You Are Not Broken

Dr. Sameena Rahman on menopause, PMDD, PCOS, and why naming things matters

This week I sat down with practicing gynecologist Dr. Sameena Rahman to talk about some of the most misunderstood areas in women's health: hormone replacement after oophorectomy, PMDD, and the recent renaming of PCOS. We move fast from clinical nuance to culture, stigma, and medical bias, and you'll walk away with plenty of practical takeaways whether you're a patient or a clinician.

Sameena also shares the story behind her book, Brown Girls Disease, and why she's reclaiming language around pain, shame, and access to care.

In this episode, we talk about:

• Why women who have their ovaries removed need full hormone replacement, not just a low-dose patch
• The difference between menopause management and medical neglect after hysterectomy or oophorectomy
• The evidence that early menopause plus hormone therapy can have major survival benefits
• What PMDD is, how it differs from typical PMS, and why it can feel like "Jekyll and Hyde" every month
• Why PMDD may be more about hormone sensitivity and brain receptor interactions than progesterone alone
• PMDD treatment options, including SSRIs, specific birth control formulations, progesterone, and in extreme cases medical suppression
• Why the old label PCOS creates stigma and hides the cardiometabolic risk behind the syndrome
• The new name, polyendocrine metabolic ovarian syndrome, and why I think the rename could finally bring primary care and internal medicine into the conversation
• How PCOS affects fertility, diabetes risk, heart health, weight gain, and endometrial cancer risk
• How pelvic pain, vaginismus, and sexual dysfunction are shaped by culture, religion, and medical bias
• Why Sameena chose the title Brown Girls Disease as a way of reclaiming a term that had been used dismissively
• How language changes care, from saying "vagina" out loud to replacing shame-based terms with clearer ones

Naming things matters. You are not broken.

Dr. Rahman's IG

As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.

Subscribe, leave a review, and share this episode with someone who needs it.

🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Clinic is Open

Listen to this podcast on Pinnacle to earn CME

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

This episode is sponsored by Joi and Blokes.

If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.

Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.

See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I sit down with Dr. Melissa Mauskar, a vulvar dermatologist at UT Southwestern, for a wide-ranging conversation about vulvar skin conditions, common misdiagnoses, and why so many patients are told to just "wait and see" when they actually need an exam. We dig into GSM, estrogen, OTC yeast treatments, soaps, waxing, and the biggest myths that keep women from getting real care.

If you've ever been told itching, burning, or irritation is "normal," this conversation explains why that advice can delay diagnosis for years, and what to do instead.

What We Cover

• What vulvar dermatology is, and why the vulva deserves the same care as skin anywhere else on the body
• Why so many patients see 5 or 6 clinicians before getting the right diagnosis, often because no one ever actually examined the vulva
• How symptoms get mislabeled as yeast when the real culprit is lichen sclerosus, psoriasis, eczema, contact dermatitis, or GSM
• Why numbing products like Vagisil (and benzocaine specifically) can become irritants or allergens that make things worse
• Barrier care for "red angry vulva," including zinc oxide for irritation and moisture-related skin breakdown
• How overcleaning, douching, and scented washes disrupt the vulvar microbiome — and the shame baked into that marketing
• Waxing, microtrauma, and hair as a protective barrier
• GSM, recurrent UTIs, and why vaginal estrogen is still so underprescribed
• Late diagnosis of vulvar melanoma, and why genital skin needs to be looked at, not just talked about over telehealth

Notable Quotes

• "My five year old can say vulva."
• "I really like talking about uncomfortable things and making comfortable people uncomfortable."
• "Just do what brings you joy."

About Dr. Melissa Mauskar

Dr. Melissa Mauskar is an Associate Professor of Dermatology and of Obstetrics and Gynecology at UT Southwestern Medical Center, where she's the founder and Director of the Vulvar Health Program — a tertiary referral center for gynecologists, dermatologists, and primary care physicians across Texas and the nation. She's a Fellow of the International Society for the Study of Vulvovaginal Diseases (ISSVD), founding president of the Vulvar Dermatoses Research Consortium, and serves on the board of the Women's Dermatologic Society. Learn more at utswmed.org/doctors/melissa-mauskar.

As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.

Subscribe, leave a review, and share this episode with someone who needs it.

🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

This episode is sponsored by Joi and Blokes.

If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.

Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.

See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I walk through the basics of vaginal estrogen and vaginal DHEA for genitourinary syndrome of menopause, recurrent UTIs, painful sex, urinary urgency, and vulvar tissue changes. I also answer audience questions throughout, covering safety after breast cancer, use alongside systemic HRT, dosing, formulations, and what to do when symptoms don't improve.

This one's for clinicians and the general public alike, the focus is correcting misinformation, improving access, and helping people understand that low hormones can affect the pelvis long before or long after menopause.

What We Cover

• What genitourinary syndrome of menopause (GSM) actually means, and why it replaced older terms like vaginal atrophy
• The full range of GSM symptoms — urinary urgency, recurrent UTIs, bladder leakage, pain with sex, dryness, tissue thinning — as one unifying hormone-related syndrome
• Why GSM is so common (roughly 50–90% of women at or after menopause) and can start in perimenopause, during breastfeeding, on oral birth control, or after cancer treatment
• Data showing vaginal estrogen can reduce recurrent UTIs by about 50%, plus a large database study linking vaginal estrogen use to lower hospitalization, ICU admission, and sepsis-related death in women with recurrent UTIs
• Why "too old for vaginal estrogen" is a myth, and why age alone is never a reason to deny it
• Safety after breast cancer — why the evidence supports vaginal estrogen for many survivors, and why "zombie myths" keep resurfacing anyway
• The difference between systemic and local hormone therapy, and why some people need both
• Creams vs. tablets vs. rings vs. vaginal DHEA — and why DHEA can be especially useful for reversing established atrophy (it converts to both estrogen and testosterone)
• Practical stuff: burning, discharge, application technique, dosing frequency, and when it's time for a pelvic exam instead of another product
• Using vaginal estrogen alongside clobetasol for lichen sclerosus, and alongside systemic estrogen or testosterone when appropriate

Notable Quotes

• "The third pillar of academia is to communicate the research, to communicate the knowledge to the general population."
• "There is not an age your driver's license tells you if you're too young or too old for vaginal estrogen."
• "If atrophy happens because of low hormones and you add hormones back, you can reverse atrophy."

Key Frameworks

• GSM as the unifying diagnosis for urinary, sexual, and vulvovaginal symptoms
• Local hormone therapy vs. systemic hormone therapy
• Prevention vs. symptom treatment
• "Zombie myths" — outdated beliefs that keep resurfacing despite the evidence

Want to join me live for these? Get on my email list so you don't miss the next one.

As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.

Subscribe, leave a review, and share this episode with someone who needs it.

🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

This episode is sponsored by Joi and Blokes.

If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.

Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.

See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I talk with Dr. Lexx about how to have honest conversations about sex with kids, why sexual shame still shapes adult relationships, and how to think more clearly about desire, consent, and pleasure. We dig into misinformation around sex education, sex as a form of power, and what healthy support can look like from educators, counselors, and therapists.

What We Cover

• Sex-positive parenting and how to talk to kids about bodies and boundaries
• Why sexuality education in the U.S. is more restricted than people think — and why "medically accurate" isn't a given
• The real difference between sex educators, sex counselors, and sex therapists
• How midlife, menopause, and shifting desire reshape relationships
• Practical ways to rebuild intimacy and connection when the spark fades

Key Frameworks

• Personal parts — Language that reduces shame and emphasizes ownership over the body.
• Unwanted touch / secret touch — Clearer safety language than "good touch, bad touch."
• Sexuality as a whole-life concept — Not just intercourse, but identity, embodiment, relationships, and power.
• Compersion — Feeling happy for a partner's pleasure or joy, even if it isn't personally relevant.
• Sensate focus — Purposeful nonsexual touch used to rebuild connection and learn what feels good.
• Consent first — The baseline for everything, including fantasy, touch, and negotiation.

About Dr. Lexx

Dr. Lexx (Lexx, The Sex Doc) is a sex therapist, educator, and speaker whose work centers healing, pleasure, and connection — with a particular focus on Black, Brown, and queer communities often left out of traditional therapy spaces. Learn more at lexxsexdoc.com.

https://lexxsexdoc.com/

Subscribe, leave a review, and share this episode with someone who needs it.

🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

This episode is sponsored by Joi and Blokes.

If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.

Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.

See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode 387, I sit down with Dr. Lucy McBride to talk about the widening gap between the traditional medical system and the wellness industry, and how patients can find solid ground in between. Lucy makes the case for evidence-based advice, realistic expectations, and actually engaging with your healthcare system instead of trying to DIY your way to health.

What We Cover

• The gap between the medical system and the wellness industry
• Why evidence-based health advice matters more than ever
• The risks of wellness products and influencers overpromising certainty
• How patients can better engage with (not opt out of) the healthcare system
• Supplements, vitamins, and gadgets — what's worth your money and what isn't
• The wellness industry often overpromises certainty and results it can't back up.
• Living in the "middle ground" means engaging with the healthcare system effectively rather than avoiding it.
• Dr. McBride's book, Beyond the Prescription, is a practical guide for navigating health choices.

About Dr. Lucy McBride

Dr. Lucy McBride is a practicing internist and the author of Beyond the Prescription: How to Contextualize Your Health and Break Free from a Lifetime of Fatigue, Anxiety, and Stress. Grab her book here: Beyond the Prescription

https://www.lucymcbride.com/

https://www.instagram.com/drlucymcbride/

Substack

As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.

Subscribe, leave a review, and share this episode with someone who needs it.

🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

This episode is sponsored by Joi and Blokes.

If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.

Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.

See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The longer we treat menopause as something to survive quietly instead of understanding fully, the more women get left without real answers.

Dr. Shepherd is an OB-GYN, and we use menopause as the entry point into a much bigger conversation — the myths still circulating about menopause and sexual health, why clinician expertise and actual hands-on experience matter more than a lot of people realize, and how insurance and the broader healthcare system quietly shape what choices women even know they have. We also get into AI and new technology in medicine — where it genuinely helps, and where it's moving faster than anyone can vet it. And we land on something I keep coming back to on this show: aging well is not a solo project. Community and connection are part of the medicine.

Dr. Jessica Shepherd is a board-certified OB-GYN focused on women's health, menopause, and sexual wellness in midlife. Generation M - Dr. Jessica Shepherd's book

What We Cover

• Menopause as a gateway. Why menopause is so often the first time women start really engaging with their own health, and what that says about the gaps earlier in the system.
• The myths that won't die. Common misconceptions about menopause and sexual health that Dr. Shepherd still has to correct in the exam room, every week.
• Expertise actually matters. Why the clinician you choose, and how much hands-on experience they have, changes the quality of care you get, especially in a field this nuanced.
• The system shapes the choice. How insurance coverage and healthcare structures quietly limit what options get presented to women in the first place.
• AI in medicine — promise and risk. Where artificial intelligence and new technology are genuinely useful in healthcare, and where the pace of change is outrunning oversight.
• Community as medicine. Why connection and support are not a "nice to have" in aging well, they're part of the actual strategy.

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

Thanks to our sponsor ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.joinmidi.com⁠

See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Half a million of you on Instagram. I still can't quite get over that number.

To celebrate, this episode is all you — an open Ask Me Anything where I answer the questions you've actually been sending me. No guest, no agenda, just me working through your real questions about hormones, menopause, sexual health, and the stuff nobody explains to you in a normal doctor's appointment.

We cover a lot of ground — how I ended up a urologist obsessed with female sexual health in the first place, the myths about hormone therapy I am still correcting in 2026, DHEA, the estrogen patch shortage, why your labs don't always tell the whole story, and yes, the Ferrari engine analogy makes another appearance. If you've been wondering something and never had the nerve to ask your own doctor — there's a good chance I answer it here.

In This Episode

• How I got here. My background as a urologist and how that path led me into female sexual health — a specialty most people don't expect a urologist to end up in.
• Hormones, menopause, and aging. Why hormones matter so much more than most of us were taught, and what's actually happening in your body during the menopause transition.
• Hormone therapy myths, corrected. I'm clearing up the misinformation that's still floating around about HRT — including specific questions on risk for women with a Factor V (Factor two) clotting diagnosis.
• DHEA and vaginal estrogen. What they do, why the estrogen patch shortage is happening, and what to switch to (gels, oral options) in the meantime.
• Testosterone, decoded. Comparing creams versus injections, how to interpret SHBG, and why I care more about how you feel than what the lab printout says.
• Progesterone tolerance. What to do when the standard dose doesn't agree with you, and where extended-release formulations fit in.
• Persistent UTIs on vaginal estrogen. Why they still happen even when you're doing everything "right," and what else might be going on.
• Weight gain and menopause. What the data actually says — and what gets blamed on hormones that isn't really about hormones at all.
• Talking about sex — with clients, with partners. A layered, step-by-step way to open the conversation about low libido without it feeling like a confrontation.
• Individualized care. Why hormone management should never be one-size-fits-all, and how I think about lab testing versus symptoms.
• What's next. vulvar DHEA, book clubs, and more ways to keep learning together.

Subscribe, leave a review, and share this episode with someone who needs it.

🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

Thanks to our sponsor ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.joinmidi.com⁠

See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Age is just a number. We say it all the time. Do we actually believe it?

This week I sit down with Dr. Arnold Gilberg, MD, PhD — a psychiatrist with over 60 years of clinical experience and author of The Myth of Aging. Sixty years. Let that sink in for a second. He has watched mental health care go from something people hid to something people post about. And he has spent just as long studying what actually keeps people vital as they get older, and it is not what most of us assume.

We get into what a psychiatrist actually is (and how that's different from a psychologist or a therapist), why the shame around therapy has mostly disappeared since the 1960s but hasn't fully left medicine itself, and why he'd argue we're over-medicating a problem that often needs connection more than a prescription. Then we go somewhere I did not expect, his own path to becoming a rabbi, and what spirituality has taught him about the mind that medicine alone couldn't.

If you've ever felt "stuck," or assumed decline was just the deal you signed up for by getting older — this one's for you.

Dr. Arnold Gilberg, MD, PhD, is a psychiatrist with more than six decades of clinical experience and the author of The Myth of Aging. Over the course of his career he has treated patients through massive shifts in how our culture understands mental health — from the stigma of the mid-20th century to today's very different, more open landscape. He is also a rabbi, a path that grew out of his clinical work and shapes how he thinks about meaning, purpose, and healing. The Myth of Aging book

What We Cover

• Psychiatry vs. psychology vs. therapy. What a psychiatrist actually does, how that role differs from a psychologist or therapist, and why the lines have blurred (and shifted) as the field has evolved.
• From shame to normal. How therapy went from something you hid to something you casually mention at dinner — and why stigma still lingers inside the medical community itself, even as it's faded in the culture at large.
• The culture of medication. Dr. Gilbert doesn't hold back on this one — the over-reliance on medication, what gets missed when a prescription replaces psychotherapy, and why informed consent about side effects matters more than most patients realize.
• Body and mind are not separate systems. Why physical activity is one of the most underused tools in mental health care, and how movement changes the brain, not just the body.
• Becoming a rabbi. Dr. Gilbert's own journey into spirituality, and how faith and religion show up as legitimate tools for emotional and mental well-being — not as an alternative to psychiatry, but alongside it.
• Cultural shifts, real clinical impact. How broader acceptance of diverse sexualities and identities has changed what shows up in the therapy room and how mental health providers practice.
• Connection is the treatment. Why trust between patient and therapist predicts outcomes more than technique — and what that means for how we should be evaluating "good" therapy.
• The myth of aging, dismantled. Aging does not have to mean decline. Investment in physical, mental, and social health changes the trajectory — and it's never too late to start.
• Midlife crisis, reframed. What's actually happening during a midlife crisis, and why it can be the opening for real change instead of just a cliché to laugh off.
• Mindset changes your biology. The Harvard research on mindset and lifespan — and what it tells us about how much of "aging" is happening in our heads before it happens in our bodies.
• Getting unstuck. Practical ways to turn a feeling of stagnation into an actual growth opportunity.
• Community, movement, purpose. The three pillars Dr. Gilbert keeps coming back to for aging well — and why none of them are optional.

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Menopause conversations center on women. For good reason.

But what about the guy standing next to her?

Joe Warner and Rob Kemp wrote Burning Up, Frozen Out — the first real guide to perimenopause written for men. Not about fixing her. About understanding what's happening and showing up anyway.

We talk about why men are so in the dark on this. What actually helps versus what just feels helpful. And why this works better as a team sport.

In this episode:

• The stereotypes that make menopause a no-go topic at home
• Why communication breaks down exactly when you need it most
• Small, low-effort ways men can actually support their partner
• Men have their own midlife hormonal shifts too — sleep, stress, food, fitness
• Why "support" means listening, not solving

Burning Up, Frozen Out book

Website

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Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

Thanks to our sponsor ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.joinmidi.com⁠

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Menopause doesn't just happen to a body, it happens to a relationship. In this episode, Traver Boehm joins Dr. Kelly Casperson to talk about what's actually going on hormonally during perimenopause and menopause, and what that means for the partners trying to understand it from the outside.

Kelly breaks down the real difference between perimenopause and menopause (hint: most people are using these words wrong), what's happening biologically during the transition, and why the emotional and relational fallout is often just as real as the hot flashes. Then the conversation turns to men — what's shifting for them hormonally during this same midlife window, and how couples can actually talk to each other about all of it instead of quietly drifting apart.

This one's for the women in it and the partners trying to show up for them.

In this episode:

• Perimenopause vs. menopause, where one ends and the other begins
• What hormonal changes are actually doing to mood, sleep, libido, and connection
• The emotional and relational ripple effects of menopause that no one prepares you for
• Hormonal shifts in men during midlife, and why this isn't just a "her" conversation
• How to actually talk to your partner about what's changing
• Rebuilding pleasure and intimacy when everything else is in flux

Reminder: none of this is individual medical advice, discuss your own plan with your own clinician.

https://www.manuncivilized.com/

https://www.instagram.com/traverboehm

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Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

Thanks to our sponsor ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.joinmidi.com⁠

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