385. 500k on IG Celebration - Ask Me Anything

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.

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