But don't be shy about a pat on the bottom or a rub on the back or a holding hands or sitting next to the. Intimacy has to be there and be.

Alive because our bodies are changing so much, like physically, just the appearance that also becomes such a mental block with sex.

Fantasy can also be an important tool for midlife women to use when they are in the midst or trying to focus to get to orgasm.

Because I do feel bad for the men in our lives if we don't know how to navigate. Like, how can they know?

I don't want to speak for all women, but we don't want to be feared. We want to find our voice and say, this is what's important to me.

There's a lot of shame and even resentment when your libido doesn't match your partner's libido.

For women, I think this is true psychologists. Emotional closeness leads to sexual closeness. You have emotional intimacy leads to sexual intimacy. For men, I think it's the other way around.

Yeah. Physical intimacy leads to emotional intimacy. You take something just as simple as couples counseling. That is the type of counseling that gets the most results the quickest.

Okay, so, so let me just say this. If you're in midlife, in a long term relationship, wondering what happened to your sex drive, or trying to keep connection alive while juggling a million things, this episode is for you. Today I'm joined by a couple who not only live together, love together and work together, but also talk publicly about all the things most people avoid in private. Dr. Kate White is a nationally recognized OBGYN author and unapologetic advocate for women's sexual health. Jay White is a licensed marriage and family therapist who helps couples navigate the real stuff. Resentment, disconnection, intimacy and communication. Together they host the podcast Heads and Tails where no topic is off limits. From fantasies and mismatched libidos to the truth about what happens behind closed doors in long term partnerships. We're talking sex and midlife emotional labor. Bodies that are changing, desires that are evolving, and how to reclaim intimacy on your own terms. This one's bold, raw and real. And if you're listening with earbuds in, you might want to turn the volume down just a little. If you're in the carpool aid, let's get into it. Welcome Jay and Kate to the iconic midlife. I'm so excited to have you guys today. How are you doing?

We're doing great. It's so nice to have be on here with you and talk about all things menopause, perimenopause relationships, sex and hormones and all those things. Yes.

Oh, my God. It's, like, never ending. I feel like we step into midlife, and we're kind of like, where's the roadmap? Like, where are we going? Like, are we jumping off here at this exit? Are we. Are we continuing on the freeway? Like, it is just this, like, tornado of things that happen. Almost feels like all at once, Mario.

Kart, where the things will get.

Oh, you're trying not to get hit by people throwing.

Yes. You're, like, driving along and it's all good, and all of a sudden, we're like a banana comes out at you.

Right, right, right. And. And you don't know, with menopause, perimenopause, different things. Like, you. You don't know if it's coming from the problems coming from within side you or. Or from life itself throwing. Throwing something at you. So.

Right. I do feel like it's a mix of those things.

You know, life doesn't stop.

That's right. It feels like our bodies are betraying us, you know, a bit. And then you've got all of these external factors, your relationships, you know, kids, sometimes, you know, work. It's like all these things are happening at once. But before we fully dive into that, I want to talk about you guys for a second, because what I find is fascinating is that not only do you guys have this amazing podcast, but you guys are married in real life. You know, you work together, you podcast together. You know, you had a great family together. So what came first? Was it the work and that's how you guys met each other, or you got married and then found a way to work together?

Working together. It was accidental where we. We're doing completely different things, and we live, what I like to say, in a. In a big, small town in Charleston. And. And we noticed that we were seeing some of the same people just because Kate would deliver them, and then I.

Would see them for gynecology, and then you.

Yeah, mine for. For therapy or couples counseling or something like that. And they would come in and they say, I have to tell you, your wife deliver my baby. We love her. You know, and then. Then it would be. And so. But we. We realized we are hearing the same a lot of times, the same complaints, but taking a different approach to it. So a psychological and a more medical approach. So that's. That's kind of how that happened. It was on accident.

That's amazing. And you guys clearly have made it work. And it's, you know, I was just listening to your podcast, actually, the latest, one of the latest sex episodes, which is like, so what I want to talk about because as you can imagine, you know, I'm getting messages and dms and like just so many questions from midlife women out there who are just so confused by their body and the changes, not only just physically, but mentally and emotionally as it relates to sex. So to kick it all off, if you could just kind of explain, because I feel like when I'm on this journey, especially with this podcast, I too am learning things about my body that I never knew before. And I think I feel like a lot of women are in the same boat. What is happening to our bodies biologically that that affects our sex drive?

So when we look at any kind of sexual interaction, there's really three things at play. There's biology and then so it's biopsychosocial psychology. So it's by the biology, like, how is my body responding to these, this input? And then there's the social part, which is, do I have, is this the appropriate time for us to respond or do I have to go to take to someone to soccer practice? Or, or. And then, then there's the psychology part of am I feeling really anxious and depressed? Because that's going to shut down any desire to really have sex now. So that you have to look at these three prongs of this, that, that and all that all have to be able to align to have a sexual response. Because if any of them is off, that's going to derail your sexual. Your desire for sex.

Correct. Yeah.

Yeah.

Well, so talk about the. What's happening physically.

Yeah, so, absolutely. So when we look at the biology of the changes of midlife, you've got the, the these follicles that may have an egg inside them and you only have so many of them. You are given all that you have that you're ever going to have when you're born, and they gradually decrease, and they also gradually decrease in quality. So you've got the big drivers of hormonal drivers. The primary ones that fluctuate from your ovaries are estrogen, progesterone. And so each follicle that has an egg in it has cells around it that make estrogen. And your brain has estrogen receptors and your estrogen receptors are, if they're empty, they're going to send a signal to the, to your pituitary and say, hey, we want more estrogen. And it sends follicle stimulating hormone to the ovary and the Ovary is going to supposed to respond by recruiting a follicle that has an egg in it and all the cells around it will make estrogen. Well, that works great in your 30s and, and you from 15 to 35. But then as your ovaries age and your, your follicles become less responsive, you get your messages to your from your brain are like, oh wait, I really mean it, I really want that estrogen receptor. And your, your ovaries are like, and they're kind of slow to respond and it's like no, no, and follicle stimulating hormone. And then it's gradually recruiting all these semi poor quality follicles but each of those follicles has cells around it that make estrogen. And the estrogen levels get higher and higher and higher. And so you go through these cycles where finally your, your ovary responds and you've got these super high levels of estrogen. And is that a real problem? Your brain does pretty well with high estrogen. In fact, when you're pregnant your hormone levels of estrogen a lot of times will be close to a thousand. But a normal cycle, they only get to be about 200, 300. So we do pretty well with high estrogen. What our brains do not like is when your estrogen plummets and you, and comes down after you ovulate and then you go from a level, a nice arc of up and down with your hormones to this huge spike and, and your brain is like hey wait, where'd that estrogen go? And that's when you start getting brain fog. And your dopamine and your serotonin are not controlling your cycle and you're getting more anxiety because your serotonin is off and you're getting more crazy. Loss of executive functioning where you feel like you have ADD all the time. And the worst thing about it in some ways is that it's so irregular and cyclic and sometimes it's happening and firing off and you're hitting all your marks and you're killing it at work and you're remembering all the words all the time and then the next day you will be feeling moody and irritable and can't remember any words and can't remember where you put anything. And that is a real sense of loss and urgency. And because you are no longer able to manage what you easily were able to manage previously.

And it's terrible because the husband or the kids or whatever will wonder where, where did mom go or where did my partner go or something.

Yeah, so, so sorry. That was a Long biology lesson, but that those big spikes are why you' to feel. Because your. Your dopamine estrogen helps your dopamine. And dopamine is responsible for attention and activation. And it's. It. When you lose it, you no longer are able to pay attention to the things and get the things done that you needed to do. And so when that happens and you're already the person in the house that's responsible for. For so. Or in work for so many things. And you were. And it's a lot to juggle all the time as being an adult and being an adult in this part of your life. And then when you lose that regulation and support in your brain, it is that you are feeling. And so you're feeling like you're out of control. And that psychological biological part is going to impact your sexual function. Because if you don't feel like you're in control and you feel like you're fighting a battle to get your. The rest of your life, you're. You're not going to feel like that this is the time to reproduce.

Right. Psychologically, you'll. You will. There's a. There's a great. It's called the Garcia effect, where that's where you have too much of something and you. And. And it. It either it makes you sick or you. You had something and you. Your body blames it.

Like Fuzzy Navels.

Yeah, that was very bad.

Yes.

Everybody has something like that. You've seen people that say, I can't drink tequila anymore because I spent a night.

Yeah.

You know, or a day and a half throwing up over, um. Yeah. So this kicks in for couples. And, and, and where she is wondering, wait a minute, what is going on with me? It must be something in my life. And, and so that a lot of times the, the partner can. Now, a lot of times the partner is to blame, but sometimes the partner can be blamed for something that's happening internally. I mean, it's. And because you'll see guys. And we're guilty of this. Where guys will say, wait a minute, I haven't changed. I'm. I'm the same person I was and used to like these things that I did. Used to think that this was funny. Used it, you know, and then all of a sudden that's not working anymore. And, And. Yeah. Yeah. And so where do you go from there?

Yeah, where do you go from there? And I'm glad you're bringing up the partners because I do feel bad for the men in our lives that don't really know how to. If we don't know how to n. Navigate, like, how can they know you know how to navigate these. These waters? And, you know, I feel like, you know, for example, my husband does the best he can, you know, trying to see. But even he's kind of like, I don't know what I'm stepping into. You know, he's like, he will like walk into a room and if he thinks I'm in a bad mood, he'll be like, tiptoeing back out because he's like, I don't want to face the wrath, you know.

Right.

Yeah, well, that's exactly right. And that's the. Yeah, that's the cycle guys go through where they start off with just trying to weather the storm, whatever it is that's happening. And then we will try to fix, of course, which sometimes goes quite poorly. And then, then you'll. You can fight. I mean, it'll just be, what is wrong with you? And now what's wrong with you? And then it goes back and forth, you know, and nothing happened. And then right then it's the tiptoeing out of the back of the room.

And that loss. It's even loss of more connection and loss of more intimacy and that. And, and no, I wouldn't say I don't want to speak for all women, but we don't want to be feared. We want to find our voice and say, this is what's important to me. But we don't want to be feared or resented. And so. So it's. It's a. It's. It's a. It's trying to find that tipping point between taking that autonomy of saying, this is what's important to me. This is what I need without screaming it, and so that everyone shuts down. So, so it's try and sometimes. And that self regulation that you get, so your frontal cortex is, Is the part of your brain that it allows you to say that this is the time to say this or this is not the time to say this. And when you have hormones that are not firing correctly to stimulate that part of your brain, you lose that regulation. So people say, I lose. Lost my filter. And some of that is good because it clarifies what is important to you and what's not important to you.

Yeah, some things need to be dropped.

Yeah, there's some things that to change. But if it's damaged, the point at which you. That loss of filters starts being damaging, that's where you have to say, okay, do I need something to even this Out. Do I need do. Is it going to be mindfulness? Is it going to be meditation? Is it going to be possibly hormone therapy or. And that's why a lot of people do end up going on SSRIs, which is not necessarily the bad thing for. But it's not necessarily where you have to start. And so I think that when we look at how many people get started on SSRIs at this point in our. Which is things like Zoloft and Prozac. They're not wrong things, but. And they do help with the serotonin imbalance that we do have. But is there. Are there different ways to balance those things so that you have that give you just that beat of time and control in your. So to not blow up your.

Can I tell you about our fight last night?

Oh, yes, please tell me.

So we're. We're sitting upstairs and we're. We were. Well, we had our own podcast today and then we had your podcast. We have different things going on today. And she's about to take. There's a lot of stress. She's about to take a test.

Huge exam. Yeah.

So at this point in her life is still taking tests. And, and so I'm upstairs and watching the. On mute the end of the Phillies game and, and I've been working all day and preparing and getting stuff to do and. Well, not at your level, but. But she comes up. I mean, she comes upstairs and obviously there's. There's some, there's some tension and buildup and I'm just, you know, just watching the game. Absolutely. And, and she says, sure wish I had time to sit up and watch baseball. And, and I, I thought wait a minute. What, what. What. What is. And, and it was just being nervous about the test and it was being nervous about, you know, all the things that we had to get done today. But boy, there. Yeah, the, the. The filter was off. It was great.

It was. And I did go back and, and I think that how do you. How do you. If you do have these times where you. Things come out the way that I think that you don't necessarily in the best way, can you bring it back around?

Yes.

You have to be able to heal those moments too. And I think that. That it is. It is. That is where you can bring it back around to. To. And that's where investing in your intimacy in general, because intimacy leads that emotional connection for women. I think this is true psychologists. Emotional closeness leads to sexual closeness. You know, you have. Emotional intimacy leads to sexual intimacy for Men.

I think it's the other way around. Yeah. Where physical intimacy leads to emotional intimacy. And so it's a great circle when it's working and then when it's not, it's. Yeah, yeah, it can, it can fall apart pretty fast and I, and I feel bad. There's all sorts of things that can go, that can go wrong. But certainly if physically you're not, you're not feeling like there's pain with sex or something like that, the guy can still feel rejected and it's not him at all. I mean it's, it's, it's. And I don't mean it's not. I mean he's certainly a part of the pair, but it's not as if, you know, he can feel like, well, why is she mad at me? Or why is she. And it's not that or. Yeah, that's just a simple example.

So yeah, when we get those hormone changes and they can even start in perimenopause, which people don't realize that you can start having some of that dryness and it's not. And vaginal dryness and irritation and, and it can be cyclic. You can get it just when your estrogen drops with your period and you, and it's okay to use, certainly okay to use lubricant at any time, but, but certainly using a lubricant is, can be helpful because if you're, if you do have pain, your desire center is going to shut down. It's like, it's going to be like, nope, we're not doing that. And so even using a little vaginal estrogen during those, that time can be helpful because there's so many estrogen receptors in the, in that area of the, at that, especially at that entrance to the vagina. And you can also get decreased sensation in the clitoris and a decreased bulk in the clitoris with a, as your hormones change there. So adding back some estrogen can. Even if you are on other hormone therapy, that, that can be very valuable and really helpful because if the equipment doesn't work, then yeah, yeah, that's a, that's just a non starter. Right. So, so that is. So just adding that back. And then we have changes in estrogen, progesterone, testosterone. All of these things change for. Well, the Testosterone changes from 40% of men are low testosterone, have low Testosterone in their 40s. And as those changes happen that can affect their ability to, to feel desire or maintain erections, things like that. So, so but it's important to address for both Parties. Because if you're. So the pain, that's one part of it.

Right.

And then it's just the emotional anxiety and depression that can happen. Increased about 30 to 40% in perimenopause.

Yeah. There's lots of different directions that. Wow. That you could go.

And then if you get your audience ssri, then your sexual function gets even worse.

Goes even worse. Yeah.

Right. And then the connection. I thought it would. I thought it was so interesting that you guys really talk about, you know, how men and women are so different, especially with sex. You know, like, it's almost like two ships passing in the night. So if you don't have that connection, like, especially with all these things going on, what are, like, things that we could do to reestablish connection with our partners?

I think that's important.

Yeah. So for. In therapy, we talk. First of all, I always use the term intimacy and not. I mean, obviously we talk about sex in therapy, but. But. But we use intimacy and intimacy. As you say, intimacy starts in the kitchen. So it's. It's the hand holding, it's the. It's the leaning in when they're talking. It's the pat on the bottom. It's the, you know, it. It's being interested in one. So intimacy is something that can be going on all the time rather than you're. You're sitting up stairs watching a western and then say, all right, let's get it on. You know, and that does.

Giddy up.

So. Yeah. Right. Right. So that. And. And. And that's the biggest thing is if you ask what's the. So the two biggest things are intimacy that should be going on all the time and communication going on all the time. And there's. There's all sorts of ways to mess those up. But. But to. To. To. To do those and to try those and to keep those alive. That's. Yeah, that. That would be the best advice. I would.

And it means different. Everyone if we look at different thing. You have to. Figuring out what is valuable to your partner. So you can say, keep your. Keep intimacy and connection alive. But it really has. And some of the things that I. I think there are structures for things like the five love languages. That's a really good place for people to start. Say if you can't even think about what is important to your partner, you don't. You're like, I don't know what she wants. And she may not know what she wants. You can say, let's give some structure. Say, okay, how does she feel? Love. Does she. Does she want gifts? Does she want you to acts of service like this? She just wants you to do the laundry, you know, and just give her one less thing to do. Can you tell that's mine? Could you just do something?

Totally do a lot of things.

I accidentally sat down and watched baseball last night.

You're like, hint, hint.

That's right. And there's. There are people who. It's physical touch. And in that physical touch can be that they want some physical touch that doesn't. That isn't necessarily associated with sex.

Right.

So they want that physical touch to be. I don't want to be. They don't. I got all the time. I'll talk to patients and they'll say, well, I don't want my foot touch foot to touch his. Touch his foot in bed. Just in case he thinks that let's get it on. And. And so. And that is a law that's such a loss in your relationship. If you feel like there's any. That any overture is going to lead maybe a signal that you are going to have sex, then you've lost a lot of the closeness that you had. And so that physical touch doesn't have to be an intimate in terms of sexual intimacy, but intimacy. It could be like you were when you were trying to tell someone that you liked them back in the day. You're like, you get closer. You like walk with your hand in his back pocket. I was like, that was from the mall when you walked in the mall.

Totally.

And then. But that. So we've got gifts which some people do that gift like bring her flowers. Physical touch. Acts of service.

Quality time.

Quality time.

Just the main thing is to figure out which one you are.

Yeah. What was the last.

I don't.

We'll do the four love languages, but that it. But there are structure constructs that you can say let's fill this paper out to figure it out. If you can't. If you going to a couple therapists is great but not accessible to everyone. But if you can figure out what that is and then say, okay, I'm going to concentrate on doing some of these things and investing in our relationship in that way for both of you. So that you could say, okay, this is. This is what's going to help to get this framework a little bit more solid.

And the moment you start working at it, it gets better.

Yeah. Any step. It's like baby steps even. And you know, I feel like too there's a lot of shame and even resentment when your libido doesn't match your partner's libido. You know, it's also like one of those things where it's like you feel bad if you know you don't want to have sex and he does or vice versa, you know. And so how do we kind of navigate those waters when they don't match?

You just get it on.

Anyway, that's what we've been doing, right? No, that's what a lot of women are doing is.

Oh, you mean we, we as women, not we as a cult. Tmi.

Yeah. Is there that libido metric mismatch is so common and so you. I think it, it, it is again, where you have to think of it as. There's also, there's things that affect the hormonal part of that. And if you, if you've ever done any an A diet like that's an elimination diet, like sugar busters or keto or something like that. At first when you cut out all sugar, let's say you, that first couple weeks you're like, oh my God, I would kill for a Snickers. But then after you get to about six weeks, eight weeks in, you're like, oh, that does sounds gross to me. And the desire center of your brain is, is programmed that way. So you get all these. This. If you stop having sex wherever, whether it's you're just in a bad place emotionally or you're having pain or whatever reason, you get more and more of this distance. Your desire center is like, that seems like a lot of work and it's kind of messy and it sounds like I've got. I would actually rather sleep because I'm not sleeping well. And so that all gets down. Regulated. So trying to reestablish that may take a lot more mindfulness, a little bit of sensate focus. Trying to reconnect and do things where as a couple that are in, in the bedroom that aren't necessarily just put out there. This, this is tonight is not going to lead to sex.

I do that, I do that a lot with couples where I will say, well, let me just back up one half step. So if you, if you take kind of a triangle of women's health or, and mental health, there's, there's the physical health part of it and there is, and what goes along with that, of course in menopause and so forth, are the, the estradiol and all the, the, the hormone changes and, and, and hormone replacement and so forth. And whatever it is that helps you. Breathing exercises, supplements, whatever helps but then life keeps going. I mean, all the problems of the day, you know, the bills still come in the mailbox. I mean, if you felt zero symptom from menopause, you would still have life coming at you. I mean, it's. It's still going. So to. To find the. To. To. To find the best combo of that which. Which keeps you going. And, and then. Yeah. Communication. And I say to couples, I'll say, all right, here's what we're going to do this week. You can be as physically intimate as you want without sex. So you can hold hands, you can sit together, you can hold each other, you can shower together, you can do anything. You can do whatever you want, but no sex. And then we'll talk about it next week. And often they come back and they say, we had sex all week. Yeah, interesting. Okay. Yeah, yeah, yeah. So part of it is that is okay, we took away the pressure. Now, that doesn't. I shouldn't say work every time. I'm not trying to trick them or doing it. But. But if the problem has been pressure, that one libido is here and one's here, then then that can often take that away. Or let's just. Let's just take the pressure and just be together. Yeah. And then there's. Well, there's all sorts of other.

And there are things. Testosterone. There are. Unfortunately for women, there are not very many medicines that actually can help in that neurotransmitter area of, like. Because our problem is not a. Men are.

Have.

You know, there's desire, arousal, orgasm, resolution.

So men, that's the chart we all saw in the seventh grade.

Yeah, right. Health class, remember?

Yeah. We all.

Coach was teaching.

Right, Right. Yeah, we had Mr. World. It was awesome.

And so they. And so for most men, they're already at desire, like 80% of the day, if not more so. But the. For women, they're. They're. That. That is. Their problem is typically arousal. So whether it's erectile dysfunction that they can't. It's a plumbing problem. And so they can take medicines that vasodilate the vessels of the penis. And then they're like, look, I have a bone. Let's go. I mean, that's, That's. And we're. Oh, our problem is I can't even get to, you know, the starting line.

Right.

And so the. There are things that work. And testosterone is the only FDA current FDA indication for testosterone in women is for hypoactive sexual desire or decreased libido.

And that's Hypoact, hypho, right hyper low, right.

Low, low, low sexual desire. And so that it. And so it's a definitely a potent neurotransmitter. Now there's all, all other thing. Kinds of things that testosterone does in other places. But the other, the only other two medicines there are for hypoactive low libido in women are a medicine called V, which is an injectable medicine. It's Brenitide. And then there is Addie, which is an oral medicine that you take daily. And that, and that those medicines work in the desire center of your brain and they, and that one. And, but they're not, they don't work like Viagra in, in lots of different ways. One is they're not meant to give people an erection. That's, that's what Violet, the Viagra is supposed to do. And there are products actually women that have sildenafil, which is the, there's some topical things that can help with vasodilation of the clitoral vessels and, but they don't work the same way in women, unfortunately. So the, the medicines that are centrally acting for women that. It's funny when I, I heard the statistic because when we think about things that work in the brain, whether it is medicines for depression, anxiety, they typically work in about 60% of people. That's what they could think is successful. So like if this medicine works for Your depression in 60% of the people that tried it, they did. But this, these, so these medicines, they're not going to be perfect for everyone, but they'll, they can help with about, in about 60% of. And you just have to try these different things. So some people are like, oh my gosh, I could not live without my testosterone. I went on it and I feel like a million bucks. And then other people are like, it's still not, still not really happening for me. And then you have to say also, are there maybe some other parts of that biopsychosocial part of your sexual function that are not supporting, supporting that. So there are medicines for, for hypo, for low libido in women. They are, they don't work for everyone, but they do. You deserve to have a conversation about whether those things might be helpful. Well for you and because there are some things out there and we hope as women's health gets more money put into research, which is like, come on now that we'll get more products that will be available and, and we're hoping to get a female dose testosterone within the next two years. So that is, that will be helpful too.

So a friend of mine started testosterone. She loves it. And she is like, you know, the gardener comes over and she's like, I'm looking sideways at him out the window because her desire has come back. You know, like, she's like getting excited and she has said it has been really effective for her sex drive. So that's interesting that the, the conversation continues with testosterone. So it looks like we'll be seeing some new developments in these next coming years.

We hope. We. It is, it's. It is something that's actually sort of crazy that they have. Not that the FDA has not moved forward with approving a FDA a dose of testosterone for women because they don't think it's safe. Even though we have tremendous safety data. Women have been using it for many, many years. And we, we know that it is safe because we use it in much higher doses for women, for trans men who are using that. And we know how it works. If they saying we don't know how it works in women when we use it in trans men, that is what we see at much, much higher doses. And we know that it is safe. So it is been a little bit crazy that we haven't had more.

More.

Movement from the FDA on approving it. And one of my mentors who I just think the world of, who's a big researcher in sexual medicine, Jim Simon, said he was actually in a meeting with the FDA and he was talking about getting these drugs approved. And he. There was actually someone from the FDA and the end who said, well, this is not really a priority because women don't have to have an orgasm to have sex. And that was a woman from the fda.

What?

Yes. Oh, I shouldn't have probably said call it, but that, but so they're like, this is just like, oh, well, yeah.

Now everybody's googling fda.

This was a long time ago.

Yeah, that.

Yeah, right.

What government function would not want increased women's sexual function?

It is, yeah, it's. It's kind of crazy. But, but yeah, I think that the.

Main thing is that'll, that'll turn around, that'll come.

That you deserve to at least have the conversation. And there are safer and less safe ways to deliver testosterone. And you, there are definitely side effects that you potentially can have if your levels get too high. So you have to go to someone who is doing it for responsibly and checking your levels and making sure because you don't want hair loss on your head, you don't want that hair growing places. You don't. You don't want to have your voice change and what, have acne. So you. Yeah, you have to be. It's. You have to view.

Nobody wants hair loss.

Yeah, that's already coming with perimenopause.

Yes. And again, there are ways of managing that too. That's a whole. Another conversation. But. So, so, yeah, it is. It is reconnecting and seeing which part of it is. If it is just the desire. Is it desire that's bio. That's biologically mediated, or is it the loss of.

I think, I think you're hitting it on there because the. So if somebody is listening to this and wanting intimacy and, and sexual activity and so forth back. Yeah, there's. There's a few points, starting points, and you're exactly right. Would it be physical? I mean, is there. Is there a problem physically? Am I depressed? Is it. Is it a. Is it closeness?

Is it. I'm just not sleeping.

Right, right, right. We're kind of jumping all over the place. But to, To. But we're hitting on all the points and, and to find your starting point, to find where it is that you are. Wow. If I, If I start on this path, then it will lead the right direction. Is a. Yeah, it's. It's. It's really important in how quickly this can turn around. And you take something just as simple as couples counseling. Man, you talk about that is that is the type of counseling that gets the most results the quickest. I mean, you can. You can do. You'll hear about folks that are going to individual counseling for years, and you'll hear about some couples, but it's more of a maintenance. It's more of a checkup. It's more of an oil change. It's more. But, but gosh, there is. There can be a. A lot of work done pretty, pretty quick.

I feel like two women in midlife and just from talking to other women at this point in life feel stuck. Like, they're like, oh, like it sounds like, you know, I've got a plan or I've talked about this, but, like, I can't even just make that first step. So what kind of advice would you guys give to them if they feel stuck? They want the change, you know, they want it to happen, but they don't even know how to do it or where to start or where to begin.

From the sort of other side of the coin, I have a big group of lucky to have some good friends in town and so forth. And and let me tell you six months ago if you had told me I would be giving giving talks on menopause I yeah they probably wouldn't wouldn't have believed you. And again it's not me that I'm more talking the the every man and the and the and the couples part of it but so many of them even though everybody made fun of me so many of them have come to me and said and they come to me individually and I mean it'll be in a bar or something and they'll say hey listen, yeah it's time to go to bars. Oh yeah.

And watch Philly's lucky Ham.

Gosh, I wish I had that time. Yeah. Anyway, back to me the no but people will come they'll come up to me and they'll say hey my wife is or my wife's having pain with or da da. Or is there something that can be done and and both of them are afraid to ask the question. I mean it's it's. And so where to go first would probably be the, the answer and and I I would imagine, I would imagine your physician and just kind of yes.

You would think but I have seen many many women who have gone and it's been dismissed. I had one person who told me that she went to a older male physician who and she was having pain with intercourse she needed. She asked him about vaginal dilators and he said well your husband's walking around with a vaginal dilator in his pants every day.

Oh my God, no no, no.

And so that kind of dismissing it it's hard enough to bring it up but you the fear of being dismissed is horrible. And so there are a couple of places that you can go for more reliably be able to get someone who is educated in contemporary menopause care and sexual health. 1 It would be the Menopause Society website for look to find a provider the Menopause Society is people who have done extra education specifically to address menopause. And then the other the second one and I think for sexual health is even better which is the International Society for the Study of Women's Sexual Health that is the organization that does research promotes research and and evidence based care is the International Society for Study of Women's Sexual Health which is is which which just you know super rolls off the tongue ISS W S H do Org and so that you and find a find a provider but they also have a a site that is for patient facing education called PROA. Again I don't have no Idea why that. What that name comes from. But it's. But the issuance will is a really good resource and it's gonna. Yes. And they have. They have people that are gynecologists, pelvic health, sexual sex counselors, all of these things. And then if you're looking more for a psychologist, actually, don't you think like Psychology Today, believe it or not, has a website and. And it's very helpful of putting in what you're looking for. So looking for OCD or you're looking for the. That I'm eye movement kind of what is.

Yeah. Or test.

Whatever you're like. Then you can say, okay, I want someone doing couples therapy or sex therapy. And you can find that.

Yeah, it narrows it down. And every psychologist and psychiatrist are. Are on it or on psychology because. Yeah, yeah, yeah.

So. So trying to find the resources that when you don't know where to start.

Right.

Is that those would be some places where you can say, you don't have to do it on your own. You don't have to figure it all out on your own. There should. There are people that can help you with that and try to figure out what are the right hormones. Do I need hormones? Do I need something different? But that's it.

Yeah, that's.

Yep, yep.

You're like, that's it. That's where you go.

That's all I have to say about that.

So let's talk fantasies. Because fantasies are a big part of intimacy and sex. You know, everybody probably has some sort of a fantasy here and there. Do you think it's a good idea for couples to show. Share fantasies with each other or is it better to keep it a mystery?

So to talk about them with each other, their fantasies?

Correct.

Oh, no, absolutely. I mean, communication would. Yeah, yeah, yeah. I mean that. I. Well, in talking to a lot of couples, it's. It's amazing how simple sometimes some of the fantasies can be and they have not shared it. They. They just. They haven't shared it with their partner. And so. Yeah, I mean, you're just kind of adrift if.

If you wanted those things you're talking about. I guess there's different types of fantasies that you. Because there's ones that can be realized with your partner and then there's things that are going to be things that are not that don't involve your partner. And so. And I think that. I would think that some people may not be. May feel threatened by that. There may be something.

Oh, okay. Yeah.

Oh. I always think of my ex Girlfriend when I'm having sex with you.

Yeah.

Yeah. That's probably not what you want, right?

Yeah, I would be careful. Yeah. No, but yeah, yeah, yeah. But if it's, yeah, if it's. I've always wanted to do it at the beach or something like that, you know, then absolutely you gotta, you gotta let them in on that. But it's a pretty, the thing is that with, with a couple, I think that most people have a pretty, pretty clear line of what, what would be crossing and what would make them uncomfortable or what would hurt their feelings or what would do something like that.

Yeah.

And I guess it's something you. Yes. You can pick and choose those things.

So sharing to a point. Yeah.

But I think that one thing that I do we see that's an important tool for in midlife is you do when you lose your estrogen, one of the things you lose is that dopaminergic control of, of executive functioning. So people that have ADD before menopause, it increases by about 60% which is horrible. And then, and, and then if you have, if you didn't it you, it increases by about 30%. And so when you look at one of the things that's really interesting nerdy like this is that when you look at functional MRIs where that light up different parts of your brain when they're stimulated and if you look at ones because they do do this where they have it where people are having sex and in an MRI machine which who doesn't have that fantasy but, but they have. So when they, when they light up, light up during sex and then in orgasm, you cannot have this part of your brain, the frontal L, which is in, in charge of keeping everything organized and executing things has to go completely dark to have an orgasm. When you look at it, it's, it's like not functioning.

Which is why it's so easy for men. Yeah, our brains just stop.

There you go. You said it.

So, so if you are someone who is struggling with controlling and that, that, that part of your brain is just firing off, firing off all the time, then you, then it's going to be harder for you to have an orgasm. And that's part of why one of the reasons that women can have find it harder to orgasm in midlife. And so one of the things that, that we talk about is how to override that. And I promise I'm bringing it around is that some sensate focus which is just concentrating on the sensations and it, and focusing on the sensations is one way, but also fantasy can also be an important tool for midlife women to use when they are in the midst or trying to focus on there to get to orgasm. Because that. You need to occupy your brain a little bit and get it to focus not on, you know, do I need to pick up the dry cleaning? Or you need it to focus in on something that's internal to the situation so that you can actually get to orgasm. And so fantasy is an important part of thing of, of midlife sex. And whether that that fantasy is something that you feel comfortable sharing or not, or if you're like, I'm just going to keep this into. Because it may be like, I'm not thinking about you at all. That may not go over real well. But it, but it's. It is. I want to be intimate in this moment and it's hard for me to stay focused. And that's a, That's a whole other thing anyway. So that's. That's my take on, on that.

When we're going into our OB GYNs and our GPS, are there any like, tests that we should be asking them for? Like that we could test like our sec. You know, sexual health and you know, from that end, like, is there any. Are there any specific tests that we should be asking?

Well, there's a few things that I. That come to mind that is just that you really need. If you're having any pain or you're feeling it, they really need to look and try to help you figure out where is that pain coming from. Is it just superficial pain because you have a little. That you need some estrogen or has it. A lot of times you'll have that, that if you have any dryness, even intermittently, your muscles are like, well, keep that thing out of there. And so you get a lot of muscular, hyper. Hypertrophy where the muscles cannot relax. And so people are like, well, I'm using lube, but that it feels like he's hitting into a wall. Because it's. The muscles of your pelvic floor are so tight. And so you need your doctor to be like, okay, is this just a superficial problem or is this. Do I need to see a pelvic physical therapist to help with a muscular problem? And so, so that's the first part. It's just. And are there. What's going on with the clitoris? Can you even see the clitoris anymore? Is it just. Is the clitoris so diminished that maybe I need to use a little. I need a little estrogen testosterone to the. To around that area to Try to help with that. Are there adhesions around the clitoris? A lot of people aren't even looking at that. And they say if you're, if you've lost your orgasm, that can be part of it. It just can be that the clitoris is, is diminished or it's, it's adherent to the tissue that it needs to be freed. So then, then we go into, and then to go in it a little bit further, you can get your, test your testosterone level and there's no testosterone level. That's like this is exactly where it's supposed to be. But if you see that it's undetectable. I mean I'll have, I'll test people's testosterone and it'll be like, okay, well you have essentially none. I mean, so then that way, like, okay, well maybe this would be helpful. It's at least something we could try. And then, and just so these are, that would be where the. A testosterone, sex hormone binding globulin, which is another thing that's too complicated but needs to be tested as well. But it binds up your circulating testosterone. So even if you have testosterone, it can't fit into the receptor. It's like it's wearing a sock. So it's like. And so those things can be helpful to try to see if it's a biochemical problem, is it a structural problem. And so I think that's it.

And so, and back to what you said about make sure that you go to a doctor that knows to test these things, that, that is familiar with all of these.

Yeah, that's one of the craziest things is that you go to a doctor sometime and they know nothing. Like an OB GYN sometimes knows very little about menopause. And, and really to no fault because in med school it was not really taught when they were in med school, was it?

We had, we just hired the most lovely new resident and for our practice and she is delightful and she's fantastic surgeon and she is an amazing obstetrician and delivering babies, she can take care of any high risk thing. She knows almost zero about menopause. So she's always coming down the hall to me be like, hey, I have this person, can you teach me about this? And, and I'm happy to do it. In fact, she actually had a baby two days ago and I brought her a little packet on menopause for her to look at while she's on maternity. She's like, oh, I was expecting like maybe a cute blanket, but thank you. This is Take this packet on minimum. So it is. This is a person who just finished residency in July and from a very good training program. But it is a lot to pack in. And it's so much. It's so much more nuanced. If there's a bleeding uterus and you take it out, it stops bleeding. So you've solved that problem. But this is. It's so much more nuanced to teach people about how to take care of menopause and perimenopause. It's really. You can't do it in one lecture. You can't do it in. I. I went to Iswitch, which is a really fabulous learning society, and I went for several years before I felt like I was even starting to get capable of. Of treating my menopausal patients.

When Kate took that pamphlet on menopause to the doctor and she handed it to her and then also made her cut off the Phillies game so that she would read it.

Yeah, don't pay attention to this cute baby. I want you to look studying.

Now's the time for work.

To be fair, it was just coincidence. I had that packet for her already, but I was like, since I'm here.

Yeah, yeah, yeah.

Here's your little light reading. It's fine.

Yeah, that baby's gonna be asleep in a good bit of the time, so. And you don't need to sleep with babies. Be studying.

Go to somebody that knows. Knows what they're doing. Yeah.

So, absolutely. You know, I think. I think to women, because our bodies are changing so much, like, physically, just the appearance of our bodies, that also becomes such a mental block with sex and, like, intimacy, too, because you kind of look at yourself and you're like, this is not my body. Like, this body is, like, different than when I was in my 20s and 30s and even early 40s. So what do you say to those women that feel like, the loss of confidence even within their body to kind of put it all out there, even with their partner?

I have asked. It is. It is funny. I have had women complain about In. In. In therapy and with the guy sitting right next to him who's just holding up his hands and saying, I. I like the way you look. I don't. I don't know what else to say. I. I like, you know, how. How. How you look. And we. We were talking with. On. On another podcast, a comedian that's. That's our age, and he says. He says, I. My. He was on the algorithms of. Of dating websites or whatever, where it was sending him 20 and 30 year olds and. And. And he just kept flying by him and then it. When it was somebody 50 that he stopped. And so I think partners as they get older also like. Like somebody the same age. I don't know. I mean speaking for men, not all of them but I mean it's. But I mean it's gonna be. Yeah yeah yeah. But to have the confidence. Gosh, confidence. Just confidence itself is sexy and and to. And to. To maintain that. And a lot of times again guys will feel helpless because wait a minute. I like the package. I like how. I like how you.

Well I. So I go back one of the fit my favorite old country songs with as now. I guess it's very. It's old but Randy Travis had that line in one of his songs that said, you know, I didn't fall in love with your hair. Right. So that. And it's. If it is something that is forever and it's not the person you're not in love with. You know, if you have. If you have a role or not don't have a role or what's appealing to you or not. Most of us are. Are looking for connection from sexual activity. You're looking for endorphins and release but you're looking for connection. And that body confidence is an important part of your own Libya for. Especially for. But understanding that. That your partner is really looking for that connection.

Right.

Not necessarily for just that that the.

Visuals perfect figure or whatever and.

But there is a but there is a whole. There's. It's a whole lot of changes and if I have patience we like a.

Little pat our precious metals. Feel free to steal that one.

Good point.

That's right.

I will.

Exactly Tina. So it. It is. It's. It is that but losing that confidence and you're not who you were and you're not look. You look at yourself and you're very be very judgmental. I'm actually working on a program for women for body confidence because it is such a. This time you do lose that body confidence and, and reconnecting with that is. Is really important. And how do you get back to appreciating what's going on in your. In your body and, and appreciating that is the beginning of confidence. Yes, but it is a pain when you have to buy new jeans because it's just a pain. Nobody likes to buy new jeans.

The weight shows up in all these crazy places. You know, it's like my mom called.

It the shifting sands of time. Yes.

So poetic.

Yes. Yeah, but it is. She's like, I weigh exactly the same. It's just not in the same places.

Yes, yes, it's true.

Metabolism does definitely changes. And it's. And it, it is. And that can't. Estrogen is, I will say that estrogen and, and progesterone and those contribute to those changes, but they. So helping to get the estrogen low estrogen can contribute to insulin resistance and there's a whole feedback system that goes into that. So people are like, now that my hormones are back where they were, why am I not losing all this weight? And it's because estrogen and progesterone and testosterone are not weight loss medicines. They can help to stop the changes in the metabolism that you have, but they're not necessarily going to have you help you lose weight. And so it will have to be looking at other increasing muscle mass and God, like, yes, I hear you eat more protein. But like, everybody's like, but it is. If you. For us to reset some of that set point, we have to increase our muscle mass and, and try to. And so that's why the resistance exercise, once you do, if you do choose or are able to do or hormone therapy or if you choose to, then that can be part of the toolkit of getting metabolism back. But it's not, it's only one part of that. And if you can't use hormone therapy or you choose not to, it's okay. You don't have to. You just need to know that you are going to have, you're going to have to address your insulin resistance and, and glucose metabolism and those cholesterol changes in, in more aggressive ways and use other parts of that tool bit but toolbox in more aggressively. So you're gonna have to make sure that you build that muscle and really get to the point where you are increasing that metabolic set point.

I'm glad you said that because I think that's a big myth that's floating around is if you take HRTs, you're going to magically start losing weight.

It can help for some people, but it is not necessarily going to be the magic bullet. It's not the same as taking something that actually is changing your metabolism. And there are things, there are things, the GLP1s and things like that that are going to help to change that metabolic set point and really shift how your body is metabolizing. Should everyone be on a GLP1? No, they shouldn't. They should. There are lots of way. But it is one tool in the toolbox. Of trying to deal with the metabolic changes that we have and that are, are going to affect all of us because men and women have metabolic changes at this point in and they, that they're that are going on and we are not slapping an estrogen patch on him.

Right. Well, it's often women care more or seem to.

Yeah. But it is, it is definitely just, it's all, it's only one part. You can't out patch poor diet or change it. The changes that and then sometimes they're like I'm eating less than I ever have, I'm eating more protein, I'm doing all the things and you still may not be able to get the metabolism back. And so there are, that's a whole other nuanced conversation of okay, if I can't get it back with changing my diet then then where do we go from there? But I think that absolutely we know that estrogen has a, it affects the, the gut microbiome, it affects the glucose metabolism and lipid metabolism. And so when you lose those you're going to have to in some way address them in a different or you're, or you're going to have. Everybody's going to have that.

I'm nodding along as if everything she's saying is correct.

Yeah, let's hope it is. Right?

As if I have any idea what this is. No, it is.

But okay, let me tell you, I will say I'm studying for a huge test that I'm taking tomorrow is the American Board of Obesity Medicine. And that's why because I felt like I had to know more about this. It affects my patients so dramatically at this point. And, and in the board this is how the midlife women are treated. Okay. So one of the questions was I'm probably they're really like going to not let me be board for certified for calling them out on this. But they say it says well this.

Will come out after the test.

Oh good, good. That's good. So the, it says a, a, a, a 43 year old woman because you give you vignette. So a 43 year old woman comes in and she is having sleep disruption with intermittent hot night sweats and she has, has these lab values, blah blah, blah. And it says she it what are these. One of the, what are the choices of treating this woman? It's like add back hormone therapy, have her run more or you know, change her diet. And so then it goes and the answer was have her exercise more, whatever. So and add more protein which is not bad. I mean that's not bad advice. It's part of the toolbox. But when you go to the explanation of what below it, it says the average weight gain for women in midlife is between 6 and is between 6 and 20 pounds. And so this is expected weight gain. So you should not add back hormone therapy, even though we do know that it changes your glucose metabolism because it is not indicated unless she has other menopausal symptoms.

So until like, until she gains £20, until she gains, we won't worry about.

It or more, more than 20 expected. And it's expected. And so what they're saying is what other disease or, or metabolic state would they say? We know what will help fix this. Your thyroid is not working and that's why you're gaining weight. But we're not going to give you back thyroid hormone because you haven't gained £20 yet. Even though you're, we know you're on your way to that. We're not. So if they know, they know that this is. Impacts your metabolic health. But for some reason the medical community has decided that it shouldn't be treated. But they don't do that with any other type of medical problem. They don't say, we're just going to sit back and watch this. We're going to let you have a little bit of asthma and not, but not treat it.

Right. Or any mental health thing and watch.

You suffer, you know, Watch you suffer. Yes. Yeah. So anyway, sorry about that. Was a little bit of my soapbox on, on what you're battling out there because they're like, oh, well, yes, I'm.

Glad you're bringing that up because I had Dr. Louise Newson on the show a few months ago, who's out of the uk, who's amazing and she said the same thing. She's like, in what other world. Yes. Would, would they would watch a woman for six months suffer and not do anything about it or even longer, you know, and just kind of watch, you know, it just, it makes zero sense, you know.

Right.

So for the women out there that are listening right now that want to do like a change, you know, like do something to not night. What can they do? What are like three things that they could do to help with their sexual help, their connection with their partner, you know, the physical, the mental, emotional. What are like three key tools that they could do?

I, I would, I, I think one of them is going to be sleep the hallelujah. Yeah, yeah, yeah, yeah. Just get, get enough. No, I would go back to the, the, the intimacy all day, every day. And, and just the connection with, if you, if you're, if your spouse or if you ask a question, don't answer the question while looking at your phone. Don't feel, don't be shy about a pat on the bottom or a rub on the back or a holding hands or a sitting next to. Or. Yeah, the, just the, the intimacy has to, has to be there and be alive and, and, and be healthy. So that would be my answer.

Yeah, I, I think it would. If I would say anything, it's. You just want to know that it, that it's important. Just express that it's important to you. Say, hey, I know that I am struggling with the, with I haven't been able to have an orgasm or I am having some dryness. I, I really want this to be a part of our relationship. And even if you said, just even saying that, like you said, any, any effort at connection.

Yeah.

Or, and it is, is, is a tremendous step in the right direction because it's just showing that you, that's, you know, it's valuable to them, but it's also valued. Valuable to you. And so that the fact that you want to even work on it is going to be a big step, but it, and it lets you even say those words. And I think that if for women who feel like they don't even want to bring it up because that, that's not. It could. It's, it's a source of disappointment. Disappointing their partner or, or themselves. Or, or themselves. Yeah. That it is just to say, hey, I know that we're not going to fix this tonight, but let's, let's start looking into ways that we can't, we can fix. This would be the first thing I would do tonight. And then, then I'd say, are you still watching the Phillies game?

There we go. Here we go. Full circle.

Yeah. So just trying to.

I need another drink.

Invest. Invest in each other and invest into the relationship.

Yeah, no, it's a good point. And maybe even go in and see your doctor. Like go in and just have the, the full head to toe checkup. Make sure there's nothing going on like you know, in, in the body itself, you know, which is always helpful. So what, what advice would you guys give to your 25 year old selves?

Oh, Rogaine. No, I'm just kidding. God, that's a great question. 25 year old self, I would say. Yeah. Make sure that when you're 30, you reconnect with that cape girl.

That we met that you Met back, that I.

Met back when I was 21. Yeah. Make sure you do that. I think, man, that's, that's good. Well, yeah, there's, there's always things that you could have gone back and done better. I would, I would tell myself that of all the things in with your spouse or with your partner or with your kids, my only regrets would be I didn't do some things with them. So I would have invited them more on, I mean, just trips to Lowe's, just time together. Yeah, you don't get any of that back. And we did a pretty good job of hanging out together and having the kids with us and so forth and, but it's, yeah, I would, I would just go back and, and, and tell myself, man, if there's ever an opportunity to have them with you or to skip what you're doing and be with.

Them, I would, in terms of it being with a partner, I, I, my 25 year old self, I would say that in making sure that you, the things that, because when we talk about body changes and those things that the person that you're with look for the person who is going to, who likes the things about you that are never going to change. You mean, so you have to like about them. Like you think of the person you're with and then think of them as having none of the physical attributes that you like. If that, if the only thing you really like about them is that soul patch, then hopefully it'll still be there. But no, it was like if the only thing you like about them is the physical things, then you say, okay, I, I, those other things are going to go away. Who is this person?

What's going to stay?

What's going to stay? And if this person just think of the person that's, that's there and then think about them not, you know, like 25, 30 pounds heavier. And the things that annoy you now are going to annoy you like 20 to 30 times more. And so if those things are not outweighed by the, the things that, that you, that are valuable to you, then you need to just move on because don't, don't stay in a relationship that is not giving you what you need right now because those things are, that are going to get even more people. We all become more or more of ourselves.

Ourselves.

And I think that some of that does get stripped away in, in menopause.

That's good.

Yeah, it's like, so you're becoming like a more crystallized version of you. So. And, oh, and I would say do not ever drink green alcohol Slurpees. Those are a horrible idea. Don't ever do that.

Don't do it. You'll see it the next day and it's not pretty.

That's horrible.

The Mind Eraser. When the name of the drink is the Mind Eraser. Yeah. Yeah. Okay, okay. Solid advice from your doctor.

Right?

Oh, right. How are y' all living iconically right now?

Oh, what does that mean?

Like, what. What are our. What is our. Our driving. So are we. Are we living? We're. Well, we're empty nesters, so we can. We can ostensibly go and do anything anytime we wanted to, but we're. We have to. Like, we have a gimpy dog.

We have a gimpy dog. And. And we have a whole lot of responsibilities that we've taken on at work. So we're living less iconically and more ironically. We have all the time in the world to do something we're not used to.

We're like, let's start new jobs.

Yeah, let's start.

Let's go. Let's go ahead and give ourselves 18 more things.

Yeah. Yeah. Let's take a test on Saturday.

Yeah, let's get a new. Another board certification. People need and does nothing to further your career.

The. Wow. Wow. Somebody needs a session.

But the other thing I want to say to your point is invest in yourself because. Investing in yourself and your. Which is. And invest in your relationship because if you. The more you put back into it, the more you're going to. It's going to be there to support. Support you when you need it.

That's beautiful.

Yeah, good. That's a good point. You guys are so amazing. You gave me so much good, you know, information and knowledge. No doubt the women listening are gonna love this. So it's been amazing. Thank you guys so much for coming. Tell everybody where they can find you guys. I know you have a bunch of new projects coming up too, so feel free to share.

So we are in Charleston, South Carolina. But, and, and I. But we're really most available as heads and tails.

So it'd be heads and tails podcast dot com.

Yeah. And so we're on Instagram and on.

The TikTok and all the. And you can type in heads and tails in any way. You listen to podcast everywhere. Kind of the main thing.

Everywhere. The podcasts are heads and tails. If you put that in. And to follow you and to follow me, It's. I'm at Dr. Kate White OB GYN, but you can also follow podcasts at Heads and Tails podcast on all platforms and he's@charlestontherapy.com so good.

Yeah, I've been listening to your guys podcast. It's so good, so informative. Yes, absolutely. So everybody should listen to it. You will learn so much about your body, your partner, communication, like all the good things. So. And I know you guys just got back from Dr. Kelly Casperson's amazing event. I'm sure it was great. So you guys spoke on the panel and everything.

It was first place.

Yes. And her, her new menopause book is wonderful and, and, but the New York you are not broken. If you, if you haven't read her book or listened to her podcast, it is amazing and it really addresses all kinds of sexual health problems and so much information there. So that's great.

Great. Well, everyone listen to Heads and Tails. It's a great show. They're also fellow Southerners like me. We always love that.

That's right.

Thank you so much.

Well, take care and. And we'll. We just had a great time, man.

Thank you. Thank you.

Okay, I hope you're walking away from this conversation with more than just ideas. I hope you feel seen, empowered and maybe even a little inspired to schedule a no pressure connection building moment with your partner tonight. Huge thanks to Dr. Kate White and Jay White for bringing the real talk, the clinical truth and the relationship wisdom, along with the laughs and a few blush worthy moments. If you loved this episode, do me a favor. Favor tap. Follow on the iconic midlife. Share this with a friend who needs to hear it and leave a review telling us your biggest takeaway. We read them all. You can find Kate and J at Heads and Tails podcast. And of course I'll drop all their links in the show notes. Until next time, keep redefining what midlife looks like. And remember, it's not about fading away. It's about showing up louder, bolder and more connected than ever.