#348 ‒ Women's sexual health, menopause, and hormone replacement therapy (HRT) | Rachel Rubin, M.D. | The Peter Attia Drive

In this episode of The Drive Podcast, Peter Attia interviews Dr. Rachel Rubin, a board-certified urologist and expert in sexual health, focusing on women's sexual health, hormone decline, and menopause. They discuss the neglect of sexual medicine for women, the physiology of the menstrual cycle, hormone fluctuations during perimenopause, and the risks associated with menopause, including osteoporosis, cardiovascular disease, and dementia. They delve into the history and misinterpretation of the Women's Health Initiative study, the use of estrogen, progesterone, and testosterone therapy, and the importance of personalized care. Dr. Rubin shares her experiences and insights on the challenges in women's health, the need for more research, and the importance of training doctors in hormone therapy. The conversation also covers the role of testosterone in women's health, the benefits of local vaginal hormonal therapy, and the need to address the misinformation and fear surrounding HRT.

Outlines

Part 1: Introduction and Menopause Basics

Part 2: HRT History and Misconceptions

Part 3: Testosterone and Women's Sexual Health

Part 4: Practical HRT Considerations

Part 5: Symptoms, GSM, and Vulvar Pain

Part 6: Advanced HRT Topics and Resources

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#348 ‒ Women's sexual health, menopause, and hormone replacement therapy (HRT) | Rachel Rubin, M.D.

The Peter Attia Drive

Part 1: Introduction and Menopause Basics

00:10Introduction to Longevity, Women's Sexual Health, and Dr. Rachel Rubin's Background

Introduction to Longevity, Women's Sexual Health, and Dr. Rachel Rubin's Background

03:57Menopause as a Castration Event: The Gas Tank Analogy

Menopause as a Castration Event: The Gas Tank Analogy

07:43Perimenopause: Erratic Hormone Fluctuations and the Role of FSH and LH

Perimenopause: Erratic Hormone Fluctuations and the Role of FSH and LH

14:17Progesterone Sensitivity and the Need for More Research in Women's Health

Progesterone Sensitivity and the Need for More Research in Women's Health

17:12The Risks of Hormone Deprivation After Menopause

The Risks of Hormone Deprivation After Menopause

Part 2: HRT History and Misconceptions

20:10The History of HRT and the Women's Health Initiative (WHI) Study

The History of HRT and the Women's Health Initiative (WHI) Study

23:54Misinterpretation of the WHI Data and the Resulting Fear-Based Medicine

Misinterpretation of the WHI Data and the Resulting Fear-Based Medicine

26:13The Injustice of the WHI and the Lost Generation of Doctors

The Injustice of the WHI and the Lost Generation of Doctors

30:09The Lack of Menopause Education and the Need for Change

The Lack of Menopause Education and the Need for Change

Part 3: Testosterone and Women's Sexual Health

35:06The Role of Testosterone in Women's Sexual Health

The Role of Testosterone in Women's Sexual Health

39:09Addressing Concerns and Side Effects of Testosterone Therapy in Women

Addressing Concerns and Side Effects of Testosterone Therapy in Women

42:30Topical Testosterone, the Lack of FDA-Approved Products, and the FDA's Inconsistent Standards

Topical Testosterone, the Lack of FDA-Approved Products, and the FDA's Inconsistent Standards

47:09Paternalism in Medicine and the Lack of Funding for Women's Health Research

Paternalism in Medicine and the Lack of Funding for Women's Health Research

51:16The Importance of Training Doctors and the Rise of Fringe Hormone Practices

The Importance of Training Doctors and the Rise of Fringe Hormone Practices

54:06The Need for Evidence-Based Medicine and the Underutilization of Hormone Therapy

The Need for Evidence-Based Medicine and the Underutilization of Hormone Therapy

Part 4: Practical HRT Considerations

57:27Progesterone: Oral vs. Vaginal, Dosage, and IUDs

Progesterone: Oral vs. Vaginal, Dosage, and IUDs

1:01:14Alternative Progesterone Delivery Methods and the Importance of Stacking Hormones

Alternative Progesterone Delivery Methods and the Importance of Stacking Hormones

1:04:40Estradiol: Avoiding BiEst and the Importance of FDA-Approved Products

Estradiol: Avoiding BiEst and the Importance of FDA-Approved Products

1:07:32The Importance of Individualized Care and Addressing Patient Fears

The Importance of Individualized Care and Addressing Patient Fears

1:11:15Systemic Estrogen: Delivery Methods and Their Pros and Cons

Systemic Estrogen: Delivery Methods and Their Pros and Cons

1:17:16Estrogen Rings: Types, Dosing, and Potential Issues

Estrogen Rings: Types, Dosing, and Potential Issues

1:21:27The Importance of Sensitive Estradiol Assays and the Limitations of Lab Testing

The Importance of Sensitive Estradiol Assays and the Limitations of Lab Testing

1:25:05Balancing Symptoms and Lab Values in Hormone Therapy Management

Balancing Symptoms and Lab Values in Hormone Therapy Management

Part 5: Symptoms, GSM, and Vulvar Pain

1:27:27The Importance of Education and Finding the Right Pit Crew

The Importance of Education and Finding the Right Pit Crew

1:31:31The Symptoms of Menopause and the Importance of Recognizing Them

The Symptoms of Menopause and the Importance of Recognizing Them

1:34:27Brain Fog, Depression, and the Neurological Impact of Menopause

Brain Fog, Depression, and the Neurological Impact of Menopause

1:37:59Genitourinary Syndrome of Menopause (GSM) and the Importance of Vaginal Hormones

Genitourinary Syndrome of Menopause (GSM) and the Importance of Vaginal Hormones

1:42:35The Marketing Problem with Vaginal Estrogen and a Personal Story

The Marketing Problem with Vaginal Estrogen and a Personal Story

1:47:09Systemic vs. Local Estrogen and the Benefits of Vaginal DHEA

Systemic vs. Local Estrogen and the Benefits of Vaginal DHEA

1:51:14The Vulvar Vestibule and the Importance of Androgens

The Vulvar Vestibule and the Importance of Androgens

1:55:00A Compounded Topical Cream for Vulvar Vestibule Pain

A Compounded Topical Cream for Vulvar Vestibule Pain

Part 6: Advanced HRT Topics and Resources

1:57:03The Timing Hypothesis and the Importance of Shared Decision-Making

The Timing Hypothesis and the Importance of Shared Decision-Making

1:58:21The Duration of Hormone Therapy and the Saturation Model Concept

The Duration of Hormone Therapy and the Saturation Model Concept

2:00:32Managing Hormones in Women at Risk of or with a History of Breast Cancer

Managing Hormones in Women at Risk of or with a History of Breast Cancer

2:05:24Resources for Women Seeking Hormone Therapy and the Importance of Self-Advocacy

Resources for Women Seeking Hormone Therapy and the Importance of Self-Advocacy

2:08:12Red Flags for Exploitive Hormone Practices and the Impact of Menopause on Men

Red Flags for Exploitive Hormone Practices and the Impact of Menopause on Men