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E132
April 23, 2026
The Testosterone Conversation with Dr. Kelly Casperson: Beyond Libido
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In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Kelly Casperson, urologist, author, and host of the podcast "You Are Not Broken." Part 2 goes deep on testosterone therapy for women, the most misunderstood hormone in women's health, and covers the full range of what it actually does in the female body, why every woman will experience declining levels over time, and why there are still zero FDA approved testosterone products for women while men have more than a dozen.

Dr. Casperson opens with the basics: ovaries make testosterone, the hormone pathway runs one way from cholesterol through progesterone to testosterone to estradiol, and women in normal cycling years carry four times more testosterone than estrogen in their bodies. She explains where testosterone receptors are found, which is everywhere from the brain to bone to muscle to the clitoris to the tear ducts, and why reducing testosterone in women to a libido drug misses the full picture entirely.

The conversation covers what testosterone actually helps with across every domain of female sexual health including desire, arousal, orgasm, and blood flow to the clitoris, as well as its role in energy, motivation, mood, nerve function, and mitochondrial health. Dr. Casperson explains why women and testosterone research is lagging decades behind male data, why women on estrogen who add testosterone are able to reduce antidepressant use at significantly higher rates, and why she describes it not as a libido medication but as a motivation medication that supports the dopamine and serotonin pathways.

They address the safety data directly. Decades of data exist on testosterone use in trans men at ten times the female physiologic dose with no increased risk of death, cancer, or breast cancer over 50 years. Dr. Casperson also walks through the emerging research on testosterone and breast cancer risk reduction, the cadaver data showing higher brain testosterone levels correlating with lower rates of dementia, and why she would spend a blank check on a randomized placebo controlled trial studying testosterone and dementia prevention.

Dr. Casperson walks through how to prescribe testosterone responsibly without FDA approved products, why pellets tend to run supraphysiologic and what that means for hair loss and side effects, and how to evaluate whether a patient is a candidate. Dr. Casperson also walks through what labs she runs on every woman who presents with hypoactive sexual desire disorder or who simply does not feel like herself, from a full thyroid panel to fasting insulin to B12 to omega-3 levels.

The episode also covers genital urinary syndrome of menopause, the Medicare data showing only 7% of women who received a GSM diagnosis were given vaginal estrogen within 18 months, how to apply vaginal estrogen cream correctly and why a loading dose is often counterproductive, and the data showing vaginal estrogen decreases urinary tract infections, reduces ICU admissions and death from sepsis, does not increase breast cancer recurrence, and may be associated with decreased risk of rectal cancer.

Also covered are vaginismus, pelvic floor dysfunction, the role of vibration and blood flow in restoring sexual function, the sexual side effects of birth control pills, antidepressants, and GLP one medications, and why moisture during sex is not a reliable indicator of desire or arousal.

The episode closes with Dr. Casperson's message to every woman listening: you are not broken.

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Chapters

00:00:00 – Intro & Part 2 Setup: Why Women’s Sexual Health Still Gets Missed
00:02:00 – Medical Disclaimer + Episode Focus on Testosterone
00:02:30 – Testosterone 101: The Most Misunderstood Hormone in Women
00:04:00 – How Testosterone Is Made (And Why It Doesn’t Convert Back)
00:05:30 – Testosterone vs Estrogen: The Surprising Ratio in Women
00:06:00 – Where Testosterone Works in the Body (Hint: Everywhere)
00:07:00 – Beyond Libido: Brain, Mood, and Whole-Body Benefits
00:08:30 – Why Testosterone Research Lags (And Gender Bias in Medicine)
00:10:00 – FDA Reality: Why Women Have Zero Approved Options
00:14:30 – What Testosterone Can (and Can’t) Fix in Relationships
00:16:00 – Energy, Motivation & the “I Feel Like Myself Again” Effect
00:18:00 – Mental Health, Dementia Risk & Long-Term Brain Impact
00:21:00 – Breast Cancer, Safety Data & Why Research Isn’t Funded
00:25:00 – GSM Explained: Genitourinary Syndrome of Menopause
00:30:00 – Lab Testing, Hormone Panels & Finding Root Causes
00:33:00 – Should You Try Testosterone? Risk, Cost & Expectations
00:36:00 – Delivery Methods: Gels, Pellets, Dosing & Common Mistakes
00:41:00 – Pelvic Health: Clitoral Changes, Exams & Missed Diagnoses
00:45:00 – What Is GSM Really? Why It’s So Common & Undertreated
00:50:00 – Vaginismus: Pain, Misdiagnosis & Cultural Myths
00:52:00 – Body Image, Labiaplasty & The Pressure on Women’s Bodies

About the guest

Dr. Kelly Casperson

Dr. Kelly Casperson is a board-certified urologic surgeon, CEO and founder of The Casperson Clinic, a modern practice dedicated to hormones and sex medicine, renowned public speaker, sex educator, and host of the top-ranking podcast You Are Not Broken. Dedicated to empowering women, Dr. Kelly blends humor, candor, and science to demystify sexual health, intimacy, and midlife wellness. Through her podcast and online courses, she tackles myths about desire and normalizes conversations around healthy, fulfilling sex. Her work also provides essential education on hormones and midlife health.