Urologist Reveals 75% of Women Not Getting Life-Saving Hormone Prescriptions
"More than 75% of people in large database collections are not getting prescriptions for this. And so women are not getting access to generic medications that could save their lives and also really improve quality of life."
About this episode
In this episode, host Stephen Bartlett sits down with Dr. Rachel Rubin, a board-certified urologist and sexual health specialist, for an unflinching examination of the catastrophic state of women's healthcare in America. Dr. Rubin opens by declaring she is 'filled with rage' because women across all income levels—from Oprah to Melinda Gates to Halle Berry—are receiving shockingly inadequate medical care for hormonal and sexual health issues. The conversation reveals systemic failures in medical education: the word 'clitoris' does not appear in OB-GYN training checklists, over 75% of women who need vaginal hormone therapy don't receive it, and only 1.7% of menopausal women get hormone replacement therapy despite safety data. Dr. Rubin explains how a misinterpreted 2002 study created two decades of unfounded fear around hormone therapy, leaving doctors untrained in basic prescribing. She details the biology of female sexual response, revealing that 23% of women have clitoral adhesions blocking orgasm capacity, that most women require clitoral stimulation rather than penetration to orgasm, and that simple, cheap interventions like $14 estradiol cream can prevent deadly UTIs and transform sexual function. The episode tackles communication breakdowns in relationships, with Bartlett candidly sharing his own past relationship failures rooted in ignorance and poor communication around sex. Dr. Rubin argues the root problem is education—both medical professionals and the general public lack basic knowledge about female anatomy, hormones, and sexual health. She outlines a framework comparing sexual health literacy to financial literacy, emphasizing that great sex requires communication, hormonal optimization, pelvic floor health, and vulnerability. The conversation concludes with Dr. Rubin's passionate call for systemic change in medical training and cultural attitudes toward women's bodies.
Key takeaways
- The word clitoris does not exist in OB-GYN training requirements in 2026, leaving doctors fundamentally ignorant about female sexual anatomy.
- Over 75% of women who should receive vaginal hormone therapy are not getting prescriptions that could prevent deadly UTIs and improve sexual function.
- Only 1.7% of menopausal women receive hormone replacement therapy due to a misinterpreted 2002 study that created unfounded fear lasting two decades.
- Halle Berry was misdiagnosed with genital herpes when she actually had genitourinary syndrome of menopause, illustrating systemic failures even for wealthy patients.
- 23% of women have clitoral adhesions that significantly impair orgasm, yet almost no doctors examine for this treatable condition.
- Most women require clitoral stimulation rather than penetration to orgasm, but pornography and lack of education perpetuate harmful myths.
- Testosterone levels in women drop precipitously in their 30s, often causing libido issues long before menopause, but doctors rarely address this.