Solving the Testosterone Mysteries with Dr. Kelly Casperson

Dr. Kelly Casperson, urologist and author of "The Menopause Moment," highlights the importance of testosterone in women's health, particularly for mood, motivation, and muscle building, not just libido. She discusses various administration methods (pellets, creams, troches) despite the lack of FDA-approved female testosterone products. Dr. Kelly stresses the need for comprehensive sex education, addressing lifestyle factors, and open communication to optimize testosterone therapy and a healthy sex life, noting that desire isn't the primary factor in fulfillment. She also touches on the health implications of asexuality, emphasizing community and partnership alongside orgasms for longevity. To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visit https://drmindypelz.com/ep307 Dr. Kelly Casperson, MD is a board-certified urologist with over 15 years of experience who now specializes in women's sexual health and hormone therapy. After realizing that traditional medical training left a gaping hole in addressing women's intimate needs, she created the You Are Not Broken podcast and authored You Are Not Broken and The Menopause Moment. She also founded The Casperson Clinic, a membership-based model that provides tailored, unhurried care. Known for being "like a big sister who's a doctor," Dr. Casperson delivers clinical expertise with humor, candidness, and unwavering support. Check out our fasting membership at https://esetacademy.drmindypelz.com https://resetacademy.drmindypelz.com/. Please note our medical disclaimer https://drmindypelz.com/medical-disclaimer/.

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

• 0:02Mindy Pelz?

  On this episode of the Resetter Podcast, I am bringing you Dr. Kelly Casperson. Now, this is a really fun conversation. I can't wait to see how you all enjoy it and eat it up. I really wanted to bring a testosterone expert to all of you. We've talked about the pros and cons of estrogen. You've heard me talk about progesterone, but I haven't really done a deep dive on testosterone. And Kelly has a new book coming out called The Menopause Moment that has a whole chapter on testosterone. I also follow her on socials and she just went before the FDA to get the warning signs, the warning updates that go on the packaging

• 0:46Mindy Pelz?

  for testosterone off because she believes so passionately that women deserve to have testosterone and to bring it in to their menopause repertoire of hormone replacement. And as you'll hear in this incredible conversation, you'll hear her clinical experience. She is a urologist. She's also an international speaker and thought leader. She's a podcaster and she has a great podcast called You Are Not Broken. And she has some very strong opinions on testosterone. So in this conversation, we go through what does testosterone do beyond libido? And I think this was the most important thing I wanted to bring to you

• 1:30Mindy Pelz?

  because as you'll hear, it affects a lot in our life. And when testosterone goes down, our motivation can change, our mood can change, our ability to build muscles can change. And so there's a lot more at play here than just libido. So we discuss that. Then I wanted to talk about the different ways to get testosterone into your body because I've seen so much controversy of pellets, no pellets, creams, trokeys, what do we do? And so Kelly does a really good job educating us on that. And then, of course, we need to talk about how do you bring it to your doctor? Because I keep hearing from more and more women that are experiencing their doctors saying no to testosterone and not prescribing it for

• 2:14Mindy Pelz?

  them. So we talk about how do you talk to your doctor about this? And then where we land is really beautiful. We landed on libido. So, most people think of libido and testosterone first. In this conversation, we put it last. But what what transpired in the back half of this conversation around what is sexual desire? What is libido will fascinate you. It is not a sex conversation, a desire conversation like you've ever heard before. And I just really appreciated the way in which she brought forward the conversation of libido because it's intricate. And she did a good job of talking about it from many different angles. So, Dr. Kelly

• 2:57Mindy Pelz?

  Casperson, her book, The Menopause Moment, it's out for order right now. Run to whatever your favorite store is and grab a copy. But most importantly, educate yourself on is testosterone right for you? And I think you'll see that Kelly and I both wanted to just make women aware. What you choose to do with the knowledge is always up to you. So, take the whole conversation with love and dive into the world of testosterone if it fits for you. As always, enjoy, and I hope this helps. Welcome to the Resetter Podcast. This podcast is all about empowering you to believe in

• 3:39Mindy Pelz?

  yourself again. If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you.

• 3:56Mindy Pelz?

  So, I want to start off with the testosterone mystery, is what I'm going to call it, that I feel like we have a lack of knowledge in the culture on how testosterone plays out in the female body, what it does during menopause. So, I want to go through like, is it supposed to decline? Is it not decline? And then, how do we bring it back into our body through exogenous ways like hormone replacement therapy? And because each one of those is a hurdle, I see for women, that they get stuck at some point of those three things.

• 4:36Speaker 01

  Let alone, if I add a fourth thing, the regulatory burden and the availability of options, and the DEA, right? There's just hurdle after hurdle with testosterone.

• 4:47Mindy Pelz?

  It's, do they not want us to have testosterone? Is that the problem going on here?

• 4:52Speaker 01

  The burden of proof of safety within the FDA is a much higher burden of proof for female bodies than male bodies. And we can say, is that valid or not? It might be valid because of the, look at what happened with thalidomide. Right? So the history of harm helps direct current fear-based withholding. Right? And that's a very nice thing for me to say. Otherwise, that could be like, they just don't care about helping anybody. Right? But if you look at safety data, like Viagra had six-month safety data. Male testosterone had six-month safety data. We actually have four-year safety data on the intrinza patch, which went up around 2004, female-dosed testosterone. So that's 20 years ago now.

• 5:35Speaker 01

  They had four-year safety data at the time, did not get approved. But what happened two years before they went up to the FDA, the Women's Health Initiative? So the being like, oh, my God, hormones kill people was still, you know, that took about 20 years to get over. But a lot of people still don't know hormones don't kill people. But so, you know, that's like, dude, we had four-year safety data to the men's six-month safety data, and we still didn't get it FDA-approved. But the timing, one will argue the timing was very bad.

• 6:04Mindy Pelz?

  Yeah, yeah. So, okay, so talk to me about why testosterone is important in the female body. And I know, I mean, what I want to point out is the elephant in the room, which is it's way more than libido.

• 6:15Speaker 01

  Thank you.

• 6:17Speaker 01

  Jesus, Lord.

• 6:20Mindy Pelz?

  Thank you.

• 6:21Speaker 01

  So, yeah, I mean, you have to start, where I like to start is that all bodies have testosterone. All bodies have estradiol. We just have them in different amounts. Ovaries make testosterone, which converts to estradiol. You can't make estradiol without going through the cholesterol pathway, which includes testosterone. Right? So it's like, everybody needs the 101 biology, because if they're like, here's Dr. Casperson saying all women should be on testosterone, like, I sound nuts. When you don't have the background info of ovaries make testosterone, ovaries make four times the amount of testosterone than estrogen.

• 6:59Speaker 01

  We just make 10 to 20 times less than male bodies and testicles. So that's like the

• 7:05Mindy Pelz?

  And I just want to point out something you just said is testosterone helps make estradiol.

• 7:12Speaker 01

  And you can't, you can't get estradiol without testosterone.

• 7:16Mindy Pelz?

  Right. Okay. So, so let's just pause there for a moment. So everybody's into their patches and their creams of estradiol. But the precursor to estradiol is testosterone.

• 7:29Mindy Pelz?

  So it seems like that might be the, should be one of the first exogenous hormones that we bring in because then it could help make estradiol.

• 7:37Speaker 01

  It's a very interesting because take a, a normally cycling pre-menopausal woman. She has four times the amount of testosterone than estradiol. What that means, all the testosterone isn't there just as a job to make estradiol. It's working as testosterone on testosterone receptors that are everywhere in the body. Cause I think that's a, that's a myth. It's like, we just make testosterone to make estradiol. No, because then we'd have equal amounts. Right. And then we wouldn't have, why would we have testosterone receptors everywhere if it's only job was to sit in the ovary and make estradiol. Right. So it's, it's fun to educate by kind of pointing out those things. And the other thing is we have many studies where we give women physiologic female dose testosterone and their estradiol does not go up. What does that, what does that mean?

• 8:21Speaker 01

  We're using the testosterone's going to the testosterone receptors. And you actually have to push testosterone pretty high to get a lot of it to convert over. And, and we've done those studies. We've, you know, there's a study looking at testosterone in women on aromatase inhibitors. So breast cancer people, right? So we've actually, cause that's the other myth. Testosterone only helps you with menopausal symptoms because it's converting to estradiol. That's another myth. We're like, well, let's test that. Let's give them a medication that blocks the conversion to estradiol. Hot flashes get better, joint aches and pains get better. You know, lots of things get better. Zero conversion to estradiol because we had them on a medication that blocked it. Right? So there's like, those tests are, those studies are very useful in kind of challenging

• 9:04Speaker 01

  these myths of like, it's only there for estradiol, and it only converts to estradiol, and it only works because it converts to estradiol. Like testosterone's doing its own thing. One of the things it does is convert to estradiol, but it actually, when we give replacement doses, a lot of it doesn't. And they'll do this, they'll measure your estradiol, your testosterone level goes up, your estradiol didn't go up, because we're not giving you huge doses.

• 9:25Mindy Pelz?

  Yeah, large enough doses.

• 9:27Speaker 01

  Yeah.

• 9:27Mindy Pelz?

  So, okay, so tell me what, what testosterone does in the body?

• 9:31Speaker 01

  Oh.

• 9:32Mindy Pelz?

  All the miraculous things.

• 9:33Speaker 01

  All the things it does. So testosterone is a hormone, just like estradiol's a hormone. Hormones go into the cells, into the mitochondria, and they help the cell function better. And I like to break it down to be like, yay, these aren't miracle workers, they're not light switches, they're not Band-Aids, they, they're molecules that move around the body to help the body communicate, and they go into cells and they help cells function better. Mitochondria, nerve cells, all the things. So, many experts will say, these are, we should call these neurohormones, because of the profound effect on the brain. But there's also, we have testosterone receptors in bone, we have testosterone receptors in muscle, we have testosterone receptors in our blood vessels, right? We can give women testosterone, their blood pressure goes down because it's a vasodilator, right? We give women testosterone, their clitoral blood

• 10:18Speaker 01

  flow goes up because it's a vasodilator. So, really, I know, yay, and that's how it helps sexual function. So, testosterone really is everywhere, just like people don't, I think people don't know that estradiol receptors are everywhere, right?

• 10:32Mindy Pelz?

  Right. Hopefully by now, they do. I think, I mean, I feel like that is, yeah, that has been a message that is permeating, hopefully, anybody who pops on socials.

• 10:43Speaker 01

  Yeah, so to answer, to better answer your question of what does testosterone do? Like, what does it look like when your cells are functioning better? People will get very picky, and again, this is the myth, is the best data we have is in libido. That doesn't mean that testosterone only helps libido, right? And I always joke, I challenge people, I'm like, where's libido located in the brain? Like, right side, left side? Is it a square centimeter box? Is it a one inch box? Like, where's the libido box? Right of like, that's right. The brain is, the brain is a sexual organ. And if you, Moscone, Moscone did the, Moscone in Britain did the paper that showed like, they put women in MRI, functional MRI machines and gave them testosterone and their brains light up everywhere. Right of like, yeah, libido, libido is multiple areas of the brain.

• 11:28Speaker 01

  And that's why it helps, mostly because it just makes you feel more like yourself is one of the big things.

• 11:35Mindy Pelz?

  Yeah, I love how you, in your book, you use, talk about how libido is mood. It's a mood.

• 11:40Speaker 01

  It's a mood.

• 11:41Mindy Pelz?

  Like, it, like, it's such a beautiful way to, like, bring it down to, you know, it is a mood, like happiness and sadness and, and all the other moods we experience throughout a day. So the brilliant.

• 11:52Speaker 01

  Thank you. Because I think, you know, on social media, people will be like, it doesn't help with mood and it doesn't help with energy. You can't say that. And you're like, well, libido's a mood and we have an international consensus on testosterone in women and that, and that mood. Right? And it does help with energy because it literally helps your mitochondria function better, which is the energy producer of your cells. Right? So people get very distracted by what is FDA approved versus what do women say it helps with, which are two incredibly separate, different things.

• 12:25Mindy Pelz?

  Well said.

• 12:26Speaker 01

  But I think, you know, especially in medicine, like, saying, I want more energy. I want my, like, we don't like things that are hard to touch or measure. Right? Especially with the not feeling like myself.

• 12:38Mindy Pelz?

  You can't measure that.

• 12:39Speaker 01

  Like, well, how does Mindy feel? And how do we make Mindy feel more like Mindy? Like, I can't, I can't actually that. Right? Like, there's no blood level that says, oh, Mindy, she's now feeling like herself enough. Right? Like, it's up to Mindy to tell us if she feels more like herself. But a classic thing with testosterone is, I feel more like myself.

• 13:01Mindy Pelz?

  Okay. What I I can tell you that I've heard a lot of women and I've experienced this myself that motivation is a major challenge when they lose testosterone and when they supplement with testosterone, the motivation comes back.

• 13:16Speaker 01

  Oh, my God, yeah.

• 13:17Mindy Pelz?

  Is that is there a hierarchy of different aspects of the brain that we know? Because so if libido is a mood, motivation is

• 13:26Speaker 01

  I would say motivation is more of an energy.

• 13:30Mindy Pelz?

  Right?

• 13:30Speaker 01

  Yeah, I was gonna say, I wouldn't even know.

• 13:31Mindy Pelz?

  It is an energy.

• 13:32Speaker 01

  And women will say, I don't have to reach for the coffee at 3:00 PM. I don't hit a wall at 3:00 PM. I'm just intrinsically more motivated to get stuff done. I mean, I did a very informal poll on my Instagram. I was like, hey, just wondering how many people started businesses since you started on testosterone? Because women were telling me I've started businesses. And I'm like, is this a thing? Because I have like, two or three patients that have started businesses and starting on testosterone. And so I'm like, anybody else? And I had about eight women be like, yep. And so to me, I'm like, good God, watch it. Watch out, world. But you know,

• 14:07Mindy Pelz?

  Watch out what can happen.

• 14:08Speaker 01

  It's a slippery slope to be like, Dr. Casperson says that you should be on testosterone. So you'll start a business of like, not everybody will start a business. But it kind of gets you like, it puts that energy behind you, right? Like, I actually want to do this. I want to go out and do.

• 14:26Mindy Pelz?

  Yep. I would say the first time in my 40s that I started to really look into testosterone was when I didn't feel like working out anymore. And my background is as a competitive athlete. And I working out was my drug of choice. And all of a sudden, I didn't want to do it. And I'm like, what it was like, I was, that was 10 years ago, I was like, 45. I'm like, why don't I want to work out? Like, this was my, this is cured everything. And now I don't want to do it.

• 14:54Speaker 01

  The thing you love.

• 14:55Mindy Pelz?

  And that's when I, yeah, exactly. And that's when I went into looking at testosterone for hormone as through hormone replacement therapy. It really and sure enough, it was like, all of a sudden, I got off the couch and started working out again. So I can see where businesses would want, people would want to create businesses and do stuff.

• 15:15Speaker 01

  And to me, I'm like, it's very interesting, because in medicine, we're like, let's not study any of this on women, but then let's give it to them. We did that with sleep meds. We do that with high blood pressure meds. We did that with statins. You know, like, we're perfectly fine not studying things on women and then giving them to women. But in the realm of hormones, we're like, no, we don't have enough data in testosterone in women. I'm like, but you do this with all the other meds, first of all. Second of all, we've been giving testosterone to women since like 1942, right? So we've got tons of data and tons of decades. And the other thing is like, why can't we extrapolate the male data? If you take a man with low testosterone and you give him testosterone, his mood gets better, his energy gets better, he wants to go to the gym again. You know,

• 15:56Speaker 01

  it's like, we, it prevents dementia. Like, we know, we've got data, let's use it.

• 16:03Mindy Pelz?

  Yeah. Why do you thi- why do you think that exists? What do you think is behind that? Is it pure patriarchal?

• 16:11Speaker 01

  Testosterone and not letting women have it? Yeah, yeah. I think there's a huge jet, two, I think two things. Number one, I think there's a gender bias in like, being like, well, male bodies have testosterone, women's bodies have estradiol. Like, Google thinks that's how it is, right? Like, it's ingrained. Men are over here with this hormone, women are over here with this hormone, and like, people aren't curious about that. And so it's just very much like, why do you want a male hormone? Instead of like, it's an ovarian hormone. It literally makes women's brains work better. Stop saying only the men can get it. And I think the other thing is, medicine's pretty crappy at women's quality of life. And I think one of the reasons I've been so successful in my advocacy is because

• 16:55Speaker 01

  I'm a urologist. I take care of men's sexual functions and men's low testosterone all the time. And when a man comes in and he's like, I just, my libido's in the toilet, I just, I can't get, I must, like, me working out at the gym, like, I don't have any gains anymore. Like, I just kind of want to go home and scroll on social media. Like, low energy, low libido. What do we do? Viagra and testosterone. We've got options for you. We don't tell him, go get acupuncture, go do more yoga, go eat more organic food. Like, we care about his quality of life and we treat it. And women aren't given that same amount of privilege in the doctor's office. And I think, you know, gynecologists don't

• 17:37Speaker 01

  see how we treat the other 50%. They only treat women. Right?

• 17:42Mindy Pelz?

  That's fascinating. That's an interesting perspective.

• 17:44Speaker 01

  We don't tell men just to put up with shitty sex. Ever.

• 17:48Mindy Pelz?

  Right, right.

• 17:50Speaker 01

  Right? And so I think there's bias in the, like, I'm sorry, you're tired, this is just getting old. You know, there's a lot of dismissal.

• 17:59Mindy Pelz?

  What are your thoughts on the adrenals make testosterone or part of the testosterone making machine? And if a woman is completely stressed out, is her testosterone, are her testosterone levels going to decline?

• 18:12Speaker 01

  Yeah, well, I think, I think we know that in, in all animals. You stress them out and their hormones just don't work as well. But you know, they've looked at this. If you, if you take a woman and you cut her ovaries out, because ovaries are the main testosterone producers, adrenals do some precursors. The adrenals won't make up for that either. And so that's like the other myth of like, you don't really need your ovaries because you've got these other things that can make it of like, not really. We've measured that. They don't like make up for it. So to me, I'm like, adrenals are a piece, but it's not all of it. And we know chronic stress, it's, that's not good for anything. Well, our bodies weren't built for chronic stress, right? We were built for like acute stress and resolution. And I think, yeah, so many people can't get themselves

• 18:54Speaker 01

  out of this chronic stress at this point, and their body takes a beating for it.

• 19:01Mindy Pelz?

  So in that scenario, if, if you are, what I hear you saying is, well, we don't say, hey, you should get your stress under control, come back in, in, in six months. And if your testosterone's still low, then maybe we'll talk about testosterone. What I hear you saying is, well, but what if we go in the other door and we're like, hey, how about we give testosterone? And then your ability to handle stress and regulate your life is, is much better. So you're, you're looking at it through a different lens, using the example of what we say to men.

• 19:35Speaker 01

  Yeah, I mean, I think we should use all tools, right? Like, so men, men's testicles by and large will take them through their lives. They're big, they're bigger than ovaries, right? They've got more factories there. And when a man has low testosterone, we can say, okay, what lifestyle is contributing to this? Is your sleep shit? Are you using drugs or alcohol? Are you chronically stressed? Are you exercising at all? How, how's your diet? And trying to get them to get their body as healthy as it can, your testosterone will can go up. Not all the time, but like, those are the five pillars of testosterone health in men. But you give them a little bit of testosterone, so they can go to the gym, so they can deal with their stress, so they can advocate for themselves, so they can start seeing gains in the gym,

• 20:18Speaker 01

  right? And so it's like this whole like, well, you gotta go through all the natural things first is like, yeah, but we can help people with that, right? We can help people, especially in the, you know, the male testosterone experts are like, give a little bit of testosterone, so he can actually get his ass to the gym, right? And then he can start seeing gains because he's got the, and it can kind of add. So it's this like, this whole like, well, you've got to fail all natural things first is like, maybe, but that's not, it's not always helpful.

• 20:51Mindy Pelz?

  What about do it, what about doing it in conjunction? Like, here's your, yeah, like, kind of, I think about it through the lens of Ozempic. I've spent a lot of time thinking about, you know, the weight loss drugs. And when I first, when they first came out, my thought was, this sounds like a fasting lifestyle. This is what I hear people when they start fasting, like, they lose weight and their appetite goes away and they can't eat anymore. And then, you know, everybody got on Ozempic, and then we were told, oh, but then you're going to need to get off at some point. There became conversations around that. And my brain always goes, why don't you do them at the same time? Why don't you always do them at the same time? And then see where you are a year, two, three years from now, and make that decision?

• 21:31Speaker 01

  Yeah, and I think when you're not, you know, going back to hormones, it's like, if hormones help you sleep, now you can sleep, now you're sleeping, now you can tackle your problems during the daytime, like, it can all just kind of help. And the other interesting thing with, and maybe, you know, you've already talked about this with Ozempic, terzepatide, there's just an abstract on terzepatide and hormones of when you're on testosterone, or estrogen, you know, if we're gonna say any gender, whatever, if you're on your optimal hormone therapy, and your GLP-1s, the weight loss is actually greater. And so to say like, well, you get to pick one, and you got to do that one first, is like, no, the bodies, these are like synergistic, that they're, with

• 22:12Speaker 01

  the terzepatide one, the women lost 35% more weight when they were on hormones plus terzepatide than terzepatide alone. Because what do hormones do? They help your cells function better, right? So it's like, it's all additive.

• 22:26Mindy Pelz?

  So what, what lifestyle tools would you say if you're going to go on testosterone? What would be like, are there any that are like, you absolutely need to look at these?

• 22:35Speaker 01

  Well, I think, you know, one of the big myths with female testosterone is like, you're gonna, I'm just gonna get muscles because I'm on testosterone. It's like, yeah, that'd be nice. It's like, no, you aren't. Like, you gotta eat for muscles and you gotta lift for muscles. And yes, then testosterone will help you. Like, if you're already doing those things and you're like, so many women will be like, I'm just, I'm doing the same thing I've always done at the gym. I'm just not seeing the gains. And then you will put them on testosterone and it takes a while. It's slow. This is not like next Tuesday, you're gonna have a bicep. But they'll be like, okay, four months in, yeah, I'm starting to see that definition that I was working so hard for that now I'm helping. But people will think like testosterone alone, well, if you're not eating for muscle and building for muscle is not going to give you muscle.

• 23:22Mindy Pelz?

  Okay. So, so lifting weights would be one to do with your testosterone. Any, I mean, if we know that DHEA is a precursor to both cortisol and, and testosterone, managing stress, I would think, which is like the worst thing anybody ever wants to hear. But, but we could, it's like, how do you do that?

• 23:41Speaker 01

  Mindset and boundaries and that you're like, that's always the answer. Right. But do you have to get your boundaries locked in tight before we can help you out? Like, no, it's, yeah, doesn't make much sense.

• 23:53Mindy Pelz?

  So are, so are there, is it outside of stress and lifting weights? Is there anything else you can do to facilitate the integration of your exogenous testosterone?

• 24:06Speaker 01

  I don't know. Are you, are you thinking anything of like, what did I miss? I don't know.

• 24:10Mindy Pelz?

  Well, I, no, I, well, I think stress is a big one. Of course, I'm always gonna slant metabolic health. I'm always gonna go, what's your A1C? Because, and this is one of my bigger complaints, probably my, one of my major complaints about just rushing to HRT is that we, what is that A1C? Everything that I have seen comes back to that number. What is that number? And if you can get that number closer to five and you're metabolically healthy, everything we're talking about from, you know, estradiol to, to Ozempic, to testosterone, like we're, all of that works better. So that's the target that I see everybody needs to focus on.

• 24:51Speaker 01

  People need hormones to get the A1C optimized. And we have this in male data, we have this in female data, right? Like, men with low testosterone have higher risk of diabetes. Women with low estrogen have higher risk of diabetes. We've got a randomized placebo-controlled trial of women on estradiol. Thirty percent decreased risk of turning prediabetes into diabetes at one year. Right? So it's like, again, these are molecules that help cells function better. Get them functioning better, you've got a better chance of regulating your metabolic health.

• 25:19Mindy Pelz?

  Yeah. And I've watched millions of people lose weight, massive amounts of weight, and bring that A1C down without the use of... Now, I don't have the studies of all the people and who was using exogenous hormones and who wasn't. But I've been blown away by 70 and 80-year-olds that have lost over 100 pounds by learning how to fast and metabolically switch. So I always come back to N1, see if you're not succeeding, then go and look.

• 25:49Speaker 01

  So important.

• 25:50Mindy Pelz?

  Well, quality of food, for sure.

• 25:52Speaker 01

  Because it's like, you know, for somebody to be like, "Oh, just go on hormones and you can eat pizza." Like, no. You can't. No. You can't.

• 25:57Mindy Pelz?

  Yeah. Yeah. Yeah. So do we have a number that we can track on testosterone? Like, when you're 40, it should be at this level. 45, it should be at this level in women?

• 26:10Speaker 01

  No. There's ranges, but even, you know, we're in America, we're speaking American ranges, just for anybody who's listening internationally. These are nanograms per deciliter, because that's how we measure our testosterone. Number one, you have to, if you're going to check testosterone, check a mass spec lab, because that's good for lower amounts. Your traditional testosterone lab is for male ranges and is not good at measuring things under 100. So again, just make sure you're ordering the female slash child or mass spectrometry testosterone lab if you're going to get a lab checked. But then the other problem with labs, there's multiple problems with labs, but another one is that in America, like Quest Labs is a big lab in our country. Normal goes down to three.

• 26:56Speaker 01

  And so they say, yeah, I love the people who say, normal is a setting on a washing machine. So it's like, there's not a person with a testosterone of three, who if they wanted to try testosterone, I would say, yeah, it's worth a trial for you because just because it's normal on a lab, doesn't mean that that's a normal testosterone where you wouldn't function better with a little bit more. So again, it's the normal, and I see so many people like, my doctor said my testosterone was normal, it was five. You're like, that's low. But the lab says it's normal. But the other thing that's a problem with the labs is number one, it just changes through the daytime, right? So just checking, people will take a lab like it's written in stone, or it's like a Ten Commandment, and they'll be like, this is how it is.

• 27:40Speaker 01

  And I'm like, at 8:00 AM on Tuesday in January, that's how it was. Right. And so, but people will carry that. They'll be like, I'm estrogen dominant, I'm just, I'm low, it's like, at that moment, that's what, right? Like, they're not, they don't understand that the body is this, you know, liquid chemistry kit, right? The other thing that the serum level of testosterone won't tell you is how many testosterone receptors do you have? How sensitive are they? How well does your testosterone get in your brain? Does your brain need a higher level? We can't measure any of that right now. Which is why I really shy away from being like, a 47-year-old should be at a 62. Of like, that is way too simplified. So what we care about is how do you feel? How do you feel of getting side effects?

• 28:25Speaker 01

  Are you within this range that we think is probably a pretty safe, normal range, long term? And that, if you want me to give you numbers, 40 to 150. When you're above 150, I really start seeing people develop androgenic side effects. Not everybody. Some women do better at higher testosterone doses. But I always say, earn that level, and don't go from sea level to Everest Base Camp in one, in one dose, because it feels crappy. Hair hates it. That's where you get like, hair doesn't care so much what your level is, but the delta change. Hair hates drastic changes. So I'm like, earn your higher hormone level, don't take it gradually, slow, slow, slow, slow, slow, slow.

• 29:10Speaker 01

  So that's my long, my long answer to your, hopefully, short question.

• 29:15Mindy Pelz?

  Yeah, I want, I want to go back to the testosterone receptor sensitivity. Do, do we see a very variance in women that some have, are more sensitive to testosterone?

• 29:25Speaker 01

  Well, when you, so this is data that's been done, because this is not something that's a commercially available lab. But the researchers who are looking at volvodynia, vestibulodysnia, so pain at the vulva. So the vulva has a lot of androgen receptors. And they're like, how come some women get volvodynia or atrophy on oral birth control pills and some people don't? Maybe it's the same dose of birth control pill. Maybe it's the amount of receptors that you have in your vulva, right? That are being affected by it. And so you can actually measure receptor, you know, density and how sensitive, but it's not, that's not a commercially available thing. But I bring it up to just explain that a lab number on one day for one person is, I

• 30:10Speaker 01

  mean, it's, there's so much that we don't know. That, that's why I just, I get super cringey when people are like, what, what should my level be of like, how do you feel? And are you getting side effects?

• 30:21Mindy Pelz?

  Right. Right. Okay. And what about the way that we administer testosterone? So like, I, I've been on, in a lot of ladies' nights out where I've got the pellet, I'm doing cream, like, what do we need to know about the, the way in which we get it?

• 30:37Speaker 01

  Yeah. So right now, there's no FDA approved female dose testosterone product. That was what I was advocating for at the FDA. And that's for various reasons. But there will be, probably within three years, that we might, we've got a couple of companies that are going to go forward and it's just going to explode this conversation. Right? Like, it's just going to validate what people are doing and, and hopefully have, start having insurance coverage. Right? Because the insurances will-

• 31:05Mindy Pelz?

  Oh, it's not covered by insurance?

• 31:06Speaker 01

  Some insurances, but their fight will, their, their refusal will say- There's no FDA approved product and insurance doesn't cover compounded products as well. Insurance doesn't cover pellets. Yeah. Right. So it'll, it'll, getting an FDA approved product will be very validating and help provide coverage for people. So it's, it's going to be great, but we don't have, we don't have that right now. So we have several options. What, so what do we do? Right? We can microdose a male product, most commonly test them. It's the male gel. We can microdose an injectable male product. We, there's no patches right now, but there's no patches for men. There is an oral FDA approved dose for men. Like a trokey? Yeah. Oh. Trokeys are compounded.

• 31:50Speaker 01

  So oral that you swallow, but it's specially formulated. So it passes through the lymphatic system because oral is with testosterone is actually toxic to the liver. So these are lymphatically processed oral testosterone medications, FDA approved for men. Some women are taking the smallest dose. Trokeys are compounded. My problem with trokeys that they're very poorly published studies, very few studies on it. And I want to know how much is going through your liver because you're putting it in your mouth. Are you sure it's completely transdermal? What are your doses on it? How long does it last? What's the half-life? It is so poorly studied, used a lot, but I would say we have the least amount of studies

• 32:31Speaker 01

  on that. We have way more studies on pellets than we have on tro, on trokeys. So I tend to try away from, I rarely, yeah. Women, I see a lot of women saying my trokey X, Y, and Z, hair fell out, blah, blah, blah. Like people have issues with it, but it's in, in some corners of the world, it's people use it. I just, we do not have great data on that. You can get a compounded cream. Great, great data on that. Lots of people do that. I, I call the cream idiot proof because you can get like one pump, one dose instead of trying to microdose a male tube, which can be done, but. Compounding, it's just one pump. Then we've got the pellets. The pellets are, have been around for decades. And I think there's two schools. There's the like, I love pellets,

• 33:16Speaker 01

  everybody pellets, always pellets. And then there's the ban the pellets, right? And those people, those people tend to war with each other.

• 33:22Mindy Pelz?

  Yeah, right.

• 33:23Speaker 01

  Those are two camps. I tend to, I did an Oprah Daily article on this. I tend to say, earn your pellet. And what do I, again, what do I mean by that is know that you tolerate testosterone. Know that you might tolerate a higher dose of testosterone. Now say, okay, I like to live a lot higher. I'm not getting androgenic side effects. Maybe switch to a pellet for convenience. But it's the most expensive, the most invasive, and is expensive, invasive, highest dose. So that's your, that's your pellet world. If you go to a person and all they offer is pellets, then you need to know, there's actually a lot of different options, and that person's probably profiting just from pellets. So like, a true hormone provider is going to say, here's the menu. This is why I choose X, Y, and Z for people.

• 34:05Speaker 01

  These are the pros and cons. These are the different costs. There's a lot of ways to get testosterone into the body.

• 34:12Mindy Pelz?

  And you have a lot in your book about how do you talk to your doctor about testosterone? Because I don't want to, we don't want women to leave this conversation, be all excited, and then meander into their doctor's office only to be shut down. So is there a way to talk effectively to our doctor about testosterone?

• 34:31Speaker 01

  Yeah, I mean, the, I, this is a, in general, problem right now. But after the Women's Health Initiative, we have two decades of clinicians that didn't learn how to prescribe hormones. Because the WHO, it wasn't the WHO so much as the media of the WHO said hormones are bad for people. So we stopped, we stopped teaching people how to do it. Right? And now we have 80 million women over the age of 40 getting empowered to be the healthiest they can be. Right? So it's, that's a hormone conversation. And so, the best way, I think, is by calling ahead and saying, does Dr. Jones prescribe testosterone for women? Like, find out ahead of time if it's going to be a friendly conversation. If you already have

• 35:12Speaker 01

  an established relationship with a provider, great. You probably have a better chance than going in cold, not knowing if this person's open to it. And bring them in the international global consensus on testosterone for libido. Because that's really validates and says, it's been around forever. Safety is great. This is how we do it. I have a course in the, from the Heather Hirsch Academy that where I, basically I'm like, I want clinicians to know it's safe. We've been doing it for decades, that we actually have data that says it's effective. And at the end of the day, if you're on it for four to six months and it's not helping you with anything, you could stop it. Yeah, like there's, there's, it's pretty low hanging fruit with a massive safety profile.

• 35:53Speaker 01

  And you know, I said this at the FDA is like, what other drug do we give people 10 times the safety dose and follow them for 50 years and then publish on it and say, the people who took 10 times the dose did well for 50 years. And then we still just don't give the regular dose to women because we're like, I don't know if it's safe or not. Right? Like we do that. We have, we have, there are 30 year and a 50 year trans male data where we give female bodies 10 times the safety dose and they do just fine. Right? And so for people to be like, it's not safe. It's like, we give 10 times the dose to people because they ask for it and they like it and they do fine.

• 36:33Mindy Pelz?

  Mm hmm. And is there anything that women should know once you go on it? Like as far as like, I'll, I'll just share my testosterone experience. When I first went on it and maybe I got, went too high of a dose too quick, but if I, the rage, the irritability was real.

• 36:52Speaker 01

  Too high, Mindy, too high.

• 36:54Mindy Pelz?

  Yeah, I, like, I know. All of a sudden I was like, is this how men feel? Oh my God. But I also want to tell you that the orgasms were through the goddamn roof. I'm like, oh, is this what men feel? Like, there was like, I really had walked around for like a week going, oh, is this how men deal with this hormone? But I didn't like the rage and I found out later it was too high. Anything else we need to know about what we can expect when we get on it?

• 37:20Speaker 01

  Well, I think, I mean, this is what I joke with women is like, there are some women that two weeks on it, they're like, light switch, brain's back on. The one woman said, you know that part in The Wizard of Oz where you go from like black and white to technicolor? That's my brain on testosterone. Right? So it's like, some women are like, light switches and they're like, aha, I'm back. And I'm like, and then everybody else hates those women because it takes longer for everybody else. Right? Like, not everybody gets the light switches. And so to me, I'm like, if you're dosed low and slow,

• 37:50Speaker 01

  It might take a while, right? And libido is a bio-psycho-social thing and muscles take a while to build. And like, it takes a while and that's okay. Don't push it high just so you try to get a light switch. You know, I recently had some women and I'm like, is testosterone doing anything for you? It's been like four weeks. Can you tell? And she's like, I don't know yet, but I did have two days this week where I felt completely invincible. And I'm like, and I'm like, take the win. Let's take it as well. Another woman with with sexual health issues. I'm like, anything with the testosterone yet? And she's like, I don't know, but I had amazing sex last night. My partner actually wrote me a thank you letter the next day. And I'm like, take the win. Right? Take the win. And so like,

• 38:34Speaker 01

  my, my point is it's subtle. Like these were like, clearly these women are noticing that life is a little bit different, but it's not a massive light switch for people. And it's like, to me, that's the perfect hormone. Where it's like, you're just functioning a little bit better, but you're still yourself, right? You're not having these huge side effects. But a lot of people think like, where's the light switch? It's like, that's not how it works when you're appropriately dosed. You're, you're not like, oh my God, I'm angry. Oh my God, my hair fell out. Like, you know, we don't want that to happen to you.

• 39:05Mindy Pelz?

  We don't want that. No, no, the anger's no fun. The, so if you go low and slow, what are you looking at as, as a clinician? Are you looking at, okay, over six months, nine months?

• 39:15Speaker 01

  Four to six months is what the guidelines say. And they're like, if no benefit, you know, decide to take it or not. I mean, there's, there are some women who like, they want to take it for preventative health. Like my ovaries aren't coming back online. I know this helps bone strength. The data on testosterone and the brain and dementia prevention in men exists. It also, like, men with low testosterone increase risk of depression, increased risk of dementia, increased risk of Parkinson's disease, increased risk of multiple sclerosis, like, and their bodies aren't that much different than ours. And how does testosterone work? It's a neurohormone. It helps myelin sheaths. It helps glios survive. It helps our brain. And so some, some women, if they're like, hey, my libido's not all that much better, but like, I actually want to take this because I think long-term, it's

• 39:59Speaker 01

  probably good to have a little bit of this in my body. So, you know, you can decide at four to six months. Like, do you want to stop? Is this worth it for you? Do you like it? You know?

• 40:09Mindy Pelz?

  And once you're on it, do you stay on it forever? Like, is it like something you just keep going?

• 40:14Speaker 01

  Yeah, I mean, I always, and I always tell women to think about it, like, are you getting an ovary transplant? Is the ovary coming back at age, yeah, is the ovary coming back at age 68? Now, interestingly, physiologically, women later in life, in their 70s, there is some data that shows testosterone starts going up again. Where is it coming from? Why is it doing that? We don't know, but it's likely core, the women with the higher, and again, higher physiologic, this is not 10 times the dose, right? Physiologically, women whose bodies make higher testosterone later in life seem to have heart protective benefits from it. So.

• 40:52Mindy Pelz?

  And what makes, what, that's natural? That's a natural state of women?

• 40:56Speaker 01

  So testosterone does not fall off a cliff with menopause, right? There's nothing magical about your last period that makes testosterone drop. Testosterone just naturally starts to decrease from your 20s onward, just slow linear decrease it with, with age.

• 41:08Mindy Pelz?

  Right.

• 41:09Speaker 01

  But there's a hockey stick for some women in their 70s where it'll kick up a little bit. We don't know why, but they tend to have less heart disease.

• 41:16Mindy Pelz?

  Right.

• 41:17Speaker 01

  So, it's fascinating.

• 41:19Mindy Pelz?

  I wonder why the body would do that.

• 41:20Speaker 01

  We don't know.

• 41:20Mindy Pelz?

  Why would the body like kick it into the end?

• 41:22Speaker 01

  The body probably doesn't have any evolutionary benefit to that because we weren't, there's no survival benefit as a species, living to 72 versus 78, right? So it's, there's probably no like grand design, but we don't know.

• 41:37Mindy Pelz?

  Maybe, maybe, maybe the, maybe the modern body is like, hey, you made it this far, we're gonna give you a little, a little extra juice because you made it and you deserve.

• 41:48Speaker 01

  You passed go 72 times, so here's a little, here's a little help. But, so by, to answer the question, by and large, ovaries aren't coming back online. You take testosterone, you like it, you stay on it.

• 41:59Mindy Pelz?

  Got it. Okay, talk to me about libido, because one of the things I loved about the way you write about libido throughout your book, but especially in the testosterone chapter, is that we don't, we don't have clear evidence that there's a direct correlation between low testosterone and libido. Can you speak on that? Because if libido is a mood, you know, we also have the statistic of, you know, 70% of divorces are happening or initiated by women as they go through menopause. And you also, I hear so many women that are like, my libido is horrible and I've been married to my husband for 20, you know, 30 years. I feel like libido needs a rebrand, especially for the menopausal woman.

• 42:44Speaker 01

  I mean, libido is an amazing, awesome, big topic. And that's why I started my podcast originally was started for adult female sex ed. And my first book called You Are Not Broken, Stop Shitting All Over Your Sex Life, is all about the adult female sex ed. Because libido is, and I hated the word biopsychosocial. Like, I hated it. I go to the Ishwish conferences and I'm like, oh, it sounds so PhD and blah, blah, blah. But there is no better word to describe libido than biopsychosocial because it's our biology, it's our hormones. How well are you sleeping? How stressed are you? You know, do you exercise? Do you feel good in your body? How's your, and then so bio, psycho, social. So psycho is like, how do you feel about sex? Were you told it was bad and dirty your whole life? How are you taught about touching

• 43:26Speaker 01

  yourself? How's your body image? What does society tell you? That's the social. What does society tell you about being a woman who's sexual at age 62? Right? How much do you listen to that?

• 43:35Mindy Pelz?

  Yep.

• 43:36Speaker 01

  And who initiates sex in your partnership? And when you have sex, who gets to have the orgasm? When does sex end? When one person has an orgasm? Right? Like, so it's, sex is so big of a topic. That's just, you know, women are like, my testosterone's not working. My libido's not better. Or I'll see clinicians, they'll be like, I gave my patient testosterone and her libido's not better. And I'm like, it's not just testosterone. And by the way, you throw an estrogen patch on some women and they're like, libido's back, thanks. Like, estrogen's also a great libido drug. It just doesn't have the stereotype that testosterone has. And so to just think that sex is one thing, our sex life does not exist in a vacuum.

• 44:17Speaker 01

  It's incredibly complex and everything matters with it. Right? And which is why, again, in Instagram, you can't even say sex. So I say intimacy a lot, which you

• 44:28Mindy Pelz?

  Oh, you get, oh, you get nailed for saying sex?

• 44:30Speaker 01

  That's another reason why we don't

• 44:31Mindy Pelz?

  You get like shut down?

• 44:32Speaker 01

  Like many sex, like legitimate sex educators have been gotten kicked off that platform. You can be like mostly naked and that's fine. But you, but you can't say like, this is a clitoris, this is a vulva. You know, when you talk about sex.

• 44:45Mindy Pelz?

  I, that's crazy.

• 44:47Speaker 01

  I mean, yeah, which is another reason why we don't like calling them sex hormones is because number one, you get kicked off Instagram, but number two, like it diminishes the hormones as just for sex and there's, it's so much more. So I think, you know, I, and I say I work really hard to, to make my clinic really easy, but like by and large now, women have listened to the podcast, they've read the book, they come in understanding all of that. Because to, to take a woman who doesn't understand clitoris and orgasmic equality and, and responsive desire and like all these pieces that are so important and she just thinks it's a medication. Well, guess what? You put her on a medication and she fails the medication because she doesn't know all the rest of this. And now you're a medication

• 45:32Speaker 01

  failure. So now you feel way worse about yourself, right? Is like, get a sex educate, we didn't get a sex education, or if we did, it was a shitty one. Right? And so I don't think it's hormones for everybody, but for some people, they need their hormones back because hormones affect dopamine, which affects sex drive and blood flow. You know, like blood flow to your pelvis, easier orgasm, better arousal. Like these are vasodilators, right? So it's like sex is so complex, which is why it's so awesome, but that's why it takes so long to talk about it.

• 46:07Mindy Pelz?

  Right. And, and the, the thing that I see in my community the most is you've got a lot of women who've been married a really long time. And if you go to like Esther Perel's teachings, which I think are fascinating about, yeah, like the novelty's gone. You're like, oh, you again? And so there, you know, if you were to put reinvigorating a woman's sexual desire in her 50s, as she's been married to somebody for 30 plus years, would, if you could put a protocol together or a package together, what would that look like?

• 46:42Speaker 01

  Well, first, treat any genital urinary syndrome, syndrome of menopause, GSM, previously called vaginal atrophy, right? Like if it hurts, you will not desire it. That is 101, that is basic math. You do not want to hit your thumb with a hammer. Like you have to fix any sort of pain, right? As women will come in, they'll be like, I have two problems. I have low desire and I have pain with sex. And I'm like, good news. You have one problem. Nobody desires pain with sex, right? So I like, I like to take away as many problems as I can from people. Cause they're heavy backpacks that people carry. I like want to take the bricks out. So like fix the pain with sex first, and then you have to break the pain fear cycle of like, is it gonna hurt again? Right? That's sex therapists are amazing. Um, pleasure. Orgasmic inequality is real.

• 47:27Speaker 01

  If somebody's having a better time at the party, they're gonna want to go to the party more than the person who's like, the, the food's kind of shitty over here. Why should, why show up? Right? So in that part, my education in learning about it, you know, people talk about women's desire, women's desire, low desire, fix the desire. And I'm like, you're assuming they're having good sex in the first place. And they're, and they're, and they'll be like, yeah, well, yeah, we're assuming they're having good sex in the first place. And I'm like, what a male centric view you took on that, right? Of like, you don't desire mushy broccoli. You don't desire boring movies. You don't desire the same old, same old. Like you have to have sex worth desiring for desire to be there.

• 48:10Speaker 01

  Like dopamine is released on the pursuit of something rewarding. If it's not rewarding, no dopamine release. So, you know, I think everybody focus, right? We should all be talking about sex. It's very important. We should be prioritizing women as much as men, but we focus so much on women's desire, forgetting that they're eating Chef Boyardee when the partner, if especially if they're male, is eating at a five star Italian restaurant. Right? And we're like, well, he, he desires Italian. Why don't you like Italian? And you're like, it's fricking cold Chef Boyardee again. That's what's on offer. Like fix the menu. And it's, it's hard to do because people are like, well, what do you want? Women don't know, they don't know what they want. They've never been allowed to desire before.

• 48:56Speaker 01

  Right? And so it's very hard to say, what do you want? When you're like, I just thought chicken was on the menu my whole, my whole life.

• 49:04Mindy Pelz?

  Yeah.

• 49:05Speaker 01

  Right? And you're like, well, there's actually a lot of other things on the menu besides chicken.

• 49:11Mindy Pelz?

  Yeah. Have you seen, surely you've seen, I think it's called Hello Leo Grand? Oh, that is such, is that what it's called? It's such a good movie. Because it, yeah, it shows what a woman who loses her husband, she's in her 60s and she's never had great sex. And she's like, I want to experience this. And it's such, they did such a beautiful job with that movie. And so I, I hear you, like, I, I've had a lot of these conversations with women in my life. And one of the things that I hear a lot of women say is, I, I just don't desire it like, like, I'm not locked and loaded and ready to go.

• 49:47Speaker 01

  Of course you're not.

• 49:48Mindy Pelz?

  You need to, you need to emotionally connect to me. My, I, one of my favorite interviews here on my podcast with, with Dr. Zach Bush. And he said, if, if you want to have sex with a woman at night, you need to have foreplay at breakfast.

• 50:01Speaker 01

  And the problem is that women think they're broken over that. Instead of being like,

• 50:06Mindy Pelz?

  That's right. That's right.

• 50:07Speaker 01

  That's normal. That's human. That's you're having a human experience. You think you're asking for more or asking for too much.

• 50:14Mindy Pelz?

  Yeah.

• 50:14Speaker 01

  No, it's not asking for too much to feel connected for, and here's the interesting thing. Two people living in a house, apparently having sex with each other for a very long time. This person has sex to feel connected. This person needs to be connected to have sex. They have no idea they're living with each other.

• 50:29Mindy Pelz?

  Yep. Yep. Yeah. Talk about that a little bit because that's what I heard that, I mean, I'm just really straightforward. That, that was the, when I heard that statement, I went right, right to my husband and I'm like, here's the deal. If you, in order to feel like I want to have sex, we're, we're going to have to talk about emotions and feelings. And, and it's really, really true in our relationship. So just, I think that's such an important point. Can you talk a little bit more about?

• 50:54Speaker 01

  Yeah. I mean, I think, you know, we, again, we didn't get good sex ed. So we didn't get taught how to talk about sex. Literally, everybody thinks they're going to die when they talk about sex with their partner. It's like, no, they, they all like, I didn't die. I'm like, oh yeah, because you don't die talking about sex. But it's like so fearful of like, oh my God, right? But it's like, dude, talk about it now. Because there will always be bumps in the road. There'll be health issues. There'll be stresses. There'll be, you know, dry times and there'll be pain because of menopause, whatever. Talk about it now. Talk about when it's good. People love knowing what they're good at. Like this is a pro move from my friend, Juliana Hauser, who's a sex therapist. She's like, ask your partner what you're good at in bed.

• 51:36Speaker 01

  And because like, because everybody loves hearing what they're good at, and then you can say what they're good at. Yeah. And so I like went home from that. We did a conference together. I'm like, that's it. That's a pro tip. So I went home and, and I'm like, what am I good at? And my, my husband told me what I was good at. And I was like, no shit. Really? Like, we've been together for 20 years and I didn't know I was good at that. Right? And then they're like, you don't know what, you don't know what you're good at. So it's like, it can be like, Yeah. fun. Like, just talk about it. Right? And then the other question is, what does sex mean to you?

• 52:06Speaker 01

  Right? What do you get out of having sex? And usually the answers are very different. And that's okay. They're, you're two different people. Right? And the other myth about desire is that is a couple has to be matched in their desire. And it's like, dude, you don't like playing tennis as much as your partner does. You don't like oatmeal for breakfast as much as your partner does. It's like, you guys aren't matched and everything else, and it's not a crisis. Right? But like for sex, we think, like by default, it is unmatched. But what's good for the relationship? What does the relationship need? And then everybody else can either take care of themselves when, if it's more than what their relationship needs. Or they can say, you know what? Their relationship, it's, this is important to the relationship. So I'm going to prioritize it.

• 52:47Speaker 01

  And I think the other thing that you had brought up is like, women think because of Hollywood, again, bad sex ed Hollywood. Like, we're not light switches. We, we can't go from executive, you know, Enneagram eight, running the day to like, open, relaxed, safe, welcoming, present moment. Right? Like when you have an orgasm, the frontal lobe literally turns off. Like it's, it's, it's dark in the MRI machine. And so it's like, if you're planning it like tomorrow, yesterday, this, this at work, lunch for the kids tomorrow, blah, blah, blah, blah, blah. Like you literally have to turn the frontal lobe off to get into your pelvis and be where an orgasm can happen. And that's not a light switch for people. Like that's, you know, learning how to regulate your nervous system.

• 53:32Speaker 01

  We could all get better at it, but it helps with sex. There's books published on this mindfulness for better sex. So women thinking they're broken because they can't just like, hey, you want to have sex? Yeah, let's do it. Like, that's not how it all works.

• 53:48Mindy Pelz?

  So if you have a male body and a female body and you just take all life experiences out of the picture, are both bodies meant to desire sex the same way?

• 53:59Speaker 01

  That's a good question. Um, prob- probably not. Again, you, you can't in this, in this awesome grand experiment, you can't take socialization out of the person of like,

• 54:09Mindy Pelz?

  I know, I know.

• 54:10Speaker 01

  Men have to hold their genitals to urinate starting at age two, right? Like they're just intimately more familiar with their genitals than, and then women are told, don't touch your genitals, ever. Right? So even then biologically, one's more familiar with genitals than the other one is, let alone how you are socialized, what a good girl does, what a man's supposed to do. Like, there's so much socialization in this, you can't pull that out. But testosterone's at 800. I mean, again, ask the trans population. Libido changes with very high testosterone. And it going strictly evolutionary, sex is expensive for a woman, right? Death, one in eight childbirth without, without modern

• 54:53Speaker 01

  medical care, right? Like, it's, it's risky, it's expensive, it's vulnerable. And in a man, he's like, I, he doesn't have any of that. His job's to get the genes out. And that's, that's stereotyping, but that's where some experts are like, yeah, biologically, there's different scenarios going on. It will always be a bigger burden on the female body because that is the, that's the Ferrari that grows the human, right? The Honda's a Honda, Ferraris are Ferraris. And there are wonderful variations within all of that. And for anybody who thinks I'm over gender stereotyping, I apologize. But

• 55:28Mindy Pelz?

  That's okay. I, I've been, I keep saying that the woman's body is like a sophisticated violin and a man is like a kazoo.

• 55:35Speaker 01

  I love it. I go Ferrari and Honda because it's like Honda, nice resale value, you know, reliable, not a effing Ferrari. And Ferraris take more maintenance, but it's a goddamn Ferrari. Like, you know, it creates life. So

• 55:51Mindy Pelz?

  So is it a, it's more biologically expensive, but is it a myth then that women have less of a libido than men?

• 56:00Speaker 01

  Yeah. I mean, even if you look at stereotypical heterosexual couples, the stereotype is that the man always has the higher libido and about a third of cases, that's not true. So even in the modern where, you know, where you can't, it's, they've got different hormones and they've got different socialization and still in that, a third of the women have more, a higher libido than the male does. Right? I think another big stereotype is that it's more difficult for a woman to orgasm, or it takes longer, or blah, blah, blah, blah, blah. Like, women masturbating? They know how to, they know how to have an orgasm. There's this fascinating study looking at bisexuals. And then, again, this is going along the orgasm gap and who's allowed to have an orgasm and, you know, blah, blah, blah. So this is a bisexual woman, same body parts, right?

• 56:45Speaker 01

  They had her sleep with female versus sleep with a male and rate of orgasm. You put a male in the room, orgasm rate goes down. Same body. Same human.

• 56:55Mindy Pelz?

  Hmm. Okay, what happened?

• 56:57Speaker 01

  Who's allowed to have the orgasm? Who has the orgasm first in a penis and vagina sex? Right? Penis and vagina sex, just penis and vagina sex. That's a very successful way for a penis to have an orgasm. That's not a very successful way for a female to have an orgasm. You need clitoral stimulation. But if you've got no sex ed and it's just Hollywood, guess what sex is to you? Penis and vagina sex.

• 57:22Mindy Pelz?

  Well said. Do you think, do you think the porn, the uptake of porn has hurt that, that perception that we have? Or do you think that?

• 57:31Speaker 01

  Yeah, cuz that's our, cuz that's our sex ed. And I love, this is, I did, I did not come up with this and it's effing brilliant, is like watching Fast and the Furious and thinking, that's how you drive a car?

• 57:42Mindy Pelz?

  Well said. Oh, my God, that's so good.

• 57:45Speaker 01

  That's highly produced. Right? And then that's what porn is. And we know, like, the people who study this, like, first of all, body image and what I'm supposed to look like, right? Porn's damaging for everybody. That, that this is how female bodies orgasm. A performance anxiety, feeling like sex is a performance. Right? So there's a, it's like, a lot of things have changed since the onset of on-demand video on your phone. Like, porn used to be very difficult to come by. And now it's, it's almost difficult to not come by it. Unintended, but um, so yeah, it is like, you know, I talk to people who are, you know, health counselors at universities and stuff and like the man will come in and he's like

• 58:29Speaker 01

  despondent because his penis doesn't work like it does in the porn movies. You're like, no, you, you have a healthy, normally functioning body. You're just, you're watching the Fast and the Furious and thinking that that's how sex is, right? And that's not how sex is. It's just, it's very produced to usually get the male body off as quickly as possible.

• 58:50Mindy Pelz?

  Wow. So what about the movement of, and the upswing of people announcing that they're asexual? And we're seeing that in the younger generation, but I see that a lot in menopausal women. They're just like, I'm just not interested. Like peace out. Is there any kind of, like, what, what, what do you think of that? Like, is there environmental impact? Are we all just so stressed out that our libido went down? Are we not having cell phones? Oh, because, okay.

• 59:18Speaker 01

  Well, you're always on and you're always checking something, right? You're always out of your body. Like sex is a very embodied thing. Like you have to be present and it actually takes work, right? Where do we get our dopamine from now? Right? Mint, mint, chocolate chip Haagen-Dazs and like Instagram, anybody? Right? Like it is easy to get dopamine without any exertion, right? Where you're like, dude, even a hundred years ago, like, sex was the best time you could have, right? There's things that are better than sex now.

• 59:48Mindy Pelz?

  Such a good perspective.

• 59:49Speaker 01

  There's a crazy study. It might be by a cellphone company, but there's a crazy study about how many people actually check their cellphone during sex. Like, like, I would hope that was close to 2% or less. Like maybe you're on call or something, but it's not, it's not 2%. It's much higher than that. I admit, I don't want to misquote it, but it's way higher than you'd think. I think it's like 20% of people check their cellphone during sex, or at least have at least once. And you're just like, yeah, that's going to make an orgasm a lot harder, my friends. But

• 1:00:19Mindy Pelz?

  And what do you think, like with this movement of people that have, I think that's such a brilliant about the dopamine, but this movement of people that are asexual.

• 1:00:26Speaker 01

  Let's get back to that.

• 1:00:26Mindy Pelz?

  One of the things, yeah, one of the, no, just one of the things I've been thinking about is that if your body was designed to do it, you create, you should crave it like thirst and hunger. And we put it all in that category.

• 1:00:38Speaker 01

  That's Freud, that's Freud.

• 1:00:39Mindy Pelz?

  No, okay.

• 1:00:40Speaker 01

  So Freud said, Freud said that libido is appetitive, which I love the word appetitive and I love saying it, but appetitive means appetite driven. Which if you're, if you don't have water, you'll get more thirsty. If you don't have food, you'll get more hungry. If you, if you don't have enough sleep, you'll get more sleepy. For many people, you don't want more sex the less you have it. It's by definition, not an appetitive drive. But Freud said it was, and so a lot of people continue to think it is. Now for some people, they do think that, right? But not for everybody. The less you have it, the less you're like, I forgot how good that was. I don't remember, right? I got Haagen Dazs and YouTube, right? And so, so the sex therapist, because I asked this question to some sex therapist friends and I'm like, how do you, how do you tell?

• 1:01:26Speaker 01

  Have you ever liked sex or been sexual or that's one question they'll use. So say it's a 55 year old woman and she's like, I'm asexual now. First of all, validate them. That's real for them right now. But did you have a good sex life? Were you a sexual person? Did you enjoy it versus never have I ever wanted to have sex? That's one way that people will kind of break that apart. But to me, like what happens in perimenopause and menopause, 40 to 60% of people don't feel like themselves. Well measured. So we got half the population not even feeling like themselves. Which is, you don't really want to have sex if you're not feeling like yourself. You feel awful, right?

• 1:02:04Mindy Pelz?

  Yeah, of course.

• 1:02:05Speaker 01

  You're disembodied. You do not feel like yourself. Your sleep is shit, right? And so to be like, I'm asexual now, like, or there's a lot of things going on, including genital urinary syndrome of menopause, changing hormones. That affect sexuality. Doesn't mean you're, today you might not want to have sex and that's validated and I believe you. But it might be because of something else other than the fact that you are an asexual person, because sex doesn't exist in a vacuum. And I've seen too many people go from like, I could take it or leave it to like, best sex of my life. Not that I can help everybody, but I've had too much of that now to be like, sex is not a fixed state, my friends. Right? Like, it could change.

• 1:02:49Mindy Pelz?

  And what's, what's the cost to the body if it doesn't have sex? Is it, is there a long-term, if somebody's just like at 40, they're like, boom, I'm out, peace out, I'm not, I'm asexual. Obviously, you miss out on the orgasms and the oxytocin and you miss out on the pleasure. But like, do we see a decline of health if somebody has, makes a declaration that they're asexual and they don't have sex?

• 1:03:13Speaker 01

  There's some data, it's male data, we don't have this in women, because we care about women's sex lives less. But there's some data that men who have orgasms live longer. Now, remove, how do you remove the orgasm from a loving partner who's at home with you, who's eating meals with you, who's socializing with you, who's getting you to bed at the same time, who's taking you to the doctor?

• 1:03:34Mindy Pelz?

  Yeah, you can't.

• 1:03:35Speaker 01

  Like, you can't. And so, you know, you'll, you're, your Instagram clickbait of like, orgasms will make you live longer. I was like, ah, I can't suss out that data. From living in community also makes you live longer and having a partner, having a partner who prepares nutritious meals, who also sleeps with you. Right? So, I get, I get very protective. I'm an Enneagram eight, I'm very protective of women and I get super cringey when anybody's like, tell them why they need to have sex for their health. It's like, choosing to have sex is a healthy behavior. Helps people sleep, it boosts your immune system. Orgasms are really great for bonding, like, it's great for relationships. It's probably really good for your pelvic floor.

• 1:04:15Speaker 01

  You know, there is like, it's healthy, but I'm never in the position of saying, you should, you need to, you have to. I get very cringey, when, again, when people should all over people's sex lives. It's like, if that's not where you are right now, cool. Learn about sex, learn about how your body works, because we're all lacking good sex ed. If your relationship, it was a sexual relationship and it's being threatened now because sex is different, that's worth addressing.

• 1:04:43Speaker 01

  Right? Like, address that and start learning and exploring. Like, I really think sex ed and learning about it as a midlife person, it's the final frontier of personal growth. I'm gonna learn boundaries. I'm gonna learn to say no. I'm gonna learn to communicate about hard things. I'm gonna try things and maybe not be great at them. Right? I'm gonna learn how to be a better listener. Like, everything that makes sex good, just it's a tool that you can use anywhere in life. And in the other, I think the big myth is people are like, if only I had desire. And it's like, well, yeah, if only I had desire to work out, and if only I had desire to eat vegetables, and if only I had desire to go to bed at the same time every day of like, we do things because we want them in our lives, not because

• 1:05:22Speaker 01

  we have spontaneous appetitive drives for them. And if you look at the experts, Peggy Kleinplatz did a book called Magnificent Sex, and she basically was like, who here has great sex? And people were like, I have great sex. And she's like, great, can we, can we interview you? So she interviewed these like self-proclaimed, like, my sex life is great. And she's like, what makes that? Nowhere in the top 10 is desire for sex a reason why these people have amazing sex lives. Right? I can communicate. I prioritize my sex life. I try new things. I'm okay with failing. You know, it's like, all these things that make a great sex life when like Hollywood and, you know, your, your first boyfriend told you like, desire for sex was everything. It's like, it's not, it's not everything.

• 1:06:07Mindy Pelz?

  Mm hmm. Yeah. Oh, so well said. So let's finish up on, tell me about your new book. I, I mean, I luckily, I got a, I got an advanced copy and I've read it and it's, I, here's, as an author, I just want to say, I love your conversational style. Like, you know, this is the first live conversation that I've had with you, but I felt like I was having conversations with you throughout the weekend as I was going through your book. So like, I got a, I got a real feeling for what your personality was like, and I, and I loved that.

• 1:06:37Speaker 01

  Did you know I was an eighth before you read the, the final page of the book?

• 1:06:41Mindy Pelz?

  I mean, I could have guessed it, but I'm on the so here's the funny thing. I'm an acknowledgement fan. I think if you want to know an author, read their acknowledgements. It's like they pull back the curtain and they say, here's the team of people that helped me. And this is how I wrote this book. So I read every acknowledgement. So I don't know, I was maybe three chapters in. And I was like, I wonder what she said in her acknowledgements. And that's where I found the

• 1:07:04Speaker 01

  eight. Yeah, thank you. So this is the second book. This is the menopause moment mindset hormones and science for optimal longevity. I wanted to this is the this is the 2.0 like I feel like the 101 of menopause has been written at this point. And I really wanted people I wanted to give people the receipts. Because I'm as much as I agree with people when I say we do need more data on female bodies, I think we're at the point of like, let's use what we have because we actually have a lot. We just don't know it and we're not using it. And so this is the like 201 of like, these are the receipts. And I'm not here to tell you what to do. I actually don't care. I don't care. I don't care if you take hormones or not. I don't care because it's yeah, I'm not living your life. But I do care desperately that you have

• 1:07:47Speaker 01

  the information to make an educated decision and to advocate for yourself if you want them.

• 1:07:53Mindy Pelz?

  Mm hmm. Yeah, I would say it is a 2.0. I mean, if you're are you saying that Mary Claire's is 1.0? I feel like there was. Yeah, there's a lot. We should say there's a lot of 1.0s. But but it's it's dense with information like that was also my takeaway. And I just want to point that out to my followers. Like, I just really was like, wow, there's a she she really put a lot in here. And

• 1:08:18Speaker 01

  And how much you have to leave out, you know, you write books of like, how much data you're like, I didn't put that in. Of like, this is not everything. But it's enough for people like I'm so sick of people being like, we don't have any data on women and testosterone. I'm like, Good God, we've been giving this to women for 80 years. You know, like, I just I want people to have the receipts to fight back against what we were told out there.

• 1:08:42Mindy Pelz?

  Yeah, yeah, it's beautiful. Well, how do people find your book?

• 1:08:45Speaker 01

  Anywhere they want to Barnes and Noble, Amazon on I have a book page on my website that has mom and pops for people who don't want to use the the main retailers for it. And it's Kindle, it's audio, it's hardcover, and it's international. So September 16 for America, September 18 for Canada, UK, Australia, New Zealand.

• 1:09:05Mindy Pelz?

  Not that anybody's counting.

• 1:09:06Speaker 01

  Right? Like so far, so far.

• 1:09:11Mindy Pelz?

  It's just a little behind the scenes. It's a great day because everybody gets it in their hands and it's a very vulnerable day.

• 1:09:18Speaker 01

  Yeah, it is. It's like, here's my baby. I hope, don't tell me it's not cute. I hope it's cute. I think it's cute.

• 1:09:24Mindy Pelz?

  Oh, my God. I always say that putting a book out, and I've put five of them out now, is like putting naked pictures all over the website and being like, what do you guys think?

• 1:09:34Speaker 01

  I know. Yeah. Leave your review here. You're like, oh.

• 1:09:37Mindy Pelz?

  Yeah, exactly. Exactly.

• 1:09:40Speaker 01

  Thank you.

• 1:09:40Mindy Pelz?

  Well, I love this conversation. Yeah. Thank you for everything you're doing and everybody go grab the book.

• 1:09:45Speaker 01

  Thank you so much.

• 1:09:47Mindy Pelz?

  Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends and let me know what your biggest takeaway is.