The Diary of a CEODr Rachel Rubin: The Truth About HRT & Menopause Doctors Won't Tell Women | Dr Rachel Rubin
CHAPTERS
- 0:00 – 7:24
Why women's sexual healthcare lags behind (and why Rubin is "filled with rage")
Dr. Rachel Rubin opens by arguing that women are being denied basic information and evidence-based care for sexual health, hormones, and menopause. She frames the problem as systemic: doctors aren’t trained, time is limited, and misinformation drives overly rigid medical gatekeeping.
- 7:24 – 11:29
The clitoris knowledge gap in medicine (yes, even among specialists)
Rubin explains that many clinicians— including OB-GYNs—receive little to no practical training in female sexual anatomy and function. She argues that lack of language and visualization keeps patients disempowered, so she uses mirrors during exams to teach anatomy in real time.
- 11:29 – 11:54
What people ask most: hormones, libido, and pain with sex
Rubin identifies the top reasons people seek her help and why hormones are so confusing. She argues that hormones are treated as dangerous after a certain age due to politics and misread science, not because the biology is inherently risky.
- 11:54 – 14:03
Testosterone in women: the misunderstood driver of desire and function
Rubin reframes testosterone as a human hormone, not a “male” one, and emphasizes that it can decline notably in women starting in their 30s. She links this to changes in libido, arousal, orgasm latency, lubrication, and genital engorgement (clitoral erection).
- 14:03 – 23:33
Libido killers and boosters: birth control, antidepressants, and GLP-1 weight-loss drugs
The conversation explores how common medications affect sexual function and why patients often aren’t warned. Rubin explains how combined birth control suppresses ovarian hormone production (including testosterone) and discusses known sexual side effects of antidepressants and emerging reports with GLP-1s.
- 23:33 – 29:46
A clear menstrual-cycle primer and why perimenopause may start earlier than you think
Rubin walks through the menstrual cycle—low hormones during bleeding, estrogen rise to ovulation, then progesterone in the luteal phase—then connects this to symptom patterns. She asserts perimenopause can begin roughly 10 years before menopause, putting many women in the 35–45 range in transition.
- 29:46 – 33:44
HRT explained: what it is, how it works, and the four main “buckets”
Rubin defines hormone therapy and clarifies why estrogen is paired with progesterone when a uterus is present. She introduces a practical framework: systemic estrogen, systemic progesterone, testosterone, and local vaginal hormones—each targeting different symptoms and goals.
- 33:44 – 41:16
Vaginal hormones and UTIs: the ‘GSM’ toolbox that improves sex and can save lives
Rubin makes a strong case that local vaginal estrogen or vaginal DHEA is underused despite decades of evidence. She explains genitourinary syndrome of menopause (GSM), the vaginal microbiome’s dependence on hormones, and why these treatments reduce UTIs while improving dryness, pain, arousal, and orgasm.
- 41:16 – 47:27
When to start hormones: symptoms, life stage, breastfeeding, and a success story
Rubin rejects a single ‘right age’ to begin therapy and instead ties decisions to symptoms, risk goals, and shared decision-making. She discusses postpartum/breastfeeding as a temporary low-estrogen state and shares a patient story illustrating stepwise improvement with vaginal hormones, then systemic therapy and testosterone.
- 47:27 – 50:08
Pain during sex isn’t normal: the differential diagnosis and what to do next
Rubin stresses that painful sex requires diagnosis—no one should accept it as normal. She outlines multiple causes (skin conditions, hormones, pelvic floor muscle dysfunction, nerve/spine issues, endometriosis/scarring) and recommends seeking specialized pelvic pain clinicians and often multiple opinions.
- 50:08 – 1:05:20
Better sex basics: pelvic floor function, orgasm education, and clitoral adhesions
Rubin connects sexual pleasure to muscles, nerves, blood flow, and anatomy—especially the clitoris as the primary orgasm organ for most women. She discusses pelvic floor physical therapy, the orgasm gap driven by misinformation about penetration, and clitoral adhesions as an underdiagnosed contributor to dysfunction.
- 1:05:20 – 1:32:04
Arousal, porn, and intimacy: responsive desire, expectations, and talking about what you want
The conversation shifts to relationship dynamics: men’s focus on penis performance vs women’s pleasure pathways, the role of toys, and how porn can distort expectations. Rubin frames desire as often responsive (especially for women) and argues that communication, novelty, and curiosity are the antidotes to shame, secrecy, and mismatched needs.
- 1:32:04
Stress, scheduling, self-esteem, and why biology + communication must be addressed together
Rubin and Bartlett link modern burnout and chronic stress to lowered libido and advocate creating intentional time for intimacy, including scheduling. They address performance pressure, suggest “quarterly partner days,” and highlight how body image and self-esteem block pleasure—then close on the core message: biology matters, and communication turns conflict into teamwork.
Why HRT got a bad reputation: the WHI fallout and lingering misinterpretation
Rubin recounts how early-2000s messaging about the Women’s Health Initiative led to widespread fear and a collapse in prescribing. She argues the study was miscommunicated and that modern interpretations and formulations differ, leaving today’s clinicians undertrained and overly cautious.
Practical ‘how-to’: creams, tablets, rings, and DHEA—plus myths like cranberry juice
Rubin demonstrates different delivery methods for local therapy and explains how patients actually use them. She critiques common UTI advice as largely folklore and emphasizes that while cranberry/water may help modestly, vaginal hormones are the most effective prevention tool discussed.
