You Are Not Broken

In this episode, I walk through the basics of vaginal estrogen and vaginal DHEA for genitourinary syndrome of menopause, recurrent UTIs, painful sex, urinary urgency, and vulvar tissue changes. I also answer audience questions throughout, covering safety after breast cancer, use alongside systemic HRT, dosing, formulations, and what to do when symptoms don't improve.
This one's for clinicians and the general public alike, the focus is correcting misinformation, improving access, and helping people understand that low hormones can affect the pelvis long before or long after menopause.
What We Cover
What genitourinary syndrome of menopause (GSM) actually means, and why it replaced older terms like vaginal atrophy
The full range of GSM symptoms — urinary urgency, recurrent UTIs, bladder leakage, pain with sex, dryness, tissue thinning — as one unifying hormone-related syndrome
Why GSM is so common (roughly 50–90% of women at or after menopause) and can start in perimenopause, during breastfeeding, on oral birth control, or after cancer treatment
Data showing vaginal estrogen can reduce recurrent UTIs by about 50%, plus a large database study linking vaginal estrogen use to lower hospitalization, ICU admission, and sepsis-related death in women with recurrent UTIs
Why "too old for vaginal estrogen" is a myth, and why age alone is never a reason to deny it
Safety after breast cancer — why the evidence supports vaginal estrogen for many survivors, and why "zombie myths" keep resurfacing anyway
The difference between systemic and local hormone therapy, and why some people need both
Creams vs. tablets vs. rings vs. vaginal DHEA — and why DHEA can be especially useful for reversing established atrophy (it converts to both estrogen and testosterone)
Practical stuff: burning, discharge, application technique, dosing frequency, and when it's time for a pelvic exam instead of another product
Using vaginal estrogen alongside clobetasol for lichen sclerosus, and alongside systemic estrogen or testosterone when appropriate

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

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

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As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.
Subscribe, leave a review, and share this episode with someone who needs it.
🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi
This episode is sponsored by Joi and Blokes.
If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.
Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.
See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, I talk with Dr. Lexx about how to have honest conversations about sex with kids, why sexual shame still shapes adult relationships, and how to think more clearly about desire, consent, and pleasure. We dig into misinformation around sex education, sex as a form of power, and what healthy support can look like from educators, counselors, and therapists.
What We Cover
Sex-positive parenting and how to talk to kids about bodies and boundaries
Why sexuality education in the U.S. is more restricted than people think — and why "medically accurate" isn't a given
The real difference between sex educators, sex counselors, and sex therapists
How midlife, menopause, and shifting desire reshape relationships
Practical ways to rebuild intimacy and connection when the spark fades

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

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

Subscribe, leave a review, and share this episode with someone who needs it.
🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi

This episode is sponsored by Joi and Blokes.
If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.
Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.
See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode 387, I sit down with Dr. Lucy McBride to talk about the widening gap between the traditional medical system and the wellness industry, and how patients can find solid ground in between. Lucy makes the case for evidence-based advice, realistic expectations, and actually engaging with your healthcare system instead of trying to DIY your way to health.
What We Cover
The gap between the medical system and the wellness industry
Why evidence-based health advice matters more than ever
The risks of wellness products and influencers overpromising certainty
How patients can better engage with (not opt out of) the healthcare system
Supplements, vitamins, and gadgets — what's worth your money and what isn't
The wellness industry often overpromises certainty and results it can't back up.
Living in the "middle ground" means engaging with the healthcare system effectively rather than avoiding it.
Dr. McBride's book, Beyond the Prescription, is a practical guide for navigating health choices.

About Dr. Lucy McBride
Dr. Lucy McBride is a practicing internist and the author of Beyond the Prescription: How to Contextualize Your Health and Break Free from a Lifetime of Fatigue, Anxiety, and Stress. Grab her book here: Beyond the Prescription
https://www.lucymcbride.com/
https://www.instagram.com/drlucymcbride/
Substack
As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.
Subscribe, leave a review, and share this episode with someone who needs it.
🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi
This episode is sponsored by Joi and Blokes.
If you’ve been wondering whether hormones could be playing a role in how you feel, Joi and Blokes can help you get answers. Start with comprehensive lab testing, then work with a licensed clinician to understand your results and discuss treatment options that may be right for you.
Visit JoiAndBlokes.com/notbroken and use code NOTBROKEN for 65% off labs and 20% off treatment.
See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The longer we treat menopause as something to survive quietly instead of understanding fully, the more women get left without real answers.
Dr. Shepherd is an OB-GYN, and we use menopause as the entry point into a much bigger conversation — the myths still circulating about menopause and sexual health, why clinician expertise and actual hands-on experience matter more than a lot of people realize, and how insurance and the broader healthcare system quietly shape what choices women even know they have. We also get into AI and new technology in medicine — where it genuinely helps, and where it's moving faster than anyone can vet it. And we land on something I keep coming back to on this show: aging well is not a solo project. Community and connection are part of the medicine.
Dr. Jessica Shepherd is a board-certified OB-GYN focused on women's health, menopause, and sexual wellness in midlife. Generation M - Dr. Jessica Shepherd's book
What We Cover
Menopause as a gateway. Why menopause is so often the first time women start really engaging with their own health, and what that says about the gaps earlier in the system.
The myths that won't die. Common misconceptions about menopause and sexual health that Dr. Shepherd still has to correct in the exam room, every week.
Expertise actually matters. Why the clinician you choose, and how much hands-on experience they have, changes the quality of care you get, especially in a field this nuanced.
The system shapes the choice. How insurance coverage and healthcare structures quietly limit what options get presented to women in the first place.
AI in medicine — promise and risk. Where artificial intelligence and new technology are genuinely useful in healthcare, and where the pace of change is outrunning oversight.
Community as medicine. Why connection and support are not a "nice to have" in aging well, they're part of the actual strategy.

Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi
Thanks to our sponsor ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.joinmidi.com⁠

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

Half a million of you on Instagram. I still can't quite get over that number.
To celebrate, this episode is all you — an open Ask Me Anything where I answer the questions you've actually been sending me. No guest, no agenda, just me working through your real questions about hormones, menopause, sexual health, and the stuff nobody explains to you in a normal doctor's appointment.
We cover a lot of ground — how I ended up a urologist obsessed with female sexual health in the first place, the myths about hormone therapy I am still correcting in 2026, DHEA, the estrogen patch shortage, why your labs don't always tell the whole story, and yes, the Ferrari engine analogy makes another appearance. If you've been wondering something and never had the nerve to ask your own doctor — there's a good chance I answer it here.
In This Episode
How I got here. My background as a urologist and how that path led me into female sexual health — a specialty most people don't expect a urologist to end up in.
Hormones, menopause, and aging. Why hormones matter so much more than most of us were taught, and what's actually happening in your body during the menopause transition.
Hormone therapy myths, corrected. I'm clearing up the misinformation that's still floating around about HRT — including specific questions on risk for women with a Factor V (Factor two) clotting diagnosis.
DHEA and vaginal estrogen. What they do, why the estrogen patch shortage is happening, and what to switch to (gels, oral options) in the meantime.
Testosterone, decoded. Comparing creams versus injections, how to interpret SHBG, and why I care more about how you feel than what the lab printout says.
Progesterone tolerance. What to do when the standard dose doesn't agree with you, and where extended-release formulations fit in.
Persistent UTIs on vaginal estrogen. Why they still happen even when you're doing everything "right," and what else might be going on.
Weight gain and menopause. What the data actually says — and what gets blamed on hormones that isn't really about hormones at all.
Talking about sex — with clients, with partners. A layered, step-by-step way to open the conversation about low libido without it feeling like a confrontation.
Individualized care. Why hormone management should never be one-size-fits-all, and how I think about lab testing versus symptoms.
What's next. vulvar DHEA, book clubs, and more ways to keep learning together.

Subscribe, leave a review, and share this episode with someone who needs it.
🎙️ You Are Not Broken is available on Apple Podcasts, Spotify, and wherever you listen.
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Take my ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Adult Sex Ed Master Class:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠My Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
Interested in my sexual health and hormone clinic? ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waitlist is open⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
Thanks to our sponsor: Addyi, the little pink pill. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.And great news: with commercial insurance coverage Addyi is as little as $20 a month! Visit Addyi.com/notbroken. Eligible patients only. Restrictions apply. See Full Prescribing Information including Boxed Warning at addyi.com/pi
Thanks to our sponsor ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Midi Women's Health⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.joinmidi.com⁠
See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.