The New Testosterone Story with Dr. Kelly Casperson, Urologist
about the episode
What Does Testosterone Do for Women? Dr. Kelly Casperson on Hormones, Menopause & Midlife Health
Is testosterone really just about libido or has women’s health been missing a much bigger conversation?
In this episode of Innovate & Elevate, Sharon Kedar speaks with Kelly Casperson, board-certified urologist, author, and host of the You Are Not Broken podcast, about why testosterone may be one of the most misunderstood hormones in women’s health.
Together they discuss testosterone, menopause, medical education gaps, hormone access, and why many women are turning to social platforms and AI tools in search of answers. The conversation explores why hormones may influence motivation, energy, cognition, and quality of life, while also examining larger issues in women’s healthcare and patient advocacy.
What You’ll Learn from this Episode:
- The New Testosterone Story: Learn why testosterone is a human hormone that helps with motivation, energy, and brain clarity—not just libido. Dr. Casperson reveals that female bodies have four times the amount of testosterone than estrogen and why this hormone is vital for longevity.
- Barriers to Access: Understand the shocking truth about what’s holding women’s health back—from outdated regulations and the misinterpretation of data that has driven black box warnings to the lack of training for well-meaning doctors. You'll hear why the system is in "catch-up mode," and how doctors and organizations, including the FDA, are now working hard to correct the misinformation from decades ago and bring accurate information to the public.
- The Power of Patient Advocacy: Discover why women are turning to sources like Instagram and ChatGPT for medical advice and how this is a sign of a larger problem. Dr. Casperson provides a powerful call to action for women and men to advocate for proper health and to stop accepting a life of struggle and ill health.
About dr. kelly casperson
Dr. Kelly Casperson is a board-certified urologist, speaker, author, and women's health advocate. After realizing the significant gap in women's sexual health and hormone education, even within the medical community, she dedicated herself to empowering women through her work. As the host of the popular podcast "You Are Not Broken," and author of books like You Are Not Broken and The Menopause Moment, she uses humor, candor, and science to demystify complex topics around sexuality, menopause, and hormonal health, helping women to advocate for themselves and live their best intimate lives.
Connect with Dr. Kelly Casperson on LinkedIn, Instagram, or her website. Buy her book The Menopause Moment now.
Episode Outline
Introduction — 1:34
How Dr. Casperson Got Into Hormone Health — 1:19
Medical Education Gaps Around Women's Health — 2:59
The New Testosterone Story — 5:44
The Challenge of Getting Care — 23:55
The Scale of the Problem — 29:33
The Importance of Treating Both Partners — 33:27
Closing Thoughts — 38:10
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Sharon Kedar, CFA: Welcome back to Innovate and Elevate. I'm Sharon Kedar, your host.
Today we're exploring the relationship between women and testosterone, a topic that is close to my heart and one I believe has been missing from the conversation about women and our wellbeing. Her book, The Menopause Moment, will be released in September.
Sharon Kedar, CFA: I'm delighted to be joined by someone who blew me away at the FDA, a leading voice on testosterone and women today, Dr. Kelly Casperson, a urologist, thought leader, international speaker, and all-around expert on hormone health. Dr. Kelly Casperson, welcome to the podcast.
Dr. Kelly Casperson: Thanks for having me.
Sharon Kedar, CFA: What got you so interested in HRT?
I read... Kelly's book, The Menopause Moment, and I read about how, you know, as important as UTIs are - I love how you started the book by saying that became a little bit redundant and you had the 7-year-itch, but what got you to blaze this trail?
And I cannot wait to basically take the viewer and listener into your doctor's office, which is an impossible appointment to get for most people in America. Obviously see your individual doctor, but I can't wait for them to learn from you. So what got you so into this?
Dr. Kelly Casperson: Well, I mean, I always joke that sex got me into hormones. I was about 7 years in, like it's, you're bored, right? Like you're bored, you're good at your job. What did I do all this training for? And a patient came in and I truly think it was the universe being like, she's ready, here you go.
And it was somebody I really cared about and it was a sexless marriage scenario. I didn't know how to help her. And I handed her the box at Kleenex for the tears, and I was like, basically the universe just delivered lightning to my brain. And it was like, you don't know how to help her.
Does anybody know how to help her? And it's like, reminder, for people who don't know, urologists are the masters of erections, testosterone in men, Viagra. A man comes in and they're like, well, I kind of a low libido and like, I don't feel like myself anymore. And we don't tell them to drink more wine and go get some acupuncture.
Like we treat them as medical conditions with hormones and Viagra, and we treat them like the important issues that they are in their life. So basically I got into female sex ed. What makes my perspective so unique is that I take care of men. The gynecologists have no idea how 50% of the people are treated in a doctor's office because they don't take care of them. I do. I give 10 times the dose of testosterone to men every single day. When a woman goes in, it takes the average woman about 6 different doctor visits.
People are like, women are more expensive; they use more health resources. And it's like if you treated them initially in the first place, they probably wouldn't. But if you have to go see 6 doctors to get your healthcare taken care of, you are looked at as the more expensive gender.
Sharon Kedar, CFA: When you were in medical school, what did they teach you about women? Like when you trained to be a urologist?
Dr. Kelly Casperson: So I don't remember.
Sharon Kedar, CFA: Okay. That's awesome.
Dr. Kelly Casperson: But I actually talked to a friend - right after the FDA - talked to a friend I went to medical school with, and she's like, do you remember that lecture about the WHI in medical school and like how afraid we were of hormones?
And I'm like, I don't remember the lecture because, you know, that was like 25 years ago at this point. But I can tell you, I was told in urology residency, women are difficult. And don't worry the gynecologists are taking care of them. Like, I remember that very specifically.
I was not taught that ovaries make testosterone. I was not taught that female bodies have 4 times the amount of testosterone than estrogen. Nobody dissected the clitoris in the anatomy lab. And I remember being in private practice, so done with my training... I have great relationships with the sex therapists in town and we have this meeting that we go to and she like held up a model of the clitoris.
I went to medical school, but I'm like, holy crap, I operate around this structure every single day and didn't know the extent of it. So yeah, if I didn't know everybody else is in trouble, man, because I did pelvic surgery residency and I know how to give testosterone and Viagra to the guys.
Sharon Kedar, CFA: Well, to me the theme of today is that we need a new testosterone story. I mean, I think all of the recent news, the FDA panel, and I just was in the audience. People asked why I was there, and I just said, well, I'm 50 and I'm patched, you know? I think the fear around HRT is so incredibly high, but really when we talk about HRT or Hormone Replacement Therapy, the huge hurdle that we're talking about is estrogen and progesterone and like this 20 years of just a gap in knowledge.
But what I love about today is, it is not simply estrogen and progesterone, I mean, you call it in chapter 4 of your book: The Forgotten Quarterback. Can you talk about sort of the new testosterone story and I feel like this is like a Public Service Announcement to all American women and families,
like if people knew what I know as a patient and just a problem solver. I mean, testosterone to me, as a lay person, I'm not the twin with the 5 diplomas from Harvard Medical School; that's my identical twin. Okay, libido, it's obviously an important topic. But what you said at the FDA about women starting businesses, about someone who talked about the Wizard of Oz and how it felt like the lights turned back on when you talk about bones. To me, this is a - it's a human issue. It's like if you're pro human, why aren't we talking about testosterone for women?
But you're the global expert on this. What do you think and how do we create this new story for women?
Dr. Kelly Casperson: Yeah, well, I mean, thank you for the platform for it because testosterone's really hot right now and it's gonna get hotter. You know, like you said, the FDA meeting was fantastic. And really what Dr. Marty Makary asked us to bring, he asked us to bring science, he asked us to bring heart.
He asked us to bring patient stories, and that's really how I did incorporate what I hear every single day about women on testosterone. And for anybody who wants to check that out, my 5-minute one is on my YouTube, Kelly Casperson MD, and you can watch the whole free FDA 2-hour meeting on the FDA YouTube if anybody wants to reference those things.
Sharon Kedar, CFA: Watch it. Kelly blew me away.
Dr. Kelly Casperson: I hit it out of the ballpark.
Sharon Kedar, CFA: Yeah, girl.
Dr. Kelly Casperson: I came prepared.
Dr. Kelly Casperson: I came with the receipts.
Sharon Kedar, CFA: I had chills when you were talking.
But
Dr. Makary talks about outdated medical dogma. How come HRT is such a 4-letter word these days when it shouldn't be. But it doesn't even include testosterone for most people?
Dr. Kelly Casperson: People are like, is testosterone HRT? And I'm like, is it a hormone? Are you giving it? Is it therapy? They're like, yeah, yeah, yeah. And I'm like, Uh-huh. So it's HRT. Testosterone has a massive problem. Like there's so many barriers at this point. Number 1, the Anti-Doping Act of 1991, right?
At the Olympics in the 1980s, there was a lot of doping going on. America was doping, but also a lot of former Soviet Bloc countries. Our Congress put up the Anti-Doping Act of 1991, which put basically all synthetic anabolic steroids -
and remember, anabolic just means to build. Anabolic, in and of itself, is not a dirty word. But they put one hormone that our body naturally makes on that list, so that's testosterone.So that was one of my requests
for Dr. Marty Makary is to deregulate female dose testosterone when we get an approval.
I can't make you a gold medal pole jumper on female dose testosterone, like it ain't gonna happen. And why that's important for the lay person is because physicians or nurse practitioners, whoever the prescribers are, have to have an individual state DEA license on top of a medical license to give restricted medications.
That's number 1. It's about $1,000 every 2 to 3 years per state.
Sharon Kedar, CFA: Wow.
Dr. Kelly Casperson: So the telehealth companies that are doing this are basically just throwing money at this problem. Number 2 is telehealth, right? Who accesses telehealth the most? Women. And restricted medications are consistently being threatened. I get it. We don't want to abuse oxycodone, like I get it. But that's why we need to get to testosterone off of the restriction list.
Sharon Kedar, CFA: Can you get it? If you do telehealth, can you get testosterone that way?
Dr. Kelly Casperson: Depends.
Sharon Kedar, CFA: For the viewers and listeners as we come into your office for an unreasonable amount of time that's more than 10 minutes, which is the unfortunate reality. I mean, it depends, is a little bit of like Russian roulette with the health of women, if...
Dr. Kelly Casperson: Well, yeah, like you said, you know, the average woman goes to 5 different doctor's appointments before she gets her hormones addressed. And now you've got DEA restrictions on top of testosterone, in addition to no FDA-approved female testosterone dose, on top of testosterone.
So you know how hard it is to get fricking estrogen and progesterone. Now you've got all those barriers on top of testosterone.
Sharon Kedar, CFA: So you're saying it's
harder...
Dr. Kelly Casperson: I'd say it's way harder.
Sharon Kedar, CFA: I was looking into it before the podcast, because I'm on estrogen, progesterone, and testosterone, and actually the first recommendation for me when it came to hormone therapy, which I was gonna ask you about, was testosterone.
I did the Health of Women podcast last year. So I'm not as in with the hormone health crew yet, but I know a lot of people and so I got referred to a pretty leading-edge doctor. So I called my husband, we have 3 kids, and you know, been with him for 30 years.
I love Greg. I'm at the doctor. This doctor is telling me that a testosterone pellet is gonna change my life. I run a large venture capital firm as our co-founder. I had the podcast, the 3 kids, you know, at 40 I had my 10-year-old, so I've got like between 10 and 19.
And so I was like, so for a minute gonna do the testosterone pellet. And I called my husband, he's like, Sharon, just wait a minute. Which is sort of the magic of sometimes he's the brakes. Because I'm like, let's go. It turns out that I am a hyper-absorber of testosterone.
Most people under-absorb it. So when Rachel Rubin, our mutual friend, prescribed me the 5 milligrams, I remember sending her a note after a couple uses and I'm like, I think my voice is getting hoarse. Maybe I'm on too much testosterone.
I'd love to hear you talk a little bit about sort of the clinical diagnosis, like how do we know if we need it? And for me, I'm literally on a fraction of the amount that most people start on.
Dr. Kelly Casperson: Yeah. Well, so let's talk about that. I mean, and the first thing we have to talk about, just for the people in the back who are catching up is like, we are not talking about giving women male hormones. Ovaries make testosterone, adrenal glands make testosterone. In the female body,
testosterone starts to decline after your 20s. And that is why, like you had said, it's quite common, especially if a woman's in perimenopause to maybe be offered testosterone first, because that might be lower than say her estradiol is right?
So individualized is always the answer any good clinician's gonna tell you. And I want to also talk about the pellets. Our DEA's restriction, and the fact that insurance won't cover anything that's not FDA approved, right? All these barriers that testosterone has, women are pushed and they're suffering, right?
They're going to their doctor, they're looking for answers, they're not getting help. They're being pushed to the - I call 'em the pellet mills or the pellet pushers, the one trick ponies. I call 'em in my book of like, it's a pellet or the highway, right? And pellets are the most expensive option, the most invasive option, and the highest dose option.
So I always say, earn your pellet, right? And what that means is know that you tolerate low-dose testosterone, that you aren't a hyper-absorber like you... well, you just need a baby dose, right? So it's like, heaven forbid you threw a pellet in you and it's not reversible.
Sharon Kedar, CFA: We were with some you know, known folks for dinner who I will not mention and I was telling, I have not told it, but I think it was after the FDA and I was telling the testosterone story and everybody was laughing. But it's so not funny. But when you talk about hormone replacement therapy, are most women offered testosterone first or estrogen and progesterone?
And like, I realize that that's even the lucky ones that get to have this conversation, which is part of this podcast, is so that people start asking these questions.
Dr. Kelly Casperson: I mean, the bar is super low, right? So even people who are Menopause Society certified, you can go on the menopausesociety.org, type in your zip code, get somebody who's taken the test... that doesn't even guarantee you that they're gonna offer you estrogen and progesterone.
The gender stereotype is estrogen and
progesterone. You need to have somebody who understands testosterone, who understands it's a menu, right? Most common for physiologic replacement is either microdosing the male product at 1/10th the dose to start. Or you can compound it again at 1/10th the standard male dose.
There's also injections... but people who sell pellets make money off of pellets. They don't tend to want to offer super cheap compounded male options. So by and large, gynecologists didn't learn testosterone is made in the ovaries. So you have to have a gynecologist who did additional training.
I have, for people who are interested, on the Heather Hirsch Academy, I actually have a testosterone and sexual health course. Just realize testosterone's not dangerous at physiologic doses and realize we actually do have a lot of data.
There's a lot of myths that people keep perpetuating like, we don't have any data for anything... that's not true. There is a paper published in 1945 by a gynecologist who said, at this point we have enough data to say that women can use physiologic dose testosterone. That was 1945.
Sharon Kedar, CFA: The part that really gets me, and I do want to get to how people know whether they should consider testosterone and curious like what you start with. But the part that is like a circular reference in Excel for me in my head is I just cannot believe that the data got misread for 20 whole years.
Like I think about the older ladies. There is a track record of data and women's hormone health getting misread. I think that the track record here when it comes to data, and I love data, is that for whatever reasons, which I don't really understand, it's been misread.
So I don't know why everybody's trying to almost misread it when it comes to testosterone. You talk about how in the book, someone who's transgender gets multiples of what a woman might get for... 10 times the female For many, many years. And so...
And it's off-label, and insurance often covers it for transcare.
I don't understand why testosterone is... I understand a little bit more about why estrogen and progesterone. I understand how it was misread. I don't understand why. I think it's actually one of the biggest things that have held women back.
I think that the health of women is across political lines. I did a post about how breast cancer doesn't care about what political party you are.
Neither does heart. Like to me, I realize that there's regulations and we met at the FDA, but to me this is just human basic stuff. But when it comes to talking about the health of women, like sometimes I call it XX human biology, which people need to, I sometimes have to explain that women are XX and men are XY.
But I think that the fear from the Women's Health Initiative from 2002 has made the words Women's Health, fighting words and the wrong words. I just don't understand, and I think I'll never understand it.
Dr. Kelly Casperson: Until we start calling it human health...
Women live many, many more years in ill health than men. The amount of money we are giving up because of divorces. You want to talk about money loss and midlife: divorce. You want to talk about a reason for divorce: menopause.
Sharon Kedar, CFA: People don't talk about it.
Dr. Kelly Casperson: The divorce lawyers know why people are getting divorced in midlife.
Sharon Kedar, CFA: But Kelly, there's, it's like, it's being buried. I saw a study about, in the UK, it was like some massive contributor to divorces. And the world that I live in is very, very much... like I stand out for my gender. I think why people are like, oh, she's doing a podcast on the health of women. She said mice don't menstruate. But I truly, truly believe this is that it's better, why is anyone fighting this? Because it's better for all humans.
Even the testosterone, like, you know, going back to that, people are like, it's only indicated for libido. Alright, let's talk about that. Where's libido located in the brain?
It's a mood. So for people to be like, there's no data for mood, but there's only data for libido. I'm like, what the F is libido? It's how you feel about yourself.
Wait, but Kelly, so then who are the women who have the audacity to show up in your clinic?
Dr. Kelly Casperson: Badass
women.
I have the absolutely coolest patients because they care about their body, they care about longevity, they care about aging well. They're taking care of their aging parents, and they say, I think I can do this better. I've worked very hard to make my clinic very easy because they've read my books, they've listened to my podcasts, they're already educated.
I'm not telling them testosterone's safe, they already know that. Right. Do you know that the 2002 JAMA WHI study is free online? That's what's so insane, we've been afraid for 23 years, it's fricking free online. It doesn't reach statistical significance that this caused breast cancer. It's free online. Like that should piss people off.
Sharon Kedar, CFA: I don't think I'll ever understand the why, but so, if a patient comes to you, can you just unpack what age a woman typically should start considering testosterone? What are the symptoms... how do you sort of frame it up for someone who really is aspiring to be in your office, but they're going to a well-meaning doctor who probably hasn't been trained on testosterone at all?
Dr. Kelly Casperson: Well, so I want to break this age rule. This is not voting. This is not a driver's license. This is not buying alcohol. This is not a legal age requirement, right? Because women are told 2 things in the doctor's office. You're too old for that, or you're too young for that. So I don't like this age thing. There's no age thing for testosterone. Remember, testosterone starts going down after your 20s. If you're on birth control, you know what birth control does? It blocks testosterone.
I read that in your book and I was, I had no idea. If you truly wanted to build a better birth control, you're gonna build testosterone into the product, because you gotta replace what's being blocked.
Sharon Kedar, CFA: Birth control, my 2 cents on it, it's transformed society. It's absolutely been huge. And women need true informed consent in the doctor's office. I think they're not getting true informed consent. Most birth control prescriptions are used off-label.
Right?
Dr. Kelly Casperson: So the fact that people are like picking and choosing about what's FDA approved for testosterone, but they off-label antidepressants and birth control pills every single day. That's biased. It doesn't matter how old you are, this is not a legal requirement for a hormone your body naturally produces.
It's part of a conversation about what's bothering you, what are your goals, what's your health? It's reasonable to check other labs to make sure other things aren't going on, like insulin resistance, thyroid issues, high blood pressure, like how is your health, right? Testosterone, people want testosterone to help with everything.
Testosterone doesn't help with everything, right? Even with libido, it helps about 50% of people. So it's not a miracle, it's a hormone and hormones are transmitted in the body to help our cells communicate and to help our cells function well. So there's no right age. You want to use it in the context of what are your other health problems? What are your goals? Do you understand female sexuality? Do you understand the breaks to your sexual desire? Right? So I always joke like I don't prescribe on the first date, if a woman doesn't know that.
Because if you go in and you have all these reasons for low libido: you drink alcohol, you don't sleep, you have a super high stress job, you're not prioritizing your pleasure, you hardly ever have an orgasm, it's all about him, right? Like if you're having shitty sex, testosterone's not gonna help you. So there's a big
sex ed that has to come in because otherwise a woman's gonna take testosterone or one of the FDA-approved medications for low libido and she's gonna fail that medication and then she's gonna feel like a double failure because now the medications don't even work.
And that was my first book, You Are Not Broken.
Because I'm like, I didn't get a good sex ed. We got a disease and pregnancy prevention plan. Right. If you were lucky.
Sharon Kedar, CFA: Right.
Dr. Kelly Casperson: And that was when you were, what?
Sharon Kedar, CFA: Eighth grade?
Dr. Kelly Casperson: So now it's like, we've all been married for like 20 years. We've got a couple of kids, we've got a high powered job.
Sex is kind of mediocre. And we just think like other people are blessed and we're not.
Sharon Kedar, CFA: We need to rewrite the testosterone story. And I have a question about that, but I will tell you that the leading book, you know, having a girl who's 19, a boy who's 16, and then the 10-year-old who's almost 11, I actually... I got smarter, you know, just preparing her.
And so I bought the leading book to educate girls about their body.
And if I send it to you, your jaw will drop. It's like they literally show... they don't talk about testosterone. I read it to like, you know, they don't talk about hormones like some mystery, and then they show the vagina as a button.
Like when they show, like the body, it literally looks like a button to teach you how to put in a tampon. I'm taking us way further back; there's a hole to your point, which we won't solve; like an education that starts with what we teach girls.
I actually unboxed the period kit from Amazon that I bought from my daughter after the FDA; I had just given it to her. I'm like, sweetie, if mommy's away, just open this bag. But when I opened the bag, it was disgraceful what was in there. Like it wasn't the right tutorial.
Dr. Kelly Casperson: It's bad out there, my friends.
The best hope we have is mothers, right? Mothers like you. Mothers that care, mothers who educate. And going back to sex ed, like when you talk to adults who have a good sex life and they know what they're doing, what we usually hear is, I had a mom who taught me how things go, right?
Like that's the number 1 is that caring, trusted adult who's gonna be like, this is how things actually work. Because otherwise you're piecing together porn, Hollywood, country music. Like it's not, it is not a good education. It's an education, but it's not a good education.
Sharon Kedar, CFA: Well, but when you talk about a new testosterone story, to me, testosterone is so much more than libido. It's about brain clarity, it's about energy, it's about overall health. So when you frame it as the expert on this, what are the top benefits that you see?
Because I really think it needs a reframe. It's so much more than libido, chemistry. What's Lebido?
Dr. Kelly Casperson: Energy, motivation, mood. That's what libido is.
Sharon Kedar, CFA: Okay.
Dr. Kelly Casperson: Right? Like people think a libido means like a forward motion towards propositioning somebody for sex.
Sharon Kedar, CFA: I think they think of it as like the female equivalent of Viagra.
Dr. Kelly Casperson: Testosterone does help genital blood flow. We have that paper, right? They gave women testosterone and then they took an ultrasound and put it on their clitoral artery and said, look, the clitoris has better blood flow when you have testosterone in your body. Right? Which again, goes against the naysayers who are like, it's only for libido it helps every single domain of sexual function except for pain.
Arousal, orgasm, libido, blood flow, all domains of sexuality. Testosterone helps.
Sharon Kedar, CFA: That's amazing, Kelly. I just don't understand if that's the case. My mom has a question for you. She's 77. Like, can she take it?
Dr. Kelly Casperson: Why not?
Sharon Kedar, CFA: Okay. But I mean, that generation, it's like a whole question. Maybe you have a perspective, but I mean, estrogen and progesterone, they're told no.
I think about the women 40 to 60; the big message there is it's gonna be really hard to actually find a doctor, not because doctors aren't well-meaning, and this is something that Dr.
Biden had to clarify at the White House. It was just that there was outdated medical dogma. HRT and menopause was pulled out of medical training. But it's really hard if you're sort of in that sweet spot. But then, what do you do if you're like a 70-year-old plus person?
Dr. Kelly Casperson: You need to find an expert. We have 2 decades of untrained clinicians at this point, right? WHI came out 23 years ago. And I sat on a Zoom with Dr. Biden's team when they announced all the money going into research.
And I said, if you just put money into research and you don't put any money into translational knowledge sharing here, you will just put more research behind a paywall and you won't help Americans. Like, that's what my podcast is; that's what your podcast is. It's translating the science to the people.
It's called translational. It's the missing third pillar of academics. Horrifically underfunded. But you know, when I say like, dude, we've been giving women testosterone for 80 years.
So little old ladies can be on it?
Why not?
Sharon Kedar, CFA: But should they be?
Dr. Kelly Casperson: There is no "should" in the hormone world, except for possibly vaginal estrogen.
Sharon Kedar, CFA: Yeah. I mean, that's one where there's no debate that twice-a-week, women need to do that...
Dr. Kelly Casperson: The vulva and the bladder need estrogen to function well. Period, end of story. And the risks are so low and the cost, if you do it rightly, the cost is so low that vaginal estrogen's probably getting close to should at this point. But you have to, I mean, if you look at American healthcare, it's a very high bar to tell everybody they "should".
Sharon Kedar, CFA: Yeah.
Dr. Kelly Casperson: We don't do that with statins, we don't do that with blood pressure, we don't do that with baby Aspirin. We don't do that with GLP-1s. We don't tell America to "should" on any... that's a very high bar. This is an individual choice based upon your individual risks and benefits.
You've gotta see a trained clinician who actually knows how to evaluate that.
Sharon Kedar, CFA: That's why I think this pin might...
If people wear it in, it's like in a 10 minute... that's how you move the needle.But what you said is fascinating because I wrote a piece that I haven't quite published yet, but it was titled, "Why Women Are Using ChatGPT and Instagram for Medical Advice."
And you just help me realize... You talk about this in the book, people don't talk about heart, and you talk about that is the number 1 killer for all genders. I always think about heart and then I think about autoimmune, how 80% in women and we don't understand why.
And that sort of Barbie thing about how it's literally impossible to be a woman. If there's a 100+ autoimmune diseases, they often coexist. Nature Magazine only in 2024 highlighted the extra X chromosome. And by the way, there's not a Kelly Casperson for autoimmune because you could be at a GI, a neurologist,
rheumatologist, it's probably 10 different doctors depending on whether it's Lupus, MS, Rheumatoid Arthritis, you know, Hashimoto's. That's a whole thing. But then the hormone piece feels like it's finally, finally getting traction. I mean, to me, I feel like we actually haven't made that much progress in explaining to women how women's hearts are different.
You and I won't solve that today, but hormones, it's fascinating what you're saying, that there is a part of the population that is more educated than the doctors, but how does that translate into good healthcare? And, you know, we weren't in the age of Instagram and ChatGPT, so this is probably unprecedented.
Dr. Kelly Casperson: It is wild, right? Because, and this goes into, you know, socio-cultural issues of doctors are out there educating the lay population because; don't hate me for saying this, but it's more of a pain in the ass when an educated person comes into your clinic.
because they can take longer because they actually have questions.
Like the ship is sailed, right? Do not get educated in your doctor's office. You don't have enough time to do it.
Sharon Kedar, CFA: You really don't, Kelly, and that's the thing of why I'm doing this season is because I think it's something like, and you'll correct me, but it's something like 15 years from when new guidelines are created to when they make it, because there's so much for doctors to keep up with.
Dr. Kelly Casperson: New research to the bedside is 17 years.
Sharon Kedar, CFA: 17 years.
Dr. Kelly Casperson: And that's why, you know, I'm on the Zoom with Jill Biden's team and I'm like, if you don't plan for millions of dollars of implementation, don't put another dollar towards research because we've got data and it's not getting out to the average American.
Like, what are we doing about that?
Sharon Kedar, CFA: But is it going to change? I was at quite a few events in 2024 and the last thing I did actually was the White House until I showed up at the FDA. I wrote an article with Shelley Zalis, who runs The Female Quotient and Lucy Pérez, who is with the McKinsey Health Institute.
She's the one who did that audacious, awesome trillion dollar opportunity in women's health that talked about how 25% of our life is in poorer quality to men. But we don't understand why. So we wrote a piece about hormone health in May of this year and the education that's needed. But do you see that shifting in this administration?
I mean, I was a bit encouraged that the FDA, which is like right near me, had that panel which was clearly pro-hormone. Like, do you actually see a shift? And then, by the way, like, who do you think is gonna actually educate the world? Because to me, there's millions of people on Instagram that you and people who are listening to my podcast have probably not heard the word Menoposse, but that is something you said, that's the group that's like educating. But how do we actually translate this so that you go into your GP or your OB and... to me, I imagine an AI- based questionnaire where it's almost like it does the work...
And I don't know if the government will fund it or if it's private funding...
Dr. Kelly Casperson: Yeah, I think AI, especially in the startup world, and the clinics that are being backed to do this on scale, right? Like just to zoom out for a hot second. This is 51% of the population. This is a massive problem when 4% of the women are on hormones right now.
Sharon Kedar, CFA: Wait...is that what it is?
Dr. Kelly Casperson: 80 million women over the age of 40 in America, 4% are on FDA-approved prescriptions paid by insurance
that doesn't count the compounded, which is probably equal. They're just hard to measure
Sharon Kedar, CFA: 'Single digit. Yeah.
Dr. Kelly Casperson: And Genitourinary syndrome of menopause, just the pelvis will happen to about 80% of women.
So this is massive. So it's gonna be online clinics, specialty clinics who can scale.
Because if you say, hey, 80 million women over the age of 40, go see your doctor today and ask them about hormones... you can't get in to see a primary care doctor for 10 months right now.
Sharon Kedar, CFA: But Kelly, so maybe I'm, I am an optimist and I am an innovator and a problem-solver and take on crazy, audacious problems. I'm not saying we're gonna solve this, but like, what if, you know how teenagers, when they go to the pediatrician, they're given an iPad and they fill out basically their mental health assessment, which is really, really personal to me.
I had a transgender niece who took her own life 2 years ago. So it's very, very personal to me that happens. But like, why can't we have the equivalent of that assessment where it sort of takes the history for the patient, it takes the current symptoms and it gives
doctors - because it's like you can't go into a pediatrician's office now if you're a teenager and not get that mental health assessment. Why can't we sort of get to that world for women, because I just think that there's gonna be so many people who are receivers of care. And both my siblings are doctors.
I love doctors. But the big PSA is that's 17 years of catch-up. So if you don't want to wait 17 years, is it an optimistic thing to imagine a world where that iPad is handed to women when they're between 40 and 60?
Dr. Kelly Casperson: No, I think it's coming. I mean, the UK is ahead of us for multiple reasons. Number 1, they have one healthcare system. Number 2, they have way less people and women are fleeing employment right now because of untreated menopause. So this is like a monetary issue for them to keep women in the workforce.
The UK is ahead of America, so we look to them. And the UK has mandated that at age 50 they must get a discussion about menopause in the doctor's office.
Sharon Kedar, CFA: So you're saying a precedent?
Dr. Kelly Casperson: There's a precedent. America's different from the UK but the healthcare system is full and people are fleeing it every day.
So it will be telehealth, asynchronous, AI-assisted... like this is the future. And, and for people, you know, and for, I'll call out doctors because that's who I hear from most. People are getting their information on the internet. The ship has sailed, that's not gonna change.
To your point, the ship has definitely sailed, I put on my LinkedIn a question that I was really careful to word, in addition to going to your doctor, where else do you get medical advice?
Sharon Kedar, CFA: And so my LinkedIn went from like 2000 to 20,000. I know you've got like hundreds of thousands of people. And ChatGPT and Instagram, at least for the LinkedIn folks, was 30%. And it was still 50% friends and family.
It just feels like it is happening. And so the question becomes, if you're a patient, like how do you take advantage of it? And some naysayers are like, well, the information's not accurate. But the reality is the gap is there, so people are searching and people are struggling and I really think men and women want to solve this.
Like my first HRT visit with Rachel Rubin, Greg came and he was like, wait, this is 2 hours?! We sat with Rachel for 2 hours. But I think this is an education, in my opinion, of all genders. Think like of couples and I think that, if you are imagining a male/female couple, like, I think that that man wants their wife treated for HRT because, if she's not sleeping or depression that isn't treated with SSRIs. I mean, that all impacts American families.
Dr. Kelly Casperson: The thing about me and Rachel, Rachel and I are, we're both urologists, so we see all genders. Some of my favorite days are when couples come to see me because the man also has testosterone issues and erectile dysfunction issues, and lean body mass issues.
And there's, there's been, you know, more published on this recently. But if you treat one part of the couple, traditionally, that's the man getting Viagra, right? You treat one part of the couple, you destabilize that relationship. And I'm a much better urologist now than I was because now when a man sees me, I'm like, what's your plan?
Is your wife on vaginal estrogen? You don't have to tell me what your plan is, but if your plan is to go home and sleep with your wife who's had no healthcare of her pelvis, and you haven't been intimate in years and you didn't get a good sex education, you're going to be disappointed.
Sharon Kedar, CFA: I also think, to your point, that helps, like for me, on my wishlist is an education that includes men. Because when Greg was in Rachel's office with me, he's like, oh, that's why we went to a Family Weekend... My daughter's a sophomore now in college, but like Family Weekend, my big wake up call last year, I wasn't on the right HRT dose and I was up all night and my husband turned to me and he's like, you're tired, why can't you sleep? And I wanted to smack him. Like, I love him. I love you, Greg, but I literally just want to smack him.
Dr. Kelly Casperson: I have a chapter in my book on how to talk to men about this. You mostly just tell them it's as if your testicles get chopped off at age 50 and you're just told the deal. And then they usually understand that.
Sharon Kedar, CFA:
Dr. Kelly Casperson: If you look at the statistics, 70% of divorces are initiated by the woman, and if it's an educated woman, 90% of the divorces are initiated by the woman. So what that tells me is men don't want to get divorced.
Sharon Kedar, CFA: I have chills. because I think it's true, and so that's where I think, you know, just to, to close, like, I just think what you're doing is so important. When a woman goes in and is told, well, maybe you should be on HRT or underdosed on the estrogen, if she's given estrogen... These things are, to me, completely unacceptable.
And so teaching people how, as you are, to handle HRT the right way, I hope that the title of your book, The Menopause Moment, I hope we really are having a moment because I feel like, you know, we deserve it. Kelly, I love you for what you're doing.
I don't know where you get your audaciousness, but send some of it my way because I'm just so blown away.
Dr. Kelly Casperson: Says the woman who started has like a billion dollar venture capital fund.
Sharon Kedar, CFA: In the world that I'm in, I think that the piece that I'll be able to bring to this is kind of like I am just a person who's trying to translate this from the patient perspective.
And I think the big fallacy that people need to get over is that you're gonna go into the doctor's office and actually get proper treatment, which is, for most basic things you have it. But I tried to explain it to my parents; you actually are not gonna get the current information. And it's not the doctor's fault that they weren't trained for it.
Dr. Kelly Casperson: It is not the doctor's fault; we should end with full on respect to the doctors because they are working in a system that they did not create.
No doctor was like, I want to see 26 people a day and then do a bunch of work for free at home until 10:00 PM and then get up and do it again tomorrow for a full on career.
Sharon Kedar, CFA: Yeah.
Dr. Kelly Casperson: And by the way, our culture is devaluing experts left and right. There's no room in a 10-minute patient visit for curiosity.
Sharon Kedar, CFA: And also, doctors want patients to be healthy but they have to be given the tools. If they're not given the training and the tools... it's not like they're not trying.
Dr. Kelly Casperson: Yeah. I mean, do you understand what it took for me to be this level of expert on this? I didn't get taught in med school. I did not get taught in residency. I did not get taught seeing patients in the clinic.
This was my own time, my own investment. And that's every Menoposse and advocate who's teaching this comes from this fire within, whether it's gender equality or understanding the power of hormones. We are the first generation of, oh my God, the system is not representing what the actual truth is.
And it took us years and years and hours to get this level of understanding because it didn't come from school, and it didn't come from residency. And hopefully that will change.
Sharon Kedar, CFA: Yeah. And to me it's such a beautiful work that you're doing.
I think the T [in HRT] needs to be like, including testosterone, because I think it's a human...
Dr. Kelly Casperson: It's a human hormone that helps mitochondria and nerve cells function. End of story.
Sharon Kedar, CFA: Well, thank you Kelly. You are such a gift to this world. I really appreciate you.
Dr. Kelly Casperson: Thanks for having me on.
Sharon Kedar, CFA: And that's the end of today's episode.
Thank you so much, Kelly, for your time today and for sharing your expertise with our audience. To our listeners and viewers at home, it's time for us to hear the real data and the truth when it comes to women, hormone health, including testosterone. That's why I got this pin. I Heart HRT. Obviously check with your doctor, but there's so much to know.
There's so much new data that needs to be shared, and I think about women like my mom, who are sort of the lost generation, who flushed their hormone therapy down the toilet 20 years ago, and it's time to bring proper information forward. Well-meaning doctors want everyone to be healthy and the systems in catch-up mode.
So please help us catch up by spreading the word. Make sure you're subscribed to Innovate and Elevate wherever you listen to podcasts, and I'll see you in the next episode.
Additional Resources
FDA Menopause Panel Video
Dr. Kelly Casperson at the FDA Menopause Panel Video
Dr. Heather Hirsch Academy - Testosterone and Sexual Health Course
You Are Not Broken - Dr. Kelly’s first book
About Your Host
Sharon Kedar, CFA, is Co-Founder of Northpond Ventures. Northpond is a multi-billion-dollar science-driven venture capital firm with a portfolio of 60+ companies, along with key academic partnerships at Harvard’s Wyss Institute, MIT’s School of Engineering, and Stanford School of Medicine. Prior to Northpond, Sharon spent 15 years at Sands Capital, where she became their first Chief Financial Officer. Assets under management grew from $1.5 billion to $50 billion over her tenure, achieving more than 30x growth. Sharon is the co-author of two personal finance books for women. Sharon has an MBA from Harvard Business School, a B.A. in Economics from Rice University, and is a CFA charterholder. She lives in the Washington, DC area with her husband, Greg, and their three kids.
Connect with Sharon
Connect with Sharon on LinkedIn: Sharon Kedar
Follow with Sharon on Instagram: @sharonkedarcfa
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FAQS
What does testosterone do for women?
On Innovate & Elevate, Dr. Kelly Casperson explains that testosterone is a human hormone involved in much more than libido. The conversation explores its potential role in motivation, energy, brain clarity, wellbeing, and overall quality of life in women.
Is testosterone only used for sex drive?
In this Innovate & Elevate discussion, Dr. Kelly Casperson challenges the idea that testosterone only affects libido. She explains that testosterone may influence multiple systems in the body and may contribute to how women feel physically and mentally.
Do women naturally produce testosterone?
On Innovate & Elevate, Dr. Kelly Casperson explains that testosterone is not only a male hormone. Women naturally produce testosterone as part of normal physiology and the discussion explores why it may play a broader role in health than many people realize.
Why are women struggling to access hormone care?
On Innovate & Elevate, Dr. Kelly Casperson discusses barriers including limited physician training, misinformation, regulatory challenges, and decades of misunderstanding around hormone therapy.
Why do many doctors receive little education in women's hormone health?
In this Innovate & Elevate conversation, Dr. Kelly Casperson explains that many healthcare providers received minimal education in menopause and women’s sexual health. She discusses why healthcare systems are now trying to close these knowledge gaps.
Why are women using ChatGPT and social media for health information?
On Innovate & Elevate, Dr. Kelly Casperson discusses why many women increasingly seek information through platforms like social media and AI tools. The conversation suggests this trend may reflect broader gaps in access, education, and healthcare experiences.
Does testosterone affect longevity and healthy aging?
On Innovate & Elevate, Dr. Kelly Casperson discusses broader conversations around hormones, aging, and long-term health. The episode explores why some clinicians believe hormone discussions should extend beyond symptom management alone.
Why is patient advocacy important in women’s health?
On Innovate & Elevate, Dr. Kelly Casperson encourages women and families to advocate for evidence-based care and ask questions about symptoms and treatment options. The conversation explores why self-advocacy has become increasingly important in modern healthcare.
Why are hormone conversations changing right now?
On Innovate & Elevate, Dr. Kelly Casperson explains that doctors, researchers, and organizations including the FDA are reexamining decades of assumptions around women’s hormones and menopause care.