Summary
Overview
Dr. Rachel Rubin, a urologist and sexual health expert, discusses the major gaps in women's healthcare, particularly around hormones, menopause, and sexual function. She reveals how medical professionals lack training on basic topics like the clitoris, vaginal hormones, and female sexual response, leading to widespread suffering and relationship problems. The conversation covers hormone therapy, painful sex, orgasm gaps, communication barriers, and practical solutions that could dramatically improve women's health and intimate relationships.
The Medical System's Failure of Women's Health
Dr. Rubin opens with her core frustration: women across all socioeconomic levels are being failed by a healthcare system that doesn't teach doctors about female hormones, sexual health, or basic anatomy. Even wealthy women like Melinda Gates and Oprah had to see multiple doctors before getting proper menopause treatment, highlighting how pervasive the problem is. The word 'clitoris' doesn't even exist in OBGYN training checklists, and doctors aren't learning how to prescribe hormone therapy despite clear evidence of its benefits.
- Trust is critical in business and healthcare, but women aren't getting the medical information they need
- Dr. Rubin is filled with rage because people lack access to information that could improve their sex lives, relationships, and health
- Women aren't orgasming as much as men, and most don't know where their clitoris is
- The word 'clitoris' doesn't exist in OBGYN training requirements in 2026
- Melinda Gates saw three doctors before getting proper hormone therapy; Oprah saw five
- Halle Berry was misdiagnosed with genital herpes when she actually had genitourinary syndrome of menopause
" I am filled with rage because people are limiting their ability to have great sex, great health, because they aren't having access to all the information that they could. "
" The word clitoris today, in 2026, does not exist in the checklist for what an OBGYN has to learn in their training. "
Understanding Hormones Through Life Stages
Dr. Rubin explains how hormones work throughout a woman's life, from puberty through menopause. She breaks down the menstrual cycle, explaining how estrogen and progesterone fluctuate, and reveals that testosterone—often thought of as a male hormone—actually drops precipitously in women starting in their 30s. This decline explains many symptoms like low libido and difficulty with arousal and orgasm that women experience well before menopause, yet doctors rarely discuss or address it.
- Testosterone is not just a male hormone—women make it too, and it drops significantly starting in their 30s
- Testosterone decline in the 30s can cause low libido, delayed orgasm, and reduced arousal
- Birth control pills can lower testosterone levels by shutting down ovarian hormone production
- The menstrual cycle involves estrogen rising first, then progesterone in the second half after ovulation
- Perimenopause typically begins around age 35-45, a full decade before menopause
" Testosterone is just a hormone. It's not a male hormone, a female, it's just a hormone. "
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