Language of Love with Dr. Laura Berman - Hormonal Imbalances: The Invisible Culprit

Episode Date: March 20, 2024

In this episode, we're continuing our conversation with Ken and Marla, who have been kind enough to share their intimacy journey with us. If you've been following their story, you know that we've been exploring some of the challenges they've been facing in their relationship, particularly around intimacy and sexual health. For those who might have missed our previous episodes, I highly recommend going back and checking them out to get the full context of Ken and Marla's journey. It's been an enlightening experience, not just for them but for all of us listening in. Now, picking up from where we left off last time, Marla was opening up about her struggles with a lack of sexual response, which she suspects might be linked to hormonal imbalances. And Ken has been dealing with low energy and sleep problems, which can certainly take a toll on intimacy. I want to stress the significance of hormones in sexual health. They play such a crucial role, and it's important that we don't overlook them. It's not uncommon for sleep issues and low energy to be connected to hormonal imbalances, and identifying any issues there is vital for overall well-being and, by extension, Ken’s relationship with Marla. So, let's dive in and see how things have been going since our last conversation.  In this episode, we’re diving into: Marla's concerns about her lack of sexual response and arousal Ken’s struggles with low energy levels and poor sleep quality The role of estrogen, progesterone, and testosterone in sexual response and overall well-being Marla's previous experience with hormone replacement therapy and concerns about family history of breast cancer. Recommendations for personalized hormone therapy and regular monitoring The potential risks and side effects of hormone therapy Remember to check out my free course on Quantum Sex. It's going to teach you how to take your sexual response to the next level. Just go to my website’s homepage. Until next time! Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, I'm sex, love, and relationship therapist, Dr. Laura Berman, and for the last 30 years, I've been helping people learn to love and be loved better. Welcome to the Language of Love Sessions. This is where I get to work with you one-on-one, on air. You, my listeners, my goal in these sessions is to empower you to enjoy better relationships, both with others and with yourself, and to help you embrace how precious and sacred your body, your love life, and your sexuality really is. It's time we all become fluent in the language of love. Hi, guys. Hi. It's time for our session.

So how are we doing since the last time we spoke? Oh, it's tricky. Our intimacy in terms of day-to-day conversations, laughing, supporting each other, it's like 10 out of 10. I'm going to get emotional. I kind of feel like I need some hormone support. like I really feel like it's that time last night we re-listened to your our sessions with you and I was like okay Kenny I'm Cleopatra and we were being playful and fooling around and I'm like I don't even know who Cleopatra's like people were he's like okay I'll be your servant it's just fun we had we were being playful and then I got down to business and nothing like nothing and it was just mind you 2 30 in the morning so i just i had oral surgery last week so i wasn't able to sleep and kevin's being very sweet like do you want to watch tv do i'm like no it's okay so i'm

like oh what the heck we're awake let's try this and so when you say nothing happened do you mean i felt nothing dr nothing like literally like i was like an activation of the kid i was just like what's going on here okay you're talking about your sexual response just so yes I had I just didn't feel any tingly no excitement no arousal like I was kissing Kenny on his face and he was freshly shaved and I really liked being near him and I was like you know what I think I can't sleep because I want to do something here you know I was really like trying to spiritually connect yeah my mind to my body and then Kenny was trying also now it's funny it was not funny last night it was just I just started to just get really hopeless and sad and then I just

started saying things that not just I just wasn't very nice I wasn't mean but I wasn't nice you know i was just you were frustrated yeah and when you say he was trying things meaning he was trying to stimulate it wasn't working or yeah he's like well let me let me try and all the playfulness stopped yeah and then it became excavation like he was getting a splinter out kind of well he wanted to fix it of course he did of course he did and i i just made me feel worse which isn't his fault it just i mean no it's not it's not his fault right nobody's fault but i want i think that's important because he gets really nervous about doing the wrong thing and i told him it wasn't i did right i wasn't kind i did i didn't say it was his fault all right

before i dive into this because i have a lot of thoughts let me check in with you kenny about what your take on this was that happened the last night? No, I mean, Marla summed it up well. I went to bed whenever, and Marla came up, and we talked for a while, and we sort of

fool around a little bit, and like Marla said, we just couldn't get out of the starting gate. And yeah, it just made Marla very frustrated. Understandably so. And like Marla said, everything was great, except from 2.30 to 3 o'clock.

Yeah. And have you guys have you been sexual since our last conversations? Because at our last conversation, life had gotten crazy. You weren't finding that. Yeah. Yeah. That was like a month ago. So until last week, have you been able to be successfully sexual with one another? No. Yeah, not really. I mean, a couple of times, but nothing. I wouldn't say sex. What do you when you this sounds silly, but when you say sexual, I don't know. it could be we haven't had sex okay we haven't had sex i was away no i was away for a bit no excuses we just haven't we we moved the massage table because we were you know we're still bringing furniture and taking stuff out so we moved the massage table upstairs and by moving

it upstairs it was sort of out of sight so that touching and evening it was like a visual reminder for us to like nurture each other now it's like put away in another room it takes more effort and planning and I have to say neither one of us have been good at that I also had oral surgery last week yeah so there's been a lot yeah how old are you now Marla I'll be 63 um in a month and so how long have you been without a period oh my goodness I had a hysterectomy a partial hysterectomy at 43. Okay. And so, but you kept your ovaries after that? I did. Okay. So we don't know because you don't have a uterus when you went into menopause, but we can guess since the average is 50, 51, you know, it's been at least 10 years, but you haven't, it doesn't sound like from our

past conversations that you have, I mean, we've talked about lubricants and stuff, but you don't really have a lot of pain or dryness that makes things uncomfortable. And you have been able to sexually respond until recently. Yes. I'd say about a year when I really break it down for my normal response. Yes. Well, so just so you understand, and this is really important, I'm glad you're bringing this up because you're certainly, I mean, this is really normal. Usually the symptoms start much earlier than in your 60s. Although I know there was a long period of time where you weren't really sexual together, so you maybe didn't test it. You know what I mean? And now that you've been testing it, the symptoms are becoming apparent. But basically what happens as

we move into perimenopause and menopause, which is usually perimenopause can start in our mid to late 30s. But menopause for most of us is average age of 51, but it can be earlier or later. And And what constitutes menopause is basically moving from perimenopause to menopause is going a year without a period, but whatever. Let's just talk about the symptoms. Basically, what's happening is you have a drop in estrogen. There's different kinds of estrogens, progesterone and testosterone. Those are your three sex hormones.

And the important ones for sex is estrogen, which plays a role in the thickness of the vaginal tissues. So any kind of thinning or atrophy or pain or dryness that's usually related to low estrogen levels. And estrogen also plays a role in cardiovascular health and memory and lots of different things. And testosterone is central to sensation, nipple and genital sensation. By the way, this is true for men and women, nipple and genital sensation, ability to get aroused and ability to have orgasms and muscle tone and energy and general sense of well-being, all of those things, testosterone plays a role. Now, testosterone is slowly, unlike estrogen, which just drops off once our ovaries have

decided it's time to go to sleep, sort of, with menopause, the testosterone is slowly declining. So like a woman in her 60s has half the testosterone that a woman in her 20s has. And so desire, sexual response, and energy will be significantly affected the lower your testosterone levels get. So there are lots of variables. I just did a podcast interview. It'll come out probably in a little bit if it hasn't come out already because I don't know when this episode is going to air. But I just did an interview with a menopausal expert who I was so grateful because I really had her take us through the disservice and how incorrect there is this big women's health initiative study that happened in around 2000, 2001, which came out with a false, it wasn't a well-designed study.

There were a lot of flaws in it. We get into all of this in the podcast, but basically stating that in this study, hormone therapy caused was correlated with an increased breast cancer risk. And at that point, every doctor in the country took every woman off hormones and refused to give it anymore. And that's where we've been since 2001. line, but I'm a PhD. I'm not an MD. I'm not going to get into all the new, you know, we, you can listen to that podcast about menopause to learn more about if you want to get into the minutiae of it, but here's the bottom line that unless you have a significant risk factor, like your BRCA positive, you have the genetic risk factors, or you had an estrogen sensitive breast cancer or something like that, or you have a medical condition that puts you at risk for something

really hormones, if managed and given carefully and knowledgeably, actually are protective versus harmful. And they help with all the things I talked about, memory, weight, energy, general sense of well-being, and sexual response. So I do think it's worth you going and talking. First of all, I'm curious why you are now. I actually was on HRT for about six years. And then my doctor said, because my mother and both grandmothers and both aunts, both matrilineal, patrilineal, had breast cancer. She's like, I think five years is enough.

I think you have to stop. So now I have an S-string vaginally, which is doing very, a little. That'll be locally. That doesn't get systemic. so that will help with the vaginal tissue piece and i take progesterone at night to sleep because i had trouble sleeping yeah and then last year the year before last i had i experimented with the tea pellet being implanted and that made me like a bit of a gorilla for the first 15 to 20 days i was just like a mad woman and then it would settle and i felt great i felt like working out

and my joints felt great and everything. So I can't seem to get like the magic. And what happened with that? Did you stay on the testosterone? No, I got another pellet. And then I actually went back to her about two months ago. Excuse me. And she was saying, you know,

maybe we could do it again with just a little lesser in it this time. Yeah. But I feel like I need my compounding pharmacist, my hormonal lady I went to before is in Italy right now with her family. Cause I just checked her Instagram this morning. I was going to DM her and just be like, Oh, cause she's really, she's good.

She, she prescribed like a spray for my nose and these little pellets, suppositories to put, you know, up inside, but like, it's all gotta be a symphony, you know, it can't be like. It has to be. And it's not. And just so everyone understands you included, it's a little labor intensive because there's no like one size fits all approach. This is why I don't really like the pharmaceutical company. I understand there's a role for them, but all the kind of prescription brands of, of hormone replacement therapy,

they are like in two or three sizes, you know, small, medium, and husky, right. And they're all kind of, there's nothing personalized about them. And a lot of them are made from synthetic products or horse urine or other things. So first of all, you're on the right track with the compounding pharmacist and using what we call bioidentical hormones. But it is a process of getting the right symphony, as you say, getting the right combination, monitoring your side effects, monitoring your symptoms, but not succumbing to the hype. So for me, and this is once again, my PhD suggestion, being someone who's ushered thousands of women through this and been through it been going through it myself is get the genetic testing if you can right i actually

did i'm brock i'm brock and negative okay so you're brock and negative and they look at other things to check too you know it's not just brock anymore they've learned a lot more genetically but if you had genetic testing i'm sure they unless if you had it five years ago get it done again because they did i did it was i'll get it done again i would get it done again because they have a whole new layers of genetic understanding, which is helpful and also soothing. Because like in my case, for instance, I went to the geneticist and I was like, all right, what are my risk factors here? And she's like, you basically have, even though you've had breast cancer and your mother and your aunt and this person, that person had it, you're actually, you have

this one thing that may make you a little more susceptible to colon cancer, but because you have this other thing, you don't really, your risk is basically the same as anyone else. I was like, I would have thought my risk was through the roof. So now you can move into, once you understand the whole genetic platform, right? Then you can start moving into quality versus quantity, right? Like, okay, you can make those more informed decisions. And I've worked with many women who are like, okay, yeah, maybe I do have a slightly more increased risk of breast cancer if I take these hormones, possibly, although those studies

are extremely flawed. So we don't even know. there's lots of arguments being made for the opposite being true, but let's just pretend it's potentially true. This is affecting my quality of life enough that it's worth it to me. Like I, you know, I want to live vibrantly and fulfillingly and feeling good and having energy and enjoying my sensual and sexuality. And so it's worth it to me. Right. So, but you have to make an informed decision and you have to work with either a physician or a nurse practitioner or a pharmacist who can monitor you

and work with you to create the symphony. So it's not just like giving them to you and then seeing you in six months and being like, maybe we should lower the dose. But it's also, it really pisses me off when doctors do what your doctor did was like, okay, you just need these for five years. Screw you, I just need these for five years.

Yeah, it was the worst decision ever. Yeah, but she was doing it because she was scared by this one freaking study. Yeah, you're right. initiative. It just pisses me off. Yeah, no, it's true. So I feel like the fact that you're saying it, unless like if you were having trauma coming up or issues with Penny coming up and none of that was going on. And this is more of like, I don't have the tingling warmth. I feel numb. I don't have the sensation physiologically. Like I have the emotional desire, but I don't have

thoughts, fantasies, and motivation. I don't have horniness. I don't have tingling and warmth in my genitals or my nipples don't get erect or whatever it is. And it's new. It's not something that's always been the case. And it isn't related to significant body image or trauma stuff or relationship stuff. It's probably, and you're the right age and stage. If it quacks and walks like a duck, it's probably a duck. Right. Yeah. It's just like, I just, I'm tired of feeling this way and thinking this way like I had at my physical therapist trainer is helping me with some other issues and she had me do this exercise and I was like I don't think I feel what you're asking me to do and first we started to giggle and then it was like a light bulb went off like holy moly

there's no there's just no connection and I kept thinking I was it was me and you know I'm I'm whatever just away from myself I feel like one of those you know those things where you're cutting to parts when you get puzzles for your kids and that one just slid over like this way you mean from the waist down yeah from like my waist yeah that whole solar plexus you know my tummy my like even my breasts it's it's very very it's upsetting yeah and because it wasn't that way before. No. And what about Kenny's hormones? How are your hormones, Kenny? How's your energy, directions, general sense of well-being? Yeah, I mean, I'm in reasonably good shape. I mean, my energy is definitely below where I think it should be. And even if it's not below where it

should be, it's below where I want it to be, which to me is more important. But yeah, I mean, And I don't sleep particularly well. So that's very frustrating. And have you had any hormonal evaluations or anything? I mean, I go for regular blood work and my testosterone is consistently in range. But other than that, no. Yeah. Okay.

So just make sure that they don't just test your testosterone, but that they also test your free testosterone, which is really what you're testing. And that's normal. That's normal. Okay, good. Because that's important too for you, right? And it may be, and Lord knows there's a poop ton of testosterone therapies available for men, not as funny for women. But if you go to the American Academy of Anti-Aging Medicine, it sounds like you have some resources already. But if you go to the American Academy of Anti-Aging Medicine, which I think is a4m.com, and we'll put that in the show notes as well for folks, you can find someone. I like to look for someone who is ideally a diplomat in the organization or has a lot of experience being part of the organization as one who teaches others because they have a lot of experience.

but you can usually find someone in your area who does and works with bioidentical hormone therapy because that you want to be a partner with this person where every three weeks you're checking in about symptoms and every few months you're measuring levels because basically what you're doing is they started a really ideally they started a really low dose and you can do it through pellets through patches through injections like i do testosterone injections because my doctor doesn't like the pellets because if you have a bad reaction to it, you're stuck with them in you. And then it also is a nerve. And so I give myself an injection every week, which is no big deal. I thought it would be, but it's not. So it's a teeny tiny little needle, bada boom, bada

bing. I freak my husband out, but I'm fine with it. Hey, it's Dr. Laura Berman. I've been a sex love and relationship therapist for over 30 years. And the main question I always get asked is how the heck do we spice it up in a long-term monogamous relationship? Well, if you want to take your love life, your sex life to the next level, whether you're in a relationship or not, check out my free course on quantum sex. It's going to teach you how to take your sexual response to the next level, capable of full body orgasms, how to use sex magic to manifest your dreams and how to connect on an even deeper level sexually with your partner. Just go to drlauraberman.com and you'll find it right there on the homepage, the quantum sex free course.

Check it out. Let me know what you think. So there's lots of ways to do this, but what you're looking to do is to start with the lowest possible dose and then slowly titrate up until your symptoms are better and you're feeling better. And then you're there for a while and therefore you're taking the lowest possible dose of something that's bioidentical, usually a combination of things. Because like I said, there's several different kinds of estrogen and progesterone and testosterone. And then maybe a few years down the line, you'll notice the symptoms are there And then you need to adjust or add in more or whatever. So it's in an ideal world.

And this is tricky for people to understand because we're really the second, really the first generation that is going to live probably half our lives in menopause, if we're lucky. You know, the average life expectancy is 100 years. And we're not, our evolution hasn't caught up with modern medical technology, which now keeps us alive until 100 with all these medications and medical interventions and heart surgeries and everything else. But the problem is that we are not intended to live this long in without hormonal support. And so people think, oh, I'm 50 now. I should just, it's just a natural part of aging. No, it's no more a natural part of aging than that's to be the equivalent of saying

stopping active, being active as a natural part of aging, no longer having sex as a natural part of aging, having no life as a natural part of aging. No, it's not. It was when we lived another 10 years and there was no options and nothing to be done, but that's not true anymore, right? So it may mean that in some cases, and I'm not saying this is true for you because you may not even need or want systemic estrogen. You'll decide that with your doctors and your genetic testing and your symptoms and everything else. But someone who is taking estrogen systemically will continue to get a period probably if they have a uterus. And maybe that's a deal breaker for them. For me, like I haven't started estrogen yet, but I'm fine getting a period for the rest

of my life if it means I feel great and I'm active and I'm supported and my memory's good and my sex life is good. And yeah, bring on the period. But everyone's, it's an individual decision, right? But we're entitled to make that decision. Yeah. Yeah. I really dropped the ball because I really trusted what they were saying was true. Yeah. Well, it was to them. I'm not saying they intentionally lied no no no no but everyone meant well it's just I should have questioned because I'm educated I know about these studies I know you know how tilted I mean we all know how every part of care for women is tilted but and it's really about the dot what's saddest to me is how it's really about the medical community covering their own asses right because

everybody's so, and I, and that's our fault too, not your, you know, individuals, but as a culture and a society, it's our fault because they all get the crap suit out of them and their malpractice insurance is through the roof because they're getting the crap suit out of them for ridiculous things. And the people for nefarious purposes, some legitimate, but mostly nefarious, right? So because of all of that, the medical community is so paranoid about getting sued that they won't even give you the treatment you need because of one stupid study. I mean, I had just launched a whole women's sexual health center that had this huge medical arm in it. I remember in Chicago, I launched it in 2000 and the study came out and I had a board of directors and all these investors

and this whole medical team. And in 2001, the board of directors, when the study came out, I was like, nope, we can't do hormones anymore. Nope, absolutely not. I was like, well, you just shut down my whole medical side of my practice. And I now got to get rid of all these physicians that i just hired that have been helping all these women and now i can't help these women with the medical aspects of their desire which is like cutting off one of their my arms to help them and it's been that way ever since so that's changing again but it's it's so far it's not changing in the medical training so it has to be the patient advocating and finding the right clinician who and that's why i sent you to the american academy of anti-aging medicine because

they are in this world and working with it in a way that your ob-gyn or general practitioner has probably been told no stay away from hormones well you know that that's part of the problem like i think marla and i were looking into the t-pellet thing you know together and for every article i found that was in favor of if there was an article said don't do it and you can't get it through your doctor they're not going to do it to your point so you go to some naturopath who may or may not be a doctor but you know it's doing a naturopath practice and sometimes you just don't know who you're dealing with and you don't even know if they're qualified and i was going to get the tea pellet i couldn't get it because i had a blood clot thing going on at the time and i'm on a blood

thinner so i can't take the tea pellet so marla took it and i felt bad that while i had to do it you know without me she shouldn't be the guinea pig but you know she took one for the team and you know what she said was right you know it was a rough beginning and then it got a little smoother but it just on on balance it just didn't seem to do much well then then i'm sorry it didn't do what it was supposed to do well it did but then our desire was like this right so first i was like no like crazy like everything was why did you do and then then it normalized and i was like i feel great you know and my everything felt better my joints my brain my was like high functioning you know because i keep saying i have adhd i think i just have brain fog yes i just think i have

severe and that's estrogen that is estrogen and as a new study just came out that shows that estrogen actually has protective effects on on alzheimer's against alzheimer's and dementia brand new study so there's those studies are starting to be done and coming out but that's why you're absolutely right, Ken, that you need to be careful because there are a lot of kooks out there that aren't being careful, right? And that are prescribing,

hormones are no joke, right? Like we need them to live, but if you have too much of them, they can cause other side effects and other risk factors. And if you have the risk factors and you haven't been on them for a long time, I mean, in that study,

one of the big problems is that the majority of the women on there that they suddenly gave HRT to, And it was a very specific kind of HRT had not been on it at all for 20 years and had developed this plaque and heart disease. And now all of a sudden they're given estrogen. So the blood is pumping through their system and moving these clots of fat that had been building up into their. Oh, and they're going, oh, geez. Right. Well, the reason they were having strokes is not because they were on estrogen, but because they hadn't been on estrogen for 20 years.

And then we'll put on it without thinking that that was good, you know, and evaluating what the risk factors are. So it's really important to go. First of all, that's to say that one of the many reasons the study was flawed, that it changed the entire medical world around dealing with women's health, but also because we have to do it carefully. And so that's why I say if you go to the American Academy of Anti-Aging Medicine, yeah, there are lots of osteopaths with lots of people that may or may not have experience, but you're also looking for someone who has those badges that they are like in this world, they're training other people, they have a robust and responsible medical practice, and you can see that in their credentials. one of the complications initially is i have this the mthfr gene mutation and i wasn't methylating properly so when i first went on it which i'd have to go back to my records i have a whole book of records things were not moving quite so right and they weren't monitoring me properly and it was a big renowned center around here but i just said look i know my body something's not quite right and then dim came out and you know it's like we'll go on dim and dim will you know help too but nothing really does that methylation process except your body yes so i really need

somebody super sharp and i've i've been to so many doctors in new york city and they're like at the end they're like we don't know why you can't lose weight we don't know why they aren't responding we can't figure you out i just did an interview that's coming out with sarah gottlieb who is in philadelphia she runs the precision medicine center and she just wrote a book that's i don't even know if it's out yet but i think it's available for pre-order and that's what one of the reasons we did the podcast called i forget what it's called but it's basically about auto immune disease and did the hormone reset book yes yes i just unpacked my books to the bookcase and i I just had it in my head.

Okay, great. She is an example. And I hadn't even heard, ironically, because I am pretty up on the medical stuff. But I hadn't heard of precision medicine as a term before. But she, basically, they deal with a lot of those kinds of things. And they do poop tests and chelation tests and testing to see how you're not only how your immune system is functioning, but also how your gut is functioning and how you're methylating things and all of the things you're referring. Right. Because basically what you're saying is that your body doesn't process out toxins effectively. And so that does cause brain fog, weight gain, low desire.

And she was talking about that in our interviews. So I don't know. I just think you should check her out because she's not. We're not. I mean, it's not the farm. But check her out and check out maybe another precision medicine person because this is and also be careful if you don't easily process out things right, then maybe a weekly. This is just a theory.

Once again, as a Ph.D. therapist, not an M.D., but makes sense that maybe putting pellets in your body that your liver has to process a certain way and a big chunk of it and then it has to be, you know, kind of spread out is maybe not as good of an idea as a weekly shot. Right. That you're kind of giving your maybe like how does the the delivery system, if the delivery system, for instance, is something that's going to really put a lot of pressure on your liver. there's many different delivery systems. Let's try one that bypasses the liver, right? Let's, I'm not saying that's an injection, but I'm just saying that's one question that you can explore with someone who understands all these nuances. Yeah. That's what I learned with the tea palette. It was so, it was so long lasting. And I was like, oh, but there's nothing I can do about this. I just got to ride this out. Yeah. We don't want you to have to open and pop it out.

Yeah. And that, you know, that's as somebody who has witnessed Marla taking, you know, going through an HRT protocol and other things like that for years. It's a very, I mean, I can't imagine how Marla feels. I mean, being with Marla, I feel so frustrated for her because I think half of the time these people are just guessing. it's such a hit or miss thing it can take decades to get it right by the time you get it right your body's changed yeah and i've read articles and i don't read a lot of medical stuff i just when i come across them you know i read them and you know it's it's one article i read that you know stuck with me is if you think your body doesn't know that you're putting fake hormones into your system you're out of your freaking mind yeah no it does so you don't know you know you don't know what rabbi to believe you just you just don't yeah and it's exhausting trying to figure out the right combination and trust somebody who likely and you're right when you said earlier

you know as a society we've just learned to listen to what doctors tell us because they're doctors and you know doctors don't do this stuff so you're going to non-doctors yeah and then you wonder if they know what the hell they're doing well that's why i think yeah i think it's really important to just be really discerning and to go to people who have had a tremendous amount of training and to understand that this is a partnership. This is a process. And in an ideal world, it should not take 10 years, but a very like, and I'm not saying it doesn't because it does for people who aren't getting the proper support. It should take three to six months to start seeing some improvements

and find the right formula for you. Maybe a year if you're complex, but ideally if you're working with someone who sticks with it, who understands the science, who has experience, who has a protocol that is working for them and they're not just shooting in the dark and they're someone who really has the experience

and maybe even teaches it themselves. I'm always looking for that. Yes, me too. then you are likely to be really kind of supported properly within at least six months, ideally, and definitely a year. And so that would be what I would say is the next step. And the only other thing I will give you guys as homework is just like stop worrying for now, because let's just accept that there is a physical infrastructure that isn't in place yet right now. So stop trying to squeeze water out of a stone or sexual arousal out of an under-testosteronized system and just enjoy the experience with no goal.

What would sex be like if it was just an act of love and intimacy between the two of you and maybe you aren't having the tingling warmth and orgasm and everything else that you want to have, but can you maybe have some intimacy without that? now. Right. Just to me, I put all the toys away today. I'm just like, it's just, it's too much for me. Right. And if it's too much pressure to have an orgasm or to have arousal, let's just take arousal out of the puzzle for now. We're not at all saying permanently, I do not want you to say bye-bye arousal for Marla. Right. But for now, until you get in to see the physician, until you get the hormones, like arousal may or may not happen and probably don't expect it to. If it does, it's a lovely visitor. But in the meantime, it's about sensuality. It's about intimacy. It's about connecting, obviously not in a way that's going to be physically or emotionally uncomfortable

for you. If you're having pain or whatever, don't do it, but otherwise play with it without any expectation, but don't, don't. Yeah. I think last night I just got off the rails a little bit because I even said yesterday, we had a great day. You know, Kenny's taking such good care of me with this surgery. He always does. And I don't like this fracturing that foundation, but I also don't want to give up on the, the hopes that, you know, so it's like, but I want, well, it's about knowing and not giving up because it's going to get better once you get properly the proper hormonal infrastructure that's going to happen right and i think what's going to happen is you're going to find the right doctor and then kenny's going to come in too and do the same thing but in the

meantime what we don't want to do is put intimacy in the closet and lock the door until you quote unquote figure this out which is what a lot of couples naturally do because like i don't know how we're not gonna have like this i don't you know put all the vibrators away i'm not gonna have an orgasm like let's just stay away from all of it all together and that's kenny's mo right he's gonna do that anyway so don't do it you guys been talking behind my back or something no no you know what i mean yeah yeah okay so keep that connection even if it's giving each other a massage or having about it having to lead to orgasm and just like yeah stare into each other's eyes and be really intimate and be close you know how to do that right but yeah we do that

yeah i just feel badly because i don't even have the desire to help kenny get there like because there's a there's this little bratty part of me like i can't do it and i don't want to help you either which is so silly but no it's not fair it's not fair it's understandable no it's not there it's one of the reasons that i haven't really been more aggressive with marla because I know Marla's not feeling it. I don't want to, you know, throw myself at her. That's not fair either. But I disagree.

I get and that's beautiful and lovely and sweet. The truth is you have to think of it less as like getting him off or whatever and more as nurturing and feeding the underbelly of your connection to each other, the foundation of your connection to one another. It doesn't matter. Yes, of course, we want you both to have orgasms. We want you always to have orgasms. But the truth is that kind of physical intimacy, whether he has an orgasm and you don't, or neither of you have an orgasm or whatever orgasm happens, having that physical connection and ease and flow around the physical connection and willingness to receive initiation and make initiation, that energy, we absolutely want to keep feeding.

that's the foundation of your emotionally intimate connection and so don't get all caught up in that well if she can i won't either and like no that does not apply here it's not fair it's not fair and it's not it's not going to help anything and then once she gets all riled up and hormonal but we have to now go back and open that door that's been closed and get you comfortable again and all of that like why do that right all right you got your marching orders you're going to find got it doctor you're going to stay in and i will see you thank you for not giving up on us this is good it's normal project you see the this is how it goes this is how it rolls it's an it's not a beginning middle and end it's an evolution thank you you're very you give us a lot of hope

And I needed to process this with, it's just, I have to start fresh and forget what happened before and just move forward. March on. March on, babies. As they say, Mrs. Maisel, tits up, right? All right, I'll see you next time. Thank you so much. I'm crazy for your love

I wrote me a prescription But there's no cure for crying