Low libido in women is often blamed on stress, aging, or relationship problems, but changes in desire may begin years before menopause and can involve hormones, medications, pain, sleep, blood flow, and the difference between spontaneous and responsive desire. Dr. Natalie Crawford sits down with board-certified urologist Dr. Kelly Casperson, author of “You Are Not Broken” and “The Menopause Moment,” to explain why women may stop wanting sex, how testosterone and estrogen affect sexual health, and what to discuss with a clinician when something feels different. They also examine birth control and SSRI side effects, hormone therapy, vaginal estrogen, and why women’s sexual health deserves greater attention. IN THIS EPISODE: 00:00 Why Women Can Lose Desire Before Menopause 02:10 Can Your Hormones Change While You Still Have a Period? 03:38 Why Testosterone Matters in Women 05:41 Can Birth Control Lower Your Libido? 08:04 How Estrogen Affects Desire, Arousal, and Vaginal Health 10:02 What Does Low Libido Actually Mean? 10:56 When Low Libido Is Really Painful Sex 13:15 Spontaneous vs. Responsive Desire 15:25 Are You Having Sex Worth Desiring? 16:53 What Causes Arousal Problems in Women? 17:20 How SSRIs Can Affect Sexual Function 17:50 How Couples Can Navigate Mismatched Sex Drives 21:05 Why Perimenopause Can Make You Feel Unlike Yourself 21:24 How Sleep, Estrogen, and Progesterone Affect Desire 21:50 Testosterone’s Role in the Brain, Mood, and Motivation 24:40 How Is Testosterone Prescribed to Women? 27:15 What Happens When Testosterone Is Too High? 30:30 Can Testosterone Affect More Than Libido? 32:00 Testosterone, Wound Healing, and Bone Health 33:25 Could Testosterone Support Hip-Fracture Recovery? 34:00 Can Hormone Therapy Still Help Women Over 60? 36:00 Systemic vs. Vaginal Estrogen 37:00 Why Hormone Treatment May Begin Before Menopause 39:55 Can You Get Pregnant During Perimenopause? 41:41 When Vaginal Estrogen May Help 46:12 How to Talk to Your Doctor About Hormones 48:25 Where to Find Dr. Kelly Casperson GUEST RESOURCES:Website: https://kellycaspersonmd.comInstagram: https://www.instagram.com/kellycaspersonmdPodcast: https://kellycaspersonmd.com/you-are-not-broken-podcastYou Are Not Broken: https://kellycaspersonmd.com/you-are-not-broken-bookThe Menopause Moment: https://kellycaspersonmd.com/the-menopause-moment-book AS A WOMAN WITH DR. NATALIE CRAWFORD: YouTube: https://youtube.com/playlist?list=PLveZDgg3_HZ9m7Wy3C6Vvyrj_NtEOwj_l Apple Podcasts: https://podcasts.apple.com/us/podcast/as-a-woman/id1449553339 Spotify: https://open.spotify.com/show/12IYOLH9liu60gk5D0bRPk HOST RESOURCES: Order The Fertility Formula: https://www.nataliecrawfordmd.com/book Newsletter: https://www.nataliecrawfordmd.com/newsletter Instagram: https://www.instagram.com/nataliecrawfordmd YouTube: https://www.youtube.com/@NatalieCrawfordMD Become a patient: https://www.forafertility.com Earn FREE CE/CME: https://learnatpinnacle.com/education This episode is brought to you by The Pinnacle Podcast Network. ABOUT DR. NATALIE CRAWFORD: Natalie Crawford, MD, is a double board-certified OB/GYN and reproductive endocrinologist, co-founder of Fora Fertility, and author of The Fertility Formula. She helps women understand their hormones, fertility, and reproductive health so they can make informed decisions about their bodies. Disclaimer: Natalie Crawford, MD, is a doctor, but she is not your doctor. This content is for general education and is not a substitute for individualized medical care. Learn more about your ad choices. Visit megaphone.fm/adchoices
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