Sex, Menopause & Feeling Like Yourself Again | Dr. Caissa Troutman - Coffee With E

Episode Transcript
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Erica Rawls (00:00):
Hey you! We're talking sex, we're talking
hormones, and we're talking whyyou're not crazy.
I sit down with Dr.
Troutman, who is a quadrupleboard certified hormone
specialist, and she is sharingall.
You ever wonder why you just nolonger feel like you want to
have sex ever?
She's gonna break it down.
And after watching thisepisode, you just may have the

(00:22):
answer to start feeling likeyourself again.
Today's roast, stop feelingashamed about the way that
you're feeling, your insides,your hormones are going crazy.

(00:44):
Did you ever think that you mayneed hormotherapy?
I mean, I know that we don'ttalk about it a lot, and it's
something that we should talkabout.
It's one of those things whenyou go through menopause, it's
one of those things that yousay, um, you know what?
You'll get through it.
Your mom probably said it, yourgrandma probably said it, or
your aunt said it.
Oh, honey, you'll get throughit.

(01:05):
Those hot flashes, oh, that'sjust part of being a woman.
Guess what?
You are a woman, and it doesnot have to be that way.
You are here on earth to liveyour best life.
So, how about getting thathormone therapy that you always
thought that you should have butdidn't know what to call it?
I gave you the answer.
Now go get it.
Well, Dr.
Troutman, I gotta tell you,I've been very excited about us

(01:28):
actually getting togetherbecause of what I know to be
something that's the topic we'regonna have a couple today.
It needs to be had.
And I know you've been having alot of conversations with women
just individually, alsoprobably at workshops and all
the things.
And that is menopause.

Dr. Caissa Troutman (01:49):
Yes.
Menopause and perimenopause.
Yes, which is which isfrequently like confuse or kind
of merge together, I think.

Yeah, yeah.
So let's get into it.
So let's define perimenopauseand then menopause, and then
we're just gonna have a chatabout both of them.
Love it, yeah.

Yeah, and I think that's the best way to
start is to start with facts,right?
Um, so did you know thatmenopause is actually one day?
Huh?
Yep.
Menopause.
So that's that's the fact,right?
You can start off facts.
How about it?
So menopause is literally oneday, which is literally the day
that is 12 months after awoman's last menstrual period.

(02:28):
Really?
So the life uh after menopausetechnically is a post-menopausal
period.
And the life before that oneday is technically
perimenopause.
Okay.
So do we know what that one dayis?
So unfortunately, it's a veryrear-view mirror diagnosis,
right?
Like today, let's say uh Iwould not know from today when

(02:52):
I'll be in menopause.
So it's very um, again, rearview.
Like you'll only know when youyou are 12 months after this,
after your last period.
So I so I actually havepatients that say, 11 months and
22 days, like they're not, thenthey're not in menopause yet,
because technically, you know,they're still in that
parametopause phase.
So that's I think that's let'sstart with that.
That's the one thing.

(03:12):
Now, of course, that definitionwill only be applicable to
women that are actuallymenstruating, right?
So there are women that havehad a hysterectomy, had
something called an endometrialablation, where they really
don't have, or as someone whohas an IUD, um, which means they
don't have uh regular cycles orthey don't have cycles.
So for them, it's a lot harderfor them to know whether they're

(03:33):
in quote-unquote menopause.
Yeah.
Whereas perimenopause, again, itis um the number of years
before menopause, aka thetransition years from
reproductive years to tomenopause.
So again, this is definitionslooking at women really from a
reproductive standpoint, whichis which is something I'm like,

(03:54):
um, which is how we'vetraditionally defined it.
Um, but I think now the the theyou know, one of the things we
talk about, the one of thethings I'm very passionate about
talking is having womenunderstand the symptoms that
happen both in perimenopause andmenopause, because they are not
necessarily just about ourperiod.

So at what age can someone start like
perimenopause?
Love that question.
Yeah.

So let's talk about averages.
So in the US, the average ageof perimenopause is 51.5 years
old.
The average age ofperimenopause is 47.
Oh.
Okay.
However, average age, so thatmeans that you could be in your
20s and start perimenopause.
Well, so so um definitely canhappen in your 20s, but the com

(04:40):
the earliest start of normalperimenopause is 35.
So 35 and over, if you'rehaving some of the symptoms we
attribute to the um symptomslike brain fog, uh anxiety,
irritability, mood swings, andof course irregular periods, you
could be in parametopause.

Okay, okay, Dr.
Chalman.
Okay.
I had to take two seconds tointerrupt this episode.
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Now, back to the show.
Anxiety, brain fog,irritability.

Yeah.

If you're in your 30s, 35 and over 35 and over,
you're thinking you're goingcrazy and you're going to a
therapist first.

Yeah.
Yeah.

Want to get medicated.
Is it possible people aregetting medicated with like
anxiety medication and it'sbeing misdiagnosed that you're
just going throughpre-menopause?
Yes.
Perimenopause.
Is it pre-peri.
Perimenopause.
Okay.
Yeah.
Throughout this wholeconversation, I'm going to mess
it up and you're going tocorrect the day.
Totally fine.
Okay.

So yeah, so so let's so again, let's look
at menopause is that one day.
Yes.
Perimenopause is the years oftransition, transition years,
where you're still getting yourperiod, but you could have you
could be exhibiting symptoms ofperimenopause.
And um the way of kind of how Iexplain it to my own patients
is estrogen is not just areproductive hormone.

(06:26):
It's not just a sex hormone.
It's a hormone that isaffecting our entire body from
our brain to our heart to ourskin to our joints.
Okay.
So it's kind of like for thethis is how I always kind of
mention it too to my patients.
Like, you have an amazingassistant, right?
Yes.
And when your assistant goes onvacation, what happens?

Lord Jesus.

Right?
Everything is thrown into trynot to call.
Everything is thrown intochaos.
Yes.
So estrogen for our braincells, for our neurons, is like
it's a CEO of our brain.
Okay.
It's the it's the bestassistant that your brain has.
So when your estrogen goes onvacation because of what we call
the zone of chaos, where yourhormones go down and up, down

(07:09):
and up, um, it's not yourbrain's not working anymore.
So I always discuss it ordescribe it as the brain breaks
first on perimenopause.

So is it possible that we just need to get more
estrogen when we're goingthrough these phases?

Or yeah, I think it's it's I think
everybody, I think first thingis we want to understand what is
normal.

Yeah, what is normal?
Let's yeah.

And the normal is is is literally the
zone of chaos.
Oh jeez.
It literally is.
Like one day your estrogen canbe if you're in if you're 35 and
over, if you're exhibitingsymptoms of what I just shared,
um, in if we look at thehormonal status, the levels,
right?
Today you could be a low andthen went Friday, right?

(07:51):
Mm-hmm.
On what on Monday you could besuper high.
Okay.
And then on the next Wednesdayit could be low again.
So it's really like the up anddown.
Um and I usually kind of have agraph which makes it easier to
explain because visuals are arewhat uh very powerful, right?
Yeah.
But suffice it to say thatreally again, perimanipause is
literally um chaotic, both inour hormonal levels and how we

(08:13):
feel.
So going back to your questionearlier, like um, you know, a
woman 35 and over has stress andanxiety, I I think it's again,
just like anything else, it'smultifactorial, right?
Like the stress we all have,the lives we lead, the the
hustle culture, the the sandwichgeneration, right?
Taking care of kids, takingcare of older parents or loved

(08:35):
ones.
Um, all the but if you and thenif and then you layer in like
perimenopause and the up anddown of hormones, um, it just
makes it so much harder.
So yeah, now we know there'sactually research now.
There's uh studies that showthat for women struggling with
depression and anxiety and thenthey're a peramenopause, um a

(08:57):
good treatment would beconsidering hormone therapy.
Now, again, it's a very nuanceddiscussion, right?
It can't be like everybodyshould be on hormone therapy.
Yeah, I wouldn't say that, butI think um if they're exhibiting
other symptoms.
Here's what I found.
Look, it's they foundsomething.
Serious, so annoying.
But but and I can tell you likeuh my own patients, right?

(09:21):
I have patients that come to methat have significant some of
them have never had anxiety intheir whole life.
And then when they hit their30s, 40s, just anxiety out of
nowhere.
And anxiety, it's notnecessarily panic attacks, but
just like overwhelming umuneasiness, kind of rumination,
thinking about like having tothink about several things.

(09:41):
I've had patients thatliterally had the million-dollar
workout, like go to thecardiologist, go to the ER
because of the anxiety, and somesome of them would have the
panic attacks.
Thankfully, all their cardiactesting were all normal, right?
And then once they startworking with me, I mean, like,
oh, they come back and like,yeah, my anxiety is controlled,
my depression is controlled.
It's it's it's solife-changing, basically.

So then the hormone therapy, like what does that
consist of?

Yeah, so um we would normally describe
menopause hormone therapy as uhgiving patients back estrogen
and progesterone andtestosterone.
So all of these are hormonesthat our na our bodies naturally
produce.
So we would utilize, I usuallyI prescribe FDA-approved
bioidentical hormotherapies.
Literally means biologicallyidentical to what your body, um,

(10:31):
our bodies used to give uhproduce before.
So we're just giving it alittle bit back, not super high,
just a little bit back torelieve the symptoms um and make
us really feel better.

So, what are some potential like side effects from
it?
Do some people have adverseeffects to Yeah.

So again, nuance discussion.
We always want to uh thisdiscuss the patient's yeah, but
we always want to look at thepatient's medical history, their
their their underlying medicalissues, their underlying kind of
um concerns.
Um but really the only kind ofthe there are of course any
medication the side effects,right?
The the most common sideeffect, number the most common

(11:11):
um concern, I should say, is therisk of blood clots.
But I always like to put itinto numbers that my patients
understand.
Okay.
So every woman has a umbaseline risk of blood clots,
like three out of 10,000 womencan have a blood clot.
Did you know that birth controltriples that being placed on
birth control, the patient'srisk goes up to nine out of

(11:33):
10,000?
Really?
Um, oral pregnancy will bringit up to 20 out of 10,000.
So those are again natural lifestates or prescriptions that
will increase our baseline riskof blood clots.
So if you have a child, yourbaseline risk is higher.
During pregnancy.
During pregnancy.
Okay.
And actually the risk is higherpostpartum.

(11:55):
The risk post spartom is 65 outof 10,000.
So oral.
We have postpartum depression.
So that's so postpartumdepression is another
transition, right?
Where your hormones are kind ofover.
Okay.
Yeah.
So yeah, make definitely makessense.
Um oral um hormone therapy,their risk is four out of ten
thousand.

(12:16):
Okay.
Transdermal.
So again, it's transdermal isum a route of giving hormone
therapy back.
So that's the skin.
So so the studies have shownthat transdermal estrogen,
transdermal hormone therapy,their risk is the same as
baseline.
Okay.
So again, nuanced discussionbecause there are different
types of hormone, there aredifferent routes of delivery.

(12:38):
So um, but and a lot of peoplekind of confuse that.
Well, they say like birthcontrol is hormone therapy.
So, yes and no, birth controlhas hormones in it, but it's not
the same as bioidenticalhormone therapy.
And as I just share with thatkind of statistics, actually,
with birth control, the risk ishigher for birthday.
But you don't see thatadvertised or talked about, you

(12:58):
know?

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(13:20):
So I want to stop for a secondbecause this is amazing.
How in the world did you end upin this field?
Like what brought you to this?

Yeah, so what's interesting about my
personal and professionalpursuits, they actually really
like merged.
It all started really with whatwas happening to me, you know.
I've been a physician for 20plus years, and um, you know,
I've I've taken care of womenwho um were going through their
own like life.

(13:51):
And in the past, I I did say,here's an antidepressant.
Yeah, in the past I did say,um, you know, hormones are th
are scary, but it didn't itwasn't until it started
happening to me, um, myparamenopause journey, that um I
had to like figure out what wasgoing on with me.
So for me, my story, you know,I was at the peak of my um

(14:15):
physical health.
Uh I lost a bunch of weight, Ilost like 50 pounds, I was
exercising right, I was eatingright, right, you know, I was
eating healthy, but I wasn'tsleeping.

Really?
Yes.
So you lost weight.
Oh, yeah.
That was So you were, okay.
I call that fortunate because Iwas the person that never had
to work out.
I did, but you naturally hadthe athletic body.
I um never really gainedweight, could eat whatever you
want.
Yeah.
And then all of a sudden.

Yeah, so that the uh a sentiment echoed
by a lot of my patients.
So my story's a littledifferent because I've struggled
with weight my entire life as akid.
So up and down, up and down.
So I would lose weight when Iwas on point, would regain
weight back plus 10 poundsduring my medical residency,
during medical school, aftereach pregnancy, I would also
lose weight again.

(15:03):
So I had that yo-yo umrelationship with my weight for
the longest time.
Um, but then there was a timewhen I, you know, again, um,
when I applied the modernscience of weight, what I what I
actually do right now with myown patients, um, when I started
applying it to my own life,that's when I had that, you
know, sustained weight loss.
But again, despite doing allthe right things, I I wasn't so

(15:24):
for me, the issue my issue wasnot that I couldn't sleep, I
could fall asleep, but I wouldwake up at 2 a.m.
and 3 a.m.
and couldn't go back to sleep.
Really?
And I and I um dealt with thatfor years, you know, for like, I
don't know, three and again,it's like, you know, because uh
of my my br my inquisitive mind,I'm like, I gotta figure this

(15:46):
out.
So I did everything.
I did alternative medicine, um,I did ashwagandha, L-theanine,
lavender, uh, melatonin.
I did all that.
I I mean everything.
You're calling me out.
Don't even yell it.
I did um, I got counselingbecause I thought I was just
stressed and depressed becauseyou know, why am I up at 2 a.m.?
Must be anxiety.
Again, um, I was onprescription medicine for

(16:10):
anxiety, and I actually asked mydoctor about it because I was
like, I need to sleep.
What's going on with me?
Must be it must be stress.
And again, very understandable,right?
I was at the height of mymedical career, I had kids, I
had my I had life, and of courseit must be stress, you know,
right?
Yeah.
How can you tell?
It's so hard to tell.
Um, and then I so I didcounseling, I I did um, what

(16:33):
else?
Oh, I got into coaching.
So um I currently I'm atrauma-informed coach right now,
but back then, uh I that waswhen I first kind of figured
out, okay, uh thoughts can helpme change my life.
So I got into coaching, becamea student, and joined groups,
hired a coach.
Um, and what else I do?

(16:54):
I also got certified incognitive behavioral therapy for
insomnia, which is uh thenumber one gold standard for
treating insomnia.
So I did all of those things,and they're all amazing things
in itself, right?
But they were not really likethey didn't really help me
consistently.

So it's like putting a little band-aid over
it.
Yeah.
Yeah, but it wasn't reallysolving or resolving long term.

For me.
Right.
Now for some patients, they maynot, you know, one or two or
three of the many things I did.
Oh, by the way, I didn't evenmention all the shopping things
I did to help with my sleep.
I mean, you know, like No,please.
I mean, you know, that theother phone.
Like the the the whooshingsound, you know, like the apps,

(17:35):
like so many, so many.

Because again, this is so good because I'm sure
there's someone that islistening or watching this that
is doing that exact same thing.

Like seriously, yeah, I oh I hear
you, because insomnia is real,right?
And there's so many metabolicconsequences of insufficient
sleep.
Yeah.
So um, and I I love talkingabout it because again, it was
my own struggle.
But and TMI also at that time,I had an IED.
So I didn't know uh aboutperiods.
I never had a period, I didn'thave a period for the longest
time.
So to me, it really when Itried all those things and it

(18:08):
didn't, so this was maybe over aspan of like four years by the
way.
Because what I was doing thiswhile I was working, taking care
of my kids, you know, the thewhole life, right?
This wasn't like I was doing itin a vacuum and it was like
figuring out myself.
Like, so anyway, um, so I heardabout I think it was kind of
the star of a movement at thispoint, right?
List there were whispers ofsomething called paramanipause.

(18:29):
So I looked into it and Ithink, oh my god, this is
freaking it.
Like this is like this is it.
So um I got certified byManipaw Society.
I did a lot of like um umonline um certifications with
other physicians and other umproviders that um really are
passionate about women's health,you know, um, talking about

(18:52):
estrogen, progesterone,testosterone.
And again, I applied what I'dlearned to my own life and um
and then I am sleeping amazingnow.
That is a great thing.
Among other things, you know.

That is a so what I'm hearing you say is we really
have to figure out what ourbody needs.
And it may be the therapy,right?
It may be all those but wecan't lose sight of us as women,
we're built, we're verycomplicated, right?
Um, we can thank Eve for that,I guess, right?

(19:26):
So that's also what makes usamazing.
That's what makes us amazing aswell.
I think it's important for usto take the time to figure out
what is our body telling us thatwe need.
And part of that, I know myjourney's gonna be after meeting
you, is hey Dr.
Troutman, can I get anappointment?
I need to see, I need to seewhat estrogen levels look like

(19:48):
or you know what I'm missing.
Because for someone like myselfto start gaining weight, like
the bigger um breasts, you havethe the midsection, the belly,
the belly, yeah, you do all themental belly fatigue, yeah.
Forgetting things, just want toscratch people's eyes out when
they're talking, and they'rejust saying so nice words to
you, you're thinking, I couldjust scratch your eyes out right

(20:10):
now.
You don't even know that.
That's weird.

Like no, so and that's the key.
That's what I want to say toyour listeners is that this is
biological.

Yeah.
So we shouldn't be ashamed thatwe want to scratch somebody
out.

No, you shouldn't, you shouldn't be
ashamed.
So again, because the focus forthe longest time has been, oh,
your periods are regular, youmust not be in menopause, you
must not be in perimenopause.
That is actually not true,right?
So if we look at it from thelens of the symptoms that can
happen before the periodirregularity, we just recognize
that okay, this is this isnormal, and I can get help.

(20:45):
You know, so that's one of themain things I really kind of do
with my community averages islike let people know that
they're not alone, they're notcrazy, literally biology.
It's literally biology.
You didn't do anything wrong.
You don't need to have morewillpower, you don't need to,
you know, do more like deepbreathing, although deep

(21:06):
breathing is awesome.
Medication, those are again,all of them are awesome tools,
right?
This is not and I do all ofthem on a daily basis myself,
but there it's it's biology.
Like it's it's biology.
So start with biology.

Yeah, and science.
It's it's this is science.
This is not me pulling it outof a hat.
I think it's the not knowing.
Yes because I need to even knowsomeone like you existed.
Oh.
Right.
So when we're looking upsomeone like Dr.
Troutman, what are we lookingfor?
Are we looking for a regularphysician?
Are we looking for a hormonetherapist?

(21:39):
We're looking like how do wefind you?

Yeah, um, I mean, I think you would want
someone who's competent, right?
Who knows what they're doing.
Um, so usually that would besomeone who's gone through the
menopause society, then thecertification.
Um, in you know, we havemenopause.org is the website
that you can find someone closeto you.
Okay.
If you're in the state ofPennsylvania, I would love to

(22:02):
help you.
Yeah.
Um, and I think you also wantto have someone that's
compassionate.
Okay.
Yeah.
I mean, they don't necessarilyhave to have your a specialist
in hormones.

Or like what is are you a general physician?
Are you a specialist?
Are you one of the above?

So I'm a so I'm actually uh I'm a quadruple
board certified physician.
So I'm board certified infamily medicine, obesity
medicine, culinary medicine, andmenopause society.

That's great.
In central Pennsylvania.

And Pennsylvania.
So I'm licensed in the state ofPennsylvania.
In the state of Pennsylvania.
So I have patients inPittsburgh.
I have patients, you know, um,so as long as you're in the
state of Pennsylvania, okay.
I can see them virtually or inperson.
In I my office is in Camp Hill.

Yeah.
Well, I have a feeling after usairing this um episode, just
based on just the things thatI'm seeing on Facebook or social
media that is in my community,that they are going to be
calling you.

Like seriously.
I'd love to help.
I mean they're going to becalling you.

Yes.

You know, I think it's it's about time for
women to know that what they'regoing through is is normal,
right?
Um, and that they're and thatthey're not alone and that
there's a solution for it.

There is a solution.
So the signs for someone that's35 or older right now is if
they're moody.
So so many.
So many symptoms.
But yeah, too.
There's so many.
So what are the okay, the tops?
Can we talk top or something?
Absolutely.
We could talk.
Yeah.
So and what is such aphysician, by the way, just the
way you're like, no, wait, let'sjust make sure we clarify this.
These aren't specific.

(23:35):
There's so many.
So I don't want you to thinkit.
Yeah.
So I understand.
Yes.

Well, here's what I will use a study.
Let me share let me share aWomen Menopause Society um
Menopause Journal published astudy 2024 on how women present
it to their providers.
Um, these were women aged 35 to55.
Okay, 35 to 55, got it.
And they present it to theirproviders saying, I am quote

(24:02):
unquote, not feeling likemyself.

Not feeling like myself.

Well, we call it NFLM in our in our
circle.
So that's an NFLM, not feelinglike myself.
So that's a very general term,right?
But people don't come into thedoctor's office saying I'm in
parameters.
Maybe some who've done someadvanced reading, yeah, but for
the most part, women say I don'tfeel like myself.
Yeah, we're not.
I'm a shadow of who I am.
Yeah.
I'm not the I used to be morepatient, now I'm snapping at

(24:26):
everybody.
I used to be able to do, youknow, five tasks well.
Now I can barely finish onetask.
I used to be able to loseweight without doing anything,
and now I can, you know, now Igain weight sitting and staring
at the table.
Like so many.
So basically a change of whothey are.
And in that same study, butthey they try to quantify what
NF not feeling like myself mean,meant.

(24:47):
And there are five topsymptoms.
Okay.
Already.
Okay.
I'm gonna start with the flow,the fifth.
The fifth is difficultyconcentrating.
Okay.
All right.
So people would dis describe itas brain fog, or just again,
multiple tabs open in your brainand like unable to finish the
task.
I always like to describe likethe computer, right?
You have like five tabs, or inmy case, I have 20 times two,

(25:10):
because I have two screens.
Yes.
Yes.
And you're not able to finishone task because you're like
flip, flip, flip, flip, flip,right?
Wow.
Okay.
So that's one.
The fourth one is anxiety.
So again, not anxiety attacks,although some patients do suffer
from that.
Um, and and by the way, anxietycan be someone who's never had
anxiety before and now have itin their in their peramenopause,

(25:32):
or someone who's been stableunder meds.
They've had long chronicanxiety and they've been stable
under meds.
Um, and then all of a suddenit's not controlled.
Same thing with AD withconcentration, by the way.
I have ADH patients that sufferfrom ADHD that um are labeled
ADHD in perimenopause, whichlikely may not necessarily be

(25:53):
that, but more paramenopausalchanges.
Yeah.
Or patients have been stableunder ADHD regimen for most of
the years and then come 35 andover, the meds are not
controlling it and they have toum increase the dose and so on
and so forth.
And I have a similar semi somany patients that once they
worked with me and we'vestabilized their hormone, like
they've actually gone back down,you know.

So anyway, on their so good.
Yeah.
We're not done that though,because you said I know there's
three more.

So three is um I know it is low feelings.
Okay.
So again, not depression,right?
Just like low feelings, nomotivation to do what they no
used to do.
Um just blah.
You know.
Second is overwhelm.

(26:44):
The feeling of overwhelm.
This difficulty with coping.
I mean, you know, when I readthis study, I was like, yeah,
check, not me, check, check.
And then number one symptomthat was an FLM or not feeling
well myself in this one study isfatigue.
Wow.
Yeah, okay.
So again, we're not saying hotflash of course in that study,

(27:06):
hot flashes were answered, youknow, irregular periods were
also on the answers.
But this just again highlightshow it's not just about periods.
Like this, again, the brain isaffected first.
So all of these are are are areare part of that.
Right.
Okay.
I mean, you ask anybody, 35number, they're all tired,
right?
I mean, and again, the king isso multifactorial.

(27:29):
I and like we don't want tolike say it's all hormonal or
it's all parabenophlaws, right?
But what if what if it was?
This is how I always phrase it.
Like, what if it was?
Yeah.
What if if giving you back alittle bit of hormones that your
body used to produce before canhelp you?
Which will help you move yourbody more, which would help you
like, you know, meal prepbetter, which would help you

(27:51):
like, you know, do amazing I wasabout to say something, do
amazing things.
Yes.

Yeah.
Yeah.
So for someone that neverexperienced anxiety, like what
does that feel like?
Because you say anxiety, I'mlike, okay, so if you never had
it, you're like, so what doesthat feel like?
Like, how do I know I'mexperiencing anxiety?

Yeah, I mean, I could just share what
how my pa my my own patientshave described it.
Um, so for them, it is aboutlike um thinking about tomorrow.
So so here's how I describe itin general.
Anxiety is when you're notliving in the moment.
You're look you're looking atthe future.
What's happening tomorrow?
How am I gonna, how am I gonnatalk to the people tomorrow?
What um um what if they don'tlike what I'm gonna say?

(28:33):
And or living in the past.
Wow.
You're like, oh shit, did I saythat right?
Like I should have, I shouldn'thave done that, I shouldn't
have said that.
Yeah.
Like you're ruminating, right?
Not like again, there's a s acertain like I it's always a
spectrum, I think, right?
You have the anxiety attackswhere you're literally like
paralyzed, cannot make adecision.
I have patients that tell me Ihave palpitations, you know.

So that's good to know because um from someone
that doesn't know how to labelanxiety, like me, myself, I'm
talking about me now.
It's good to hear thatdefinition.
Yeah, so what I heard you say,just so I can make sure I got it
defined properly, not beingpresent.
You're either thinking aboutthe future um or the past.

And again, um let's for let's give that a
little bit of like refinement.
Like, yes, thinking about it,but then in a negative way.
Like it's impacting younegatively.
Do you know what I mean?
Right?
I mean, so of course it's wehave to think about tomorrow.

So negatively, yes, negative thoughts towards what
you have to do tomorrow or whathappened.
Yeah.
Yeah.

Like fear of or like shame.
But shame about what you did inthe past.
And again, that's so okay.
The coach in me is coming out.
So let me just yeah, likeright, right.

The doctor coach is trying to define it.

Yes.
Yeah, I so I think it's alwayshow you're affected by it.
If you're affected negatively,then you know, but racing
thoughts.
Thinking about, I mean, I cantell you about myself too.
Like, I just would likeruminate.
I would think about what I saidyesterday.
I shouldn't have said that.
Okay.
And again, I'm not saying thatthere's no role for evaluating

(30:12):
what we did in the past orthere's no role for thinking
about tomorrow.
Of course there is.
But it's negatively affectinghow you're performing today, I
guess.
Right.
So let's talk about sex withhormones.
Talks about sex.

Yeah.
Let's talk about you and me.

You sound crazy.
I love it.

I love it.
So when it comes to menopause,perimenopause, post-menopause.
I love it.
I fly muff.
I'm learning.
Yes.
So how does that affect thewoman's desire or need or the
sex?

Yeah.
Love you're talking about thisbecause this is not discussed at
all in the doctor's offices.
Okay.
But sexual health, first ofall, is part of our health.
It's part of woman's health.
Right.
So we need to, and veryfrequently it's not discussed.
It's or it's discussed withtinged with shame or guilt.

(31:09):
Right.
So what happens in menopause?
So again, menopause means weare, uh perimenopause means
fluctuating levels of estrogen,progesterone, testosterone, but
also in menopause, estrogen isout the door, I like to call it.
Done.
Done.
Yeah.
Okay.
So that affects our body,including uh libido in our
brain.
Because libido is actually abrain thing.
It's not a vagina thing or avulva thing, right?

(31:31):
Libido is a big thing.
Am I supposed to say that outloud?
So would you please?
We're educating the kingdom ofthe thing.
Okay, I'm just saying, like theV were yeah, okay.
Yeah, libido is in our brain.
Libido is in our brain.
Desire is in our brain.
So, yeah.

You know, first of all I'm learning something,
y'all.
Am I blushing?
Because I'm learning something.

I never knew that.
I never knew that.
Desire.
Think about desire.

Hold on, how do you desire?
Did y'all know that?
Did you know it was a brainthing and not a vagina thing?
Because I didn't know.
I can't be the only one thatknew that.
No, no, you're not the onlyone.

Okay.
I mean, I didn't know iteither.
I mean, can I just be honest?
Like, I tell you, like, a lotit's so fascinating when a topic
that's not discussed.
I mean, I grew up Catholic,number one, so sex was never
something you talk about.
Right.
You know?
I'm a doctor for 20 somethingyears, and sex was never so I
mean it's so sex from a from alens of pleasure in midlife.

(32:26):
Right.
Right.
Normally it's sex like don'thave, you know, don't get STD.
You know, that's all we usuallywould talk about.
Yeah.
Which is again a good topic todiscuss.
Sure.

We're talking hormones now.

Yeah.
Yes.
Let's go back to that.
Hey, so what was I saying?

Umbust Dr.
Troutman.

So so yeah, so but the one thing that is a
hallmark of a menopause issomething called genito-urinary
syndrome of menopause.
Have you ever heard the term?
Have I ever heard it?
Yeah.

No.

No.
Okay.
Never.
Yeah.
So it's cool.
So we we we kind of, you know,in medicine we like to like give
acronyms or just make shorterthings.
So wait, say it again though.
What is it?
So it so GSM.
GSM.
Genital.
Genital.
Urinary.
Urinary.
Syndrome.
Syndrome.
Oh, genital.
G genital urinary.
Urinary syndrome.
Got it.
Yeah.
So that just talks about thisdifferent symptoms that are

(33:20):
attributed to the loss ofestrogen that affect the genital
area and then the urinarysystem.
Okay.
So it presents in patients asurinary frequency, going to the
bathroom frequently.
Even so a lot of people getdiagnosed with a UTI when they
don't actually have a UTI.
Really?
And you know, and you know youso that how will you know you

(33:43):
don't have a UTI?
You go to a doctor, you'll geta urinalysis, and they tell you
like your urine is normal.
But you have symptoms, right?
You have symptoms of urinaryurgency.
Urgency means you have to goright away.
Frequency is you go to thebathroom, you know, every often.
Yeah.
Those are symptoms of GSM,which can be treated with

(34:07):
hormone therapy.
Really?
Yeah.
And I want to just kind of talkabout that a little bit.
So please.
One of the most common issuesin menopause is UTI, which if
left untreated if it was a trueUTI, right?
If left un because menopausechanges our um vaginal

(34:28):
microbiome, like the bacteriathat lives on the vagina and
vulva.
And then that does increasetheir risk of UTIs.
And UTIs can lead toeuroscepsis.
So you're admitted in thehospital given IV antibiotics.
And that can lead to um beingadmitted in like um the hospital
and then ever so so many thingselse, so so many things kind of

(34:49):
downstream from there.

So if untreated, it could be something that's not.

But what if we can prevent that from even
happening?
Yeah.
Right?
And that's there's a role forthat with both vaginal estrogen
and systemic estrogen.
So that's the urinary symptomthere.
But genito of the GSM, so thatis the vaginal canal.
So a lot of women come to meand say, I haven't had sex in
five years.
Because it hurts.

(35:13):
It's like sandpaper to have sexwith my partner.
So we end up my partner, mypartner and I have not been
intimate because um it hurts.

Oh man.

And of course, again, that affects a
marriage, right?
That affects intimacy, thataffects how how deep that
relationship can be, I think.
Um and one of the amazingthings I can do for my patients
is to give that back to them.

Had to take two seconds to thank Allstate
Insurance for sponsoring thisepisode.
If you're looking for car,life, or casualty insurance,
they're going to be yourultimate insurance company.
Thank you, Rob Shaw, withAllstate Insurance.
Now, back to the show.
So through hormone therapy, youcan, I guess, reverse it, if
you will.
So thank you.

Yeah, so what estrogen does is again
thinking of it from a cellularlevel or from an organ level,
estrogen will increase bloodflow to the to this to the
lining of the vagina vulva.
Estrogen will improve collagenformation.
So um so what used to be, wecall it atrophic, um, let's see,

(36:18):
like dry is a Sahara, as mypatients have mentioned, um,
isn't is now not dry.

Sahara is hilarious.
Yeah.
Oh, yeah.

I have a coat.
I have like uh I have not acoat, I have a story for that.
Can I share your stories?
Sure.
So in my practice, I always talkto my patients about what are
their top three symptoms,because that's why I I
personalize hormone therapy.
Okay.
So we decide on hormone therapybased on their goals, based on
their top three issues.
So one of one of my patients,one of her symptoms was um

(36:53):
painful sex because of uh whatwe call vaginal atrophy or the
lack of estrogen in the vaginalcanal.
So so so one of her, of course,goals was to um initiate
intimate connections with herpartner, right?
So um, so we started, you know,we got treat we did treatment,
um, and then one day I got atext.

(37:13):
So my patients can text me andemail me, which is so I got a
text uh from her and it wasfireworks.
Like, what is this?
I'm like, all right, I'll justignore it.
And then the next time we metuh for her appointment, I said,
Did you text me this isfireworks?
Yes, because that was I didn'tknow how to tell you, but that

(37:35):
was like number three was Matt.
So that I love sharing thatstory because it's just like
that is so great.
That is so great.
So yeah.
So again, it it's hormonetherapy is just life-changing.

I mean, it sounds like it.
It does, it sounds like it.
I need to meet with you.
Yeah.
Yeah, I definitely need to meetwith you because just the fact
that uh one, this conversationalone I learned so much.
And then the fact that um theremay be hope for um we didn't
touch on it though.
So how does the hormone therapyhelp with the weight gain?
Yeah for the women that used tolook a certain way and now

(38:14):
their body composition ischanging, you know.

Yeah, yeah.
How does that work?
Yeah, so I think the firstthing I'd say is weight gain is
multifactorial.
Okay.
Right.
Um and I always say this allthe time like the old, the old
day, the old science is caloriein, calorie out.
Now we know it's not caloriein, calorie out.
Oh, it is not.
It is not.

(38:37):
I didn't know that.
Okay.
It's not.
So what is it?
It's definitely more than that.
So um the way I kind ofdescribe it to my patients, it's
energy in and energy out.
So it sounds the same, but it'sactually not, right?
So by working out?
Is that what you mean?
Oh, so so for example, thereare hormones that actually
affect energy in and energy out.
So one of the things thataffect women is in midlife is

(39:00):
insulin resistance and cortisoldysregulation.
So when we hit when we loseestrogen, um we have become more
insulin resistant and we haveum increased cortisol
dysregulation.
So it's not that we have umhigh cortisol, all or I should
say, it's not like cortisolblood levels go high.

(39:22):
It's more like our reaction tostress, our resilience, that we
lose a little bit of that whenwe lose estrogen.
So um, so these are hormonesthat affect how how much and how
energy is stored.
And usually when we lose that,again, insulin resistance
specifically, we we store itmore in the belly.

So insulin is that it's equivalent to like um like
sugar?

Like insulin, yeah, insulin is the
hormone.
Insulin resistance is thephenomenon that happens where
our body tends to um store fatuh more in the belly versus just
um utilizing energy.

So when patients take these, this the hormones
that you share with them, dothey do do they see themselves
going back to their normalworld?

So yeah, so I always want to say, but like
weight loss is nuanced andcomplicated, right?
So it's not just so I always Inever say so what I want to say
okay, you're a miracle worker,I'm coming tomorrow.
What I always say is likehormone therapy is not a weight
loss medicine.
Okay.
It's not.
So I always I I say that fromthe get-go.

That's fair.
Okay.

Yeah, because again, it is nuanced,
right?
So so for example um, buthormone therapy can help you if
you're not sleeping well.
Let's just say if you're notsleeping well, and you now um we
can help you sleep now.
And when you sleep better, yourcortisol improves.
Oh and then when you sleepbetter, you're not gonna be as
tired in the morning.

(40:46):
So you're more likely going todo the things that we So with
weight, right?
We know we need to move ourbody, we need to eat um um, you
know, our protein, our fiber,our water.
We kind of know a little bit ofthe rules.
Yeah.
The struggle is applying thethe rules into our real life.
Right.
And how can I, and and here'show I always tell my patients
that um work with me for boththeir hormone and weight is that

(41:07):
I want to start with hormone, Istart with hormone therapy to
make you feel better.
Okay.
Because how can I ask you to doXYZ when you're literally
tired?
That's so overwhelmed.
Yeah.
Like adding like another to-dolist on your to-do list is gonna
be a to-do list.
It drains you.
A hundred.
So we really want to just startby, in a way, like, you know,

(41:30):
again, healing, stabilizing thehormone, so you feel better.
Because when you feel better,it's so much easier to do the
lifestyle changes that we thatwe encourage.
So in my practice, I talk aboutthe 4M um pillars, so 4M
playbook, meals, movement, mind,and eds.
So all of them combined, youknow, is is is how again women

(41:56):
feel the best.
You know.
So yeah.
So I think I slightly ununanswered your question, did I?

No, you did.
Okay.
So basically you're saying,hey, look, you can get these
hormones, however, you're stillgonna have to put in the work to
get back into the shape thatyou desire.
Yeah, is what I heard you say.
It's not a spherical peel.
Yeah.

And there's a strategy for that, right?
Looking at how you're eating,yeah, looking at how you're
moving, which is the old caloriein, calorie out model, right?
But it's also looking at howyou're handling stress, because
that affects the cortisol.
Looking at how you're sleeping,because that affects cortisol
and insulin.
Yeah.
And then for those that um forsomeone like me, for example,
who struggle with weight theirentire life, right?

(42:36):
Then medications might helpthem treat the dysregulation
that happens.
Is so again, horm menopause islike a metabolic switch, I call
it.
And like we're more insulinbecause we lose estrogen, these
are the downstream effects.
You're right, right.

So, what causes the hot flashes?
Like, why do people like startdripping sweat and then they're
like freezing cold?
Yeah.
What is that from?

Yeah.
So again, it's in the brain.
So our brain is so magnificent.
Okay, first of all.
So in our brain, there's a whatwe call a thermoregulator
thermoregulatory center.
Okay.
So it gets input from our skinthat tells us how the
temperature is.
So skin sends a message to thethermoregulatory center and say,
I mean, it doesn't say this,but it's like 65 degrees.

(43:17):
It doesn't say that.
So it's like, oh, it's it'scold, so let me go and shiver,
or let me go and or if it's like100 degrees, let me go and
swept.
Yes.
Yeah.
So it gives a signal to thebrain.
Okay.
And the brain regulates processunder gets the message and
tells the body what to do.
Tells the body to sweat, tellsthe body to have a um, you know,

(43:39):
you know, shiver, etc.
So what happens in menopause iswhat did I say earlier?
The brain breaks first.
Yes.
So that the regulation centeris also affected.

Okay, so my brain is broke.
Is that what you're saying?
I have a broken brain.
Well, here's the thing.
Menopause breaks our brain.
Nowhere.
Out of nowhere, just besweating.
Yeah.
Like, what the heck?

Yeah.
And you know what's interesting,not really interesting, but
what a lot of people don'trealize is hot flashes, it's
more than just an annoyance.
It really is something thatimpacts our health.
Really?
Oh, yeah.
Yeah.
It impacts our um your sleep.
So I've be so it's sleep, umcardiovascular impacts, so much.

(44:24):
So it's not just people, and Isay this because a lot of my
patients, if we were coming tome, were told, just deal with
the symptoms.

Just deal with it.
Because you know what?
That's what your parents did.
That's what your grandparentsdid.
That's what their parents did.
So you just deal with it.
It's just part of being awoman, honey.
Yeah.
Yeah.

And it's like, like, but it's not.
It's not you again, we can dealwith it or we can advocate for
treatment that will improve thesymptoms.
So you know, um, it is anatural transition, right?
Everybody, every 100% of womenwill go through paramenopause
and menopause, but it doesn'thave to be in suffering.

It does not have to be in suffering.
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(45:25):
Now back to the show.

There's no medal.
There's no medal that says, youknow, when you're like 65, I
wait, I didn't I didn't takehormone therapy, so I deserve a
medal.
Like, no, there is no medal.

So there's no shame in doing the research and okay
and figuring it out.

And that's what that's that's why I always
start with science.
You know, I always start likethis is normal.
This is what happens.
And numerous women, hundreds,thousands of women, say that
same thing, right?
So you're not alone.
This is normal, and you don'thave to suffer.

Yeah.
So is this natural medicine oris this like um I don't know,
unnatural.

I'm talking about hormotherapy.
Yeah, the hormotherapy.
Yeah, so hormotherapy again,there's different types, right?
There's different routes,there's different types.
Um, as a menopause societyspecialist, I prescribe any and
all of them.
Okay.
But my first choice is usuallywhat we call bioidentical
hormone therapy.
So bioidentical is made in thelab, right?
Yes.
Um, but it is biologicallyidentical to what our body norm

(46:30):
produced before.
Okay.
So it's literally giving youback what we used to have.
Okay.

Now, is this something that's paid for
through our our benefits?
Yes.

Did you know estradiol?
So the bi-identical estrogen isestradiol.
It's been around for four toeight years.
Okay.
It's generic.
Oh.
Yep.
Okay.
I would say what I've seen ismaybe 95%.
Every insurance is different,right?
And we can go through thatwhole discussion how insurance
is so confusing.
But I would say 95% of the timeit's covered, unless it's a

(47:04):
weird insurance.
And if it's not covered, it'sgeneric.
Like it's not a thousanddollars, is what I'm trying to
say.
Right.
Um, anywhere from my patientspay anywhere from $5 to like
$300 for it.

So that's the other thing.
A lot of people don't seek itout because they think, oh my
gosh, it's so expensive.

You know?
Yeah, it's not.
It's like it's just it'scost-effective.
It's older than it's I mean,estrogen itself, the older
version has been there, oh mygod, like 70.
It's been around for a while.
But the bi-identical that'syour dial is like 48 years.
Wow.
I mean it's it's been aroundfor a while.
Same thing.
Progesterone has been aroundfor a while, testosterone has

(47:43):
been around for these are likegeneric um tools that are
available to us.
Again, it is it is differentroutes, different forms,
different options.
Um, and you have you it'sfinding the one that works for
person.

Yeah.
Well, this was a great lesson.
Yeah, yeah.
I feel lighter just listeningto the conversation.
Like, seriously, I walked awaylike, okay, yeah.
Um, one, there's something outthere that can help me
personally, and we probably helpso many other people that are
gonna be watching this.
So how can someone get incontact with Dr.

(48:19):
Troutman?

Yes, so definitely a lot of ways.
If you just kind of want tolisten to like science, I have a
YouTube channel.
I have also uh follow me onFacebook.
I d I drop What's the name ofyour channel?
Midlife Remedy.
Midlife Remedy.
Oh, definitely gonna betagging.
Yeah, yeah.
Um so I give like um advice,not advice, um, educational

(48:41):
insights.
I talk about the symptoms.
Yeah.
Um, and then I also seepatients.
I mean I'm licensed in thestate of Pennsylvania, so I have
a brick and mower in Camp Hill,but again, can see any any
anybody virtually, well,virtually in Pennsylvania.

Yeah, that's awesome.
Yeah.
So then do you have a referralsystem for someone that's not
local in Pennsylvania butlooking for a good resource?
Absolutely.

So um, so so for being my patient, I've I
have everything online.
Um patients do an initialconsult with me and everything,
and you know, they could atleast meet Nini once to go over
their story, and then they candecide to work with me.
Um, and then I have the freeresources on my website,
midliferemedy.com, on just likemaybe what's what is

(49:26):
perimenopause and how do we andthen weight as well.

So the person that's in California that's
looking for a Dr.

Troutman, do you have a referral system?
Um no.
So I usually would refer ifthey're outside the state of
Pennsylvania, there's somethingcalled menopause.org.
So that is um menopausespecialists that have been
certified.
Okay.
Um their MDs, their PAs, NPs,and stuff like that.
Yeah.
That's great.

(49:52):
Yeah.

But no one's like me.
This is so good.
I keep saying it because it wasit was really good.
I'm so glad.

I was educated.
That's the purpose of our chattoday, right?
Yeah.
Again, it's it's if I can if soto me, this is how my mission
in in life is is like just letpeople know that this is normal.
What I just kept saying, andthen there's hope.

There is hope.
And then you'll hope it'snormal and it's hope, and you do
not have to suffer, and you donot get a medal of honor by
going through it.

Naturally.
And you know what I always likekind of reflect upon in my own
journey was like I had like fouror five years of insufficient
sleep.
Right.
And then what is the cost ofthat?
What is the un what was the howmuch not not mon not just
monetary, but like life, right?
I could have been a betterparent.
I could have been a betterwife.
I could whatever, right?

(50:43):
So if if I could just give thatif I could shorten someone's
struggle, yeah, to not not theeight years, five, you know,
four years, but hey, let meguide you.
You know, that's just you know.

So all I can say is I'm very grateful that I had
the opportunity to I I shouldsay I got the opportunity to run
into you.

Right.

At the women's mastermind.
Yes.
Was that two years ago?
Yes.
And we literally just had acomic a casual conversation,
like, what is this about?
Yeah.
I don't know if you rememberthat.
And I was like, oh, and she'slike, and you said, um, it looks
like it might be a room full ofjust realtors here.
I was like, no, because you'rehere.
And what do you build?
So and it's like a full circlemoment because we're gonna have

(51:29):
one in January.
Yes.
And I know that um, so BrittanyGuile, she's the CEO of Kell
Williams.
Okay.
So she's actually having it inJanuary.
And I'm excited because um thefeedback that we received from
from it the last time.
Yeah, I have a funny feelingthat's probably gonna be heavy
on the non-realtor side.

(51:51):
Good.
Which is actually gonna bereally good.
Yeah.
Yes.
So we get to meet more peoplelike you.
Because you were, yeah, just tomeet you.
I was just like, ooh, I have afeeling I'm gonna meet her
again.
Yeah.
Yeah, I did.
I walked away and I said that.
Uh, see?
Yeah.
He does, he does.
And I I didn't even know thatyou were like a hormone doctor.

Yeah, yeah.
We'll call you a doctor.
Oh, you certainly can.
I mean, I think, and uh eventhe weight stuff, that's
actually also hormonal.
Yeah.
You know, I was like, tellpeople it even the weight is
Yeah, so good, so good.

Thank you so much.
Thanks for having me.
I really appreciate it.
Yeah.
So if you're looking to get incontact with her, we're going to
make sure that we have all ofthis information in our
description because I believethat your life could actually
change by just having aconversation and getting an
analysis of what's going on withyour body.

(52:43):
And who knows, you're gonnahave a better life for it.
I'm glad we covered sex too.
Because I know that a lot ofpeople, that's something that
people don't want to talk about.

They don't talk about it at all, at all in
their doctors or even in theirOBGYN stuff.
Yeah.
I never talk about my owndoctor.

Yeah.

Like, you know what I mean?
Like, they don't ask me, like,how's sex going?
Like, they're so that's anotherone of my kind of passions is
sexual health, because I likethere it so first okay, fun
fact.
One second.
Not fun fact, but d are youaware of the there's something
called spontaneous desire andresponsive desire?
No.
So a lot of my patients wouldtell me, like, I have low

(53:28):
libido.
Yeah.
So I asked them, like, what doyou mean by that?
I just like really sit in thatcuriosity and have them explain
to me and not have anyprejudgment on what that means.
That's one.
So in and usually the datesays, before I used to want to
have more sex, now I don't wantto have sex.
Now my husband touches me andlike, oh my god, get away from
me.

Yeah.

That's kind of nice though.

That's stuff that should have been in there, girl.

Okay, let's keep rolling.
Just kidding.
But that could be that could bea really good So so for
example, so so the so the firstthing I always say is like, did
you know that that's normal?
So there are actually two kindsof desire.
Yeah.
So there's the spontaneousdesire and response.
So spontaneous desire, this Idescribe it as Hollywood.

(54:11):
Like in the movies.
Yeah.
You see someone across theroom.
Yes.
You locked.
Yes, and then you go to a room,and then you take off your
clothes, and then you you youhave sex and you come at the
same time, and then like youfall back, and then it's sheen
of sweat.
Like that's Hollywood, right?
That's spontaneous desire.
Yes.
Responsive desire is actuallyum something that is like I this

(54:32):
is how I describe it.
Like, hey Erica, let's go to aparty on Wednesday.
And you said, I don't reallywant to go, but sure case, I'll
go to a party with you.
So it's Monday, likeWednesday's coming soon, and
you're like, I really don't wantto go because I have to shave
and I have to get a dress.
Like, I really don't want togo, but you decide to go anyway
because you you you know, youwanna you said you were gonna go

(54:54):
with me.
So so you go to the party, andlike, oh, I like the music in
this party.
Oh, I like the food in thisparty.
Yeah.
So after the party, and you sawyou have fun, you I like the
people in this party.
So at the party you have fun,and at the end of the day, you
said, like, I should have Ishould go to more parties.
So that's for that's responsivedesire.
Basically, you have desire inresponse to something.

(55:17):
Okay.
So it's not spontaneous.
Right.
So what people um may notrealize is a person, a a may a
mere um well, I don't want tojust say so a long-term
relationship, usually a majorityof the people are in the
responsive desire.
You could have spontaneousdesire in the beginning, right?
Because really um desireslashsex, a lot of it is like

(55:40):
excitement, right?
If you're in a long-termrelationship, that's usually
like safety and like, you know,um accountability.
Like, so less of the mystery,right?
So a lot of people are in thatresponsive desire, and that's
very normal.
Very normal.
So when patients tell me that Iused to want to have more sex

(56:01):
and now I don't, I'm like, sowhat hap- I say that that's
normal.
Yeah.
And this is a this doesn't meanthat you have low libido.
This means we need tounderstand what are you in
responsive desire and is partneraware that you are in
responsive desire?
Which means that partner andyou need to start talking about
it.
I was gonna say havingconversations, being having open

(56:22):
communication.
Yes.
And then just telling partner,partner, I kind of like it when
what makes what makes youdesire?
Whether it's this is myfavorite, husband taking care of
the dishwasher, so I don't haveto deal with that shit.
You know?
Yeah.
Husband taking care of theplans so that I don't have to
like have the mental load ofdoing XYZ.
That's definitely gonna get mein the mood.

(56:43):
I mean, so like I would seethat's so partners have to have
that discussion that it'snormal.
Right.
And then what what what is youryou know, again, I'm I talk
about the chores, but it's notjust that.
It's about like, you know, itcould be like, what's your
favorite?
I I don't know, like sexy thingto do, you know, right?
Um so just even talking aboutit, I can tell you right now, I

(57:05):
I've helped a lot of my patientsjust explaining that this is
normal.
Again, it's aboutnormalization.

Because you're wondering why I say, how can the
man get so excited and theyjust walked in the door and
you're like, whoa, give me asecond.
Yeah.
Like I need to be built up tothis.
You can't just yeah.

So again, so actually what happens in the
bedroom actually starts in themorning, right?
So if you kind of really likegood.

So it's it's it's it's it starts in the morning.
Yeah, this is a great behindthe scenes clip.
There you go.
Yes, yes, all right.

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Sex, Menopause & Feeling Like Yourself Again | Dr. Caissa Troutman

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