403: Understanding Sexual Health, Hormones, & Your Body After 35 - Dr. Kelly Casperson {PART 1}

Ella: 00:00:03

Welcome, you're on air with Ella, where we share simple strategies and tips for living a little better every day.

If you're interested in mindset and wellness or healthy habits and relationships or hormone health, aging well, and eating well, honestly, if you're into just living better and with more energy, then you're in the right place. Welcome to real honest, no fluff conversations about creating a better you. We're not here for perfect. We're here for a little better every day.

Let's go. Hey, you're on air with Ella, and it is my utter pleasure to share Dr. Kelly Casperson with you today. Hey, Kelly. Welcome to the show.

Dr. Kelly Casperson: 00:00:42

Thanks for having me.

Ella: 00:00:43

I'm delighted, as mentioned, that you're here. Listen, we got to spend some time together late last year, and we had fun. We did have a good time. I wanted to steal your black leather jacket.

I'm happy to tell you. Santa brought me one.

Dr. Kelly Casperson: 00:00:57

I'm so glad I told Santa to get you one.

Ella: 00:01:00

I appreciate it.

Dr. Kelly Casperson: 00:01:01

Glad it worked out. Have you worn it with your white dress yet?

Ella: 00:01:04

No. I need a stage event. Why don't you invite me to your next one? Only for the wardrobe.

Dr. Kelly Casperson: 00:01:08

That's it.

Ella: 00:01:09

Just for the opportunity to work.

Dr. Kelly Casperson: 00:01:10

I don't organize those things, man. Organizing events stresses me out. I'm the talent.

Ella: 00:01:14

It's like throwing a wedding. I'm actually. I have a big event coming up in May. Let's see if we can debut. I feel like May is still black leather jacket time.

Dr. Kelly Casperson: 00:01:22

You can do that.

Ella: 00:01:22

And listen, that's why we're here. We're here to talk fashion sense. We're here to talk about your keen sense of style.

Dr. Kelly Casperson: 00:01:28

What I don't like to do, I jest.

Ella: 00:01:32

Dr. Kelly Casperson, would you tell us who you are and what you do?

Dr. Kelly Casperson: 00:01:36

Absolutely. So I'm Dr. Kelly Casperson.

I am a urologist by training who about six years ago, had lightning strike my brain when I realized I couldn't help a woman who was crying in my office because of low sexual desire and function. So I deep dove into that, did that, started a podcast, wrote a book, did a TEDx, and then was.

I kept hearing people say, yeah, but, you know, yeah, but you know, yeah, but you know what happens with menopause. And I'm like, I don't know, but I'm staring down the barrel at it. Maybe I should know.

And the big myth, of course, about sex and menopause is that sex goes away. Now, it does go away for some people. I think it goes away because people just did not get a good sex education.

They also did not get a good hormone education.

So now my life is being the translator between good science and good people and helping them understand what they can do to help them live the life they want to live. That's what I do.

Ella: 00:02:35

And you are a board certified urologist. How do you even say urologist? Surgeon.

Dr. Kelly Casperson: 00:02:42

Yes, urologic surgeon. So for people who don't know what a urologist is, we are surgeons of the genital urinary symptoms, organs.

So kidney stones, kidney cancer, bladder tumors. I can't pee. I pee too much. I leak when I pee. I hurt when I pee. I have recurrent UTIs, penis, testicles, scrotum, vulva, vagina, urethra.

That's the urologist's territory.

Ella: 00:03:08

Thanks for blowing up my search engine optimization, Kelly. Straight out of the gate. The more people like you who are extremely educated and well versed in allopathic medicine. And now what I'm calling.

I don't know if this is correct, Kelly, but I would call more integrative medicine and looking at the whole person and treating them accordingly.

Dr. Kelly Casperson: 00:03:30

Oh, you mean doctors who care about people. People.

Ella: 00:03:32

That's kind of where we're. Yeah, that's what I mean. Too long. Didn't read doctors who care about people care about people.

Dr. Kelly Casperson: 00:03:38

Yeah, no, like, you know, I'm creating this new Casperson clinic. So basically, like, spending hours with people and I'm like, oh, yeah, I'm creating this new doctor patient relationship. And I'm like, no, I'm not.

I'm creating what used to exist and has fallen and gone away.

Ella: 00:03:53

Listen, when women come to you in this new clinic, Congratulations. And when people come to you, what are some of the most common myths that you see?

See, I want to talk about sex ed and I want to talk about body parts. Let's start first with. With sex.

What are some of the most common myths about sex and even sexual desire in, say, women over 35, women over 40 that are presenting to you all.

Dr. Kelly Casperson: 00:04:16

All the myths, Lots of shoulding, lots of shooting all over sex lives because our sex ed was so bad to begin with. So we're like extrapolating from what our partner tells us in Hollywood and our first boyfriend and our religion, and we put all these shoulds on us.

So it should be a certain way you should orgasm. A, you shouldn't have to use a vibrator. You should be able to orgasm by putting a penis in your vagina. You should want sex all the time.

Spontaneous desire is the only type of desire.

The Other big myth is that sex goes away after menopause or it gets worse, that you can't do anything about pain with sex, that you should just grin and bear it. Like, the list goes on and on and on.

Ella: 00:04:51

Kelly, we have talked on this show before about spontaneous versus responsive desire. I will link to that because it is worth a refresh.

And we have talked about some of the physical symptoms, physical manifestations that aging brings into sexual dynamics. What do you see from your point of view? What is plaguing women the most?

Dr. Kelly Casperson: 00:05:17

Not knowing that responsive desire is a thing. So they need to learn that more than what I hear from women over and over is like, I had no idea I was normal. That's what I hear a lot.

And then for aging in the pelvis, erectile dysfunction and vaginal dryness, pain with sex, tightness, tightness being painful, decreased lubrication, decreased ability to orgasm.

I'm making it sound like all these things, but it's just what happens when your hormones go down, your blood vessels start aging, Your body just starts aging. Big shout out to, don't smoke cigarettes. That's like, the worst thing you can do for erections and sexual function do.

Ella: 00:05:53

Did I make this up? I heard you speaking about erectile dysfunction, and you said, you know, women get that, too. We just call it something else. Am I making that up?

Dr. Kelly Casperson: 00:06:03

Yeah, no, that's right. Yeah.

We call it, you know, arousal disorder or orgasmic disorder, or female sexual dysfunction is kind of the big umbrella under which those things fall. So if men, we have penises, too. It's just called the clitoris.

Ella: 00:06:18

Okay, that's a news flash. Okay, this is. This is like table stakes for you. Some people are like, wait, what? Oh, my God. Please explain that comment.

Dr. Kelly Casperson: 00:06:27

Well, embryo.

embryologically, we all start out as these beautiful pluripotent stem cells, and we' or in the majority of cases, convert to the male default or the female default. Of note, female is the default.

So you have to actually have to turn on some genes to convert to male, and then those structures embryologically will turn into a clitoris or a penis, depending upon what genes are turned on. So I always joke, the penis has three jobs. It has to pee. It has to get sperm out to fertilize and reproduce, and it has to. And it can have pleasure.

Right. So the PS has three jobs. The urethra in us is separate from the clitoris, and our ovaries are separate. So our clitoris has one job.

It's just pleasure. It's all it has to Do?

Ella: 00:07:08

Well, it is regarded, in my humble and layman's opinion, it is regarded as quite distinct in the research world, in the pharmaceutical world. And what I mean by that is if I'm a man with erectile dysfunction, I have a physical disorder, and how many drugs are there to treat it?

Dr. Kelly Casperson: 00:07:26

Oh, like seven or eight on the market right now in America.

Ella: 00:07:29

Okay, so we'll say seven.

Dr. Kelly Casperson: 00:07:31

At least. That's. That's just the Viagra and Viagra's cousins and the generics. But there's also a surgery.

You can get the pump, multiple types of pumps, cock rings, and then there's the injectable medications.

Ella: 00:07:42

Okay, so the list goes on.

Dr. Kelly Casperson: 00:07:44

Yeah, yeah. It takes a urologist or there's a lot of options.

Ella: 00:07:48

And then with the clitoris, if there's any dysfunction, it's not typically described as a physical problem. It's described as a responsive problem, as an arousal problem, as a sexual desire problem. And how many drugs are there to treat that?

Dr. Kelly Casperson: 00:08:02

Zero.

Ella: 00:08:03

Oh. What can we deduce from this? Math?

Dr. Kelly Casperson: 00:08:06

Yeah. Oh, God, we're peanut. We're fallow. We're a fallow centric nation. Yeah. I mean, 90% of men are heterosexual.

So the big question is, who's taking care of the people who are supposed to be sleeping with the people that I'm giving Viagra to? Right. And the urologists are.

The smart ones, are wisening up and they're realizing if you give Viagra to a partnered relationship and you don't address the other partner, you're destabilizing that relationship.

Ella: 00:08:33

Let's talk about how to address. I'd love to talk with you about some of the ways that you do, in fact work with female patients, please.

In resolving some of these issues, mitigating them, reducing them in some cases, hopefully healing and resolving them. If someone comes to you and they are having pain with sex. You mentioned atrophying. In fact.

In fact, I have heard you say part of the labia can disappear with age. Is that correct? I'm like, I'm like clenching. As I say that to you.

Dr. Kelly Casperson: 00:09:05

Don't clench. Your pelvic floor doesn't like.

Ella: 00:09:06

Is it helping?

Dr. Kelly Casperson: 00:09:07

No. But you can use vaginal estrogen and stay on systemic hormones and keep your labia, more than likely. Not that we have a lot of research on this.

I mean, I've seen. I've seen 74 year olds. You wouldn't believe the beautiful labia they have because they've maintained their hormones.

Ella: 00:09:22

That is very interesting. I won't Google it. I'm going to take your word for it. Hey, are you ready to level up both your professional game and personal growth?

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When you talk about vaginal estrogen, and we've touched on this before, but by God, it is worth mentioning again, you are not talking about susceptible systemic estrogen that treats the whole body. True or false?

Dr. Kelly Casperson: 00:10:27

Yeah, Correct. By and large, when we talk about hormones, we talk about two different levels of hormones.

So there's systemic, which means that you put it in your body, whether you inject it or have a patch or swallow it or put a cream on your arm, that's a dose. And people are, people like, do not understand. They're like, I don't see what the difference is. And I'm like, it's dosing.

It's the amount of hormone in the product. And then there's vaginal estrogen, also called pelvic estrogen. Low dose estrogen. Just a very, very low dose. It's bas to the level of skin care.

You're just treating the vulva, the urethra, the bladder gets some estrogen cause it shares the wall with the vagina. I say they're condomates. They share a wall. And so vaginal estrogen is safe for everybody. You can start it when you're 92. It does not.

The warning label on it is wrong. We're petitioning the FDA to remove that.

If you care to be involved, go to letstalkmenopause.org to petition the FDA to say, we want accuracy in our medical and government labeling and this product should not say it causes cancer or strokes or blood clots. CA it does not.

And many women, about 20 to 30% of women, will get a prescription from their doctor for vaginal estrogen and then not use it because the label is so scary. They don't know the label is wrong.

Ella: 00:11:40

So this is local estrogen. It does not even get. I get why some people are in disbelief. I don't understand how it's not absorbed into the bloodstream.

But you're comparing it to the same way you put skin cream on your face. Of course it's absorbed by the skin, but this is like skin cream. I think you said for those parts that you mentioned.

The vulva, the urethra, the vagina, the labia. I'm making stuff up now.

Dr. Kelly Casperson: 00:12:04

Yep, yep. I mean, think of it like this. So like kombucha versus a vodka shot, right? Both have a. Have alcohol in them. Kombucha is like nothing.

You can buy it at the grocery store and it won't get you drunk. Vodka shot, very potent, totally going to get you drunk. Right. It's just dosing.

Ella: 00:12:20

Okay.

And then in America, the FDA put a warning on all estrogen products across the board, whole cloth, without discerning between systemic estrogen and local vaginal estrogen. Do I have that right?

Dr. Kelly Casperson: 00:12:35

That's right. So different doses, same warning label.

Ella: 00:12:38

Same warning label, different dose, and different animal entirely. Like, if you have been treated for breast cancer, you can use local estrogen. Is that generally true?

Dr. Kelly Casperson: 00:12:47

Yes, that's true. I mean, there's always the very rare weird cancer. So I always say check with your oncologist.

But by and large, it is more common that your oncologist doesn't know the data that you can use it than the fact that you have a cancer that you actually can't use it. But there are, there are the rare ones. Uterine sarcoma is one of them. It's incredibly rare. But that's why we can't say 100% of people.

Ella: 00:13:09

Okay. In medicine, you can't say 100% of anything except that 100% of people die. That's like the only stat. That's true. Okay.

Dr. Kelly Casperson: 00:13:16

Yeah, exactly Right.

Ella: 00:13:17

I'm going to link to that petition after I sign it and I'm going to link to a number of your resources because you have a great podcast and it's just like it's a masterclass in all of these topic. So we will absolutely share that. But I do have one more question in this vein. Why on earth does local estrogen help with UTIs?

What is the relationship there?

Dr. Kelly Casperson: 00:13:37

Yeah. So local estrogen basically provides the. The right environment for lactobacillus. Lactobacillus makes acidity, so it acidifies the vagina.

And when you have a nice acidic vagina, which is what you have, when you have good hormones, then it's a lot harder for the poop bugs to walk up to the pea bladder area. So it's actually a healthy vagina is bioprotector. It is the moat that prevents the bad guys from going in the castle.

And so you take that estrogen away naturally. Breastfeeding, some cancer treatments, just menopause. Right? There's a couple of different things that'll do it.

And then that vagina cannot protect you anymore. You. Your lactobacillus dies off, you lose your biodiversity. So microbiome matters. And that's why vaginal estrogen.

That's how vaginal estrogen decreases urinary tract infections. I tell people, I'm like, would you. If I had something that decreased your risk of UTI by 50 to 60%, would you want it?

And they're like, yeah, that sounds like that's pretty good. Because I would say nobody can have zero UTIs. Those are called dead people. We're living things. But 50 to 60%, there's nothing better on the market.

And that's vaginal estrogen. People don't know.

Ella: 00:14:46

There are so many women walking around not understanding why they're getting UTIs at 45, at 55, at 65. Is there more data coming out now about the benefits of vaginal estrogen? Is that happening now?

Dr. Kelly Casperson: 00:15:01

We already have the data, but the problem with research is you can do great research, but if it doesn't, if people aren't translating right? Like, what's my job? My job's to translate. People are like, we need more research on this. And I'm like, we have the effing research, right?

You just hasn't gotten out.

Ella: 00:15:16

Okay, well, that's why you're here. I was just speaking with a friend today. She's turning 50 this year.

She went to OB her OB GYN, and she asked him about hormone replacement therapy or menopause hormone therapy. And he was like, nope, terrible for you. And I was just like.

I just had my head in my hands, and I was like, this is such old science, but this is every day. This is happening every, every day. Day.

Dr. Kelly Casperson: 00:15:42

Dude, Somebody. You know, people send me messages all the time now. People are like, my OB GYN said that hormones are like cocaine.

And of course I would like cocaine because it makes you feel good, but it's just cocaine. And so I'm not going to give you hormones because it's like cocaine.

And I'm like, remember, doctors are the smartest people who went to medical school. Truthfully, in all fairness, I don't blame doctors. They're overworked. They are legitimately underpaid for how freaking hard they Work.

They sacrifice their health and their family every day for this job. And when you see 35 people a day, you can't be curious, you can't learn new things.

So you stick with the things you learned 20 years ago and you didn't get updated right. So, and to me again, and to protect the OB GYNs is like, dude, these people, they're in charge of every single damn thing.

And it's like, that's not fair. Women are 50% of the population.

They can't learn how to do surgery, save babies lives, make you not get pregnant, treat all abnormal uterine bleeding and be the only experts on hormones. It's impossible to put that on them.

Ella: 00:16:43

I have a great deal of empathy actually for physicians in the system.

I think for me, the resounding takeaway here is that we have to be advocates for our own health and we have to do our own research and we cannot out outsource our wellness. And feeling terrible and not enjoying sex and wondering what the hell is happening to your vagina and your vulva as you age.

That's not an acceptable manner with which to age. There are resources that I don't think people know enough about. And that's why, hence, you know, conversations like this can be, can be so useful.

In fact, I'd like to extend the conversation to something that plagues a lot of people and that is overactive bladder. Which is a nice way of saying maybe they pee when they cough and God forbid they do a jumping jack or interact with a trampoline in any way.

And we have had, we have started this conversation before. But Kelly, you are so good at explaining like what that is and what we can actually do about it, because there are options.

Can you just tell me, like, what should we consider normal and what is not normal and should be resolved in this area?

Dr. Kelly Casperson: 00:17:53

Good question. Yeah. Because so many people say is this normal? And I say common things aren't normal. Clear. Let's clarify that up because what you.

Just to clarify the. For the listeners, you said overactive bladder is leaking with cough, sneeze, trampoline. Those are two very separate things.

Ella: 00:18:06

Oh, good, talk to us.

Dr. Kelly Casperson: 00:18:07

So overactive bladder is urgency frequency. I gotta pee all the time. I wake up at night to pee. I might leak with running water or on the way to the toilet.

But it is more like the bladder wants to go, go, go.

Ella: 00:18:18

Okay.

Dr. Kelly Casperson: 00:18:18

And then leaking with cough, sneeze, laugh, trampoline. That's stress in common. Now, one third of women have both.

Usually the overactive bladder is more Bothersome because you kind of know when you're going to cause knees you can guard. You're not going to go on the trampoline. And the overactive bladder is a lot more out of the blue like ah, crap leak.

So one third have both the and the reason why we care. Why do I care being so nerdy that I'm picking apart. The treatments are different because the causes are different.

Ella: 00:18:44

Fair enough.

Dr. Kelly Casperson: 00:18:45

Now that said pelvic floor physical therapy and vaginal estrogen can help everything. But vaginal estrogen tends to help overactive bladder more because that's more muscle spasticity problem. And the bladder muscle loves estrogen.

So as the bladder muscle is losing its estrogen, it's going to start misbehaving more.

Ella: 00:19:04

So pelvic floor exercises can be they, they work. That's not magic.

Dr. Kelly Casperson: 00:19:08

They work.

Ella: 00:19:09

Okay. Which problem necessitates sometimes the insertion of that mesh that people have put in. Is it under their bladder? I don't want to say it wrong.

Dr. Kelly Casperson: 00:19:18

It's. It's a. Called a mid urethral sling and that is for stress incontinence.

So think of it kind of like a hammock that's just stronger than your own pelvic tiss. So it's just adding in support that's lost with age, childbirth and changes to your pelvis.

Ella: 00:19:33

And that is a surgery is a procedure. Something is put in your body. But you have been quite vocal about another option that is available to women. Can you please share what that is?

Dr. Kelly Casperson: 00:19:42

Bulkhamid. We love Bulkhamid.

Ella: 00:19:43

Bulkamed. Is that what you're saying? Bulkhamed.

Dr. Kelly Casperson: 00:19:46

Bulk. Yep. Bulk Ahmed. Bulkhamid.

Ella: 00:19:48

Bulk Amid.

Dr. Kelly Casperson: 00:19:49

And I mean most people know what filler is now. Like face fillers, right? Not Botox filler. When you get bigger lips or more cheeks. Different from Botox, it's filler for your urethra.

It's just adding volume. As we age, our volume, you know, gets lost or collagen decreases, especially with decreasing hormones.

And you just add in a little bit of filler in your urethra, usually under very light anesthesia because it's a little needle to get the filler in. Takes about three minutes to do. No downtime.

You can exercise the next day, have sex the next day, whereas with a sling that's like a four to six week downtime time. Bulkhamid's revolutionary. It actually works. Doesn't work in everybody, but I've probably done 300 bulkhamid and put slings in.

Ended up putting slings in about Five of them. So success is really great. Might have to repeat it because it wears off over time, but it's different for everybody. Some people, it lasts years.

Some people are getting another injection in six to 12 months.

Ella: 00:20:45

Okay, I hear you. That's not a permanent solution. But it sounds so, so straightforward and simple.

Dr. Kelly Casperson: 00:20:52

It's a, it's a game. And you don't permanent mesh in your pelvis.

Ella: 00:20:55

Yeah.

Dr. Kelly Casperson: 00:20:55

For the rest of your life.

Ella: 00:20:56

Yeah. I think this falls in the category of things people don't know exist, Kelly.

Dr. Kelly Casperson: 00:21:01

No, People do not know Balcomid exists. And there's not, in all fairness, there's not a lot of doctors that do it.

You know, urologists are, there's a thousand female urologists, there's about a thousand urogynecologists. Those by and large are the surgeons that do this procedure.

Ella: 00:21:15

Okay, that was my next question was can you go to your urologist and ask your doctor about this? And you're saying that a lot of them aren't familiar with it yet?

Dr. Kelly Casperson: 00:21:24

Yeah, well, it depends upon if they are specialized in incontinence and treatments for bladder leakage. So the best thing to do is to go on the bulk of it.

I think it's bulkamid.com and do find a provider and then go by zip code and then that'll tell you who the hive. Because you want somebody who does this because it's, it's like any surgery, you get good at it. Right.

So you don't want to be like, can you learn on me.

Ella: 00:21:44

I am personally just speaking for me. I'm a big believer in everybody doing whatever works for them. But I am scared away from and not willing to use filler in my face.

Is it a different type of filler that we're talking about in the urethra?

Dr. Kelly Casperson: 00:22:00

Yeah, yeah. It's very specific for the urethra. It's been around for almost a decade at this point.

Ella: 00:22:04

So none of the same hang ups that you hear about with the facial stuff. It's not going to move around. You're not going to have pillow urethra.

Dr. Kelly Casperson: 00:22:11

Yeah.

Ella: 00:22:12

Okay.

I, I do want to say that even though it's not as common as it will be five years from now, seven years from now, it's not fringe medicine we're talking about here. Isn't this covered by insurance in the U.S. yep.

Dr. Kelly Casperson: 00:22:24

Yep.

Ella: 00:22:25

Okay, last question I have for you. I really want to talk to you about testosterone therapy.

We were talking about this when we were together and we were talking about, okay guys, there's so much here and I don't want you to feel overwhelmed or to miss a single thing from Kelly. I'm gonna split this into two episodes but don't worry, you don't have to wait. I'm going to drop the other one immediately.

It is in your feed right now. Tune in for part two where we talk all about testosterone.

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Thanks for listening and thanks for inspiring me. You are quite simply awesome.