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

Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts offering you a step-by-step guide to proactively avoid disease and most importantly, extend your health span. What if your low libido isn't a problem to fix, but your body is sending you an important signal about your hormones and your health? For decades, women have been told that loss of desire is all in their heads, or worse, just part of getting older. But one of the real issues is biological and completely curable. In this episode of Extend, I'm going to be sitting down with Dr. Kelly Kasperson. She's an MD urologist, a sex educator, and author of You Are Not Broken, and the upcoming book, The Menopause Moment. As one of only 10% of urologists who are female, Dr. Kelly brings a rare perspective on female sexual health and hormones. We break down why perimenopause and menopause are hormone crises affecting brain, bone, heart, and sexual function. You'll learn why estrogen loss causes physical changes that make sex painful and how testosterone drives desire and energy. We'll learn why vaginal estrogen and HRT are evidence-based treatments and how to talk to your doctor without getting dismissed. If you've ever felt broken or blamed about your sex life or body in midlife, this conversation will change how you understand what's really happening and give you the tools you need to take action. Kelly, so excited to have you on the podcast. Thanks for having me. Yeah, this is amazing. So You just got off the stage with Jane Fonda. I just got off the stage with Jane Fonda. What was that like? Surreal. I knew she was an icon. Yeah. Right? I knew, and then I was there, and I was like, oh, no, the icon's for real. There's a reason she's an icon. There's a reason she's an icon, and you hear the story. The one thing that struck me the most is she's like, yeah, when I started my fitness business company, I was like 45, or maybe I was 48. And I was like, that's right. we have a ton of time and you were born and she's like you're not too old yeah right like you don't even remember when you like changed the world with your fitness company right like and it's not because her memory is poor her memory is very sharp yeah she's super great but you're like that was one of those things that happened that decade and she's like in the 70s in the 60s in the 80s and you're just like wow and i i went to medical school you know in the 80s and i i remember like growing up with jane fonda like she was always she was one of the first fitness influencers yeah Right? Yeah. Everywhere. On TV. And videos, tapes when those were the thing. People probably listening don't even know what a videotape is. Yeah. No, totally iconic. Very funny. Yeah. Very sharp. And we had a great talk. And I did like an hour-long panel with her. And then when I gave my keynote, I followed her. And I'm like, I am following Jane Fonda on stage. Yeah, that's pretty incredible. It's like incredible. Well, you deserve it. I mean, you are also an icon in the field of women's health. Thank you. And I'm so excited to have you here. So she's 88 years old. She's 88 years old. Yeah. Her Wikipedia page takes about 45 minutes to read. I know from experience. It's a long life. And you know what's really cool about that, too? She was in her 40s when she started her fitness company. That's right. And a lot of people I meet right now in their 40s, they feel like now they're on the decline. Isn't that insane? And you look at people like Jane, and it's like you can't be just getting started. Life expectancy has never been longer. Right. And we're like, well, it's over, you know. I know. Why? Why do we do that? I don't know. Well, our society puts a lot of weight on youth. Yeah. Right. And a lot of weight of like, a lot of weight on like, well, you weren't first and other people did it before. Like, there's a lot of like age shame happening. There is. Like, I saw a patient, I see a lot of people for sexual health and hormone health. And I saw this couple and they're in their 70s and they're having the best sex of their lives. Been married for four years. They needed some help. They've had some pharmaceutical help. But like, they're like, this is the best. Right. Literally like that same morning, a married couple in their 40s came in and they're like, well doc if you just tell us that we're too old for this to be good anymore like i said we'll just we'll believe that we'll take that like we just and i was like i had some 73 year olds in here earlier today who are having the best sex of their life right and i'm like i've got 40 year olds who are like well if you say it's over i guess it's over oh my god yeah yeah it's like the perspective right it's like you have jane fonda who's at 88 is like exercise every day i know that's the key to my success. Keep learning new things. Surround yourself with people who love you. I'm taking notes before I go on stage. A lot of it's mindset. Yeah, a lot of it. I mean, I would venture to say it's almost all mindset and getting your hormones, right? It might all be mindset and a little bit of hormones and a little bit of muscle. Yeah. Exactly. If you really boil it down, you and I have been doing this stuff for a long time, and you look at age-related decline, it really is just a decline in muscle and decline in hormones. Yeah. Right. I think everything else is comes from that, like all the other aging, the frailty, the bone issue, you know, Vonda is and we're very good friends of Vonda, right, too. Like we were just talking to Luisa, who talks about the brain, all of it, all of that sequela, I would say, of aging comes from loss of muscle and loss of hormones. Yeah, I completely agree. And, you know, and especially in medicine, we're so organ centric, Like, these are the liver guys. That's the brain lady. This is the glucose person. And it's like, you guys, it's all a unit, right? And the unit affects each other. It's like hormones, you know, hormones get so stereotyped. Like, they're just for hot flashes or they're just for libido. And it's like, it goes everywhere and it affects everything. It really, really does. So I'm so curious about you, though, as a person. You know, you and I both trained in Minnesota at some points in our lives. And when you go through medical training in Minnesota, like, you really put your time in because it is not. Minnesota is a land of overachievers. Exactly. And it also has the weather for overachieving because like what else are you going to do in January? It's like unless you play ice hockey. Yeah. Like you're in the library studying. Right. You know, so it's like the most educated or the most advanced degree state in the nation. Yeah. And it's like you're competing with like very smart people in Minnesota. Yeah, exactly. You know, I trained in the Mayo Clinic and when I first got there my first day of training, I'm like, why is this massive, incredible hospital with the smartest people in the world out here? And then my first winter, I figured out why. It's because during the winter, there's nothing else to do except for learn and work and just be in it to win it. And so I get it. Yeah, yeah. And there's a work ethic, I think, in the Minnesota people as well of like, it's just expected of you. I actually interviewed for residency on the East Coast at a place. And they're like, oh, you're from Minnesota. And they said, you will find we don't work as hard here. And I was like, oh, the reputation, the reputation travels. Yeah, it definitely does. Definitely. So you're a urologist. I mean, that's intense training, a lot of surgical training. And I'm just wondering, when was the moment that you decided to just really hone in and focus in on women's sexual health and hormone health? Yeah. Because, you know, I mean, you'd spend a lot of time learning how to do urological surgery, et cetera, et cetera. So was there a defining moment or like a career path change? Yeah, tell us about that. Yeah, totally. So I was a general urologist. For any listener that doesn't know, urologist is a surgical subspecialty of the genital urinary organs. So starting from the top, adrenals, kidneys, ureter, bladder, urethra, and stereotypically male genitalia and male quality of life, right? Stethosterone, Viagra, et cetera. So that's the urologist. And so I fell in love with urology. Nothing beat urology. Urologists are funny. You have to not take things too seriously when you work in the pelvis, right? So I was a general urologist. urologist tended to see more women because there are so few female urologists so the patients just gravitate towards me so really liked female urology bladder leakage pelvic organ prolapse is a lot of my work and still nothing better than a distal ureteroscopy though that's my favorite so in residency i had an attending tell me watch out for the seven-year itch whether that's your marriage or your job something happens at seven years you get a little bored you might get a little complacent, seven-year itch. And at seven years, I was kind of bored. And I was like, why did I do all this training to just see recurrent urinary tract infections 27 times a day and say the exact same thing, right? And am I making a difference? And I actually told one of my partners, I'm like, I'm bored. And so I now believe, looking back, I'm like, I now believe the universe was like, she's ready. And the universe delivered to me one of my patients, who I was already very bonded with and very much, I loved her. We had treated her for invasive bladder cancer, very big surgery, got her through that, got to know her family, know her husband. And that day in clinic, seven years into my private practice career, she was crying in my office. She was crying in my office because of her sexless marriage. And I'm handing her a box of Kleenex and everything from residency that I was told came up. Women are difficult. They take too much time. we don't know about they're too complex we don't know how to help them and don't worry the gynecologists are taking care of them anyways these are things i'm like people are blown away by it but like you know the indoctrination of medicine like absolutely i was young i was told that and you're like okay like that's i was told to do a fellowship so i didn't have to deal with women oh my god that is what i was told wow yeah so all that came up so much gaslighting in the medical it's wild like i tell this story and i'm like no no that was my reality like that was the We grew up in, you know, I can corroborate that because I remember doing my OBGYN fellowship and talking to some of the attendings and they're like, you don't want to do this if you can't deal with hormonal, emotional issues. Like, what do you mean? And, you know, it's the same kind of thing. It's like, you know, prepare yourself, you know. And what I am, I'm much older and wiser now. What I think they're saying now, if I look at it in a kind way, our system isn't set up for women. Right. So women became the problem. Right. It's like women aren't the problem. The system's not set up for them. Right. So here's my patient. Everything's going through my brain. I'm handing her the box of Kleenex. And I thought, I don't know how to help her. Wow. But I take care of men with sexual health problems, which begs the question, who's taking care of the people who are supposed to be sleeping with the people that I'm giving testosterone and Viagra to? Yes. And that started basically a year-long educational journey for me. Great opportunity because I was bored, right? Fantastic time to learn something new. So I started going to the conferences, IshWish Conference, International Society for the Study of Women's Sexual Health for people who don't know what that is. Started reading the journals. Started talking to all the sex therapists. Started figuring out, you know, hormones. And then I was like, I can't change the world. I was starting to realize how big of a problem this was. I can't change the world just by being in my clinic and seeing people in my town. This is too big now. Like, I realized it. And so a voice in my head was like, you need to talk. You need to talk. You need to share your knowledge. You need to talk. And I was like, this voice is very annoying. But it wouldn't go away. And this was, you know, seven years ago now. And I was starting to listen to podcasts. And I was like, well, I like podcasts. Maybe we should do a podcast about women's sexual health. And I'll teach adults about women's sexual health. And I was like, ah, but I didn't do a fellowship in this. there's one at the time there was one fellowship one spot in america you're kidding one spot now there's two spots it's still only two spots for female sexual health yeah one's by a gynecologist one's by a urologist and so i'm like i didn't do the fellowship though maybe i don't know enough and so i was wait i was actually waiting for somebody to give me permission to be like kelly you know enough now right yeah and i got out of the shower one day and like lightning strikes and the only permission you need is your own. Yes. And I was like, okay, start the podcast. So I started the podcast. It's called You Are Not Broken. And the reason it's called You Are Not Broken is because women kept coming in and being like, I don't have an orgasm with penetration. And I'm like, well, you're not broken. Only 30% of women do. The clitoris is actually the organ of pleasure. Another woman would come in and be like, I've never had an orgasm. And I'm like, well, you're not broken. 10% of women have never had an orgasm. not because our bodies don't work, but because the way we shame women about touching their body, learning about their body, boys get to learn about their body. They have to hold their penis to pee. Yeah. Right. Yeah. So boys get to touch their genitals. Right. In a very socially acceptable way. They understand their body more. Women are told not to touch their body. Right. So you're not broken. You just didn't get the education. And I think so much can be fixed by just a little bit of education. Absolutely. And so the podcast started for sexual health and then morphed also into hormones because they're like, you know what happens to your sex life with menopause? And I'm like, no, moving on. And then the next one, you know what happens to your sex life with menopause? You know what happens to your sex life with menopause? And I'm like, what the heck happens to your sex life with menopause? Let's go down that. Yeah, let's go down that aisle. Right. And I'm like, I'm staring down the barrel like, let's learn about this. Right. And so I'm like, oh, estrogen is essential for blood flow and moisture and to decrease pain. Oh, testosterone. We've got international guidelines on female testosterone for low desire. Oh, my gosh. Plus, I give 10 times the dose to men every day. I'm not afraid of testosterone. And so I started learning about hormones and, oh, my gosh, why are we afraid of them? What the heck was the WHI? And just kept peeling off the layers of the onion at a time when this was getting really big. So to me, I'm like, man, I caught the wave of sexual health. I caught the wave of menopause. you know and now i'm like oh yeah international international expert on this because a patient changed my life one patient yeah one patient incredible story changed my life well i mean and kudos to you too because you actually listened and you did more than what you know unfortunately like we only have sometimes 15 20 minutes with our patients so yeah it's really easy just move on to the next thing write a referral to somebody like you should talk to your ob-gyn about this and you actually paid attention and you listened and you didn't know something and you realize it and you admitted it to yourself, and you went out there and learned about it. Yes. And I think that's critical. And I wish so many more physicians would do this because so many physicians are stuck in the mentality of hormone replacement therapy is something that you have to protect yourself against more than anything, you know? Yeah, I mean, I think two things. I think the traditional medical system, curiosity is not available anymore. You need time for curiosity. You need space for curiosity to learn things, right? So I'm like, the traditional medical system is not set up for people to be like, I don't know. Let's figure this out. And then number two, I was taught in medical school is 50% of what we teach you will be wrong. But we don't know what that 50% is. And in that sense of like, stay humble, man. Stay humble. We don't know. Things are always changing. And I see that a lot of like, tell me exactly the dose and exactly the lab and exactly this. We're still figuring it out. But a lot has happened between you learning in med school that hormones are dangerous and 2026 yeah exactly in you know to compound the problem to the speed of dispersion of medical knowledge is so slow yeah and and the speed of new knowledge it's like yeah did you read about this it's like the the rate of change or knowledge gained right now in medical publications alone is like a whole new textbook exactly like yearly like it's insane the knowledge to stay up on top of it. Right, right. And so it's so hard for the average physician to keep up with it. And then it's so, you know, medical schools are still stuck back in what they were teaching people maybe 20 years ago. And so you have all these new physicians that are going out there. And I just talked to a brand new physician, like, I think this was like six months ago, just graduated from a family practice residency, okay, going out there, talking about hormone replacement therapy. And even this new physician told me that hormone replacement therapy, there's a risk of cancer, so you have to be very careful. I was so sad to hear this. Exactly. I was so sad to hear this. And the prevailing kind of thought process there is you might get sued if you give someone hormone replacement therapy if they develop a cancer. So it's probably in your best interest not to do this or to send it to an endocrinologist. Yeah. Yeah. Which there's plenty of endocrinologists sitting around with nothing to do, waiting to take care of 50% of the population if you look at female hormones. The other thing that's crazy about it and me kind of learning, and to me, I'm like, listen, I'll admit that maybe I am weird. Maybe it is weird that I like reading medical journals, but I'm obsessed with this topic now, right? I'm obsessed with it. And what's so crazy is the initial WHI study from 2002 published in JAMA is open access and free on the internet. It is, right. Anybody can read that the cancer was not statistically significant. You can read that at any time right now. Right. Right. And so to me, for people just to be like, it's in the zeitgeist, it's just in the ether. Yeah. But it's that fear. And truthfully, when I talked to women, I was talking to women today about it. I was like, what's the best way to control a woman? Yeah. Fear. Keep her afraid. Keep her afraid. Keep her afraid. What better way than to keep her afraid of something her body naturally makes? Right. Right. And once you see that you're like oh my lord wow right and it's like that fear that we're trying now that we're 20 some years past the whi is like that fear we're still it's so ingrained it's so in the zeitgeist it's so in the ether that i asked women like where did you hear that from like are they are they going to quote me a 2002 jama paper right right where do you hear that from they don't know it's just it just is it's just there's gravity and there's one moon and it just is exactly and To me, I'm like, is nobody curious about where that came from? Right, right. Exactly. I wonder that too. And, you know, just this year and now, we're finally living in a time where there's mainstream media attention to that not being a study that we should be hanging our hat on anymore. Yep, yep. And, you know, finally, there's some momentum, especially with podcasts, the work you're doing. Yep. But it just, you know, I speak all over the nation and I just got back from Tulsa, Oklahoma and someone asked me in the audience, I heard estrogen replacement therapy causes cancer. Is that not true? And it made me boil up a little bit inside because I was like, oh, no, it's not true. And then I explained to WHI, the misinterpretation of it, et cetera, the new studies. And I think we just got to do the best we can, which is what you're doing, spreading this knowledge. To me, it's almost like any man or woman that comes to our clinic, we have to almost find a reason to not put them on hormone replacement therapy, right? There's, it is, and you and I were talking about this earlier, is that aging really is due to two things. There's loss of muscle and loss of hormones for the most part, right? And if you can mitigate both of those, there's a chance that you're going to age like Jane Fonda did. Yes. 88 years old and still sharper and stronger than people half her age, probably. Yeah, yeah, yeah. And I think, you know, people don't understand their own power in the control of the health. And there's probably many reasons to blame for that. But I think one of them, give me your opinion, but it's like this gene theory kind of messed us up because we're like, well, you know, it's just your genes. It's just your genes. You can't pick your parents. And it kind of took away this agency of like, and now the experts know like genes are really not everything. You can have genes for cancer and never get cancer. And people do not know that. Right. And it's like there's this lack of agency because we're like, well, it's just genetics. Yeah. I am so with you on that. And it was another one of those media frenzies that turned out to be nothing. But it turned out to be worse than nothing. Because like you said, it gave people an excuse, but it also took their power away. Like obesity became a genetic thing for many, many years. And, you know, obviously there's components to it, but you can fight through that. And also to your point there, Alzheimer's disease, this ApoE gene, And how, you know, if my mom had it and I have family members with it, I'm probably going to get it. It just is what it is. And the reality is we know that's not the truth. You can't protect against this. Yeah, totally. And genes aren't everything. But I think the, like, genes, you know, remember, I remember the couch I was sitting on when the news announced we have mapped the human genome. Like, it was such a big deal. Like, we're going to cure everything now. We know everything now. And here we are, like, genes aren't everything. Like, I'm glad we are doing all this work, but it's not everything. So many people are like, well, it's just my genes. Yeah. How do you feel about the current kind of sphere of knowledge out there in medicine right now? How are you feeling about it? Like what we're learning now, what we know now, do you feel optimistic? Yeah. I mean, it's a wild, crazy time right now, right? Because, I mean, let's just do the math for a second. in America alone. We have 80 million women over the age of 40, 1 million physicians. Of those, because again this is the other damning thing we did There one type of doctor that takes care of women Yeah Yeah And there 35 of them Right Right OB for anybody who wasn tracking that But to tell 50 percent of the population there one type of doctor for you to go to for everything is immense bullshit Yeah Like the numbers don't mess. Because everybody's so upset at the OB-GYNs of like they don't know anything about hormones. They don't know blah blah blah. I'm like why are you putting all of why are you putting 50 percent of the population on one type of doctor? And there's only 35,000 but half of them are delivering babies all the time. Yeah, that's what I said on stage today. I'm like, babies cause bleeding. They get stuck in vaginal canals. Like, OB-GYNs are busy. Give them space. Right? And we know we do not have enough OB-GYNs for our population, and it is getting more dire. So this basic math, you're like, okay, 80 million women over the age of 40, 100% of them will outlive their hormones. Yeah. What are we going to do? Right? The math doesn't math. And so I think all of these things that are happening of like, I call it mass transit, which is the online telehealth company of like, we need mass transit. The numbers can't matter. Even if you just do 10-minute appointments, we need mass transit. Yeah. So, and AI. Exactly. And how do you scale a brain? How do we scale your brain with your knowledge of longevity and what's fresh and what's new? How do we scale that? Yeah. Right? Because how many people can only one person see? Absolutely. So it's AI, it's mass transit. And there's something that we've lost that I think is precious, and it's called the doctor-patient relationship. And there will always be a role for caring, compassion, the expert who helps interpret. But I think the role, and you're seeing it right now, like the role of the doctor as the person with all the information, that's going away. Because the doctor used to have the medical library, right? That's all they had. But nobody else had that. Everybody has AI. Right. Everybody has a cell phone, right? Not everything on that's true, but doctor, how do I navigate all of this? Right. Now I have the information. I can get all the information. I can go home in a relaxed environment and do tons of research on this. Right. And so it's a power dynamic that's shifting. And I think some physicians are like, what's our role? Oh, my gosh. Elon Musk, I think, said we don't need to go to medical school anymore. Right. You said that a couple weeks ago. Yeah. But my God, do you want somebody to hold your hand through all of this when shit's hitting the fan? Yeah. So I think there is a role for that. And there will always be, you know, we call them normal Barbies and weird Barbies of like normal Barbie. You don't need as much. If you're a weird Barbie, you might need a different level of care. Right. And so like to me, I don't think it's all doom and gloom. No. I mean, I'm having the time of my life as a physician right now. I agree. Like I am so glad I went to medical school. I'm so glad I knew what I what I know now. And so it's changing. But it's not going to be one size fits all. I agree with you. And, you know, the other thing, other component of this, I think is really transformative is people finally are not gatekept from the data of their own body. Yes. Right. They can get their own blood biomarkers done. Yep. They can do it themselves without even having to request a doctor to order them. Yep. That's how it was 10 years ago. Yep. Ask your doctor for this. I think it's fascinating. I do. So I was talking again, I was talking to very intelligent, well-connected women. And I'm like, okay, there's a company. We don't need to name names, but there's a company. All it does is labs. It won't interpret them for you. It won't help you know what to do with them. It just checks labs. It's worth $2 billion. Right. Right? Like, that's what's been missing because people go to their doctor and they say, can I check my labs? Can I check APOB? Can I check blah, blah, blah? And the doctor says no. And they're not gatekeepers anymore. And I'm like, that's your health. That's your body. You should have access to that. You might want somebody to help you interpret it. Right. Right. Or hold your hand through what do you prioritize? What should you be looking out for? What is optimal? Then, you know, I think like with the access that we have to our own data right now, doctors are going to now be held to a higher standard because the patients know what this data means. Yes. But I love it because all of my patients have their data. Yeah. Right. And they hold me to a higher standard. and then I can be more of a guide and a confidant and, like you said, an emphatic ear to listen to them. And I love my role so much better now, you know? So I don't know. I'm excited about it as well. Totally. I think a lot of people think that labs are, I say God, but labs are God, labs are the commandments, labs are the Bible, whatever you want to call it. Because they're like, what exact lab value should this be? What exact lab value should that be? And I'm like, what are your goals? No. And do you have side effects when you're trying to get those goals? Right. And they're like, oh, yeah. And so especially when it comes to testosterone, for example, what exactly should the right testosterone be for a woman? And I'm like, three things matter to me and my patients. What are your goals? How do you feel on it? Do you have any side effects? And what are your lab values in that order? Right. And they're like, oh, because, you know, people are learning on the Internet and we like concrete things. Right. But you need that expert to be like some people have side effects when they're at that level. 100%. The labs aren't everything. Help interpreting them is what our role is going to be now, but not access to them. Those companies have been created. They're doing very well. Exactly. And guess what? Every individual's biology is completely different. So what's the best testosterone level for you is going to be different than your own sister. It's going to be different than what your mother's testosterone was, right? And so it's different for every individual completely. And so we don't know what is the optimal one for you. And we have to use, what are your goals, what are the side effects, and then what is the level as kind of like our guiding principle to optimizing any piece of blood work, right? So yeah, I love that. I love that model. The other thing that we have now is wearable devices too, which they're giving you constant feedback. Yeah, exactly. So it's very interesting when I do public speaking, I'm like zone four, zone five. Like I'm working out on the stage. Yeah. Yeah. And they actually have a thing you can record your activity and there's a public speaking thing. There is. I Yeah, so now I'm like public speaking. I just got a whoopie, and I also wear an Oura ring. I'm going to wear both. I feel like they're both such great pieces of, first of all, they're great to wear so you have your own data, but they're also, I think, the companies that have done a really good job of really getting the data as accurate as possible. Yeah, I want to see a little bit more female focus. Yes. We can't just take male data and tell a woman that this is how things are supposed to be. Right. So I would like them to be, and I think they're headed in that direction. But I call mine my gentle parent because I'm like, I know I should go to bed. I should go to bed. Right. Like it's like gently guides me to be like, I know that I should put in a little bit more extra couple more steps. So to me, it doesn't stress me out. It's more a guy like don't forget that stuff. Right. Especially when you're traveling. Exactly. Right. Like get your sleep. Otherwise, it will mess with you. The travels are really kills me. Yeah. And I really use the guide when I'm traveling. So can you can I push you on that a little bit? How should wearable companies think about women and how to use the data a little bit differently? Do you have any specific examples for us? I mean, this is just talking to friends who are in the space and are trying to design this stuff of like, how does heart rate variability change when you throw on an estrogen patch versus not having an estrogen patch on? Estrogen influences heart rate variability, right? That would be fantastic data to have. How does sleep change? What do women need to sleep versus men need to sleep? So to me, I'm like, we're not all Toyotas that came out of the same factory. So it's like if we try to put everybody's factory settings to the Toyotas, well, we've got some Ferraris over here. Right. But we should probably pay attention to the Ferraris. And Ferraris on hormones, Ferraris off hormones. Women are the Ferraris in this scenario, in case anybody – because we create life. Exactly. So, yeah, to me, the experts are like a lot of the data for the Whoop and the Oura Ring are built on mail. Right, absolutely. And so to me, I'm like, the people who will start – and to me, I'm like, the market's huge. like you start saying you've got female data to track and like you've done that like that's good for your brand yeah yeah and also um there's probably an opportunity in how the data changes throughout the cycle of the month as well right and so hrv should probably be interpreted differently at some some weeks of the month versus right are you stressed or do you have low estrogen yeah right like we don't know and can we can we figure that out what else can we use respiratory rate like i don't know that's how well you're sleeping so Hi, Dr. Shah here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30-year-old people with cells that look like they're pushing retirement. And I've also seen 60-year-olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones, and they have limited cell phone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IMA. IMA powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92 ingredient formula designed specifically for cellular health and longevity. I'm talking 900 milligrams of vitamin C. That's like 20 oranges worth of DNA protection. the clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha-lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IM8 actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IM8 had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should, unfortunately. You don't have to be one of them. Try IM8. I actually have a discount secured for you if you go to drshaw.com slash IM8 or go to im8health.com slash discount slash Dr. Shah and you can get 20% off with my discount code Dr. Shah. You can also find the link below. I'm really also excited about these continuous monitors that put a filament into our skin, like the continuous glucose monitor. There's a lot coming out. I'm talking to some of the CEOs and the researchers of these companies that they're going to be adding cortisol. They're going to be adding lactate, maybe hormones. I think hormones are coming. I think hormones are coming. I mean, that's going to be a game changer. Yeah, yeah. The data's in your hands. I mean, especially for the perimenopausal women, because it's zone of chaos. Yes. Right. And to know like, oh, wow. Okay. Estradiol is 350 right now. Right. Let's prioritize sleep. Maybe do I need to exercise? Like, what do I need to do? Or even just a validation of like, oh, that's why I'm off. Right. Like all of that is just, it's again, gentle parent, right? Like, hey, you might, you might have a loop cycle right now. Like, what do we need to do to make you feel better? Right. Right. Right. Yeah. And we're such an incredible time with all these converging technologies and AI being there as well. Yeah. I'm super excited about it. Yeah. So let's go, you know, you're one of the foremost hormone experts in the world, right? And so I'm sure you synthesize thousands of patients worth of data and your experience and the conversations that you've had. And so if a woman were to come to you today on 2026, and she is right now perimenopausal, what should she do? like she's experiencing some symptoms, maybe hot flashes, maybe brain fog, weight gain. Give her some advice from you that she can then take and put into her own protocol moving forward. Yeah. Where should she go? So the first thing is basic education because body literacy is crappy for everybody. So what is perimenopause? Do you know what it is, right? What's happening to you? And validating that our symptoms are real. So many people get dismissed, right? of like, I think I'm the crazy one because they said, especially the all my lab values are fine in air quotes, right? Like those people get very dismissed. And again, lab values are not written in stone, right? That was Tuesday at 10 a.m. That is not the whole week, right? So it's really validating what's your understanding of this? Do you know what's going on? You know, anything about your mom? Did that go well? Do you know when she went through menopause? Just kind of get the story of it. And then what's your goal, right? Because again, I don't, this is not cookie cutter. This is not one side. Some people hot flashes. Some people sleep. Some people sex drive. Some people I want to preserve bone mass because my mom just broke her hip. Right. So what's everybody's priority? And then the basics of like, are you sleeping? Do you exercise? Are you drinking every day? Why are we still drinking every day? We drink ounces of water, not alcohol. Right. And so I had a perimenopausal woman. She came in, had a bladder cancer scare, low grade, non-invasive, cured the bladder cancer. And I'm like, well, of course you don't smoke cigarettes. Like I'm kind of assuming, right? And she's like, does a bong every day count? And I'm like, honey, we count ounces of protein, grams of protein, ounces of water at this stage. We don't do bong hits anymore. And her husband's like, thank you. So they go back to the basics of how are you treating the Ferrari? Are you hitting it up against the curve every day? And that really does move the needle on how you feel. right exercise exercise is fantastic for helping out basal motor symptoms and perimenopausal symptoms and all that so to answer your question is like basics first right we're americans we want quick fast fixes yes right just give me the right testosterone level of like if you don't do the basics right you're gonna be like these hormones don't work yeah yeah exactly i say that all the time like you know it's a pyramid and you have to build the base first otherwise the rest of it just comes crashing down every time you try to do anything. And so those bases are exactly what you said, exercise, nutrition as an intervention, and sleep as an intervention. How should a woman in their 40s think about an exercise routine? What would be the optimal exercise routine for that woman? Yeah. What do you like to do? Right? Because you're like, I've done all the research, and this is exactly what you do. Do you like doing it? I think you can learn to like things. I was like, I need some more zone four or five. Let's start spinning. And I was like, I did not like this for a while. But now I'm like, I like it. So I truly believe you can start to like things that you haven't done before. But it's like, just move the body. I think mobility, like yoga, stretching, mobility, range of motion exercises, nobody talks about that. I'm sure Dr. Wright does because she's amazing. But it's like just the feeling of your body moving. and to me I'm like getting out all those like cracks and kinks and everything every day like feels very good yes and just kind of getting into your body so to me I'm like are you exercising at all because if she's not you're not going to be like okay you need zone four and five and this much zone two and lift heavy like if she hasn't done that it's very overwhelming and it's not sustainable sure I mean low-hanging fruit is walking yeah walk walk walk walk like get the steps in so you gotta meet people where they are you can give them data but if they're not going to do it. Right, right, exactly. You know, in my practice, what I find when I talk to specifically women, let's just focus on women, is that there is a huge percentage of them, maybe 40% that are not doing any exercise. You know, I look at their phone, and they're getting two to 3,000 steps in a day. And all of this advice is absolutely critical, got to get moving, right? But then I also have a big percentage of women, I would say 30-40% of women are also going to the gym. and they're not overweight, they're going to the gym, they're spending three to four hours in the gym a week just on the treadmill. All they do is run. And they're really focused on calories and maintaining their weight. And the running feels good. It's like an endorphin hit to them. It can be a stress relief. Yeah, it is a stress relief for them too. And so one of the things I try to prioritize with those particular women is changing it up a little bit though, adding some strength training in, adding some yoga, mobility exercises as well. Is that something that you believe in? Oh, my God, yeah. Women should be adding strength. Women in their 40s and 50s. We grew up in the 90s. Yes. Skinny is best. Skinnier is better. Not eating is good, right? And so it's like to explain to people, we exist within a culture. Yes. And if the culture tells women, and we're seeing this again, women are getting skinny again, right? If we exist in a culture that says thin is beautiful, well, I've been told like muscles make me bulky. I don't even know what does bulky look like. And frankly, the guys are like, we wish lifting weights made us bulky, right? The guys are like, I wish. And so you have to like undo this societal beauty, perfection culture. Like there's so much, let alone the women in their 70s. They had it worse, man. They didn't have sports. Yeah. Right? And so I see my 70-year-old, I call them my pissed advocacy boomers because they're like, we didn't get hormones. Our friends are breaking their hip. I want mine. I'm a little upset about it. Like, I have a large, large practice of them. I love taking care of them because there's so many myths about what's allowed in their 70s. My mom is, like, eight inches shorter than she was when I met her. Eight inches? She's so tiny. Unbelievable. Wow. Yeah, she's had many, many joints replaced. I lost count of all the joints that have been replaced. Yeah. It's just unbelievable. Yeah, that generation, like, they didn't have girl sports. This was before Title IX, right? Right. So it's like at least we have the 40 year olds on a treadmill. Yeah. Right. But it's the culture you grew up in. That is so true. And the education that we give does have to acknowledge like we're asking them to do something that we told them don't do that. Right. Right. And then they get things are always changing. And we're like, of course they are, because 50 percent of the things we learned in med school are wrong. Yeah. Things will change. Right. Things will change. It's really good to update your knowledge base and kind of understand where we need to be right now with our thoughts around exercise, right, especially. Yep. And so, okay, so say they're exercising and they're coming to you, but they're still struggling with symptoms and you want to talk to them about hormone replacement therapy. How does that conversation go? Where should they start? What should they be looking at? How do you pick the hormones they should be on, et cetera? So I always ask them what they know about hormones. Okay. Because if you have a woman and in their head hormones cause cancer and you're like, let's get you started on estrogen, then we'll do blah, blah, blah. You're like, my doctor's trying to kill me. Right. So what do you know about hormones? What have you heard about hormones? Do you have any questions about hormones? Do you think hormones would play a role in your plan? Right. So it's like I want her to give me the download of what she knows because I'm here to help. I'm not here to tell her what to do. That's butting up against her beliefs. Right. Right. Right. So, I mean, luckily, I joke that I've worked very, very hard to have very, very educated patients. Yes. I'm like, I have a seven year podcast. I have two books. Most of my patients know that and have read them. So by the time they get to me, they're like, give me the things. I'm good to go. I know. I know all the things. Which is a super fun way to practice because you're like, I've got educated people who know. You're not starting a square one every day. We're not starting a square one anymore. Yeah. So really, why do you want? What do you want? What do you know about this? what would you like? And then I like to tell them, this takes adjusting. And I think that's why if you hear women say, like, hormones didn't work for me. One type of hormones with one dose maybe didn't work for you. But in our traditional healthcare system, see you in six months. You're lucky to see you in three months. And so many people think they failed hormones. And I'm like, different formulations, different types, different doses. It's all individualized. amazing paper just got published looking at transdermal estradiol and that if I give you a 0.05 patch and you have 0.05 patch, your symptoms might get better and you might not because you absorbed them and you didn't. It's like, we're not Toyotas. So I tell people that up front so that they have the expectation of like, sometimes we hit it out of the park right away, but not always. How often are you following their hormone levels and talking to them? So in my clinic now, because I run a concierge clinic now, because I was like, 27 patients a day plus three add-on surgery cases plus on call. Yeah, that was crazy. I only think, had we had the aura ring or the whoop in training. Oh, my God. It would be like, can we please call 911 for you? Like, is your supervisor aware that you're dying? Someone at the aura headquarters would be like, this person is in big trouble. Totally. Like, barely surviving. So, to me, I now have that concierge. And what did women and men, anybody, what did they want from me in the traditional medical system? time. Right. Absolutely. Time. Right. And so now I have time. So I see them every six to eight weeks to change things, dial things in, usually get people dialed in around four to six months. Got it. Yeah. So and that's I think this is a very realistic expectation. Like you're not going to get dialed in before four to eight months. Like you got to like have have that time period in your head so you don't think that you're failing. Yeah. Things aren't perfect one month into it. And if it's perimenopause, I'm like, that's a moving target. That's a moving target. Things will change. Absolutely. And it's just like postmenopause is easy. You don't have any hormones. Right. Right. Let's add some. Exactly. Exactly. So in the perimenopausal woman, are you starting with estrogen, progesterone? What are you starting with? Testosterone, in fact? What are her goals? What are her symptoms? Yeah, okay, got it. Right. So it changes. It changes based on it. If I'm not sleeping, let's start with progesterone. Right. Right. Low libido, low energy, blah, blah, blah. Let's start with testosterone. So estrogen, and this is, again, I'm stereotyping. We're not all Toyotas. Estrogen tends to come last because estrogen seems to be the hanger-on-er. Yes, it is. And the brain and the ovaries are doing everything they can to try to get enough estrogen to get a follicle and an egg out. And so that tends to be the last one out. But, again, we're not all created equal. Right. But, yeah, I mean, people are like, what are the guidelines for perimenopause? It's like, there's no guidelines for perimenopause. And people are like, there should be. And I'm like, have you treated perimenopausal people? Like it all different right Like you make up a guideline for that But if there was going to be a guideline it would probably be progesterone testosterone first followed by estrogen plus or minus vaginal either to get on it for prevention Because why are we waiting for – if 50% to 80% of women will have genital urinary syndrome and menopause, why are we waiting for them to suffer? So plus or minus vaginal estrogen at any time. Got it. Yeah, I think the vaginal estrogen piece of this is really important to mention and highlight because almost universally, when I see a patient that's coming from like a primary care doctor that's treating the person's, you know, in air quote, treating their menopause, they're never on vaginal estrogen. And so whether or not you're on any form of estrogen, do you feel that vaginal estrogen should be added to that mix? Yeah, unless you're completely asymptomatic. But even then, like, you want to break the internet. Right. tell people that their labia minora goes away after menopause. And so there's two groups of people, the people who don't know what a labia minora is. And then the other group of people are the people who are horrified by this. They're like, are you joking? Like, no, no. Genitals need hormones. Hormones go away. Because a lot of people just think, I mean, people don't understand even what menopause is. So it's not a hot flash or the end of periods. It's profound gonadal hypofunction. You are outliving it. Right. So that's why the labia it goes away. But so even if you're, I mean, the argument is even if you have no symptoms, should you be on it to preserve sexual health, right? Like, do you want to wait for your clitoris to get phimotic? Right. Like that's 20% of people as far as we know, not that there's a lot of research, but the best research we have. But here's what's super exciting. And this is brand new. Our president that two days ago just announced his health care plan. Yeah. Right. And one of them is taking safe, effective medications that could be over-the-counter, over-the-counter. So we've already talked as high as we can in the administration because vaginal estrogen is the lowest hanging fruit for over-the-counter medications. Should be over-the-counter, for sure. Should be over-the-counter, over-the-counter in multiple countries. And here's some damning studies. So there was just a study published out of Stanford looking at Medicare recipients, so age 65 plus, again, 50% to 80% of these women have GSM. and this study ended in 2018, so I'm hoping it's better now than 2018. But if you went to a doctor and got the proper diagnosis, so these are women diagnosed with GSM, either recurrent UTI, pain with sex, any sort of GSM symptom, lucky enough to see a doctor, lucky enough to get the proper diagnosis, what percentage of those women had a prescription for vaginal estrogen within 18 months of that diagnosis? Oh, my gosh. I know. I know it's going to be a depressing number. is it like 40 percent seven seven percent with symptoms so these were symptoms saw a doctor got the proper diagnosis seven percent got a treatment seven to nine percent another paper just came out of canada looking at the exact same thing 71 percent didn't get treatment so 30 percent got treatment oh my gosh so when i think about that i think about okay what about all the women who aren't seeing the doctor. Yeah. Who doesn't know that this could be helped. Right. Right. And it's like, okay, we're not treating. The doctor is the problem, right? It's like, they went to the doctor, they got the right diagnosis, and they still didn't get the right treatment. Exactly. All right, let's move that vaginal estrogen over the counter. That needs to go over the counter. Yeah, it's a no-brainer. We're like, make that your first medication over the counter. Because the risk of side effect is incredibly low. Incredibly low. And the potential benefit like getting rid of recurring UTIs, for example, for the loss of sexual function through the atrophy of the labia minora. This is why the vagina looks so different as you get older, is because of the lack of estrogen, right? And so you can maintain even just the function and the anatomy just by using vaginal estrogen. There's so many benefits. The strength of the pelvic floor as well, right? Oh, totally. Bladder leakage. Bladder leakage. There you go. So Rachel Rubin did this study. Dr. Rubin did this study. If Medicare gave every Medicare recipient with a vagina, vaginal estrogen, and they used it, it would save Medicare $13 billion a year just to reduce urinary tract infections. There you go. And this was an abstract from last year of women with recurrent UTIs. The ones on vaginal estrogen decreased admission to the hospital, decreased admission to the ICU with sepsis, decreased risk of death. Yeah, it's massive. A tube of generic vaginal estradiol at Mark Cuban cost plus drugs is $13. Yeah. So you look at what should a preventative medicine be. It should be safe, it should be cost effective, and it should prevent something that's common within the population, right? Vaginal estrogen checks all the boxes. It does, yeah. Okay, so good. So I'm so glad we talked in depth about this because I do believe that's foundational, right? So let's move on to just estrogen. Your favorite form of estrogen is an estrogen patch orally. What are your recommendations? I would say right now in 2026, a transdermal estradiol patch is probably the gold standard starting. Somebody asked a question today, actually, they were like, is bioidentical better? Blah, blah, blah, blah, blah. I like to have a different conversation and say hormones are under a tent and it's a very big tent and there's lots of different options. And if we say bioidentical, meaning what your ovaries naturally make, if we say that that's better, it makes people who can't take that feel like they're really missing out or they're broken or blah, blah, blah. Because some of us need different formulations. We just do, especially when it comes to progesterone and progestins. And so I want to change the language away, but at the same time saying the estrogen your ovary naturally makes in transdermal form, so you're decreased or eliminated first-pass hepatic metabolism. So no increased risk of blood clot, no increased risk of stroke. It's incredibly safe. Right. Yeah. And safe and effective for reducing symptoms, but also effective for long-term chronic disease prevention as well. Let's talk about that. Please. Let's talk about that. So the counter to us, because our view is let's keep healthy people healthy. Exactly. That's our view. Right. So the counter to that is hormones shouldn't be used for primary prevention of any disease. All right, well, let's look into that data. So the United States Preventative Services Task Force, Independent Task Force, which urologists don't like anyways, because they told us not to screen for prostate cancer. And that backfired bad, like more people with metastatic prostate cancer now. Right. So we're already like, not sure, not sure about this group, but okay. So what they did is they published, like two or three years old now, they published grade D recommendation, which means do not recommend hormones for the primary prevention of any disease. Now, if you actually read their analysis, their biggest study that they weighted, because we talk about weighting studies, like a big study, was the WHI. All right, let's talk about that. Oral synthetics, increased risk of gallbladder disease, increased risk of blood clot, blood clot then suggesting stroke risk and cardiovascular risk. Okay. Transdermal estradiol doesn't do any of those things. Exactly. So you're taking an oral synthetic and taking a national statement to say, don't use that for primary prevention of any disease. And we're like, it's apples and oranges. Yeah. Right. It's apples and oranges, but most people don't read into that data. No. Right. But the majority of that data is oral synthetics. Yeah, and that's the key fallacy of the WHI, is that it was an oral synthetic. We can't draw any conclusions from that because it's just basically what people don't really even use anymore, right? Right, and the good news from it, I mean, there's plenty of good news out of the WHI, but the good news from it is, okay, if we gave you an oral synthetic, it actually isn't that, that's not that bad of a drug. It actually did a lot of great things. Yeah, it still did great things. With risks, but now we have something that even has less risks. Right. Right? So people are like, oh, oral synthetics. And you're like, they weren't actually that bad. Yeah. I mean, this is a powerful study. So the HERS study. The HERS study, right. Looked at, a subset of it, looked at oral synthetics, so the PREM-PRO, as secondary prevention after cardiovascular event. This is an important study. So women who've already had heart attacks. Yes. Oral placebo versus oral PREM-PRO, oral synthetics. No increased risk compared to placebo. So don't use it for secondary prevention because it didn't make you have less second heart attacks. But it was no worse. It was no worse. Follow-up greater than four years. That's an important study because now what we're talking about, we've got the pissed boomers. Yeah. Right? And this whole, we can't take, you can't start hormones after 10 years. Like, we need to talk about this. So the guidelines, 2022 menopause guidelines say within the first 10 years, benefit outweighs risk. In medicine, you know, that is a very strong statement. It's a very strong statement, right? That is an incredibly strong statement. I say that to him like, I hope you understand what I mean. That's an incredibly strong statement. Benefit outweighs risk, right? 10 years after or age greater than 60, individual risk-benefit discussion should happen. So that's what it says. That's what it says. Right. And you can go read it. It's free online. People have taken that to say you can't start. It's too late. It's too late. Is it true? What are the risks? 18-year follow-up of WHI. Women up to the age of 70 started on oral prem pro. Did fine. No significant risk. And the dementia risk was self-reported or family reported. This was not even a physician diagnosis of dementia risk. Right. So when you say increased risk of dementia, you're like, we don't really know. Yeah. Right? And so that kind of falls away. And I've done, you know, webinars. I have these classes available on my website of like, let's talk about it. Am I too old for hormones? Hormones is a big tent. You're never too late for vaginal. Right. Right? Right. And so the big question is, are you too late for transdermal estradiol? You're never too late for oral progesterone. You're never too late for testosterone. It's just a transdermal estradiol. That's the... Right. But let's look at transdermal estradiol. Right? So you can't tell me the WHI risks are transdermal estradiol. They're not. Apples and oranges. Right. So like, oh, the increased risk of heart disease or stroke or dementia. No. Show me the data. Now, do we want more studies in older people? And absolutely, we want more studies. But there's actually a very old, old study. And this was transdermal versus placebo in women who'd already had a heart attack. No worse than placebo. Right. So you're telling me a 71-year-old, because of her age, who has never had heart disease, can't start a transdermal estradiol, when the women who've already had a heart attack, even if we gave them oral prem pro or a transdermal estradiol, did no worse than placebo. We have those studies. Yeah. Right? And we have the WHI. Yeah. And you don't get a transdermal estradiol patch. And this is my 2026 soapbox. It's like the older women, give me the data on why they can't start. Yeah. Because I have so much data to say you can. That's great. Right? We have multiple placebo-controlled trials looking at really low-dose patches in older women, specifically for bone improvement. So we have those studies. Risks, no worse than placebo. So to me, I'm like, why do people keep telling a woman she can't start a hormone that has an excellent safety profile? SSRIs are more risky. Yeah, absolutely. Overactive bladder medications are more risky. Right. And so to me, I'm like, and again, this is me being obsessed with this topic that I actually went and like read all of these things. But I'm like, God darn it. Tell me why they can't start this. Yeah. And my other argument is if at age 75, a woman can't say what she wants to do with her body after being informed with a risk benefit thing, what age is she able to say what she wants to do with her body? Right. This is like quality of life, too. And a lot of people are like, oh, the symptoms are gone, though. Menopause symptoms only last for seven years. and these people aren't suffering. These people are suffering profoundly. They don't sleep. They've got negative moods. They've got osteopenia or osteoporosis. Like they're profoundly suffering and we are not taking care of them properly. Exactly. Yeah. I think there's a great soapbox for 2026 for you because all of these boomers are coming up to this now. And like my mom, again, perfect example. She should be on hormone placement therapy right now, you know, and she would protect what joints she has left and her bones and her mood, all of it. And so I think this is an important, very important topic. And I'm really looking forward towards the narrative on hormone replacement therapy completely changing. And so, you know, I also think that a lot of women, they also think of their sexual health as something that it's supposed to decline as you age. And we talked about this with a 70-year-old couple. And a lot of what's going on with their sexual health also is very tied into like their pelvic floor as well. And so we know, like we talked a lot about vaginal estrogen and how it helps the pelvic floor to be stronger. But what else can a woman do to maintain their sexual health into older age? Exercise. Exercise. It's blood flow. Like nobody thinks about female sexual health in terms of blood flow. But erections are obviously blood flow, right? And clitorises or penises, they're the exact same as a stretch. but incredibly similar anatomy, right? But people, again, going back to what's my why, right? Of like, you got a disease and pregnancy prevention plan, probably, if you were lucky, right? You did not get a like, how does this work? How do we get both people equally interested in going to the party? Right, we didn't get, did any of us learn about the clitoris, right? Or the fact that women get erections, we get blood flow. Best way, I mean, this is the same for penis owners, exercise. Like, the blood flow is good for everything, right? And we studied it. Women who exercise more have more satisfying sex lives. Up to a point, the over-exercisers, their sexual function drops. What do I mean by over-exercising? You're exhausting yourself, right? Or you're using exercise as a coping mechanism for other things. So the more you exercise, the better your sex life is, except for the very top, those are the over-exercisers, where you're like, you're stressing yourself out, and nobody has a great sex life when they're horribly stressed out. So I would say if I had to pick one, exercise, number two would be sleep. We have this data, shift workers, worse sex lives, night workers, less sex life. It's like all domains of sexual function when measured diminish. Right. Right. So your body prioritizes things. Right. And if it's not sleeping, it doesn't want to reproduce. Right. It doesn't want to have pleasure. So sleep and exercise are key. Got it. And then, you know, just like you said, like when you go through medical school, you do days and hours and hours of studying the man's penis. But the clitoris is like, here it is. That's it. It's like five minutes of discussion. I can't remember. I can't remember on my cadaver. I had a female cadaver. I know that. Did we dissect the clitoris? I don't know. And the other crazy thing is I'm a pelvic surgeon. Yeah. I put mesh around clitorises. Right. That's what a sling is. Yeah. I didn't understand the full anatomy of the clitoris. I had a sex therapist have a clitoris model. She's like, this is a clitoris model. And I'm like, what? So, I mean, that's like only to be very humble, to be like, I got through surgical pelvic training. Absolutely, right. And then I learned all the places the clitoris goes. Yeah. This episode was brought to you by Next Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Next Health is the Apple Store of Wellness, where you can optimize your health span and lifespan using cutting-edge technology. I actually founded Next Health eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in Next Health using hyperbaric oxygen, sauna, cryotherapy, and LED light is a game changer. In addition, the doctors at Next Health measure thousands of biomarkers and put into place a longevity optimization plan using advanced tools like ozone, plasma exchange, and peptides. Go to www.next.health to check it out. So what about some pharmaceutical therapy for sexual health? You know, men have Viagra. Is this effective for women as well? Yeah. So Viagra is a blood flow drug, right? fascinating stuff in the longevity world looks like people who take viagra or cialis or i call them the cousins right the cousins of the pde5 inhibitors less dementia right why blood flow drug blood for the brain so i it'll be interesting to see where we are with pde5 inhibitors in about five years yeah interesting thing about there's a lot of people taking it for like longevity yeah like it's like a daily 2.5 milligrams right it's safe right and and in a world and i will argue this with hormones too. In a world where dementia is deadly, costly, impossible to treat, or at least very expensive, why are we doing everything we can to prevent it? Number one killer of women in Australia now, this year, is dementia. UK is right behind. It's a past heart disease? Yep. Wow. That's massive. It's massive. UK is right behind. I joke, it's not something to be joking about. And like America, not quite there yet, because we're really good at killing off people for other reasons. Yeah, exactly. But yeah, no, the developed countries where people are living longer, dementia is now the number one killer in Australia. Wow. So it's like, if it's cheap, if it's safe, it's a fact, why aren't we doing everything we can to prevent this from happening? It's not inevitable. Right. Right. So do you think there's a world in the future where men and women would be taking PD5 inhibitors like low dose Cialis or Viagra preventatively possibly? I mean, I would hate to say, oh, Kaspersen said this is what we should do. No. But what do we need for a good preventative medication? Safe? Cheap? Sure. And it's something big, like a large part of the population to prevent it. And, like, it checks the boxes. It does, yeah. It also helps overactive bladder in women. Right. Why? Blood flow to the bladder. Yeah, absolutely. And blood flow to the pelvis. So go back to the initial question. When a man gets an erection, so I improve blood flow, so you have an erection, Your brain is linked and it's like, oh, I'm interested in sex now. Right. They've done these studies in women because you're like, Viagra can help in women, but not all women. You make a woman have blood flow to her pelvis. She doesn't always want to have sex. She needs other things. Am I safe right now? Is this a socially acceptable place to have sex? Right. So just because she has blood flow doesn't mean she's interested in sex. Right. Right. So just a little bit different. We're just hooked up in a little bit different ways. So people, that's the argument of like Viagra does work. viagra doesn't work viagra improves blood flow right but that doesn't always mean you want to have sex but can it improve the likelihood of having an orgasm or the intensity yeah right it's erections so they're actually coming out now with a topical sildenafil right right and so they've got some some funds behind it it's gonna i think people are gonna know about it right and it's safe it helps blood flow and the big question is especially you know when you look at female sexual dysfunction, there can be a lot of different reasons that you don't like sex. Right. So it might help, especially this is so under-researched. We know the role of heart disease, high blood pressure, diabetes on erections in men. Right. Same, same. Same. Way less research. That's so true. Right. So the mechanism is probably there for a woman to have decreased blood flow as she ages and collects comorbidities. We just have way less data on it. Right. Right. What about nitric oxide? Like, you know, as well as, is it as important for A woman is for men's erections, right? Basal dilator, blood flow, right? Green leafy vegetables increase nitric oxide, yeah, and exercise. And red beets, huge nitric oxide boost with that as well. Okay, and then what about some of these peptides like Kispeptin? And what are some of the other ones that are marketed? Oxytocin. Oxytocin is one of them, yeah, that people are interested in. Not as much data. Okay. And I think the low-hanging fruit probably hasn't been addressed. So to me, I'm like, don't go for the next trendy thing. How's your hormones? How's your relationship? Are you prioritizing orgasm? Or does sex end when a partner has an orgasm? Right? Like there's so much sex ed that's missing that to be like, kiss pepins is going to work for everybody. I'm like, probably not. But is it a specific arousal problem? Is it a specific orgasm problem? Right? Like there are things for people, but doctors did not get taught about sex. Yeah. Right. Zero. There's one, there's two fellowship spots in America for women's sexual health with 80 million women. Right. Yeah. Viagra was approved in 1998, became the fastest selling pharmaceutical ever created. Record profits. Right. Right. Was fast tracked by the FDA, got approved with less than six months data because it was such an essential new medication. Yes. Right. Yes. I got, I was part of a team, which was awesome to get the boxed warning off of estrogen in 2025. nice what's estrogen it's a blood flow medication right right so these people got blood flow medications these people got this stuff's going to kill you on their blood flow medications we've been destabilizing heterosexual relationships for 27 years that's so true right absolutely i mean it's it's uh it's so it's such a huge hill to climb when all the men had this new drug viagra and the woman had nothing basically and so you know both going through that same sexual dysfunction at the same time period of their life Yeah The perimenopause for men is andropause Mm And one group got a solution and one group didn get a solution Yeah And to your point that makes complete sense We have to point that out to people. Right. You know, to be like, we took care of half of that heterosexual relationship. And so most urologists, and this has moved pretty fast, but most urologists, when a man's in the office, we're like, oh, you want Viagra? You want testosterone? Great. Now they come to see me and knowing what I know now, to be like, what is your plan with this super penis we're going to give you? Mm-hmm. And I thought it would be the rare man who didn't have a plan. And to me, I'm like, I don't care what you do with it. You do you. Great. But if your plan is to put your brand new super hard penis in a vagina, does she want that? Right. Has anybody been taking care of her? Is she on vaginal estrogen? Do you use lubrication? Right. And they're like, I haven't. I'm telling you, this blowed my mind. They don't have a plan. No. I'm like, you made an appointment with a urologist to get Viagra, and you did not have a conversation with the person you haven't slept with in seven years who you now want to go home with and try to sleep with. Yeah. And they're like, yeah, no, we haven't talked about it yet. I just thought she'd be ready. I just thought she'd be ready. We actually joked in residency women would return their partner's Viagra to the clinic, and we would joke like, oh, my God. And now I'm like, oh, that's not funny, right? I'm like, she's undertreated. Right. Nobody's taking care of her. Yeah. Right? Nobody asked her if this was the plan. Yeah. But he just assumed this would be the plan. It should have been at least vaginal estrogen, maybe a low-dose testosterone, maybe even some PDE5 inhibitors. Yeah. And everyone would be on the same page. Yes. And did she actually ever have good sex in the first place? Before you stopped, was she actually ever having good sex? Right? And this was mind-blowing to me as I was, you know, going into my journey of female sexual health. is one of the leading researchers in female desire is a man. And he was like talking about low desire and the different types of blah, blah. And I'm like, hold on. You're assuming the woman was having good sex in the first place and she's just not desiring good sex. And he's like, well, yeah. And I'm like, that's such a male-centric view of the party that that woman was at. Right. I'm like, a lot of them aren't having great times at the party. Yes. Right. And so in the first place. So you have to back up and be like, you know, before we go to like, which vibrator, which lube, blah, blah, blah. Like, did she ever have fun at the party? Right. Was she just doing this for somebody else? And again, it's the we never got taught how to talk about sex. Right. And if we don't talk about sex when it's good, how the hell are you supposed to talk about it when it's bad? That's so true. Right. In fact, you know, I would postulate that many women, when the husband's desire went away, that they were probably happy about it because they weren't having good sex in the first place. Many people say that. Yeah, I didn't mind. And so for this return to sexuality, when the man got the Viagra, was actually a traumatic event in their life. And so, you know, you hear this story every once in a while. And then couples break up, divorces happen, et cetera, et cetera. Yeah. And the reality was no one really explored was the sex good when it was happening. And now that it's returned, how can we get it to be good at this point in time? Totally. And like adults can learn new things. Yes. Right? You too, like adults are capable of learning new things, but we have to want to learn new things. Right. Right. I have retreats and a divorce lawyer came to one of my retreats and she's like, I pull people out of the river. Right. Like I can't save anything. By the time they're in my office for a divorce, they're already drowning down the river. Right. That's so true. And she's like, I am convinced these women, they're not taken care of. Like these are untreated menopause. The relationship fractures. And by the time they get to her, like she can't help. Right. But it's like when the divorce lawyers are telling you we're not taking care of the women properly, we should probably listen to them. So true. Yeah. I mean, I think every divorce lawyer out there should have a partnership with a physician like yourself. Yeah. That could be like, let's try to unwind this. Let's put some interventions in place first. Let's talk about these things. Yeah. But you're right. By the time you're there, it's often too late. Yeah. There's so much like animosity and like the relationships fracture by the time you're in a divorce lawyer's office. Right. of like you got to go 10,000 feet above that awful spilled ship to like try to right the boat. Absolutely. Absolutely. So in your big picture assessment for a woman that has never had good sex and she's listening to this right now, what are some of the techniques that she can use to maybe rehab this or get to a point where she's actually enjoying sex the way she should be? Yeah. So I think a lot of people jump straight to self-exploration, masturbation, vibrators. I want to back it up. What are your thoughts about sex? What do you think sex is? What would you hope to get out of sex? It's the thoughts, right? We're talking about mindset, right? Of like, if you think it's dirty, it takes too long, it's for somebody else, what's the point? Certainly if it hurts, right? Like, what are your thoughts about sex? And let's just understand that that's what we think sex is. Because if we don't unpack that first, me being like, I designed the best vibrator for you. Pointless, right? Like, I can make blood flow happen. Yes. But if you're not on board with sex, right? And, like, that's why I'm like, I'll have a podcast till I die, because this topic is huge. How were you raised? What did your religion tell you about sex? What did your stupid first boyfriend tell you about sex? Right. Right? Like, let alone any traumatic experiences that you've had. So who's allowed to desire in our culture? Right? Who is sex for? Who gets sex freely? Right? Who's the gatekeeper of sex? Like, it's such a huge topic. Right. It's a massive topic. It's massive. They say sex is biopsychosocial, and there's no better word for it. It really is. It's your biology. It's your relationships. It's the fishbowl you're swimming in, which is society. And so to me, I think people jump. They're like, you need a good lube, vaginal estrogen, and a vibrator. It's like, of course. When you're ready for the hardware, let's do hardware. But if the software thinks that sex is like, what's the point? Or I was hurt in the past, or I don't really like my partner in the first place. right but it's all this like when we just say like women can have great sex and should have great sex like yes we got to unpack where they're at right right and be like could it be possible that sex could be something different for you in the second half of your life compared to how it was in the first half of your life right and i think the stereotype is like that the 22 year olds are having great sex that's not what the data says first of all the 22 year olds are having way less sex than they've ever had really because they're not hanging out anymore oh that's so true Right? Like COVID happened. We've got phones, all the things. And when you think of, even think like 100 years ago, sex was the best dopamine, besides like a shot of whiskey. That's true. Like sex was the best. You couldn't get it anywhere else. What was better dopamine? Right, exactly. Sex was amazing and you couldn't have it and it was really rare, right? Like it was very good dopamine. And now we're like, dude, a pint of mint chocolate chip ice cream and Instagram scrolling. Like I'm good. Yeah. Right? Like it rings all the bells. Yeah. And so sex takes work, right? especially if you want to do it with somebody else, right? How's your schedule? What's my schedule? Are you tired? Like, you've got a bum knee. Okay, well, what position? But, like, it's work to get that dopamine, right? Absolutely. And so when we're, like, where sex plays a role in our society now, like, it's actually harder dopamine. It's changed a lot. You're absolutely right. Yeah. Especially in the context of all the other dopamine hits we get throughout the day. Yes, totally. There's some crazy statistic about how many people look at their phone during sex. Like, and it's a crazy, it's way more than, I would be like, five percent like yeah no it's like i can't quote exactly what it is but it's it's a surprising number frightening amount of people that is frightening who check their phone during sex like oh don't for anybody who's uh uncertain don't do that yeah yeah that's not that's not it takes you out of the present moment yeah so the young people aren't having that much sex but we think they're having the best sex but the data actually suggests the older you get the better sex you're having, especially for women, because they're like, I'm throwing away the rules. I'm making this about me. I'm a lot less concerned about how I look, how I'm, you know, we're less spectatory, right? We're more experienced. Yeah. We might want it. We've done it enough that we're like, let's have a little bit of novelty now, right? And so that's what people don't know, right? Because our society is like, the sexy, beautiful young people are having, no, they're not, right? And the other, there's an amazing book by Peggy Kleinplatz. She's a PhD, and it's called Magnificent Sex. And what she did, she's at a university, and she's like, hey, anybody who has really great sex, like, raise your hand, can I interview you? Right? So it was kind of a qualitative research study. Like, what does it take to, like, be a self-admitted, like, I'm great at sex? Yes, yes. Because everybody thinks desire for sex is what allows you to have great sex life. Nowhere in, like, the top ten is desire, sexual desire, a necessary ingredient. That's interesting. Communication, prioritizing time to be sexual. Right. trying things, recorrecting, starting and stopping. That wasn't great. How can we do it different? Right? So willingness to try, just being involved, and communication, communication, communication. Especially if you want sex with another human. Right. Right. So that's a great book because everybody's like, the typical male model, and this is, you know, Kinsey and Masters and Johnson, and they're like, desire first, or desire was assumed. Right. Because like, these are people in the 1950s being hooked up to electrodes in the Midwest in winter. Like by default, they had a spontaneous desire for sex. Yeah, yeah, yeah. They're like, let's do this. Let's learn for science. So, but then desire was assumed as coming first. And so women say, well, I don't have a desire for sex. So I don't have sex. Right. And a nice analogy is like, if you're full after a meal, you don't really want more food, but like the dessert table comes around and they're like, okay, let's do it. Or it's Friday night. I don't really feel like going to the party. but when I go to the party, it's a freaking good time. Yeah. Right? So it's like, let your partner take you to the party. And especially how women's brains work, we need a safe sexual context. So if there's kids around, if we're stressed, if we don't feel safe, you're not going to have desire for sex. You must go in a sexual context. So our role or our partner's role to bring us along or us to go there. Because in women, this is Rosemary Besson's work, desire for sex happens during sex. Yeah, I love this. This is really good. This is good. I love this party. Yeah. Right? So desire happens during sex when I'm in the sexual context, or desire happens after sex. Interesting. That was so good. I forgot how good that is. That is a great time. Will you remind me again that I liked that? Because I forget that I liked that. That's desire for sex after I had sex. Yeah. Right? So many women are like, don't have desire. I'm like, of course you don't. You just got off of work. You just packed the lunches. You're in the living room where you don't usually have sex. You're not in a sexual context. Yeah. So it's like provide the avenue. Be willing to go to the party. You can always stop. And I'd never mean have sex when you don't truly want it, if you don't feel safe and it's not good. But be willing to go to the party. See what adventures at the party might be interesting. Because desire for sex might happen during. Desire for sex might happen after. This is such critical, great information for women that are listening. They're feeling that they're not having the desire. Just completely reframe that. The desire might come during, it might come after, and get yourself in the sexual context. This is great information for men, too. 100%. Right? Because I think men need to know this in order to understand why their partner doesn't potentially have the desire. At this moment, the context might not be right, or we just got to get them into the place, and then the desire will come. And the word for that is responsive desire. Responsive desire. So I respond to being in the sexual experience, but spontaneous, again, that's what Hollywood tells us, It's just on demand, drop of a hat, yeah, let's go, anytime. It's not the real world. Well, that's like the male version too, right? Yes. And so men need to realize that the female contacts around desire is different than the male contacts around desire. Men can also have responsive desire. And this is also what's very interesting in a heterosexual relationship, is the woman's desire is usually anchored around where the man is. So if she wants more sex than him, she has too high of a desire. And if she wants less sex than him, she has too low of the desire. We've anchored the man as the default and made her the problem. And that is not what we should do. We should say desire mismatch. That's what it's called, desire mismatch, when two people want different amounts of sex. That's a couple's problem, not an individual person's problem. And that's to be navigated with the couple. That's such critical information, too. I think the one other thing I want to make sure we cover, because it's golden. Have you heard of the orgasm gap? No. Okay. So the orgasm gap, fascinating research, is the percentage of times that a male is going to have an orgasm in a given sexual experience compared to the percentage of time. And we're using orgasm as a proxy for enjoyment. True. Satisfaction. Right. Because you have to have sex worth desiring. You can't desire mushy broccoli. You can't desire boring sex. So proxy orgasm to safe. Right. Yeah. And in a heterosexual relationship, man orgasms around 97 percent of the time. pretty successful, pretty enjoyable sex. Heterosexual female clocks in around 60% of the time. They're literally having different meals, right? I mean, you look at same-sex couples. Lesbians about equal right around 86% of the time. Heterosexual male both clock in right around mid-90% of the time, right? So the biggest gap is the heterosexual couple. What's worse is that's in a committed, loving relationship. If you do hookup sex, college campus hookup sex, he still gets the orgasm, high 90%. her percentage of orgasm? 7%. 7? 7. That's massive. So to me, I'm like, why are you participating in this? Right. Why are you participating in this situation? Like, why are you in it anyway? Why are you in it anyways? Yeah. Yeah. Huh. I did not realize that that is, you know, committed relationship. There's a 30%, 25% mismatch. Yeah. In a non-committed relationship, cook-up sex. It's horrific. Horrific odds. It's just like not even right. Exactly. Yeah. Yeah. Yeah, I mean, that should completely change the mindset around the current hookup culture through these apps like Bumble or what have you. I mean, I've never used one, but I mean, it just seems like there's such a new paradigm around meeting people and then how you hook up and how quickly that goes into sex. Right. And I'm hearing about it right now because my nephews are in college and they're living it real time. And they don't use these apps because of this kind of massive mismatch. They're actually feeling it. Yeah. Like it's just too easy now, I think. Right. Yeah, yeah. No, I mean, it's crazy research. The other stereotype is that women want sex less than men. That's a common stereotype, right? And it probably stems from many places. But one study was people on a college campus. They went around. They asked men, would you like hook up sex tonight? And most of the men were like, yes, that would be great. Thank you very much. They went around, women, would you like hookup sex tonight? And they're like, 0% said yes. They're like, no. Which begs the question, we're using a lot of alcohol to coerce or to get women's inhibitions down so they will participate in this ruse of 7% orgasm. Right? So they're like, oh, well, look, men like sex more than women do. And then some very smart researchers were like, I think there's different menu items here. They went up to women and they said, if we offered you shame free, nonjudgmental, safe, no risk of pregnancy, no risk of disease, loving, orgasmic pleasure. Would you like that tonight? All the women said yes. Right. And so the researchers in their wisdom said men are eating at five star Italian restaurants. Women have Chef Boyardee in a can. Yeah. And don't wonder why they like Italian food less. Right. Right. Right. And so that's the whole stereotype. Like women just aren't as sexual. And it's like, have you seen what's on offer? Right. Like up up the ante for this. Yeah, that's such incredible information. So many great reframes that you have for us that I think empower both men and women with this knowledge and give you a different perspective of how to think about sexual relationships. And also, you know, going back to the beginning of this conversation, just getting your mindset around perimenopause and menopause and how it is a completely treatable, the symptoms can be treated away and you don't have to live in that state and it's safe for you. Yeah, I think mindset about that too, because we're like, why do we have to do this when we grow old? Especially if you identify as somebody who doesn't take medications, right? Yeah. Like, why do we have to do this? Why do we have to outlive our ovaries, blah, blah, blah? I just want to remind people, we've been massively successful at extending lifespan. I did this research for my book of like, the wealthiest land-owning males in early Britain. This is like 1400s. So like, you were worth spending a pencil on to like, write your birth and death date, right? Because there were no birth and death records for like, the peasants. Yeah. So you were wealthy, you had land, you had parchment, right? And you didn't die in childbirth. Average life expectancy, 47. 47. 47. That was as good as it got. Right. Right. So people are like, well, great grandma didn't use it. And it's like, we've never aged. She never got there. Yeah. And going back to like how we think about aging versus like the traditional medical system is like, we're seeing people age and we're like, maybe there's a different way of doing this. And maybe we do actually have to start now to not have this happen when we're 80. and like the amazing blessing it is to have we're outliving our ovaries and if you take any animal from fruit fly to yeast to orangutan and you age them in captivity they all live longer than their reproductive potential because they're like only only humans and whales and i'm like first of all most mammals don't menstruate they don't have periods to track don't say they don't do this but if you put them in a zoo you feed them and you give them antibiotics when they have an infection and you take away their predators. They all live longer than their reproductive potential. So I wanted to name my book Aging in Captivity. But the publishers were like, I don't think people will get it. And it seems like they're in jail. And I'm like, my fans love that name. They're like, we're aging in captivity. Absolutely. Do we want to do it well? Most people say yes. Yeah. I make this point all the time. In the longevity space, there's always this fear of getting old because you imagine it as frailty. and there's also a perception that, well, you know, humans are meant to get old. It's natural to age. There's nothing natural about what we're doing. We've artificially extended our lifespan by double and our organs that were producing these hormones just were not made to last this long. Yeah. And I tell, I tell, I'm like, once we push the lifespan even longer, more men will outlive their testicles. Right. Like I just, that's just how it's going to be. Right. And we're not going to shame them and say, like, this is Mother Nature's plan to make it past your 80s. Right. We're going to be like, oh, well, we replace eyes, we replace hips, we replace teeth, we replace shoulders, we replace heart valves, we replace insulin. We replace everything except for ovaries. Right. Like, what a bias. Yeah, exactly. And the interesting thing, why can't our ovaries last longer? Ovaries are built to be proportional to the size of the mammal. Ah, I see. So a mouse has very small mice ovaries. Elephant has big elephant ovaries. Human have human-sized ovaries. There's only so many follicles, so many eggs. Enough years go by, you've outlived the size of the ovary. Absolutely. Right? Because people want to overthink this and judge it and say what you should do is like, if we get that health literacy and understand all of that, we're like, okay, yeah, yeah, yeah. I want to live long. Antibiotics alone increase human life expectancy by 26 years. Oh, absolutely. Absolutely. Yeah. And then we developed a whole pharmaceutical industry around antibiotics. And now they're keeping us alive even longer with even more therapeutics. So there's more lifespan coming. We just got to get our heads wrapped around replacing these hormones, giving our body the things it needs that it can't make anymore. Yeah. That's the way I look at it. In the 1990s, 40% of American women were on hormones. Because if you just want everybody to be on hormones, and I'm like, well, going back to the 90s would be a start. They were. Right, exactly. Let's just get there, right? Let's just get there. 7%, 8% of women are on hormones right now, right? Yeah. Amazing conversation. I can't wait. I could spend hours and hours talking to you. Well, we're going out to dinner next, so we'll get more time. Let's get some more time. We'll just have it recorded. I love it. Yeah, so this was absolutely fantastic. You're a force of nature, and I really appreciate you being here. And where can people hear more from you directly? Tell us about your podcast, your social media handles. So the podcast and the first book are called You Are Not Broken. I love hanging out on Instagram. That's kellycaspersonmd. Website's kellycaspersonmd.com. The second book is called The Menopause Moment, not Aging in Captivity because the publishers didn't like it. But that's one of my main ones. Yeah, I got YouTube, Substack, all the things. Incredible. Well, we thank you so much for being here. And can't wait to have you back on again. I'm sure we can talk a lot more about a lot more fun topics. Thanks for having me. Thank you. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.