little upset about it. Like I have a large, large practice of them. I love taking care of them because there's so many myths about what's allowed in their seventies.

• 38:58Dr. Darshan Shah?

  My mom is like eight inches shorter than she was when I met her.

• 39:01Speaker 01

  Eight inches?

• 39:02Dr. Darshan Shah?

  She's so tiny, poor thing.

• 39:04Speaker 01

  Wow.

• 39:05Dr. Darshan Shah?

  Yeah. She's had many, many joints replaced. I can't even, I lost count of all the joints that have been replaced.

• 39:10Speaker 01

  Yeah.

• 39:11Dr. Darshan Shah?

  You know, it's, it's just unbelievable.

• 39:12Speaker 01

  Yeah, that generation, like they didn't have girl sports. This was before Title IX. Right? So it's like, at least we have the forty year olds on a treadmill.

• 39:19Dr. Darshan Shah?

  Yeah.

• 39:19Speaker 01

  Right? But it's the culture you grew up in.

• 39:22Dr. Darshan Shah?

  That is so true.

• 39:23Speaker 01

  And the education that we give does have to acknowledge, like we're asking them to do something that we told them, don't do that.

• 39:30Dr. Darshan Shah?

  Right.

• 39:30Speaker 01

  Right? And then they get, and they're like, things are always changing. And we're like, of course they are. Cause fifty percent of the things we learned in med school are wrong. Yeah.

• 39:38Dr. Darshan Shah?

  Things will change, right?

• 39:39Speaker 01

  Things will change.

• 39:40Dr. Darshan Shah?

  It's really good to update your knowledge base and kind of understand where we need to be right now with our exercise, our thoughts around exercise. Right? Especially.

• 39:49Speaker 01

  Yep.

• 39:49Dr. Darshan Shah?

  And so, okay, so say they're exercising and they're coming to you, but they're still struggling with symptoms. And you want to talk to them about hormone replacement therapy. How does that conversation go? Where should, where should they start? What should they be looking at? How do you pick the hormones they should be on, et cetera?

• 40:03Speaker 01

  So I always ask them what they know about hormones.

• 40:05Dr. Darshan Shah?

  Okay.

• 40:06Speaker 01

  Because if you have a woman and in their head hormones cause cancer and you're like, let's get you started on estrogen, then we'll do blah, blah, blah. You're like, my doctor's trying to kill me. Right? So what do you know about hormones? What have you heard about hormones? Do you have any questions about hormones? Do you think hormones would play a role in your plan? Right? So it's like, I want her to let, give me the download of what she knows because I'm here to help. I'm not here to tell her what to do. That's butting up against her beliefs. Right? Right? So I mean, luckily I joke that I've worked very, very hard to have very, very educated patients. I'm like, I have a seven year podcast. I have two books. Most of my patients know that and have read them. So by the time they get to me, they're like, give me the things. I'm good to go. I know, I know all the things, right? Which is a super fun way to practice. Cause you're like, I've got educated people who know.

• 40:51Dr. Darshan Shah?

  You're not starting a square one every time.

• 40:53Speaker 01

  We're not starting a square one anymore. So really, why do you want, you know, what do you want? What do you know about this? What's, what would you like? And I then I like to tell them, this takes adjusting. You know, and I think that's why if you hear women say like, hormones didn't work for me. One type of hormones with one dose maybe didn't work for you. Right? But in our traditional healthcare system, see you in six months. Right? Oh, you're lucky to see you in three months. And so, so many people think they failed hormones. And I'm like, different formulations, different types, different doses. Like it's all individualized. Amazing paper just got published, looking at transdermal estradiol. And that if I give you a point oh five patch and you have point oh five patch, your symptoms might get better and you might not because you absorbed them and

• 41:36Speaker 01

  you didn't. It's like, we're not Toyotas. Right? So I tell people that upfront so that they have the expectation of like, sometimes we hit it out of the park right away, but not always. Sometimes.

• 41:46Dr. Darshan Shah?

  How often are you following their hormone levels and talking to them?

• 41:49Speaker 01

  So in my clinic now, because I run a concierge clinic now, because I was like, 27 patients a day, plus three add-on surgery cases, plus on call.

• 41:57Dr. Darshan Shah?

  Yeah, that was crazy.

• 41:58Speaker 01

  I only think, had we had the Oura ring or the whoop in training?

• 42:01Dr. Darshan Shah?

  Oh my God.

• 42:02Speaker 01

  It would be like, can we, can we please call 911 for you? Like, is your supervisor aware that you're dying?

• 42:09Dr. Darshan Shah?

  Someone at the Oura headquarters would be like, this person is in big trouble.

• 42:12Speaker 01

  Totally. Like barely surviving. So to me, I now have that concierge clinic. And what did women and men, anybody, what did they want from me in the traditional medical system? Time.

• 42:23Dr. Darshan Shah?

  Right? Absolutely.

• 42:25Speaker 01

  Right? And so now I have time. So I see them every six to eight weeks.

• 42:30Dr. Darshan Shah?

  Perfect.

• 42:30Speaker 01

  To change things, dial things in. Usually get people dialed in around four to six months.

• 42:34Dr. Darshan Shah?

  Got it. So, and that's, I think that's a very realistic expectation. Like, you're not going to get dialed in before four to eight months. Like, you gotta like, have, have that time period in your head, so you don't think that you're failing if things aren't perfect one month into it, right?

• 42:50Speaker 01

  Yep. And if it's perimenopause, I'm like, that's a moving target. We don't, that's a moving target. Things will change.

• 42:56Dr. Darshan Shah?

  Absolutely.

• 42:56Speaker 01

  And it's just so, like, post-menopause is easy. You don't have any hormones.

• 43:00Dr. Darshan Shah?

  Right.

• 43:00Speaker 01

  Right? Let's add some.

• 43:01Dr. Darshan Shah?

  Exactly, exactly. So in the perimenopausal woman, are you starting with estrogen, progesterone? What are you starting with? Testosterone, in fact?

• 43:08Speaker 01

  What are her goals? What are her symptoms?

• 43:10Dr. Darshan Shah?

  Okay, got it. So it changes.

• 43:12Speaker 01

  It changes based on, if it, I'm not sleeping, let's start with progesterone.

• 43:16Dr. Darshan Shah?

  Right.

• 43:16Speaker 01

  Right. Uh, low libido, low energy, blah, blah, blah. Let's start with testosterone. So estrogen tend, this is, again, I'm stereotyping. We're not all Toyotas. Estrogen tends to come last, because estrogen seems to be the hanger-oner.

• 43:28Dr. Darshan Shah?

  Yes.

• 43:28Speaker 01

  Right? And, and the, the brain and the ovaries are doing everything they can to try to get enough estrogen to get a follicle and an egg out. And so that tends to be the, the last one out. But again, we're not all created equal.

• 43:39Dr. Darshan Shah?

  Right.

• 43:40Speaker 01

  But, yeah, I, I mean, if people are, what are the guidelines for perimenopause? It's like, there's no guidelines for perimenopause. And people are like, there should be. And I'm like, have you treated perimenopausal people? Like, it's all different, right? Like, you make up a guideline for that. But if there was gonna be a guideline, it would probably be progesterone, testosterone first.

• 43:57Dr. Darshan Shah?

  Right.

• 43:57Speaker 01

  Followed by estrogen. Plus or minus vaginal. Either to get on it for prevention?

• 44:02Dr. Darshan Shah?

  Yes.

• 44:02Speaker 01

  Because why are we waiting for, if 50 to 80% of women will have genital urinary syndrome of menopause, why are we waiting for them to suffer?

• 44:08Dr. Darshan Shah?

  Right.

• 44:09Speaker 01

  Right? So plus or minus vaginal estrogen at any time.

• 44:12Dr. Darshan Shah?

  Got it. Yeah, I think, I think the vaginal estrogen piece of this is really important to mention and, and highlight, because almost universally, when I see a patient that's coming from, like, a primary care doctor that's treating the person's, you know, in air quotes, treating their menopause, they're never on vaginal estrogen.

• 44:27Speaker 01

  Yep.

• 44:28Dr. Darshan Shah?

  And so whether or not you're on any form of estrogen, do you feel that vaginal estrogen should be added to that mix?

• 44:34Speaker 01

  Yeah, unless you're completely asymptomatic. But even then, like, you want to break the internet?

• 44:39Dr. Darshan Shah?

  Right.

• 44:39Speaker 01

  Tell people that their labia minora goes away after menopause. And so there's two groups of people, the people who don't know what a labia minora is. And then the other group of people are the people who are horrified by this. They're like, are you joking? Like, no, no. Genitals need hormones. Hormones go away because a lot of people just think, I mean, people don't understand even what menopause is. So it's not a hot flash or the end of periods. It's profound gonadal hypofunction. You are outliving it, right? So that's why the labia goes away. But so even if you're, I mean, the argument is even if you have no symptoms, should you be on it to preserve sexual health? Right? Like, do you want to wait for your clitoris to get phimotic?

• 45:15Dr. Darshan Shah?

  Right.

• 45:16Speaker 01

  Like, that's 20% of people as far as we know. Not that there's a lot of research, but the best research we have. But here's what's super exciting, and this is brand new. Our president, that two days ago, just announced his healthcare plan.

• 45:29Dr. Darshan Shah?

  Yeah, saw that.

• 45:30Speaker 01

  And one of them is taking safe, effective medications that could be over the counter, over the counter. So we've already talked as high as we can in the administration because vaginal estrogen is the lowest hanging fruit.

• 45:44Dr. Darshan Shah?

  Agreed.

• 45:44Speaker 01

  For over the counter medications.

• 45:46Dr. Darshan Shah?

  Should be over the counter for sure.

• 45:47Speaker 01

  Should be over the counter, over the counter in multiple countries. And here's some damning studies. So there was just a study published out of Stanford looking at Medicare recipients. So age 65 plus, again, 50 to 80% of these women have GSM. Medicare, and this study ended in 2018, so I'm hoping it's better now than 2018. But if you went to a doctor and got the proper diagnosis, so these are women diagnosed with GSM, either recurrent UTI, pain with sex, any sort of GSM symptom.

• 46:14Dr. Darshan Shah?

  Right.

• 46:14Speaker 01

  Lucky enough to see a doctor, lucky enough to get the proper diagnosis. What percentage of those women had a prescription for vaginal estrogen within 18 months of that diagnosis?

• 46:24Dr. Darshan Shah?

  Oh, my gosh.

• 46:25Speaker 01

  I know.

• 46:26Dr. Darshan Shah?

  I know it's going to be a depressing number. Is it like 40%?

• 46:30Speaker 01

  Seven.

• 46:31Dr. Darshan Shah?

  Seven percent with symptoms.

• 46:34Speaker 01

  With symptoms, saw doctor, got the proper diagnosis. Seven percent got a treatment, seven to nine percent. Another paper just came out of Canada, looking at the exact same thing. Seventy-one percent didn't get treatment, so thirty percent got treatment.

• 46:50Dr. Darshan Shah?

  Oh, my gosh.

• 46:51Speaker 01

  So, when I think about that, I think about, okay, what about all the women who aren't seeing the doctor?

• 46:56Dr. Darshan Shah?

  Yeah.

• 46:56Speaker 01

  Who doesn't know that this is, this could be helped.

• 46:59Dr. Darshan Shah?

  Right.

• 46:59Speaker 01

  Right? And it's like, okay, we're not treating, like, the doctor is the, doctor is the problem? Right? It's like, they went to the doctor, they got the right diagnosis, and they still didn't get the right treatment.

• 47:10Dr. Darshan Shah?

  Exactly.

• 47:10Speaker 01

  All right, let's move that vaginal estrogen over the counter.

• 47:13Dr. Darshan Shah?

  That needs to go over the counter.

• 47:14Speaker 01

  Yeah.

• 47:14Dr. Darshan Shah?

  And so.

• 47:14Speaker 01

  Yeah, it's a no-brainer. We're like, make that your first medication over the counter.

• 47:18Dr. Darshan Shah?

  Because the, the risk of side effect is incredibly low.

• 47:22Speaker 01

  Incredibly low.

• 47:23Dr. Darshan Shah?

  And the potential benefit, like, getting rid of recurring UTIs, for example, for the loss of sexual function through the atrophy of the labia minora.

• 47:35Speaker 01

  Yep.

• 47:35Dr. Darshan Shah?

  Like, this is why the, that vagina looks so different as you get older, is because of the lack of estrogen.

• 47:41Speaker 01

  Yeah.

• 47:41Dr. Darshan Shah?

  Right? And you can maintain the, even just the function and the, and the anatomy, just by using vaginal estrogen.

• 47:48Speaker 01

  Yeah.

• 47:48Dr. Darshan Shah?

  There's so many benefits, the strength of the pelvic floor as well, right?

• 47:51Speaker 01

  Totally, bladder leakage.

• 47:52Dr. Darshan Shah?

  Bladder leakage, there you go.

• 47:53Speaker 01

  So, Rachel Rubin did this study, Dr. Rubin did this study. Uh, if Medicare gave every Medicare recipient with a vagina, vaginal estrogen, and they used it, it would save Medicare thirteen billion a year, just to reduce urinary tract infections.

• 48:07Dr. Darshan Shah?

  There you go.

• 48:07Speaker 01

  And in the, and this was an abstract from last year, of women with recurrent UTIs. The ones on vaginal estrogen decreased admission to the hospital, decreased risk, admission to the ICU with sepsis, decreased risk of death.

• 48:19Dr. Darshan Shah?

  Yeah, it's massive.

• 48:21Speaker 01

  And, you know, a tube of generic vaginal ester dial at Mark Cuban, cost plus drugs, is thirteen dollars.

• 48:26Dr. Darshan Shah?

  Yeah.

• 48:27Speaker 01

  Yeah, so you look at what should a preventative medicine be? It should be safe, it should be cost effective, and it should it should prevent something that's common within the population, right? Vaginal estrogen checks all the boxes.

• 48:39Dr. Darshan Shah?

  It does, yeah. Okay, so good. So I'm so glad we talked in depth about this because I do believe that's foundational, right? Let's move on to just estrogen. Your favorite form of estrogen is estrogen patch orally? What are your recommendations?

• 48:53Speaker 01

  I would say right now in 2026, a transdermal estradiol patch is probably the gold standard starting. Somebody asked a question today, actually, they were like, is bio-identical better? Blah, blah, blah, blah, blah. I like to have a different conversation and say hormones are under a tent, and it's a very big tent, and there's lots of different options. And if we say bio-identical, meaning what your ovaries naturally make, if we say that that's better, it makes people who can't take that feel like they're really missing out, or they're broken, or blah, blah, blah. Because some of us need different formulations.

• 49:23Dr. Darshan Shah?

  Sure.

• 49:24Speaker 01

  We just do, especially when it comes to progesterone and progestins.

• 49:26Dr. Darshan Shah?

  Right.

• 49:27Speaker 01

  And so I want to change the language away, but at the same time saying the estrogen your ovary naturally makes in transdermal form, so you're decreased or eliminated first pass hepatic metabolism. So no increased risk of blood clot, no increased risk of stroke. It's incredibly safe.

• 49:43Dr. Darshan Shah?

  Right.

• 49:44Speaker 01

  Yeah.

• 49:44Dr. Darshan Shah?

  And safe and effective for reducing symptoms, but also effective for long-term chronic disease prevention as well.

• 49:52Speaker 01

  Yeah, let's talk about that.

• 49:53Dr. Darshan Shah?

  Let's please.

• 49:54Speaker 01

  Let's talk about that. So the the the counter to us, because we're our view is let's keep healthy people healthy.

• 50:02Dr. Darshan Shah?

  Exactly.

• 50:03Speaker 01

  That's our view, right? So the counter to that is hormones shouldn't be used for primary prevention of any disease. All right, well, let's look into that data. So the United States Preventative Services Task Force, independent task force, which urologists don't like anyways, because they told us not to screen for prostate cancer. And that backfired bad, like more people with metastatic prostate cancer now, right? So we're already like, not sure, not sure about this group. But, okay, so what they did is they published, this is like, oh, two or three years old now, they published grade D recommendation, which means do not recommend. Hormones for the primary prevention of any disease. Now, if you actually read their analysis, their biggest study that they waited, because we talk about waiting studies, like a big study,

• 50:48Speaker 01

  was the WHO. All right, let's talk about that. Oral synthetics.

• 50:53Dr. Darshan Shah?

  Yes.

• 50:53Speaker 01

  Increased risk of gallbladder disease, increased risk of blood clot, blood clot then suggesting stroke risk and cardiovascular risk. Okay, transdermal estradiol doesn't do any of those things.

• 51:05Dr. Darshan Shah?

  Exactly.

• 51:06Speaker 01

  So you're taking an oral synthetic and taking a national statement to say, don't use that for primary prevention of any disease. And we're like, it's apples and oranges.

• 51:15Dr. Darshan Shah?

  Yeah.

• 51:16Speaker 01

  Right, it's apples and oranges, but most people don't read into that data.

• 51:20Dr. Darshan Shah?

  No.

• 51:20Speaker 01

  Right, but the majority of that data is oral synthetics.

• 51:23Dr. Darshan Shah?

  Yeah, yeah, and then that's, that's the key fallacy of the WHO. Is that as an oral synthetic, we can't draw any conclusions from that is because it's just basically what people don't really even use anymore, right?

• 51:36Speaker 01

  Right, and the good news from it, there's good, I mean, there's plenty of good news out of the WHO, but the good news from it is, okay, if we gave you an oral synthetic, it actually isn't that, that's not that bad of a drug. It actually did a lot of great things.

• 51:49Dr. Darshan Shah?

  Yeah, it still did great things.

• 51:50Speaker 01

  With risks, but now we have something that even has less risks.

• 51:53Dr. Darshan Shah?

  Right.

• 51:54Speaker 01

  Right, so people are like, oh, oral synthetics, and you're like, they weren't actually that bad.

• 51:57Dr. Darshan Shah?

  Yeah.

• 51:57Speaker 01

  I mean, the HERS, this is a powerful study. So the HERS study.

• 52:00Dr. Darshan Shah?

  The HERS study, right.

• 52:01Speaker 01

  Looked at, subset of it, looked at oral synthetics, so the Prem Pro, as secondary prevention after cardiovascular event. This is an important study. So, women who've already had heart attacks.

• 52:14Dr. Darshan Shah?

  Yes.

• 52:15Speaker 01

  Oral placebo versus oral Prem Pro, oral synthetics. No increased risk compared to placebo. So, don't use it for secondary prevention, because it didn't make you have less second heart attacks, but it was no worse.

• 52:29Dr. Darshan Shah?

  It was no worse.

• 52:29Speaker 01

  Follow-up greater than four years. That's an important study, because now what we're talking about, we got the pissed boomers.

• 52:36Dr. Darshan Shah?

  Yeah.

• 52:36Speaker 01

  Right, and this whole, we can't take, you can't start hormones after 10 years. Like, we need to talk about this. So, the guidelines, 2022 menopause guidelines, say, within the first 10 years, benefit outweighs risk. In medicine, you know, that is a very strong statement.

• 52:52Dr. Darshan Shah?

  It's a very strong statement, right?

• 52:53Speaker 01

  That is incredibly strong statement. I say that to him, like, I hope you understand what I mean. That's an incredibly strong statement. Benefit outweighs risk, right?

• 53:02Speaker 01

  10 years after or age greater than 60, individual risk benefit discussion should happen.

• 53:07Dr. Darshan Shah?

  So that's what it says.

• 53:08Speaker 01

  That's what it says.

• 53:09Dr. Darshan Shah?

  Right.

• 53:10Speaker 01

  And you can go read it, it's free online.

• 53:12Dr. Darshan Shah?

  Yep.

• 53:12Speaker 01

  People have taken that to say, you can't start.

• 53:15Dr. Darshan Shah?

  It's too late?

• 53:16Speaker 01

  It's too late.

• 53:17Dr. Darshan Shah?

  Uh huh.

• 53:17Speaker 01

  Is it true? What are the risks? 18 year follow up of WHOI, women up to the age of 70, started on oral Prem Pro, did fine. No significant risk. And the dementia risk was self-reported or family-reported. This was not even a physician diagnosis of dementia risk.

• 53:36Dr. Darshan Shah?

  Right.

• 53:37Speaker 01

  Right? So when you say increased risk of dementia, you're like, we don't really know.

• 53:40Dr. Darshan Shah?

  No.

• 53:41Speaker 01

  Right? And so that kind of falls away. And I've done, you know, webinars, I have these classes available on my, on my website of like, let's talk about it. Am I too old for hormones? Hormones is a big tent. You're never too late for vaginal.

• 53:52Dr. Darshan Shah?

  Right.

• 53:52Speaker 01

  Right?

• 53:53Dr. Darshan Shah?

  Right.

• 53:53Speaker 01

  And so the big question is, are you too late for transdermal estradiol?

• 53:56Dr. Darshan Shah?

  Exactly.

• 53:57Speaker 01

  You're never too late for oral progesterone, you're never too late for testosterone.

• 54:00Dr. Darshan Shah?

  It's just a transdermal estradiol, that's the.

• 54:02Speaker 01

  Right, but, but let's look at transdermal estradiol, right? You, so you can't tell me the WHOI risks are transdermal estradiol.

• 54:08Dr. Darshan Shah?

  They're not, right?

• 54:09Speaker 01

  Apples and oranges.

• 54:10Dr. Darshan Shah?

  Right.

• 54:10Speaker 01

  So they're like, oh, the increased risk of heart disease, or stroke, or dementia. No, show me the data. Now, do we want more studies in older people? And absolutely, we want more studies. But there's actually a very old, old study, and this was transdermal versus placebo in women who'd already had a heart attack, no worse than placebo.

• 54:27Dr. Darshan Shah?

  Right.

• 54:28Speaker 01

  So you're telling me a 71-year-old, because of her age, who's, has never had heart disease, can't start a transdermal estradiol, when the women who've already had a heart attack, even if we gave them oral Prem Pro, or a transdermal estradiol, did no less than, no worse than placebo.

• 54:42Dr. Darshan Shah?

  Right.

• 54:42Speaker 01

  Like, we have those studies.

• 54:43Dr. Darshan Shah?

  Yeah.

• 54:44Speaker 01

  Right? And we have the WHOI.

• 54:45Dr. Darshan Shah?

  Yeah.

• 54:46Speaker 01

  And you don't get a transdermal estradiol patch? And, this is like, this is my 2026 soapbox, is like, the older women, give me the data on why they can't start.

• 54:54Dr. Darshan Shah?

  Yeah.

• 54:55Speaker 01

  Cause I have so much data to say, you can.

• 54:57Dr. Darshan Shah?

  That's great.

• 54:57Speaker 01

  Right? We have multiple placebo-controlled trials, looking at really low-dose patches in older women, specifically for bone improvement.

• 55:05Dr. Darshan Shah?

  Uh huh.

• 55:06Speaker 01

  Right? So we have those studies.

• 55:07Dr. Darshan Shah?

  Yeah.

• 55:08Speaker 01

  Risks, no worse than placebo.

• 55:10Dr. Darshan Shah?

  Right.

• 55:10Speaker 01

  Right? So to me, I'm like, why? Why do people keep telling a woman she can't start a hormone that is an excellent safety profile?

• 55:17Dr. Darshan Shah?

  Right.

• 55:18Speaker 01

  SSRIs are more risky.

• 55:19Dr. Darshan Shah?

  Yeah, absolutely.

• 55:21Speaker 01

  Overactive bladder medications are more risky, right? And so to me, I'm like, and again, this is me being obsessed with this topic. That I actually went and like read all of these things, but I'm like, God darn it, tell me why they can't start this.

• 55:32Dr. Darshan Shah?

  Yeah.

• 55:33Speaker 01

  And my other argument is if at age 75, a woman can't say what she wants to do with her body after being informed with a risk benefit thing, what age is she able to say what she wants to do with her body?

• 55:45Dr. Darshan Shah?

  Right.

• 55:45Speaker 01

  This is like quality of life too. And a lot of people are like, oh, the symptoms are gone though. Menopause symptoms only last for seven years and she like, these people aren't suffering. These people are suffering profoundly.

• 55:55Dr. Darshan Shah?

  Yeah.

• 55:56Speaker 01

  They don't sleep, they've got negative moods, they've got osteopenia or osteoporosis. Like they're profoundly suffering and we are not taking care of them properly.

• 56:07Dr. Darshan Shah?

  Exactly. Yeah. I think there's a great soapbox for 2026 for you because all these boomers are coming up to this now. And like my mom, again, perfect example, she should be on hormone replacement therapy right now, you know, and she would protect what joints she has left and her bones and her mood, all of it. And so I think this is an important, very important topic. And I'm really looking forward towards the narrative on hormone replacement therapy completely changing. And so, you know, I also think that a lot of women, they also think of their sexual health as something that it's supposed to decline as you age. And we talked about this with a 70 year old couple and a lot of what's going on with their sexual health also is very tied into like their pelvic floor as well.

• 56:50Speaker 01

  Yep.

• 56:51Dr. Darshan Shah?

  And so we know, like, we talked a lot about vaginal estrogen and how it, how it helps the pelvic floor to be stronger. But what else can a woman do to maintain their sexual health into older age?

• 57:02Speaker 01

  Exercise. Exercise, it's blood flow. Like, nobody thinks about female sexual health in terms of blood flow. But erections are obviously blood flow.

• 57:11Dr. Darshan Shah?

  Right.

• 57:11Speaker 01

  Right? And clitorises or penises, they're the exact, they're exact same is a little stretch, but incredibly similar anatomy, right? And, and, but people, again, going back to what, what's my why, right? Of like, we did, you got a disease and pregnancy prevention plan, probably, if you were lucky, right? You did not get a like, how does this work? How do we get both people equally interested in going to the party?

• 57:33Dr. Darshan Shah?

  Right.

• 57:33Speaker 01

  Right? We didn't get, did any of us learn about the clitoris?

• 57:36Dr. Darshan Shah?

  Right.

• 57:36Speaker 01

  Right? Or the fact that women get erections? We get blood flow? Best way, when this is same for penis owners, exercise. Like, get, the blood flow is good for everything.

• 57:45Dr. Darshan Shah?

  Absolutely.

• 57:45Speaker 01

  Right? And they have, and we've studied it. Women who exercise more have more satisfying sex lives. Up to a point, the over-exercisers, their sexual function drops. What I mean by over-exercising? You're exhausting yourself, right? Or you're using exercise as a coping mechanism for other things. So, the more you exercise, the better your sex life is, except for the very top, there's the over-exercisers, where you're like, you're stressing yourself out, and nobody, nobody has a great sex life when they're horribly stressed out.

• 58:11Dr. Darshan Shah?

  Yeah.

• 58:12Speaker 01

  So I would say if I had to pick one, exercise, number two would be sleep.

• 58:15Dr. Darshan Shah?

  Uh huh.

• 58:16Speaker 01

  We have this data, shift workers, where sex lives, night workers, less, less sex life, is like, all domains of sexual function when measured diminish.

• 58:26Dr. Darshan Shah?

  Right.

• 58:26Speaker 01

  Right. So, you, your body prioritizes things.

• 58:29Dr. Darshan Shah?

  Right.

• 58:29Speaker 01

  And if it's not sleeping, it doesn't want to reproduce.

• 58:32Dr. Darshan Shah?

  Uh huh.

• 58:32Speaker 01

  Right? It doesn't want to have pleasure. So, sleep and exercise are key.

• 58:35Dr. Darshan Shah?

  Got it. And then, you know, just like, like you said, like, when you go through medical school, you do days and hours and hours of studying the man's penis, but the clitoris is like, here it is, that's it, it's like, five minutes.

• 58:48Speaker 01

  Yeah. I can't remember, I can't remember on my cadaver, I had a female cadaver, I know that. Did we dissect the clitoris? I don't know. And the other crazy thing is, I'm a pelvic surgeon.

• 58:59Dr. Darshan Shah?

  Yeah.

• 58:59Speaker 01

  I put mesh around clitorises.

• 59:01Dr. Darshan Shah?

  Right.

• 59:01Speaker 01

  That's what, that's what a sling is.

• 59:03Dr. Darshan Shah?

  Yeah.

• 59:03Speaker 01

  I didn't understand the full anatomy of the clitoris.

• 59:06Dr. Darshan Shah?

  Wow.

• 59:06Speaker 01

  I had a sex therapist have a clitoris model. She's like, this is a clitoris model. And I'm like, what? So, I mean, that's like, only to be very humble, to be like, I got through surgical pelvic training.

• 59:16Dr. Darshan Shah?

  Absolutely, right?

• 59:17Speaker 01

  And then I learned all the places the clitoris goes.

• 59:19Dr. Darshan Shah?

  Uh huh.

• 59:20Speaker 01

  Yeah.

• 59:24Dr. Darshan Shah?

  This episode was brought to you by Next Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Next Health is the Apple Store of wellness, where you can optimize your health span and lifespan using cutting-edge technology. I actually founded Next Health eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in Next Health using hyperbaric oxygen, sauna, cryotherapy, and LED light is a game changer. In addition, the doctors at Next Health measure thousands of biomarkers and put into place

• 1:00:08Dr. Darshan Shah?

  a longevity optimization plan using advanced tools like ozone, plasma exchange, and peptides. Go to www next.health to check it out.

• 1:00:22Dr. Darshan Shah?

  So what about some pharmaceutical therapy for sexual health? You know, men have Viagra. Is this effective for women as well?

• 1:00:29Speaker 01

  Yeah, so Viagra is a blood flow drug, right? Fascinating stuff in the longevity world. Looks like people who take Viagra or Cialis, or I call them the cousins, right? The cousins of the PDE5 inhibitors, less dementia. Why? Blood flow drug, right? Blood for the brain. So it'll be interesting to see where we are with PDE5 inhibitors in about five years. Interesting thing about-

• 1:00:49Dr. Darshan Shah?

  There's a lot of people taking it for like longevity.

• 1:00:51Speaker 01

  Yeah.

• 1:00:52Dr. Darshan Shah?

  Like they'd take a daily 2.5 milligrams, right?

• 1:00:54Speaker 01

  It's safe, right? And in a world, and I will argue this with hormones too, in a world where dementia is deadly, costly, impossible to treat, or at least very expensive, why are we doing everything we can to prevent it?

• 1:01:09Dr. Darshan Shah?

  Right.

• 1:01:09Speaker 01

  Number one killer of women in Australia now, this year.

• 1:01:12Dr. Darshan Shah?

  Is dementia.

• 1:01:12Speaker 01

  Is dementia. UK is right behind.

• 1:01:14Dr. Darshan Shah?

  Past heart disease?

• 1:01:15Speaker 01

  Yep. Just dead.

• 1:01:17Dr. Darshan Shah?

  It's massive.

• 1:01:18Speaker 01

  UK is right behind. I joke, it's not something to be joking about, but I'm like, America, not quite there yet because we're really good at killing, killing off people for other reasons.

• 1:01:26Dr. Darshan Shah?

  Yeah, exactly.

• 1:01:27Speaker 01

  But yeah, no, the, the developed countries where people are living longer, dementia is now the number one killer in Australia. So it's like, if it's cheap, if it's safe, it's a fact, why aren't we doing everything we can to prevent this from happening? It's not inevitable.

• 1:01:40Dr. Darshan Shah?

  Right.

• 1:01:41Speaker 01

  Right?

• 1:01:41Dr. Darshan Shah?

  So do you think there's a world in the future where men and women would be taking PD5, PD5 inhibitors, like low dose Cialis or Viagra, preventatively possibly?

• 1:01:52Speaker 01

  I mean, I would hate to say, oh, Casperson said this is what we should do.

• 1:01:55Dr. Darshan Shah?

  No.

• 1:01:55Speaker 01

  But what do we need for a good preventative medication? Safe? Cheap?

• 1:01:59Dr. Darshan Shah?

  Sure.

• 1:02:00Speaker 01

  And it's something big, like a large part of the population to prevent it. I'm like, it checks the boxes.

• 1:02:05Dr. Darshan Shah?

  It does, yeah.

• 1:02:06Speaker 01

  It also helps overactive bladder in women.

• 1:02:08Dr. Darshan Shah?

  Right.

• 1:02:08Speaker 01

  Why? Blood flow to the bladder.

• 1:02:10Dr. Darshan Shah?

  Absolutely.

• 1:02:11Speaker 01

  And blood flow to the pelvis. So that, go back to the initial question. When a man gets an erection, so I improve blood flow, so you have an erection, your brain is linked and it's like, oh, I'm interested in sex now. Right? They've done these studies in women because you're like, Viagra can help in women, but not all women. You make a woman have blood flow to her pelvis, she doesn't always want to have sex. She needs other things. Am I safe right now? Is this a socially acceptable place to have sex?

• 1:02:37Dr. Darshan Shah?

  Right.

• 1:02:37Speaker 01

  Right? So just because she has blood flow, doesn't mean she's interested in sex.

• 1:02:41Dr. Darshan Shah?

  Right.

• 1:02:42Speaker 01

  Right? So just a little bit different, we're just hooked up in a little bit different ways. So people, that's the argument of like, Viagra does work, Viagra doesn't work. Viagra improves blood flow.

• 1:02:51Dr. Darshan Shah?

  Right.

• 1:02:52Speaker 01

  But that doesn't always mean you want to have sex.

• 1:02:54Dr. Darshan Shah?

  But can it improve the likelihood of having an orgasm or the intensity of orgasm?

• 1:02:59Speaker 01

  Yeah, because it's blood flow.

• 1:03:00Dr. Darshan Shah?

  Right, exactly.

• 1:03:01Speaker 01

  It's erections. So they're actually coming out now with a topical sildenafil.

• 1:03:05Dr. Darshan Shah?

  Right.

• 1:03:06Speaker 01

  Right? And so it's, they've got some, some funds behind it. It's gonna, I think people are gonna know about it.

• 1:03:11Dr. Darshan Shah?

  Yeah.

• 1:03:12Speaker 01

  And it's safe, it helps blood flow. And the big question is, especially, you know, when you look at female sexual dysfunction, there can be a lot of different reasons that you don't like sex.

• 1:03:22Dr. Darshan Shah?

  Right.

• 1:03:22Speaker 01

  So it might help, especially, this is so under research. We know the role of heart disease, high blood pressure, diabetes, on erections in men.

• 1:03:30Dr. Darshan Shah?

  Right.

• 1:03:30Speaker 01

  Same, same.

• 1:03:31Dr. Darshan Shah?

  Same.

• 1:03:31Speaker 01

  Way less research.

• 1:03:33Dr. Darshan Shah?

  That's so true.

• 1:03:33Speaker 01

  Right. So the the mechanism is probably there for a woman to have decreased blood flow as she ages and collects comorbidities. We just have way less data on it.

• 1:03:42Dr. Darshan Shah?

  Right, right. What about nitric oxide, like, you know,

• 1:03:45Speaker 01

  Yeah.

• 1:03:45Dr. Darshan Shah?

  as well as is it as important for women as it is for men?

• 1:03:48Speaker 01

  Yeah.

• 1:03:48Dr. Darshan Shah?

  Erections, right?

• 1:03:49Speaker 01

  Basal dilator, blood flow, right? Green leafy vegetables increase nitric oxide, yeah, and exercise.

• 1:03:55Dr. Darshan Shah?

  And red beets, huge nitric oxide boost with that as well, so. Okay, and then what about some of these peptides like kisspeptin? And what are some of the other ones that are marketed?

• 1:04:08Speaker 01

  Oxytocin.

• 1:04:09Dr. Darshan Shah?

  Oxytocin.

• 1:04:10Speaker 01

  Is one of them, yeah, that people are interested in. Not as much data.

• 1:04:13Dr. Darshan Shah?

  Okay.

• 1:04:14Speaker 01

  And I think the low hanging fruit probably hasn't been addressed. So to me, I'm like, don't go for the next trendy thing of how's your hormones?

• 1:04:22Dr. Darshan Shah?

  Yes.

• 1:04:22Speaker 01

  How's your relationship? How's your relationship? Are you prioritizing orgasm? Or does sex end when a partner has an orgasm? Right? Like, there's so much sex ed that's missing that to be like kisspep is gonna work for everybody. I'm like, probably not. But if it's a, is it a specific arousal problem? Is it a specific orgasm problem? Right? Like, there are things for people, but doctors did not get taught about sex.

• 1:04:47Dr. Darshan Shah?

  Yeah.

• 1:04:47Speaker 01

  Right?

• 1:04:48Dr. Darshan Shah?

  Zero.

• 1:04:48Speaker 01

  There's one, there's two fellowship spots in America for women's sexual health with 80 million women.

• 1:04:55Dr. Darshan Shah?

  Right.

• 1:04:55Speaker 01

  Yeah, Viagra was approved in 1998. Became the fastest selling pharmaceutical ever created. Record profits.

• 1:05:03Dr. Darshan Shah?

  Right.

• 1:05:04Speaker 01

  Right? Was fast tracked by the FDA. Got approved with less than six months' data because it was such an essential new medication.

• 1:05:11Dr. Darshan Shah?

  Yes.

• 1:05:11Speaker 01

  Right?

• 1:05:12Dr. Darshan Shah?

  Yes.

• 1:05:12Speaker 01

  I got, I was part of the team, which was awesome, to get the box working off of estrogen. In 2025.

• 1:05:17Dr. Darshan Shah?

  Nice.

• 1:05:18Speaker 01

  What's estrogen? It's a blood flow medication.

• 1:05:20Dr. Darshan Shah?

  Right.

• 1:05:20Speaker 01

  Right? So these people got blood flow medications. These people got this stuff's gonna kill you on their blood flow medications. We've been destabilizing heterosexual relationships for 27 years.

• 1:05:30Dr. Darshan Shah?

  That's so true, right? Absolutely. There's, I mean, it's, it's a. It's so, it's such a huge hill to climb when all the men had this new drug Viagra and the woman had nothing, basically. And so, you know, both going through that same sexual dysfunction at the same time period of their life.

• 1:05:50Speaker 01

  Yeah.

• 1:05:50Dr. Darshan Shah?

  The perimenopause for men is andropause. And one group got a solution and one group didn't get a solution.

• 1:05:56Speaker 01

  Yeah.

• 1:05:56Dr. Darshan Shah?

  And to your point, that makes complete sense.

• 1:05:58Speaker 01

  We have to point that out to people, you know, to be like, we took care of half of that heterosexual relationship. And so, most urologists, and this has moved pretty fast, but most urologists, when a man's in the office, we're like, oh, you want Viagra? You want testosterone? Great. Now they come to see me and knowing what I know now, to be like, what is your plan with this super penis we're gonna give you?

• 1:06:17Dr. Darshan Shah?

  Mm hmm.

• 1:06:18Speaker 01

  And I thought like it would be the rare man who like didn't have a plan. And to me, I'm like, I don't care what you do with it, like you do you, great. But if your plan is to put your brand new, super hard penis in the vagina.

• 1:06:31Dr. Darshan Shah?

  Yeah.

• 1:06:32Speaker 01

  Does she want that?

• 1:06:33Dr. Darshan Shah?

  Right.

• 1:06:33Speaker 01

  Has anybody been taking care of her? Is she on vaginal estrogen? Do you use lubrication? Right? And they're like, I haven't, I'm, I'm telling you, this blew my mind. They don't have a plan.

• 1:06:45Dr. Darshan Shah?

  No.

• 1:06:45Speaker 01

  I'm like, you made an appointment with a urologist to get Viagra and you did not have a conversation with the person you haven't slept with in seven years, who you now wanna go home with and try to sleep with.

• 1:06:57Dr. Darshan Shah?

  Yeah.

• 1:06:57Speaker 01

  And they're like, yeah, no, we haven't talked about it yet.

• 1:07:00Dr. Darshan Shah?

  He just thought she'd be ready.

• 1:07:01Speaker 01

  He just thought she'd be ready. Like, you know, we actually joked in residency, women would return their partner's Viagra to the clinic. And we would, we would joke like, oh my God, and now I'm like, oh, that's not funny, right? Like, I'm like, she's undertreated.

• 1:07:15Dr. Darshan Shah?

  Right.

• 1:07:16Speaker 01

  Nobody's taking care of her.

• 1:07:17Dr. Darshan Shah?

  Yeah.

• 1:07:17Speaker 01

  Right? Nobody asked her if this was the plan, but he just assumed this would be the plan.

• 1:07:22Dr. Darshan Shah?

  It should have been at least vaginal estrogen, maybe a low dose testosterone, maybe even some PDE5 inhibitors. And everyone would be on the same page.

• 1:07:31Speaker 01

  And did she actually ever have good sex in the first place? Before you stopped, was she actually ever having good sex? Right? And this was mind blowing to me as I was, you know, going into my journey of female sexual health is one of the leading researchers. And female desire as a man. And he was like talking about low desire and the different types of blah blah. And I'm like, hold on. You're assuming the woman was having good sex in the first place. And she's just not desiring good sex. And he's like, well, yeah. And I'm like, that's such a male centric view of the party that that woman was at. I'm like, a lot of them aren't having great times at the party. Right. And so in the first place.

• 1:08:11Speaker 01

  So you have to back up and be like, you know, before we go to like, which vibrator, which lube, blah, blah, blah. Like, did she ever have fun at the party? Right. Was she just doing this for somebody else? And again, it's the, we never got taught how to talk about sex. And if we don't talk about sex when it's good, how the hell are you supposed to talk about it when it's bad?

• 1:08:29Dr. Darshan Shah?

  That's so true. In fact, you know, this, I would postulate that many women, when the husband's desire went away, that they were probably happy about it because they weren't having good sex in the first place.

• 1:08:39Speaker 01

  Many people say that.

• 1:08:42Dr. Darshan Shah?

  And so for this return to sexuality when the man got the Viagra, was that your traumatic event? In their life. And so, and you know, you hear this story every once in a while and then couples break up, divorces happen, et cetera, et cetera. And the reality was no one really explored was the sex good the first, you know, when it was happening. And now that it's returned, how can we get it to be good at this point in time?

• 1:09:07Speaker 01

  Totally. And like adults can learn new things. Right. Like adults are capable of learning new things, but we have to want to learn new things. I have a, I have retreats and a divorce lawyer came to one of my retreats. And she's like, I pull people out of the river. Like I, I can't save anything. By the time they're in my office for a divorce, they're already drowning down the river. And she's like, I am convinced these women, they're not taken care of. Like these are untreated menopause. The relationship fractures. And by the time they get to her, like she can't help. Right. But it's like, when the divorce lawyers are telling you, we're not taking care of the women properly, we should probably listen to them.

• 1:09:45Dr. Darshan Shah?

  So true. Yeah, I mean, I think every divorce lawyer out there should have a partnership with a physician like yourself.

• 1:09:52Speaker 01

  Yeah.

• 1:09:52Dr. Darshan Shah?

  That could be like, let's try to unwind this. Let's put some interventions in place first. Let's talk about these things.

• 1:09:57Speaker 01

  Yeah.

• 1:09:58Dr. Darshan Shah?

  But you're right. By the time you're there, it's often too late.

• 1:10:00Speaker 01

  Yeah, there's, there's so much like animosity and like the relationship's fractured by the time you're in a divorce lawyer's office, right? Of like, you gotta go 10,000 feet above that, that, that awful spilled ship to like, try to right the boat.

• 1:10:14Dr. Darshan Shah?

  Absolutely, absolutely. So in your big picture assessment for a woman that has never had good sex and she's listening to this right now, what are some of the techniques that she can use to maybe rehab this or get to a point where?

• 1:10:28Speaker 01

  Yeah.

• 1:10:28Dr. Darshan Shah?

  She's actually enjoying sex the way she should be?

• 1:10:30Speaker 01

  Yeah. So I think a lot of people jump straight to self exploration, masturbation, vibrators. I want to back it up. What are your thoughts about sex? What do you think sex is? What would you hope to get out of sex? It's the thoughts, right? It's, we're talking about mindset.

• 1:10:46Dr. Darshan Shah?

  Yeah.

• 1:10:46Speaker 01

  Right? Of like, if you think it's dirty, it takes too long, it's for somebody else, what's the point? Certainly if it hurts, right? Like, what are your thoughts about sex? And let's just understand that that's what we think sex is.

• 1:10:59Dr. Darshan Shah?

  Right.

• 1:10:59Speaker 01

  Because if we don't unpack that first, me being like, I designed the best vibrator for you. Pointless, right? Like, I can make blood flow happen.

• 1:11:07Dr. Darshan Shah?

  Yes.

• 1:11:08Speaker 01

  But if you're not on board with sex, right? And like, that's why I'm like, I'll have a podcast till I die because this topic is huge. How were you raised? What did your religion tell you about sex? What did your stupid first boyfriend tell you about sex?

• 1:11:21Dr. Darshan Shah?

  Right.

• 1:11:21Speaker 01

  Right? Like, let alone any traumatic experiences that you've had. So who's allowed to desire in our culture? Right? Who is sex for? Who gets sex freely? Right? Who's the gatekeeper of sex? Like, it's such a huge topic.

• 1:11:33Dr. Darshan Shah?

  It's a massive topic.

• 1:11:34Speaker 01

  It's massive. And you know, they say sex is biopsychosocial and like, there's no better word for it. Like, it really is. It's your biology, it's your relationships, it's the, the fishbowl you're swimming in, which is society. Right? And so to me, I think people jump, they're like, eat a good lube, vaginal estrogen and a vibrator.

• 1:11:50Dr. Darshan Shah?

  Yes, so true.

• 1:11:51Speaker 01

  Of course, when you're ready, when you're ready for the hardware, let's do hardware.

• 1:11:54Dr. Darshan Shah?

  Right.

• 1:11:55Speaker 01

  But if the software thinks that sex is like, what's the point? Or I was, I was hurt in the past, or I don't really like my partner in the first place. Right. But it's all this like, when we just say like, women can have great sex and should have great sex. Like, yes, we gotta unpack where they're at.

• 1:12:11Dr. Darshan Shah?

  Right.

• 1:12:12Speaker 01

  Right. And be like, could it be possible that sex could be something different for you in the second half of your life? Compared to how it was in the first half of your life. Right? And I think the stereotype is like that the 22 year olds are having great sex. That's not what the data says. First of all, the 22 year olds are having way less sex than they've ever had.

• 1:12:29Dr. Darshan Shah?

  Really?

• 1:12:29Speaker 01

  Cause they're not hanging out anymore.

• 1:12:30Dr. Darshan Shah?

  Oh, that's so true.

• 1:12:31Speaker 01

  Right? Like COVID happened, we've got phones, all the things. And when you think of, even think like a hundred years ago, sex was the best dopamine. Besides like a shot of whiskey.

• 1:12:41Dr. Darshan Shah?

  That's true.

• 1:12:42Speaker 01

  Like sex was the best.

• 1:12:43Dr. Darshan Shah?

  You couldn't get it anywhere else.

• 1:12:44Speaker 01

  What was better dopamine?

• 1:12:45Dr. Darshan Shah?

  Exactly.

• 1:12:45Speaker 01

  Sex was amazing and you couldn't have it and it was really rare. Right? Like it was very good dopamine. And now we're like, dude, a pint of mint chocolate chip ice cream and Instagram scrolling. Like, I'm good.

• 1:12:56Dr. Darshan Shah?

  Yeah.

• 1:12:57Speaker 01

  Right? Like it rings all the bells.

• 1:12:58Dr. Darshan Shah?

  Yeah.

• 1:12:59Speaker 01

  And so sex takes work, right? Especially if you wanna do it with somebody else, right? How's your schedule? What's my schedule? Are you tired? Like you've, you've got a bum knee. Okay. Well, what position? But like, it's work to get that dopamine, right? And so when we're like, where sex is, plays a role in our society now, like it's actually harder dopamine.

• 1:13:17Dr. Darshan Shah?

  It's changed a lot. You're absolutely right. Especially in the context of all the other dopamine hits we get throughout the day.

• 1:13:22Speaker 01

  Yes, totally. There's some crazy statistic about how many people look at their phone during sex. Like, and it's a crazy, it's way more than, I would be like, 5%? Like super, no, it's like, I can't quote exactly what it is, but it's.

• 1:13:35Dr. Darshan Shah?

  It's a surprising number.

• 1:13:36Speaker 01

  Frightening amount of people.

• 1:13:38Dr. Darshan Shah?

  That is frightening.

• 1:13:39Speaker 01

  Who check their phone during sex. Like, oh, for anybody who's uncertain, don't do that.

• 1:13:45Dr. Darshan Shah?

  Yeah, yeah, that's not, that's not.

• 1:13:46Speaker 01

  It takes you out of the present moment. Yeah. So the young people aren't having that much sex, but we think they're having the best sex. But the data actually suggests the older you get, the better sex you're having, especially for women. Because they're like, I'm throwing away the rules. I'm making this about me. I'm a lot less concerned about how I look, how I'm, you know, we're less spectatory, right? We're more experienced. We might want it. We've done it enough that we're like, let's have a little bit of novelty now. Right? And so that's what people don't know. Right? Because our society is like, the sexy, beautiful young people are having, no, they're not. Right? And the other, there's an amazing book by Peggy Kleinplatz. She's a PhD and it's called Magnificent Sex.

• 1:14:26Speaker 01

  And what she did, she's at a university and she's like, hey, anybody who has really great sex, like raise your hand, can I interview you? Right? So it's kind of a qualitative research study of like, what does it take to like be a self admitted, like I'm great at sex.

• 1:14:38Dr. Darshan Shah?

  Yes, yes.

• 1:14:39Speaker 01

  Because everybody thinks desire for sex is what allows you to have great sex life. Nowhere in like the top 10 is desire, sexual desire, a necessary ingredient.

• 1:14:49Dr. Darshan Shah?

  That's interesting.

• 1:14:50Speaker 01

  Communication, prioritizing time to be sexual.

• 1:14:54Dr. Darshan Shah?

  Right.

• 1:14:54Speaker 01

  Trying things, recorrecting, you know, starting and stopping. If that wasn't great, how can we do it different? Right? So willingness to try, just being involved and communication, communication, communication. Especially if you want sex with another human.

• 1:15:08Dr. Darshan Shah?

  Right, right.

• 1:15:09Speaker 01

  So that's a great book because everybody's like, the typical male model, and this is, you know, Kinsey and Masters and Johnson. And they're like, desire first, or desire was assumed.

• 1:15:20Dr. Darshan Shah?

  Right.

• 1:15:20Speaker 01

  Because like, these are people in the 1950s being hooked up to electrodes in the Midwest in winter. Like, by default, they had a spontaneous desire for sex. Yeah, yeah, yeah. They're like, wait, let's do this. Let's learn for science. So, but then desire was assumed as coming first. And so women say, well, I don't have a desire for sex, so I don't have sex.

• 1:15:38Dr. Darshan Shah?

  Right.

• 1:15:39Speaker 01

  And then nice analogy is like, if you're full after a meal, you don't really want more food, but like the dessert table comes around and they're like, okay, let's do it. Or it's Friday night, I don't really feel like going to the party. But when I go to the party, it's a fricking good time.

• 1:15:54Dr. Darshan Shah?

  Yeah.

• 1:15:54Speaker 01

  Right? So it's like, let your partner take you to the party. And especially how women's brains work, we need a safe sexual context. So if there's kids around, if we're stressed, if we don't feel safe, you're not going to have desire for sex. You must go in a sexual context. So our role or our partner's role to bring us along or us to go there. Because in women, this is Rosemary Basson's work, desire for sex happens during sex? Yeah, I love this. Yeah. This is good. I love this party.

• 1:16:21Dr. Darshan Shah?

  Yeah.

• 1:16:22Speaker 01

  Right? So desire happens during sex, when I'm in the sexual context, or desire happens after sex.

• 1:16:28Dr. Darshan Shah?

  Interesting.

• 1:16:29Speaker 01

  That was so good. I forgot how good that is. That is a great time. Will you remind me again that I liked that? Cause I forget that I like that. That's desire for sex after I had sex. Right? So so many women are like, don't have desire. I'm like, of course you don't. You just got off of work. You just packed the lunches. You're you're in the living room where you don't usually have, you're not in a sexual context.

• 1:16:48Dr. Darshan Shah?

  Yeah.

• 1:16:49Speaker 01

  So it's like, provide the the avenue, be willing to go to the party. You can always stop. And I'd never mean have sex when you don't truly want it, if you don't feel safe and it's not good. But be willing to go to the party, see what, see what adventures at the party might be interesting. Because desire for sex might happen during, desire for sex might happen after.

• 1:17:09Dr. Darshan Shah?

  I I this is such critical, great information for women that are listening that are just, you know, they're feeling that they're not having the desire. Just completely reframe that. The desire might come during, it might come after.

• 1:17:21Speaker 01

  Yep.

• 1:17:22Dr. Darshan Shah?

  And get yourself in the sexual context. This is great information for men, too.

• 1:17:25Speaker 01

  Hundred percent.

• 1:17:26Dr. Darshan Shah?

  Right? Because I think I think men need to know this in order to understand why their partner doesn't potentially have the desire. At this moment, the context might not be right, or we just got to get them into the place.

• 1:17:36Speaker 01

  Yeah.

• 1:17:36Dr. Darshan Shah?

  And then the desire will come.

• 1:17:38Speaker 01

  And the word for that is responsive desire.

• 1:17:40Dr. Darshan Shah?

  Responsive desire.

• 1:17:41Speaker 01

  So I respond to this being in the sexual experience. But spontaneous, again, that's what Hollywood tells us. It's just on demand, drop of a hat, yell, let's go anytime. Just not, it's not the real world.

• 1:17:53Dr. Darshan Shah?

  Right? And so that men need to realize that the female context around desire is different than the male context around desire.

• 1:18:00Speaker 01

  Men can also have responsive desire. And this is also what's very interesting in a heterosexual relationship, is the woman's desires usually anchored around where the man is. So if she wants more sex than him, she has too high of a desire. And if she wants less sex than him, she has too low of a desire. We've anchored the man as the default and made her the problem. Right? And that is not what we should do. We should say, desire mismatch, that's what it's called, desire mismatch. When two people want different amounts of sex, that's a couples problem. Not an individual person's problem, and that's to be navigated with the couple.

• 1:18:35Dr. Darshan Shah?

  That's such critical information.

• 1:18:37Speaker 01

  I think the one other thing I want to make sure we cover because it's golden. Have you heard of the orgasm gap?

• 1:18:41Dr. Darshan Shah?

  No.

• 1:18:42Speaker 01

  Okay, so the orgasm gap, fascinating research, is the percentage of times that a male is going to have an orgasm in a given sexual experience compared to the percentage of time. And we're using orgasm as a proxy for enjoyment.

• 1:18:55Dr. Darshan Shah?

  True.

• 1:18:56Speaker 01

  Satisfaction, right? Because you have to have sex worth desiring. You can't desire mushy broccoli. You can't desire boring sex. So proxy orgasm to save, right?

• 1:19:06Dr. Darshan Shah?

  Yep.

• 1:19:06Speaker 01

  And in a heterosexual relationship, man orgasms around 97% of the time. Pretty successful, pretty enjoyable sex. Heterosexual female clocks in around 60% of the time. They're literally having different meals, right? When you look at same-sex couples, lesbians about equal, right around 86% of the time.

• 1:19:24Dr. Darshan Shah?

  Really?

• 1:19:25Speaker 01

  Heterosexual male, both clock in right around mid 90% of the time, right? So the biggest gap is the heterosexual couple. What's worse is that's in a committed, loving relationship. If you do hookup sex, college campus hookup sex, he still gets the orgasm, high 90%. Her percentage of orgasm, 7%.

• 1:19:45Dr. Darshan Shah?

  Seven?

• 1:19:45Speaker 01

  Seven.

• 1:19:46Dr. Darshan Shah?

  That's massive.

• 1:19:47Speaker 01

  So to me, I'm like, why are you participating in this?

• 1:19:49Dr. Darshan Shah?

  Right.

• 1:19:50Speaker 01

  Why are you participating in this situation?

• 1:19:51Dr. Darshan Shah?

  Why are you in it anyway?

• 1:19:52Speaker 01

  Why are you in it anyways?

• 1:19:53Dr. Darshan Shah?

  Yeah.

• 1:19:53Speaker 01

  Yeah.

• 1:19:55Dr. Darshan Shah?

  I did not realize that that is, you know, committed relationship, there's a 30%, 25% mismatch.

• 1:20:01Speaker 01

  Yeah.

• 1:20:02Dr. Darshan Shah?

  In a non-committed relationship, hookup sex.

• 1:20:04Speaker 01

  It's horrific.

• 1:20:05Dr. Darshan Shah?

  It's just like not even, right, exactly.

• 1:20:07Speaker 01

  Yeah.

• 1:20:07Dr. Darshan Shah?

  Yeah, I mean, that should completely change the mindset around the current hookup culture through these apps like Bumble or what have you. I mean, I've never used one, but I mean, it just seems like there's such a new paradigm around meeting people and then how you hook up and how quickly that goes into sex.

• 1:20:27Speaker 01

  Right.

• 1:20:28Dr. Darshan Shah?

  And I'm hearing about it right now because my nephews are in college and they're living it real time. And they don't use these apps because of this kind of massive. Mismatch, they're actually feeling it.

• 1:20:41Speaker 01

  Yeah.

• 1:20:41Dr. Darshan Shah?

  Like, it's just too easy now, I think.

• 1:20:44Speaker 01

  Right. Yeah, yeah. No, I mean, it's crazy research. The other stereotype is that women want sex less than men. That's a, that's a common stereotype, right? And it probably stems from many places, but one study was people on a college campus. They went around, they asked men, would you like hookup sex tonight? Most, most of the men were like, yes, that would be great. Thank you very much. They went around, women, would you like hookup sex tonight? And they're like, 0% said yes. They're like, no, which begs the question, we're using a lot of alcohol to coerce or to get women's inhibitions down so they will participate in this ruse of 7% orgasm. Right? So they're like, oh, well, look, men like sex more than women do.

• 1:21:18Dr. Darshan Shah?

  Uh huh.

• 1:21:19Speaker 01

  And then some very smart researchers were like, ah, I think there's different menu items here. They went up to women and they said, if we offered you shame-free, non-judgmental, safe, no risk of pregnancy, no risk of disease, loving orgasmic pleasure, would you like that tonight? All the women said yes.

• 1:21:40Dr. Darshan Shah?

  Hmm.

• 1:21:41Speaker 01

  Right? And so the researchers in their wisdom said, men are eating at five-star Italian restaurants. Women have Chef Boyardee in a can.

• 1:21:47Dr. Darshan Shah?

  Yeah.

• 1:21:48Speaker 01

  And you don't wonder why they like Italian food less.

• 1:21:52Dr. Darshan Shah?

  Right.

• 1:21:53Speaker 01

  Right? And so that's the whole stereotype, like, women just aren't as sexual. And it's like, have you seen what's on offer?

• 1:21:57Dr. Darshan Shah?

  Yeah, exactly.

• 1:21:58Speaker 01

  Right? Like, up, up the ante for this.

• 1:22:00Dr. Darshan Shah?

  Yeah. That's such incredible information. So many great reframes that you have for us that I think empower both men and women with this knowledge and give you a different perspective of how to think about sexual relationships. And also, you know, going back to the beginning of this conversation, just getting your mindset around perimenopause and menopause and how it is completely treatable. The symptoms can be treated away and you don't have to live in that state and it's safe for you.

• 1:22:28Speaker 01

  Yeah, I think mindset about that too, because we were like, ah, why do we have to do this when we grow old? Especially if you identify as somebody who doesn't take medications, right?

• 1:22:36Dr. Darshan Shah?

  Yeah.

• 1:22:36Speaker 01

  Like, ah, why do we have to, why do we have to outlive our ovaries, blah, blah? I just want to remind people, we've been massively successful at extending lifespan.

• 1:22:44Dr. Darshan Shah?

  Exactly.

• 1:22:44Speaker 01

  Like, I did this research for my book of like, the wealthiest land-owning males in early Britain. This is like 1400s. It's like, you were worth spending a pencil on to like, write your birth and death date, right? Because there were no birth and death records for like, the peasants.

• 1:22:58Dr. Darshan Shah?

  Yeah.

• 1:22:59Speaker 01

  So you were wealthy, you had land, you had parchment, right? And you didn't die in childbirth. Average life expectancy, forty seven.

• 1:23:06Dr. Darshan Shah?

  Forty seven.

• 1:23:07Speaker 01

  Forty seven. That was as good as it got.

• 1:23:09Dr. Darshan Shah?

  Right?

• 1:23:10Speaker 01

  Right? So people are like, well, great grandma didn't use, and it's like, we've never aged.

• 1:23:14Dr. Darshan Shah?

  She never got there.

• 1:23:14Speaker 01

  Yeah, and going back to like how we think about aging versus like the traditional medical system is like, we're seeing people age and we're like, maybe there's a different way of doing this. And maybe we do actually have to start now to not have this happen when we're eighty. And like, the amazing blessing it is to have, we're outliving our ovaries. And if you take any animal from fruit fly to yeast to orangutan and you age them in captivity, they all live longer than their reproductive potential. Cause they're like, only, only humans and whales. And I'm like, first of all, most mammals don't menstruate. They don't have periods to track. Don't say they don't do this. But if you put them in a zoo, you feed them and you give them antibiotics when they have an infection and you take away their predators. They all live longer than their reproductive potential.

• 1:23:59Speaker 01

  So I wanted to name my book Aging in Captivity. But the publishers were like, I don't think people will get it. And it seems like they're in jail. And I'm like, my fans love that name. Like, we're aging in captivity.

• 1:24:08Dr. Darshan Shah?

  Absolutely.

• 1:24:09Speaker 01

  Do we want to do it well? Most people say yes.

• 1:24:11Dr. Darshan Shah?

  Yeah. It says, I make this point all the time, you know, is in the longevity space, there's always this fear of getting old because you imagine it as frailty. And there's also a perception that, well, you know, humans are meant to get old. It's natural to age. There's nothing natural about what we're doing. We've artificially extended our lifespan by double. And our organs that were producing these hormones just were not made to last this long.

• 1:24:42Speaker 01

  Yeah. And I tell, I tell, I'm like, once we push the lifespan even longer, more men will outlive their testicles.

• 1:24:48Dr. Darshan Shah?

  Right.

• 1:24:49Speaker 01

  Like, I just, that's just how it's gonna be, right? And we're not gonna shame them and say like, this is mother nature's plan to make it past your eighties, right? We're gonna be like, oh, well, we replace eyes, we replace hips, we replace teeth, we replace shoulders, we replace heart valves, we replace insulin, we replace everything except for ovaries? Like, what a bias.

• 1:25:06Dr. Darshan Shah?

  Yeah, exactly.

• 1:25:07Speaker 01

  And the interesting part, why can't our ovaries last longer? Ovaries are built to be proportional to the size of the mammal.

• 1:25:14Dr. Darshan Shah?

  Right?

• 1:25:15Speaker 01

  So a mouse has very small mice ovaries, elephant has big elephant ovaries, human have human sized ovaries. There's only so many follicles, so many eggs. Enough years go by, you've outlived the size of the ovary. Right? Because people want to overthink this and judge it and say what you should do is like, if we get that health literacy and understand all of that, we're like, okay, yeah, yeah, yeah. I want to live long. Antibiotics alone increased human life expectancy by 26 years.

• 1:25:40Dr. Darshan Shah?

  Oh, absolutely. Absolutely. Yeah. And then we do have the whole pharmaceutical industry around antibiotics and now they're keeping us alive even longer with even more therapies. So there's more lifespan coming. We just got to get our heads wrapped around replacing these hormones, getting, giving our body the things it needs that it can't make anymore.

• 1:25:58Speaker 01

  Yeah.

• 1:25:58Dr. Darshan Shah?

  That's the way I look at it.

• 1:25:59Speaker 01

  In the 1990s, 40% of American women were on hormones.

• 1:26:02Dr. Darshan Shah?

  Hmm.

• 1:26:03Speaker 01

  Because it's like, do you just want everybody to be on hormones? And I'm like, well, going back to the 90s would be a start.

• 1:26:07Dr. Darshan Shah?

  They were. Right. Exactly. Let's just get there. Right?

• 1:26:09Speaker 01

  Yeah. Let's just get, let's get there.

• 1:26:10Dr. Darshan Shah?

  7%, 8% of women are on hormones right now. Right?

• 1:26:12Speaker 01

  Yeah.

• 1:26:13Dr. Darshan Shah?

  Amazing conversation. I, I can't wait. I could spend hours and hours talking to you.

• 1:26:18Speaker 01

  We're going out to dinner next, so we'll give more time.

• 1:26:20Dr. Darshan Shah?

  Let's get some more time and let's talk. I love it. Yeah. So this is absolutely fantastic. You're a force of nature and I really appreciate you being here. And where can people hear more from you directly? Tell us about your podcast, your social media handles.

• 1:26:33Speaker 01

  So the podcast and the first book are called You Are Not Broken. The, I love hanging out on Instagram. That's Kelly Casperson, M.D. Website's Kelly Casperson, M.D. com. Second book's called The Menopause Moment, not Aging and Captivity, because the publishers didn't like it. But those are the main ones. Yeah. I got YouTube, Substack, all the things.

• 1:26:50Dr. Darshan Shah?

  Incredible. Well, we thank you so much for being here and can't wait to have you back on again. I'm sure we can talk a lot more about a lot more fun topics.

• 1:26:56Speaker 01

  Thanks for having me.

• 1:26:57Dr. Darshan Shah?

  Thank you.

• 1:27:01Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps us support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider. or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.