Solving the Testosterone Mysteries with Dr. Kelly Casperson

On this episode of the Resetter podcast, I am bringing you Dr. Kelly Kasperson. 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 on the warning updates that go on the packaging 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 the libido? And I think this was the most important thing I wanted to bring to you 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 discussed 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, trokies. 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 them. So if 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 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 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 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. So I want to start off with the testosterone mystery is what I'm going to call it. That I feel 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. Well, let alone the if I add a fourth thing, the regulatory burden, yeah, and the availability of options and the DEA, right? Like there's just hurdle after hurdle with testosterone. It's, do they not want us to have testosterone? Is that the problem going on here? The burden of proof of safety within the FDA is a much higher burden of proof for female bodies and 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 months safety data, male testosterone had six months safety data. We actually have four year safety data on the intrinsic patch, which went up around 2004 female dose testosterone. So that's 20 years ago now that 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 big like, Oh my God, hormones kill people was still they know that took about 20 years to get over. A lot of people still don't know hormones don't kill people. But so we don't bet 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. 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 the female. Thank you. Jesus, Lord. So yeah, yeah. The weakness 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, then estrogen, we just make 10 to 20 times less than male bodies and testicles. So that's like the and I just want to point out something you just said is testosterone helps make estradiol. And you can't you can't get estradiol without testosterone. 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. 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 as it's interesting. It's very interesting because we take 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. Because I think that's a myth is 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 its only job was to sit in the ovary and make estradiol. Right. So 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 mean? We're using the testosterone is going to the testosterone receptors and you actually have to push testosterone pretty high to get a lot of it to convert over. 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, because that's the other myth, testosterone only helps you with menopausal symptoms because it's converting to estradiol. That's another myth. We'll be like, 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 or those studies are very useful in kind of challenging 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 is doing its own thing. One of the things it does is convert to estradiol. But 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. Yeah. Large enough to push it over. So okay. So tell me what, what testosterone does in the body? All the miraculous things it does. So testosterone is a hormone just like estradiol is 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 are 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 flow goes up because it's a vasodilator. So it 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? And they could, 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 social media. Yeah. So I did, 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 give them testosterone and their brains light up everywhere, right? Of like, yeah, libido, libido is multiple areas of the brain. And that's why it helps mostly because it just makes you feel more like yourself is one of the big things. Yeah, I love how you in your book, you use talk about how libido is mood. It's a mood. It's a mood. 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. 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 is a mood and we have an international consensus on testosterone and 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 yourselves, 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. 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. Can't measure that. Like, 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, right? 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. 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. Is there a hierarchy of different aspects of the brain that we know? Cause so if libido is a mood, motivation is, I would say a motivation is more of an energy. Right? I was going to say, I won't even know. It is energy. Women will say, I don't have to reach for the coffee at 3pm. I don't hit a wall at 3pm. 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 started businesses. And I'm like, is this a thing? Cause 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, watch out what can happen. It's slippery slope to be like, Dr. Casper, and 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. Yeah. I would say the first time in my forties 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, 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 has cured everything. And now I don't want to do it. Yeah. The thing you love. And that's when I, yeah, exactly. And that's when I went into looking at testosterone for 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. 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 into 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, it's like, it prevents dementia. We know we've got data. Let's use it. Yeah. Why do you think that exists? What do you think is behind that? Is it pure patriarchal throne and not letting women have it? Yeah, yeah. I think there's a huge, I think two things. Number one, I think there's a gender bias in being like, well, male bodies have testosterone. Women's bodies have eschewed dial. Google thinks that's how it is, right? It's an 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 man 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 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 let my libidos in the toilet. I just, I can't get muscle 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 see how we treat the other 50%. They only treat women. Right? And so to me, I'm like, we don't tell men just to put up with shitty sex ever. Right? 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 is a lot of dismissal. 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 levels going to decline? Yeah. Well, I think, I think we know that 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 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. Our bodies were built for chronic, right? We were built for like acute stress and resolution. And I think so many people can't get themselves out of this chronic stress at this point, and their body takes a beating for it. 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 six months. And if your testosterone is 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 much better? So you're, you're looking at it through a different lens, using the example of what we say to men. Yeah, I mean, I think we should use all tools, right? Like, so 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'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 and 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, right? And so it's like, this whole like, well, you got to go through all the natural things first is like, well, yeah, but we've can help people with that. Right, we can help people with it. Especially in the, in the, you know, the male testosterone experts are like, give them a little bit of testosterone so we can actually get his ass to the gym. Right. And then he can start seeing gains because he's got that and it can kind of add. So it's just like, this whole like, well, you've got to fail all natural things first is like, maybe, but that's not, that's not always helpful. What about doing it? What about doing it in conjunction? Like, here's your, yeah, like kind of like, I think about it through the lens of ozempic. I've spent a lot of time thinking about the, 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 or two, three years from now and make that decision. Yeah. And I think when you're not, you know, going back to hormones is 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, terzepotide, there's just an abstract on terzepotide and hormones of when you're on testosterone or estrogen, you know, if we're going to say any gender, whatever, if you're on your optimal hormone therapy and your GLP ones, 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 a terzepotide one, women lost 35% more weight when they were on hormones plus terzepotide than terzepotide alone. What do hormones do? They help your cells function better. Right? So it's like, it's all additive. 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? Well, I think, you know, one of the big myths with female testosterone is like, you're going to, I'm just going to get muscles because I'm on testosterone. It's like, yeah, yeah, that'd be nice. It's like, no, you aren't, like you got to eat for muscles and you got to 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 going to 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 the 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. 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 testosterone managing stress, I would think, which is like the worst thing anybody ever wants to hear. But we could, but we can only do that mindset and boundaries and 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. So are there is outside of stress and lifting weights? Is there anything else you can do to facilitate the integration of your exogenous testosterone? I don't know. Are you thinking anything? Like what I miss? I don't know. Well, I know I will. I think stress is a big one. Of course, I'm always going to slant metabolic health. I'm always going to 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 estradiol to ozempic to testosterone, like we're all of that works better. So that's the target that I see everybody needs to find. Some 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, 30% decreased risk of turning pre-diabetes 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. 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 N1C if you're not succeeding, then go and look. So important. Well, quality of food. For sure. For some of you, I would just go on hormones and you can eat pizza. Like, no, you can't. 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. No. There's ranges, but even in, 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 check. 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. 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 or NSE. 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. So just checking out, people will take a lab like it's written in stone or it's like a 10 commandment and they'll be like, this is how it is. And I'm like, at 8am on Tuesday in January, that's how it was. Right. Right. And so people will carry that. They'll be like, I'm eschewed and dominant. I'm low on testosterone. At that moment, they don't understand that the body is this liquid chemistry kit. 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? Are you getting side effects? 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 C level to Everest Base Camp in one in one dose because it feels crappy. Hair, hair hates it. That's where you get low 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 so gradually, slow, slow, slow, slow, slow. Yeah. So that's my long my long answer to your hopefully short question. Yeah, I want to go back to the testosterone receptor sensitivity. Do we see a very variance in women that some have are more sensitive to testosterone? 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 vulvodynia vestibulodynia, so pain at the vulva. So the vulva has a lot of androgen receptors. And they're like, how come some women get vulvodynia 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 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 mean, it's there's so much that we don't know that that's why I just I get super cringy when people are like, what should my level be of like, how do you feel? And are you getting side effects? Right? Right. Okay. And what about the way that we administer testosterone? So like, 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 way in which we get it? 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 Oh, it's not covered by insurance, 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 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 micro dose a male product, most commonly test them. It's the male gel. We can micro dose an injectable male product. We can there's no patches right now, but there's no patches for men. There is an oral FDA approved dose for men like a trachea. Yeah. Oh, trochee is a compounded. 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 lymphatic reprocessed oral testosterone medications FDA approved for men. Some women are taking the smallest dose trochee are compounded. My problem with trochee is 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 transformable? 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 on that. We have way more studies on pellets than we have on trochee. So I tend to try away from I rarely, yeah, women, I see a lot of women just saying my trochee X, Y, and Z hair fell out, blah, blah, blah. Like people have issues with it, but it's 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 call the cream idiot proof because you can get like one pump, one dose instead of trying to micro dose 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, everybody pellets, always pellets. And then there's the band, the pellets, right? And those people, those people tend to war with each other. 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. These are the pros and cons. These are the different costs. There's a lot of ways to get testosterone into the body. 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 to women to leave this conversation, be all excited. And then me, Andrew, into their doctor's office only to be shut down. So is there a way to talk effectively to our doctor about testosterone? 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 a, 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 an established relationship with a provider, great. You probably have a better chance of 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. 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 a 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. And is there anything that women should know once you go on it? Like as far as like, I'll just share my testosterone experience when I first went on it. And maybe I got, went a too high of a dose too quick, but if I, the rage, the irritability was real. Too high. Too high. Yeah. 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? 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 brains 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, 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. I recently had some women and I'm like, 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 another one 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 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 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. We don't want that. No, no, the anger is no fun. So if you go low and slow, what are you looking at as a clinician? Are you looking at, okay, over six months, nine months? Or six months is what the guidelines say. And they're like, if no benefit, decide to take it or not. I mean, there are some women who they want to get 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, increase risk of dementia, increase risk of Parkinson's disease, increase risk of multiple cirrhosis, 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 glia survive. It helps our brain. And so some women, if they're like, hey, my libido is not all that much better, but like, I actually want to take this because I think long term, it's probably good to have a little bit of this in my body. So, you know, you can decide it four to six months. Like, do you want to stop? Is this worth it for you? Do you like it? You know. And once you're on it, do you stay on it forever? Like, is it like, yeah, I mean, I always tell women to think about it. Like, are you getting an ovary transplant? Is the ovary coming back at age? Yeah. Is it coming back at age 68? Now, interestingly, physiologically, women later in life in the 70s, there's 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 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. And what makes, what, that's natural? That's a natural uptake. 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 age. Right. 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. Right. So it's fascinating. I wonder why the body did that. We don't know. Why would the body kick it into the air? 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. Maybe, maybe the, maybe the modern body is like, Hey, you made it this far. We're going to give you a little, a little extra juice because you passed go 72 times. So here's a little, here's a little help. But so by in, to answer the question, by and large, ovaries aren't coming back online. You take testosterone, you like it, you stay on it. 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. I mean, libido is an amazing, awesome big topic. And that's why I started my podcast originally was started for adult female sex. And my first book called you are not broken, stop shooting all over your sex life is all about adult female sex. Because libido, and I hated the word biopsychosocial, like I hated it, I go to the Iswish 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 yourself? How's your body image? What does society tell you? That's a social. What does society tell you about being a woman who's sexual at age 62? Right? How much do you listen to that? 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 you just, you know, women are like, my testosterone is not working, my libido is not better. Or I'll seek clinicians, they'll be like, I gave my patient testosterone and her libido is 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 is 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. 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 Oh, you get, oh, you get nail-presading sex. I mean, that's another reason why we don't, you get like shut down, like many sex, like legitimate sex educators have been gotten kicked off that platform. You can be like mostly naked. That's fine. But you, but you can't say like, this is a clitoris. This is a vulva. You know, wouldn't you talk about sex? That's crazy. 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 responsive desire and like all these pieces that are so important and she just thinks it's a medication. Guess what? You put her on a medication and she fails the medication. Cause she doesn't know all the rest of this. And now you're a medication failure. So now you feel way worse about yourself, right? Is like, get a sex education. 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. Right. And 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 a stair, Perrell's teachings, which I think are fascinating about, yeah, like the novelties 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 fifties, as she's been married to somebody for 30 plus years, would, if you could put a protocol together, a package together, what would that look like? First treat any genital urinary syndrome, syndrome and menopause, GSM, previously called vaginal atrophy, right? Like if it hurts, you will not desire it. That is one on one. 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 and 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 to take away as many problems as I can from people because they're heavy backpacks that people carry. 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 going to hurt again? Right? That's sex, therapists are amazing. Pleasure, orgasmic inequality is real. If somebody's having a better time at the party, they're going to want to go to the party more than the person who's like, the food's kind of shitty over here. Why show up? Right? So in that part of my education and 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 like, 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. Like dopamine is released on the pursuit of something rewarding. If it's not rewarding, right? No dopamine release. So 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 Boy Rd. When the partner, especially if they're male, is eating at a five star Italian restaurant. Right. And we're like, well, he did he desires Italian. Why don't you like Italian? And you're like, it's freaking cold chef boy Rd again. That's what's on offer. Like fix the menu. And 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. 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. Yeah. Right. And you're like, well, there's actually a lot of other things on the menu besides chicken. Yeah. Have you seen surely you've seen, I think it's called Hello Leo grand. Oh, that is such. It's 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 sixties and she's never had great sex. And she's like, I want to experience this. And it's said they did such a beautiful job with that movie. And so I hear you like 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 just don't desire it like, like I'm not locked and loaded and ready to go. You need to you need to emotionally connect to me. My one of my favorite interviews here on my podcast was with Dr. Zach Bush. And he said, if you want to have sex with a woman at night, you need to have four play at breakfast. And the problem is that women think they're broken over that instead of being like, that's right. No, that's right. That's normal. That's human. Yeah. That's you're having a human experience. Yeah. You think you're asking for more or asking for too much. Yeah. No, it's not asking for too much to feel connected for it. 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. Yeah. Yeah. Yeah. Talk about that a little bit because that's what I heard that. I mean, I've 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 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 that? 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 is like, no, 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. And because like, because everybody loves hearing what they're good at, and then you can say what they're good at. 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 I'm like, what am I good at? 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. And then they're like, you don't know what you're good at. So it's like, it can be like fun, like just talk about it. Right. And then the other question is, what does sex mean to you? Right. What do you get out of having sex? And usually the answers are very different. And that's okay. You're two different people. Right. And the other myth about desire is that 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 player does. 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 that everybody else can either take care of themselves when, if it's more than what the relationship needs, or they can say, you know what, the relationship, it's just important to the relationship. So I'm going to prioritize it. 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 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. We can all get better at it, but it helps with sex. You know, 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. 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? That's a good question. Probably not. Again, you can't in this, in this awesome grand experiment, you can't take socialization out of the person. Like, I know, I know, I've tried to. Men have to hold the 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 is at 800. I mean, again, ask the trans population. Labito changes with very high testosterone and going strictly evolutionary, sex is expensive for a woman. Right? Death, one in eight childbirth without, without modern 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. Cause that is the, that's the Ferrari that grows the human. 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 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. I love it. I go Ferrari and Honda. Cause it's like Honda, nice, resell 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, so is it a, it's more biologically expensive, but is it a myth then that women have less of a libido than men? 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? 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. Hmm. Okay, what? 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 very successful way for a female to have an orgasm. You need clitoral stimulation. But if you got no sex ed and it's just Hollywood, guess what sex is to you? Penis and vagina sex. 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? Yeah, because that's our, because that's our sex ed. I love this is, I did, right? 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. Well said. Oh my God. 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? Dorn's damaging for everybody, that this is how female bodies, orgasm, 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 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. 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 advice, 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? Cell phones. Are we not having cell phones? Oh, because, okay. 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, Hagen-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. Such a good perspective. There's a crazy study. I might be by a cell phone company, but there's a crazy study about how many people actually check their cell phone during sex. 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. What is it? 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 cell phone 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. 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. Oh yeah, let's get back to that. Sorry. 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. That's Freud. That's Freud. No, okay. So Freud said, Freud said that libido is a petitive, which I love the word a petitive and I love saying it, but a petitive 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 a petitive 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? That's, I got Hagen-Dazs and, 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? Have you ever liked sex or been sexual or blah, 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, it like what happens in perimenopause and menopause? 40 to 60% of people don't feel like themselves. Well measured. So we have half the population not even feeling like themselves. She's, you don't really want to have sex if you're not feeling like yourself. You feel awful, right? Yeah, of course. 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 effect sexuality doesn't mean you're, I mean, 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 in 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. 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? 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 we, 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. You can't, like you can't. And so, you know, you'll, you'll, your, your Instagram clickbait of like, orgasms will make you live longer. It's like, 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 protect, I'm an enneagram eight, I'm very protective of women and I get super cringy 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. That's probably really good for your pelvic floor. 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 get very cringy 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. 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 going to learn boundaries. I'm going to learn to say no, I'm going to learn to communicate about hard things. I'm going to try things and maybe not be great at them. Right. I'm going to 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 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 we have spontaneous, repetitive 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 are 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, let's like all these things that make a great sex life when like Hollywood and you know, your first boyfriend told you like desire for sex was everything of like, it's not, it's not everything. Yeah, that was so well said. So let's finish up on tell me about your new book. I mean, I luckily, I got an advanced copy and I've read it and it's 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 it, I got a real feeling for what your personality was like. And I loved it. Did you know I was an eight before you read the final page of the book? I mean, I could have guessed it, but I'm on it. 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 acknowledge. So I don't know, I was maybe three chapters in and I was like, wonder what, what she said in her acknowledgements. And that's where I found the 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 the information to make an educated decision and to advocate for yourself if you want them. Yeah, I would say it is a 2.0. I mean, if you're, are you saying that Mary Clairs is 1.0? I think there's, I think there's 1.0. I feel like there was, I'm, yeah, there's a lot. We should say there's a lot of 1.0s, but, but 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 I think that was, you know, you know, you write books of like, how much data you're like, I 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 in 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. Yeah. Yeah. It's beautiful. Well, how do people find your books? Anywhere they want to. Barnes and Noble, Amazon. I have a book page on my website that has mom and pops for people who don't want to use the main retailers for it. And it's, it's Kindle, it's audio, it's hardcover and it's international. So September 16th for America, September 18th for Canada, UK, Australia, New Zealand. Not that anybody's count. Right? Like so far. So far. That's just a little behind the scenes. It's a great day because everybody gets it in their hands and it's a, it's a, it's a very vulnerable day for them. 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. Oh my God. I always say that putting a book out and I've put five of them out now, I is like putting naked pictures all over the website and being like, what do you guys think? I know. Yeah. Leave your review here. You're like, hold on. Yeah, exactly. Exactly. Thank you. Well, I love this conversation. Yeah. Thank you for everything you're doing and everybody go grab the book. Thank you so much. 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.