354. Building Companies, Busting Myths, And The Power Of Hormones

Welcome to the You Are Not Broken podcast. I'm your host, Dr. Kelly Kasperson, a board-certified urologist, thought leader, and conversation starter on midlife living, hormones, and sexuality. Enjoy the show. Hey, everybody. Welcome back to the You Are Not Broken podcast. Today, we're going to talk to my friend, Joanna Strober, who is huge in the menopause world because she is changing a lot of people's lives. Joanna, thanks for coming to the podcast. I'm very excited to be here. So we're going to talk like all the halves, a third maybe, a third business, a third empowerment, a third menopause, because I want to get into the story of like how you are running this massive company that you're running. People don't just come out of the gate running massive companies. There's always a buildup. So can you tell us your story on like your career and how you got to... And for anybody who doesn't know yet, she runs MIDI. M-I-D-I Health, which provides hormone therapy to hundreds of thousands of women at this point. About 25,000 a week. 25,000 a week. So Midi takes care of a town of women every single week. That's like a large stadium of women every single week. And we're just getting started because there's 80 million women over the age of 40. And as of the last data collection, only about 5% are on hormones. we're working to change that. So tell us how, how did you get to helping 25,000 women a week with hormone therapy? Yeah. So God, if you had said we would get here, I'm not sure I would have believed you a few years ago, but we started MIDI a few years ago and only less than four years ago, but we knew that getting insurance covered care for menopause was incredibly difficult for a whole variety of reasons. And my co-founder Sharon and I had experienced trying to get people to give us appropriate menopause care. And we both ended up using concierge doctors, which is great. But what we realized is that there was a huge need for insurance covered menopause care and also for a huge need for education for providers who could provide this care. So we started with a pilot. It was actually really fun. We went on Facebook and we did a pilot and we had two providers and we recruited about 150 patients. and we said we will take care of you for free for three months and we will get you your hormone therapy we're going to include testosterone we're going to include weight loss we're going to include all the different things that women need in midlife and we're going to take great care of you and during that process you're going to give us feedback and you're going to tell us what we're doing right what we're not doing right how we can improve this to be a great consumer product for you and at the end there was this panic when we said we were done and they said no you can't go away we don't have any place else to go to get this care. And that was really our aha moment that we were building something that the world needs and that women would appreciate. So we went out and we spent the next few years really trying to train expert providers to do this care and also to get insurance contracts throughout the country. So for us, our key differentiator is that we believe women deserve this care covered by insurance. And so it's taken us years, but we now have about 70 million women who are covered by insurance contracts that we have, and we're working on more. But we are getting the country to be covered so that we can offer insurance-covered menopause and perimenopause care to anyone who wants it. Absolutely love it. People who listen to the You're Not Broken podcast, they're educated, and a lot of them are clinicians. But for anybody who's been living under a rock, physicians, nurse practitioners, PAs, prescribers, they didn't learn for the past two decades because of the Women's Health Initiative. And so it's changing quickly, I think. But even if... This is the numbers game again, because it's shocking to say the numbers out loud. We've got 1 million physicians. I think they all need to be trained in menopause care because this is 50% of the population. 1 million physicians, about 300,000 nurse practitioners. Even if all of them get trained, it's not enough because so many women are outside the system and haven't gotten care, even if you trained everybody to know about it, it's not enough. We need your platform because even when everybody is trained, it's not enough people to take care of all the women. Because people are like, you want every woman to be on hormones and we can chat about that. And I'm like, I want every woman to be educated enough to make the decision. And it would be nice to go back to the 1990s because in the 1990s, 40% of women were on hormones safely. And so to me, I'm like, even if we got to 40%, which is really just getting back to 30 years ago. Well, I joke about that menopause math, right? I mean, the reality is, and we can talk about it, I believe about 90% of women over 40 should be on hormone therapy. So the menopause math is actually pretty disconcerting. If we have less than 5% on it now and over 90% should be on it, that's a huge care gap that we're addressing. No, it's absolutely huge. You've got a lot of work to do, but you've come a long way in three years. Yeah, we're scaling fast. A lot of it is making sure we have expert providers. So we have to do a lot of training. People come to us not trained in how to do this. They don't have any understanding of the complications and the intricacies of providing hormone therapy when it's appropriate, when it's not appropriate. Too often they come to us saying no too often. So they have been trained to say no. You had breast cancer. No. You had a stroke. No. You had a blood clot. No. So you're 10 years and one month past menopause. No, no, exactly. So most of them have been trained on no. And our goal is to get them to yes, as long as it's safe. So we think of it as a getting to yes training system to understand when yes is appropriate and then make sure that anyone who is eligible for these medications are given to them. What I say when I talk is the word hormone. It's a very large tent, right? So there's so many things under the tent, testosterone, progesterone, systemic estradiol, vaginal estradiol, DHEA for the vagina. Like there's so many things under the tent, synthetic, not synthetic, patches, creams, gels, blah, blah, blah, blah, blah, the whole thing. It's an apothecary. I joke we have an apothecary. It's a huge tent. So for people to say you can't have hormones, I'm like, what you're meaning by saying hormones isn't what I think when I think about hormones, which is like this large tent of options instead of like oral synthetic estrogen is what people usually say when they say they can't have hormones. So you're not a doctor. How fast did your education have to be? Because you're very savvy when you talk to the doctors who are trained. We're like, yeah, yeah, we don't have to catch you up. How did you get your education in this to the level of like, you can talk with the experts at a level where we're like, oh, right, She's not a doctor. Thanks for reminding me. I mean, the good news is there's a lot written about this, right? So I start with books. I have a whole lot of books sitting here on my counter, starting with Estrogen Matters, but I have a whole lot of books. I have your book sitting here. I have lots of books. I read lots of books and read lots of research. And then what we have is at MIDI, we have a complex care channel. And so when there are complicated patients that come in, the NPs can come and write questions to the doctors. And then we have doctor experts on the back end. So for example, Dr. Mindy Grossman, who's an expert in cancer, she will come and read the cancer channel and say, oh, this woman had breast cancer, but it's been five years and this and this, and she is actually eligible for hormone therapy. So I've had the ability to read these things for the past four years. So I've really been very enmeshed in, I would never say that I'm a doctor, but I have, I've learned the protocols and I've learned most of the questions are pretty repetitive at this point. And so I can, there's not so many different ones. Were you interested, because you were in business and had companies before this, were they health oriented or was your own perimenopause menopause journey, the reason where this came from? Like what was the like, aha and seeing this need? So for me, it was actually, so before this company, I actually started a company called Curbo Health, which was a, the first digital therapeutic for childhood obesity. And I learned doing that company, how well you could use digital help to provide a solution, that you didn't need in-person care in order to help children lose weight. You could use an app and a remote coach, and that could be as impactful. And we proved that it could be as impactful as in-person programs. So I sold that to Weight Watchers. And after integrating that company into Weight Watchers, I had extra time. So I started looking at the weight loss medication space. And I basically said, look, Weight Watchers, you have this big issue coming. weight medications are coming and you should be paying more attention to this. And so while learning that, that's when I learned how to set up a national healthcare practice. I learned how to get medications sent to people's houses. I learned how to basically set up this national care practice. Turns out I was ahead of my time. I thought I actually had good support from the company to do this. And then eventually it got to the board and the board completely shot me down. And they said, you're turning us into pill pushers. We're a behavior care company. We are not a medical care company. And that's when I quit. But what I had realized is that I could take all of that learning and turn it into a menopause company, which was much more interesting to me than just being a weight loss company. And now, I mean, I don't follow this, but isn't Weight Watchers like getting on? Menopause. Yes. Yeah. Yeah. Weight Watchers is like, oh, wait, we lost that person. And she was actually the visionary. Yes. They first realized they had to do medications and then they're realizing. I mean, the truth is Weight Watchers audience is hormonal and is prairie menopause. So it makes sense for them to go into this because what I've learned is that women's health between 40 and 60 is essentially hormones and weight. Like a lot of those things are related. And so, you know, I don't think you can take care of weight without thinking of hormones and vice versa. Well, we have data and I think there will be more and more, but we have data that when women are on both, they're more effective. They're complementary. So to say like, we're just going to do one or blah, blah, blah, is like, at the end of the day, the body is an integrated system. And when you give it more tools to work with, it tends to work better. So less muscle loss and more adipose tissue loss when you're on hormones and GLP-1s compared to either one alone is what the, for people who don't know the data that I'm talking about, those are the papers that I'm saying. And men have it too for testosterone and GLP-1s. So it's all bodies work better when you've got both on the plate. We are absolutely seeing that. And we were one of the first menopause companies starting offering GLP-1s. And it was because we saw that the weight loss, when you combine the hormones and the GLP-1 was the best. Yeah. Yeah. It's winner, winner. A lot of this is slow stuff, right? And Americans tend to like fast fixes. And when women, you just give, like, they get a little bit of like, aha, something's working. You're more likely to stick with it. Truthfully, like creating the healthy lifestyle and lifting weights and seeing that change, it does take a while. And so you want to tell people the truth, but also let them start seeing a win. This show is sponsored by Midi Health. When we experience perimenopause, menopause, and midlife issues, we feel unheard, dismissed, and unserved by the traditional healthcare industry. And here's the powerful truth. It's time for a change. It's time for MIDI. MIDI is not just a healthcare provider. It's a woman's telehealth clinic, founded and supported by world-class leaders in women's health. MIDI is leading the way by providing expert, personalized, insurance-covered virtual healthcare for women in midlife, empowering us to thrive and experience our second act with vitality and confidence. Ready to feel your best and write your second act script? Visit joinmidi.com today to book your personalized insurance covered virtual visit. That's joinmidi.com. Midi, the care women deserve. Now back to the show. You know, the other thing that takes a while is research And it one of my bugaboos I have to say People are always saying well I want to wait for the research And if I have to wait for the research that demonstrates 100 that hormone therapy presents Alzheimer's, I might be dead. Yeah, yeah. Or at least you'll be having Alzheimer's. I'll be having Alzheimer's, yes. So I'm very much thinking about how we look at early research, smaller studies, really spending the time to go out into the early research instead of waiting for the final research to come out because it just takes too long to get the right information. Yeah. Since you're going there, let's talk about that. So I think the naysayers who say, we don't have enough data to say the hormones for prevention of Alzheimer's, what they're saying is we do not have a 30-year randomized placebo-controlled trial showing significant benefit for hormones and decrease. So that's what I think they're saying when they say we don't have enough research because to me, I'm like, if you talk to the people who know the data like you do, like I do, if you look at basic science data, how neurons work, how hormones work to protect glial cells and myelin sheaths, how estrogen helps glucose metabolism in the brain, right? So if you take all this data, how hormones help people sleep, how sleep protects you from dementia, right? Like how hormones, I'm like, I'm just giving people the laundry list of like, this is why, I would add how estrogen prevents diabetes, which affects the brain. So it's like there's a laundry list of once you understand how this stuff works, we're like, oh, well, add in Dr. Lisa Moscone's meta-analysis. Let's add in the male data with low testosterone. You just add on this pile, you're like, listen, maybe I'm wrong. But in the meantime, I'm protecting my bone, helping myself sleep, preventing diabetes. Likely, it's all the things that lead to dementia. And so to me, and I think, I don't know if you've seen this too, is like the end of this year, I think the beginning of 2020, the news media on hormones preventing dementia, it's getting loud. And so to me, I'm like, I think we're on the right side of it. And I think in a year, in two years, we're going to be like, listen, we don't know for sure, but man, it's neuroprotective. man it's metabolically protective man it helps you sleep which prevents dementia like that's what we mean when we say likely hormones prevent dementia but like you have to have a podcast so you can actually like dispel all of that down did i miss anything that you'd like to add of of why we think hormones prevent dementia no i just feel like i just need to be yelling it from the rooftops yeah i feel like when people yell and if i was to yell on i broke the internet one day when I said that the brain eats itself after. It was not my best clip. So when hormones go down, the brain can't utilize glucose. So the brain needs ketones. So where does the brain get ketones from? From the white matter of the brain. So it starts to catabolize, which is breakdown, which is what our bones are doing, which is what our muscles are doing, which is what our skin is doing. It's what our vagina is doing. Is anybody surprised that the brain does this also? Right. Yeah. So I think that's the interesting issue. And, you know, one thing that actually makes me really sad, Kelly, is how many people say to me, I'm done with menopause. They say this all the time. They'll say, oh, I like your shirt. Menopause is hot. I'm so glad I'm done with that. Like, you're not done. I don't know how to like say to them, you're not done. Like you actually, you're 53 years old. There are real benefits that hormone therapy can have for you. You're not done with aging. It's almost like saying you're done with aging, like saying you're done with menopause. So one of the things I'm actually trying to really explain to people is that, yes, you should get treated in peri and yes, you should get treated in post. And none of this, like I'm too old to get the treatment because the hormones are showing, you know, really good efficacy, both with the brain stuff, but also with the bone stuff and the heart. So that's something else I've been trying to get people to stop saying is that I'm done with that. I think that would be good marketing for midi because it'd be like midi because you're not done because you're not done. That's exactly right. It's so uplifting too. And I think people say that because they do not understand fundamentally what menopause is because the word menopause is no more periods. And with that comes hot flashes, right? So they're like, I don't have hot flashes anymore. My periods were eight years ago, so I must be done. And we're like, you don't understand you're fundamentally outliving ovarian hormone production. That's what the truth is. That's right. So we have to change that. We have to change that whole dialogue. I feel like that's my mission is to change the whole dialogue. I really am trying to kind of yell about these things and get people to understand them better so that we have a different discussion about this. And it's the same issue with people thinking that menopause equals old ladies. If you think that's what menopause is, employers certainly don't care about helping with menopause because they think all those women are gone and society just cares less about them. So trying to show young vital women in perimenopause and menopause so that people understand that it's not an old lady thing, I think is actually really important. Yeah, totally. On the other end of you're done with menopause, which you're not, you always have low hormones as long as you choose to live past your ovarian function, is the you can't have hormones yet because you still have a period. Right. Another crazy one. Completely random. Yes. You can't have hormones because you have like blonde hair and you need glasses. Like having a period is irrelevant to actually what your hormones and your ovaries are doing. And the level of hormones that your body needs to produce a period is actually quite low, right? So by the time your periods end, you really got low hormones. Yeah. So it's another thing, right? Or just doctors will only prescribe birth control pills and they won't prescribe hormone therapy. So there are a lot of misconceptions we need to be getting rid of. I think in the next five to 10 years, hopefully, God bless, hopefully five, we're going to start treating perimenopause way more than we are now. And I think we're going to start treating 10 years post-menopause a lot more. Because the more and more I read and I break down the data on the risk of a transdermal estradiol patch in a 72-year-old, there ain't a significant risk compared to... Look at all the other drugs 73-year-olds are put on. Name a drug that is more safe in a 73-year-old than a transdermal estradiol patch, I would argue vaginal estrogen. But besides that, it is damn safe. No, I think that's right. So we have to just get rid of all these misconceptions. And I think, I mean, people like you, people like us, that's our job is to really... But what we have to do really is get women to look for this and demand it. This is going to be a movement demanded by women. It's not going to be a top-down movement. It's very much a bottoms up movement of women saying, I deserve better care and looking for that better care and then the market responding and giving it to them. So that's really the approach that I'm thinking of. It's not led by the government. It's not led by the medical organizations. It's going to be very much led by women who are looking for better care. Yeah, absolutely. I mean, women ask me all the time. They're like, how do I have this conversation? What do I do? What do I do if my doctor doesn't want to. And very often I say, go to the online companies where this is their job. This is their job. This is what they do. They're a warm audience. You want a warm audience when you want to present your pitch for this. And that's what's so great about your company is like, this is what you do. You don't have to be like, I hope they're good. Do they prescribe hormones? No, you prescribe hormones. Medically appropriate. You're going to evaluate everybody's risks and benefit differently. It's still healthcare, but you're like, we know the data on hormones. You don't have to teach us that part. No, that's exactly right. We need to know women's bodies and we need to understand women's bodies really well. And then we can give you the right medical advice because we understand how women are different than men. And as we know, women were not even included in research studies until 1992, right? So there's just not enough research out men versus women's health, but our job is to do that research, to learn the research and then educate our providers on that research. Yeah. I mean, the exciting thing that's going to come out of the big companies is your data, I mean, your data sets. So many, and so many wins. And especially, you know, what I'm excited about is like, what do we not know? What are you going to be able to pick up that we haven't picked? What else is this helping with? You know, like all of that exciting stuff of like, when you look, you're going to find stuff. That's so exciting. What are some of your, like when you hear, when people send you feedback and wins, like what are some of your like favorite wins that you get from women. Quince is all about elevated essentials that feel effortless. Designed for layering and mixing, each piece helps build a timeless wardrobe made to last. 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I mean, I could just read you the things that came in today. we have this channel of kudos that come in and people basically saying that they usually we save their marriage we enable them to go back to work lindsey was great she was able to get me started quickly on my plan she was informed and i feel like she really heard me and genuinely wanted to help they go on and on and on it's pretty it's pretty remarkable i mean honestly you don't need to know this but the reality is once you get someone on the right medication they feel better very fast. And then they're kind of amazed how fast, right, that they're feeling better and how much better they spent, right? I mean, this person says, this person has so many great things to say about how Mitty changed her life. We were teary at the end of her call when she recapped the last year of her journey. Another one, I feel incredible and recently received a promotion at work. I couldn't have done it without Mitty getting me back on track. I mean, they just come in all day. It's really, it is very rewarding. Thank you so much for sharing those. And to me, I'm like, yeah, Joanna, I know. That's why. Exactly. For the people who don't know, like the wins, and this is what I always tell people, like I gave up surgery to make high functioning women be high functioning again. That's my job. Make smart women function again because the wins are so big. It's insane. I'm like, what do you fix somebody with surgery? You're like, don't get me wrong. Taking a kidney stone out, that's a big deal. You're turning their life around for sure. But the wins that you get when you get women to feel like themselves again is absolutely insane. I just want to follow up with a woman yesterday. It was my first follow-up. The first time I saw her, she was ready to quit her job. And now she's like, oh, yeah, no, no, no. I'm good. Exactly. That's exactly right. That's what I think. I feel like my job is that I save marriages and I save jobs. And mental health. We save mental health. Yeah, definitely. A lot of women just present with anxiety, right? and they were never anxious before. And they find that it's debilitating. I had a woman who stopped vaping when we got her hormone doses dialed in because she's like, I just don't need it anymore. And it's like, I feel like society, where we are, we look at the general population and we're like, some people are just anxious and some people just need to vape. And so we're so used to just being like, that's how you are. And we've lost our curiosity of like, what could we do to make it a little bit better? I think that right Particularly for women I think I mean I just think there is some misogyny about this And I think women have just really been told that if you suffering it just okay And I don really understand that but I feel like that is just a big part of our society. When you think about it with giving birth, right? Like the pain that women feel has been part of that. I think accepting women's pain has been, and accepting women's aging has just been something that is just par for the course. And when our eyes go bad, we get glasses, right? Why is it that we have not thought about the same for women's bodies? And instead, we've just been very willing to accept the fact that they are just less important as they get older. And maybe that's why we don't need to take care of them. Yeah. Hearing aids, eyeglasses, teeth, shoulders, hips, knees, heart valve, take out the appendix if it bursts. If you need insulin, give it to you. If you need thyroid, give it to you. But don't replace your ovaries. It becomes this one exclusionary organ when you you look at it like that, you're like, that doesn't make any sense though. Yeah. So I don't understand that. But it's really clear to me that has to change. And that's going to come from women. It's going to come from women demanding better care. And that is just, it's not going to come from the government. I mean, we can talk about this. The government's trying to pass these menopause bills and that's not going to be the answer. It's going to have to come from women and it's going to come from women demanding better care. And that's how the change is going to happen with women basically showing up at their doctor's office with your book and saying, I would like to do what Kelly Casperson says. That's how the system is going to change. And I feel really strongly about that. It is going to be driven by women being proactive about their care. Yes. And when I was doing my book tour, I came upon something that now I repeat because it makes a lot of sense. Culturally, we've got two waves hitting each other. We've got the millennials. The millennials, because they're like, how do we tell these young people about what's going to happen? And I'm like, that's important, but let me tell you something, they're paying attention. They're watching, right? So these millennials are watching the Gen X, they're watching the boomers and the millennials are coming up. They're like, hey, I've got a new idea. How about we don't suffer in the first place? And then the Gen X and the boomers are looking at the millennials and they're like, oh, what an idea. So let's start the hormones earlier. Why are we waiting for bone loss before we try to replace bone? Why are we waiting for depression and anxiety? Why are we waiting for diabetes to happen? Why don't we not suffer in the first place? So that's this big cultural wave that's happening. And it's hitting this big cultural wave called the medical system as it currently is. And I'm like, you got these two waves that are crashing on each other right now. And I know who's going to win. The millennials are going to win. And every time I say that with an audience, people are like, damn straight, blah, blah, blah, blah, blah. It's like, dude, they're demanding change. They ask a great question. Why suffer? right we're like oh it seems why didn't we think of that like we're like why didn't we think of that yeah well look and we look at our old ladies like you know you see old ladies who are crunched over and i feel so sad about that right that they weren't given things that could have helped them or told they should do weight lifting or told about hormones like there's so many things that could have been done that you don't end up like that and so you know i'm sure that the younger women are looking at women like us going i don't want to end up like her yeah yeah we'll totally because like you know like they're like why are you bitching about something that you can do something about right well i think about this like when i get off an airplane and i see the women have to have help to get into a chair to be pushed like they're and they're not independent right and my mindset has changed just in learning about this instead of like that's how it is that's how it's gonna be now my mindset is why did nobody help her why didn't she go get help if she knew like it doesn't have to be like that. And I think that's the culture changes. We're like, we're watching enough old people do it default. Like what it looks like if you aren't proactive. Default sucks. And I think it's, you know, that's the concept of longevity, right? But I think it's female longevity is just how do we live healthier, right? It's not so much, I'm not trying to live longer. I just want to not be that woman in the wheelchair. I want to run after my grandkids. Like I want to have energy and live a vibrant life. And so what can I do? I think a lot about this, like what can I do in my 30s, 40s, and 50s so I can live the life that I want in my 70s and 80s? And that's a lot of what menopause care is, quite honestly. Oh man, hormones is female longevity. And I say this over and over because I don't think people understand it. Hormones help healthy cells stay healthy. Yeah. So that's the ultimate longevity medicine for women. And I really believe that. The ultimate longevity medicine. The other huge bias, I think, is in medicine, we study blood pressure medications on men and then give them to women. We study sleep meds on men and give them to women. Study antidepressants on men, give them to women. But with all of the decades of testosterone data in men, we're like, but now we need individual woman data before we can give you any testosterone. And I'm like, that doesn't make any sense. And furthermore, that's massively expensive. It's not going to happen. Understand how testosterone fundamentally works, which is neuronal support, muscle support, bone support. It's a brain neurohormone. The fact that we're on the internet is like, its primary job is male sexual characteristics. I'm like, well, male brain, it's brain. The stereotype is so profound with testosterone. Tell me about your journey with that and where... Did Midian from the ground up say we're always going to start trying to do testosterone. Why bring it in when so many people think menopause care is just an estrogen patch? So what was interesting about testosterone is that, I mean, the world has really changed just in the last few years. Maybe not you, but overall, the research wasn't there for more than libido a few years ago. So initially, when we started offering testosterone, right now it's in 12 states. It will be in 30 states starting in January. If they deregulate it, we're actually holding our breath because we think they're close. Okay. Well, we're going to find out, but by the time this comes out, we'll know who's right or wrong, but I am not optimistic. Oh, this is good. But regardless, because right now you understand, just for the audience to understand, it's a DEA regulated substance, which is crazy. Because of a sport doping. Because of sport doping scandal in 1990. Yeah. Not because it was dangerous to the general population at general population doses. No, it's ridiculous. But because of that, it's incredibly difficult for telehealth providers to do it. We've figured out how to navigate in 12 states. We're working. We're going to have 15 to 20 more states in January. But boy, this has been an insane amount of work. Maybe Kelly's right, and we will not have had to do it, but we'll find out. Joanne is such an optimistic, optimistic, energetic person that I'm like, oh my God, I'm more optimistic than you on this one. This is wild. I'll take it. I know. But the research, even if you look at the protocols we wrote four years ago, we were only talking about testosterone for libido. But the research is really emerging, often from Europe, showing that there's many more benefits of testosterone, that there's some mental health benefits to it, that there's bone strength benefits to it. So it's exciting to see that emerging research. And so we are now retraining all of our providers on this new research. And this is what I say, like, you know, yes, it's not FDA approved for women. Proven? No. Is it 100% proven? No. But again, we'll all be dead by the time that proof comes out. But the research is good enough that now I feel really good about saying there are other things that we can be offering it for. And since there's no downside, as long as you test your blood levels, it's worth trying. Yeah. I'm going to go out on my plank on this one, because if you read the male data on the risks of low testosterone and the risk of depression and dementia. And then you think that doesn't apply to female brains. Neurons are fundamentally the same people. We've got rearrangements in different ways, but the neurons function fundamentally the same. We've got the same building blocks. So this is my argument going back to the dementia. It's the number one killer of women in Australia right now. It's quickly, likely by next year, will be the number one killer of women in the UK. America's headed that way. Two-thirds of dementia people are women, devastating psychologically, but certainly financially, no good cure, no good treatment. So that's the argument. Okay. And now you're telling me there's something that's cheap, fantastically safe, has data in men that it decreases the risk of depression and dementia. And we're not curious about this. It becomes a fool's errand at this point because I'm like, tell me again why this doesn't make any sense to anybody. I do want to make a pitch for the shingles vaccine. There is good research also on the shingles vaccine of helping prevent dementia. Really exciting new research. It's exciting because of decrease in inflammation. Is that the mechanism? But it looks like so if you're over 50, you should be getting that shingles vaccine. Inflammation is bad for the brain. Yes. Right. And that's the same thing with GLP-1s could be. So it's all interconnected, right? Our bodies are so connected. And it's I think part of the problem is the health care system has said, oh, here's a brain doctor and here's a bone doctor and here's a, you know, it's not all seen as a one body. Well, and I think the other problem that medicine did is they said, and I think that, you know, they started doing this like really 20 years ago. So they're like, the gold standard is a randomized placebo controlled trial. That actually is true in certain circumstances, but it's like for long-term things, for preventing disease, for like, there are so many things we do that don't have randomized placebo controlled trials. For example, exercise. We're never going tell anybody, hey, you're the group that we don't want you to exercise because we got to see if exercise is actually good or not. And exercise can cause harm sometimes. You can get hurt. There are risks to exercise. So to me, I'm like, there's plenty of things we recommend that don't have randomized placebo-controlled trials. So for people to die on that stake, I'm like, you're just willing to say status quo is acceptable? Yeah. So I think that's the really interesting thing. If it doesn't harm you, why not try it? And so what I've tried to do at MIDI, and this is like my and our philosophy, not just my philosophy, is give women access. Stop saying no. Stop being a gatekeeper. If women are interested in things, whether it's testosterone or hormones or, you know, we're looking at things like samoralin and other peptides, like give them access to what they'd like to try. See if they feel better. If it's no downside, why not? Why should we stop people from getting something that could actually make them feel good or can prevent them, you know, from getting sick in the future. And it's just a different way of thinking about medicine. But I think it's a very empowering way of thinking about medicine. And I think it is what women deserve, which is access to the best solutions. And then they can choose whether they want to take them. Ultimately, it comes down to body autonomy of like, listen, if I want to eat four sticks of butter every day, people can tell me that might not be the wisest thing, but my body, my choice, I'm going to eat four sticks of butter every day. And with prescriptions, it does require a partnership with somebody who can prescribe. And I learned in medical school, so it's like 25 years ago, shared decision-making, shared decision-making. And every time women's health comes up, it's like we forget about shared decision-making again. It's like this is supposed to be a partnership. It's supposed to be let's try it, come back, adjust, see how you do. It's not a black and white open or closed door. And so often women's health is treated like a black and white open and closed door. That really is one of our top beliefs at MIDI is in shared decision-making, autonomy and shared decision-making. I think that is key. We talk about breast cancer patients who come to us, right? And some of them are really suffering. And if it's been some number of years post-breast cancer, we're willing to give them hormones. And we think that's a shared decision you can make together. So I think that is what is really important. You shouldn't just be told no, you should be given options. And I don't know that to me, that is certainly what I'm trying to empower women to get. Yeah. With breast cancer, it is again, culturally having to change medicine because what's medicine rewarded for? What are all the studies for? How long can you live without having this disease come back? No matter if you get divorced, have to quit your job, can't get off the couch, hot flashes are so bad Like these women their genital urinary syndrome of menopause is so bad they can wear pants right and so it like we completely lost the humanism in the like don do anything that might affect our statistics or don do anything that might affect the breast have you noticed that like the breast is the like you know everyone's so worried about the breast the breast is important i'm not downplaying that and breast cancer is terrible but like they're you women are more than their breasts like we really are our whole bodies and i think that's really important yeah and i will stereotype and i don't mean to but the average post breast cancer survivor will come in and wonder about hormones and we downplay her suffering. We just don't think her suffering is ever bad enough. And I'm like, who are we to judge? Who are we that are the litmus test that say they aren't suffering enough? It's not like these women are like, I am perfectly fine. Can I have hormones? I have no issues. Can I have hormones? Like these are profoundly suffering humans and we've lost the humanism in healthcare because of us saying nobody wants their breast cancer to come back. And breast cancer is stupid and evil and it comes back super late. And I hate that about it because it makes this all difficult. But like we've lost the human part of caring for humans. Yeah, I think that's right. I had just last week I was at a party and there was a woman came to me and she started she came hugged me and started crying. She said, you know, I had breast cancer 10 years ago. No one would give me hormones. I thought my life was just over. I couldn't have a partner. And she said, and Mitty did give me hormones and it has changed my life. And she started crying. And I was like, oh, you know, that's my job. I'm so lucky. Why do we treat women like they're stupid? I mean, you're very, very smart. And I think I'm near the top of the bell curve on some areas of intelligence. Like we're really smart people. It's like, why do we assume that women are stupid? We know we're smart. It's so incredibly true. One of the other myths I know that we wanted to bust was, how long can I take these hormones? Do I have to stop at a certain age? A woman came to me, just to elaborate on this point, and she said, I hear this all the time on my Instagram. My doctor said, I shouldn't start hormones because I'll have to stop them at some point. Isn't that horrible? Which we don't say about anything else. Don't get married because you might get divorced. Don't treat your blood pressure because someday you might not need the blood pressure. Like we don't talk about that with anything else. It's this really weird thing we say about hormones. It's just, as far as I can tell, you're the doctor, but wrong. You should never go off of your hormones because they're keeping your bones strong. And so why would you ever want to go off of them? And I don't actually even understand why they think you should go off. And I think the Menopause Society has changed its position on that. But I tell women, I'm going to die with my patch on. And I don't know why they would ever stop taking it. Yeah, I always tell women, And we've got the menopause guidelines on our side because it says yearly benefit outweighs risk. As long as benefit outweighs risk, you can continue. That's what the guidelines say. So to me, I'm like, the guidelines are on our side on this one. You can take it to the grave. And I always think I've got to find these people for my podcast or we need a documentary on these people. So when the WHI hit, about 20% of women stayed on their hormones. And now it's been 25 years and some of them are still on their hormones. They have fought and found doctors, and the doctors retired, and they moved towns. These women have stayed on hormones through hell and high water, finding somebody who will do it back in the day when the culture was so against it. And so now these women are 84 years old. They're in their 80s. And I thought I was like, is it just me? But my friends say this too, when they walk in, we're not perfect, but we can tell. We can tell you're on hormones, right? There's this vitality. There's this speed of movement. There's this effervescence of energy. They're not worn down. So my point is, and I tell this to women, I'm like, go find an 84-year-old who's been on hormones ever since menopause. They exist. Go find one. Ask her what she thinks about stopping hormones. People tell me all the time they can tell who's on testosterone. Women, right that there's like a certain look of women who are on testosterone and they look a little happier than everyone else they're starting they're starting the businesses i have so like my rough study is i know eight people who've started businesses since starting testosterone and people are like you can't tell you can't say women to start and i'm like uh well women have told me they've started businesses because they got started on testosterone i mean i've heard like they definitely feel really good and you know feeling really good enables you to do a lot of things. I mean, I think that's the bias. I'm a sex med doc. I help people have better sex. And I hate that testosterone has gotten stereotyped as libido. I think there's at least eight issues with that. But number one, there's how the body works. You don't have this secret organ that's just for having sex and it's one inch big and it's on the left side of the... It's insane to be just for libido, like it's just for your left thumb. Libido is a motivation, which is a mood. So when people say it doesn't help move, but it helps libido. I'm like, you just said two opposite things. You don't get to be right in all of those things. It's not how it works. It's why are they starting businesses? Why are they rebuilding their deck? Why are they getting a project done? Why did they ask for a promotion? It's a motivation towards something. This is a neuroendocrine drug that is a motivating thing, which is hard to study and it's hard to x-ray. It's like, how do I know Joanna isn't motivated today? I have to believe her when she tells me that. So what are all of our myths today? There's no absolute age limit. You can start in perimenopause. You're not done with menopause ever. You're always low hormones. I think the big myth is you can't start after 10 years. Oh yeah, that's a big one too. That is absolutely based on initial WHI data. Because even if you read the 2004 New England Journal of Medicine paper, let alone the 18-year follow-up paper, right so even time-adjusted whi people did not do poorly hardly at all so and that was oral synthetics i just think that we're looking at the wrong data when we say women over the age of 10 years post-menopause can't be on hormones plus hormones is a big tent yes there might be less benefit doesn't mean there's not any benefit and so again it's the risk-benefit analysis that every woman should get to make for herself that's exactly right yeah and shared decision making and body autonomy. All the things, what do you think the biggest challenge is for a company like yours looking into the next year or two? Certainly, it's not a saturated market. No, right. We're just getting started on this. The way I think of it is what Midi is building is a healthcare home for women. And we want to make sure that women have a place to go for all of their women-oriented things. And I start thinking about hair loss, and I start thinking about aging skin, and I start thinking about postpartum issues. There are a lot of different areas that we want to go as we build out this health care home for women. The biggest challenge for us is actually finding and training great providers. So we have a very extensive training process and we do a lot to try to make sure that everyone gets really good care. But that's a hard challenge for us because, as you mentioned all the time, women were not trained in this earlier. So we have to do the training. And a lot of providers come to us with the old information. So we have to retrain it, right? They've been told no hormones after 10 years. You know, they've been told a lot of the old rules that we have to get out of them. And that's hard. And so my pledge is that we get all of those providers to be experts in women's health and then make sure that everyone gets access to great care. And that's really what we're working hard to do. I love it. I love it. I couldn't thank you more for solving this problem. So this is what I say when people talk to me about like, what do I think about the online companies and blah, blah, blah. And I'm like, I call online hormone clinics mass transit. And I'm like, we need mass transit to solve. Going back to the menopause math problem of like, we need mass transit. I have a concierge clinic. We cannot concierge our way out of this problem. I think concierge is good for certain things. Mass transit is going to actually move the needle on this. I think the reality is the healthcare system is what it is. Like the healthcare system pays a lot more for procedures and surgeries and complex care and specialties than it does for this type of care, which means that the healthcare system itself is not going to build more of this care. It is not financially incentivized to do so. So no healthcare system is incentivized to hire a whole lot of menopause providers because for that slot that they have a doctor for, they will make so much more money on cancer care, so much more money on surgery. And so we need new incentives. And what we've realized building MIDI is that because we don't have to have in-person care, because we're able to license people in multiple states, we can actually build a business that works and that can provide this type of care in a way that in-person cannot build a business that, a scalable business that works. So absolutely, the concierge is great. And if you can afford that, that's fantastic. It's just not easily accessible for everyone. It's not going to solve the problem. So what we need to do is build a new healthcare system. And we need to build a new way of people getting healthcare. And that's really what we're thinking about is our thought is that we become the first trusted brand for women's health. And we're building a national trusted brand for women's health, a healthcare home for women. And that national company will be able to take care of a lot of women. If you need in-person care, we will always get you there. We will always make sure women get their mammograms, they get their colonoscopies, they get their DEXA scans, they get their blood tests. We'll always make sure that if you have cancer, which we're diagnosing every week, we get you to a great cancer doctor. But essentially, there's this layer of virtual care for menopause that this is the best business model to solve that. And that's really what we're doing. You're so inspiring. You are a visionary. You're Weight Watchers loss for sure, but women's gain for sure. Like, thank God, you know, you're like, you're like, these people aren't moving fast enough. I know what I know what the future looks like. Like, let's go get this done. Honestly, I'm so lucky to get to do this. I feel extremely lucky every day. Oh, I know. It's the best show. Like, I came home yesterday. My mother-in-law and my father are in town and they're like, how was your day today? And I'm like, it was the best day. Like, it was just a day of wins. You know, it's not everybody that gets to say that. It's so rewarding. Ah, well, thank you so much for joining me. This is a blast. I hope you had a good time, too. Thank you. This is really fun. I'm such a fan. Ah, well, the feeling's mutual. I'm like, look at what she built, people. We must talk about this. All right. Until next time. Great. Thank you for listening to this week's episode of You Are Not Broken. If you want to dig deeper with me, sign up for my adult sex education masterclass, where you learn adult things like communication skills, anatomy lessons, and desire types, and how to talk to your doctor about sexual health concerns. 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