{PART 2} Why Women Need to Talk About Testosterone - Dr. Kelly Casperson

Ella: 00:00:00

Hey, welcome Back to part two with Dr. Kelly Casperson. This is Ella, and I split this one into two episodes because there's so much information here.

But you will want to start with part one. And here is part two. Dr. Kelly Casperson on all things testosterone. Let's go.

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Let's go. Okay, last category of question I have for you. I really want to talk to you about testosterone therapy.

And we were talking about this when we were together, and we were talking about pellets versus, like, the daily cream. Kelly, can you give us just a quick refresher on why women should be evaluating the option of testosterone therapy for themselves?

Like, under what circumstances?

Dr. Kelly Casperson: 00:01:13

Yeah. Well, thanks for that.

Because if women don't know their ovaries make testosterone, if women don't know that they only have estrogen in their body because they have testosterone that converts to estrogen, Right. You have to back up and give them the education that they never had. And don't get me wrong, I didn't learn this in medical school either.

Like, we literally gendered the hormones and we said estrogens for females and testosterone for males, and that's not true. Men have more estrogen in their body than a post menopausal woman does.

Ella: 00:01:41

Of course they do.

Dr. Kelly Casperson: 00:01:43

Right. Like, just say I. I had this woman. She was. She was suffering. Like, she. She'd been to so many doctors, nothing was working. When did this all start?

Oh, about 10 years ago. Okay. Was 10 years ago. Was that when menopause hit? Yep. Okay, so give her a low dose estrogen patch. See her back in a couple of months.

Like, how are you doing? She comes in laughing, not wearing black. She started painting again. The husband's like, I have my wife back. Thank you.

And I said, congratulations, I've given you your husband's level of estrogen. There's a big difference between zero estrogen and like, 15. A level of 15 of, like, a little teeny bit goes a very long way.

Ella: 00:02:22

Kelly, there's so much bad information out there.

Dr. Kelly Casperson: 00:02:24

It's a shitstorm. It's really bad out There, dude, I just had an OB G guy and tell a woman that. That hormones are crack.

Ella: 00:02:31

Yeah, there's that.

Dr. Kelly Casperson: 00:02:33

The world is mad. But luckily important podcasts like you are getting the word out.

And then you have to, for better or for worse, we have to tell women that you have to advocate for yourself. And here's my argument. It's a hell of a lot easier to advocate for yourself when you're not feeling completely shitty already.

Ella: 00:02:49

Oh, God, that's such a good point. Say it again louder, for the people in the back.

Dr. Kelly Casperson: 00:02:52

Well, it's this big argument, you know, and that you should only get on hormones if you're suffering enough. And it's like, what the hell? Suffering enough?

Do I ask a man with erectile dysfunction, are you suffering enough from your erectile dysfunction function? Do I ask a man with low libido, are you suffering enough from your low libido?

Like, we don't challenge men in the same way that we challenge the validity of a woman's experience.

The big question is, which is a push pull with the, you know, the longevity people versus the guideline people is like, should you use hormones for preventative medicine? And I'm like, well, it's easier to start on them when you don't feel like complete shit.

Ella: 00:03:28

Yeah, it's tricky. I mean, I'm all about advocating for my own health. I still need a doctor to say yay or nay.

Dr. Kelly Casperson: 00:03:36

Yes, you do. That's right.

Ella: 00:03:37

That is.

Dr. Kelly Casperson: 00:03:37

Which is probably, truthfully, probably not bad. Except for vaginal estrogen. Vaginal estrogen should be over the counter. It is that damn safe.

It's over the counter in the UK Finland, Israel, multiple countries, more than that. So vaginal estrogen, again, remember, low dose, very safe. But, you know, hormones in general, we need good trained oversight.

Not people saying you can't have it because it's cocaine.

Ella: 00:04:01

Yeah. And, God, because it's not.

Dr. Kelly Casperson: 00:04:04

Because it's not cocaine.

Ella: 00:04:05

Okay. Testosterone. So men have estrogen, women have testosterone, women have testosterone, and it depletes right there along with everything else.

Dr. Kelly Casperson: 00:04:14

Yes. And the important thing to know about testosterone is our testosterone starts decreasing after our 20s, so kind of a linear decline.

And then we still make. When the. When the proverbial cliff happens and menopause happens and you have no estrogen, you still have some testosterone.

It's just way less than you used to have. Right. So, like, I'll see the poo pooers being like, nothing actually happens with menopause and testosterone. And I'm like, that's technically true.

But it's kind of dismissive because you're like, well, testosterone started falling a long time ago.

Ella: 00:04:47

Yeah. It's correlated with something else, but it's still declining. Is that true?

Dr. Kelly Casperson: 00:04:51

Yeah, but I mean, that's, that's very interesting. It's very interesting, at least to people like me, because the international guidelines on testosterone say it's for postmenopausal low libido.

And if nothing actually happens on the day of menopause with your testosterone, why can't you use it premenopausally? And the testosterone expert will be like, yeah, yeah, yeah, you can use it.

Your testosterone is just as low nine months after your last period as ten months after your last period. It's just for the definition of when menopause is. Right. So very safe. Very safe doesn't fall off a cliff on the day of your last period.

Ella: 00:05:24

Okay, so this is interesting and that is useful to know because it's create. It has side effects. Basically, there are consequences. What you're saying is menopause is not the direct reason.

It is not the driving factor behind plummeting testosterone in the same way that it, it can be called for estrogen and at the same time, your testosterone is dropping after age 20x and replacing it seems to be something that men are very comfortable with at almost any age. And what is the FDA approved mechanism for replacing testosterone in women?

Dr. Kelly Casperson: 00:05:57

Doesn't exist.

Ella: 00:05:58

Sorry, I, I am not soapboxing here. And this is not men's fault. I mean, what is it is in the. Not all.

Dr. Kelly Casperson: 00:06:07

Pretty sure women don't run the fda. I'm pretty sure women aren't running major pharmaceutical companies until that changes. It is men's fault. Okay?

Ella: 00:06:17

It's in men's best interest to get some testosterone into these women, let me tell you right now.

Dr. Kelly Casperson: 00:06:21

Oh my God, it is. Yeah. But rumor has it somebody, somebody big at the FDA a couple years ago said, what do we need a bunch of horny women walking around for?

Ella: 00:06:30

Oh, I can think of lots of reasons.

Dr. Kelly Casperson: 00:06:32

Right. Yes, exactly.

Ella: 00:06:34

Kelly, tell me some of the things that women notice when they start supplementing their testosterone.

Dr. Kelly Casperson: 00:06:41

Mood and cognition are the biggest ones. And it's, I mean, I love it. Like, a woman will come back and every woman will tell me a different story about what they feel.

And as it should be, your description of your mood is yours and yours alone. Right? So what do I mean by that? The glasses on my face don't feel as heavy. I can do math better. Humans are sexy again.

You know that point in the wizard of Oz, when it goes from black and white to color, that's my brain on testosterone. I'm asking more questions about the world. The world is more interesting.

Ella: 00:07:14

Wow.

Dr. Kelly Casperson: 00:07:14

I feel like myself again. I actually feel like getting stuff done. I cleaned my house. I'm finally starting to see the gains in the gym that I was working so hard for.

So all of those things, you know, and people are like, again it's the naysayers or the purists, but they're like, it's only for low libido. It's only indicated for low libido. And I'm like, where's libido located? The brain. What's libido? A mood.

Okay, so you're telling me the testosterone works in one little part of the brain to only affect one little mood? That's not how it works. It's not how hormones work. So for anybody to say it's only for this is not understanding the body very well.

Ella: 00:07:56

Talk to me about the modalities you prefer as a practitioner. What modalities do you prefer for delivering testosterone and what are some of the riskier ones?

Dr. Kelly Casperson: 00:08:07

Yeah, Oh, I love a transdermal cream. I tend to compound it. Now otherwise you have to micro dose a male product which has issues with pharmacy and stuff like that.

Ella: 00:08:17

Okay.

Dr. Kelly Casperson: 00:08:18

All, all insurances have trouble covering it because again they will say it's not FDA approved. And to back up one second, the remember my friends, the FDA says they don't practice medicine. Insurance companies say they don't practice medicine.

But here we are hamstrung to what insurance companies will or will not cover. Although they say they're only following the FDA and the FDA says they're not practicing medicine. So what are you going to do?

So anyways, we compound it. It's pretty cheap. Transdermal compounded product is very safe. It's very hard to go too high on that. It's just a nice slow rise.

Most people notice some improvement and if they don' we usually say, remember testosterone can take four to six months to kick in. So you have to upregulate your receptors. Especially if you've had low T for a while. So it can take a while.

You know people, if you expect a light switch, if you expect just to go home and for to be horny, like that's not how it works. I think the less safe, and this is not just my opinion, this is multiple published papers.

But if you have low testosterone and then you go put in a pellet or you get a high injection, you're More prone to side effects.

The body and the hair, especially the follicles, are very sensitive to a stress in the body, whether that's rapid weight loss, whether that's issues with your thyroid, whether that's very drastic hormone changes. Your hair follicles hate that and will fall out.

So that's where a lot of women, they're like, it's not the testosterone so much as the way and speed it was dosed and the level you took it to. And the higher you push it, the more side effects or, you know, air quote side effects you're going to get.

It's like, that's just what happens when you have a testosterone that high.

Ella: 00:09:55

Why do I see in the market certain types of practitioners pushing pellets? Why do I see that everywhere?

Dr. Kelly Casperson: 00:10:01

Because they make money off of it.

Ella: 00:10:02

Oh, because they're making that direct revenue as opposed to you go. Going and buying a cream.

Dr. Kelly Casperson: 00:10:06

That's right.

Ella: 00:10:07

Okay.

Dr. Kelly Casperson: 00:10:07

Yeah. I mean, are pellets. Some people will be like, should pellets be banned? I don't think they should be banned. I don't think they will be banned.

I think pellets are. Who are they useful for? They're useful for somebody who doesn't like a daily application. They like the plug and play.

They've slowed their way up to a higher testosterone, and they know that that's where they feel better and they're not getting side effects and they did it slowly. So I always say, you got to earn your pellet. But that's not how many people. So many people have practitioners who are like, all I do is pellets.

So you're kind of in this take it or leave it scenario instead of like, testosterone is useful, let's start slow. If you get to where you like it and you want to go higher, let's go higher.

If you get to the point where you're like, can I just not mess with this every day and just mess with it every two to three to four months. Great, let's do a pellet. So pellets can be on the menu, but it shouldn't be the only meal.

Ella: 00:11:01

Okay. And for the Unindoctrinated pellets are delivered through an incision made somewhere in your glute, in your butt, and then pushed in there.

And then they dissolve over time. Have I got that about right?

Dr. Kelly Casperson: 00:11:15

Yeah, that's right.

Ella: 00:11:16

Okay. And then the daily cream is exactly what it sounds like. And then somewhere in between those two options are injectable. And how.

How often would women inject testosterone?

Dr. Kelly Casperson: 00:11:26

Standard is Once a week. Because that's kind of the standard for, for men. And that's how it's formulated.

Ella: 00:11:31

Okay.

Dr. Kelly Casperson: 00:11:31

I see goofy stuff. I see goofy stuff. Like people are like, I'm on a cream three times a week.

And I'm like, well if you'd like your testosterone to go to zero three times a week. Right. Like creams formulated as a steady state to be a daily application. You know, the side effect is hair growth at application site.

And if you put it on your leg, you shave so you don't care or you don't shave so you don't.

Ella: 00:11:51

Care if I put some, if I get some, can I put it on my ey eyebrows?

Dr. Kelly Casperson: 00:11:54

Well, it's, it's actually in discussion with some dermatology people of like, has that been studied? Will it work? Right, because it's different. Different hair follicles. Right. Like the top of the head hair follicles.

Too much testosterone makes it fall out. But in other places on the body, testosterone makes it grow. So it's not universal that it will make all hair grow.

Ella: 00:12:14

Okay, last question in this arena then.

I know, I believe I have retained that men, typically, when we talk about ranges, men have 10x the amount of testosterone 10 to 20, 10 to 20 times as much testosterone as a woman. What, what range do you like to see for say 40 to 60 year old women when it comes to testosterone? What's a, what's a nice balanced range?

Dr. Kelly Casperson: 00:12:40

Yeah, I don't try to get you to 52. I try to get you to, I feel good on testosterone.

Ella: 00:12:45

Important, right?

Dr. Kelly Casperson: 00:12:46

The other thing to know is lab values. So the two biggest lab companies in America are Quest and LabCorp and their testosterone.

First of all, you have to make sure you're ordering the right test. It has to be the mass spectrometry test, not the, not the other one.

So you can't just order a male testosterone lab because it's not, it's basically worthless and value is less than 100. So you need to order the mass spec test. That's for women, children and men because it's better at low ranges. So you got to order the right test.

And then you have to realize their ranges are very limited. With like what papers they decided normal is like I have, it's one of them where like normal goes down to two.

Ella: 00:13:26

What?

Dr. Kelly Casperson: 00:13:27

And I'm like, I'm like, two is not normal. Like, but your lab test says it's normal. So what lab did you use?

What lab values are your ranges and the data on low libido it's, it's slightly super physiologic, not crazy super physiologic. So a woman will usually start noticing testosterone kick in at a level of like 50 80s. Fine. Many happy women at 80.

I believe, I believe some women do better in the 1/ hundreds. But you're going to start, you might start seeing androgenic side effects. And you just have to know that. Right.

And remember some energetic side effects happen slowly over time. You give a person. What I love about all of this is we have amazing trans data.

We give women bodies 10 times the female dose because they want to be trans men. That's safe. I can be like, I can give you 10 times the testosterone dose.

You're not going to get any more heart disease, any more cancer, any more crazy. Like it's safe. You will slowly develop characteristics that look very male.

Ella: 00:14:23

Okay. Your voice is gonna deepen. You might get facial hair, your body.

Dr. Kelly Casperson: 00:14:27

Fat distribution is different. You might go bald.

Ella: 00:14:29

Interesting.

Dr. Kelly Casperson: 00:14:31

Orgasms change.

So the thing to know is if, even if, like, if you want to stay at a testosterone to say like 120 or something, be like over time, just monitor that stuff. Because if you put, if you give, if I give you trans male doses today, you're not going to look like a man tomorrow, but over time you will.

It takes them a couple of years to like fully transition. So those are the things I think about when, when I talk to women about testosterone.

It's complicated, you know, I don't know everything about all aspects of medicine at this point. And we can't expect all doctors to know everything about all aspects of hormones.

Ella: 00:15:07

No. And we're not linear equations, we're not thermostats like I wish we were, but we've got a bunch of dials.

Dr. Kelly Casperson: 00:15:13

Yeah, yeah, yeah.

I mean hormones in and of itself like there I can, I can argue both sides of the coin of like listen, throwing an estro estrogen patch on somebody's pretty damn simple. But it's the nuances, you know, especially in perimenopause. What do you do first? Like there's, there's some skill involved.

Ella: 00:15:28

Yeah. An art and a science, I should imagine.

Dr. Kelly Casperson: 00:15:30

An art and a science. And past performance does not guarantee future returns.

Ella: 00:15:35

That's right.

Dr. Kelly Casperson: 00:15:36

Like just because your sister did well doesn't mean that's the same, that's what you need.

Ella: 00:15:40

Or hell, just because 44 year old you did well doesn't mean 52 year old you is going to have the same response.

Dr. Kelly Casperson: 00:15:45

That's exactly.

Ella: 00:15:45

Aren't we Fun.

Dr. Kelly Casperson: 00:15:46

Oh, my God. The best things ever. Like, nobody likes being complicated, but, like, that's actually what makes it. That's what makes you unique.

Ella: 00:15:54

Well, just to wrap up the tea conversation with a bow, I want to be super clear in case it got muddled that you're talking about when the ranges get above 100, 120. You said you've heard, you've seen people who are in the 200 range, even.

Dr. Kelly Casperson: 00:16:10

Like, oh, pellet people. Pella people will be 300, 400, which is a low. Which is a low male but low male level.

Ella: 00:16:18

And that is not what someone can expect if they go in and have a conversation with their practitioner about transdermal testosterone.

I just want to draw a real clear line between those things because sometimes people are multitasking and they're just like, wait, I don't want a beard. I don't need testosterone.

Dr. Kelly Casperson: 00:16:33

Yeah, well, that's the stereotype, right? It's like testosterone. It's all about dosing. Kombucha versus vodka shots.

Ella: 00:16:40

Okay, okay.

Dr. Kelly Casperson: 00:16:41

Dosing.

Ella: 00:16:42

Dr. Kelly Casperson, you are an absolute font of information, and I couldn't thank you more.

Dr. Kelly Casperson: 00:16:47

Yay. Thanks for having me.

Ella: 00:16:49

I'll make it super easy for folks to find you. And I just want to plug your podcast one more time. Tell everybody what the name is.

Dr. Kelly Casperson: 00:16:55

You are not broken.

Ella: 00:16:56

You are not broken. Thanks, Kelly.

Dr. Kelly Casperson: 00:16:58

So much value. Thank you.

Ella: 00:17:01

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