Latest / Cortisol Coach / Low Libido After 40: The Hormonal Truth Behind the Intimacy Problem in Your Marriage with PA Josh Reiners

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Low Libido After 40: The Hormonal Truth Behind the Intimacy Problem in Your Marriage with PA Josh Reiners · Cortisol Coach

0:03
Welcome to the Cortisol Coach Podcast. If you're exhausted, gaining weight,
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losing your hair, your anxiety is through the roof, or the depression and emotional
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overwhelm have completely consumed your life, or maybe you're not showing up
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as the wife and mom you want to be.
0:17
You've spent years never feeling
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good enough, taking care of everyone else while you quietly fell apart.
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And your body has been keeping score of every single bit of it.
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The chronic stress, hormonal shifts, perimenopause, menopause,
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whatever season you're in, cortisol is making all of it worse.
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And until you heal the root, nothing changes.
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But this show here is about to change that. I'm your host, Christine Marie,
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Holy Spirit-led Biblical Mindset Coach, and I have helped thousands of women
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heal their hormones and cortisol levels.
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Every week, I bring you leading experts, doctors, and coaches who will help
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you heal your body, mind, emotions, and your spirit so that you can step into
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every kingdom purpose that God has planned for your life.
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So go grab your cup of coffee and let's jump in.
1:06
Welcome to the very first co-hosted episode of the Cortisol Coach Podcast.
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I am so excited that you're here today. I have a very special guest.
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I have a healthcare provider on this show today and hold on for it. Are you ready for this?
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We are going to talk about women's libido and intimacy.
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Just hold on for a second there. I want you to think about how you felt when you heard me say that.
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Because if you're anything like me, maybe you felt a little bit of discomfort,
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a little like a slight cringe, like are we really going there?
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Maybe you got an instinct to just skip the episode. Let's just move right along.
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But that's why we need to have this conversation today because that was me too.
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And that is exactly why this needs to happen. But let me share a statistic that stopped me cold.
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One in five married couples.
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Is living in a sexless marriage right now. And hold on.
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And 27% of women have reported not having sex in the last 12 months.
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Does that give you pause at all? Because it did for me. And this is not because
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they don't love their husbands. It's not because their marriage is broken.
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It is because nobody, not their doctor, not their pastor, not their best friend
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ever told them what it was like when you are experiencing hormones that are
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out of alignment, and this is not your fault.
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So today, my guest is Josh Rainers.
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He is a physician's assistant with over 20 years of clinical experience and
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a background that spans some of the most complex areas of medicine.
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He earned his undergraduate degree in animal science and exercise science from
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the University of Nebraska.
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Before going on to earn his Master of Physicians Associate Studies from Eastern
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Virginia Medical School, Josh has worked in orthopedic spine and sports medicine.
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Joint replacement surgery, and family practice.
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He has assisted in thousands of surgical cases over his career and continues to do so today.
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He has worked on the sidelines as a sports medicine provider at high schools,
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colleges, and the semi-professional level.
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For the past four years, he has been in family practice with a specialized focus
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on orthopedics and hormone therapy, which is exactly why he is here today.
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I told you I was going to bring you the best of the best for women's health
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over 40, and that's what he is, but what makes Josh truly unique.
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Is that in addition to being a clinician, he is a former Division I track athlete,
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a man of deep faith, a former men's ministry director, father of four,
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and incredible husband to his amazing wife, Carly.
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He brings the kind of perspective that is rare in medicine.
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He is somebody who has lived in the body of an athlete, served in the church.
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Now he sits across from patients every single day helping them to understand
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the connection between their hormones.
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And everything else. If you are a woman who has ever felt broken,
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ashamed, or disconnected from your husband and you didn't know that hormones
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were the root of it, this episode is for you.
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Josh, it is such an honor to welcome you to the Cortisol Coach Podcast.
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Well, I appreciate that. The pleasure is mine. I'm just happy to be a part of
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it. Thanks for having me on.
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Yes. So, okay, let's just, let's dig in. So, for me, this topic is so meaningful.
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Why you and I had a conversation probably six months ago, and we were talking
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about specifically the church.
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I have never once ever gone to church and heard a sermon on sex in your marriage,
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and yet marriage is the most holy covenant that God created between man and
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wife, and yet also, I believe,
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a spiritual warfare tactic of the enemy to keep this topic under a lamp,
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hidden, never discussed.
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And so when I say one in five married couples live in a sexless marriage, does that surprise you?
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It doesn't. And I would go so far as to say that your pastoral staff is potentially
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in that demographic as well.
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And that's one of the reasons why it's a really hard topic to talk about is
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because it's something they're struggling with as well.
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The enemy is, if not singling them out more than us even, that's a pretty common area.
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There's so much stress with being pastoral staff and all of that,
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taking on the emotional burden, the spiritual burden, the physical burden of
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that, often intimacy in pastoral staff is probably even higher than one in five, to be honest.
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That's in my opinion, that's the only sermon I've ever heard from a pastor on
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a topic that had anything to do with sex was a pastor I knew well,
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and he had an awesome sex life in his marriage and had for 25, 30 years.
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So not to be disrespectful, but I would imagine, unfortunately,
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they are probably falling into that same category.
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Wow. I had a conversation with somebody earlier today, and she was talking about
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how this is actually something she struggles with in her marriage as well,
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but she doesn't talk about it.
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And I feel like there is this huge covering of shame that if you are married
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to somebody you deeply love, there's nothing wrong with your marriage,
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yet there's no sex happening.
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Right. Talk to me about what is actually happening hormonally in a woman's body
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after 40 that may be impacting libido. It's super multifactorial.
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But if we just strictly talk about the hormones, so obviously hormones peak,
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this is estrogen, progesterone, and testosterone in a woman, peak at the age of 24.
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Not surprisingly, and I'm sure that resonates with kind of how either some folks
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are feeling or how they used to feel. little known fact, a woman has five times
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more testosterone than she has estrogen.
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So that ends up kind of being a big deal. But if you look at the graph of hormone
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levels over a woman's lifespan, I mean, obviously, they're peaking at 24.
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By 30, 35, a little bit of variation there, we begin to get a pretty decent decline.
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Now, wheels kind of fall off the wagon statistically at about 45,
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where perimenopause goes into menopause.
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Statistically, the age of 46 is the average. But if you look at that slide,
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that 35 to 45 slide, and if you, I mean, look, it's just gradually going.
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But when you blow it up, it's sawtoothed. So hormones are going crazy.
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So perimenopause is very, very difficult, of course, to experience,
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but even to treat, because hormone levels may be incredibly high for two or
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three days and then will plummet to almost nothing.
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And that's why women experience, hey, I had three periods in a row,
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but now I've dropped the last two, but that's where you get all that variability.
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So one way to unpack this, if you get into a healthy menstruating woman,
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let's say a 25, 30-year-old woman peak, so it starts with what's called the follicular phase.
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So you start getting into days nine of her cycle, nine to about 13 or 14 estrogen,
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we're getting ready, we're building up that egg and we're getting ready to release it.
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A woman's estrogen levels are at their absolute peak during that window.
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Progesterone is almost zero and testosterone is maxed out at that level.
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A couple of things about that.
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So, Olympic athlete, female Olympic athletes will even time the Olympics,
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like they will synchronize their cycle so that their competition is somewhere
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between that 9 and 13 day window of their cycle because they are faster,
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stronger, mental clarity is enhanced. It's a pretty incredible thing.
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But that is also the area of max libido.
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So let's say you're a 45-year-old woman, and for the last 20 years,
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that's what you have been used to.
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And so for at least, you know, a couple of weeks out of every month,
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your testosterone is really high, your estrogen is really high,
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you feel good, mood is often good.
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And then, you know, as we get older, that, you know, that is declining in those women.
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That is, it's tough. Not only is it tough physically, But it's also,
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of course, tough psychologically, too. Like, I don't know what's wrong with me.
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I used to almost always, every couple of weeks or so, enter into a phase where
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I really desired my husband.
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We would really connect. And then maybe he's on a downswing for a couple of
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weeks out of that month as well.
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And now it feels like it's like that all the time. And that's why it makes the jump to the emotional.
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Because something's wrong with me. I felt like this...
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And now, I mean, you see your husband getting out of the shower after he mowed
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the grass, made you supper, did dishes, you know, blah, blah, blah.
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And, you know, for 25 years, this has been, you know, inspiring to you towards
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intimacy, or at least hopeful.
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And then now that same thing is happening and you're, you know,
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making a grocery list in the back of your head.
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And then you feel guilty about it because you see what's happening intellectually
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and you're like, oh my gosh, that used to, you know, that used to be something
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from a libido standpoint that interested me. just out of care,
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you know, physical, emotional, spiritual intimacy is all a part of that.
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And now all of a sudden, I just don't have that anymore. There's something wrong with me.
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And then there's shame because women in that situation, again,
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especially if you are siloed off from deep, intimate, personal friends with
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godly women or pastoral staff, you know, you think it's only you because no one's talking about it.
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I think if you take that situation alone and then you superimpose a woman who's
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starting to drop periods or has dropped them altogether, now her whole identity
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of how she even sees herself is completely different.
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Like she doesn't even see herself as the woman that she once was.
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And then you do, you get a little dip in mental clarity and focus and task completion
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just as a part of perimenopause into menopause.
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And then suddenly like her whole world is changing just even how she sees herself.
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It can be a really downward spiral that's hard.
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Wow, like this just, there are so many pieces to it. And then when you add in, tell me about how does.
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Somebody who's struggling with high cortisol, which I feel like,
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especially the world we're living in right now, chronic stress is at an all-time
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high for not only men, but especially for women who are trying to do it all,
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be all, and still, in their 40s, try and be the person they were in their 20s or 30s.
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So, how is cortisol fitting into this picture for libido specifically?
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Yeah, it's super complex. One
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of the best ways to kind of unpack that is understanding normal cortisol.
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Cortisol is not by itself bad. In fact, there are features of cortisol that
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are really good. Cortisol is what wakes us up in the morning.
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So let's say you're an hour to 45 minutes before you wake up,
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you kind of come out of that deep, deep sleep and you're like,
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oh, it's not time to get up, but I'm kind of starting to wake up a little bit. That's cortisol.
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That's cortisol that's doing that. It's just getting you fired up for the morning
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and this is what we're going to do. We're going to get our groove on and we're
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going to hit the, you know, hit the ground running kind of thing.
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The same thing, then it will kind of de-escalate and that will get you through
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your morning typically.
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And then by late morning to early afternoon, cortisol levels normally begin
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to decline to the point where you are evening, you know, a couple hours,
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a few hours before you go to bed, cortisol levels should be dropping.
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So you will get a corresponding drop in body temperature, mood will kind of
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level out as well, and then it plummets then as you go to bed.
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And that's how you get your deepest sleep in order. So a dysfunctional cortisol
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pathway, and we've all been there. So cortisol is also the fight or flight.
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So like, hey, I just, I'm worried about this. I'm stressed about this.
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There's physical danger.
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Cortisol levels will skyrocket. The problem gets is when you are maintaining
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a really high or even a medium high level of cortisol that is no longer cyclic.
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It just throws off your whole circadian rhythm.
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So now you are, when you are supposed to wake up, cortisol levels can be quite low.
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And then, I mean, you are literally trying to crawl out of your bed like it's hanging on to you.
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Counter to that, then in the evenings, you can't wind down.
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You just, not for the life of you, you're having tea, you're putting on light
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music, you're dimming the lights, it just doesn't matter. That's dysfunctional cortisol.
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So it's when it's maintaining this steady level. And once you kind of enter
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into a pathway like that, where, hey, this is kind of where I live, whether it be.
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Physical, emotional, or spiritual stress, it can drive that to the point where
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your body gets kind of acclimated to it, and that's where it is living at.
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It's really tough to break that cycle. I'm so glad you said that because what
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it's making me think of is, so I was diagnosed with social anxiety disorder
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in 2007, and that was seven years into our marriage.
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And so because my anxiety was so high, I was constantly with the chronic stress
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and I felt like I operated in a place of fight or flight. And then you add in
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us becoming foster parents, taking in very high needs foster kids.
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Intimacy maybe once a month, maybe as a duty, that was it.
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Right, right. But my cortisol was at an all-time high. When you look at the
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mental health piece and then you look at the hormone piece, they're so interconnected that,
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100%. And yet, I felt like the whole time, something's wrong with me. Why is my body broken?
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So that brings me to my next question. If this is so common,
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why are we not talking about it? That is a complicated question.
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Number one is studies on cortisol, studies on sexual intimacy,
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sexual health are extremely rare.
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Now, there's some studies in the works, but as far as like, oh let's look at
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a large body of medical data to give us some indication of trends and treatment options. There isn't.
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It's very rudimentary. There are very few studies, they are few and far between,
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and some of the connections with them are, you know, we're kind of making a
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best educated guess between this study and that, and we're kind of putting things together.
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But we are only on the beginning of just starting to research this.
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So as far as like checking in with your clinician,
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Number one, they weren't trained on this in medical school. Now,
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like let's say, like I mentioned the, you know, the follicular,
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the ovulation cycle, follicular phase, LH surge.
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I mean, we learned that in medical school, but as far as like dysfunctional
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rhythms or even perimenopause versus menopause, we did not have that in medical
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school. Just absolutely not.
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Along with anything about nutrition, lifestyle, exercise, nothing, absolutely nothing.
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So, which is so a part of what's making your overall health,
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whether that be emotional health, physical health, spiritual health,
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sexual health can be tied, of course, like we just talked about to lifestyle, stress, nutrition.
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Vaginal lubrication can be completely tied to a medication or you're actually
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dehydrated chronically or you're taking a medication that can kind of alter that.
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Like, there's a whole bunch of factors that most clinicians,
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unless they've done some research on their own time after their training,
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we just, we're just not presented that information.
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And we're already being overloaded with information.
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This is not a personal endeavor to be master some of this. It's not the norm, for sure.
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Well, and I love everything that you're sharing. And I just really,
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truly hope that the women who are listening to this podcast episode.
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And first of all, if you are a woman and you are listening to this episode,
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share this with your husband.
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Share it with a friend because this is a topic that is so covered in shame that
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people are not talking about.
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Let's give our listener a roadmap.
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So, let's say she's sitting in her car, she's listening to this episode,
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and she's like, maybe I should make an appointment with my doctor.
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What should she say? Like, what does she say to her doctor? Yep, absolutely.
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First, let's start with women that are going into a doctor's appointment for
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their sexual health. 80% of the time, it's by themselves.
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Okay. Which is just a shocking statistic, especially given the topic,
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which is, I mean, intimacy, sexual intimacy, assuming that is with,
16:45
of course, your partner.
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That is a really, so you're already, this woman is on her own,
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summoning the strength to put a stake in the ground and do something different
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and just not bury this, which is the tendency for all of us,
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men or women, who there's a problem of intimacy in our marriage.
17:00
So right away, it takes a tremendous amount of, exactly.
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Okay, do you remember what you're saying? Or you can just start.
17:07
Oh yeah, like you're going into your doctor's appointment to discuss sexual
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health, absolutely. Okay.
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I think one of the other best things you can do is if you can't get your husband
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on board to come in with you, which I strongly recommend just from the overall
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health of your marriage, whether that be physically, emotionally, or spiritually.
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The other thing is take notes on your own behavior and what you've got going on.
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If you can go into your provider with, I am feeling like this,
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this is when it happens, maybe even relative to your cycle, these are what those
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symptoms look like. and I've tried this, it didn't really work.
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I tried this, maybe it was a little bit better.
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You know, I tried hydration. I tried light to moderate exercise.
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You know, what have you tried to this point and what kind of results have you gotten from that?
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I'd say, honestly, the patients that I see the most, I'm coming in and I just
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have a ton of fatigue that's super consistent throughout the day,
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somewhat irrespective of what we even did that day.
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And so we all, we're talking thyroid and whatever, but then we get into how is sleep?
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Well, it's usually horrible and we get into nutrition and lifestyle,
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like how is intimacy and there's usually a hard stop because that's not really
18:12
why they came in. They came in for their fatigue.
18:14
I'm like, oh, okay. So, I mean, I'm sensing that maybe we have a little speed bump here.
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Like, let's, you know, let's kind of unpack that a little bit.
18:23
Is there, you know, and it's very, you know, specific to that individual.
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But oftentimes what we're finding is, hey, I haven't just been extra fatigued
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here these last few months. Yeah.
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I've had problems with my sleep for six months. We've had problems with intimacy for 18 months.
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And it just, it has now snowballed into some physiologic manifestations that
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are actually why she presented to me as a provider.
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But then as you walk that back, it just ends up being a lot more convoluted in sexual health.
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There was a big study, Peter Atiyah did this within his practice across thousands of patients.
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And it said, hey, if you could make a list of 10 actionable items that you want
19:00
to maintain into your last decade of life, what would they be?
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66% of all people responded, of those 10, they want sexual intimacy to be present.
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So it's super important, irrespective to your overall health,
19:13
to how you see yourself, to your intimacy with your partner,
19:16
irrespective of your age.
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So I think a lot of women are going to the doctor at late 30s,
19:21
early 40s, to mid to late 40s, and they have grieved this just as a natural
19:27
part of what's healthy, and that is not true.
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One of the issues going to your provider with the Women's Health Initiative.
19:33
Where all, you know, MHT, HRT was black label, like black boxed,
19:39
like, you know, completely inappropriately, the last 25 years,
19:43
you've been coming in to your provider and like, hey,
19:45
yes, we did about, you know, we took your FSH, we took your LH,
19:48
we did your free and total testosterone, we did cortisol, all of that.
19:52
But in reality, there's really not a whole lot safely that we are even able
19:55
to offer for you. So it ended up progressing to, we just don't even ask the
19:58
question, across most providers.
20:01
It's only been repealed here in the last several months, that black box warning.
20:05
So all of a sudden, you know.
20:08
Clinicians are looking into like, hey, maybe I do need to equip myself with
20:12
some more knowledge base here now that we have some options.
20:16
So this is a really, really great time for you to go in and check in about this.
20:20
Like I said, if you can kind of come in with a log of what's been happening
20:24
and how, I would take into account, depending, of course, on your relationship
20:27
with your provider, you know, where are the pinch points with intimacy?
20:31
One of the things, a piece of data that's super interesting,
20:34
and this is women ages 30 to 60, if foreplay lasted more than 21 minutes,
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percentage of orgasm is at 90%. And that's purely physiologic.
20:44
So it's just taking longer and an older woman to get things to progress in the
20:49
way. And we're talking blood flow as we get a little bit older.
20:52
Blood flow to all of these is not as stout as it was when we were in our 20s
20:58
and 30s. So there's a few, you know, there's a few workarounds that are available
21:01
to make intercourse and sexual activity a little bit more enjoyable.
21:06
Well, and one thing that you had brought up that you and I had talked about
21:10
was, so the big, big things when you are getting older, over 40, is your protein.
21:18
Your sleep. We talked about sleep. Can you share the statistics?
21:23
Because we're talking, you're talking about sleep. People are fatigued.
21:27
People have chronic stress.
21:28
Your entire body's regeneration. A hundred percent.
21:33
And the medical term is restorative sleep, where you're getting,
21:36
you're needing those deep cycles of sleep that happen intermittently throughout
21:40
the night to, I mean, that's where your muscle recovery is.
21:43
And that's where your brain, mental and emotional reset comes from.
21:47
So a higher cortisone level, those patients are processing things during the
21:52
night, checklists, if you will, grocery lists, checklists,
21:55
you know, what do I got to do to get through my life list in stages where they
21:59
should be in deep restorative sleep and they're not. And you start stacking those.
22:03
There's some data that if you're getting less than eight hours of good high
22:06
quality sleep per night, you start extrapolating that over years.
22:09
Those people live somewhere between four and six years less, less long.
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And then you start getting into like one is 150 and the other was like over
22:18
250% increase of heart attack and stroke if you're getting less than eight hours of sleep.
22:23
So sleep is a really big deal, not just for longevity, but for overall health,
22:28
let alone the emotional benefits of that as well.
22:30
Right. So can you talk to me about intimacy and sleep?
22:34
Uh-huh. There's a really interesting study where they found,
22:37
so the baseline, of course, is a woman going to sleep just her regular normal routine.
22:42
Sleeping slightly better than that is a woman who induces an orgasm on her own.
22:48
Sleeping slightly better than that is a woman who had intercourse with her partner.
22:53
Sleeping better than that is a woman who had intercourse with her partner and had an orgasm.
22:57
So there's just a couple of different studies on sleep where the ultimate endpoint,
23:02
especially if you look at that data, the two different studies,
23:05
if you look at it through a spiritual lens, So that woman is having better sleep
23:09
after intimacy with her partner, even better than when she had an orgasm by herself.
23:15
Because obviously there's a, and that's not physical at that point, right?
23:18
That is, there's an emotional connection there if you read between the data.
23:21
I think if you look at those two bookends on how that works,
23:25
intimacy with your partner is great physically, emotionally, and spiritually.
23:29
Now physiologically, you will, just the oxytocin release, dopamine release will
23:34
lower your body temperature, and sleep latency, how long it takes you to fall
23:37
asleep, shortens dramatically.
23:39
So basically, after intimacy, body temp drops, hormones, you know,
23:44
kind of the fun pleasure hormones are up, and then you fall into the deepest,
23:48
most restorative sleep that you can have, that a woman can have. Yes.
23:52
So when we go back to the statistic that 27 percent of women have not had sex
23:58
in 12 months and we wonder why are we even more stressed out and overwhelmed?
24:03
But I just feel like truly that's where I say I believe this is just another
24:09
way that the enemy is using spiritual warfare to take out marriages,
24:15
families, and also the identity and like the plan that God has for women to
24:23
accomplish during their life.
24:24
So let me ask you this, because I feel like this is so important.
24:27
If a woman goes to her doctor and her doctor dismisses her or tells her this
24:32
is just part of aging or I don't know, let's take a wait and see approach.
24:38
What would you tell them?
24:39
Great question. I would say you are in the large, large majority of women,
24:45
again, that we just talked about, who are courageous enough to even bring this
24:48
up with their provider, male or female.
24:50
I'd say a very large majority of those individuals are probably going to be
24:54
essentially shot down. Like, hey, we'll do some labs.
24:57
Labs will probably be relatively normal, depending on where they are,
25:02
perimenopause or menopause.
25:03
Let's say thyroid is fine. I'm sorry, we did all we can. Everything's fine. It's you.
25:07
It's psychosocial. It's whatever, you know, you need to go see a therapist and
25:11
whatever. In reality, I'm especially perimenopausal.
25:14
I mean, depending on where you're at in your cycle, FSH and LH,
25:17
all of that can be extremely high.
25:19
But then, you know, 72 hours from now, it's going to be extremely low.
25:22
So you're feeling all the symptoms, but the one-off visit you had with your
25:25
provider didn't show anything.
25:27
So there's a whole bunch of, because this is such a new hot topic,
25:30
there are a whole bunch of resources.
25:31
There are a bunch of vocal people, not all of them believers,
25:34
for sure. But there's a lot of new discussions out there, whether it be podcasts,
25:40
book, or just information.
25:42
Unfortunately, not a lot of that yet has trickled into the church,
25:46
of course, let alone your general provider's office.
25:49
And again, like we talked about, that is your provider who has taken a special
25:53
interest to educate themselves in this arena. And that is not the norm.
25:57
So I think if you can come in as prepared as you can, I will say this is kind
26:01
of a weird thing that's very new, where some of the providers that are most
26:05
into this and also the most educated on data.
26:09
Prescribing trends, treatment options, do tend to be fairly active on social media.
26:14
So they ask around or just even do some searches.
26:17
We've got several different clinics here in Nebraska that are not particularly
26:21
close to where we live, but resources are available to kind of step into that
26:28
arena with someone who's much better
26:30
well-versed on to what's going on about this whole cycle.
26:34
And it may not be your local provider that you have the closest access to or
26:38
previous relationship with.
26:40
You may have to do a one-off now and again and check in about this.
26:45
Even your OB-GYN, when it comes to sexual health, like the whole gamut of perimenopause
26:52
and menopause isn't always as well-versed in this as well. I love that.
26:57
So speak up for yourself. And if you're not getting your needs met with your
27:01
doctor, reach out to somebody else.
27:04
Find a resource of somebody who's going to help you.
27:06
Now, let me ask you this follow-up because you did mention the church.
27:11
Why do you believe that this silence around sex and intimacy,
27:17
why do you think it's so damaging to marriages?
27:19
I think my honest opinion probably starts on the top that this is very obviously
27:24
opposed and we're being opposed by the enemy.
27:27
If you, I mean, if the marriage is representation of Christ in the church and
27:31
then within marriage, physical intimacy, sexual intimacy is probably the most
27:36
involving of emotional, physical and spiritual unity that you can do with your spouse.
27:41
I think if we can attack that, then we really, if you're the enemy,
27:45
if we can do that, then we really have some traction here about separating it.
27:49
So first we begin separating intimacy.
27:51
As a timeout, let's just see how to unpack this just practically.
27:54
If a woman is having what's called dyspareunia or painful inner force,
27:58
it's super frustrating.
27:59
We've been intimate for a long time. That wasn't previously happening. And now it is.
28:03
A loving empathic husband is just going to be like, oh shoot,
28:07
you know, like not going to, if we push the envelope, it makes it worse.
28:11
And pain begets pain, or we just withdraw, and then the husband is telling himself
28:15
that, you know, it's no big deal,
28:18
I don't want her to be uncomfortable, so we're just going to avoid the whole subject.
28:21
And then weeks become months, become years. And pretty soon we have a huge gap
28:26
physically, emotionally, and spiritually that just kind of slipped out from
28:28
under us and we didn't even know what was happening.
28:30
It felt like we were doing the right thing at the time, but then at the time
28:33
became a significant amount of time.
28:35
And now we're having a loss of intimacy across the whole gamut.
28:39
And next thing you know, then just nobody's talking about it.
28:42
I mean, it snowballs really, really fast.
28:44
And no different than a healthy marriage. like, hey, a really,
28:47
really healthy marriage, communication is the absolute pinnacle of what's driving
28:52
that intimacy every day.
28:53
Of course, spiritually, of course, emotionally, but also physically.
28:57
As a woman gets older, one of the frustrations we see in the clinic all the
29:02
time, especially as it relates to sexual health, is we've had a great sex life for the last 25 years.
29:07
We're literally doing the same thing we've always done that used to be working
29:10
and now it's not. What's the problem?
29:12
And it could be innervation or nerve supply to all those structures.
29:16
It could be blood supply.
29:18
Healthier women have healthier sex lives. And if you look at who has the healthiest
29:22
sex lives, they are also the healthiest women.
29:25
So, I mean, physical health, like, hey, now I have hypertension.
29:27
Now I have this other condition. It can be very challenging.
29:30
And a healthcare provider that's on board and a student and all that can really
29:35
help walk through the pinch points.
29:37
Maybe we need a different lube. Maybe we need to, you know, change foreplay a little bit.
29:41
I mean, there are a lot of different options that are non-pharmacologic that can really change your
29:46
your marriage, change your intimacy. I love that. So as far as the church,
29:49
I mean, that is a rabbit hole that the church just, where do you even begin?
29:53
In order for that to happen in your marriage, you have to have authenticity
29:57
and honesty between each other.
29:59
That, of course, is the same thing that needs to be happening at the church.
30:02
Number one, we need to be honest.
30:04
Number two, we say we're about grace and understanding. That has to,
30:08
of course, come next because that's where the trust comes from.
30:10
And as long as we're honest, like, hey, I mean, like I said,
30:14
pastoral staff is probably going through the same thing that you are.
30:17
So, if we can all walk along with this together as brothers and sisters in Christ,
30:22
we will find an answer that's helpful to everybody.
30:25
Even if it's not what we had at 25, it can still be sweet and precious and intimate and connecting.
30:32
Well, and it was interesting because I was thinking about it as I prepared for
30:35
the show, and we talk about anxiety in the church. We talk about depression
30:40
in the church. We will even talk about suicide. We will talk about so many topics.
30:46
But yet I compare sexual intimacy in your marriage equivalent to food and water and survival.
30:55
And yet in over 46 years, I've never heard a sermon on sexual health.
31:02
And it just, there's definitely room for improvement.
31:06
And it's so refreshing to have this conversation with you today and to hear
31:14
a roadmap on potentially how you can go talk to your doctor.
31:18
I would encourage women to go get a full panel of your blood testing.
31:25
What sort of testing would you recommend for a woman to ask for? Yeah.
31:29
Typically, especially if it's
31:31
also usually, almost always, within the context of some fatigue as well.
31:35
So we do a basic blood count, especially depending, you know,
31:38
periods can get a little spotty.
31:40
You know, sometimes they can be quite heavy as well.
31:42
So, you know, just making sure you're not anemic during all that.
31:46
Make sure electrolytes are good. So far we're CBC, CMP, but then we get into
31:50
total testosterone, free testosterone.
31:53
We also need sex hormone binding globulin. So, sometimes your hormone,
31:58
specifically your testosterone,
31:59
can be fairly high, but if it's bound up, it's basically worthless because it's
32:06
stored in tissues and not available to do anything.
32:09
So, SHBG can be a really critical component.
32:13
Progesterone actually helps kind of free up SHBG too.
32:17
So, obviously, that ends up being kind of at a declining state as we get a little
32:20
bit older. So even if estrogen is pretty high, if progesterone is too low,
32:24
then some of the testosterone and more androgen-based stuff stays bound in a woman's body as well.
32:29
So also getting into, of course, estradiol level, which is the functional estrogen
32:34
equivalent. But then, of course, I would recommend we do a thyroid stimulant,
32:38
TSH, thyroid stimulating hormone, as well as free T4.
32:41
Those are kind of the staples of fatigue and sexual health for sure.
32:46
So, so helpful. I know for me, having all of my hormones tested and realizing
32:52
that my estrogen had left the building, it made such a huge impact.
32:57
And so sometimes being put on hormone replacement therapy, it's been life-changing for me.
33:03
And so just going into somebody having these tests done so that you can see
33:08
where you might need some hormone support, because based on this conversation,
33:13
you might think it's not a big deal,
33:16
but it's impacting your marriage, your sleep, your longevity.
33:20
Your total life on this earth. So let me ask you this, the final, one final question.
33:25
What would you say directly to the woman who's listening to this now?
33:28
She's been living with this for years. She's feeling ashamed.
33:32
She's maybe never talked to anybody about it, or maybe just a few people.
33:35
And she just is feeling like it's just not that big of a deal.
33:40
What do you want her to know? This ends up hormonally being such a slow fade
33:44
that a lot of women have let this kind of go and not even really realizing how
33:50
much ground they've given up,
33:51
how much worse they feel, or how much intimacy has become complicated,
33:56
either because it's uncomfortable or you're just not responding in the way you
34:00
used to and you just chalk it up to that I'm getting older.
34:03
And the reality of it is, number one, it's not necessarily true,
34:07
and number two, there are some actionable things we can do to step into that
34:12
so it doesn't have to be that way.
34:14
I ended up seeing a whole bunch of women for MHT, menopausal hormone therapy,
34:19
because I was actually doing TRT with her husband.
34:22
And he was. He was fatigued, slept horrible, had no libido.
34:26
We corrected that, and he is an absolutely different person like he used to be.
34:30
And then their wife comes in like, okay, I saw what can happen with him, and now I'm in.
34:34
Like, we need to do the same work up in me, and what can we do so that I can
34:38
walk back all this fatigue and depression and frustration and physical symptoms?
34:43
And just didn't even realize that was possible until you kind of see it in someone else.
34:48
100%. It was funny because I'm on day nine of estrogen and my husband has been
34:54
on testosterone for years.
34:56
And he said, I'm so happy you get to feel how I've felt.
35:01
And I just didn't know there was an issue.
35:04
100%. I thought it was all in my mind. It was all my mental health.
35:08
I've just got to work on all these things. But when you have a hormone like
35:13
estrogen or whatnot that needs some assistance...
35:17
It's life change. I've never felt better in my whole life. My mental clarity,
35:22
like it's impacted everything. My sleep is better.
35:25
My energy is better. I am certain there are going to be so many people who are
35:30
going to want to connect with you, hear more.
35:32
So how can people connect with you? I'm on Instagram and TikTok as TheCowboyDoctor,
35:38
and I am on Facebook just as Joshua Reiners.
35:41
Okay, perfect. And I will put your links in our show notes. So if you are wanting
35:46
to connect with Josh, check the show notes.
35:50
This has been such a good conversation. And my hope and my prayer is that if
35:55
you are listening to this and you have been struggling, living in a place of
35:59
shame or thinking it's something's wrong with you,
36:02
it's time to go talk to your doctor and have a conversation so that you can
36:07
fully step into everything that God has created you to be.
36:10
So until next time, I will see you all later.
36:15
Friend, I am so thankful that you are here today. I pray this episode blessed you big time.
36:20
And if it did, would you do me a favor and leave me a review on Apple Podcasts?
36:24
It helps more women just like you find the show, and it may be the very reason
36:28
that somebody else gets the answers that they need.
36:30
I would also love to connect with you personally on Instagram.
36:32
You can find me by searching cortisol underscore coach.
36:36
That's where I show up every single day and send me a DM. I would love to connect
36:40
with you. I'll see you next time.