The MiDOViA Menopause Podcast

Episode 024: Sex, Hormones & Midlife Health

• April Haberman and Kim Hart • Season 1 • Episode 24

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Unlock the truth about hormones and women's health with our enlightening episode featuring Dr. Kelly Casperson, a distinguished urologist turned women's sexual health advocate. Have you ever wondered why testosterone is crucial for women too? Dr. Casperson unpacks common misconceptions about hormones, revealing their significant roles in brain, bone, and muscle health for both genders. Her journey from treating kidney stones and bladder cancer to becoming a key player in women's midlife well-being is inspiring and informative.

This episode dives deep into the systemic sexism in healthcare that limits women's access to essential hormone treatments like testosterone. Discover why it's vital for women to be their own advocates, demanding proper hormone checks and pushing for systemic changes in the medical community. Dr. Casperson also shares her insights on the controversial rise of pellet clinics and the risks associated with high-dose testosterone treatments. You'll learn practical tips on how to manage hormone therapy effectively, ensuring optimal health outcomes.

We also explore the complexities of interpreting female testosterone levels and why standard lab ranges might not be sufficient. Dr. Casperson explains the importance of finding knowledgeable healthcare providers and giving treatments adequate time to show results. Whether you're postmenopausal, in late perimenopause, or simply interested in hormone health, this episode provides comprehensive guidance and expert advice to help you navigate your journey. Don't miss this opportunity to empower yourself with knowledge and take control of your health.

Dr. Kelly Casperson is a urologist, public speaker, sex educator, and top international podcaster whose mission is empowering women to live their best lives. Dr. Kelly identified the need for better resources and developed a sex education class for women that covers topics like sexual health, intimacy, mind work, and the science of desire. She combines education, humor, and candor in her podcast "You Are Not Broken" where she dismantles the myths women have learned and normalizes healthy, enjoyable sex worth desiring, in addition to essential education on midlife health and hormones. Follow Dr. Kelly on Instagram (@kellycaspersonmd), or visit kellycaspersonmd.com.

Order Dr. Casperson’s book, “You Are Not Broken: Stop “Should-ing” All Over Your Sex Life” here.

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Instagram: https://www.instagram.com/mymidovia
LinkedIn: http://www.linkedin.com/midovia
Email Us: info@midovia.com

Welcome to The MiDOViA Menopause Podcast! Your trusted source for evidence-based, science-backed information related to menopause. 

MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness and supporting women in this stage of life, both at home and in the workplace. Visit midovia.com to learn more.

The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. 

Speaker 1:

Welcome to the Medovia Menopause Podcast, your trusted source for evidence-based, science-backed information related to menopause. Medovia is dedicated to changing the narrative about menopause by educating, raising awareness and supporting women in this stage of life, both at home and in the workplace. Visit medoviacom to learn more home and in the workplace. Visit Medoviacom to learn more. I'm one of your hosts, april Haberman, and I'm joined by Kim Hart. We're co-founders of Medovia, certified health coaches, registered yoga teachers and midlife mamas specializing in menopause. You're listening to another episode of our podcast, where we offer expert guidance for the most transformative stage of life, bringing you real conversations, education and resources to help you overcome challenges and reach your full potential through midlife. Join us and our special guests each episode as we bring vibrant, fun and truthful conversation and let us help you have a deeper understanding of menopause.

Speaker 1:

Hi friends, we have a special treat today. We have Dr Kelly Kasperson on the show and for those of you that are familiar with Dr Kasperson, you know that this is going to be a fun episode. Dr Kasperson is a urologist, public speaker, sex educator and top international podcaster whose mission is empowering women to live their best lives. Dr Kasperson identified the need for better resources and developed a sex education class for women that covers topics like sexual health, intimacy, mind work and the science of desire. She combines her education, lots of humor and candor in her podcast you Are Not Broken, where she dismantles the myths that women have learned and normalizes healthy, enjoyable sex worth desiring, in addition to the essential education on midlife health and hormones. There's a lot packed in there.

Speaker 1:

You can follow Dr Kelly on Instagram at kellycaspersonmd, or follow kellycaspersonmdcom. Let's go right to the show, kelly. We are so incredibly excited to have you with us, dr Casperson. We met in June, I think, at the Women in Work Summit and, for those of you that weren't there, dr Kasperson comes up next to me, sits in a chair and I look down and you've got a cast on your leg, which I didn't expect, and I think that little snafu had partly.

Speaker 1:

It was partly due to your lovely black lab, I think, and I'm glad to see that you are all healed. I can't see your leg, but I assume that you are out of the cast.

Speaker 2:

Yes, thank you. Yeah, I had just been sidelined by a black lab on a hike it was like the most Pacific Northwest injury that exists and I hobbled my way down to Seattle, had an amazing night and I was such a good patient. I did the physical therapy, I did the massage, I got checked out to make sure it wasn't anything severe, so I was like I think I healed properly and I'm back. I'm back Good.

Speaker 1:

Yay, and you're hiking again.

Speaker 1:

I hope in the Pacific Northwest. All right, good, we're going to go on a hike someday. We were just talking about that before we hopped on here and hit record. We you know, kim and I probably have gathered 100 questions for you today and, no kidding, the list just gets longer and longer and there's just so much to unpack. We're not going to be able to unpack it all on this podcast, but we're thrilled to have you, because I want to start here with your story, because your story is really incredible.

Speaker 1:

We were also talking, before we hit record, on the privilege that we have of leaning into our passion and changing our mind and changing our career, and you've just got such an incredible story in how you started and where you are right now. You just got such an incredible story in how you started and where you are right now. So, if we can, let's dive in and go back to the very beginning. You're a urologist, and how the heck did you start in that trade, first of all, that profession, rather and tell me that story. And then, how did you lead to sexual health, because that's different, right? Yeah, what happened?

Speaker 2:

So for people who don't know, a urologist is a surgeon, a specialty surgeon, who operates on kidneys, bladder, technically male genitalia, although there is the niche of female urology, but not all urologists can move around a female pelvis with ease Kidney stones, bladder cancer, prostate, enlarged men who can't pee, right, so really genital urinary structures is what the urologist does. So when I was looking I thought it was going to be internal medicine because I wanted to know everything. I bought all the books in medical school. I just loved reading it and I did a two-week urology rotation only men. I was in Minnesota. There was one female urologist in the entire state. I have yet to remember her and now I don't remember her name, but there was one in the state and so I'd never met her.

Speaker 2:

But the male urologist, they were happy, they were funny, they fixed things instantaneously, which is kind of hard in medicine, right, and so like, kidney stone gone, bladder cancer gone. And I was like, because you showed up, big things happened in that day and that was very attractive, the short term, instant gratification. So like, okay, I'll just do whatever beats urology, because you spend another year doing a bunch of stuff and nothing beat urology. So that's what I ended up doing and trained in Denver for six years, was in Bellingham for seven years when I got my seven year itch. So for anybody who hasn't heard of the seven year itch, it's legitimate, whether it's your relationship or your career.

Speaker 2:

Something happens at seven years. You kind of get like, you get bored, you get a little. What am I doing? And I'm like oh, recurrent urinary tract infections, day in, day out. Train for you know a decade to tell people to drink more water and pee more yeah, yeah and um, so it was kind of having that like career midlife crisis, and then that was when the universe was like she's ready, you know you have to be like ready to receive the message.

Speaker 2:

So I had a woman come in. I was very bonded with her because I had cured her from cancer years in the past. We just see each other every once, once a year. How are you doing, how's things? And she was crying because of her sexless marriage great marriage, just not not full of physical sexual health and was. She was very, very disturbed about it and I'm handing her a box of Kleenex and the lightning strikes my brain and I don't know how to help her. I was like, does anybody know how to help her?

Speaker 2:

Because when I was in training for urology, we were told women were difficult. I was told to do a fellowship so that I didn't have to deal with women. Women are difficult. They took too long in the clinic and we'll never figure them out. And the gynecologists are. They're dealing with them like legit things.

Speaker 2:

I was told that I didn't question then because you're the trainee, right? And so I was like well, is it true? Is it true? We haven't figured any. How come we give by? We've been giving viagra as a prescription since 1998. Who's taking care of the people who are supposed to be sleeping with the people we're giving the viagra to yeah, right, and so, like, all these questions just started coming up for me when I started learning and I was was like oh, we actually know a lot about female sexual health. It just doesn't trickle down to the people because Hollywood feeds us a load of baloney and the doctors don't know. So there's this voice in my head and the voice was like you need to talk. And I was like this voice is super annoying. No, I'm fine, but like every morning, the voice was like you need to talk, you need to talk, you need to talk and one day I was like I don't know enough yet, Like I didn't.

Speaker 2:

There was there's one fellowship in female sexual health. Now there's two. Wow, so that means two people a year in this country get actually fellowship trained in female sexual health, and so I hadn't done one of those. Like all of this, like I wasn't smart enough. Who?

Speaker 1:

am I All those messages?

Speaker 2:

right All those messages. So I was waiting for permission for somebody to like tell me I knew enough. And like I was waiting for somebody to like pick up the phone and be like Kelly, you should start a podcast. And like I, even it was so bad, like I even knew who that person was. I was waiting for permission and so I got out of the shower one day and we're all good ideas of the shower come from.

Speaker 1:

Exactly.

Speaker 2:

Lightning strikes again and they're like. The only permission you need is your own Do it, I was like God darn it.

Speaker 2:

Like that's true, right.

Speaker 2:

So I started a podcast four and a half years ago and it's doing very well. It's like usually in the top 10 of medicine on Apple. It's called you Are Not Broken and it really started out with sexual health because that was my like women need to be educated on this, blah, blah blah. And so the book came out you Are Not Broken Stop Shoulding All Over your Sex Life Because people, you know, it's like we have all these shoulds. Like you should have sex a certain amount of times a week. You should take this long to orgasm. You should, you should orgasm. Like this, right, like we have all these shoulds about what we think sex is.

Speaker 2:

And so wrote the book and, uh, really, women started being like yeah, but you know what happens with menopause? And I'm like what happens with menopause, right? And they're like your sex life goes away. And I'm like is that true? And so that was like the next deep dive of like what it? What happened? I'm staring down the barrel at this, what the heck is coming, right, what's coming? And so it's then started to get into like is that true? Are hormones related? Why are we so scared of hormones? What's the truth about hormones and breast cancer and just started like digging deep on all of that stuff that kept coming up. And then I was like, oh we, because of the women's health initiative, we are incredibly number one in the dark about what's actually happening. People just think this is a hot flash right they have no idea that like it's a profound hormonal change.

Speaker 2:

I say change because people get all moody when I'm like it's, the hormones go very, very low and people are like we don't like the word. Oh, I don't like the word and I'm like you guys need to freaking deal with what's happening.

Speaker 1:

So yeah, yeah, Interesting, interesting yeah.

Speaker 2:

It's super interesting that women get picky about the word. But because I had posted, it's ovarian decline, I think, or I'd posted something about ovarian demise, ovarian decline, something that it was kind of medical, it wasn't demise and people get all like you guys don't know what this is. Yeah, like that's what it is. And so really started educating about hormones and educating about fear and then started prescribing it in my clinic and I'm a urologist, so we give 10 times the dose of testosterone to men, like every Tuesday. Like I am not afraid of testosterone and I know what testosterone, how good it is for people.

Speaker 1:

Yeah.

Speaker 2:

So really started kind of becoming the like sex med hormone testosterone guru of the United States of America.

Speaker 1:

Yeah, you really are, and roll credits. Note first, you do have a. What do we call it? It's a new release of your book.

Speaker 2:

Yeah, a re-release.

Speaker 1:

Okay, there you go.

Speaker 2:

So it's yeah, a publisher bought the rights to the book and is now it's going worldwide. So it's in UK, canada, australia right now.

Speaker 1:

We're so excited it's coming in September so you can pre-order that, I know you can. We're going to put that in our show notes. Just super excited I did too. And you're going to have all kinds of fun things with some, you know, private conversations with anyone that's pre-ordered, and so we can right. Yeah, yeah, I'm pretty excited, all of that in the show notes, but I I just first of all, I want to say I love the story.

Speaker 1:

You went from urologist to sexual health expert. Now you're hormonal health expert and I want to dive into testosterone, estrogen hormones, because there are so many questions about that, as you just said. And you just said something that I don't think that our general audience might realize that males take 10 times the amount of hormone testosterone that we do right, but there's not an FDA approved testosterone for women that's dosed at that one 10th of the male hormone, correct? So let's unpack that a little bit. Let's talk about that. We also know that testosterone is good for our bodies, not just to increase our libido. So that's where we go. You know, when we talk to women, it immediately equates to sex libido, and that's the only reason why I need to take testosterone. And, by the way, if I take testosterone, I might grow hair on my face and places that I don't want it, and so can we. Can we talk about that a little bit? And what the heck? Why are there so many confusing messages out there on testosterone?

Speaker 2:

Yeah, it's a one of my favorite topics because you and you have to start well and we'll back up for the people. Because if I just come out of the gate and be like all women need testosterone, like I sound, sound crazy yeah right, because their lack of education hasn't caught up to like where I am or I'm like how do you want it? Do you want to inject it? You want a cream? You want a gel right right, like, like.

Speaker 2:

You have to catch up to to where I am. So all bodies make testosterone. It was labeled the male sex hormone just by a bunch of male researchers, because researchers were men back in the day and just got labeled androgen, which means if you look it up, it means the male sexual characteristics. But it's completely made up. Men make estrogen, women make testosterone. It's like calling insulin male or calling thyroid female of like. No, these are just things all bodies have. We just have them in different ratios. So the first part of the whole discussion is really cutting down these gendered terms that we used, which kind of puts these hormones in a box, and it puts these hormones in a box of like. That's for him. This is for her side note. Men have more estrogen in their bodies than women do after menopause.

Speaker 1:

Interesting.

Speaker 2:

Yes, men have a level of 30 to 40 on average and women have a level of like less than 10. That's estrogen after menopause. So just to open people's minds of like everybody has hormones, everybody needs hormones. The hormones go crazy low in menopause to the point of you know, I have this woman and she's like I want estrogen and blah, blah, blah. And I look at, I point to her husband and I'm like you know, he has more estrogen in his body than you do right now. And that really helps them realize like, oh, I have a profoundly low level of estrogen now because I don't think of him as having estrogen. But estrogen in men is very good for their bone health, is also really good for their libido and sexual health. They've got amazing studies where they knocked out men's estrogen and they're like eh, ah, that's interesting. But you don't go around with the stereotype of like estrogen is great for men's sex lives right, right.

Speaker 3:

So you have to back up that either yeah.

Speaker 2:

So you have to back up and be like okay. So now we know everybody makes testosterone. And the other thing we need to know is before menopause. So when we're having normal cycles, our testosterone women's testosterone level is four times our estrogen level.

Speaker 3:

We don't know that either.

Speaker 2:

So we're always told. The other interesting thing is you can't make estrogen in your body if it doesn't go through the testosterone pathway. So you take cholesterol and then cholesterol goes into all of these hormones. It first has to become testosterone before it becomes estrogen. People think these are like separate floating things.

Speaker 2:

We get our estrogen from our testosterone, which is four times what our estrogen level is. It's important. It's important. But our body doesn't just use testosterone to make estrogen. We also use we have testosterone receptors in our brains and our bones and our muscles everywhere else. So that's the spiel of like okay, now we can talk about testosterone in women and actually using it as a pharmacologic drug. Once we understand I'm not trying to take something that a man has and put it in your body that you've never seen before seen before. The other interesting thing to know about testosterone is it doesn't fall off a cliff when your periods stop. Testosterone starts declining from our 20s and really kind of has a low, a gentle slope down into our 40s, where it stays low. Now the interesting thing and we need more data on but we're finding that women in their 70s their testosterone is starting to rise again, naturally.

Speaker 2:

We don't know why that's important or why that's happening, but we think those women tend to have more heart protection from it. Interesting data on natural testosterone levels when you're older and risk of heart attacks, heart disease. So that's infancy research, because nobody was really looking.

Speaker 1:

testosterone in 70-year-olds yeah, that's fascinating to me.

Speaker 2:

Yeah, so testosterone tends to. It goes down slowly from 20 to 40, stays very low and then in some women will start to rise again much later in life. But we do not have an FDA approved product for it, the FDA. There's a I don't know how else to say it. There's a strong gender bias right, we've had.

Speaker 2:

We have multiple forms of Viagra FDA approved since 1998. We just got two FDA approved medications for women's low libido a couple of years ago, so we're horribly behind on equity and equality when it comes to equal issues. So men have an FDA approved. They have about 20 FDA approved testosterone products.

Speaker 1:

And we have two, did you just say?

Speaker 2:

No for testosterone. Well, we don't have any FDA approved testosterone right Testosterone we have zero.

Speaker 2:

And look at the numbers About 15 to 20% of men that might be generous will use a testosterone product, because not all men get low testosterone. What percentage of women get low testosterone? A hundred percent. So if my math was mathing, we would have more products available than the men do Now. The other gender issue with the FDA is male testosterone. Is FDA approved for hypogonadism low hormones why do you take hormones? Cause your hormones are low? The FDA has said, and it will happen, that when we get it FDA approved testosterone dose for women, it will be approved for low libido.

Speaker 1:

And that's it. That's okay.

Speaker 2:

Yeah, so, so, yeah, it should make you mad. And so in Australia, australia's FDA, they have their own FDA, but they're FDA approved for low libido in Australia. And so women come to me and they're like, do I need should I lie to my doctor, should I say I have an issue with my sexual health to get this testosterone? And it's the, it's the, the tail wagging, the dog right, dog right. Because, like, well, the most data we have is for low libido. Why is that? Because the fda said they'll approve one for low libido, right, so the research follows what you're actually going to get it approved for? Um, there is, we have other data for testosterone and you only, you only have to talk to a woman who takes testosterone, who understands how great she feels, and this is not not just for sex and the other. The other thing to step back of, like, what's libido? Libido is a mood. Where do moods come from? Moods come from our brain. Okay, so testosterone works in your brain.

Speaker 2:

Yeah, yeah, and there's a big role in cognitive health, clarity, thinking. I mean. So many women are like I'm faster, I'm quicker, the world's more in color, I'm asking more questions, I'm more curious. My German I learned as a kid, is coming back. My math is faster. It's a brain hormone, and to say it's libido really is like you guys. Libido is in the brain. Where do you think libido is?

Speaker 1:

Yeah, and it's so limiting, limiting, it's just so limiting and so frustrating how?

Speaker 2:

sexist is it to say like I'm going to give you something for your interest in sleeping with somebody else? Right, that's crazy right it's so nuts, like people should be. You know, I only have to open my mouth and actually like explain all this and then people are like who do?

Speaker 2:

I sign me up yeah, yeah, write your legisl, write your legislatures right here. Write the FDA. It matters, right? Insurance companies won't, won't pay for your testosterone, but they'll pay for male testosterone and they'll pay for people who are transitioning to male testosterone which, by the way, it's not FDA approved for. And so the women have to be loud to say I want this. Women pay more out of pocket for their health care than men do, and this is one reason why is because they're like we're not going to cover it.

Speaker 1:

It's't cover it, right? So here we are in 2024 and we're still having the same conversations, and that's incredibly frustrating. So what do you know? What do women do? If there isn't an FDA approved testosterone and and we don't understand how testosterone affects our body, what do what do we do, right? So here are and we go to the doctor and they might say, well, you need hormones. But I have never had a doctor talk to me about testosterone. It's always estrogen and progestin. I mean, it's just yeah, always.

Speaker 3:

And I just had a whole blood workup done on everything, on every everything and on the on the hormone piece. Testosterone was not on there. I was looking again this morning as we were preparing for this, because I was like where? And I love my doctor, she's super smart and would like do the right thing, but it seems like I need to specifically ask for my testosterone to be checked. You do you do at this point?

Speaker 2:

I I listen, I went to medical school and didn't learn that women had testosterone in their bodies, and it was probably only like three years ago where I learned that we have more testosterone than estrogen in our bodies, like you know, shut the door. So, unless you're like, I'm innately curious about these topics, right, and so my level of education now is not where I was when I got done with medical school, and so doctors have to be innately curious or they have to learn from other doctors, because once you're 10, 20 years in practice, you're not learning new things unless you're like, very interested. But here's, this is how the change happens. Women go in and they request and they ask and they demand and they repeat themselves, because I've had many doctors come to me and they're like listen, I need to learn this now, because women keep coming in, right, and so thinking about, how do we change systems? Do we change systems from top down or do we change systems from bottom up? And I really think with the hormone menopause world, we're changing the system from the bottom up, because if we are expecting what there's 1 million doctors in America if we're expecting 1 million doctors to get an education that they didn't get or they got the opposite education because they trained during the Women's Health Initiative.

Speaker 2:

When hormones remember, hormones cause cancer for a while. Now they don't again, because that was bad research, right. But we can't wait, for the doctors are too busy, right, exactly Busy. So to me I'm like I educate the woman, she goes in and that's how we get it to change. But going back to this specific testosterone issue, it is a big issue and this is kind of where the pellet, the pellet wellness.

Speaker 2:

Yeah, let's talk about this Because our healthcare system number one doesn't pay for these products. Number two, isn't educated about these products. Women will go to these clinics where all they offer is pellets, and to me I'm like, if you only offer one type of hormone, you're not a hormone expert. You're a one-trick pony and you're making money off those and you're not a hormone expert. You're a one trick pony and you're making money off those and you're making a lot of money, Right, Right. But I get it. I understand why women go and some women do very well. If everybody did poorly, they'd shut down.

Speaker 1:

Yeah, sure.

Speaker 2:

Some women do very well, but pellets are super physiologic, so they're going to take you if you're already in a low state and now I shoot you past normal and I put you up really high. With these levels, whether it's estrogen or testosterone, side effects happen.

Speaker 1:

And then a high dose, fast and quick right. So my analogy is like you know we live at sea level.

Speaker 2:

If you fly me to Everest Base Camp, I'm going to fall over. Yeah right, like I'm not used to. It is like you know we live at sea level. If you fly me to Everest base camp, I'm going to fall over.

Speaker 3:

Yeah, right Like.

Speaker 2:

I'm not used to it, but like, if you fly me to Denver, I'll probably be pretty happy in Denver, like Denver.

Speaker 1:

Oh.

Speaker 2:

I'm so going to use that yeah Right. And so to me I'm like get to Denver. Then there are some people who like going. They might want to go to Nepal, but like a lot of people are happy at Denver.

Speaker 3:

Yeah.

Speaker 2:

So hang out there. But yeah, so the side effects can be irreversible. Really high doses of testosterone enlargement, so really high doses, think you know 10 times the male dose, but high doses. You can get enlargement of your Adam's apple. You can get irreversible clitoral enlargement. You can get, you know, androgenic alopecia, which is male pattern balding, and so again, not everybody. That's why these places exist. They exist because Western medicine is failing people, Insurance companies aren't covering it and women want to feel better. I get why they go there. I just don't think it's the most comprehensive, best way to get your hormones.

Speaker 1:

Yeah.

Speaker 3:

Go ahead, kamie. How can women advocate for themselves? You were saying, like you know, show up and ask for it. But you're doing a lot of education and we want to talk about your book too Very important work that you're doing there. But how should women think about when they? How do they get informed? How do they ask for what they want? How do they help change it? Like you said, ask the doctor, the doctor, but what?

Speaker 2:

what would you tell our audience about really how to move the not dial I mean to me. I'm like there's, there's good people, whether I always ask women how do you like to consume your content? Right? Do you like to listen that's podcast? Do you like to read? That's a book um, estrogen matters is an incredible book about hormones. My book for you are Are Not Broken for Sexual Health. To advocate in the office for sexual health is very uncomfortable. The doctors are uncomfortable, the patients everybody's uncomfortable.

Speaker 1:

Yeah.

Speaker 2:

So you can say hey, I've read this book. I brought this book in and for when people, when women come and see me, like I've made my job really easy by working really hard. Because now when women come see me, they're educated, they've listened to my podcast, they've read the book, they're on my Instagram, they're like let's go and have this conversation Exactly.

Speaker 1:

They're not scared about it.

Speaker 2:

You have to get over so many barriers. You have to get over the fear of hormones. You have to get over you know, so many issues and navigate.

Speaker 2:

I didn't even know hormones got low and right, like all this education, before you can say you can go advocate right and so to like, when women come see me, they're, they're just ready to go, because they've done that already, you know, and it's it's more fun for me because now we can just talk about really high level stuff or like other cool stuff. So it's education first, then you can't be empowered about this stuff if you don't know right. So education, then empowerment.

Speaker 1:

Yeah, and I think there are a lot of hurdles still. I mean, you mentioned the study 20 years ago that is still scaring the dickens out of women right now about hormones and we're still having that conversation with women that hormones are safe. So barrier, and then right, and then and then and then. So advocating, I think comes back to education. I agree.

Speaker 2:

Yeah, and knowing who you're seeing right, which is not always easy, especially if your insurance is limiting to you to be like these are your five doctors you get to choose from, but so seeing somebody who's experienced in sex med, that's probably the best. Tip is sex med docs, and if you go to ISHWISH International Society for the Study of Women's Sexual Health, ishwishorg, you can type in your zip code Okay, so what a sex med doc? Why they're so special is number one, they're comfortable talking about sex. But number two, they understand the role of hormones in sex life, so they're usually pretty proficient at hormones as well.

Speaker 2:

So, that's kind of your like two for one for being like. They've already had this conversation 10 times today. It's going to be awkward, no matter what. Like I get it. It's hard to talk about personal stuff, but like seeing somebody who's like, yeah, I do sex, med and hormones, it's a heck of a lot easier. Yeah, I mean the other thing.

Speaker 2:

If you know, for primary care, there are 74 million midlife women in this country. We need all doctors on board with this, right, we need everybody. But if you don't have a relationship with a doctor which I think the doctor relationship in this country is at its worst, all time low, because people, you know, people move and jobs move now and like you're not in a community like you used to be, and so you know I'm fortunate. I've had my primary care doctor for years. She knows who I am, she knows what I do, so she's very willing to like. She's like Kelly, just tell me what you want, right.

Speaker 2:

But but not everybody has that and not especially if you have a doctor who doesn't see a lot of menopausal people, right, it's, doesn't think that anything happens with the vulva, with menopause, right, like somebody who knows what happens to your sexual health and your hormone. Health, as your hormones change is, is incredibly important and the relationship is important. They trust you, they know you're going to come back, they know you're not asking for something crazy. And that's a relationship. And I think for hormones be like can I try X, y and Z? I will come back in three months, we'll adjust as needed. Those are the magic words when you ask a doctor for a prescription.

Speaker 1:

Okay, can you say that again? Then we're going to try.

Speaker 2:

Can we try X, y and Z? I will come back in three months and I will tell you how I'm doing and we'll adjust as needed. That is the magic word for getting a prescription.

Speaker 1:

Okay, we're going to add that to our resources as well. When you are training, really, because we talk to women about how to approach your doctor and how to best prepare for those doctor visits, and this is really great information for them to advocate for themselves. Um, I want to. I want to talk about can we go back to testosterone for just a minute before we move on and I want to talk about your book. Um, when we are looking at testosterone and dosing and the fact that there isn't an FDA approved level for women, how do you do that? What does it look like? So there's still that confusion, right? So if I go to my doctor and I'm asking for this, not just for libido, what am I looking for and what am I asking for?

Speaker 2:

Yep. So we always get a baseline testosterone just to see where it is. There's the rare woman who's going to have a high testosterone. You don't want to give her more testosterone. I've never seen that woman, because most of my people are postmenopause and late perimenopause. But so get a baseline. That's how you know that it's low to begin with, and then you recheck it in about two months and you can say oh yeah, you're absorbing or you're not absorbing, or you need more, and blah, blah. So I like to to follow this with levels in the beginning.

Speaker 2:

Okay, there's two main options Pellets aside. Pellets are an option, but again, I think you have to work your way up to a pellet. You've been on testosterone for a while. You just want like an easy every three month dose instead of a daily dose. You know that you're where your levels and you like your levels to be a little. So to me I'm like earn a pellet if you're going to do a pellet is how I think about it. So I don't. I never advocate for off the bat pellets because there's just too many women that go from zero to 300 and don't like it. So with what I call physiologic dose testosterone so giving I'm giving a woman a little bit maybe higher where she was when she was like 32. Right, I mean, the best thing to do would have been to check all of our labs when we were 28, that would have been nice.

Speaker 1:

Maybe that will change too.

Speaker 2:

Yeah Right, nobody has that. So we're kind of we're a little bit guessing of like where you were happy with your, with your sex drive and your energy and your, you know, lean body mass and stuff like that but get a baseline. The two main ways to do it is you can take the male dose or a male product which is test them, or a testosterone gel, and you make a tube or a packet bonus. If you can get the tubes, I go through Amazon. Amazon's nice. You get the tubes on Amazon and you'd make a tube last seven to 10 days.

Speaker 2:

Now that's not accurate, but I would argue like it's pretty darn good. It's going to get you like you know, for the women who are, like, obsessing over one tenth of like, maybe that's not the right way to do it for you, you know. So that's not the right way to do it for you, you know, okay, um, so that's great. You can get a prescription of uh 30, so it comes in packs of 30 for men. It's a one month supply, okay, and then you take that and you do one tenth the dose. So that's going to last you 300 days. So it's going to last you 10 months and that's, I think 211 $211 on Amazon Pharmacy. Yeah.

Speaker 3:

Yeah, not bad. Costco also is very cheap.

Speaker 2:

Now a lot of. And why is Amazon nice? Amazon's nice? Because I don't have a pharmacist in the middle of a grocery store chiding my woman over. Do you know what you're doing? Because some of the pharmacists get a little bully on this. Okay, no-transcript.

Speaker 1:

You don't have to talk to them.

Speaker 2:

Yeah, I got mine. Mine got approved on Amazon and came to mind. It comes to your house too, which is nice. Ok, so that's the, that's the dosing, the male FDA approved product. Then we check your levels in about two months, two to three months and on that, some people, it takes four to six months for for you to notice. Right so give it some time.

Speaker 2:

Check your levels, make sure you're kind of up. The other problem with testosterone is the female range on labs. I think, and a lot of experts think, is low Okay. So if a female lab dose is, they're going to say anything over like 30, 35 is a high testosterone. I disagree. A lot of studies show that women do really well in the high double digits to 150 without getting a lot of side effects. So you have to kind of go to somebody who knows how to interpret these labs, because I don't even think the labs are that accurate. The Quest labs, for example, their female testosterone range is based off of one paper. Oh wow. So you have to understand your labs, right. You have to understand why your lab says what's normal and what's not normal. So recheck your labs, but do give it four to six months and they say if you don't notice any improvement in symptoms after four to six months, you could stop. Yeah, okay. Now I might argue, because I'm the hormone expert testosterone is helping your bone. Testosterone is helping your heart.

Speaker 3:

testosterone is helping your bone testosterone is helping your heart.

Speaker 2:

Testosterone is helping your brain. You can't always feel those things that's right now right, that's another podcast for the preventative use of hormones, right, which is kind of. You know, that's where the thought leaders are now. Right now it really mainstream is like what symptoms do you have? Do we help your symptoms?

Speaker 1:

and then the thought leaders are like there there's a, you can't think about your whole health span Right.

Speaker 2:

You can't feel your insulin working, but you'd like to know that it's working on the right. Same thing with the sex hormones.

Speaker 3:

Right so those are.

Speaker 2:

So the second. So that's male testosterone, fda approved. The other way to do it, which is easier, is get it compounded at a compounding pharmacy. Five milligrams a day, one pump, 90 pumps, there's your three months supply. It's about 70 bucks. One pump to your leg every day, easy.

Speaker 1:

I kind of like the pump.

Speaker 2:

It's a lot more idiot proof. I have the estrogen spray.

Speaker 1:

I'm like let's just take it you like the once a day estrogen, I like the once a day because I don't have to think about it. I don't have to do math, I don't have to figure out what day it is and did I take it? You know all of that, so that sounds better to me.

Speaker 2:

My opinion about this is 100% of women will have low hormones. We should have 20 different product options. We should have 30 different product options.

Speaker 1:

Like the fact that for estrogen.

Speaker 2:

we only have four options for something that affects 100% of people, to me only have four options for something that affects a hundred percent of people To me. I'm like, where's the?

Speaker 1:

innovation. Yeah, it's there, it's there.

Speaker 3:

And there's an opportunity?

Speaker 1:

I don't know, but they jack up the prices.

Speaker 3:

I want a ring.

Speaker 2:

Why I want a. I want a vaginal ring that has testosterone, estrogen, progesterone in it.

Speaker 1:

I was going to ask you the question If I got to design something Right.

Speaker 2:

I was going to ask you the question If I got to design something, that's what I would design, because then it would cover my vulvar, bladder, vagina, all of that, those structures too.

Speaker 1:

That would be the best. Because we haven't even talked about that. We haven't even talked about the vagina vaginal atrophy. I know you're a huge fan of that being preventative medicine as well. Right, we need that vaginal estrogen. Why even wait until we're having painful sex?

Speaker 3:

That's the big question why are we waiting?

Speaker 2:

until after. I think we wait for two reasons. I think we wait for three reasons about the time. The first reason is Western medicine is very good at treating disease, not preventing it. And if I'm a doctor who's into preventing it and you come into my office and I'm like, oh, you're 45, here's your vaginal estrogen, I've got eight more minutes to talk to you about it. You don't know what estrogen is. You still think estrogen is going to kill you. Your insurance might not cover it. You are uncomfortable talking Like it's a big ask to be preventative for the average person, right, but to me I'm like. I'm like mammogram, colonoscopy, vaginal estrogen here you go, um, because the average. So that's number one. Number two is sex is difficult to talk about, right? How many women come see me? They've stopped having sex eight years ago, right. Eight years ago, six years ago, five years ago. This isn't like a sex hurt once I'm going to get it checked out, yeah, which is what men do. Men are like. Erections were iffy one time.

Speaker 3:

Check this out.

Speaker 2:

Yeah, whereas women are like it. Just it just started hurting so we just stopped having sex. That was eight years ago, right. And then the third reason is women don't, because we don't know what menopause is and we think it's the end of periods and a hot flash. We don't understand that the pain with sex is because of low hormones, right, right, right. And so those are the three reasons that vaginal estrogen isn't happening at age 45. But I had this insight the other day because you know I'm a big preventative and for people who don't know, vaginal estrogen is incredibly low dose. There's literally hardly a person who can't be on it. There's always an asterisk of oh yeah, you can't. But, like breast cancer survivors, everybody, for for the most part, can be on vaginal estrogen because it's not systemic, it's not going, it's not going to help.

Speaker 2:

I always say it's not going to help your bones, it's not going to help your heart and it's not going to help your brain. It's such low dose. It's only for bladder health, vagina health. Vagina and bladder share a wall, so they're condo, they're condo mates. Um so vaginal, yeah, it's just so incredibly important. But they don't know that hormone changes is why you get overactive bladder and you start getting up more at night and you start getting more recurrent UTIs and all those things. People don't know that that's a hormone thing.

Speaker 1:

There is so much that is related to hormones it is mind boggling.

Speaker 2:

It's everything Hormone receptors are everywhere Vertigo, ringing in the ear, joint aches and pains. There was, finally, a paper just got published, like two weeks ago, which it was, to my knowledge, the first time this has been written in the medical literature the musculoskeletal syndrome of menopause oh so good. This has been written in the medical literature the musculoskeletal syndrome of menopause, oh so good. And it's 50 to 80% of women join aches and pains because in our collagen, our tendons, all have testosterone receptors, estrogen receptors.

Speaker 1:

Yeah, here, here I'm raising my hand on that one right. I'm really like hello, yeah, but if you look at it, you would have told me that five years ago, right, yeah, yeah, your shoulder's.

Speaker 2:

Look at it, you would have told me that five years ago, right, yeah, yeah, your shoulder starting to get stiff. Throw on an estrogen patch, um, the, the um. What was I going to say? Oh, the top two reasons that women stop having sex in midlife are availability of partner and systemic hormone. Menopause changes, hot flashes, night sweats, poor sleep, joint aches and pains. You don't feel good, you don't feel like yourself, right, right, and so that libido follows that, right, and certainly, if you're having pain, dryness, issues of penetration you do not want, women will come in and they'll be like I have two problems. I have pain with sex and low libido, and I always like to take problems away from people because you don't need more problems, right, and I'm like no, you have one problem. You have pain with sex. You can't expect a libido to happen. That's right when there's pain with sex. So I'm like fix the pain with sex, you make sex fun again. Yeah, libido can follow.

Speaker 1:

And there's good news. There is good news right. We have hormones, we have things that can help with all of these challenges.

Speaker 2:

So that's the good. Yeah, and I think my perspective, this is all good news. Yeah, people are like we're getting older. I'm like, damn right, you are.

Speaker 1:

It's a freaking blessing yeah, we get to right, we get to live longer.

Speaker 2:

This myth that we have to deal like that. It's like some burden and I'm, like you know, 200, 300 years ago, the privilege of living past 47, like it was not universally. Is it universally accepted that you're, by and large, going to go through menopause now?

Speaker 2:

yeah that was a privilege offered to very few until very recently, and I like to remind people of of like we're figuring out aging on a global scale for the first time ever. Yeah, yeah, we did. To me, all of this is a privilege, like oh my God, I have to floss. It's like, yeah, because you still have teeth.

Speaker 3:

Like it's a privilege right.

Speaker 2:

Like, oh my God, I have to wear a seatbelt. Seat belt like you don't think about, it's like a privilege to drive the car and you know what makes it safer. And so I think, and it's just that little healthy dose of like reframing, yeah, like, oh my god, to have the opportunity to be on this earth for 80 years, yeah, that's brand new it is and you're right, it's a privilege and I I do think that reminder and shift in perspective is incredibly important.

Speaker 2:

Yeah, I mean I just like to to break down everybody's limiting beliefs. Right, because they're like hormones aren't natural and I'm like you have shoes on, yeah, you have heat right. Like you have glasses, like why and people will say that, about sex too, they'll be like I have vibrators. They just seem so unnatural. And I'm like I have two vibrators for my mouth. I have like an electric toothbrush and a water pick. Why are you picking your natural for this one thing in your life? You have a.

Speaker 2:

You have a mysterious, magical internet that comes into your house and you can buy pants right like like we're living in magic at this point, and for people who get all like naturally with hormones and sex, I'm like get rid of the internet then, because that's not natural nobody's gonna get rid of that right like so. It's like you just change people's their moody perspective a little bit to be like it's kind of a good.

Speaker 2:

It's a good reminder yeah it is, but I think I mean to me. I'm like we have a new responsibility to age well, because never have we put a body through 40 years of low hormones and expected the bones not to break. Right, right, right, right Like the risk, the risk of hip fracture for us now is legitimate.

Speaker 1:

Yeah.

Speaker 2:

Because we're going to go 40 years without hormones.

Speaker 1:

We're learning how to do that.

Speaker 2:

We're learning how to do it. We're learning how to age on a global scale for the first time ever.

Speaker 1:

Yeah, and I think that's what our age group is doing right. I think we really are. We all have daughters here. We want that to be different for them and we're changing that and we're learning so that they can grow older better.

Speaker 2:

I think a lot of us are watching our parents and we're starting to say I don't want that.

Speaker 1:

Yeah, I agree.

Speaker 2:

Right, how does that not happen? And the truth is you have to start now. You can't start when you're 73. You can Some people do I do start older people on hormones. That's another podcast episode. But, by and large, protect your bones before they are weak, protect your mind before it's having issues. And again, it's a mindset change, because in Western medicine, come see me when your hip breaks, come see me when you have dementia. Women are saying I don't want to do that, though what can I? Do to prevent things.

Speaker 3:

Like, if there was a.

Speaker 2:

if there was a drug that men could take that made them live longer, decrease the risk of colon cancer by 30 percent, increase their lifespan by three years, decrease the risk of heart attack by 50 percent, decrease the risk of heart attack by 50%. Decrease the risk of all bone fractures by 30 to 50%, do you think they would be on this drug and everybody's like, yeah, a dude would take that. Those are good. Oh yeah, if you have prediabetes, it decreases your risk of diabetes developing that by 30%. Everybody would be on that drug. It's called estrogen. What are we questioning?

Speaker 1:

What are we questioning, seriously? What are we questioning? I'm going to ask you this question because I really want you to say it, because you're a doctor. If I say it doesn't have the same level of respect, but I want to ask you a question here. So you know, for the record, you just talked about preventative care, right? Why not take these drugs estrogen, um as a preventative medicine for all of these things that you just mentioned? What age? And I know that that is really hard to say. You know this particular age, age range, let's just say age range, would that be?

Speaker 1:

what age, would that be?

Speaker 2:

Well, menopause. Average age of menopause in america is 51. We know your hormones don't fall off. This is the other myth of like that periods are irrelevant. I got some. I got some heat for saying that on the internet the other day, but, like people use periods as a marker of it.

Speaker 3:

But now it's okay to start it.

Speaker 2:

It's. They're irrelevant. They're like you've got some, a little bit of some, hormones, sometimes when you're still having a little bit of periods, but there's no cliff that you drop off of. The new push now is we are severely undertreating our perimenopausal women. Massive suffering and, many people would argue, more suffering because the body's very sensitive to changes in hormone levels. Once your hormone levels are just flatlined, like it, actually things mellow out a little bit, not entirely your bones really start taking a dive, like the heart disease, the things you can't see, but like mood, sleep, hot flashes, joints, aches and pains. Like the perimenopausal woman, because of the fluctuation, is suffering without help the majority of the time. So, but by preventative, if we're having the preventative question, some people would argue perimenopause, because the biggest rate of bone loss is in the final years of perimenopause. So you could argue that. You know to me I'm like listen by by mid fifties, start having the conversation.

Speaker 1:

Yeah, I asked that question, um, because there's often well, I asked it for several reasons, but, um, we often hear from women. I don't need to worry about that right now. I don't need. I don't need that information because I think I've already been through it.

Speaker 3:

Yeah, or either you're post-menopause, and I don't need that information because I think that yeah or either you're post-menopause and I don't need to worry about.

Speaker 1:

oh, I've been through that, I don't need that.

Speaker 2:

Yeah, they think it's ended because they don't know what it is.

Speaker 1:

Right. Or yeah, the perimenopause stage right. Like I had no idea that all of this was happening to my body at this young age was happening to my body at this young age. I never thought that I would have to think about menopause and hormones when I was late 30s, early 40s and I went through early menopause. So smack me in the face right Like, oh yeah, yes, you actually do need to have those conversations April. So I do think it's important and that's why I asked it.

Speaker 2:

So thanks for- we all have that bias. We all have that bias in our head, right Like when I close my eyes and think of a menopausal woman. I'm thinking of Betty White on the Golden Girls. 100% Right.

Speaker 1:

Well, if you Google it, if you go to Adobe Stock, right, okay, so we use Adobe Stock everybody for all of our stock images, for whatever, right? If you type in that search bar menopausal women, that's what you get. That's what you get, anyway, with a fan, right Like waving yourself.

Speaker 2:

Yeah, and untreated and untreated. Yeah, I mean the myth that women, our bodies, were made for suffering.

Speaker 1:

So we should suffer Like it's it's, it's a very oppressive language. Yeah, we don't have to suffer and it comes back. No, and there is help and advocate for yourself.

Speaker 2:

It's. You know, it's kind of like advocate for yourself. Yeah, it's kind of like the body positivity world of like, just get to neutral, just get to where you accept your body. It's like no, no, no, no, no, you can actually feel really good.

Speaker 2:

Yeah, right, like it's like this like good enough to be neutral of. Like no, no, no, you can actually love your body and you can actually feel good. When you're this age, you might need to do some things, you know. You might need to prioritize your health, and I think that's the important takeaway. Also, like for both for sex and for hormones, is like these things don't exist in a bubble. Like hormones are nice, but that's that's not your, just your sex life. That's not just men. Like you need to exercise. And for sex is like you need to know how you get turned on. You need to set aside time for that. You need to work on your mindset about what you think sex is Like. It's not just like here's some vaginal estrogen. Enjoy sex. If you think hormones are the only thing, you are going to be disappointed. But hormones are tools, they're messengers and they can be profoundly helpful. But you still have to do all the other things.

Speaker 1:

Yeah yeah. You have to do some work, you have to do some self-reflection, you have to take the time and pause. Sometimes we're scared of that and sometimes we don't give ourselves permission to do that.

Speaker 3:

Well, and Kelly, you said when I heard you speak at the Women in Work, you said you ask women when they come to your office what do you want? And it made such an impact on me to just like I even asked that question about what it is that you want and that so many people are like I don't know.

Speaker 1:

We haven't asked her, we haven't asked ourselves, we haven't asked ourselves. So yeah, and I do want to just kind of like like chime in and say, yes, you've made a huge impact on Kim with that question, because it keeps surfacing since June, since June Right. I mean, like she keeps coming back to that and I'm like really important question.

Speaker 2:

I mean, you know it's. It's, I think, ancient philosophy, or you know lots of self-help of like tune in because your body, because you do know, you do, you do. You got to get quiet and you might have to try something, but you'd like that's the magic of it, is like you do know, and I think for some people they're like they've just been telling themselves they don't know.

Speaker 3:

It's like, yeah, you do or don't know how to listen, like you, when, when you heard I need to speak, you were like no, no, no, no, no, no, no, no, no. And then you kept hearing it. You kept hearing it, right?

Speaker 2:

Yeah, quiet enough to listen, oh yeah, that's a good way to end this podcast. So I was at a conference. I was at a physician conference about a year later I had started the podcast, blah blah, blah and the voice got quiet for those who are listening to that end of that story. So the voice, she got quiet and there was somebody speaking at the conference and they said that what that voice is, is your future self pulling you forward?

Speaker 2:

And I was like, oh so now? So she I mean she talks to me every once in a while and she was like two years ago she's like you got to quit your job, you got to open up your own clinic. You know, need you don't, don't do this urology thing full bore anymore. And I knew her and the voice. I knew the voice enough now, like I trusted her on the whole podcast journey thing and and then I knew she got quiet when I was doing what I was supposed to be doing. And now she's like you need to stop this urology. And you are no.

Speaker 1:

And then I'm like god damn it she's back, yeah, but now I like I trust her and I'm like God damn it, she's back, yeah.

Speaker 2:

But now I like I trust her and I'm like, hi, yeah, like hey, it's good to see you Really Right. I have to quit my my good. Yeah, that's what I got, okay.

Speaker 1:

You know that's exciting too. It's really exciting that you're opening up your own clinic.

Speaker 2:

That's in Bellingham Washington. So yeah, I mean to me. I'm like I want the doctor patient relationship. Yeah it's gone. It's completely gone with the current health insurance model of everybody's moving around and your insurance drops so you can't see that person anymore. And when you do see that person, you see them for 10 minutes Like the doctor. Patient relationship is gone. And me, having doctored this long now, what people want? They want the relationship, they want to feel heard, they want to feel like somebody cares. That's the doctoring that I want to do.

Speaker 3:

That's so great.

Speaker 2:

And so I have to get out of the broken system in order to do it. That's so great and so I have to get out of the the broken system in order to do it. Yeah, because, because our system doesn't, the doctor patient relationship is not. It's not on the top 10 things that matter it's not western medicine is really good at breaking a femur, fixing a femur fracture.

Speaker 2:

we're very good at a lot of things, sure, but that doctor patient relationship and being like I don't know what your exact hormone combo is going to be, but I'm here to figure it out with you, yeah.

Speaker 1:

Let's try something, let's figure it out, let me know.

Speaker 2:

Let me know. I texted one of my patients last night and I'm like are you sleeping? Oh, her big thing was she was not sleeping Right, hadn't slept in years, wow. And so I texted her at her. I was like you sleeping, and she's like I slept till 10 in the morning I haven't done and like she was, ecstatic. It was a good she didn't have an overslept a job or something yeah but she was like ecstatic, wow, wow, and I'm like that's what I want.

Speaker 1:

That feels so good I want that relationship so good, not not just for her, but you too, right?

Speaker 1:

oh yeah, totally to be like ah, look what I did yeah, yeah, well, your information on your new clinic will be on your website to Kelly Patterson mdcom. So, um, all of your information is on your website. I love your website, by the way, um, but we, we and all of our podcasts, um, with a rapid fire. So we're going to rapid fire and get to know you a little bit better, and then we have one question that we ask every guest, and we'll get to that in just a moment. But you're a Washingtonian, you're local. We were talking about the beautiful Pacific Northwest that we live in, but, curious, we have lakes, oceans, rivers. What would you rather? Sit by with a cup of coffee, water, yeah, what body of water?

Speaker 2:

by with a cup of coffee Water. Yeah, what body of water? Oh, I look at a lake right now. So lake is good, ocean's good, any water.

Speaker 1:

I grew up in Duluth Minnesota, so I had Lake Superior in my backyard. So water to me. So water, water, water. Just doesn't matter.

Speaker 3:

What's the best piece of advice you've ever received?

Speaker 2:

You're in charge of your own education.

Speaker 3:

Love it.

Speaker 1:

Thank you, dr Casperson. Thank you for listening to the Medovia Menopause Podcast. If you enjoyed today's show, please give it a thumbs up, subscribe for future episodes, leave a review and share this episode with a friend. There are more than 50 million women in the US who are navigating the menopause transition. Us who are navigating the menopause transition. The situation is compounded by the presence of stigma, shame and secrecy surrounding menopause, posing significant challenges and disruptions in women's personal and professional spheres. Medovia is out to change the narrative. Learn more at medoviacom. That's M-I-D-O-V-I-A dot com.

People on this episode

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April Haberman

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Kim Hart

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