Claudia von Boeselager (00:50)
Welcome back to the Longevity and Lifestyle podcast. I'm your host, Claudia von Boeselager and I'm joining you today from the beautiful Mediterranean island of Mallorca.

So if it's a little windy or there's some noise, I apologize in advance, but I thought I would take this episode from outside. I am absolutely thrilled to have two incredible guests joining me today. We'll be diving into the fascinating intersection of sexual wellness, hormones, the nervous system, and even the role of psychedelics in enhancing relationships.

I'm so excited to welcome dear friends and pioneering experts, Ashley Madsen and Dr. Dave Rabin. We actually became fast friends after speaking together at a longevity and psychedelics conference in Miami a few years ago. So I'm very excited to have them on the show.

Welcome Ashley and Dave. So delighted to welcome you to the show and have the three of us here today.

Dr. Dave Rabin (01:37)
pleasure to be here with you. Thanks for having us.

Ashley Madsen (01:38)
Yes, thank you.

Claudia von Boeselager (01:39)
To start, can I ask you both to give a brief intro to yourselves for my audience?

Ashley Madsen (01:44)
So my journey started off in the surgical subspecialties, working mostly with orthopedic conditions. And when I was really faced with multi-system changes, I started to study more for my patients where we're understanding that there was much deeper issues that were connected from systemic inflammation, cardiovascular changes. And so I started to study functional medicine, nutrition,

really segued into something called precision medicine or personalized medicine where you're looking at that person from a 360 degree view and understanding what we could do to actually stop disease in its tracks or reverse it or at least slow it down. On my journey there, I realized that sexual wellness was a huge barometer for overall health span. So not just lifespan, but health span in our patients.

and from a cardiovascular standpoint, insulin resistance, psychological, cultural. And so it really became a big focus point for me and a passion of mine to really help. And I saw it was really an under deserved, under served, I should say, under discussed area of medicine and also just a taboo topic with really little sexual education that we receive. And then also so many different variables that affect people's ⁓

understanding of it and how the dynamics play within someone's relationships and also in their overall health. So it's a huge part of my practice and I love it. And such a wonderful collaboration with Dr. Dave here on what he does with his patients as well.

Claudia von Boeselager (03:17)
Beautiful, Dave.

Dr. Dave Rabin (03:18)
⁓

Thanks, Ashley. I'm Dr. Dave Rabin I'm a board certified psychiatrist and neuroscientist focused on primarily trauma and addictions in treatment refractory or hard to treat mental illnesses where almost all of my patients have some degree of sexual dysfunction, sleep dysfunction, and other symptoms that go along with their.

mental illness symptoms and when sometimes medication related sometimes just as a symptom of their ⁓ mental illness that sexual dysfunction comes about and I think similar to Ashley I also noticed that sexual health and sexual function serve as like a barometer or a

a metric that we can think about when we understand somebody's overall health and wellbeing on a holistic scale and really trying to just notice as clinicians were taught to observe patterns very closely. And I think we start to notice eventually that when you look at the whole person that is your client or your patient, you start to see that.

these patterns of sexual function or dysfunction start to occur across large groups of people in a very similar way with all of these different kinds of illnesses, you realize that when people are doing really well, they generally tend to be more sexually active and have more desire and more drive. And when they are not doing well or they have something else going on in their lives, could be

impeding their quality of life, sexual health takes a backseat. And then there's also this gap of knowledge that many of us were not given proper sexual education growing up. And I think that's a topic that Ashley and I are always very interested in because it's just an easy point where even if you are feeling good, you are in a good place in your life and you want to have a more sexually active life, which we now know we'll get into sexual health is so important for

overall health and a prognostic factor for good longevity and health span. How do you do it safely and effectively? And I think that there's a lot of opportunity there. so getting more into sexual education and kind of revamping sexual education is a big focus for both of us.

Claudia von Boeselager (05:30)
so exciting, so many topics. I definitely feel like we have to do a round two because I'm not sure how we're gonna cover all these amazing things in the time we have allocated today. But let's dig in straight away. So looking at sexual wellness and nervous system regulation, Dave, your work highlights safety and nervous system regulation as key to sexual wellbeing, as you were mentioning. given that chronic stress is linked to 70 % increase in sexual dysfunction in women and rising ED or erectile dysfunction in men.

How does a dysregulated nervous system impede sexual health? And maybe what steps can individuals take to cultivate safety?

Dr. Dave Rabin (06:03)
I'll give you like the 30,000 foot view and then I'll let Ashley jump in for the rest. So the details. So basically in the autonomic nervous system, which is the core of our nervous system in all humans and almost every mammal and every animal going way back for millions and millions of years, which is actually what Eric in large part won the Nobel Prize for in 2000. We know that

The body is governed by two core parts of the nervous system, one of which is involved in performance and survival, which is called the fight or flight sympathetic nervous system. And that increases heart rate, increases blood pressure, increases blood flow to parts of the body and systems that help us survive threat. So skeletal muscles, heart, lungs, motor cortex of the brain, everything that we need to get resources and a lot of them, or all of them when we're running from a lion.

or running out of air, food, water, et cetera. Then there's the parasympathetic nervous system, which is governed by the vagus nerve that is responsible for all recovery in the body and healing. And it is the quintessential counterpart to the sympathetic nervous system, but it should actually be active more of the time because we're supposed to be safe and recovering more of the time than we're under threat. And whenever we are...

if fear is this trigger to the fight or flight sympathetic nervous system to get us to safety, then once we get to safety, safety is the trigger for the vagus nerve parasympathetic nervous system. And that takes all available blood flow. D diverts it to all of our reproductive organs, digestive system, immune system, integumentary system, the skin, the mucus membranes, everything that's supposed to function when we're recovering is governed by that nerve, including sleep.

and rest because you don't want to be thinking about sleep or reproduction when you're running from a lion, right? So the system is tightly evolved to prevent that from happening. But if you think about that, then when you are in the bedroom or about to be in the bedroom or about to have a even like first kiss with somebody that you really like and you get nervous about it, if you if that

triggers your fight or flight sympathetic nervous system when it shouldn't because you're worried about rejection, for instance, like many people, then that will shut down your reproductive system entirely. And you won't even get to the point of having an intimate interaction, right? Let alone with somebody that you already are comfortable with. Performance anxiety, right, can trigger the sympathetic nervous system and prevent you from getting an erection or prevent you from lubricating properly or prevent you from

Ashley Madsen (08:19)
Mm-hmm.

Dr. Dave Rabin (08:41)
⁓ just getting your body into a state where you're ready for experience, not just desire, but translating desire into action. Right. Cause I think for a lot of people, the desires there mentally speaking, emotionally, but then how do you get your body into a state where you feel safe enough really for the vagus nerve to get resources. And then when the vagus nerve gets resources is okay, reproductive system turn on, let's go. Right. But if your body's under threat.

or you perceive to be under threat, like from potential rejection, performance anxiety, anything else, right? Too many emails, leaving the stove on at home, too many responsibilities, too much news, whatever it is, right? But it's there, right? It's it's, yeah, it's totally not the time to think about it, but to many of our untrained minds where we haven't learned to meditate, and like concentrate on the task at hand, for instance, like the average

Claudia von Boeselager (09:17)
Not the time to think about that though. those emails.

Ashley Madsen (09:21)
It's there.

Claudia von Boeselager (09:31)
Present, yeah, presence.

Dr. Dave Rabin (09:33)
attention span for Americans is like six seconds or something like that. So that means every six seconds you're thinking about something else, right? And you're not, yeah, you're not focused on the task at hand, which is like making love or intimacy. And so I think the, and this affects all of us, it's not just, like I in my life have also been affected by that kind of distraction and it prevents you from getting.

Claudia von Boeselager (09:41)
ADHD minds, yeah.

Dr. Dave Rabin (10:00)
to the outcome goal with your partner. And so I think it's the stress, the impact of stress on reproductive and sexual health is real and extremely real, but it's not just mental, it's biological in terms of how our body governs resources to reproduction and intimacy.

Claudia von Boeselager (10:15)
amazing. fascinating. Ashley, do you want to add to that?

Ashley Madsen (10:16)
Yeah, agreed.

Dave and I talk about this a lot that especially when we educate clinicians and educate our patients is that, you know, it's really a biopsychosocial approach. So the bio is yes, I think what we concentrate the most in medicine where people concentrate on is the hormones. It's like, what's going on inside the body. But there's also the psychological component of feeling the trust, the relaxation and the sense of safety in yourself.

and with the partners, because this also has to go with self pleasure. So we think about partner sex, but there's also self sex. And also we have to think about that sense of safety, the relaxation, and also a little bit slightly different for a female brain versus a male brain. And we have so much more literature and data from Dr. Moscone at Cornell, who was really diving into the female brain and how it's affected, not just from a biological, but from a structural standpoint. We have MRIs to show.

how the female brain is affected during orgasm and whatnot. But the parasympathetic system is very much or needs to come into play when a woman is receiving and to be able to become aroused. And just like Dave mentioned, libido and arousal are different, which are very much confused also in the medical world because everyone thinks the little blue pill or the pink pill or whatever you want to term it as nowadays is going to fix the issue.

And the thing is to understand that we are multi-dimensional and sex is actually a more complicated function. And so there are multiple different variables that play a role, but absolutely having that sense of trust, relaxation and ability to drop into yourself and be present is such an important component for someone to also to have arousal to maintain the arousal. So we think about erectile dysfunction, 40 % of men by the age of 40 have ED.

70 % of men by the age of 70 have ED. And so we think about not only being able to have an erection, but maintain that erection. And the same thing for women, because the clitoris goes very much under discussed and unknown, and yet, clitoral tissue is erectile tissue. So I tried to also explain that, that some of those mechanisms need to also be applied for women.

Claudia von Boeselager (12:27)
Beautiful.

Dr. Dave Rabin (12:27)
And also just add,

So something like 70 % of women in studies, report not being able to achieve climax during sex with their partner. And they can achieve that on their own. And the most common reason why they report not being able to achieve climax with their partners is not because there's anything wrong with them, it's because they don't feel safe to be vulnerable to be in that peak state.

Ashley Madsen (12:36)
Yeah.

Claudia von Boeselager (12:50)
state.

Dr. Dave Rabin (12:50)
And so

that safety is a real common theme across not just getting there, but getting to the end goal as well for many people.

Ashley Madsen (12:58)
Yeah, communication. think we segue into that a lot is that there's not a lot of communication sometimes also between partners. It's also like, don't want to feel judged. I don't want to hurt my partner. And then also the lack of communication to your clinicians. So people don't really want to open up about it maybe at a 15 minute primary care visit. So that's why I really like to build it into my personal repertoire when I work with patients, because you find so much information from that.

But absolutely, is an area that, you know, it's a global issue. This is not even just an American issue, right? So 40 to 50 % of people globally are reporting some form of sexual dysfunction. And let's be honest, that's very much underreported. Because once again, it's very much a bias based off culture and, you know, just feeling, do we even know? Or, you know, some people just think it's dysfunction is one thing.

Claudia von Boeselager (13:42)
I'm pretty sure, yeah. Not many people are talking about it.

Ashley Madsen (13:54)
and it can really play in multiple sectors. So absolutely, it's very important topic.

Claudia von Boeselager (13:57)
And

it's a spectrum as well, like dysfunction, but I want to unpack that safety component And I think it's so fundamental because it's holding so many people back.

let's unpack that safety component. what is going on there? Why are they not feeling safe? Especially if it's with the partner that they're with for longer. Is it the lack of communication? Is it the lack of self? Is it trauma? What's going on that's hindering it? And what can people do to start addressing it?

Dr. Dave Rabin (14:20)
I mean, I think it's all of it, right? like each person's gonna have one thing that's like the most top of mind for them. That's the current thing that's preventing them from feeling safe, but it's all of it. And I can relate to personally, feeling thoughts. don't ever in my day to day life think about

rejection to give you an idea, right? Like it just doesn't cross my mind. I'm not concerned about it. I've done so much personal work and therapy and like develop myself that I just don't think about it never crosses my mind. And you know, you knowing me for a while would probably also notice that that's not something that comes off of me. But when I have been in the past in a situation like many, many years ago, and

Claudia von Boeselager (14:56)
Agree.

Dr. Dave Rabin (15:03)
was you my early twenties, I remember fear of rejection with female partners that, especially with people I didn't know very well, like where I was just getting to know, because of having, and recalling that that came from having been rejected in school as a kid when I was really young, like being bullied by my peers, right? And not being accepted by the community. Nothing to do with sex.

Claudia von Boeselager (15:21)
Okay, but nothing to do with, in childhood, was nothing to do with, yeah, okay.

Dr. Dave Rabin (15:26)
so I think the past trauma of being either accepted by default, what you remember as being accepted by your community or being not accepted by your community, which could be your family, your parent, your friends, your school, your school peers, whoever it is, like that feeling of not being fully

as part of the whole, which is a critical human need for safety, right? To be, one of our core needs, like it's food, water, air, shelter.

and sleep and accept and love and acceptance, right? Like those are our core human needs. So if you're missing any one of those things, or you think you could lose one of those things, your body enters into a fear state and then the safety is gone. So a lot of the practices are about that we teach and especially that I teach in my clinic are about how do you go through that checklist and remind yourself you have those six things, you don't need to worry about that right now, right? And if you can...

check all the six things, the food, water, air, shelter, sleep, and love and acceptance by our community, which you're about to get more of if you just let go of the fear of rejection, then you can overcome and retrain yourself to not be in a fear state in those experiences, which is ultimately like what I had to do for myself, but I can tell you without a doubt that past trauma has an impact because I've experienced it. I think that...

The other piece that I know Ashley will get a lot more into is the trauma and stigma around a sexual education and sexuality in general, which is a major problem where it's so taboo and it's so not well taught that people are afraid of their parts. They're afraid of being bad if they use their parts or touch somebody else's parts or what other people will think about them if parts are touching parts or whatever. There's a lot of stigma that also I think creates a sense of

of lack of safety in people because of this just being, you know, not taught properly and stigmatized for so long.

Claudia von Boeselager (17:17)
And culturally as well, right? So like ⁓ tradition, I mean, I'd love to actually, let's talk about that as well, that education piece, what is going wrong and what would, you know, and different cultures are different ways of teaching it, right? But what would you, you both, guess, love to see in terms of sexual education to change this dynamic that we have been seeing to improve it.

Ashley Madsen (17:39)
happy to talk a little bit about this. So, know, sex education is very limited depending on the country, your culture, your states, right? It's become very politicized. And what most people are reporting is that they're learning sexual education through Hollywood or through pornography, which is a problem, because most of that is very much

tilted to one side, mostly for a male perspective. And it's not really giving education on the anatomy. know, Dave, I remember there was a conversation you have with Dr. Killen, where you even mentioned some of the students in your medical school who are coming in. I think you mentioned India, and they didn't even know where the clitoris was or what it, you know, where it was located, right? I think there's a lack of, yeah, they know what was for.

Dr. Dave Rabin (18:27)
Yeah, they certainly didn't know what it was for.

Ashley Madsen (18:30)
And this is not to make fun of anyone, right? I think there needs to be like some sort of like decompress some of the clinical nature of the conversation so people feel comfortable about it. But can you imagine your doctor not knowing about these reproductive organs? And a lot of it is also that no one has felt comfortable even exploring themselves. And so when I personally work with people, said, well, are you, and they're coming in specifically maybe they're having issues with orgasm or arousal.

One of my first questions is, are you able to achieve orgasm on your own if you're having a concern with your partner? And many women especially are like, no, I don't want to touch myself. That's wrong. But where do you learn that? You don't come out of the womb thinking that. That's all cultural conditioning, sometimes religious conditioning, where you're taught, no, that's wrong. That's bad. You're bad doing that.

And again, this is not for us to teach people, know, their religion is wrong or this is right, right? It's we're not shitting on our patients. And I think that's really important. We're not we're here to do that. But people deserve to have education because what happens is becomes harmful as time goes on. And there are some really good studies talking about sex education, specifically like less than 50 percent of women in the United States actually learned about female reproductive anatomy for themselves. That's significant. It's considering that women end up having a menstrual period.

right, and learning those basic things about how do you become pregnant, right? How would it, you know, even simple things like reproduction, right? We should be talking about these things. And then in the UK, there was a great, there was a study that also said about 95 % of young women said they were never taught about sexual pleasure. And it's really interesting because from my perspective, I'm like, how is that possible, right? And so there's so much cultural biases that happen. And I think that,

we have to learn about taking some of the bad versus good out of the equation, say, this is a human body. These are functions. This is physiology. So you're not going to say no about an orthopedic. Like, this is how a joint works. This is how the liver works. This is how the heart works. But for some reason, these reproductive organs are a no-go zone. And that, unfortunately, becomes a really big hindrance, not only for clinicians. We think about the orgasm gap.

that we're experiencing also between men and women, but also the lack of education to clinicians about how to help their patients through even points of like a perimenopause and a menopause transition, which is absolutely earth changing for a woman from a health standpoint. So yeah, I mean, think we all can agree that some sort of education, obviously being respectful to people's individual feelings about their religious, it's not talking about.

yes, you should be having sex or we shouldn't have this. These are basic functions of the human body that need to be part of a curriculum for someone to learn about themselves, but also in our educational system for doctors and PAs and NPs and more healthcare providers about those types of functions that really are under discussed and educated upon. more, yeah.

Claudia von Boeselager (21:37)
100. Yeah, Dave.

Dr. Dave Rabin (21:38)
it's just very much like we take a very much abstinence only approach because talking about some of these things makes people uncomfortable. And ultimately, no matter what tradition of healing you look at, vulnerability and discomfort is where healing comes from. So we have to like face the things that make us uncomfortable. And an analogy that I would offer is like, imagine like you could never imagine this, but like imagine if,

Claudia von Boeselager (21:52)
Yes.

This is it.

Dr. Dave Rabin (22:03)
We just didn't teach you about the pinky finger because the pinky finger makes me uncomfortable. So we're just not going to talk about it ever. And you're going to have to figure out what to do with that on your own. Right? Like we didn't teach about like any other organ. Like that just wouldn't be a thing. But I think there is like, there is a very strange thing that we can't like, we don't have to dive into it here, but it's something that we can't not mention, which is the relationship between organized religion and.

Claudia von Boeselager (22:09)
You

you

Dr. Dave Rabin (22:30)
and conserved misogyny and patriarchy that has existed for like many, many thousands of years that results in this like forbidding of pleasure because pleasure is indulgence and it is not allowed and especially not allowed by women. And I think that is totally.

ridiculous when we're in the 21st century and we understand the scientific basis for these kinds of things and that these organ systems, the sexual health system, not only do we all come from a woman's every single human right was born from sex, but we can't deny that the fact now that all these studies have come out that show that sexual activity, especially with a partner, is extending to human health and lifespan.

50%, I think that study I talked about with Amy Killen that you have seen, I know Ashley, like 50 % in all-cause mortality reduction by men who have sex at least once a week. When you think about that, not just mortality from any one thing, but this is like a life-saving thing, right? It bonds humans together. It does all the good things that...

Ashley Madsen (23:32)
reduction. ⁓

Dr. Dave Rabin (23:46)
that sexuality does, but it also improves decision-making. Like this is like men who die of car crashes, drug overdoses, all cause mortality is reduced by having sex just once a week, right? Like that is something you just can't deny. So we need to be looking at this, not just from like a traditional religious cultural perspective. That should be acknowledged, because that's a problem and demeaning pleasure is a problem, because pleasure is healing.

And when we look at the impact of these studies, think that's the major message is like, feeling good heals us and we need to prioritize doing that more often and teach people how to do it better, safely.

Ashley Madsen (24:20)
Yeah, and I just to go back to the at one point it was considered hysteria for a woman to have pleasure or an orgasm is it totally based on patriarchal beliefs at the time and ⁓ if you actually look at the Greek the root of the word hysteria or hyster right with you think about hysterectomy is the uterus the Greek word hysteria is means the uterus and so it was really an interesting

component about how women, talk about the misogyny, that women's desire to have pleasure or enjoy themselves was considered actually a medical diagnosis of hysteria at one point. And women were actually put into psychiatric wards. And Dave can talk about this a little bit more. Yeah.

Dr. Dave Rabin (25:00)
for being sexually active, for just being

sexually active.

Ashley Madsen (25:04)
from that. And that gets, you know, that doesn't go away. Like that gets fed down in the, and you think about like shame, right? And I think that that is also a big thing that we try to uncover a little bit, which takes a lot of work. And you know, that's why we have wonderful people like Dave out there working with, with individuals, because it is very hard to also find clinicians who

are validating to that. Like, and understand that the shame, the misinformation, the fear around sexual development and also what our conditioning is and how our methods to absolutely help people and unpack that in a way that's safe for them and also, you know, supportive. It's really a challenging area when you are contending with someone who has a lot of that bias coming into some of their sexual dysfunction and some of the...

the conditions that they're experiencing too.

Claudia von Boeselager (25:53)
I read last summer the immortality key. I don't know if you guys have read it and it just shows, yeah, you know it as well. And the power that women used to have pre sort of organized religion the high priestesses and they used to go to, mean, also it was a precursor to LSD. But if you also look at the ancient Egyptians, I mean, they were quite promiscuous. So culturally, traditionally it was different, but I think there's that culture and control and obviously this is a different conversation, but.

Very interesting if you look back far enough in history to actually see different versions of truths, right as well. So Yeah, sometimes history can also be advantageous Actually, I want to pick up on something you were talking about midlife hormonal shifts, right? Especially perimenopause and menopause and how it impacts sexual wellness mental health And we know that up to 70 % of women experience mood changes anxiety depression during perimenopause What are the key hormonal balances you prioritize in menopause informed education?

to address these fluctuations and support both sexual and mental wellbeing.

Ashley Madsen (26:51)
Yeah, that's a great question. And I think this is the perfect time that we're seeing this revolution happen of education and advocacy, which we're all for. This is amazing. And Dave knows this better than anyone. It's one of the first line treatments for a woman when she's starting to experience anxiety and depression in the clinical psychological realm of things is SSRIs. It's still considered a first line.

Claudia von Boeselager (26:56)
Yay!

Ashley Madsen (27:15)
But what happens is during the perimenopausal shift, and I'll just say that the average age for a woman who goes through menopause, which is the medical definition of 12 months without a period in the United States I'm going off of, is age 52. But perimenopause, which is the fluctuation and can be a very erratic hormonal time for a woman, can start anywhere between eight to 10 years prior to that menopause component.

And it's a little bit different than men because women go through something called ovarian senescence where the ovaries run out of eggs and therefore stop producing hormones. And there's that slow decline that happens that can actually feel extremely erratic, meaning you'll start to see these huge spikes in estrogen and then the next day they're kind of down in the basement. And they kind of go up like this in the sawtooth component for a lot of women. Their periods might change and lengthen out.

But because these hormones are considered sex hormones, we have forgotten in the medical world that these are life hormones. And they have very important components throughout the body. We have receptor sites everywhere in the body. We have the brain with the muscle tissue, the bones, our reproductive organs. And women have more testosterone in their body than actually estrogen. But what's interesting with women is we have more estrogen receptor sites in the brain than testosterone.

receptor sites. So estrogen specifically, and I'll use estradiol because there are three types of estrogen, but estradiol is really a very strong and important component of estrogen. So I'll just use estrogen as an easy way to describe this. But estrogen is important for structural components of the brain, for volume, and also for actually a neuroendocrine connection of the brain to the ovaries. So it absolutely is important for neurotransmitters.

So for keeping us stable and our anxiety at low points, having more of a normal, I would say, hate to use the word normal, but a better response to stress and to also to, thank you, there you go, there you go. So when we start to see these shifts in estrogen, specifically, you'll start to see changes in sleep, right? So if you have worsening sleep or worsening insulin resistance,

Dr. Dave Rabin (29:15)
Adaptive, adaptive response.

Claudia von Boeselager (29:17)
There we go.

Ashley Madsen (29:29)
or mood changes, right, that's gonna affect many different areas of the body. Also, your desire to have sex or your arousal. And so we start to see these changes happen and it's not always evident on a blood test because as we know during a perimenopause shift, depending on the day that you test your labs, it's not definitive, especially in the perimenopausal shift. So you don't really always know. So you have to go off of symptoms. And then when women actually go through menopause and that estrogen basically goes to zero,

we start to see that eventually it shifts out, but you'll start to see more lack of desire for motivation, for doing things. You'll start to see women that might say, I'm having challenges in my marriage or in my relationships. I feel like I should retire. I don't have that joy de vivre of doing things that work. And so estrogen, I would say, is a very big component specifically for the female brain.

Testosterone, of course, and progesterone also have significant roles. And there's a really, I don't love to use the word hormonal balance because there's always going to be a dynamic movement. It's really the harmony of the hormones together and how they play a role. They also play a role in thyroid function. So when women go through perimenopause or menopause, you'll start to see an underactive thyroid that can sneak into the picture. We'll start to see increasing TSH, you'll see a lower free T3. That also plays a role in our

mental health and also our function metabolism. You'll start to see an increased visceral fat around the midsection. So we want to support women with education and let them be understanding and have the driver's seat on what they want to pursue as a treatment potentially if they're symptomatic. Vasomotor symptoms, which are hot flashes or night sweats, are actually a problem. And because they correlate with an increased incidence of cardiovascular disease.

So it is a system in the body that's neuroendocrine disruption. So we do want to take these seriously. And we do want to also offer treatments to women that go beyond, a pharmaceutical route of maybe an SSRI or a benzodiazepine. And we also want to offer an education piece of why these hormones are so important for these structures in our body and also for our mood. And it's OK. We kind of gaslight women and say, it's all in your head.

Not all in your head in that way, right? But yeah, their brain is a really big important component in this and these hormonal shifts do affect women and we have to really support ladies that way.

Dr. Dave Rabin (31:58)
And there's so much we can do that we're just, we just haven't been doing. I think there was, ⁓ you know, there was a lot of talk about how, hormonal supplementation was, was, not, not good or increased risk for women. think there were just not enough studies done to make those assessments. And we're now seeing that there are lots of different ways to apply hormones to the body yet at different doses that can.

Ashley Madsen (32:00)
Yes.

Dr. Dave Rabin (32:24)
in different application methods like intravaginal versus oral are very different. And there's just so many, right. And there's just so many different formulations. And so of course, you know, I think the good news is there are lots of ways to manage menopause transition and symptoms more effectively than we have. and I, but, and safely, and, and I think they, and just of note, think to that there's, it's really interesting to think about

Claudia von Boeselager (32:29)
and bioidentical as well. ⁓

Ashley Madsen (32:42)
less and safely.

Dr. Dave Rabin (32:50)
of all the symptoms that or signs that you mentioned for menopause that people think about often. Some of the most common things that people report, that women report that are disturbing to them are the hot flashes, which you mentioned, the sleep disturbances and mood changes and anxiety, right? And sleep disturbances and mood changes and anxiety are actually...

Ashley Madsen (33:08)
Yes.

Dr. Dave Rabin (33:15)
common throughout life, but they just happen to be often exacerbated or worsened during menopause. And so it's interesting to think about how different techniques that we use, vagal nerve techniques, we have a lot of women using Apollo for menopause. then also, yeah, right? And yeah, and other, there's other technologies as well. And then also like gentle hormonal supplementation can make a tremendous difference. ⁓

Claudia von Boeselager (33:27)
that metapause but I love the Apollo anyway.

Yep.

Dr. Dave Rabin (33:39)
And it's also interesting to think about one last thing in there. We don't have to dive into this, but I think it's fascinating to think about the way that cultures look at menopause. So indigenous tribal cultures think about a woman's childbearing years as being her generative years. So it's the year, the childbearing years, the years where in a woman's life, a woman is primarily outputting energy. In menopause, menopause is actually the time where many indigenous and tribal cultures view

Ashley Madsen (33:47)
Mm-hmm.

Dr. Dave Rabin (34:07)
a woman as transitioning to be closer to God in a more receptive energy in taking part of their lives. And so it's a very holy transition in many of these cultures for a woman ⁓ to go from always putting energy out, giving birth to children, giving birth to all different kinds of things in their lives in their childbearing years. Then when they transition into menopause and they go through that transformation, it's actually a very important life.

Claudia von Boeselager (34:13)
Wow.

Dr. Dave Rabin (34:33)
change, not something that's stigmatized like it is, or, you know, look down upon in our society. you're not able to have babies anymore, so you're like less valuable society. That's not true, right? Women just take on a different role. And in these cultures, that was very, very important and thought to be something that's, you know, a praise worthy and really should be cherished as an important part of women's life.

Claudia von Boeselager (34:57)
I love that, here, to taking that on in all of our cultures around the world. Very beautiful. I want to talk about relationships and longevity. And the 87-year Harvard study, which started in 1938, consistently shows deep connection, extends health and lifespan. Yet we know now that more millennials and Gen Zs are choosing not to marry or pursue traditional relationships. So how do you see this impacting their long-term well-being?

And for those who do engage, what are key markers of a truly healthy, longevity enhancing relationship? Who wants to take this? Or both of you maybe.

Dr. Dave Rabin (35:33)
I mean, can, yeah, we can just do back and forth. I think the thing we're gonna see if we continue down this path, I would call it the not evidence-based path of doing things and engaging with technology in a way that decreases the amount of human connection that we have and intimate connection we have.

We're going to see lifespan longevity actually go down and we're going to see people get more sick. And, and we're already seeing it with mental illness, right? Mental illness rates and addiction rates, whether whatever statistics you're looking at have skyrocketed since social isolation during COVID, they were already really bad and they were getting worse every year before COVID. All of a sudden you introduce COVID and

It's not the mental health consequences of COVID that are the problem. It's the mental health consequences of social isolation that occurred for that period that kept people apart that results in the lack of connection. And the lack of connection, all of a sudden, people are losing the natural feel good they get and the contentment they get from that. So what happens? Well, you get an increase in mental health symptoms.

when you don't feel like you have good ability to manage your mental health systems, you get an increase in self-medication and then you get an increase in rates of addiction, particularly to sedative and hypnotic drugs. And you see, we saw opiate and benzodiazepine use and cannabis and alcohol use and these things just go through the roof during the social isolation years. And that's hard to turn back down, right? Once people start becoming dependent on these substances to get the same good feelings they should be getting from authentic human connection and...

and touching each other and being close with one another, you start to rely on drugs for that and not your fellow people, right? But we should be getting this for free from each other and that's how we do it sustainably. And so it has a major toll on society. And I think if we don't quickly teach that and nip that in the bud for people, we are going to see that in the current generations, I think we're already seeing it that.

Claudia von Boeselager (37:20)
She's sad, yeah.

Dr. Dave Rabin (37:38)
mental health and substance use are going to go way up and longevity and health span are gonna go way down, which is the opposite of what many of our goals are in the medical and science community.

Claudia von Boeselager (37:48)
How do we solve for this? How do we solve for this? What's the answer?

Dr. Dave Rabin (37:51)
Couples retreats, sexual education. I mean, sexual education is a huge part of it. I think, know, Ashley, you could talk a lot more about that too, because you do this with your patients on a probably much more often than I do on a regular basis. But it's just teaching people how to and that it's safe to and how to use their parts. starting with, you there's all these things that we can teach people on an educational level to get them comfortable enough to connect.

and then teaching them about the biological importance of human connection, I think goes a long way. I think the next step is like creating the space, right? Like as we do a lot is we curate spaces for groups of people to intimately, non-judgmentally interact with each other, right? And then when you have, which is not a school, typically speaking, right? Like school is not that. But there are ways to create.

Claudia von Boeselager (38:36)
School of Dave. ⁓

Dr. Dave Rabin (38:41)
Collective spaces where people feel like they can non-judgmentally Meet as human beings face to face and build relationships, right? And that's that's what we need

Ashley Madsen (38:51)
Yes.

we have a little bit of an issue because we have that dopamine hit from our social medias and our phones. And so, you know, we have this common thing that you hear dopamine detoxes, right? how do we do this? Because typically, when you had wanted to form human connection, you didn't pick up your phone, right? You

went out amongst your community, you went and played chess or you danced and you played music and you were in the Plaza Mayor's, you're in Spain right now, Claudia, so I'm just using that. But when we looked at the Blue Zones, you understand that there are gonna be differences nutritionally, physically, all these types of things, but what was a common denominator was the quality of close emotionally supportive relationships.

Claudia von Boeselager (39:21)
Thank you.

Ashley Madsen (39:36)
And yes, typically one would think that may come from a romantic relationship, but of course, close friends, community events, right? But as we have moved away from that further, and as Dave just mentioned, especially during COVID, we saw this, is that people are starting to seek that closeness through devices, sometimes dolls, right? We saw some people actually investing in buying these lifelike robotic dolls, right? In Vegas, there was like this whole special on it from CNN.

But you start to see that people are moving away from actually human to human connection towards more of a tech connection. And so when I check in with people, certainly I wanna think about is there something physically going on, right? So if a woman is going through perimenopause, maybe she's having vaginal dryness. Maybe it's painful sex. Maybe she's feeling anxiety and depression and that she's got the weight of the world on her shoulders and she can't relax into that parasympathetic space of receiving.

and feeling safe and doing that, right? That's one area of the puzzle. And we certainly can help with that in many different ways. But then also the components of someone literally being addicted to their phone or, you know, and we have to explore that a little bit. What's going on there? You know, how do we try to move away from that? How do we explore what's going on? Because to Dave's point, perhaps it's the fear of rejection. Perhaps it's the, you know, I don't know how to communicate with people. And I don't say that lightly.

we sometimes will see people don't want to look at you in the eye anymore. People don't have an understanding of natural conversation anymore. And so it's a very deep answer for your question because it really depends on the individual and what some of their unique challenges are. The other thing to say is although healthy marriages, marriages that bring joy and open communication and safety can improve health span, specifically for men, by the way. Men have a...

significant better health span when they are married. But when someone's in a toxic relationship or someone is feeling stressed, they feel unsafe, they are fighting with their partner constantly, and they don't have that support, you can also say that it all can shorten somebody's ⁓ health span and lifespan too. So we want that balance and part of that also comes down to the education and the communication piece that Dave was talking about.

So it's really bringing it back to the table. And when I work with one person and they are in a coupled relationship, or they have a partner, whether it's marriage or just a romantic partner, I say, are they open to coming in with you? Is this something that they're aware of? Have you brought this up to them? And sometimes they'll say, you know, I didn't even think about it. didn't, I don't know. I just, felt, I don't know. don't want him or her to be uncomfortable. And I don't know even know where to start. And so,

sometimes just bridging the gap there and say, well, you know, why don't you, if they're open to coming in with you, I'm happy to educate them with you. I'm happy to start the conversation. And that can be really helpful for someone too.

Claudia von Boeselager (42:30)
I think just to pick up on a few points around this, what you guys were saying, right? It's that willing to have those uncomfortable conversations. putting the phone down and being present. I think that is probably number one. And even not even having the phone out. I heard Simon Sinek saying that even having it on the table, even if it's face down, you're showing that person that that has a priority over the person you're with. So number one, phone away. And then I guess number two is being willing to be vulnerable and out of the bedroom. Exactly.

Ashley Madsen (42:54)
Leave it out of the bedroom too. Leave

it out of the, that's part of my homework assignments for people. Phone out of the bedroom.

Claudia von Boeselager (43:01)
Yep, exactly.

Dr. Dave Rabin (43:03)
Definitely.

Claudia von Boeselager (43:03)
Yeah,

it's you don't even want it near you. It's just so addictive. Right. And then number two is being willing to have more vulnerable, sensitive conversations and opening up that communication to listen, to be heard, to to communicate and to speak as well, particularly for women. Right. The oxytocin starts going up and we feel more connected, et cetera. So I think maybe those are steps for people listening. what can be done? So the telephone got to go. Definitely really important.

Dr. Dave Rabin (43:26)
Mm-hmm.

Claudia von Boeselager (43:27)
I want to touch on psychedelics and deepening relationships. I know this is a very popular topic for lot of people wanting to understand more. So Dave, starting with you and growing interest in psychedelics for relationship enhancements, right? we know that there's preliminary research showing that like the nature study that you shared, it shows a promise and increased emotional openness and reduced defensiveness and relationships post therapy. How might carefully guided psychedelic experiences And I appreciate this is not for everyone.

facilitate deeper connection, empathy and understanding between partners. What mechanisms are at play there?

Dr. Dave Rabin (44:02)
well, I think simply put the experience of a properly administered psychedelic medicine in the right environment being the right environment, being a safe and trusting environment, is one that amongst all the other things that it's doing psychedelic medicines appear

across almost entirely across the board to amplify activity in a particular part of the brain called the limbic system, which is our emotional cortex in the brain and governs. It includes like the amygdala, the fear center, the insulate cortex. And the insulate cortex is one of my favorite parts of the brain because it has three core parts in it that are really important to survival that we don't talk about very much. So one of which is the, there's a stripe in the insula for

interoception, feeling and awareness of your own body, There's a stripe for introspection, which is in the middle, which is self-awareness, like self-reflective self-awareness. And then there's a third stripe for empathy, which is feeling what others feel, right? And so one of the first and most important experiences that almost anyone who has a properly

conducted or properly curated psychedelic experience notices is that we all have a lot more in common than we thought we did going into this, right? And especially when you're having an experience with your partner, and this is not unique to psychedelics, this also comes from very thoughtfully conducted couples therapy, right? Where you do eye eye contact, eye gazing therapy, there's all these different, it comes from

It comes, this experience happens when you're walking down the street and you make eye contact with a stranger and smile at them and just acknowledge their humanity, right? Like this is not unique psychedelics, but psychedelic medicines dramatically amplify the embodied recognition of feeling and knowing in your body without question or doubt that I have more in common with you as a fellow human being than different just by nature of the fact that we're both human.

And when you have that full embodied recognition, not just like a knowing in your head that it feels like you might, but a full knowing, all of the barriers of fear that exist between you start to rapidly kind of dissolve or evaporate. And you start, you can almost restart your relationship from, or reinvigorate your relationship from that perspective of common ground rather than just focusing on your differences.

Because the amygdala, which is another part of that limbic system, is responsible for sensing differences, because differences could result, and contrast can result in potential threat. So these two systems that detect similarity and differences are constantly in a dynamic duo together, balancing safety and fear. When there's too much difference in the environment, might be a trigger for, that might signal newness, it might signal uncertainty, it might signal threat.

evolutionarily how our brains develop because that's, those were potential threat signals in the environment. But now we don't have those kinds of survival threats around us most of the time. that the remind constant reminders that we have more in common than we do different is actually the core of human bonding and connection. And that's where it has to start. Once we start there, the differences between us start to get reinterpreted as enrichment, right? Not as scary.

but they're like, oh my God, you can do this and that, and you understand this and that differently than me. That's gonna make our lives so much better because I don't have that ability. Can you teach me? Right? It becomes a totally different attitude. Not like, oh, I'm afraid of you because you're different than me. Right? Totally different attitude. You know how to dance? I know how to dance. Teach me. I can learn from you. Right? It's like those kinds of things. And so that's what we want to get to, but we have to reset at the foundation. And so I think like the core is that

Claudia von Boeselager (47:45)
you

Dr. Dave Rabin (47:55)
Eye-to-eye contact can be a psychedelic experience in that even in just moments of doing it, you can remember and remind yourself of that fundamental core human connection that we have more in common than we do different just by nature of being born humans. And then from there, everything else starts to shift. Psychedelic medicine is done properly, rapidly reset that in the body that help people to...

really center around that at the core. And I think that's actually where most of the transformative capacity of psychedelics is coming from in relationships.

Claudia von Boeselager (48:29)
There's so much to unpack and I still have so many questions and I know we're at time. I just want to ask both of you before we wrap today, what's one key takeaway you'd like listeners to remember regarding sexual wellness, relationships and longevity? And we definitely need to do a round two guys.

Ashley Madsen (48:43)
What I would love to bring it back to is the fact I stole this actually from Dr. Kelly Kaspersen, so I'll give her credit. ⁓ You are not broken. And so what I think we are constantly judging ourselves and what we need to bring it back is to a sense of compassion and that remember that it's really about pleasure and compassion and communication and there is help. And so what I love people to understand is that

there are people out there like Dave and I who love to work with folks who want to explore and improve their sexual wellness and if they have any questions and there's so much available you're not broken

Dr. Dave Rabin (49:22)
And just to add to that, not only are you not broken, but you are safe enough to experience pleasure. And you should experience pleasure, not should in the way that you're not doing enough, but should in that you deserve. We all as human beings deserve to experience pleasure. It's not indulgent. It's not guilty. Something we should feel guilty or ashamed of. is especially like mutual pleasure is healing.

to the body, like when we experience pleasure, and this is like one of the most beautiful things about what I think all of us have learned from studying science for decades, is that when you really understand how the body works, you realize that the body, the human body evolved to, and many animals' bodies also, evolved to pursue things that make us feel pleasure, because pleasure is healing. It is fundamentally healing, and it is preventative to developing illnesses like mental illness.

Right? So I think like not only are you not broken, but you are safe to experience pleasure and pleasure heals us and it heals each other and we should do it more often.

Ashley Madsen (50:25)
I love that.

Claudia von Boeselager (50:25)
There we go. Me too. Absolutely love it. Thank you so much for coming on today. Thank you to your audience for tuning in. And yes, we must schedule a round two at some point to cover so many more topics. Thank you so much for your time.

Ashley Madsen (50:35)
Thank you, Claudia.