Podcast appearances and mentions of rachel rubin

A captivating conversation between Sonya and Jo explores the rapidly evolving landscape of menopause healthcare, research, and politics in Australia. In this episode we begin by unpacking the viral podcast between Dr. Rachel Rubin and Dr. Peter Attia – a two-and-a-half hour deep dive into menopause, vaginal health and GSM that's being celebrated as "the best podcast that has been recorded to date on this topic." What makes it exceptional isn't just the content but the peer-to-peer dynamic between two medical professionals sharing both evidence-based information and clinical experience.The conversation takes a powerful turn when journalist Jamila Rizvi's health journey is discussed. At just 31, a missed period led to the discovery of a rare brain tumour affecting her hormone production – a sobering reminder that health changes should never be dismissed without proper investigation. This naturally leads us to a discussion of exciting new research published in Clinical Endocrinology that examines the relationship between sex hormones and dementia risk.Politics takes centre stage as we celebrate Australia's increasingly female Parliament, with two major parties now led by women and gender equality achieved in the Labor cabinet. The shift in ministerial portfolios sees Rebecca White stepping into the Assistant Minister for Health role. We wrap up with news of an Australian company developing the first new estrogen patch in 22 years, potentially addressing supply issues and skin irritation problems plaguing current options.Links:ABC Conversations with Jamila RizviDr Rachel Rubin and Dr Peter Attia Podcast - Apple PodcastsDr Rachel Rubin and Dr Peter Attia Podcast - YouTubeSex Hormones and Risk of Incident Dementia in Men and Postmenopausal Women - Clinical Endocrinology ArticleThank you for listening to my show! Join the conversation on Instagram

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Rachel Rubin is a board-certified urologist and one of the nation's foremost experts in sexual health. In this episode, she shares her deep expertise on the often-overlooked topic of women's sexual health, exploring why this area remains so neglected in traditional medicine and highlighting the critical differences in how men and women experience hormonal decline with age. Rachel explains the physiology of the menstrual cycle, the complex hormonal shifts of perimenopause, and the wide-reaching health risks associated with menopause, including osteoporosis, cardiovascular disease, dementia, and recurrent urinary tract infections. She also breaks down the controversy surrounding hormone replacement therapy (HRT), particularly the damaging legacy of the Women's Health Initiative study, and provides guidance on the safe and personalized use of estrogen, progesterone, and testosterone in women. With particular emphasis on local vaginal hormone therapy—a safe, effective, and underused treatment—Rachel offers insights that have the potential to transform quality of life for countless women. We discuss: Rachel's training in urology and passion for sexual medicine and women's health [3:00]; Hormonal changes during ovulation, perimenopause, and menopause: why they occur and how they impact women's health and quality of life [5:30]; Why women have such varied responses to the sharp drop in progesterone during the luteal phase and after menopause, and the differing responses to progesterone supplementation [14:45]; The physical and cognitive health risks for postmenopausal women who are not on hormone therapy [17:45]; The history of hormone replacement therapy (HRT), and how misinterpretation of the Women's Health Initiative study led to abandonment of HRT [20:15]; The medical system's failure to train doctors in hormone therapy after the WHI study and its lasting impact on menopause care [29:30]; The underappreciated role of testosterone in women's sexual health, and the systemic and regulatory barriers preventing its broader use in female healthcare [35:00]; The bias against HRT—how institutional resistance is preventing meaningful progress in women's health [46:30]; How the medical system's neglect of menopause care has opened the door for unregulated and potentially harmful hormone clinics to take advantage of underserved women [53:30]; The HRT playbook for women part 1: progesterone [57:15]; The HRT playbook for women part 2: estradiol [1:05:00]; Oral formulated estrogen for systemic administration: risks and benefits [1:13:15]; Topical and vaginal estrogen delivery options: benefits and limitations, and how to personalize treatment for each patient [1:17:15]; How to navigate hormone lab testing without getting misled [1:24:15]; The wide-ranging symptoms of menopause—joint pain, brain fog, mood issues, and more [1:31:45]; The evolution of medical terminology and the underrecognized importance of local estrogen therapy for urinary and vaginal health in menopausal women [1:37:45]; The benefits of vaginal estrogen (or DHEA) for preventing UTIs, improving sexual health, and more [1:41:00]; The use of DHEA and testosterone in treating hormone-sensitive genital tissues, and an explanation of what often causes women pain [1:50:15]; Is it too late to start HRT after menopause? [1:56:15]; Should women stop hormone therapy after 10 years? [1:58:15]; How to manage hormone therapy in women with BRCA mutations, DCIS (ductal carcinoma in situ), or a history of breast cancer [2:00:00]; How women can identify good menopause care providers and avoid harmful hormone therapy practices, and why menopause medicine is critical for both women and men [2:06:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Late Breaking news today! Now we have guidelines! Thanks to Dr. Rachel Rubin for coming on IG to do this live with me! AUA GSM Guidelines Learn more about your ad choices. Visit podcastchoices.com/adchoices

In this episode of the EMJ Podcast, Jonathan Sackier speaks with Rachel Rubin, a urologist and sexual medicine specialist, about the need for patient-centred care, the importance of multidisciplinary approaches, and breaking the stigma around sexual health. Rubin also shares insights into improving medical education and advancing healthcare policies to better support sexual medicine.  Timestamps:  00:00 - Introduction  02:51 - Importance of patient-centred care in sexual medicine  06:05 - Benefits of a multidisciplinary approach to sexual health  11:45 - Gaps in sexual medicine education and training  15:20 - Addressing stigma in sexual health  23:21 - Reframing menopause in clinical practice  29:15 - Training in male and female sexual medicine  38:35 - Gender reassignment and gender-affirming care  47:45 - Three wishes for the future of sexual healthcare 

Are you ready to transform your understanding of pleasure and midlife? Join me as we celebrate a milestone 50th episode of Pleasure in the Pause, reflecting on the most powerful conversations that have reshaped how women understand their bodies, sexuality, and personal power during perimenopause and menopause.Are you ready to awaken your sensuality and feel more empowered in your body? Access the FREE Pleasure Upgrade Bundle at https://www.pleasureinthepause.com/gift.Highlights from our discussion include:Discover the truth about female pleasure from Sheri Winston's groundbreaking insights into the female erectile networkLearn how medical professionals like Dr. Rachel Rubin are revolutionizing women's sexual health educationUnderstand the critical role of testosterone in women's wellness with Dr. Susan Hardwick-SmithExplore the concept of "weathering" and its impact on women's health with Denise PinesGain insights into vulva health and body awareness from Dr. Maria UlokoPleasure is more than a moment. It's a journey of self-discovery, connection, and empowerment. Take the first step today by embracing your body, exploring your desires, and advocating for your sexual and overall wellness. Your pleasure matters, and your story is just beginning.If you're seeking to reclaim your pleasure and vitality, join Gabriella at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.pleasureinthepause.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for this enlightening journey into the heart of female pleasure and empowerment.CONNECT WITH GUESTS:Sheri Winston InstagramIntimate Arts CenterDr. Rachel Rubin InstagramDr. Rachel Rubin WebsiteDenise Pines LinkedInThe [M] FactorDr. Susan Hardwick-Smith InstagramComplete Midlife WellnessDr. Maria Uloko WebsiteDr. Maria Uloko InstagramCONNECT WITH GABRIELLA ESPINOSA:InstagramLinkedInWork with Gabriella! Reclaim your sensuality and step into a powerful new chapter. The Midlife Pleasure Collective is a monthly membership designed to help midlife women reconnect with their bodies, embrace their desires, and cultivate deeper pleasure. Join the founding members for just $20/month - spots are limited, so apply now at pleasure-in-the-pause.com/collective. Full episodes on YouTube.

Why is half the world's population walking around with an ignored, misunderstood body part? If the clitoris and penis are made of the same tissue, why is one thoroughly studied and the other barely mentioned in medical training?The clitoris is more than just a pleasure center—yet most doctors barely acknowledge it, let alone know how to examine it properly. Dr. Rachel Rubin joins me to expose the medical blind spots surrounding clitoral health, including the shocking lack of education on clitoral adhesions and why so many women suffer in silence.We also dive into the impact of testosterone in women's health, how outdated medical biases are keeping life-changing treatments out of reach, and why the FDA's warning labels on vaginal estrogen are doing more harm than good.Dr. Rachel Rubin shares her groundbreaking research on sexual medicine, why simple procedures like clitoral lysis can be life-changing, and how she's fighting to get doctors to start asking the right questions about sexual function.This episode is packed with critical insights on women's health, pleasure, and the science that's been overlooked for far too long.Episode Highlights:Why the clitoris and penis are made of the same tissue—but only one gets studiedThe hidden problem of clitoral adhesions and how they impact sensationHow testosterone plays a crucial role in women's health (and why most doctors ignore it)The truth about vaginal estrogen, the FDA's misleading warning, and the fight to fix itThe urgent need for better education on sexual health in medical schoolsIf you found this episode eye-opening, don't forget to subscribe, like, and comment! Share your thoughts and help us spread the conversation about women's sexual health.Dr. Rubin's BioDr. Rachel S. Rubin is a board certified urologist with fellowship training in sexual medicine. She is an assistant clinical professor in urology at Georgetown University and owns her own practice in Washington DC. Dr. Rubin provides comprehensive care to all genders. She treats issues such as pelvic pain, menopause, erectile dysfunction, and low libido. Dr. Rubin is the former education chair and current Director-at-Large for the International Society for the Study of Women's Sexual Health (ISSWSH), and she serves as associate editor for the Journal of Sexual Medicine Review and the Video Journal of Sexual Medicine. Her work has been featured in the NYT, NPR and PBS. She was named a Washingtonian Top Doctor in 2019-2024.Get in Touch with Dr. Rubin:WebsiteInstagramXYoutubeBlackbox AdvocacyGet in Touch with Dr. Rahman:WebsiteInstagramYoutube

Sexual health is often misunderstood and neglected in medical training. What happens when a passionate student decides to challenge the system and ignite change?The medical field often hesitates to tackle less-explored topics, but Dr. Jen Romanello is breaking new ground as a young advocate for advancing sexual medicine.As a medical student, Jen identified a glaring gap in education on female sexual health and decided to act. She founded the Medical Student Forum on Female Sexual Medicine, an initiative that has expanded to impact students across the U.S. and beyond.In this episode, we delve into Jen's journey from medical student to resident, exploring her mission to tackle the stigma surrounding sexual health in medical education. From collaborating with leading experts like Dr. Rachel Rubin and Dr. Andrew Goldstein to hosting groundbreaking symposiums, Jen has made waves in an underserved area of healthcare.We also explore the challenges of navigating medical systems that often overlook sexual medicine and how Jen's leadership is paving the way for students, clinicians, and patients alike. Whether it's addressing medical trauma or fostering a deeper understanding of patient care, Jen's work highlights the importance of multidisciplinary collaboration and a patient-first approach.Her insights go beyond the clinic, offering practical advice for medical students, residents, and professionals interested in bridging gaps in education and care.Join us for an inspiring conversation that showcases how one person's determination can spark systemic change and improve countless lives.Don't miss this eye-opening episode. If you enjoyed the conversation, please subscribe, leave a review, and share it with your network to spread awareness about the importance of sexual medicine. Your feedback helps us continue these critical discussions!Dr. Romanello's Bio:Jen Romanello MD is an intern physician in internal medicine at NYU and attended medical school at Rush Medical College in Chicago. She is President of the Medical Student Forum on Female Sexual Medicine (The Forum), which she founded in 2020. The Forum is an independent trainee-led organization that has facilitated over 1000 trainees to connect to educational, writing, research, conference, and mentorship opportunities in the field of Female Sexual Medicine (FSM).Her professional interests include sexual medicine and menopause, reproductive mental health, neuroplastic pain, metabolism and nutrition, and lifestyle medicine. Her clinical research and publications have focused on topics including clitoral adhesions,chronic pelvic pain, and medical education. She is a member of the International Society for the Study of Women's Sexual Health, the Menopause Society, and the Association for the Treatment of Neuroplastic Symptoms. She loves speaking with medical students who are deciding which specialty to pursue about how there are many great ways to approach this field.Don't miss this eye-opening episode. If you enjoyed the conversation, please subscribe, leave a review, and share it with your network to spread awareness about the importance of sexual medicine. Your feedback helps us continue these critical discussions!Get in Touch with Dr. Romanello:WebsiteInstagramMedical Student ForumAcademic ArticleGet in Touch with Dr. Rahman:

Send us a textConnection is something most of us are lacking. Which is weird, because most of us are surrounded by people daily.But it's not just people that give you connection. It's being able to show up, be yourself, ask for help, be vulnerable, and support others that creates connection.We need a balance of give and take. Period. And most of us aren't getting that, but we need that. If you are lacking this in your life, struggling as a women physician, and wanting more connection, Unbound is for you.Join us in Unbound: Women Physicians Reclaiming their Lives. This group, exclusive to women physicians (MD, DO or MBBS), starts December 1, 2024, and it's your opportunity to move ideas that we talk about on this podcast into your life. Out of your head, into your life. Together. The doors are open now for registration AND, shout out to my friend, the amazing Dr Rachel Rubin, who asked me to add a buddy option. As in, bring along another woman physician and get special savings. Such a great idea!Link to Register for Unbound: Women Physicians Reclaiming their Liveshttps://www.healthierforgood.com/offers/azBmHaNZ Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.

Send us a textHow do we take care of ourselves when we have BIG feelings, when we are used to taking care of everyone else.I'm not talking politics today, though I acknowledge that I, and many of you, have some big emotions right now, which are not limited to disappointment, but too numerous to mention.If you struggle with hard times, like most humans do, this is one to lean into. I'm sharing how to hold on to hope, acknowledge the feelings, and take care of yourself through the feelings.This is big work my friends. But it's important. We will always hit major challenges; the question is who do we want to be, how do we want to be in these moments?I'm also thrilled to announce the start of a new group coaching program, Unbound: Women Physicians Reclaiming their Lives. This group, exclusive to women physicians (MD, DO or MBBS), starts December 1, 2024, and it's your opportunity to move ideas that we talk about on this podcast into your life. Out of your head, into your life. Together. The doors are open now for registration AND, shout out to my friend, the amazing Dr Rachel Rubin, who asked me to add a buddy option. As in, bring along another woman physician and get special savings. Such a great idea!Link to Register for Unbound: Women Physicians Reclaiming their Liveshttps://www.healthierforgood.com/offers/azBmHaNZ Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.

Send us a textFeeling a bit fiery today, but I want you to sit with this one.I am done believing that I should look, work or speak a certain way, based on internalized norms passed down from generations of patriarchy in medicine. I don't want to practice that way, I don't want to speak that way, and I don't want to receive my care that way. But in order for us to change the dynamic, WE are going to need to show up differently, and ASK for things we've not asked for.I'm also thrilled to announce the start of a new group coaching program, Unbound: Women Physicians Reclaiming their Lives. This group, exclusive to women physicians (MD, DO or MBBS), starts December 1, 2024, and it's your opportunity to move ideas that we talk about on this podcast into your life. Out of your head, into your life. Together. The doors are open now for registration AND, shout out to my friend, the amazing Dr Rachel Rubin, who asked me to add a buddy option. As in, bring along another woman physician and get special savings. Such a great idea!Link to Register for Unbound: Women Physicians Reclaiming their Liveshttps://www.healthierforgood.com/offers/azBmHaNZ Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.

Ryan Gamm and Rachel Rubin live in Sackville.

Send us a textWhat happens when you clean up other people's messes?They don't get to solve the problem (and learn)They don't get to experience the consequences (and learn)You feel exhausted, and internalize that you SHOULD be the one who fixes ALL the problems.In today's episode, I'm going to walk through what this can look like, and invite you to think about these challenges differently. You are such a good problem solver. And there are some problems that truly only you can solve. But it's easy to believe that you are the only path to a solution, and that is not tenable.I'm also thrilled to announce the start of a new group coaching program, Unbound: Women Physicians Reclaiming their Lives. This group, exclusive to women physicians (MD, DO or MBBS), starts December 1, 2024, and it's your opportunity to move ideas that we talk about on this podcast into your life. Out of your head, into your life. Together. The doors are open now for registration AND, shout out to my friend, the amazing Dr Rachel Rubin, who asked me to add a buddy option. As in, bring along another woman physician and get special savings. Such a great idea!Link to Register for Unbound: Women Physicians Reclaiming their Liveshttps://www.healthierforgood.com/offers/azBmHaNZ Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.

How can we educate women about vaginal estrogen for genitourinary syndrome of menopause, especially given the black box warning? In this Brief, Dr. Rachel Rubin and host Dr. Suzette Sutherland discuss misconceptions around the use of estrogen creams and suppositories, particularly focusing on dosage and application for safe, effective treatment. They address common factors leading to inadequate results and the safety of low-dose vaginal estrogen. The doctors emphasize the importance of patience with treatment, correct understanding of hormone products, and education of patients to combat misinformation. Dr. Rubin and Dr. Sutherland also challenge misleading black box warnings associated with vaginal estrogen and stress the necessity for advocacy to update these labels and educate patients. TIMESTAMPS 00:00 - Introduction 00:20 - Debunking Myths About Estrogen Cream Usage 04:10 - Safety and Proper Usage/Dosage of Estrogen Products 05:48 - Patient Education and Compliance 08:23 - Addressing the Black Box Warning on Vaginal Estrogen 10:48 - Conclusion CHECK OUT THE FULL EPISODE OBGYN Ep. 33 - Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic https://www.backtable.com/shows/obgyn/podcasts/33/genitourinary-syndrome-of-menopause-gsm-improving-a-dry-topic

Send us a textOk, who else here likes to feel in control? Likes it too much, I mean. As in, tries to take control of every situation and then wonders why she feels so stressed, tight and yell-y.Today I'm talking about the idea that you can have complete control or complete freedom, but not both. Although this too is an illusion because we can't actually control much of what we try to control. We can have rules and structure and try to manipulate people and situations, but we don't actually succeed. We just mostly alienate people and give ourselves a headache.Let's talk about moving ourselves along the spectrum towards more freedom, flexibility, relaxation, and what that brings to the table.I'm also thrilled to announce the start of a new group coaching program, Unbound: Women Physicians Reclaiming their Lives. This group, exclusive to women physicians (MD, DO or MBBS), starts December 1, 2024, and it's your opportunity to move ideas that we talk about on this podcast into your life. Out of your head, into your life. Together. The doors are open now for registration AND, shout out to my friend, the amazing Dr Rachel Rubin, who asked me to add a buddy option. As in, bring along another woman physician and get special savings. Such a great idea!Link to Register for Unbound: Women Physicians Reclaiming their Liveshttps://www.healthierforgood.com/offers/azBmHaNZ Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.

Do you use vaginal estrogen? Recommended by top menopause specialists, backed by multiple studies, vaginal estrogen is proven to work to prevent or treat the Genitourinary Syndrome of Menopause (GSM). GSM is incredibly common and includes bladder leaks, vaginal dryness, painful sex, and frequent UTIs, which can be deadly as we age. But many women are scared of vaginal estrogen due to an outdated and misleading FDA-mandated warning label that treats local vaginal estrogen with the same broad brush as systemic estrogen. In this episode, Katie connects with three women's health leaders behind a new campaign called “Unboxing Menopause” which calls for the FDA to update or remove this misleading warning label. Top urologists Drs. Kelly Casperson and Rachel Rubin give us an explainer on how vaginal estrogen prevents the tissue decline and infections that kill too many elderly women and costs the economy billions. Let's Talk Menopause co-founder Donna Klassen loops us in on the goals of the campaign and how you can help move this critical women's health initiative forward. SHOW NOTES + TRANSCRIPT acertainagepod.com FOLLOW A CERTAIN AGE: Instagram Facebook LinkedIn GET INBOX INSPO: Sign up for our newsletter AGE BOLDLY We share new episodes, giveaways, links we love, and midlife resources Learn more about your ad choices. Visit megaphone.fm/adchoices

In a menopause muddle? In this Menopause Day special, Liz sits down to answer YOUR questions on the menopause - from HRT conundrums to body image worries. In this episode, Liz gives advice to Valentine on whether she should take HRT despite having no menopause symptoms, answers Jane's question on whether she can start HRT at age 60, helps Julie to find the right type of HRT for her, and shares advice on vaginal oestrogen for Jane. Meanwhile, Liz covers pelvic floor and prolapse for Lesley, helps Tina with breast pain and her body image worries, shares her own personal experience with HRT for Sophia, and reveals an ideal menopausal breakfast for Jo. Links mentioned in the episode:Purchase Oestrogen Matters by Avrum Bluming Visit the Balance websitePurchase the Pelvic Floor Bible by Jane SimpsonPurchase Me & My Menopausal Vagina by Jane LewisListen to our podcast with Gabrielle Lyon on proteinListen to our podcast with Dr Rachel Rubin on vaginal oestrogenListen to our podcast with Dr Milli Raizada on hormone healthListen to our podcast with Dr Louise Newson on the practicalities of HRT Purchase A Better Second Half by Liz EarleEmail us your questions at podcast@lizearlewellbeing.com Hosted on Acast. See acast.com/privacy for more information.

In honour of World Menopause Month, Liz reflects on some of our most fascinating podcast conversations on all things menopause - from libido to weight gain, oestrogen to testosterone - to help you better navigate this often tricky transition. Liz reveals the biggest menopause revelations that she found most startling, and considers her own personal journey with menopause and HRT. This episode shares highlights from Avrum Bluming on what oestrogen is and why it matters, Dr Louise Newson on getting back to basics with HRT, Dr Sarah Hillman on developing a testosterone patch, Dr Rachel Rubin on genitourinary syndrome of menopause (GSM), Dr Kuki Avery and Dr Laura Flexer on bone health, and Pauline Cox on oestrogen and metabolic health. Links mentioned in the episode:Listen to What oestrogen is why it matters, with Avrum BlumingListen to The practicalities of HRT, with Dr Louise NewsonListen to Developing the world's first testosterone patch, with Dr Sarah HillmanListen to Vaginal oestrogen could save your life, with Dr Rachel Rubin Listen to Oestrogen and bone health, with Dr Kuki Avery and Dr Laura FlexerListen to Eating for hormones, with Pauline CoxFollow Kate Muir on InstagramPurchase A Better Second Half by Liz EarleEmail us your questions at podcast@lizearlewellbeing.com Hosted on Acast. See acast.com/privacy for more information.

OBGYN Briefs - Managing Genitourinary Syndrome of Menopause Frequent UTIs and vaginal atrophy/dryness are common signs of genitourinary syndrome of menopause (GSM). In this Brief, Dr. Rachel Rubin discusses the management of GSM and why estrogen is so vital to these tissues. They address the lack of information and awareness about GSM among urologists and gynecologists while emphasizing its impact on the urinary and genital symptoms experienced by menopausal women. Dr. Rubin details how GSM is not just a matter of vaginal atrophy but involves broader symptoms like urinary tract infections and bladder issues. The doctors also discuss a range of treatment options available, including local vaginal supplementation products like estradiol creams and DHEA suppositories, and their benefits for urinary health. TIMESTAMPS 00:00 - Introduction 00:20 - Understanding Genitourinary Syndrome of Menopause (GSM) 01:42 - Symptoms and Implications of GSM 03:00 - Vaginal Supplementation Products 05:09 - DHEA and SERM Therapy 08:44 - Estrogen and Vaginal Health CHECK OUT THE FULL EPISODE OBGYN Ep. 33 - Genitourinary Syndrome of Menopause (GSM): Improving a DRY Topic https://www.backtable.com/shows/obgyn/podcasts/33/genitourinary-syndrome-of-menopause-gsm-improving-a-dry-topic 

I can't believe that I'm about to say this, but I think I've hit perimenopause!

Do you find it difficult to talk to your doctor about your sexual health? Where do you even begin finding the right doctor who will listen? And how can you empower yourself with the knowledge to understand your own sexual anatomy so you can advocate for yourself in the doctor's office and in the bedroom? Dr. Rachel Rubin is on a mission to change the landscape of sexual medicine and sexual education for medical practitioners and patients alike. Get comfortable and ready for a real education. This week, episode 21 of Pleasure in the Pause is about changing the landscape of sexual medicine and education! In this episode of Pleasure in the Pause, Dr. Rachel Rubin shares the importance of knowing your anatomy and what normal looks like for you and actionable steps you can take right now to better advocate for yourself at the doctor's office. Highlights from our discussion include:The importance of understanding patients' unique experiences and connecting with them on a personal level.The benefits of vaginal estrogen and why the FDA black box warning is misleading. Why we need open discussion about the physical changes that happen at puberty and menopause.Encouraging women to advocate for themselves and seek out specialized care for sexual health issues.For more resources regarding women's sexual health and to find a specialized provider, check out the International Society for the Study of Women's Sexual Health (ISSWSH) website.Are you ready to awaken your sensuality and feel more empowered in your body? Access the FREE Pleasure Upgrade Bundle at https://www.pleasureinthepause.com/gift.If you're seeking to reclaim your pleasure and vitality, join Gabriella at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.pleasureinthepause.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for this enlightening journey into the heart of female pleasure and empowerment.Dr. Rachel S. Rubin is a board-certified urologist and sexual medicine specialist.  She is one of only a handful of physicians with fellowship training in sexual medicine for all genders. Dr. Rubin is a clinician, researcher, and passionate educator. In addition to being the former education chair and current Director-at-Large for the International Society for the Study of Women's Sexual Health (ISSWSH), she serves as associate editor for the journal Sexual Medicine Reviews. CONNECT WITH DR. RACHEL RUBIN:LinkedInInstagramX (formerly Twitter)WebsiteCONNECT WITH GABRIELLA ESPINOSA:InstagramLinkedInWork with Gabriella! 

Sexual health is not discussed enought in midlife.  Menopause can bring about painful sex, dry vaginas and frequent UTI's. On this replay episode, we discussed these problem and solutions with Dr. Rachel Rubin. Dr. Rubin is a board-certified urologist and sexual medicine specialist.  She is also a researcher, passionate educator and the the former education chair and current Director-at-Large for the International Society for the Study of Women's Sexual Health (ISSWSH). From vaginal estrogen to lifestyle changes, we discuss it all because as Dr. Rubin says : Sexual Health is Health! Website/Show Notes: www.hotflashescooltopics.com FOLLOW US ON: Instagram: https://www.instagram.com/hotflashesandcooltopics/ Youtube: https://www.youtube.com/channel/UC6ssWfO0qeZYEIs6TzrKBHQ Facebook: https://www.facebook.com/groups/657557054765087 Want to Leave a Review for Hot Flashes and Cool Topics? Here's How: For Apple Podcasts on an iPhone or iOS device: Open the Apple Podcast App on your device. Click on the “search” icon Type into the search bar “Hot Flashes and Cool Topics” and click on the show Towards the bottom, look for “Ratings and Reviews” Click on “Write a Review” and leave us your thoughts and comments! For Apple Podcasts on a computer: On the Apple Podcasts website, go to the search bar and type “Hot Flashes and Cool Topics” After clicking on the show, find the “Listen on Apple Podcasts” button and click on it The “Hot Flashes and Cool Topics” podcast should open on the Apple Podcasts application Keep scrolling on the page until you see “Ratings and Reviews” Click on “See All” If you want to give us a five-star rating, hover over the empty stars! If you want to leave your thoughts and comments, click on “Write a Review”!

Vulvodynia - is it a mucosal issue, a pelvic floor issue, a psychological issue...or all of the above? That was the question I asked on my Instagram feed recently, paraphrasing the research into this topic by Chisari et al. So in this week's episode, I'm delighted to welcome Dr Jessica Reale back to the podcast, this time, to discuss Vulvodynia. It can be an intimidating diagnosis for both patient and provider but we explore what it takes to be an effective clinician working with people on this journey. Some of the topics we talked about - hypermobility, inflammation, dermatological considerations, ruling drivers like hips, spines and nerves in or out as contributors and of course, bowel health gets a mention here too! Jessica of course, along with Nicole Cozean, is one of the co-founders of Pelvicon and they are running a Vulvodynia Symposium with luminaries such as Stephanie Pendergast, Dr Rachel Rubin, Dr Jill Krapf, Dr Alex Milspaw and more. It's happening July 13 2024 and registration is opening on Tuesday the 9th of July - head over to pelvicon.com for registration info But also: Do you want to find out more about working with women living with pelvic pain diagnoses such as Vulvodynia, Endometriosis, IC/ Bladder Pain Syndrome and/or Pelvic Neuralgias? (And get the Functional Female Pelvic Anatomy course FOR FREE?!) My online Female Pelvic Pain Rehab course is available online with evergreen access and membership of a private student support group - you can find all the info on my website CelebrateMuliebrity.com To stay up to date on all the latest in women's health, make sure you're following me on Instagram @michellelyons_muliebrity Until next time, Onwards & Upwards! Mx (and if you enjoy this content, I'd be grateful if you could subscribe, rate & review this podcast wherever you're listening to it!

With more than half of women experiencing at least one urinary tract infection in their lifetime, Liz chats to urologist and sexual medicine specialist Dr Rachel Rubin to reveal why UTIs must be taken more seriously.Rachel shares the realities of how dangerous UTIs can be, plus how the lack of knowledge on this common infection is just another example of medical misogyny.Rachel talks Liz through the symptoms of genitourinary syndrome of menopause (GSM) and how vaginal oestrogen could be lifesaving.Links mentioned in the episode:Visit Rachel Rubin's website and subscribe to her newsletterListen to our podcast on Why your UTIs keep coming back, with Kate StephensPurchase A Better Second Half by Liz EarleEmail us your questions at podcast@lizearlewellbeing.com Hosted on Acast. See acast.com/privacy for more information.

In this episode I had the privilege of speaking with Dr. Rachel Rubin, a highly respected urologist and sexual medicine specialist known for her comprehensive approach to sexual health across all genders. Dr. Rubin enlightened us on the vital connection between urology and sexual function, emphasizing the importance of understanding our bodies' anatomy and physiology to address sexual health issues effectively. She shared her passion for educating both the public and healthcare professionals on the complexities of sexual medicine, underscoring the need for better sexual education and the removal of stigma from conversations about sexual health. It was an eye-opening discussion that challenged many preconceived notions about sexual wellness and the critical role of specialized care in improving quality of life. I was particularly moved by Dr. Rubin's insights into the challenges faced by individuals seeking help for sexual dysfunction, highlighting the gaps in knowledge among general practitioners and the importance of advocating for one's sexual health. Her stories of empowering patients to communicate their needs and desires resonated deeply with me, reminding us all of the power of education and open dialogue. Dr. Rubin's work not only offers hope to those struggling with sexual health issues but also calls for a broader societal shift towards embracing sexual health as an integral part of overall well-being. Her dedication to advancing sexual medicine and her advocacy for comprehensive sexual education are truly inspiring, making her one of my sheroes in the field. Full video episode available: https://youtu.be/abpTfFYQAmc Where to find Dr. Rubin: https://www.rachelrubinmd.com/ Instagram: @drrachelrubin Recommended reading: Vagina Obscura by Rachel E. Gross Estrogen Matters by  Avrum Bluming & Carol Travis ************************************************************* Have a burning question or topic suggestion? karen@taboototruth.com ⁠⁠⁠https://www.taboototruth.com/⁠⁠⁠ ⁠⁠⁠https://www.instagram.com/taboototruth⁠⁠⁠ ⁠⁠⁠Youtube @taboototruthpodcast⁠⁠⁠ *this podcast is not intended to give medical advice. Karen Bigman is not a medical professional. For any medical questions or issues, please visit your medical provider. --- Send in a voice message: https://podcasters.spotify.com/pod/show/taboototruth/message

Joining Mike on this 7th anniversary edition of Hitting Left is Rachel Rubin, Senior Medical Officer at Cook County Department of Public Health.

Rachel Rubin is dean of libraries and archives at Mount Allison.

If you're a woman in perimenopause/menopause and you have a vagina, listen up, because this episode is going to blow you away! My guest this week, Dr. Rachel Rubin, is a Urologist and a Sexual Medicine Specialist, and I was so excited to talk with her because the work that she does, both in clinic and on social media, has dramatically helped countless women live with greater comfort, confidence, and pleasure! Dr. Rubin joined me on this episode to talk about the life-changing benefits of using vaginal estrogen for women in menopause and beyond. She likes to say that she deals in issues of libido, arousal, orgasm, and pain, and fortunately for everybody, vaginal estrogen can help with issues surrounding all of these topics. Without revealing too much, it is well documented to improve sex life, prevent urinary tract infections, and decrease vaginal pain, leading to a higher quality of life. So you might be asking yourself, "why haven't I heard of this before?" Unfortunately, despite literature supporting the local use of vaginal estrogen having been around for decades, it hasn't been widely adopted by the medical community. This is where Dr. Rubin steps in **cue heroic music**. Dr. Rubin has made it her mission to spread this knowledge, and mind you, credible, up-to-date knowledge- to as many people as possible. She does so by shouting from the rooftops via her social media pages, running her D.C.-based practice, and training the next generation of Sexual Medicine physicians. What I love about her is that she is relentlessly herself and she won't stop at anything to share this information! So join us by tuning into this conversation, and if you're interested in supporting Dr. Rachel Rubin's work, you can visit her at: Website: https://www.rachelrubinmd.com/ Instagram: https://www.instagram.com/drrachelrubin/?hl=en Facebook: https://www.facebook.com/DrRachelRubin/ LinkedIn: https://www.linkedin.com/in/rachel-rubin-7433b0134/ Twitter: https://twitter.com/drrachelrubin I hope you enjoy this episode, and if you do, please be sure to "like" this episode and subscribe to the podcast. These small gestures help us a lot to reach other professional women over 50 who are interested in losing weight for the last time. Enjoy! ... Are you a professional woman over age 50 who's ready to lose weight for the last time? Join the Vibrant-MD weight loss course. Not sure if the Vibrant-MD weight loss course is right for you? Schedule a time to talk with Dr. Heather Awad directly to learn more. Sign up for our FREE course to get the step-by-step roadmap to permanent weight loss. You'll get a new formula that truly works for professional women over age 50, because it's long overdue that we say GOODBYE to the lousy old counting games.

Sex Symposium: Launching the First Annual Event Today I drink coffee with Dr. Rachel Rubin, fellow urologist and sex med physician and we run through ALL THE THINGS that happend when I co-hosted the first annual sex symposium with Dr. Emily Morse and with The Swell founder Alisa Volkman in New York City. Want to stay connected to hear about more upcoming events with me and the future ones with the Swell? Follow me on IG at www.instagram.com/kellycaspersonmd Check out details for my retreat March 2024: https://ascendretreats.com/ Listen to my Tedx Talk: Why we need adult sex ed Take my NEW Adult Sex Ed Master Class: https://www.kellycaspersonmd.com/adult-sex-ed Join my membership to get these episodes ASAP, a private facebook group to discuss and my private accountability group for your health, hormones and life support! www.kellycaspersonmd.com/membership --- Send in a voice message: https://podcasters.spotify.com/pod/show/kj-casperson/message

Do you struggle with low libido? Vaginal Dryness? UTI's?  This episode is one of our most comprehensive conversations on women's sexual health.  We speak with Dr. Rachel Rubin about all this and more.  Dr. Rubin is a Urologist, Sexual Medicine Specialist and assistant clinical professor in Urology at Georgetown University Hospital.  She even shares how to save money on medications. You don't want to miss it. Website: www.hotflashescooltopics.com FOLLOW US ON: Instagram: https://www.instagram.com/hotflashesandcooltopics/ Youtube: https://www.youtube.com/channel/UC6ssWfO0qeZYEIs6TzrKBHQ Facebook: https://www.facebook.com/groups/657557054765087   Want to Leave a Review for Hot Flashes and Cool Topics? Here's How: For Apple Podcasts on an iPhone or iOS device: Open the Apple Podcast App on your device. Click on the “search” icon Type into the search bar “Hot Flashes and Cool Topics” and click on the show Towards the bottom, look for “Ratings and Reviews” Click on “Write a Review” and leave us your thoughts and comments! For Apple Podcasts on a computer: On the Apple Podcasts website, go to the search bar and type “Hot Flashes and Cool Topics” After clicking on the show, find the “Listen on Apple Podcasts” button and click on it The “Hot Flashes and Cool Topics” podcast should open on the Apple Podcasts application Keep scrolling on the page until you see “Ratings and Reviews” Click on “See All” If you want to give us a five-star rating, hover over the empty stars! If you want to leave your thoughts and comments, click on “Write a Review”!

HOLIDAY SPECIAL BOOK BUNDLE OF CHEF AJ'S BOOKS! https://www.bookpubco.com/content/chef-ajs-holiday-book-special GET MY FREE INSTANT POT COOKBOOK: https://www.chefaj.com/instant-pot-download ------------------------------------------------------------------------------------ MY LATEST BESTSELLING BOOK: https://www.amazon.com/dp/1570674086?tag=onamzchefajsh-20&linkCode=ssc&creativeASIN=1570674086&asc_item-id=amzn1.ideas.1GNPDCAG4A86S ----------------------------------------------------------------------------------- Disclaimer: This podcast does not provide medical advice. The content of this podcast is provided for informational or educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health issue without consulting your doctor. Always seek medical advice before making any lifestyle changes. Subscribe to Dr Rubin's newsletter or make an appointment with Dr Rubin: https://www.rachelrubinmd.com/ Check out the Menopause Bill https://www.letstalkmenopause.org/ To find a provider that specializes in sexual health issues near you: https://www.isswsh.org/ Dr. Rachel Rubin is a board-certified urologist and sexual medicine specialist. She is an assistant clinical professor of Urology at Georgetown University and owns her private practice in the Washington DC region. She is one of only a handful of physicians fellowship trained in male and female sexual medicine. Dr. Rubin is a clinician, researcher, and vocal educator in the field of sexual medicine. In addition to being education chair for the International Society for the Study of Women's Sexual Health (ISSWSH), she also serves as an Associate Editor for the Journal Sexual Medicine Reviews. Her work has be featured in the NYT and PBS. Sign up for her newsletter at https://www.rachelrubinmd.com/and on her social media @https://twitter.com/drrachelrubin

On this year-end special edition of the Muslim Sex Podcast, Dr. Lodhi is counting down our 10 most popular episodes of 2023! In case you missed any episodes this year, this special countdown will walk you through some of the most poignant topics discussed on the show this year. Also, Dr. Lodhi expounds upon each episode, giving more insight and glimpses at these important topics, including fibroids, the clitoris, sex coaching, hormone replacement therapy, anxiety, and so much more!It has truly been an amazing year on the Muslim Sex Podcast and we could not have done it without the incredible experts who join the show as guests and most of all, the viewers and listeners! Thank you for tuning in, subscribing, and telling your friends/family about the show. And remember, if you missed any of these episodes on our countdown, you could always go back and watch/listen to each one, for free, on YouTube or your podcast app of choice. Thank you for helping the podcast grow immensely in 2023 and here's to an even more informative, fun, and exciting year of topics in 2024!Best of 2023 Full Episodes:1. Sexual Health, Wellness, and the Clitoris with Dr. Rachel Rubin - https://www.youtube.com/watch?v=LvMsDgyJ4882. Intimacy and Sex Coaching with Dr. Sonia Wright - https://www.youtube.com/watch?v=tGF-8On-GWk3. Intimacy Coaching with Dr. Uzma Jafri - https://www.youtube.com/watch?v=pWyozN9vv5E4. More About Anxiety and Relationships with Dr. Ahsan Shaikh - https://www.youtube.com/watch?v=bvyyP2ihK9M5. Comprehensive Sex Education with Saleem Qureshi - https://www.youtube.com/watch?v=3bsq6FlE7R06. Menopause and Hormone Replacement Therapy with Dr. Corinne Menn - https://www.youtube.com/watch?v=yy6hLpsPajk7. The Biopyschosocial Model with Dr. Uchenna Ossai - https://www.youtube.com/watch?v=SsIcgs5__hY8. All Things Fibroids with the Fibroid Doc, Dr. Cheruba Prabakar - https://www.youtube.com/watch?v=sSDg42qn4vc9. 2022 Lessons Learned, Highlights, and Moments on The Muslim Sex Podcast - https://www.youtube.com/watch?v=dBo31UC9zbE10. Postpartum Changes with Dr. Andrea Wadley - https://www.youtube.com/watch?v=7uUCrfMQYEUDisclaimer: Anything discussed on the show should not be taken as official medical advice. If you have any concerns about your health, please speak to your medical provider. If you have any questions about your religion, please ask your friendly neighborhood religious leader. It's the Muslim Sex Podcast because I just happen to be a Muslim woman who talks about sex.To learn more about Dr. Sadaf's practice and to become a patient visit https://DrSadaf.comLike and subscribe to our YouTube channel where you can watch all episodes of the podcast or subscribe on your favorite...

We chose this episode with Dr. Rachel Rubin as our final encore of the year because she is the person who has given us the most practical, valuable, and easily shareable information to help women with their genitourinary functions as they age. Dr. Rubin is a board-certified urologist and sexual medicine specialist who dropped so much knowledge and helpful information into one conversation that our puny little brain-sponges got super-soaked. Listen to learn about the two little-known FDA-approved drugs that actually help women's libidos with no negative side effects, why you should be using local vaginal estrogen twice a week for the rest of your life, and how even a doctor can agree with us that the field of medicine is a disgusting dumpster fire of brokenness. As if that weren't enough, we also talk about the Grow Your Clit Movement, Covid Hemorrhoids, and what the hosts never thought they'd do in their 20's that they have done now. Admit it: you're intrigued.DR. RUBIN'S LINKSDr. Rubin's WebsiteDr. Rubin's twitterDr. Rubin's facebookDr. Rubin's InstaDr. Rubin's LinkedInARTICLES AND RESOURCES MENTIONED IN THE EPISODEThe Magic of HormonesInternational Society for the Study of Women's Sexual Health - ISSWSHAddyiVyleesiThe Grow Your Clit MovementLINKS TO DREAMY PRODUCTS AND SERVICESErin's Faces Affiliate LinkPurely Elizabeth Affiliate LinkJulia's Wellness Coaching WebsiteCircling the Drain Podcast WebsiteSupport the showBe one of the helpers! SUBSCRIBE to this podcast on APPLE PODCASTS or SPOTIFY and leave us a review on APPLE PODCASTS.Please make a one-time donation of $10 (or more!) at Patreon.com/circlingthedrainpodcast to keep our show alive for another year. Support the showBe one of the helpers! SUBSCRIBE to this podcast on APPLE PODCASTS or SPOTIFY and leave us a review on APPLE PODCASTS.

This episode is a bonus episode, brought to you in partnership with Nyoo ("New") Health. Nyoo hosts the "What's Nyoo!" series, with monthly events that bring together women and experts to have engaging, honest, and educational conversations about women's health, and this one is all about Pelvic Health. This event blew us away, and we knew we had to share it. Special thanks to Priya Bathija - CEO of Nyoo - for allowing us to share this recording. We hope you enjoy it just as much as we did!Remember to like, rate and subscribe and enjoy the episode!Guest biosPriya Bathija is a nationally-recognized healthcare leader, attorney, and policy expert. She is currently Founder and CEO of Nyoo Health, an organization dedicated to improving health and healthcare for women. Previously, she was at the American Hospital Association where she led policy efforts and strategic initiatives on value, health equity and maternal health. She started her career as a healthcare attorney and served as in-house counsel and a member of the leadership teams at ProMedica and MedStar Health. Priya is also a Distinguished Practitioner in Residence at The Ohio State University Moritz College of Law and an adjunct professor at Loyola University Chicago School of Law. In addition, she serves as a public board member for the American Board of Medical Specialties, the largest physician-led specialty certification organization in the U.S.Carine Carmy is CEO and Co-Founder at Origin, the leading provider of pelvic floor and women's physical therapy. She has focused her career on increasing access to products and services that improve lives, from healthcare to 3D printing. Carine's passion for women's health started in her twenties, when she struggled with painful sex for nearly a decade.  Following years of misdiagnoses, ineffective treatment options, and hearing “that's just the way it is,” Carine discovered the power of pelvic floor physical therapy to treat, not only pelvic pain, but dozens of conditions and symptoms that impact some 40 million U.S. women and individuals with vaginal anatomy, every year. Already a go-to-market leader in healthcare and technology — with leadership roles at Amino, Shapeways, MarketspaceNext and Monitor Group — she felt compelled to help make pelvic health the norm for women across the country. Outside of Origin, Carine is an avid writer and has been published in MIT Technology Review, Forbes, Ad Age, and PSFK, and serves as an advisor to startups and nonprofits in support of diversity and economic equality.Dr. Somi Javaid is a board-certified OB/GYN, leading women's sexual health thought leader, and menopause advocate. She is the Founder and Chief Medical Officer of HerMD, a team on a mission to make women's healthcare exceptional by educating, advocating for, and empowering patients to take control of their health concerns. Dr. Javaid has been featured in Forbes, Vogue, Well+Good, InStyle, Parents, Refinery29, Mashable, Adweek, and Popsugar. In August 2020 Dr. Javaid spoke about Gender Bias and the Female Sexual Health Revolution on the TEDx mainstage, and in January 2021 she was featured in Women on Topp for her work as a trailblazer and pioneer in women's sexual health.Dr. Rachel Rubin is a board-certified urologist and sexual medicine specialist. She is an assistant clinical professor of Urology at Georgetown University and owns her private practice in the Washington DC region. She is one of only a handful of physicians fellowship trained in male and female sexual medicine. Dr. Rubin is a clinician, researcher, and vocal educator in the field of sexual medicine. In addition to being education chair for the International Society for the Study of Women's Sexual Health (ISSWSH), she also serves as an Associate Editor for the Journal Sexual Medicine Reviews. Her work has been featured in the NYT and PBS.Emma Schmidt, PhD, is a doctor in Clinical Sexology, a Professional Clinical Counselor, Supervisor, and Certified Sex Therapist, Supervisor through the American Association for Sex Educators Counselors and Therapists (AASECT) as well as the American Board for Christian Sex Therapists (ABCST). She is the owner of Emma Schmidt and Associates in Cincinnati, Indian and Kentucky, a therapy group practice which focuses on sex and relationship therapy. Dr. Schmidt received her Bachelor of Arts in Biblical Studies and Psychology as well as a Master of Arts in Counseling from Cincinnati Christian University. She received her Doctorate from Modern Sex Therapy Institutes. Her research and publications have focused on female sexual pain.Organization bioNyoo Health provides strategic and advisory support to startups, investors, providers, and others as they grow and scale new ways of delivering health and healthcare to women. Beyond that, Nyoo Health is building a movement that will redefine women's health and investing in women as they advocate for themselves in the healthcare system.FemTech Focus Podcast bioThe FemTech Focus Podcast is brought to you by FemHealth Insights, the leader in Women's Health market research and consulting. In this show, Dr. Brittany Barreto hosts meaningfully provocative conversations that bring FemTech experts - including doctors, scientists, inventors, and founders - on air to talk about the innovative technology, services, and products (collectively known as FemTech) that are improving women's health and wellness. Though many leaders in FemTech are women, this podcast is not specifically about female founders, nor is it geared toward a specifically female audience. The podcast gives our host, Dr. Brittany Barreto, and guests an engaging, friendly environment to learn about the past, present, and future of women's health and wellness.FemHealth Insights bioLed by a team of analysts and advisors who specialize in female health, FemHealth Insights is a female health-specific market research and analysis firm, offering businesses in diverse industries unparalleled access to the comprehensive data and insights needed to illuminate areas of untapped potential in the nuanced women's health market.Episode ContributorsPriya BathijaLinkedIn: @Priya Bathija Carine CarmyLinkedIn: @Carine Carmy & @OriginInstagram: @carinerachelle & @theoriginway Dr. Somi JavaidLinkedIn: Somi Javaid, MD & HerMDInstagram: @somijavaidmd & @hermdhealth Dr. Rachel RubinLinkedIn: @Rachel RubinInstagram: @drrachelrubin Dr. Emma SchmidtLinkedIn: @Dr. Emma SchmidtInstagram: @heyemmatherapy Nyoo HealthWebsite: https://www.nyoohealth.com/LinkedIn: @Nyoo HealthInstagram: @nyoohealth  Dr. Brittany BarretoLinkedIn:  @Brittany Barreto, Ph.D.Twitter: @DrBrittBInstagram: @drbrittanybarreto FemTech Focus PodcastWebsite: https://femtechfocus.org/LinkedIn: https://www.linkedin.com/company/femtechfocusTwitter: @FemTech_FocusInstagram: @femtechfocus FemHealth InsightsWebsite: https://www.femhealthinsights.com/LinkedIn: @FemHealth Insights

We are ending 2023 with a bang! Close out the year by saying goodbye to things that no longer serve you—maddening UTIs, painful sex, itching, burning, urinary urgency and more. Top urologist and sexual wellness expert Dr. Rachel Rubin walks us through the life-changing magic of vaginal estrogen and gives us the 411 on testosterone therapy. We talk pellets, creams, and the impact on libido. Plus, the link between antidepressants and sexual dysfunction.   SHOW NOTES + TRANSCRIPT acertainagepod.com FOLLOW A CERTAIN AGE: Instagram Facebook LinkedIn GET INBOX INSPO: Sign up for our newsletter AGE BOLDLY We share new episodes, giveaways, links we live, and midlife resources CONTACT US: katie@acertainagepod.comSee omnystudio.com/listener for privacy information.

Menopause is a natural part of aging, but it can cause a lot of discomfort both physically and emotionally. And, the changes in hormone levels can also drastically affect a woman's sex drive.Today, Dr. Christine Vaccaro, Dr. Rachel Rubin, and Dr. Kelly Casperson will help us understand the symptoms of menopause and how hormone therapy can help.---Kelly Casperson MD www.kellycaspersonmd.comhttps://www.instagram.com/kellycaspersonmd/https://www.facebook.com/youarentbrokenPodcast: You Are Not BrokenApple Link to podcast: https://podcasts.apple.com/us/podcast/you-are-not-broken/id1495710329Book: You Are Not Broken: Stop "Should-ing" All Over Your Sex LifeAmazon Link: https://amzn.to/3Gux9hO---Rachel S. Rubin MDUrologist and Sexual Medicine SpecialistAssistant clinical professor in Urology at Georgetown University Hospitale info@rachelrubinmd.comwebsite: rachelrubinmd.com      twitter:@drrachelrubininstagram: @drrachelrubin

In this week's BackTable Podcast, guests Dr. Sarah Psutka and Dr. Rachel Rubin join host Dr. Aditya Bagrodia to discuss the importance of considering women's sexual health in urologic oncology surgeries. The doctors go on to discuss how to ensure proper patient education and setting realistic expectations about post-surgery recovery. Additionally, they highlight the need for open conversation about sexual health and the use of hormone therapies to improve menopause symptoms. Finally, they touch on the need for more research in women's sexual health and the use of pelvic floor physical therapy. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/uYv0Hm --- SHOW NOTES 02:30 - The Importance of Open Conversations about Sexual Health 03:55 - Addressing Sexual Health in Cancer Patients 11:47 - The Role of Hormones in Women's Health 25:05 - The Renewed Interest in Gynecologic Organ Sparing 29:39 - Importance of Risks and Oncologic Outcomes in Bladder Cancer Treatment 35:56 - The Role of Pelvic Floor Physical Therapy in Bladder Cancer Recovery 44:24 - The Role of Hormone Therapy in Bladder Cancer Recovery 53:59 - Conclusion: The Future of Bladder Cancer Treatment --- RESOURCES Mark Cuban's Cost Plus Drug Company: https://costplusdrugs.com/

Introduction Guest: Rachel Rubin, COO of OVIVA Therapeutics. Focus: Discussion on OVIVA's role in biotech, women's health, longevity, and insights into operations at Invisible. In this episode of the Plain Sight Podcast, the guest is Rachel Rubin, COO of OVIVA Therapeutics. They discuss the role of an early stage biotech company focusing on women's health, particularly in relation to ovarian function and menopause. They explore OVIVA Therapeutics' research and its aims to extend women's health span and longevity. Additionally, they delve into the details of drug development, from animal models to human trials, and the importance of tailoring the process depending on different factors. They also cover the importance of strategic and careful approach in business operations to mitigate risks within startups. Rubin shares her views on the balance of risk-taking and conservative operational practices as the bedrock of sustainable company growth. Furthermore, she emphasizes on the role of human resources, budgeting, and fostering a culture of excellence in a company as paving pathways for their employees to thrive. Timestamps 00:02 Introduction and Guest Presentation 00:16 Understanding OVIVA Therapeutics and Its Goals 01:02 Exploring the Concept of Longevity 01:34 The Reality of Longevity and Its Challenges 02:33 The Role of Menopause in Women's Health and Longevity 04:36 Understanding Hormones and Their Functions 05:49 The Technological Aspects of OVIVA Therapeutics 06:09 The Role of Computation in Drug Development 10:10 The Business Operations of Early Stage Biotech Companies 10:20 Understanding the FDA's Role in Biotech 12:59 The Importance of Team Building in Biotech 19:14 The Role of Research and Development in Biotech 25:54 Promoting a Culture of Excellence Within a Company 33:07 Understanding Operations in Biotech 39:04 The Future of OVIVA Therapeutics 39:41 Final Thoughts and Advice for Invisible OVIVA Therapeutics and Its Goals Primary Focus: Developing drug assets for ovarian function and infertility. Long-Term Vision: Delaying menopause to enhance women's health span and longevity. Longevity and Menopause Connection Between Menopause and Longevity: Delaying menopause can lead to extended lifespans. OVIVA's Research: Animal model studies show potential to extend longevity by delaying menopause. Menopause Definition and Impact: A period marked by the end of menstruation, linked to declining AMH levels. OVIVA's Strategy: Developing drugs to modulate AMH levels, aiming to delay menopause and improve health outcomes. Hormonal Influence Role of Hormones: Essential for body functions; AMH is particularly stable but declines with age. Diverse Hormonal Functions: Hormones like testosterone and estrogen fluctuate differently and have varied roles. Technology in Drug Development In Silico Drug Design: Combining computation and quantum physics for efficient drug discovery. OVIVA's Methodology: Focus on licensed drug assets, particularly manipulating AMH. Building a Biotech Team Early Stages: Hiring entrepreneurial individuals valuing equity, mission, and culture. Diverse Roles and Consultants: Need for expertise in program management, regulatory knowledge, biostatistics, and drug manufacturing. Regulatory Environment FDA Involvement: Extensive interaction during clinical trials focusing on safety, dosing, efficacy, and population testing. Business Operations in Biotech Early Stage Operations: Prioritizing drug development, focusing on foundational business needs like HR, accounting, and IT. Scaling Operations: Internalizing functions such as legal, accounting, and HR as the company grows. Operations at Invisible Approach to Operations: Focusing on scaling generalists and innovating in operations. Learning Opportunities for Team Members: Emphasizing the development of cross-disciplinary skills and adaptability in various business scenarios. OVIVA's Future Directions Commercialization Prospects: Aiming for drug asset commercialization post-clinical trials and FDA approval. Strategic Growth: Exploring fundraising, partnerships, and pipeline development for broader impact. Conclusion Advice for Invisible's Audience: Embrace learning opportunities, seek support, and leverage diverse experiences for professional growth.

Dr. Christina Prevett // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Christina Prevett discusses that the fountain of function is muscle mass and estrogen in the aging female. Christina breaks down these two areas for function, and what we have physical therapist can do to help encourage both muscle mass and estrogen preservation. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - CHRISTINA PREVETT Hello, everybody, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of the team within our Modern Management of the Older Adult Division. In our division, we have three courses in our geriatric curriculum. We have our eight-week online Essential Foundations course. We have our eight-week online Advanced Concepts course. And we have our two-day live course. We have a couple of courses that are left in the remainder of the year. We have a course coming up in November in Chandler, North Carolina. We have another course coming up in South Carolina. And we have a course coming up in Texas in December. So if you are near those courses or you are looking to get in some content before the end of the year, I encourage you to check those courses out. and you'll be able to get in with some of our faculty before, you know, we ring in 2024. 01:18 - THE FOUNTAIN OF FUNCTION Today I'm going to talk about the fountain of function. And so this is a reframe that I think is really important. And we're going to talk about what those fountains of function are. You'll notice that I did not say fountain of youth. We have this idea in our society that youth is the goal, to not feel like we're getting older in any way, to not show signs of age on our faces. And don't get me wrong, I see my aging face, I was like, oh, my face doesn't look like I am 21 anymore, and I look at the wrinkles on my face, and I have those emotions. But the idea for my life is not to try and get younger. It's to try and optimize my reserve and try and live the way that I want to live with the most amount of function possible into my 30s and 40s and 50s and 60s and hopefully all the way up to 100. Because at MMA and within ice in general, Aging is a privilege. It is something that I am very thankful for because the alternative is not that great. We're not gonna be able to reverse back time, but we can have a really successful aging process, especially when we put in the steps to live the way that we want to live, whatever that filter means for us. So I'm not looking for the fountain of youth. I am looking for the fountain of function. And so the two types, the two areas that are the fountain of function in aging women, so I'm going to talk about female anatomy, is muscle mass and estrogen. And these two things, especially when taken together and optimized to the best of our capacity, is going to allow us to have more function towards the end of our life. So let's talk about muscle mass. You have not been following the Institute of Clinical Excellence in any ways if you don't know that LODE is our love language across all of our division, across all of our faculty, and that is absolutely true in the geriatric curriculum as well. And I love it so much that I did an entire PhD on the influence of resistance training in an aging body. When we look at resistance training, we are accumulating a growth and a continuation, a plethora of education and research that looks at the impact of resistance training on health outcomes. And I just posted a paper that was a narrative review from Stu Phillips, who is one of my committee members on my PhD. 04:18 - THE COMING OF AGE OF RESISTANCE TRAINING And he talked about the coming of age of resistance training and how we are starting to see some accumulation of evidence that is mirroring and is just as strong as literature that we're seeing in aerobic training to prevent stave off different chronic diseases, including some cardiovascular diseases. And so there means that there, as of course, we're going to target the aerobic system. This is not to say to not do cardio in stead, just do resistance training, but it's showing that there is a continual and persistent growth of literature talking about the impact of resistance training on health outcomes. So what we see is that those who have more muscle mass tend to have lower all-cause mortality. They are less likely to develop cardiovascular conditions. They are better able to manage diabetes. They're less likely to get diabetes. We know that muscle mass is protective around things like osteoporosis, right? Tensile strength of the bone is important and we need impact, body weight movements, resistance training across the lifespan in order to optimize that. We see that individuals who are stronger or less likely to have sarcopenia, right? Sarcopenia is clinically relevant amounts of muscular weakness that are preventing a person from completing their day-to-day tasks. It's a totally important output of frailty. Fried's physical phenotype of frailty talks about physical reserve and physical capacity as an output of individuals seeing these constellations and signs and symptoms that lead to vulnerability to external stress. That external stress includes things like hospitalizations and being able to withstand different stressors with respect to immune system insults, including things like COVID-19, pneumonia, and the flu that allows individuals, while they are sick, to have that reserve and resiliency to lean back on in order for individuals to be able to get back to baseline or improve past baseline, post-hospitalization, or acute insult. All this to say, we know that individuals need to be trying optimize their muscle mass in their earlier life and then hold on to it for as long as possible. If you are in a setting where you are not working with individuals who have optimized their muscular mass, we also know that muscular mass can be developed and we can see improvements in physical function with resistance training at any age when we start including in our 90s. The mechanism at which strength develops is a little bit different. We're looking a lot more at neuromuscular efficiency. However, we can absolutely see that it can improve function. And so whether you are 30 or you are 85, muscle mass is a fountain of function and it allows us to withstand stress. 12:24 - ESTROGEN FUNCTION & MENOPAUSE  Now let's kind of talk about this second piece, which is estrogen. I've done several podcasts on menopause, but I want to talk about the influence of estrogen around female physiology, because I think this is really important. So when we are going through the menopausal transition, on average, individuals will start menopause between 50 and 51. Definition of menopause is when you've gone a full calendar year, 12 months without a menstrual period. That is your menopausal transition. But individuals can be experiencing perimenopausal symptoms that are indicators of dwindling or are coming down of estrogen status for up to 10 years prior to the transition into menopause. And so individuals who are in their early 40s can start to see the influences of loss of estrogen on their body. And then that influence is persistent as individuals get older. When we're talking about menopause, we often are putting this into two camps. So we have vasomotor symptoms, which are these symptoms that occur because of an acute withdrawal of estrogen. These are things like night sweats and hot flashes. As individuals transition through menopause and we get into our later life, into our 60s, 70s, 80s, and beyond, those symptoms tend to decline. So those vasomotor symptoms that occur as our body transitions to reductions in estrogen status they tend to go down as our body gets used to this new state of equilibrium that occurs without estrogen. In the opposite direction, the second kind of camp that we speak about when individuals are going through menopause is genitourinary syndrome of menopause or GSM. And that is signs and symptoms across the female physiology that are responding to losses in estrogen. and anywhere where there is an estrogen receptor within our body, they are going to experience changes when individuals transition through menopause. And we oftentimes will, in the pelvic health space, talk about changes to our reproductive anatomy, which are unbelievably relevant, but we have to also extrapolate that out and talk about different areas where estrogen is influencing female physiology and how, if you are working with an aging female, they are experiencing changes because of that change in estrogen status. And so within the reproductive track, we see that there is changes in ligamentous stability around the pelvis. And I hate that word stability, but it's a change in the turnover of the way that our ligaments are restructuring. So we have a little bit more ligamentous breakdown than buildup, right? That turnover rate is different. And so we have this shift between static support in the pelvis to the requirements or dynamic support around the pelvic floor. We see that individuals start to have vaginal atrophy. We see that the vaginal microbiome starts to change. We don't have the same cervical mucus secretion. And so things like chafing and redness can be more prevalent in a person who is postmenopausal. We can see fusing of the labia minora and majora. and this can lead to increased risks for pelvic floor dysfunction. So when we are in estrogen low states, rates for pelvic floor dysfunction go up. This includes anal incontinence, urinary incontinence, pelvic organ prolapse, dyspnea, or painful punitive intercourse, and other aspects of the reproductive tract. We also see, because of this change in the vulvar anatomy, that we have an increased risk for things like urinary tract infections, that increased risk for urinary tract infection also influences individual's physical function. We know that recurrent UTIs can be a cause of changes in cognitive status for our aging females. And so something that is extremely relevant for our aging women. Other things that we see is that as individuals go into an estrogen depleted state, increased risk of cardiovascular disease goes up. Individuals as they transition through menopause, we see that in general, men tend to be more impacted by cardiovascular disease. That is shifting for a lot of different reasons, but that risk profile increases when individuals are in an estrogen depleted state. We see a change in central adiposity where weight starts to increase. Adiposity accumulation can increase, especially visceral fat accumulation, which has a risk profile in and of itself for different chronic diseases. And then we see, for example, in our bone microarchitecture that the influence of estrogen allows for continual bone regeneration and that profile again starts to switch and there's an increased risk for things like osteoporosis in an estrogen deficient state. So there's a lot of things that get impacted, right? Our skin gets impacted, our breast tissue gets impacted, our urinary tract, all of our mucosal membranes, not just in our vulva, but across our entire body, and this has impacts. And so when we are thinking about working with these individuals, one of the things that is starting to become really recommended is topical estrogens. And there's a lot of debate about this because of a study that had been done a little while ago that looked at increased risk for sex-related cancers, breast cancer, endometrial cancer, cervical cancer, et cetera, with systemic estrogen. However, what we are starting to see now and many of our menopausal experts like Dr. Mary Claire and Dr. Rachel Rubin are really trying to have this public health approach to medicine saying that we are not doing our females a service when we are saying that there is a risk profile when subsequent studies have not been able to substantiate or replicate those findings. And so there's been a big shift in the last five years to the need for or the desire for many women who are really suffering with genital urinary syndrome of menopause to be able to take things like topical estrogens in order to really significantly reduce their symptom burden. And I'm not just talking about their pelvic floor, which is an extremely important part of their sexual health, also a vital sign of aging, but also, you know, all of these other physiological signs of estrogen deficiency that are impacting our outcomes, right? We see that individuals with that combination of muscular mass, we are seeing individuals with negative consequences of osteoporotic fracture. if we were able to be preventative in this approach where we are talking about estrogen supplementation when these symptoms start to arise, especially when they hit a threshold of bother, where there's going to be this spectrum, some individuals are very bothered and very impacted by the signs of vasomotor symptoms and genital urinary syndrome of menopause, and then some individuals are not, but for those individuals with bother, is this something that should be taken? Is this something that they can talk to their physician about? Is there this literature to support these topical estrogens? And we are starting to see this mounting of evidence that is starting to come up to help individuals in the aging process. So many of our aging adults are being told that this is just what they should be living with. This is because they're going through menopause. Deal. We saw this in the peripartum space where there's a lot of advocacy still happening with respect to not having this thought process that as soon as you have a baby that pelvic floor dysfunction is just something that you should live with. We're starting to see this rise up in our perimenopausal and postmenopausal population, where they are not accepting that this is what they should be doing. They're not being dismissed anymore for these symptoms, and it's super important. When we take this lifespan approach, this education becomes extremely relevant. Talking about the peripartum space, I truly believe that that is where we start to tell females that they are not resilient, that they are somehow fragile, that they need to be concerned for their organs falling out and all these different pelvic floor dysfunctions. And then they are not encouraged to be as resilient as they could be by taking part in heavy resistance training or impact activities or things at higher intensities. We start bringing that intensity down and the idea of, ooh, be careful or, oh, monitor this or, oh, if you have these symptoms, it's time for you to stop participating in those activities. We are seeing this shift and what this shift is going to do earlier in life is it's going to set up are aging individuals with this mindset that pelvic floor dysfunction one is not inevitable two that reserve is protective when it comes to muscular reserve and three they're going to be advocates for their own health and that includes their hormonal health and that includes not accepting that some of these symptoms of menopause are things that they just need to live with, but things that can be medically managed. Genital urinary syndrome of menopause is a syndrome condition. It is a medical diagnosis, and therefore it is something that we can be treating. As physical therapists, us being educators and conduits of that knowledge translation is extremely important. And then we are going to optimize function for these individuals. Last point that I'm going to make, because I ended up being a lot more long-winded than I thought I was going to be, is that we are now seeing this interaction between menopause, genital urinary syndromes, and long-term health outcomes. We are seeing that individuals with higher physical activity, combination, aerobic resistance, or both, are having a much lower GSM burden than those who are not. And so again, it comes back full circle, whether this health promotion is extremely important, that not only are we gonna optimize a person's muscular reserve, we're gonna make that fountain of function be extremely relevant, but we're also going to make the quality of that function a lot better because their quality of life is better because we are not allowing them to just live with these symptoms and be dismissed by our medical system, us included, that just expects this to be the way that it is. And so this advocacy piece is extremely important and it's something that we are going to be screaming from the rooftops. All right, everyone, I hope you have a wonderful week. I'm going to be diving a lot more onto my page and I'm going to be collaborating it with ICE and MMOA around hormone therapies for individuals with GSM. I am not a medical physician, so I encourage you to reach out to your urogynecologist and urologist in your area. Get that relationship with them so that you can start having these conversations and we can start talking about risk profiles. All right, have a wonderful week. If you are not on our MMOA digest, I encourage you to sign up for those newsletters. Otherwise, have a wonderful week and I will talk to you all again soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Rachel Rubin is not your run-of-the-mill urologist, as you'll quickly learn in this fascinating episode! Dr. Rubin (https://www.instagram.com/drrachelrubin) believes that education is empowerment, and, today, we have the amazing opportunity to learn from her about menopause. Listen to hear host Elana Frank and Dr. Rubin discuss the "orgasm gap", whether it's plausible that undergoing fertility treatments like IVF might affect the timing of menopause later in life, the 'magic' of vaginal estrogen cream, and most importantly, how education is empowerment. You WILL feel empowered after listening to this episode!

This week on BackTable OBGYN, Dr. Suzette Sutherland and Dr. Rachel Rubin discuss the diagnosis and treatment of genitourinary syndrome of menopause (GSM) with vaginal estrogen. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/aj8lvI --- SHOW NOTES GSM is not only a condition of "vaginal dryness", but rather a multi-faceted symptom set including pain with sitting, urinary frequency and urgency, bladder pain, opioid use, and recurrent UTIs. First, the doctors discuss the myths and misconceptions about the use of estrogen creams, suppositories, and rings to treat GSM . However, Suzette and Rachel also discuss the importance of advocating against the misrepresentation of vaginal estrogen in box labeling. They conclude that the benefits of using a low-dose vaginal estrogen far outweigh the risks, and doctors should advocate for better labeling and understanding of this treatment. Suzette and Rachel also discuss the American Urologic Association (AUA) guidelines for GSM and its importance. Systemic hormone therapy is rarely enough to address GSM symptoms, so screening for GSM symptoms is essential. They also talk about estrogen therapy for special patients, such as those on hormone replacement therapy (HRT) and cancer survivors. Suzette and Rachel emphasize the importance of understanding the general hormone fluctuations of patients particularly oral contraceptives, those with disordered eating, those who are breastfeeding, and those who are transgender. They end the episode by encouraging the production of more research and data to back up treatment options for GSM in premenopausal women. --- RESOURCES WellPrept https://wellprept.com/ Femring https://www.femring.com/

This week on BackTable Urology, Dr. Suzette Sutherland and Dr. Rachel Rubin discuss the diagnosis and treatment of genitourinary syndrome of menopause (GSM) with vaginal estrogen. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/aj8lvI --- SHOW NOTES GSM is not only a condition of "vaginal dryness", but rather a multi-faceted symptom set including pain with sitting, urinary frequency and urgency, bladder pain, opioid use, and recurrent UTIs. First, the doctors discuss the myths and misconceptions about the use of estrogen creams, suppositories, and rings to treat GSM . However, Suzette and Rachel also discuss the importance of advocating against the misrepresentation of vaginal estrogen in box labeling. They conclude that the benefits of using a low-dose vaginal estrogen far outweigh the risks, and doctors should advocate for better labeling and understanding of this treatment. Suzette and Rachel also discuss the American Urologic Association (AUA) guidelines for GSM and its importance. Systemic hormone therapy is rarely enough to address GSM symptoms, so screening for GSM symptoms is essential. They also talk about estrogen therapy for special patients, such as those on hormone replacement therapy (HRT) and cancer survivors. Suzette and Rachel emphasize the importance of understanding the general hormone fluctuations of patients particularly oral contraceptives, those with disordered eating, those who are breastfeeding, and those who are transgender. They end the episode by encouraging the production of more research and data to back up treatment options for GSM in premenopausal women. --- RESOURCES WellPrept https://wellprept.com/ Femring https://www.femring.com/

Alexandra Stockwell, MD, is joined by Dr. Rachel Rubin, a renowned urologist and sexual medicine specialist, to discuss sexual medicine, as well as the art/science driving sexual desire. Dr. Rubin emphasizes the vital importance of a biopsychosocial approach to sexual medicine, highlighting the significance of understanding a patient's background and their goals for enhancing their quality of life. She defines sexual medicine, discusses when to seek help and addresses issues like low desire and arousal. Dr. Rubin recommends various treatment options, including the use of devices (ie. vibrators) for enhancing intimacy. The conversation takes a personal turn as she shares she's happily married with a supportive partner.  Also in this episode: How do you define sexual medicine? Why Dr. Rubin considers herself a sex detective Low desire is a common problem for both men and women  Why it's important to ask patients about libido, masturbation techniques, cultural and religious issues, and childhood trauma Erectile dysfunction is a marker for cardiovascular disease in men and women Where to find more information about sexual health products How our personal experiences influence our practice of medicine About Dr. Rachel Rubin: Dr. Rachel Rubin is a board-certified urologist and sexual medicine specialist. She is an assistant clinical professor of Urology at Georgetown University and owns her private practice in the Washington DC region. She is one of only a handful of physicians fellowship trained in both male and female sexual medicine. Dr. Rubin is a clinician, researcher, and vocal educator in the field of sexual medicine. She completed her medical and undergraduate training at Tufts University, her urology training at Georgetown University, and her fellowship training under Dr. Irwin Goldstein in San Diego. In addition to being education chair for the International Society for the Study of Women's Sexual Health (ISSWSH), she also serves as an Associate Editor for the Journal Sexual Medicine Reviews. Her work has been featured in the NYT, PBS and NPR. Connect With Dr. Rachel Rubin Rachelrubinmd.com | Instagram | Facebook | Twitter | Threads Links mentioned in the episode: Promescent Devices |  Mystery Vibe    Subscribe To The Intimate Marriage Podcast: Apple Podcast | YouTube | Spotify Connect With Alexandra Stockwell, MD: Website | Linkedin | Instagram   Download the first chapter of Dr Alexandra's bestselling book, “Uncompromising Intimacy,” here: https://www.alexandrastockwell.com/book Cultivate your intimacy skills (without compromise) in Aligned & Hot Marriage, Dr. Alexandra's proven method for smart couples ready to love more fully. www.alignedhotmarriage.com Join my email list to stay connected–it's where I share my latest insights and offer opportunities for live Q & A. https://www.alexandrastockwell.com/subscribe   About Alexandra Stockwell, MD Known as “The Intimacy Doctor,” Alexandra Stockwell, MD is a Relationship and Intimacy Coach and an Intimate Marriage Expert who specializes in coaching ambitious, successful couples to build beautiful, long-lasting, passionate relationships. She is the bestselling author of “Uncompromising Intimacy,” host of The Intimate Marriage Podcast and creator of the Aligned & Hot Marriage program.  For over two decades, she's been guiding men and women to bring pleasure and purpose into all aspects of life— from the daily grind of running a household to creating ecstatic experiences in the bedroom—all while maintaining extraordinary professional success!   This Podcast Is Produced, Engineered & Edited By:  Simplified Impact   The Intimimate Marriage Podcast, With Intimacy Coach, Alexandra Stockwell, MD  

Are you experiencing symptoms like burning and itching around your vulva and vagina, or painful sex? Or perhaps you have the urge to wee more often or are plagued by recurrent urinary tract infections? Joining Dr Louise this week is trailblazing US urologist and sexual health doctor Dr Rachel Rubin, to address these common menopause symptoms and the relief vaginal hormones – often used alongside systemic HRT – can bring. Dr Rachel explains why we need to stop using terms like vaginal dryness and vaginal atrophy, which hugely downplay the impact of declining hormones on your whole genitourinary system. ‘When we say women have vaginal dryness, we minimise their symptoms, we minimise that it's no big deal, that you can just use a little lubricant, a little moisturiser,' says Dr Rachel. Plus, Dr Rachel and Dr Louise also discuss DHEA – a hormone treatment which converts to estrogen and testosterone in the vagina – and the benefits this can bring to women struggling with genitourinary syndrome of the menopause (GSM), again often alongside systemic HRT. Dr Rachel's three tips if you are struggling with GSM: Know that if you have any symptoms that affect your vagina, vulva or urinary system and you're over the age of 45, you deserve a vaginal hormone product. Talk to your healthcare professional about access to this treatment that can prevent urinary tract infections, decrease your frequency and urgency of needing to urinate, decrease your pain in intercourse and lead to better lubrication, arousal and orgasm. Keep using your localised hormone replacement: it is a safe product, so can be used long term to sustain the benefits.  Click here to visit Dr Rachel's website, and follow her on Instagram @drrachelrubin.

You can also listen to this episode on Apple Podcasts or Spotify! Kelly Casperson, MD, is a urologist, sexual medicine expert, and best-selling author. She is on a mission to empower women to live their best love lives.In her wildly popular book, You Are Not Broken, Dr. Casperson breaks down the common narratives that women have been told about their bodies such as “I shouldn't enjoy sex,” “I can't get any better at sex,” and “It is my partner's job to give me pleasure,” in order to help women play, explore, and normalize their sex lives.Combining the power of mind, body and relationships, she breaks down the societal barriers that keep women from fully embracing their sexuality and intimate experiences.On this episode of Beyond the Prescription, Dr. McBride and Dr. Casperson discuss desire mismatch, relationship communication, and tools to help put women back in charge of their health and sex life. It is time to normalize healthy, enjoyable sex worth desiring, and Dr. Casperson is here to help!Submit your question about sex (or anything else) for this Friday's Q&A right here!Join Dr. McBride every Monday for a new episode of Beyond the Prescription.You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.Please be sure to like, rate, and review the show!The transcript of the show is here![00:00:00] Dr. McBride: Hello and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my Dr. Caspersons like I do my patients, pulling the curtain back on what it means to be healthy and redefining health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight.[00:00:31] We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their stories and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts.[00:00:57] So let's get into it and go Beyond the Prescription. Today on the podcast I have the honor of speaking with my friend who's also a doctor, a urologist, and a sexpert: Dr. Kelly Casperson. Last year, Kelly published the wildly popular book You Are Not Broken: Stop shoulding all over your sex life. It's a combination of real stories, conversation starters, and journaling prompts about how to have a better sex life. Kelly and I agree that mental health is health, that sexual health is health, and that women and men are unstoppable when we're armed with tools, facts, and the agency to be healthier from the inside out. Kelly, I'm thrilled to have you on the podcast today. Thank you so much for joining me.[00:01:53] Dr. Casperson:  Thanks for having me.[00:01:54] Dr. McBride: So let's get right after it. You are someone like me who believes that health includes many of the invisible components of our everyday life, including sexual health, mental health, a sense of agency over our everyday thoughts, feelings, and behaviors. You're someone who was trained in urology, which is a surgical field. And when people think about urologists, they typically think about male doctors treating male genitalia.[00:02:27] Dr. Casperson: That's right.[00:02:27] Dr. McBride: So, talk to me about what it's like to be a urologist in a male dominated field that people consider as a male dominated field, and then tell me how you came to understand Sexual health as a sort of a moral imperative to dispense more information about. [00:02:44] Dr. Casperson: Well, currently practicing urologists in America, 9% are female. We're getting there. We're about 30% of the residency slots. There's only like 200 residency slots a year. So it's not like we're going to change the 9% much quickly. It's been great. I kind of… It was challenging to get into urology.[00:03:01] I loved that. I loved the instant gratification of urology. And people are still surprised, you know, that there's women in urology and it's like I've been out of residency for 10 years now. So I don't know if that's gonna change in my career at this point. It's not changing fast. But the superpower that being a urologist brings to this whole sex medicine discussion is that I treat men.[00:03:22] And so I get to see every single day how men are treated, and I see how women are treated, and it just becomes so glaringly obvious that we treat these two people very differently, and I get to have a voice because of that. In contrast to the gynecologists who don't see that we don't downplay men's complaints, and we don't say, well, that's just a quality of life issue, or yeah, you're just getting old.[00:03:42] We don't treat men the same way we're treating women. And the sex meds and… I met a patient who was crying in my office, and the more I opened my eyes to what was going on, the more I said, I thought, “this is a huge problem, an absolute huge problem,” which I hadn't really seen before because I was not taking care of women's sexual health before I kind of got awakened to it. It's going to be lifelong work because we've got a lot of work to do.[00:04:11] Dr. McBride: Let's, so let's talk about that for a second. I think what I'm hearing you say is what I experience myself as a doctor and as a person is that we countenance men's sexual dysfunction with ease and there's a whole specialty built around men's sexual health. It's urology. But in reality, urology encompasses everyone's pelvic floor, everyone's sexual health.[00:04:37] It's just that men tend to go into the surgical field, men tend to treat men, and then the narrative is that it's really for men. So, it sounds like that was your professional path, and then you began noticing, like I do, that, hey, guess what? Women have sexual health as well. Women have pain with intercourse, low libido, pelvic floor dysfunction, vaginal dryness. And like men, women are entitled to pleasure, the absence of pain, and most importantly, in my mind, is access to nuanced information about their own bodies.[00:05:13] Dr. Casperson: Yeah, we do a very interesting thing… to stereotype what we do, we say all of men's problems are biological and all of women's problems are psychological. And so like, you know, he's got erections issues. That's a blood flow viagra problem. We've totally forgotten it could be anxiety, depression, all that stuff going on.[00:05:30] And conversely with a woman, we're like, oh, she's just depressed. She's just too uptight. We're like, no, she can have a hormone problem. Women are allowed to have biological issues also. And we really put them in these little containers and then forget about the humanness of everybody.[00:05:47] Dr. McBride: Yeah, I think, you know, we can walk and chew gum at the same time. We can have anxiety about performance, and that can be rooted in an experience that was traumatic. It can also just be rooted in low self esteem, or... Body image issues. You can also have low libido from not having enough estrogen because you're going through menopause.[00:06:08] In other words, human beings are the complex sum of different parts. So to assume that women have sexual dysfunction because it's all “in their heads” and to assume that men have sexual dysfunction because it's all just a blood flow problem is to reduce people to these very simple parts and then assign them by gender. And that is not our job as doctors. It's also just completely inappropriate. It's really depriving people of the deep understanding of how their body and minds work in tandem.[00:06:40] Dr. Casperson: That's right. Absolutely.[00:06:42] Dr. McBride: Okay, so you are sitting there with a patient who's crying. Who's and by the way, I tell my patients when they cry in my office, like, you know, they're sort of apologizing or “oh, sorry. I'm just emotional.” And I'm like, oh my gosh. I mean, it's not that I want you to cry. It's a sign that we're getting somewhere that we have something to talk about. Let's peel back the curtain on what that is. It doesn't always mean you're depressed, it doesn't mean you're a hot mess. It just means there's something that's going on that we need to connect to your body.[00:07:10] So what are you finding women come to you to complain about vis a vis sexual health, sexual dysfunction? What are the main issues they present to you with?[00:07:19] Dr. Casperson: The two main ones in my office would be vaginal dryness/general urinary syndrome/menopause. Right. So low estrogen in the pelvis causing pain with sex, burning, tearing, low lubrication, decreased arousal. It's kind of this umbrella cause. And then the second one is I don't really want to have sex, or a.k.a low libido. Oftentimes, that one's so fascinating, because it's often times not a low libido problem. They don't know what it is. They come in and they say, “I have low desire,” and you talk to them and you're like, that's not what's going on at all. And a lot of times with sex, they think it's about sex, but it's just a couple's communication problem. [00:07:56] You're assuming what he's thinking, he's not talking to you about what he's thinking, you think this is a sex problem. You're like, no, no, no, this is just a relationship communication problem. But like sex gets involved and like, it just all goes haywire.[00:08:09] Dr. McBride: Yeah, I think you're right. I think sex can be the final common pathway for a lot of personal and then relationship challenges. I was talking to one of my patients who is actually a family lawyer, like she helps people get divorced or helps people not get divorced. And she, not surprisingly, said the three things that people commonly fight about or have troubles with in their relationships are kids, money, and sex.[00:08:33] Those are three very vulnerable touch points in our lives. And so I think you're right, that sex can be kind of a symptom of other issues. But in and of itself, it's important. It's part of how we connect with our partners. It's how we experience pleasure. It's a part of the human experience. So to deny someone a conversation about what it is, whether it's truly like a body parts malfunctioning problem or it's an emotional challenge is really not okay.[00:09:02] And your book, We Are Not Broken, speaks to this notion. That having trouble with sex, whether it's desire or the parts not working isn't a personal failure or a commentary on your ability to perform as a human. It's—the diagnosis here is human. It's common. I've, I mean, patients come into me all the time, I'd say of all ages, but often in their middle age and they'll sheepishly say to me, “I'm really embarrassed to say this, but I just don't want to have sex. I love my partner, but I'm just not interested.” And they act like they're the only person who's ever thought that before. And I'll say, “Oh my gosh, I could feel in an auditorium full of women who feel the same way.”[00:09:47] They feel ashamed. They feel guilty. It's not a lack of love for their spouse. Sometimes it is, or their partner. It's simply that they are struggling to connect the body and mind and they need some support and they need to be given permission to have that conversation.[00:10:04] Dr. Casperson: Yeah. Or they've just been having crappy sex their whole life.[00:10:06] Dr. McBride: Well, that's also true.[00:10:08] Dr. Casperson: And I don't want to downplay… there is now an actual medical condition called hypoactive sexual desire disorder because they have to DSM this stuff to get FDA approved for meds, like the entire thing that medicine is, but a lot of this “low libido,” I never believe them anymore because it's there's oftentimes something else and so I'm like, “well, what about sex? Is sex good? Do you like it?” And either the answer is “yes, I love it.” And then I say, “well, you don't have a problem. Stop worrying about low libido. Just go prioritize that amazing sex you're having.”[00:10:38] It's not normal to have a spontaneous desire in a long term relationship. And number two, if they're like, yeah, I could take it or leave it. I'm like, well, that's how dopamine works. You're never going to desire something you could take or leave, right? Like anchovies on my pizza. I'm whatever, right? Like I don't desire it.[00:10:54] And then it's just like, go have the sex worth desiring, which is very stuck in depth. That's easier said than done for a lot of people. They've spent how many years having the exact same unsatisfying sex because they're having sex the other person's desiring. And really prioritizing desire equality and pleasure equality within a relationship. It's like, you don't actually have a low libido problem. You have a sexist man problem.[00:11:18] Dr. McBride: interesting. So to break that down a little bit, and I'm assuming you're talking more about women, are sort of subjugating their needs and not allowing themselves to experience pleasure as much as men are. And therefore they are just having bad sex, which of course they don't desire because why would you desire something that's not that great.[00:11:38] Dr. Casperson: I'm stereotyping, you know, a heterosexual relationship here. Within any partnered relationship, you're going to have somebody who wants sex more than the other person. That's just, that's desire mismatch, and it's completely normal. And we need to normalize that. Like you, you want to, you know, drink seltzer water way more than I do.[00:11:54] Why is there so much seltzer water in our house? Between two people, there's always different things going on. So just normalizing desire mismatch, normalizing it. The other thing to normalize is it's not the lower desire person's job to come up to the higher desire person's level. It's to work within the relationship, to be like, what does our relationship need sex wise to keep everybody happy?[00:12:14] You can fulfill some of your needs outside of my vagina, right? Now, I can say that very easily because I've been talking about sex for years, and you have to be a little more nuanced in a relationship where you've maybe never talked about sex before. Because couples don't talk about sex, and then there's a problem with it.[00:12:31] Well, I don't have the basics of how to talk about sex when it was good. Now it's broken and I really don't know how to talk about it. So even just communication skills about sex is important. But yeah, I think a lot of women and there's we do not have much research on this…We've got decent studies in like college students, which are not long term committed relationships of “well, that's what he wanted. He wanted to do it. I did it to keep him happy.” Kind of this like mercy sex to control another person's behavior. I don't want him to get grumpy. I don't want him to get mad. And so you're having sex for that reason instead of connection and pleasure. And then you come in thinking you're the problem for having low libido. It's not a low libido problem.[00:13:13] Dr. McBride: Well, and there's nothing like shame or guilt to crush a libido that's already low, right? If your relationship with your partner is rooted in shoulds, then… [00:13:24] Dr. Casperson: You need to have sex with me more is the least sexy thing you can say to somebody. The partner is telling the low desire person that they're broken and they need to up their game. Like it's worked zero out of one million times to approach it that way.[00:13:38] Dr. McBride: Well, it's also, it's probably less than zero of a million times in the sense that the telling someone how to feel and then promoting the sort of shame narrative is like the ultimate libido crusher.[00:13:50] Dr. Casperson: Yep. I'm inadequate and I'm supposed to love this thing that I don't love more. [00:13:54] Dr. McBride: So I think you're right, Kelly. I think at the end of the day, it's about communication. It's about shared responsibility for meeting each other's needs. And I think that's hard in the modern era. I mean, who has time to sit down and have a nuanced conversation about sex? But I think we have to.[00:14:11] Dr. Casperson: Right. And even I, I live, I work in a very traditional medical 15 minute visit, right? And now through my years of work, I have the podcast and the book because I cannot explain this to anybody in a 10 minute visit and undo the years of socialization that women are passive and women's pleasure doesn't matter as much.[00:14:30] Male orgasm is what we prioritize—penis and vagina sex for heterosexual people. That's the only sex you should be having. All of this stuff. And they come in with low libido, and then somebody's gonna slap them on a drug. And not undo all this biopsychosocial stuff. I saw a woman literally yesterday. She had a painful vulva and vagina from menopause. Painful to the touch, like even her just touching herself hurt. Somebody threw her on testosterone for low desire. And she's like, “well, what do you think about the testosterone?” And I'm like, “I'm a urologist. I love testosterone. I'm very comfortable with testosterone.”[00:15:06] But putting somebody on testosterone who has a painful vulva, who's never going to want to be touched in the first place, you're completely missing the boat on this. We have to address the pain before we can address the desire. And so it is complex, which is why I love this topic. And I get to keep talking about it for years.[00:15:22] Dr. McBride: Yeah, I think it's treating people from the inside out, right? It's like not band-aiding them with prescriptions and referrals and drugs before we understand the patient. We are not just a set of organs. We are thinking, feeling people who absorb the public narratives, who have been raised perhaps in our own families to think about pleasure and desire and sex itself in a certain way. I think deconstructing those narratives in our own lives, and then being comfortable talking about those things is key. And I think having people like you, Kelly, out there talking about these things in a very matter of fact way is gradually changing the narrative and hopefully empowering women to ask the right questions and give themselves permission to feel.[00:16:09] So it's interesting because you and I both know that doctors are hurried, doctors are rushed. No one has time anymore with their doctor, unfortunately. You've got the field of gynecology, which is tasked with doing your pap test, writing your mammogram order, you know, checking your pelvic exam, and how can they possibly fit into a 10 minute or even 5 minute visit a conversation about pleasure, desire, feelings, behaviors, your relationship. It's just a tall order for a single specialty, right?[00:16:45] Dr. Casperson: they can't. I mean, the other thing that we completely forget in this narrative is that women are 50% of the population, that we've completely ignored in this arena, talking about both menopause and sexual health. 50% of the population, there's not enough gynecologists. Even if they could spend 15 minutes, there's not enough of them.[00:17:02] This is primary care, internal medicine, psychiatry. We really all have to get on board, because, like, we're not a minority recessive gene problem. This is 50% of the world.[00:17:16] Dr. McBride: Right? Yeah, so one of the things I try to help patients navigate is the medical system, given that we have needs the medical system cannot meet. Arm people with the questions to bring to their gynecologists. Instead of being a passive recipient of like the pap test and the referral to the mammogram, make sure you're bringing your needs to them and asking for their advice and then making a separate appointment just for a conversation if needed because it's not the doctor's fault necessarily that they don't have time to talk about sexual desire.[00:17:49] Patients are conditioned not to ask about it. Doctors don't have time. It takes a whole lot more time to counsel someone on the nuances of behavioral health and pelvic floor and the nuances of hormone replacement therapy, which we'll talk about in a minute, than it does to hand someone a referral for a mammogram and say, you look great, see you next year.[00:18:07] Dr. Casperson: Totally. And that's where good resources like your podcast, my podcast, the book is like what you read it, you can consume it. And then our podcast will give you better resources. So you come in with the current menopause guidelines. You come in saying, “I've already talked to my partner about this.”[00:18:22] Dr. Casperson: You're telling us what you've already done. You're an engaged person. We actually want to help, right? And so it's like setting that person up to be successful in the doctor's office and to ask why so many, like, you know, the hormone thing. So many women will come to me and they'll be like, well, they took me off my hormones.[00:18:38] And I'm like, “why?” Why is a very natural question for me, right? And they're like, oh, I don't know. I didn't ask. So it's very okay to just ask why in a non threatening way to your doctor. Like that's my other doctor pro tip and how to talk to…[00:18:51] Dr. McBride: Ask why.[00:18:52] Dr. Casperson: Ask why so you understand![00:18:53] Dr. McBride: This is your body. This is your life. So let's talk about hormone… it used to be called hormone replacement therapy, HRT, now it's called menopause hormone therapy, MHT. Whatever the acronym, what I want to talk about, the conversation every woman should be entitled to about hormones and using hormone replacement therapy to offset the symptoms of menopause and to prevent the myriad potential downstream effects of the absence of hormones.[00:19:25] Just to frame the question and to give listeners a little bit of a sense of what I'm talking about, what is menopause? Menopause is defined as the absence of a menstrual period for a full year. The average age in the U.S. of menopause is 51 and a half years. That stretch of time of not having a menstrual cycle can occur in the mid 40s, it can occur in the mid 50s, there's a range.[00:19:46] And during the lead up to menopause, people can experience a variety of symptoms. As a result of our ovaries no longer making robust amounts of estrogen, progesterone, and some testosterone. That can be hot flashes, night sweats, vaginal dryness, urinary tract infections. Pelvic floor, pain with intercourse, mood instability, rage, although maybe the rage is just that we're pissed off, but yes, rage.[00:20:15] And then, of course, there are the less immediate and the long term effects of not having estrogen and progesterone in our bodies, which can be downstream osteoporosis, accelerated cognitive decline, cardiovascular disease, risk of heart attack and stroke, and then the accumulated... downsides of having painful sex or having urinary tract infections.[00:20:41] How many women do I see in their 80s, for example, who end up having recurrent urinary tract infections? They're not even sexually active, necessarily. And that could have been ameliorated with hormone therapy from the get go, when they went through menopause at age 50, for example. So, the question I want to ask you is rooted in the reality that since June 2002, when the Women's Health Initiative study was halted prematurely and the headlines read, “hormone replacement therapy is bad for you.” We really took a hard right turn in the public square on the narratives around hormones. People, patients, doctors included, have been loath to prescribe estrogen and progesterone for menopausal symptoms.[00:21:30] Because the narrative that came out of that 2002 press release was that we're doing harm to women. And that wasn't the narrative before 2002. In fact, hormone replacement therapy was almost standard of care. So you probably read the same article I did, the Susan Dominus article in the New York Times.[00:21:51] I cheered. I also was sort of pissed off reading it, thinking where has the New York Times been for 20 years, but we'll take it better late than never. Her article was a very beautiful explanation of why we deprive women of conversations around hormone replacement therapy. It's easier to not talk about hormone replacement therapy because it's a long conversation in the doctor's office.[00:22:18] There are risks of hormone replacement therapy, potential risks, but there are potential risks of not being on hormone replacement therapy. And you and I both know, and even the expert society for menopause has said that if given within the first 10 years of a woman's last menstrual cycle, hormone replacement therapy in most women does more good than harm.[00:22:47] In other words, protecting you from long term downsides of not having estrogen, osteoporosis, heart disease, stroke, etc., and treating the menopause related symptoms that you have right now, arguably is better for most women than it is to not be on hormones. Now, of course, there's nuance. If you have a personal history of estrogen sensitive breast cancer, that's going to be a different conversation.[00:23:15] To deprive women of that conversation and the choice, given that risk is everywhere and there's risks of hormones and there are risks of not being on hormones, that is where we need to start. Empowering women with facts and rooting their decisions. In their risk tolerance, not ours.[00:23:32] Dr. Casperson: Yeah, I mean, I'm to the point now in my journey of like you want to control women? I got a good idea. Make them afraid. Now you have complete control out of them.[00:23:41] Dr. McBride: Oh my gosh, Kelly, amen, hallelujah. And I'm not a conspiracy theorist, but sometimes I think I am.[00:23:46] Dr. Casperson: Well, you start, I mean, you just do this long enough and you're like, I see what's going on because you know what you do when you empower women and you take their fear away, you give them agency and you give them the ability to choose what they want to do with their body—you give them a hell of a lot more power. So, that's my whole thing now—I'm here to get rid of fear.[00:24:04] Dr. McBride: It's very simple. If you have fear and shame in the driver's seat… [00:24:07] Dr. Casperson: Boom. Control.[00:24:08] Dr. McBride: We are castrated, literally. If you have fearlessness and facts in the driver's seat and a good guide, like a Kelly Casperson or some other doctor who knows the data and is focused on you, not risk aversion for their own protection, liability wise, reputation.[00:24:29] I don't know what doctors are doing when they're depriving women of the conversation or gatekeeping on hormone replacement therapy. But when you put women in charge of their own health and give them tools and information, watch out world. [00:24:42] Dr. Casperson: Yeah. Totally. I mean, the other thing, the other piece I think that Western medicine's very bad at is preventative health care.[00:24:49] Dr. McBride: A hundred percent[00:24:49] Dr. Casperson: And if we look at menopause hormone therapy as preventative health care because what we're doing is we're preventing heart disease We're preventing dementia. We're preventing osteoporosis. We're preventing genital urinary syndrome of menopause. We're preventing diabetes. And you can't see that—you can't measure that especially on an individual scale. And so you're like well just come in when you've got osteoporosis and diabetes and heart disease. We know how to treat you; we've got tons of meds for those problems. But to change the paradigm and be like, I would like to actually not need to be treated for those things, so I want to choose hormones. Hormones aren't perfect, but they will certainly help prevent to a decent amount.[00:25:27] Dr. McBride: Right, I mean people get strokes, people get heart attacks, people get dementia for other reasons, age related, genetics, environment. But certainly the data are clear that again starting hormone replacement therapy within the 10 years of the last period tends to decrease those risks. I think what you're touching on, Kelly, is a really important point that Western medicine does a very poor job—arguably abysmal job—at countenancing things we cannot see, we cannot measure.[00:25:56] So, we can measure cholesterol, we can measure your pap test, we can look at your mammogram result. We can hold it in our hands and look at the number on the computer screen. It is less easy—it takes more time, it takes more conversation and it takes an appreciation of the invisible components of the human condition—to weave in the invisible components of life.[00:26:20] If you live to your 105 and you have perfect cholesterol and no stroke and you're, that's great. But if you are suffering for 50 years from pelvic pain, the absence of a healthy sex life, depression, anxiety, that's not necessarily a good thing we've done for this person. We can help them live long, but what about living well?[00:26:43] And by the way, they're not mutually exclusive, right? It's not like I'm saying, oh, let's knock 10 years off your life to give you a good sex life. I'm saying, let's give you both. Let's be greedy. Let's give you quantity of life and quality.[00:26:53] Dr. Casperson: I think the other thing is menopause is 30 years of your life. Right? Like, maybe you aren't going to decide to go on hormones this year, but go learn some more. You can start them next year, if you want to. Who do you want to be? What do you want your health to be? What do you want to be doing when you're 70?[00:27:12] And think about your future self, and think about how I can set her up. Because once you're 70, once you're 75, you can't start on hormones. The risk is… because, I mean, you can. Technically, you can. But the risk goes up if you don't start during what they call the healthy cell hypothesis. You've got to start on healthy cells, keep them healthy, not start hormones on unhealthy cells. So we're going to think, and I asked these 50 year old women, I'm like, what do you want to be doing when you're 72? What's your plan? And a lot of them see moms with dementia, moms with osteoporosis, they've got stiff joints, they can't get on off the ground with the grandkids.[00:27:49] And you don't have to be that. You can choose, as best as you can, to set yourself up for great health. But it requires making decisions in your 40s, in your 50s, to eat right, sleep well, exercise, possibly use hormones. We don't think about our future selves, and then, you know, she might be kind of miserable.[00:28:08] Dr. McBride: It's true. You know, you probably get this question, and I do too, from middle aged women. How can I age gracefully? What can I do to preserve my cognitive, mental, physical health over time? And that's a great question and oftentimes patients have gone on the internet and they've bought some supplements, they've bought some gizmos, they've bought some gadgets.[00:28:26] They've bought into, unfortunately, the sort of worshiping at the false idols of wellness. Not that I'm anti wellness. Wellness is part of our job, right? It's just that let's be real about what is evidence based and what is woo woo in a nice package. As you can tell, I have an opinion about that.[00:28:43] Dr. Casperson: A woman sent me on Instagram today, what do you think about this supplement? And I'm like, are you drinking alcohol? Stop. Are you exercising? Start. Are you working on love in your life and keeping your brain expanded? So many people, they get narrow in their brain and their flexibility to think as they get older.[00:29:03] Dr. McBride: Well, I think that we think that, not that people are not smart, but I think we start to think that agency exists in a pill. That we'll have control if we can just take the right supplement or pay enough money for some guru, right? And it's not that I know everything. I certainly don't. You can ask my children. It's that there is no vitamin, supplement, or pill for quality of life. It's an integrated sum of different components, and that includes agency. And hormone replacement therapy, arguably, is one of the things we can do to help people “age gracefully.” There's a whole industry, as you know, about treating the symptoms of menopause by nibbling around the edges of the symptoms, like giving you a little eye of newt and a tincture of whatever to treat the various symptoms.[00:29:50] And people will go, women will go to extreme lengths and extreme costs to avoid being on hormones because of the narrative. And so the industry is now promoting, look, you can do non hormonal treatment. And that's fine. I'm not saying, I don't think you are either, that every person should be on hormone therapy.[00:30:09] Not at all. It's not appropriate for everyone. It's not even necessary for everyone. It's just that we should be honest about the data and not steer people down the path of the sort of pseudoscientific wellness industry at the expense of their actual mental and physical health.[00:30:24] Dr. Casperson: Our good friend Rachel Rubin is quoted in that New York Times article: “menopause has the worst PR campaign in the history” of health problems which is just brilliant. [00:30:32] Dr. McBride: What is it about Rachel? She has these sound bites. That was such a freaking brilliant quote. I'm just cheering for her so big, like you are.[00:30:39] Dr. Casperson: mic drops, but it's true. Like we just, we think it's a hot flash and then we think it's done. I literally saw this woman this week. She's 52. She's having heart palpitations. She's having weight gain. She's having a moodiness. Her hot flashes are so debilitating. She has to pull over her car because it's unsafe to drive during her hot flashes.[00:30:56] She went to her provider. They're like, we'll run some tests, see what your hormones are. She's 52, hasn't had a period in two years.[00:31:03] Dr. McBride: smells like a duck, sounds like a duck, looks like a duck.[00:31:05] Dr. Casperson: To me, I'm like, you're in raging menopause, you need no blood work. Get this woman on some hormones. Like, it's so obvious to the people, because menopause and hormones actually isn't that hard. We just didn't get educated. It's not hard. We just didn't get educated for two decades. We've had two decades of doctors who didn't get taught how to treat menopause because of the Women's Health Initiative.[00:31:27] Dr. McBride: Right. And so people who are listening are going to think I'm making this up to make a point, but I'm really not. I spoke to a gynecologist this week who is someone I've worked with for decades. And again, like I'm not in the business of like demonizing other doctors. In fact, I am only as strong as my community of doctors I work with, but my patient is experiencing menopausal symptoms that are hard to measure.[00:31:49] Depression, some heart palpitations, anxiety, sleeplessness, and just feeling like she's a broken person when it's all menopause. So I call the gynecologist because I want to be a team player and ask the gynecologist, what do you think about putting her on fem ring and progesterone? This is a low risk person.[00:32:08] And she's a year and a half out of her last menstrual cycle, this was her response. She said, “can't you just put her on Prozac for the depression?” And I said, well, I'm not sure she's actually depressed. I think she's just experiencing menopause. And I think that the Prozac would maybe help with mood, but it's not giving her the treatment that is going to actually help, in my opinion.[00:32:34] She said, “can't you give her gabapentin for night sweats?” I said, absolutely. We can do the workarounds. But what are you worried about, if I may ask, about putting her on true hormone replacement therapy? Basically, the hair of the dog that bit you. And the answer was, “well, the FDA has really only approved hormone replacement therapy for vaginal dryness.”[00:32:55] I said, “well…”[00:32:56] Dr. Casperson: Not true.[00:32:57] Dr. McBride: Look, I believe in our federal government. I'm a registered Democrat, but the FDA does not know my patient. The FDA, as far as I'm concerned, is a gatekeeping apparatus to deprive women of these medications. So, as her doctors, you and me, I feel obligated to offer her something that would actually help with her symptoms instead of nibbling around the edges. What do you think? And she agreed with me. But it took a long conversation. She agreed.[00:33:24] Dr. Casperson: Well, it's the… hormones are this, it's this myth that they're so dangerous. It's like Zoloft has a black box warning for suicide. Is that the preferred drug? Besides the fact that it isn't treating the root cause, which is low hormones.[00:33:36] Dr. McBride: Exactly! The level of scrutiny on hormone replacement therapy is beyond any degree of scrutiny I've ever seen for any medication, right? Urgent cares are prescribing Z packs for viral colds. I mean... What are we doing by not giving people a natural hormone if they need it, if they want it, and they know the potential downsides?[00:33:57] Dr. Casperson: 100%. Like, once you, like, as you see, you see this. It's absolutely insane. If there was a drug that helped men live three years longer on average, every man would be on it. That drug is called menopause hormone therapy. Multiple studies showing decreased immortality, increased longevity, and not only living longer, but living quality of life longer.[00:34:22] And I'm like, do you, do you think the man would be on that if he had a chance to be on that? Heck yeah. And it's like, there's no other drug. What other drug is going to give you three extra years of life? None of our drugs, to my knowledge, have that kind of longevity data.[00:34:37] Dr. McBride: That's right.[00:34:37] Dr. Casperson: Estrogen has that longevity data. We blow it off. We would not blow it off if that was given to men.[00:34:43] Dr. McBride: So tell me what your advice to people listening to your audience, Kelly, is, when they are experiencing symptoms of menopause, their doctor may not be... interested, have the time or be informed with all the data to have a discussion. What do you tell patients to do? In the power dynamic in a doctor's office, patients assume that their doctor knows everything.[00:35:06] They're making a good judgment when frankly we are experts and we do know a lot, but it is not our job to tell you what to think, tell you how to feel or to gatekeep on medications. It's really to arm you with the tools you need to manage your everyday health. So what do you tell people? In your audience as a good kind of like three or four rules of thumb to bring to your doctor when you're experiencing menopausal symptoms or want to just have the conversation.[00:35:35] Dr. Casperson: Yeah, I would bring in the 2022 North American Menopause Guidelines. That's a great document. Doctors are going to respect that document. And it really downplays a lot of fears. It says how safe it is. So come in prepared with something that the doctor, they speak that language,[00:35:50] Dr. McBride: Great. And I'm going to link to that document in the show notes.[00:35:53] Dr. Casperson: Yep. And the other pro tip for talking to a doctor about something that they might not be comfortable with is to say, you know what I'd like?[00:35:58] I would like just to try this for a couple of months and then I'll come back and I'll report back and if it didn't go well, I'll stop. Does that sound okay to you? Most doctors are going to say yes to that. Because now they've got a plan, they know you're not going to follow up, right? I'm like, I just want to try this and see if it works.[00:36:17] Dr. Casperson: Because I think people get so bent out on hormones, they're like, “should I do hormones? Should I not? Should I? Should I not?” It's like, “just try them. You could stop. This is not an amputation. It's all okay.” But having that sort of plan with your doctor, I truly believe in a long term doctor patient relationship. They're going to know you. That is the best case scenario. That doesn't always exist in our current culture. And when women don't get what they need, the smart ones are going to go online. And that's where these online clinics for menopause are coming from, because they see we are underserving women.[00:36:51] Doctors do not have time. This is a nuanced conversation. And I think for better, for better or for worse, but I think for better, you can get your hormones online now, because you don't have to spend two hours on hold trying to make an appointment with somebody you might not even know anyways. The healthcare system is kind of bad.[00:37:08] We're not set up for this, right? We're not set up for the New York Times changing, like, how many millions of women are like, maybe I can consider hormones now. We're not set up for that. We're already full, right? So, I think that's the role of where these online clinics are going to come from. I think some are doing it well.[00:37:26] Certainly, I don't think it's as good as an inpatient, in your town doctor patient relationship. But we do not have capacity to start tackling these issues like we should. And so I think that's the new role for the online clinics.[00:37:39] Dr. McBride: Yeah, I think you're right. I mean, it's sort of like the sort of outcrop of mental health providers who are doing virtual care to kind of meet the demand. I don't think online virtual therapy is ever going to replace in person therapy, but it's better than nothing. And if they're doing good and people have managed expectations about what an online therapist can do, Great. Similarly, a lot of these outposts, these online businesses helping people with menopause and hormone replacement therapy are really doing good work, like MyAlloy, which was founded by a friend of mine, Ann Fullenweider. Their medical advisor has been Sharon Malone, who's a really well respected OBGYN in DC.[00:38:20] She's a friend of mine as well. And they're doing really good work trying to empower women with facts and information because not every woman, A, has a primary care doctor, B, is comfortable talking about these things with that doctor, and C, has the time and the visit to even discuss these things. So I think it's a net.[00:38:38] I just think people need to be careful about the snake oil salesmen that are telling you to just take this little eye of newton—whatever the metaphor is—because we run the risk of misinformation running rampant as it already is.[00:38:52] Dr. Casperson: Well, yeah. And people's dollars are limited and you go online and it's this supplement, that supplement, what's the new trendy thing? And at the end of the day, I want you to save your money. Like, you really don't need a lot of that crap. And hormones are pretty darn cheap. They've been around since the 60s and 70s, right?[00:39:08] If we came out today with a drug that made you live three years longer, you know how much that would cost? Right, and you can get that in estrogen for pretty darn cheap. So that's…[00:39:17] Dr. McBride: The other point I'd love to make that people don't always understand is there's a lot of brand sort of marketing lingo around hormones that in my opinion is unnecessary and make people think that there's like a right way or a wrong way to take hormones. The word bioidentical is sort of having a moment and I would just say to people you don't need to buy fancy brand name hormones.[00:39:41] CVS, Walgreens, not that I'm a big believer in chain pharmacies, but your regular pharmacy has “bioidentical hormones.” In other words, micronized progesterone, which is the safer progesterone and estrogen in the form of a tablet, a patch, a ring is as close as it can get to not being actually your tissue.[00:40:03] So, I think that people need to be educated on the fact that it doesn't have to be fancy, formal, or brand name, and to be suspicious of anybody who says that they have the best bioidenticals and someone else doesn't, because that is just made up.[00:40:20] Dr. Casperson: It's made up. Well, I mean bioidentical came because we were so freaking afraid of hormones That it was a way to help people stop being so afraid of hormones. So it was kind of like this lead in to safety But I tell people it's like you know when you like you have a granola bar and it says natural on it and I'm like, you know what the natural means like legally And they're like, no. And I'm like, it means nothing. It doesn't… [00:40:43] Dr. McBride: It's a marketing word. It's a marketing word. It's a way to deescalate fear and to make people feel like it's their own body. When... if we can just get rid of the charade and just get people what they need, we'd be a lot better off.[00:40:55] Dr. Casperson: Yeah. And most cheap FDA approved products are “bioidentical.” They're the same. [00:41:00] Dr. McBride: It is funny. I mean we're all victims of sort of messaging and narratives and we're beneficiaries of it too. But it's just you have to know what the landscape is because otherwise we get tripped up and believe things that are just sort of hoo ha. I'm a victim of that too. And do I buy soap at CVS that says lavender scented calming soap?[00:41:24] I was laughing at that the other day and I was like, as if this soap is going to calm my noisy brain down. If it did, that'd be awesome, but I'm just going to manage my expectations that this soap is just going to clean my hands.[00:41:37] Dr. Casperson: Yeah. A hundred percent. The power of the mind, man. I mean, going back to sex, placebo gives you an erection 40% of the time. So, the mind is very powerful.[00:41:45] Dr. McBride: It's true. So Kelly, as we come to the close of our conversation, I'd love to just thank you for helping change the narrative for arming people with facts and tools and for reaching people where they are, because this is where we need to be in the modern era. We need women to have truth, access to tools and to take shame and fear out of the driver's seat.[00:42:12] Thank you so much for joining me.[00:42:13] Dr. Casperson: Thanks for having me.[00:42:15] Dr. McBride: Thank you all for listening to Beyond the Prescription. Please don't forget to subscribe, like, download, and share the show on Apple Podcasts, Spotify, or wherever you catch your podcasts. I'd be thrilled if you liked this episode to rate and review it. And if you have a comment or question, please drop us a line at info@lucymcbride.com. The views expressed on this show are entirely my own and do not constitute medical advice for individuals. That should be obtained from your personal physician.  Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Sexual intimacy is an important part of any healthy relationship, and understandably, not being able to perform can be a sensitive topic for some men and affect relationships. However, it's important to remember that having trouble getting or keeping an erection doesn't mean that you're not desirable, or that you'll never have good sex again.Welcome to Sex- Care is Self-Care, a conversation on women's sexual health brought to you by the Patty Brisben Foundation for Women's Sexual Health. I'm your host, Patty Brisben.Today's conversation with Dr. Sheryl Kingsberg and Dr. Rachel Rubin will educate and empower men to address erectile dysfunction, improve confidence, and provide partners with ways to enhance satisfaction in their relationships.Learn more and donate: https://pattybrisbenfoundation.org/

You can also check out this episode on Spotify!Dr. Mary Claire Haver is a board certified OBGYN and women's health advocate who has helped thousands of women going through menopause actualize their health and wellness goals. Dr. Haver's goal is to empower and educate women in their mid-lives, and help women advocate for themselves in the doctor's office. On this episode of Beyond the Prescription, Dr. McBride and Dr. Haver break down the myths and facts about menopause and hormone therapy. They discuss the harms of fear-based narratives in medicine and the importance of balancing risk to help women live longer and healthier lives.So, should you or shouldn't you take hormone replacement therapy? Dr. McBride wrote a longer piece about this decision-making process here. The upshot?* Menopause is defined as having gone a full calendar year without a menstrual period. A woman's midlife decline in estrogen and progesterone levels can cause short-term symptoms (like hot flashes, vaginal dryness, and insomnia) and can increase the risk for long-term health problems (like cardiovascular disease and osteoporosis).* In general, menopausal hormone therapy (MHT) is considered safe for most healthy women when it is initiated within 10 years of menopause.* Estrogen itself does not seem to increase the risk of breast cancer for the vast majority of women.* Unless she has had a hysterectomy, a woman should take estrogen and progesterone together.* Micronized (aka “bioidentical”) progesterone does not increase the risk of breast cancer; synthetic progesterone does seem to increase the risk, but only slightly.* Dr. McBride recommends not panicking about the new Danish study suggesting an increased risk of dementia in women who take MHT. Why? It was an observational study (not a randomized controlled trial or RCT) therefore it cannot prove causation; the study population used oral estrogen and synthetic progesterone which are not the standard of care in the U.S.; myriad RCTs show the opposite finding: that MHT is likely protective against premature cognitive decline, especially when started early. * Too many women needlessly suffer through menopause because of false narratives about the safety of MHT and because discussions about quality of life often aren't prioritized.* Don't take it from her! Dr. McBride encourages you to share the latest expert statement from the North American Menopause Society with your own doctor to help guide your decision-making process.* Women are entitled to make their own decision about hormones, armed with the data, and with an understanding of their unique risks and benefits.Dr. McBride will answer your questions about menopause and HRT on Friday. Submit your question right here!Join Dr. McBride every Monday for a new episode of Beyond the Prescription.You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.Please be sure to like, rate, and review the show!The transcript of the show is here![00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight.[00:00:31] We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts.[00:00:57] So let's get into it and go Beyond The Prescription. Today on the podcast, I'm talking with the incredible Dr. Mary Claire Haver. She's a board certified OBGYN who has helped thousands of women who are going through perimenopause, menopause, and beyond actualize their health and wellness goals. She realized after decades of practice that she hadn't learned as much as she should have about the science of menopause, aging and inflammation.[00:01:27] She really took a deep dive into the science and has created an online course called The Galveston Diet with the goal of empowering and educating women in their mid lives. Mary Claire, thank you so much for joining me today on the podcast.[00:01:41] Dr. Haver: Thanks for having me.[00:01:42] Dr. McBride: Let's talk about the fact that women have been notoriously excluded from medical studies. Women have also been deprived in many ways of access to nuanced information about their own bodies and health. And so it's interesting right now that menopause is having this moment, right?[00:02:01] It's like Susan Dominus wrote this beautiful article about how women have been misled, and I think women around the country, around the world were like, “yes. Oh my gosh. Thank you for seeing me and hearing me.” And I think it's a historic moment where women are finally recognizing that they need to be seen and heard, and that their menopausal symptoms are not just in their head and that it's time to get the facts to put ourselves in the driver's seat. So let's just start with that article. So tell me what happened when that article in the New York Times came out, did that change increase the volume of phone calls coming to you? What? What did it mean to you?[00:02:39] Dr. Haver: I think it just validated and reinforced what I was already doing on social media and that really people were sending me the article by the thousands—I was getting tagged. I was getting, “why aren't you in this article?” I didn't even know it was being written, and I just felt like it was really well done and it really was the tip of the iceberg, but it was the first meaningful publication—in such a respected area—that really was drawing attention to the problem. But women have been screaming about this for years, and I'll tell you, so I finished my OBGYN training in 2002, which was also the year the WHI stopped the study on hormone replacement therapy and basically ended any meaningful research into menopause care for at least 20 years. [00:03:36] And when I graduated from that training program, I would've sworn on a stack of Bibles based on my board scores and my level of training that I was a world-class menopause doctor. And it wasn't until 20 years of clinical practice that I realized in going through my own menopause journey that I was not a good menopause doctor, that there were serious gaps in my own education and training.[00:04:03] So when you look at an OBGYN residency, and I know this because I was a former residency program director, and over half of what we do, probably 55 to 60% of what we do is obstetrics. All important stuff. Then everything else gets shoved in the box called gynecology. And in that gynecology box we have pediatric gynecology, we have GYN oncology, we have reproductive endocrinology, which is fertility.[00:04:29] We have everything, and menopause gets a tiny sliver of that time and education. There are only 20% of residents coming out today who feel that they had any clinical menopause training, meaning went to a clinic where they were specifically addressing a woman in menopause. When multiple surveys have been done, the doctors are realizing this is important, but they didn't get the training.[00:04:56] Nothing was really focused on that. Not to say that what we learned wasn't important. It's just menopause has never been prioritized.[00:05:03] Dr. McBride: Why do you think that is?[00:05:05] Dr. Haver: So I think it's a perfect storm of societal norms of medical education, how women have been treated through the years in medicine. I don't know about you, but we had a saying, if it walks like a duck, it talks like a duck… we love a differential diagnosis.[00:05:22] We love a standard set of symptoms, and I think one of the problems is that menopause has a very diverse presentation in each woman. Even identical twins can have completely different symptomatology. We're all going through something very similarly endocrinologically as far as our ovaries beginning to lose their eggs, and the decrease of estrogen and leading to the full menopause with no estradiol. But how that presents in our bodies is very different. So unless you've been trained in the nuances of how to pick this up, then you're going to miss it unless she's just waving a flag with hot flashes and no periods. But the symptoms of menopause begin in perimenopause seven to 10 years before.[00:06:03] So we have this entire generation of women who are suffering and going to their healthcare providers with this kind of laundry list of symptoms. And if the doctor isn't trained to realize that this constellation could all have a common denominator of decreasing estrogen levels, they may get told it's all in their head, or this is a normal part of aging, or there's nothing we can do, white knuckle it, suffer through it, you'll be fine.[00:06:30] And we're just leaving them without… they're walking out feeling dismissed, feeling like maybe they're crazy and that they are going home to cry over, I can't get any help for this. [00:06:42] Dr. McBride: I couldn't agree with you more that medical school and residency, while of course I learned a ton, did not do a fantastic job at countenancing suffering that you can't see, that you can't measure in a blood test or a CAT scan, night sweats, hot flashes, vaginal dryness. Pain with intercourse, relationships, struggles because of sexual dysfunction, decreased arousal—what we call low libido.[00:07:10] Those are things you can't see. Plus, women are used to suffering. We are very comfortable in the space of suffering, right? We deliver babies. We have our nipples cracking and bleeding with these infants hanging off of our chest. And I think it's not hyperbole to say that women are pretty good at suffering.[00:07:34] And so I think it makes sense that gynecologists who only have so much time in the office to talk to patients. And who only had a certain education and that didn't encompass menopause per se. And when we aren't comfortable talking about things we cannot see and we can't measure, we can't quantify despair, that it gets brushed under the rug.[00:07:57] It reminds me a lot of, my interest is in the relationship between mental and physical health. The relevance of mental and physical health, how we all have anxieties, we all have fears, we all have moods, we all have relationships, and we didn't talk about that at all in medical school. My psychiatry rotation was about addressing patients who are in institutions and paranoid schizophrenics, which of course is relevant, but it's not speaking to the universality of mental health as a common sort of ground zero for our whole health. So I think what you and I are doing is trying to shine a light on these universal phenomena—grief, loss, anxiety, moods, relationships. And in the case of women, the fact that every single woman, if you live long enough, will go through menopause as defined by…[00:08:47] Dr. Haver: A hundred percent.[00:08:48] Dr. McBride: The gradual decrease in the production of estrogen and progesterone, and a little testosterone, and we need to talk about it. We need to be open about it. We need to empower women with the questions to ask their doctors.[00:09:03] Dr. Haver: I think the other thing to mention here, and it's really getting brought to the forefront with the political discourse going on right now, is that society in general stops valuing a woman somehow after she's done with the ability to reproduce. And we're seeing it, and I think this is manifesting in how we are not focusing on menopause care, why the research dollars are not going to menopause care.[00:09:30] When you look at women's health spending at the NIH, it's, I think it was several billion, but only 45 million was spent on anything to do with menopause, and that was like 0.3% of the funding in women's health was going to anything to do with menopause when a third of us living, breathing, functioning women are suffering right now due to their menopause journey. We're just not valuing them.[00:09:58] Dr. McBride: And then we have, of course, the headlines that came out in 2002 when the Women's Health Initiative was stopped early, and the headlines screamed things like, I mean… you put the word breast cancer out there in a headline and the fear of breast cancer. What happened in 2002 is that this enormous study, that was the first study on hormone replacement therapy powered by NIH and Bernadette Healy was the first female head of the NIH was stopped early because there was a signal suggesting that hormone replacement therapy causes breast cancer. Now, when you hear that as a woman and women are—we're smart, we're paying attention, we also are not immune to fear-based messaging. And so talk about what happened and how it has taken us so long to correct the narrative on hormone replacement therapy as a treatment for menopausal symptoms.[00:10:52] Dr. Haver: So the fanfare with which that announcement was made was pretty much unprecedented in medicine. There was a press conference called in DC and there were reporters everywhere, and one of the—it was only one person in the study who decided to release this information. This was before the study had actually even been published.[00:11:17] Healthcare providers couldn't even read the article and decide for themselves. So everyone's in their offices, I'm in residency, and we're just doing our normal day-to-day lives. And it was like a shot went off across the world in our world that estrogen causes breast cancer, hormone therapy is going to kill you.[00:11:36] And that was the take home message. And all of us were reeling. We're reading the headlines. No one can get their hands on the study for another week or two. 80% of prescriptions for hormone replacement therapy stopped immediately based on one announcement. And in the 20 years, that 22 years now that have ensued since that publication, so much of that has been walked back on multiple levels.[00:12:04] It's been reanalyzed, looked at, retracted. People have apologized who were in the study, and none of that has gotten any of the fanfare. It's been really hard. The best book that came out was Estrogen Matters, the Avrum Blooming book. He really broke that study apart so a layman could read it and understand, and the fallacies of the study and the things that it really represented.[00:12:28] So the average age in the study was 65 years old. We weren't talking about newly menopausal women in the beginning of their menopause journey and the potential benefits, the estrogen only arm had a 30% decrease risk of developing breast cancer. No one talks about that. And that women who were diagnosed with breast cancer, it was itI believe the risk went from 3.2 to 3.8% if I have the numbers correct, and that represented a 25% increase, but it was still very small. And that the women who were on hormone replacement therapy at the time of their diagnosis had a 20 to 30% higher survival rate, five-year survival rate than the women that weren't.[00:13:09] So women were not allowed to digest that information and decide for themselves what their tolerance to this risk was, and if they still, for the health benefits, for their quality of life, they were absolutely denied. So in desperation, I think practitioners began giving people antidepressants, which can be helpful, but it's never the gold standard and the gold standard for menopausal symptoms is always going to be estrogen. But doctors just were so terrified. The patients were terrified. They didn't want to get sued.I remember being fearful of being sued for giving hormone replacement therapy.[00:13:49] And the mantra, like I was taught, kind of was only give it if she's threatening suicide, like if there's no other option, you know, otherwise do anything other than giving her back the hormones she so desperately needs.[00:14:02] Dr. McBride: Yeah, it's such an example of the paternalism of medicine or maternalism because I think women doctors too were depriving women of these hormones, but it's more this sort of like sense that doctors should be the gatekeepers and we should be the arbiters of the patient's risk tolerance. It reminds me a heck of a whole lot of COVID when instead of giving the public sort of nuanced information about, you know, calibrating your risk mitigation measures to your actual level of risk, given your age and underlying health conditions and number of vaccines.[00:14:39] Instead just telling people, here's what you do. Regardless, we are going to tell you how much risk to tolerate in medicine, as you well know, first of all, patients don't trust doctors who think they know everything. I mean, I don't, and I certainly don't know everything. And I think we owe patients…We owe women the ability to make their own decisions based on the facts and the information they have, and we need to countenance the invisible suffering, just like we countenance the risk of breast cancer. Certainly there are risks of hormone replacement therapy and there are risks of not being on hormone replacement therapy. And let's talk about both and let's try to thread that needle with the understanding that life is risky.[00:15:21] There's risk everywhere you go. You could live your life not on hormone replacement therapy cuz of the fear of breast cancer that may be completely founded because of a family history, a genetic predisposition, but then you're going to have to tolerate perhaps an increased risk for cardiovascular disease, an increased risk for premature cognitive decline, an increased risk for osteoporosis, sexual side effects, etc.[00:15:42] We owe women the discussion, the conversation. But as you know, the conversation takes time. And then it takes more time when you have to undo a fixed narrative that a woman is bringing to the doctor's office saying, “oh wow. I don't want to be on hormones because that causes breast cancer. And that's not because these people are not intelligent, it's because they've been told…”[00:16:05] Dr. Haver: It's going to ake everybody being on board. It's going to take years, but I am so proud to be on… I can't believe this. I'm just a regular OBGYN. There's nothing special about me and, but I…[00:16:19] Dr. McBride: Oh, there's so much special about you. [00:16:20] Dr. Haver: I'm kicking the door down on this I feel like… And it's probably the thing I'm most proud about in medicine, and I've delivered about tens of thousand, over 10,000 babies. I've done thousands of surgeries, all good stuff. But I feel like this is the biggest impact I can make for women's health ever.[00:16:40] Dr. McBride: I think you're making a big difference. I mean, it's amazing to me how menopause is having this moment right now. My friend Sharon Malone, who's a dear friend and colleague, was just on Oprah talking about menopause. I mean, thank you Oprah, for shining a light. My friend Rachel Rubin, our mutual friend, Kelly Caspersen, I mean, we're talking about sex, we're talking about vaginal lubrication, libido.[00:17:01] We're talking about taking control of our health kind of for the first time in a long time. I don't know if you think it's related to COVID and to me COVID laid bare our vulnerability to narratives that aren't always rooted in truth. COVID laid bare the vast marketplace of sort of pseudoscience and weird stuff.[00:17:24] It also laid bare how vulnerable we are as consumers of the healthcare industry. And how we really need to know what questions to ask. And so then I think, that's where I came in. I started writing and podcasting and you started doing your messaging and it's, I think people are really glad to have people they trust without any sort of agenda.[00:17:42] Dr. Haver: Social media for me opened my eyes to how much misinformation as far as menopause care, how much disinformation and misinformation was out there. And then one of the caveats of this menopause explosion and what the New York Times touched on is the gold rush. And so my… I live in the menopause metaverse, I call it, and my social media feed is just filled with everything menopause.[00:18:13] The wackadoodle companies that are coming up with miracle cures and vitamins and promising you're getting your unrealistic expectations of what this one little herb or something can do and get your life back and lose weight and get your sex life back and all this stuff. And none of it is founded in any evidence.[00:18:32] They're marketing to a very vulnerable population. They're desperate and willing to try anything at this point because they can't get it from, most of them can't get it from their healthcare provider, and so a lot of these new companies are popping up and really exploiting this very vulnerable population, and it makes me insane.[00:18:50] Dr. McBride: I know. I feel like wellness is a word that I think MDs and medical professionals should embrace, right? Like, what else am I doing other than helping people be well? But the wellness industry is taking advantage of women's vulnerabilities, insecurities and lack of access to the truth. And then it's fleeing them and giving them false promises. Not always. I mean, there's some good actors.[00:19:16] And I believe in vitamin supplementation if you're deficient in something in addition to getting your nutrients through food. But I think we agree that there's no sort of supplement that's going to kind of fix your broken marriage and your low libido that stems from sexual trauma or… we have to do the work, we have to do the hard job of looking at these parts of our lives that doctors unfortunately haven't really countenanced and we have to understand that the treatment for menopausal symptoms and the way to prevent the downstream cardiovascular, cognitive, and bone related health problems that stem from the absence of hormones is hormone replacement therapy.[00:19:56] Women are entitled to a conversation with their provider about hormone replacement therapy. Whether or not they take it is a different story, but in general, the benefits of hormone replacement therapy outweigh the risks in women who are within that 10 year window from their last menstrual cycle[00:20:11] Dr. Haver:  Right. And when a patient leaves my clinic, now again, I have a background in nutrition. I'm certified in culinary medicine. I can do this with confidence in myself that I know what I'm doing. I give them what I call the menopause toolkit, and so the first thing we address is nutrition. I'm lucky enough that I have a body scanner where I can measure muscle mass.[00:20:34] All of this is all so intertwined, visceral fat, body fat. So I give them very direct nutritional recommendations based on their body composition. We talk about hormones—pharmacology, hormonal pharmacology, and non-hormonal pharmacology based on their symptoms. We talk about supplementation based on what their nutrition profile looks at.[00:20:56] We talk about stress reduction, we talk about sleep quality, and every single one of those things is important to turn that wheel so that you can have the best healthspan and lifespan when a patient comes to my clinic. Yes, she's suffering, but her goal is not to have a bikini. Most of them… they don't care about bikinis anymore.[00:21:14] Sure, that'd be great. But they're more looking at their parents and what themselves and their siblings are going through taking care of parents with chronic disease. When I have a patient who is caring six or 10 years for a debilitated parent or grandparent, it shapes their lives and they are so motivated. What can I do now to keep me from doing this to my children, to my loved ones, to my nieces and nephews. I want to live the most independent, healthiest life that I can. So I'm not gonna burden the people I brought into this world with my disease and illness. Now, there's no guarantees on that. They're like, “how can I stack those cards in my favor?”[00:21:55] And I said, okay, let's get started. Nutrition, exercise, pharmacology, sleep, stress. It all works together to get you where you wanna be.[00:22:04] Dr. McBride: You're absolutely right and it so dovetails with the way I talk to my own patients and the way I write that sleep is arguably the best chemical boost you can give yourself—getting good sleep. Now, it's easier said than done. I mean, just telling someone to sleep more is not the end of the story for most people. But managing stress, having brain space to be mindful about our eating, our relationships, being in touch with how we feel, sort of being in the driver's seat, if you can, of your everyday habits. I think all of that relates to symptoms of menopause. It also relates to just our everyday health.[00:22:44] I think you're right. You look at our parents, our patients in their middle age often look at their parents and they see if their mom has osteoporosis and maybe some cognitive decline. Their dad may have cardiovascular disease or vice versa. And those are not a hundred percent preventable of course, but it's pretty incredible what hormone replacement therapy will and can do if you pair it with appropriate lifestyle modifications and you pair it with someone who's a good coach and a good guide because it's not enough for me to say, eat less red meat, Exercise more, sleep eight hours, manage your stress, take hormones, Good luck. I mean, first of all, I don't do all that stuff well all the time myself. Most humans need a trusted guide. They need structure, they need support, they need follow up, and they need cheerleading, and they need data and evidence and facts to guide their behavioral changes.[00:23:36] How does your program work? Like tell me, if you have a new patient who comes in, you do an assessment, let's say you recommend hormone replacement therapy. How does that look? I mean, do you typically recommend the patch? Do you recommend the ring? Do you recommend oral hormones? Tell me about the menu of options for hormones.[00:23:54] Dr. Haver: So I do stick to the FDA approved options. Estradiol is the number one hormone that I prescribe. So there are synthetic estrogens on the market. There's the conjugated, equine estrogens on the market. There are also different compounded options because compounding is not subject to regulation. It's not subject to testing. It can be very variable. I really want to stick to—I know when I pull it off the shelf, it's what I use for myself. There's a 98% chance of what they say is in that box, is in it, and that my patient's going to get a steady state. I usually go with a transdermal option over oral for estradiol because the first pass effect of the liver, which you and I know, when that estrogen bump hits the liver, it upregulates our clotting factors. So there's about a seven out of 10,000 women increase. So not very much, but still seven women who will have a blood clot. I can negate that and put you back to your baseline.[00:24:55]  Not saying you will never have a clot, but I won't increase that risk with a transdermal option. And because of cost, affordability, and options, I usually do an estradiol patch. If we decide on progesterone as well, There's some wonderful new data that's come out looking at different progesterones, synthetic versus progesterone, which is what our ovaries make… I hate the term bioidentical because it's become a marketing term, not a medical term…[00:25:19] Dr. McBride: Thank you. Oh my gosh. Thank you.[00:25:21] Dr. Haver: Women are getting sold a bill of goods and they're being told lies and they're being told the most ridiculous marketing that, oh, buy BHRT… I'm like, I don't use that term. I talk about estradiol and I talk about progesterone. I do not pick up a phone and call another physician and talk about bioidentical. That is, I would be laughed out of… I think people meant well with it, but it's turned into this crazy marketing term to get you to buy their product. So for progesterone I do the oral micronized progesterone. It has the best safety profile for breast cancer.[00:25:57] Actually, in the latest studies, no increased risk of breast cancer. It was the synthetics. So I tend to avoid those as much as possible. So for myself, I use an estradiol patch and I take my oral progesterone at night. I still have my uterus. For me, I find progesterone sedating, which is a benefit because it helps me with sleep.[00:26:17] Now, if someone is also having severe vaginal atrophy, I look at vaginal preparations. I love a vaginal ring. Nobody can afford it. It is top tier for most insurance plans. It's a wonderful method of delivery. I think it's amazing, but again, cost is a problem. So for vaginal estrogen, I tend to stick with the vaginal estrogen cream, which is generic and is very affordable for most patients if we decide she needs testosterone.[00:26:47] And I pretty much only prescribe that in a case of hypoactive sexual desire disorder. There's not enough evidence yet for me to prescribe it for other reasons I don't. Everyone's testosterone is low, guys, everyone, you don't even need it checked if you're menopausal, half of your testosterone unless you have a tumor.[00:27:06] And so if she's suffering from HSDD, then we discuss different options, the vii, the adi, the testosterone, if she chooses testosterone, because I don't have a great FDA-approved option. And it's very difficult for my patients to get the man's version because they only need 1/10  of the dose and they have to break the packets open and it's just Complicated. I will do the local compounding pharmacy to get some testosterone for them.[00:27:30] Dr. McBride: So helpful. So I wanna ask you a couple questions and just to clarify for listeners, vaginal estrogen, in my humble opinion, I wonder if you agree topical estrogen or just vaginal estrogen in a tablet form that is not systemically absorbed, is just topical to help with vaginal dryness. It also can help with urinary continence. It can help with muscle tone in the pelvic floor if paired with PT or just Kegels. That should be in my opinion, over the counter. That should be non-prescription. It should be something women are…[00:28:01] Dr. Haver: Yes, and I believe it is in the UK now.[00:28:04] Dr. McBride: And even for women who have had breast cancer, it's, and look, talk to your primary care provider, your OBGYN. Don't take my advice on the internet, because I'm not your doctor necessarily, but I think it should be over the counter when you talk about vaginal estrogen, like a femme ring. The femme ring is the vaginal estrogen formulation. That is systemic hormone replacement therapy. The hormone replacement therapy we're talking about is to help with not only the symptoms locally, but also the sort of whole person, the bone density, the cardiovascular risk protection.[00:28:38] So yeah, you're right. The femme ring is extremely expensive, but if someone's insurance happens to cover it, the femme ring, there's a nice way to go with the estrogen, and then you have to do the progesterone. In addition, if you have a uterus, you have to take progesterone with estrogen. Those are the two train tracks, because without progesterone, estrogen alone can stimulate the uterus and cause uterine cancer.[00:29:01] So that's sort of the mantra. Testosterone, as you said, is sort of out of the box a little bit, but it is becoming clear that it's good for hypoactive sexual desire disorder. I do have patients asking me about it because they're like, “What about belly fat, muscle mass? Can I use testosterone for that?” I know you have this wonderful program you're doing on Instagram with the belly fat challenge, and you're doing this on the heels of your Galveston diet. So tell me about testosterone for women a little bit more if you could vis-a-vis metabolism muscle mass.[00:29:31] Dr. Haver: So one of the phenomena that we know about in body composition changes through the menopause transition, we see an acceleration of body fat deposition. So it's kind of steady state and then whoop goes up in perimenopause and we see an increasing of the rate of muscle loss with age. It's called sarcopenia, which is the natural loss of muscle mass with age, and you have to combat that with consistent resistance training and adequate protein intake.[00:29:57] There's no way around it. You are going to lose muscle if you don't do the thing. And that's just your body breaking down. And that muscle is so much more important than I ever learned in school. It is controlling our insulin resistance. It is controlling our strength and functionality. And so I am one of those girls who was genetically low muscle.[00:30:16] I was always lean. But lean to me means muscle. I didn't have very much growing up. I could never do a pull up. I still can't do one. And so there's some thinking, so I'm using testosterone for myself off label, and I'm very clear about that because I'm genetically predisposed to low muscle mass. I measure it every day. I'm about the 90th percentile and I wanna hang on to that. So I'm doing a very low dose of transdermal testosterone in order to help my efforts of protein intake and resistance training to hang on and possibly build some muscle. So my levels are physiologic. I check my levels every three to six months.[00:30:56] I think the last one I was 47. And so in our natural lifespan, When we're our reproductive height, when our libidos were on point, your testosterone level is never above 70, and some of these pellet companies are recommending that you be super physiologically dosed with no evidence to support it.[00:31:18] I have had patients come and say, just check my level. My pellet should have worn off six months ago. They're still out of 300. That is men start at 246. Okay, so I asked the patient, okay, let me just make this clear. Are you transitioning? I fully support that. If this is what you're doing, I'm not the right doctor to help you through this, but, and they're like, no, I'm like, your levels are at a transitioning level. [00:31:41] I don't have clinical evidence to support a super physiologic dose of testosterone for patients. And that's what's being sold to them by a lot of these camp bonding companies.[00:31:53] Dr. McBride: So you're saying the data are not there yet, but there's enough evidence in your mind to use it at a physiologic dose to combat sarcopenia, which is low muscle mass. In addition to using it off label for people with low sexual desire, low libido.[00:32:11] Dr. Haver: Yes. So we have great studies for menopausal women, and testosterone clearly showed a benefit. FDA has not picked up those studies and that work hasn't been done yet. It takes a pharmaceutical company saying, it's worth it for me to do this, and they're not doing it because it's, it's all about economics and there is ot a lot of money in it for them, which is why we don't have an option.[00:32:34] Dr. McBride: Right. Let's talk diet and nutrition and what happens to our bodies around menopause. I've just gone through menopause myself. I'm on hormone replacement therapy. Woohoo. It's fantastic. I mean, my symptoms weren't that dramatic, but I think what happened was when I went on hormone replacement therapy, I just felt like myself.[00:32:54] It wasn't like I could name what it was. I mean, I had some hot flashes, night sweats weren't bad, but I don't know, I just slept better. I felt like myself again. But nutrition, so patients commonly come into me around perimenopause in their late forties, early fifties saying, my belly fat has increased. I've never had belly fat there. And they're just, their body composition has changed and they find it harder to…[00:33:20] It's true that estrogen in the absence of estrogen makes it easier to accumulate weight in our middles typically, and then it increases our risk for insulin resistance or pre-diabetes or diabetes.[00:33:33] So what are you counseling patients? I know it's not a one size fits all prescription, but what are you counseling patients in general about how to combat that metabolic shift and the weight distribution?[00:33:44] Dr. Haver: So there are certain behaviors and patterns of eating that we know through studies that for women in their menopausal journey, are going to lead to less accumulation of visceral or belly fat. When we say visceral fat, I want to be clear. So we have the fat, we've known our whole lives, subcutaneous fat.[00:34:03] It gives us our breasts, our butts, our curves, our cellulite. We don't like it. It's cosmetically distressing, but in, in usual physiologic amounts, it's not dangerous. Okay, visceral fat is different. That's the fat inside of our abdomens and our wrapping around our organs. That at a level, at a certain level starts leading to inflammation.[00:34:21] It produces cytokines, it's linked to cardiovascular disease, stroke, diabetes, et cetera. And we see a rapid accumulation of this fat in the menopause transition due to multiple factors, but leading off with decreasing estrogen levels. So, what can we do about it? So number one, women who have 25 grams or more of fiber in their diet per day have a much lower risk of visceral fat, and there's probably several reasons for this. It slows down the absorption of glucose into our bloodstreams, which lowers our insulin levels. It keeps us full longer. You're less likely to overeat or make different choices. [00:34:55] Number two, having a diet that has less than 25 grams of added sugar in your diet per day—less visceral fat and added sugars are the sugars in cooking and processing. And I'm not talking about keto, so I'm talking about the sugars that are found naturally in fruits, vegetables, dairy, they come in a package with fiber, with other micronutrients, with other things that keep you healthy and slow down their absorption.[00:35:21] It's Very different from drinking a soda, and that's the number one source of added sugar in the United States in women's diets is beverages that sugar is instantly absorbed. It instantly goes into the bloodstream, causes a spike in glucose, and the concomitant rise in insulin levels, which then drives fat to the abdomen.[00:35:37] The whole thing happens so fast before you even realize it drives your blood sugar down. Boom, you're hungry again. And so keeping those added sugars less than 25 grams per day. Not to say you can never sip on a soda or have a cookie, but you have a budget. And if you can keep it less than 25 a day, you're going to have less visceral fat and less ensuing health risks because of it. Third, there are some supplements done, checked on, menopausal women that seem like they were helpful. Number one is eating something rich in probiotics every day. So that could be yogurt, kimchi, miso, tempe, whatever… chinese pickles, there's lots of options, but the study that was done in menopausal women was actually done on supplementation, because that's easier to control and study is give someone a pill versus have them eat a tub of yogurt.[00:36:25] So, when the study was done on obese, menopausal women with hypertension, so the weight loss was the same. They put them both on calorie restricted diets, but added in a probiotic supplement for Group B, and the supplement group had less visceral fat, so they did their visceral fat measurements, and they also had lower blood pressure.[00:36:44] So keeping the gut microbiome healthy, both through fiber, which we talked about earlier and with probiotics, restocking the pond, as I call it, can be really helpful. Turmeric supplementation or eating diets rich in turmeric, not so typical in the US. People are now drinking turmeric teas or adding it to certain things, but turmeric supplementation, especially if you add a black pepper extract, can be really helpful.[00:37:06] Zone two training. It's getting real with Peter's book, Peter Attia's book. It's getting really popular right now. Zone two training is training below the level that you can talk through, so like when you're a little bit breathless and so there's multiple, you can google different ways to calculate what that is.[00:37:22] 220 minus your age, 60 to 70% of that is one thing that patients use. I wear a heart rate monitor usually, and so I know what my maximum heart rates are and I can do the calculation from there, but 150 minutes a week of zone two training is really helpful in that, and resistance training is important as well. [00:37:40] Dr. McBride: Okay, so to summarize these pearls of wisdom we're talking about ideally getting at least 25 grams of fiber a day. Ideally less than 25 grams of added sugar a day. We're talking about supplements based on your unique profile and health issues, and we're talking about resistance training and 150 minutes of exercise a week, building that muscle mass, keeping that motor running. In addition, we talked about sleep stress management. I mean, that's a good kit. I mean, it's a lot to do. You know, when I talk to patients about these kind of lifestyle modifications, they often aspire to these things. They aspire to sleep more or drink less alcohol.[00:38:19] Eat less sugar. One of the challenges is minding the gap between our best intentions and the execution, as I say to patients all the time,even walking around your block for five minutes after work is better than nothing. While you're on the phone, maybe do a couple squats or wall sits.[00:38:38] Notice how you feel if you take a week off of alcohol. I decided to take May off of alcohol, not because I have an alcohol problem per se, but just because I feel better without it. And it really does take at least a week in my mind to kind of notice the effect. One night's not gonna do it. So my advice to patients is just small, incremental bite-sized changes. Don't try to make wholesale changes in every aspect of your everyday health because you just won't do it.[00:39:08] Dr. Haver: Exactly. I say, we have the rest of your life to figure this out. Let's take this one step at a time. Here's the ultimate plan. We're building a house here, so first we have to lay the foundation, then we're gonna put up the studs. Then we're gonna, you know, like we have to take this step-by-step. We don't want you to be overwhelmed. We don't want you to feel like these are new habits. We're building one habit at a time.[00:39:29] Dr. McBride: That's right. That's right. Mary Claire, thank you so much for joining me today. How can people find you on the internet? In your clinic, like how can people find your wisdom and expertise?[00:39:41] Dr. Haver: So we have tons of blogs packed with information on how to advocate for yourself at your doctor's visit and you know what tests to ask for. There's lots of nutrition information at our website at galvestondiet.com. You can also find me on my biggest social media channels on Instagram and TikTok. [00:40:06] Dr. McBride: Thank you all for listening to Beyond the Prescription. Please don't forget to subscribe, like, download and share the show on Apple Podcasts, Spotify, or wherever you catch your podcasts. I'd be thrilled if you liked this episode to rate and review it. And if you have a comment or question, please drop us a line at info@lucymcbride.com.[00:40:28] The views expressed on this show are entirely my own and do not constitute medical advice for individuals that should be obtained from your personal physician. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

As labor tensions mount across America, we look back at the 1997 UPS strike, a major victory in the labor movement. Lane Windham, associate director of the Kalmanovitz Initiative For Labor and The Working Poor at Georgetown University, joins us. And, the Associated Press reported on Supreme Court Justices taking trips to colleges and universities, where they sometimes end up in the room with donors and politicians. AP's Brian Slodysko joins us. Then, Dr. Rachel Rubin is a urologist and sexual medicine specialist trying to break the stigma by starting conversations about pelvic health concerns that can impact both younger and older women as they age. She joins us.

Urologist and sexual medicine specialist Dr Rachel Rubin is helping women everywhere understand how their body works, so that they can be the CEO of it. Find how how she's creating orgasm equality and raising awareness for HSDD. Revive the sex drive you once knew and visit HSDDtreatment.com