Coffee With E

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

• Erica Rawls

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What if the reason you “don’t feel like yourself” anymore isn’t in your head?

In this empowering episode, Dr. Caissa Troutman, a quadruple board-certified hormone specialist and founder of Midlife Remedy (https://midliferemedy.com), joins Erica Rawls for a real conversation about hormones, menopause, and why so many women over 35 feel anxious, fatigued, or disconnected from themselves.

She breaks down what’s happening inside your body, how to know if you’re in perimenopause, and how hormone therapy can help you start feeling like yourself again.

✨ In This Episode

•The truth about perimenopause and menopause (and why menopause is technically just one day)

•Why anxiety, brain fog, and mood swings might really be hormonal

•How hormone therapy can improve sleep, confidence, and intimacy

•The real science behind sex drive and “responsive desire”

•Why women should stop feeling ashamed about how they feel

•How to find a qualified menopause specialist near you

🔗 Connect with Dr. Caissa Troutman

Website: https://midliferemedy.com

Facebook: https://www.facebook.com/midlifereMDy/

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💼 Powered by The Erica Rawls Team: https://ericarawls.com/ 


💬 Like this episode? Leave a review and share it with someone who needs a reminder that she’s not crazy. Her hormones just need a little balance.

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Erica Rawls:

Hey you! We're talking sex, we're talking hormones, and we're talking why you're not crazy. I sit down with Dr. Troutman, who is a quadruple board certified hormone specialist, and she is sharing all. You ever wonder why you just no longer feel like you want to have sex ever? She's gonna break it down. And after watching this episode, you just may have the answer to start feeling like yourself again. Today's roast, stop feeling ashamed about the way that you're feeling, your insides, your hormones are going crazy. Did you ever think that you may need hormotherapy? I mean, I know that we don't talk about it a lot, and it's something that we should talk about. It's one of those things when you go through menopause, it's one of those things that you say, um, you know what? You'll get through it. Your mom probably said it, your grandma probably said it, or your aunt said it. Oh, honey, you'll get through it. Those hot flashes, oh, that's just part of being a woman. Guess what? You are a woman, and it does not have to be that way. You are here on earth to live your best life. So, how about getting that hormone therapy that you always thought that you should have but didn'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 actually getting together because of what I know to be something that's the topic we're gonna have a couple today. It needs to be had. And I know you've been having a lot of conversations with women just individually, also probably at workshops and all the things. And that is menopause.

Dr. Caissa Troutman:

Yes. Menopause and perimenopause. Yes, which is which is frequently like confuse or kind of merge together, I think.

Erica Rawls:

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

Dr. Caissa Troutman:

Yeah, and I think that's the best way to start is to start with facts, right? Um, so did you know that menopause 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 one day, which is literally the day that is 12 months after a woman's last menstrual period. Really? So the life uh after menopause technically is a post-menopausal period. And the life before that one day is technically perimenopause. Okay. So do we know what that one day is? So unfortunately, it's a very rear-view mirror diagnosis, right? Like today, let's say uh I would not know from today when I'll be in menopause. So it's very um, again, rear view. Like you'll only know when you you are 12 months after this, after your last period. So I so I actually have patients that say, 11 months and 22 days, like they're not, then they're not in menopause yet, because technically, you know, they're still in that parametopause phase. So that's I think that's let's start with that. That's the one thing. Now, of course, that definition will only be applicable to women that are actually menstruating, right? So there are women that have had a hysterectomy, had something called an endometrial ablation, where they really don't have, or as someone who has an IUD, um, which means they don't have uh regular cycles or they don't have cycles. So for them, it's a lot harder for them to know whether they're in quote-unquote menopause. Yeah. Whereas perimenopause, again, it is um the number of years before menopause, aka the transition years from reproductive years to to menopause. So again, this is definitions looking at women really from a reproductive standpoint, which is which is something I'm like, um, which is how we've traditionally defined it. Um, but I think now the the the you know, one of the things we talk about, the one of the things I'm very passionate about talking is having women understand the symptoms that happen both in perimenopause and menopause, because they are not necessarily just about our period.

Erica Rawls:

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

Dr. Caissa Troutman:

So let's talk about averages. So in the US, the average age of perimenopause is 51.5 years old. The average age of perimenopause is 47. Oh. Okay. However, average age, so that means that you could be in your 20s and start perimenopause. Well, so so um definitely can happen in your 20s, but the com the earliest start of normal perimenopause is 35. So 35 and over, if you're having some of the symptoms we attribute to the um symptoms like brain fog, uh anxiety, irritability, mood swings, and of course irregular periods, you could be in parametopause.

Erica Rawls:

Okay, okay, Dr. Chalman. Okay. I had to take two seconds to interrupt this episode. I would like to thank one of our most recent guests, attorney Jenny Chavis, for sponsoring this show. Chavis Law Firm is an elite law firm in central Pennsylvania that helps with estate planning as well as understanding what type of business entity you should enter into when starting your business. If you're looking for a great attorney that understands estate planning as well as business entity, how to start the right way, you want to check out attorney Chavis, Chavis Law Firm. Now, back to the show. Anxiety, brain fog, irritability.

Dr. Caissa Troutman:

Yeah.

Erica Rawls:

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

Dr. Caissa Troutman:

Yeah. Yeah.

Erica Rawls:

Want to get medicated. Is it possible people are getting medicated with like anxiety medication and it's being misdiagnosed that you're just going through pre-menopause? Yes. Perimenopause. Is it pre-peri. Perimenopause. Okay. Yeah. Throughout this whole conversation, I'm going to mess it up and you're going to correct the day. Totally fine. Okay.

Dr. Caissa Troutman:

So yeah, so so let's so again, let's look at menopause is that one day. Yes. Perimenopause is the years of transition, transition years, where you're still getting your period, but you could have you could be exhibiting symptoms of perimenopause. And um the way of kind of how I explain it to my own patients is estrogen is not just a reproductive hormone. It's not just a sex hormone. It's a hormone that is affecting our entire body from our brain to our heart to our skin to our joints. Okay. So it's kind of like for the this is how I always kind of mention it too to my patients. Like, you have an amazing assistant, right? Yes. And when your assistant goes on vacation, what happens?

Erica Rawls:

Lord Jesus.

Dr. Caissa Troutman:

Right? Everything is thrown into try not to call. Everything is thrown into chaos. Yes. So estrogen for our brain cells, for our neurons, is like it's a CEO of our brain. Okay. It's the it's the best assistant that your brain has. So when your estrogen goes on vacation because of what we call the zone of chaos, where your hormones go down and up, down and up, um, it's not your brain's not working anymore. So I always discuss it or describe it as the brain breaks first on perimenopause.

Erica Rawls:

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

Dr. Caissa Troutman:

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

Erica Rawls:

Yeah, what is normal? Let's yeah.

Dr. Caissa Troutman:

And the normal is is is literally the zone of chaos. Oh jeez. It literally is. Like one day your estrogen can be if you're in if you're 35 and over, if you're exhibiting symptoms of what I just shared, um, in if we look at the hormonal status, the levels, right? Today you could be a low and then went Friday, right? Mm-hmm. On what on Monday you could be super high. Okay. And then on the next Wednesday it could be low again. So it's really like the up and down. Um and I usually kind of have a graph which makes it easier to explain because visuals are are what uh very powerful, right? Yeah. But suffice it to say that really again, perimanipause is literally um chaotic, both in our hormonal levels and how we feel. So going back to your question earlier, like um, you know, a woman 35 and over has stress and anxiety, I I think it's again, just like anything else, it's multifactorial, right? Like the stress we all have, the lives we lead, the the hustle culture, the the sandwich generation, right? Taking care of kids, taking care of older parents or loved ones. Um, all the but if you and then if and then you layer in like perimenopause and the up and down of hormones, um, it just makes it so much harder. So yeah, now we know there's actually research now. There's uh studies that show that for women struggling with depression and anxiety and then they're a peramenopause, um a good treatment would be considering hormone therapy. Now, again, it's a very nuanced discussion, right? It can't be like everybody should be on hormone therapy. Yeah, I wouldn't say that, but I think um if they're exhibiting other symptoms. Here's what I found. Look, it's they found something. Serious, so annoying. But but and I can tell you like uh my own patients, right? I have patients that come to me that have significant some of them have never had anxiety in their whole life. And then when they hit their 30s, 40s, just anxiety out of nowhere. And anxiety, it's not necessarily panic attacks, but just like overwhelming um uneasiness, kind of rumination, thinking about like having to think about several things. I've had patients that literally had the million-dollar workout, like go to the cardiologist, go to the ER because of the anxiety, and some some of them would have the panic attacks. Thankfully, all their cardiac testing were all normal, right? And then once they start working 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 so life-changing, basically.

Erica Rawls:

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

Dr. Caissa Troutman:

Yeah, so um we would normally describe menopause hormone therapy as uh giving patients back estrogen and progesterone and testosterone. So all of these are hormones that our na our bodies naturally produce. So we would utilize, I usually I prescribe FDA-approved bioidentical hormotherapies. Literally means biologically identical to what your body, um, our bodies used to give uh produce before. So we're just giving it a little bit back, not super high, just a little bit back to relieve the symptoms um and make us really feel better.

Erica Rawls:

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

Dr. Caissa Troutman:

So again, nuance discussion. We always want to uh this discuss the patient's yeah, but we always want to look at the patient's medical history, their their their underlying medical issues, their underlying kind of um concerns. Um but really the only kind of the there are of course any medication the side effects, right? The the most common side effect, number the most common um concern, I should say, is the risk of blood clots. But I always like to put it into numbers that my patients understand. Okay. So every woman has a um baseline risk of blood clots, like three out of 10,000 women can have a blood clot. Did you know that birth control triples that being placed on birth control, the patient's risk goes up to nine out of 10,000? Really? Um, oral pregnancy will bring it up to 20 out of 10,000. So those are again natural life states or prescriptions that will increase our baseline risk of blood clots. So if you have a child, your baseline risk is higher. During pregnancy. During pregnancy. Okay. And actually the risk is higher postpartum. The risk post spartom is 65 out of 10,000. So oral. We have postpartum depression. So that's so postpartum depression is another transition, right? Where your hormones are kind of over. Okay. Yeah. So yeah, make definitely makes sense. Um oral um hormone therapy, their risk is four out of ten thousand. Okay. Transdermal. So again, it's transdermal is um a route of giving hormone therapy back. So that's the skin. So so the studies have shown that transdermal estrogen, transdermal hormone therapy, their risk is the same as baseline. Okay. So again, nuanced discussion because there are different types of hormone, there are different routes of delivery. So um, but and a lot of people kind of confuse that. Well, they say like birth control is hormone therapy. So, yes and no, birth control has hormones in it, but it's not the same as bioidentical hormone therapy. And as I just share with that kind of statistics, actually, with birth control, the risk is higher for birthday. But you don't see that advertised or talked about, you know?

Erica Rawls:

Hey, I'm hoping you're enjoying this episode of Coffee with E. I had to take 30 seconds to share with you one of our sponsors for this episode, Top Construction. They are a premier construction company located in Central PA. So if you live in Dolphin, Cumberland, Lancaster, and Lebanon counties, you want to check them out. Not only are they reliable, they are reasonable, and they get the job done. Now, let's go back to the episode. So I want to stop for a second because this is amazing. How in the world did you end up in this field? Like what brought you to this?

Dr. Caissa Troutman:

Yeah, so what's interesting about my personal and professional pursuits, they actually really like merged. It all started really with what was happening to me, you know. I've been a physician for 20 plus years, and um, you know, I've I've taken care of women who um were going through their own like life. 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 it wasn't until it started happening to me, um, my paramenopause journey, that um I had to like figure out what was going on with me. So for me, my story, you know, I was at the peak of my um physical health. Uh I lost a bunch of weight, I lost like 50 pounds, I was exercising right, I was eating right, right, you know, I was eating healthy, but I wasn't sleeping.

Erica Rawls:

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

Dr. Caissa Troutman:

Yeah, so that the uh a sentiment echoed by a lot of my patients. So my story's a little different because I've struggled with weight my entire life as a kid. So up and down, up and down. So I would lose weight when I was on point, would regain weight back plus 10 pounds during my medical residency, during medical school, after each pregnancy, I would also lose weight again. So I had that yo-yo um relationship with my weight for the longest time. Um, but then there was a time when I, you know, again, um, when I applied the modern science of weight, what I what I actually do right now with my own 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 all the right things, I I wasn't so for me, the issue my issue was not that I couldn't sleep, I could fall asleep, but I would wake up at 2 a.m. and 3 a.m. and couldn't go back to sleep. Really? And I and I um dealt with that for 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 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 counseling because I thought I was just stressed and depressed because you know, why am I up at 2 a.m.? Must be anxiety. Again, um, I was on prescription medicine for anxiety, and I actually asked my doctor 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 my medical career, I had kids, I had my I had life, and of course it must be stress, you know, right? Yeah. How can you tell? It's so hard to tell. Um, and then I so I did counseling, I I did um, what else? Oh, I got into coaching. So um I currently I'm a trauma-informed coach right now, but back then, uh I that was when I first kind of figured out, okay, uh thoughts can help me change my life. So I got into coaching, became a student, and joined groups, hired a coach. Um, and what else I do? I also got certified in cognitive behavioral therapy for insomnia, which is uh the number 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 like they didn't really help me consistently.

Erica Rawls:

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

Dr. Caissa Troutman:

For me. Right. Now for some patients, they may not, you know, one or two or three of the many things I did. Oh, by the way, I didn't even mention all the shopping things I did to help with my sleep. I mean, you know, like No, please. I mean, you know, that the other phone. Like the the the whooshing sound, you know, like the apps, like so many, so many.

Erica Rawls:

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

Dr. Caissa Troutman:

Like seriously, yeah, I oh I hear you, because insomnia is real, right? And there's so many metabolic consequences of insufficient sleep. Yeah. So um, and I I love talking about 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 about periods. I never had a period, I didn't have a period for the longest time. So to me, it really when I tried all those things and it didn't, so this was maybe over a span of like four years by the way. Because what I was doing this while I was working, taking care of my kids, you know, the the whole life, right? This wasn't like I was doing it in a vacuum and it was like figuring out myself. Like, so anyway, um, so I heard about I think it was kind of the star of a movement at this point, right? List there were whispers of something called paramanipause. So I looked into it and I think, oh my god, this is freaking it. Like this is like this is it. So um I got certified by Manipaw Society. I did a lot of like um um online um certifications with other physicians and other um providers that um really are passionate about women's health, you know, um, talking about estrogen, progesterone, testosterone. And again, I applied what I'd learned to my own life and um and then I am sleeping amazing now. That is a great thing. Among other things, you know.

Erica Rawls:

That is a so what I'm hearing you say is we really have to figure out what our body needs. And it may be the therapy, right? It may be all those but we can't lose sight of us as women, we're built, we're very complicated, right? Um, we can thank Eve for that, I guess, right? So that's also what makes us amazing. That's what makes us amazing as well. I think it's important for us to take the time to figure out what is our body telling us that we need. And part of that, I know my journey's gonna be after meeting you, is hey Dr. Troutman, can I get an appointment? I need to see, I need to see what estrogen levels look like or you know what I'm missing. Because for someone like myself to start gaining weight, like the bigger um breasts, you have the the midsection, the belly, the belly, yeah, you do all the mental belly fatigue, yeah. Forgetting things, just want to scratch people's eyes out when they're talking, and they're just saying so nice words to you, you're thinking, I could just scratch your eyes out right now. You don't even know that. That's weird.

Dr. Caissa Troutman:

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

Erica Rawls:

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

Dr. Caissa Troutman:

No, you shouldn't, you shouldn't be ashamed. So again, because the focus for the longest time has been, oh, your periods are regular, you must not be in menopause, you must not be in perimenopause. That is actually not true, right? So if we look at it from the lens of the symptoms that can happen before the period irregularity, we just recognize that okay, this is this is normal, and I can get help. You know, so that's one of the main things I really kind of do with my community averages is like let people know that they're not alone, they're not crazy, literally biology. It's literally biology. You didn't do anything wrong. You don't need to have more willpower, you don't need to, you know, do more like deep breathing, although deep breathing is awesome. Medication, those are again, all of them are awesome tools, right? This is not and I do all of them on a daily basis myself, but there it's it's biology. Like it's it's biology. So start with biology.

Erica Rawls:

Yeah, and science. It's it's this is science. This is not me pulling it out of a hat. I think it's the not knowing. Yes because I need to even know someone like you existed. Oh. Right. So when we're looking up someone like Dr. Troutman, what are we looking for? Are we looking for a regular physician? Are we looking for a hormone therapist? We're looking like how do we find you?

Dr. Caissa Troutman:

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 be someone who's gone through the menopause society, then the certification. Um, in you know, we have menopause.org is the website that you can find someone close to you. Okay. If you're in the state of Pennsylvania, I would love to help you. Yeah. Um, and I think you also want to have someone that's compassionate. Okay. Yeah. I mean, they don't necessarily have to have your a specialist in hormones.

Erica Rawls:

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

Dr. Caissa Troutman:

So I'm a so I'm actually uh I'm a quadruple board certified physician. So I'm board certified in family medicine, obesity medicine, culinary medicine, and menopause society.

Erica Rawls:

That's great. In central Pennsylvania.

Dr. Caissa Troutman:

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

Erica Rawls:

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

Dr. Caissa Troutman:

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

Erica Rawls:

Yes.

Dr. Caissa Troutman:

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

Erica Rawls:

There is a solution. So the signs for someone that's 35 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 a physician, by the way, just the way you're like, no, wait, let's just make sure we clarify this. These aren't specific. There's so many. So I don't want you to think it. Yeah. So I understand. Yes.

Dr. Caissa Troutman:

Well, here's what I will use a study. Let me share let me share a Women Menopause Society um Menopause Journal published a study 2024 on how women present it to their providers. Um, these were women aged 35 to 55. Okay, 35 to 55, got it. And they present it to their providers saying, I am quote unquote, not feeling like myself.

Erica Rawls:

Not feeling like myself.

Dr. Caissa Troutman:

Well, we call it NFLM in our in our circle. So that's an NFLM, not feeling like myself. So that's a very general term, right? But people don't come into the doctor's office saying I'm in parameters. Maybe some who've done some advanced reading, yeah, but for the most part, women say I don't feel like myself. Yeah, we're not. I'm a shadow of who I am. Yeah. I'm not the I used to be more patient, now I'm snapping at everybody. I used to be able to do, you know, five tasks well. Now I can barely finish one task. I used to be able to lose weight without doing anything, and now I can, you know, now I gain weight sitting and staring at the table. Like so many. So basically a change of who they are. And in that same study, but they they try to quantify what NF not feeling like myself mean, meant. And there are five top symptoms. Okay. Already. Okay. I'm gonna start with the flow, the fifth. The fifth is difficulty concentrating. Okay. All right. So people would dis describe it as brain fog, or just again, multiple tabs open in your brain and like unable to finish the task. I always like to describe like the computer, right? You have like five tabs, or in my case, I have 20 times two, because I have two screens. Yes. Yes. And you're not able to finish one 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, anxiety can be someone who's never had anxiety before and now have it in their in their peramenopause, or someone who's been stable under meds. They've had long chronic anxiety and they've been stable under meds. Um, and then all of a sudden it's not controlled. Same thing with AD with concentration, by the way. I have ADH patients that suffer from ADHD that um are labeled ADHD in perimenopause, which likely may not necessarily be that, but more paramenopausal changes. Yeah. Or patients have been stable under ADHD regimen for most of the years and then come 35 and over, the meds are not controlling it and they have to um increase the dose and so on and so forth. And I have a similar semi so many patients that once they worked with me and we've stabilized their hormone, like they've actually gone back down, you know.

Erica Rawls:

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

Dr. Caissa Troutman:

So three is um I know it is low feelings. Okay. So again, not depression, right? Just like low feelings, no motivation to do what they no used to do. Um just blah. You know. Second is overwhelm. The feeling of overwhelm. This difficulty with coping. I mean, you know, when I read this study, I was like, yeah, check, not me, check, check. And then number one symptom that was an FLM or not feeling well myself in this one study is fatigue. Wow. Yeah, okay. So again, we're not saying hot flash of course in that study, hot flashes were answered, you know, irregular periods were also on the answers. But this just again highlights how it's not just about periods. Like this, again, the brain is affected first. So all of these are are are are are part of that. Right. Okay. I mean, you ask anybody, 35 number, they're all tired, right? I mean, and again, the king is so multifactorial. I and like we don't want to like 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 a little bit of hormones that your body used to produce before can help you? Which will help you move your body more, which would help you like, you know, meal prep better, which would help you like, you know, do amazing I was about to say something, do amazing things. Yes.

Erica Rawls:

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

Dr. Caissa Troutman:

Yeah, I mean, I could just share what how my pa my my own patients have described it. Um, so for them, it is about like um thinking about tomorrow. So so here's how I describe it in general. Anxiety is when you're not living in the moment. You're look you're looking at the future. What's happening tomorrow? How am I gonna, how am I gonna talk to the people tomorrow? What um um what if they don't like what I'm gonna say? And or living in the past. Wow. You're like, oh shit, did I say that right? Like I should have, I shouldn't have done that, I shouldn't have said that. Yeah. Like you're ruminating, right? Not like again, there's a s a certain like I it's always a spectrum, I think, right? You have the anxiety attacks where you're literally like paralyzed, cannot make a decision. I have patients that tell me I have palpitations, you know.

Erica Rawls:

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

Dr. Caissa Troutman:

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 you negatively. Do you know what I mean? Right? I mean, so of course it's we have to think about tomorrow.

Erica Rawls:

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

Dr. Caissa Troutman:

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

Erica Rawls:

The doctor coach is trying to define it.

Dr. Caissa Troutman:

Yes. Yeah, I so I think it's always how you're affected by it. If you're affected negatively, then you know, but racing thoughts. Thinking about, I mean, I can tell you about myself too. Like, I just would like ruminate. I would think about what I said yesterday. I shouldn't have said that. Okay. And again, I'm not saying that there's no role for evaluating what we did in the past or there's no role for thinking about tomorrow. Of course there is. But it's negatively affecting how you're performing today, I guess. Right. So let's talk about sex with hormones. Talks about sex.

Erica Rawls:

Yeah. Let's talk about you and me.

Dr. Caissa Troutman:

You sound crazy. I love it.

Erica Rawls:

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 the woman's desire or need or the sex?

Dr. Caissa Troutman:

Yeah. Love you're talking about this because this is not discussed at all in the doctor's offices. Okay. But sexual health, first of all, is part of our health. It's part of woman's health. Right. So we need to, and very frequently it's not discussed. It's or it's discussed with tinged with shame or guilt. Right. So what happens in menopause? So again, menopause means we are, uh perimenopause means fluctuating levels of estrogen, progesterone, testosterone, but also in menopause, estrogen is out 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 a brain thing. It's not a vagina thing or a vulva thing, right? Libido is a big thing. Am I supposed to say that out loud? So would you please? We're educating the kingdom of the thing. Okay, I'm just saying, like the V were yeah, okay. Yeah, libido is in our brain. Libido is in our brain. Desire is in our brain. So, yeah.

Erica Rawls:

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

Dr. Caissa Troutman:

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

Erica Rawls:

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

Dr. Caissa Troutman:

Okay. I mean, I didn't know it either. I mean, can I just be honest? Like, I tell you, like, a lot it'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 something years, and sex was never so I mean it's so sex from a from a lens of pleasure in midlife. Right. Right. Normally it's sex like don't have, you know, don't get STD. You know, that's all we usually would talk about. Yeah. Which is again a good topic to discuss. Sure.

Erica Rawls:

We're talking hormones now.

Dr. Caissa Troutman:

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

Erica Rawls:

Umbust Dr. Troutman.

Dr. Caissa Troutman:

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

Erica Rawls:

No.

Dr. Caissa Troutman:

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 shorter things. 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 this different symptoms that are attributed to the loss of estrogen that affect the genital area and then the urinary system. Okay. So it presents in patients as urinary frequency, going to the bathroom frequently. Even so a lot of people get diagnosed with a UTI when they don't actually have a UTI. Really? And you know, and you know you so that how will you know you don't have a UTI? You go to a doctor, you'll get a urinalysis, and they tell you like your urine is normal. But you have symptoms, right? You have symptoms of urinary urgency. Urgency means you have to go right away. Frequency is you go to the bathroom, you know, every often. Yeah. Those are symptoms of GSM, which can be treated with hormone therapy. Really? Yeah. And I want to just kind of talk about that a little bit. So please. One of the most common issues in menopause is UTI, which if left untreated if it was a true UTI, right? If left un because menopause changes our um vaginal microbiome, like the bacteria that lives on the vagina and vulva. And then that does increase their risk of UTIs. And UTIs can lead to euroscepsis. So you're admitted in the hospital given IV antibiotics. And that can lead to um being admitted in like um the hospital and then ever so so many things else, so so many things kind of downstream from there.

Erica Rawls:

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

Dr. Caissa Troutman:

But what if we can prevent that from even happening? Yeah. Right? And that's there's a role for that with both vaginal estrogen and systemic estrogen. So that's the urinary symptom there. But genito of the GSM, so that is the vaginal canal. So a lot of women come to me and say, I haven't had sex in five years. Because it hurts. It's like sandpaper to have sex with my partner. So we end up my partner, my partner and I have not been intimate because um it hurts.

Erica Rawls:

Oh man.

Dr. Caissa Troutman:

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

Erica Rawls:

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

Dr. Caissa Troutman:

Yeah, so what estrogen does is again thinking of it from a cellular level or from an organ level, estrogen will increase blood flow to the to this to the lining of the vagina vulva. Estrogen will improve collagen formation. So um so what used to be, we call it atrophic, um, let's see, like dry is a Sahara, as my patients have mentioned, um, isn't is now not dry.

Erica Rawls:

Sahara is hilarious. Yeah. Oh, yeah.

Dr. Caissa Troutman:

I have a coat. I have like uh I have not a coat, I have a story for that. Can I share your stories? Sure. So in my practice, I always talk to my patients about what are their top three symptoms, because that's why I I personalize hormone therapy. Okay. So we decide on hormone therapy based on their goals, based on their top three issues. So one of one of my patients, one of her symptoms was um painful sex because of uh what we call vaginal atrophy or the lack of estrogen in the vaginal canal. So so so one of her, of course, goals was to um initiate intimate connections with her partner, right? So um, so we started, you know, we got treat we did treatment, um, and then one day I got a text. So my patients can text me and email me, which is so I got a text uh from her and it was fireworks. Like, what is this? I'm like, all right, I'll just ignore it. And then the next time we met uh for her appointment, I said, Did you text me this is fireworks? Yes, because that was I didn't know how to tell you, but that was like number three was Matt. So that I love sharing that story because it's just like that is so great. That is so great. So yeah. So again, it it's hormone therapy is just life-changing.

Erica Rawls:

I mean, it sounds like it. It does, it sounds like it. I need to meet with you. Yeah. Yeah, I definitely need to meet with you because just the fact that uh one, this conversation alone I learned so much. And then the fact that um there may be hope for um we didn't touch on it though. So how does the hormone therapy help with the weight gain? Yeah for the women that used to look a certain way and now their body composition is changing, you know.

Dr. Caissa Troutman:

Yeah, yeah. How does that work? Yeah, so I think the first thing I'd say is weight gain is multifactorial. Okay. Right. Um and I always say this all the time like the old, the old day, the old science is calorie in, calorie out. Now we know it's not calorie in, calorie out. Oh, it is not. It is not. 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 of describe it to my patients, it's energy in and energy out. So it sounds the same, but it's actually not, right? So by working out? Is that what you mean? Oh, so so for example, there are hormones that actually affect energy in and energy out. So one of the things that affect women is in midlife is insulin resistance and cortisol dysregulation. So when we hit when we lose estrogen, um we have become more insulin resistant and we have um increased cortisol dysregulation. So it's not that we have um high cortisol, all or I should say, it's not like cortisol blood levels go high. It's more like our reaction to stress, our resilience, that we lose a little bit of that when we lose estrogen. So um, so these are hormones that affect how how much and how energy is stored. And usually when we lose that, again, insulin resistance specifically, we we store it more in the belly.

Erica Rawls:

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

Dr. Caissa Troutman:

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

Erica Rawls:

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

Dr. Caissa Troutman:

So yeah, so I always want to say, but like weight loss is nuanced and complicated, right? So it's not just so I always I never say so what I want to say okay, you're a miracle worker, I'm coming tomorrow. What I always say is like hormone therapy is not a weight loss medicine. Okay. It's not. So I always I I say that from the get-go.

Erica Rawls:

That's fair. Okay.

Dr. Caissa Troutman:

Yeah, because again, it is nuanced, right? So so for example um, but hormone therapy can help you if you're not sleeping well. Let's just say if you're not sleeping well, and you now um we can help you sleep now. And when you sleep better, your cortisol improves. Oh and then when you sleep better, you're not gonna be as tired in the morning. So you're more likely going to do the things that we So with weight, right? We know we need to move our body, we need to eat um um, you know, our protein, our fiber, our water. We kind of know a little bit of the rules. Yeah. The struggle is applying the the rules into our real life. Right. And how can I, and and here's how I always tell my patients that um work with me for both their hormone and weight is that I want to start with hormone, I start with hormone therapy to make you feel better. Okay. Because how can I ask you to do XYZ when you're literally tired? That's so overwhelmed. Yeah. Like adding like another to-do list on your to-do list is gonna be a to-do list. It drains you. A hundred. So we really want to just start by, in a way, like, you know, again, healing, stabilizing the hormone, so you feel better. Because when you feel better, it's so much easier to do the lifestyle changes that we that we encourage. So in my practice, I talk about the 4M um pillars, so 4M playbook, meals, movement, mind, and eds. So all of them combined, you know, is is is how again women feel the best. You know. So yeah. So I think I slightly un unanswered your question, did I?

Erica Rawls:

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

Dr. Caissa Troutman:

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 calorie in, calorie out model, right? But it's also looking at how you'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 for someone like me, for example, who struggle with weight their entire life, right? Then medications might help them treat the dysregulation that happens. Is so again, horm menopause is like a metabolic switch, I call it. And like we're more insulin because we lose estrogen, these are the downstream effects. You're right, right.

Erica Rawls:

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

Dr. Caissa Troutman:

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 what we call a thermoregulator thermoregulatory center. Okay. So it gets input from our skin that tells us how the temperature is. So skin sends a message to the thermoregulatory center and say, I mean, it doesn't say this, but it's like 65 degrees. It doesn't say that. So it's like, oh, it's it's cold, so let me go and shiver, or let me go and or if it's like 100 degrees, let me go and swept. Yes. Yeah. So it gives a signal to the brain. Okay. And the brain regulates process under gets the message and tells the body what to do. Tells the body to sweat, tells the body to have a um, you know, you know, shiver, etc. So what happens in menopause is what did I say earlier? The brain breaks first. Yes. So that the regulation center is also affected.

Erica Rawls:

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 be sweating. Yeah. Like, what the heck?

Dr. Caissa Troutman:

Yeah. And you know what's interesting, not really interesting, but what a lot of people don't realize is hot flashes, it's more than just an annoyance. It really is something that impacts our health. Really? Oh, yeah. Yeah. It impacts our um your sleep. So I've be so it's sleep, um cardiovascular impacts, so much. So it's not just people, and I say this because a lot of my patients, if we were coming to me, were told, just deal with the symptoms.

Erica Rawls:

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

Dr. Caissa Troutman:

And it's like, like, but it's not. It's not you again, we can deal with it or we can advocate for treatment that will improve the symptoms. So you know, um, it is a natural transition, right? Everybody, every 100% of women will go through paramenopause and menopause, but it doesn't have to be in suffering.

Erica Rawls:

It does not have to be in suffering. Dirty Dog Hauling, thank you so much for your sponsorship. If you're looking for a junk removal company, they are the go-to company. Whether you have a small job or a large job, and even excavation, you want to check them out. They are reasonable and also timely and effective. Dirty Dog hauling. Now back to the show.

Dr. Caissa Troutman:

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

Erica Rawls:

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

Dr. Caissa Troutman:

And that's what that's that's why I always start with science. You know, I always start like this 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't have to suffer.

Erica Rawls:

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

Dr. Caissa Troutman:

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 society specialist, I prescribe any and all of them. Okay. But my first choice is usually what we call bioidentical hormone therapy. So bioidentical is made in the lab, right? Yes. Um, but it is biologically identical to what our body norm produced before. Okay. So it's literally giving you back what we used to have. Okay.

Erica Rawls:

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

Dr. Caissa Troutman:

Did you know estradiol? So the bi-identical estrogen is estradiol. It's been around for four to eight years. Okay. It's generic. Oh. Yep. Okay. I would say what I've seen is maybe 95%. Every insurance is different, right? And we can go through that whole discussion how insurance is so confusing. But I would say 95% of the time it's covered, unless it's a weird insurance. And if it's not covered, it's generic. Like it's not a thousand dollars, is what I'm trying to say. Right. Um, anywhere from my patients pay anywhere from $5 to like $300 for it.

Erica Rawls:

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

Dr. Caissa Troutman:

You know? Yeah, it's not. It's like it's just it's cost-effective. It's older than it's I mean, estrogen itself, the older version has been there, oh my god, like 70. It's been around for a while. But the bi-identical that's your dial is like 48 years. Wow. I mean it's it's been around for a while. Same thing. Progesterone has been around for a while, testosterone has been around for these are like generic um tools that are available to us. Again, it is it is different routes, different forms, different options. Um, and you have you it's finding the one that works for person.

Erica Rawls:

Yeah. Well, this was a great lesson. Yeah, yeah. I feel lighter just listening to the conversation. Like, seriously, I walked away like, okay, yeah. Um, one, there's something out there that can help me personally, and we probably help so many other people that are gonna be watching this. So how can someone get in contact with Dr. Troutman?

Dr. Caissa Troutman:

Yes, so definitely a lot of ways. If you just kind of want to listen to like science, I have a YouTube channel. I have also uh follow me on Facebook. I d I drop What's the name of your channel? Midlife Remedy. Midlife Remedy. Oh, definitely gonna be tagging. Yeah, yeah. Um so I give like um advice, not advice, um, educational insights. I talk about the symptoms. Yeah. Um, and then I also see patients. I mean I'm licensed in the state of Pennsylvania, so I have a brick and mower in Camp Hill, but again, can see any any anybody virtually, well, virtually in Pennsylvania.

Erica Rawls:

Yeah, that's awesome. Yeah. So then do you have a referral system for someone that's not local in Pennsylvania but looking for a good resource? Absolutely.

Dr. Caissa Troutman:

So um, so so for being my patient, I've I have everything online. Um patients do an initial consult with me and everything, and you know, they could at least meet Nini once to go over their story, and then they can decide to work with me. Um, and then I have the free resources on my website, midliferemedy.com, on just like maybe what's what is perimenopause and how do we and then weight as well.

Erica Rawls:

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

Dr. Caissa Troutman:

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

Erica Rawls:

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

Dr. Caissa Troutman:

I was educated. That's the purpose of our chat today, right? Yeah. Again, it's it's if I can if so to me, this is how my mission in in life is is like just let people know that this is normal. What I just kept saying, and then there's hope.

Erica Rawls:

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

Dr. Caissa Troutman:

Naturally. And you know what I always like kind of reflect upon in my own journey was like I had like four or five years of insufficient sleep. Right. And then what is the cost of that? What is the un what was the how much not not mon not just monetary, but like life, right? I could have been a better parent. I could have been a better wife. I could whatever, right? So if if I could just give that if I could shorten someone's struggle, yeah, to not not the eight years, five, you know, four years, but hey, let me guide you. You know, that's just you know.

Erica Rawls:

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

Dr. Caissa Troutman:

Right.

Erica Rawls:

At the women's mastermind. Yes. Was that two years ago? Yes. And we literally just had a comic a casual conversation, like, what is this about? Yeah. I don't know if you remember that. And I was like, oh, and she's like, and you said, um, it looks like it might be a room full of just realtors here. I was like, no, because you're here. And what do you build? So and it's like a full circle moment because we're gonna have one in January. Yes. And I know that um, so Brittany Guile, she's the CEO of Kell Williams. Okay. So she's actually having it in January. And I'm excited because um the feedback that we received from from it the last time. Yeah, I have a funny feeling that's probably gonna be heavy on the non-realtor side. Good. Which is actually gonna be really good. Yeah. Yes. So we get to meet more people like you. Because you were, yeah, just to meet you. I was just like, ooh, I have a feeling 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 that you were like a hormone doctor.

Dr. Caissa Troutman:

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

Erica Rawls:

Thank you so much. Thanks for having me. I really appreciate it. Yeah. So if you're looking to get in contact with her, we're going to make sure that we have all of this information in our description because I believe that your life could actually change by just having a conversation and getting an analysis of what's going on with your body. And who knows, you're gonna have a better life for it. I'm glad we covered sex too. Because I know that a lot of people, that's something that people don't want to talk about.

Dr. Caissa Troutman:

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

Erica Rawls:

Yeah.

Dr. Caissa Troutman:

Like, you know what I mean? Like, they don't ask me, like, how's sex going? Like, they're so that's another one of my kind of passions is sexual health, because I like there it so first okay, fun fact. One second. Not fun fact, but d are you aware of the there's something called spontaneous desire and responsive desire? No. So a lot of my patients would tell me, like, I have low libido. Yeah. So I asked them, like, what do you mean by that? I just like really sit in that curiosity and have them explain to me and not have any prejudgment on what that means. That's one. So in and usually the date says, before I used to want to have more sex, now I don't want to have sex. Now my husband touches me and like, oh my god, get away from me.

Erica Rawls:

Yeah.

Dr. Caissa Troutman:

That's kind of nice though.

Erica Rawls:

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

Dr. Caissa Troutman:

Okay, let's keep rolling. Just kidding. But that could be that could be a really good So so for example, so so the so the first thing I always say is like, did you know that that's normal? So there are actually two kinds of desire. Yeah. So there's the spontaneous desire and response. So spontaneous desire, this I describe it as Hollywood. Like in the movies. Yeah. You see someone across the room. Yes. You locked. Yes, and then you go to a room, and then you take off your clothes, and then you you you have sex and you come at the same time, and then like you fall back, and then it's sheen of sweat. Like that's Hollywood, right? That's spontaneous desire. Yes. Responsive desire is actually um something that is like I this is how I describe it. Like, hey Erica, let's go to a party on Wednesday. And you said, I don't really want to go, but sure case, I'll go to a party with you. So it's Monday, like Wednesday's coming soon, and you're like, I really don't want to go because I have to shave and I have to get a dress. Like, I really don't want to go, but you decide to go anyway because you you you know, you wanna you said you were gonna go with me. So so you go to the party, and like, oh, I like the music in this party. Oh, I like the food in this party. Yeah. So after the party, and you saw you 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 I should go to more parties. So that's for that's responsive desire. Basically, you have desire in response to something. Okay. So it's not spontaneous. Right. So what people um may not realize is a person, a a may a mere um well, I don't want to just say so a long-term relationship, usually a majority of the people are in the responsive desire. You could have spontaneous desire in the beginning, right? Because really um desireslash sex, a lot of it is like excitement, right? If you're in a long-term relationship, 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 that responsive desire, and that's very normal. Very normal. So when patients tell me that I used to want to have more sex and now I don't, I'm like, so what hap- I say that that's normal. Yeah. And this is a this doesn't mean that you have low libido. This means we need to understand what are you in responsive desire and is partner aware that you are in responsive desire? Which means that partner and you need to start talking about it. I was gonna say having conversations, being having open communication. Yes. And then just telling partner, partner, I kind of like it when what makes what makes you desire? Whether it's this is my favorite, husband taking care of the dishwasher, so I don't have to deal with that shit. You know? Yeah. Husband taking care of the plans so that I don't have to like have the mental load of doing XYZ. That's definitely gonna get me in the mood. I mean, so like I would see that's so partners have to have that discussion that it's normal. Right. And then what what what is your you know, again, I'm I talk about the chores, but it's not just that. It's about like, you know, it could be like, what's your favorite? I I don't know, like sexy thing to do, you know, right? Um so just even talking about it, I can tell you right now, I I've helped a lot of my patients just explaining that this is normal. Again, it's about normalization.

Erica Rawls:

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

Dr. Caissa Troutman:

So again, so actually what happens in the bedroom actually starts in the morning, right? So if you kind of really like good.

Erica Rawls:

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

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