Medical Whistleblower: What Your Doctor Doesn’t Know Is Hurting You | Dr Rachel Rubin

A nuanced understanding of women’s hormonal health recognizes the critical roles of [restricted term], estrogen, and progesterone throughout life, and challenges misconceptions that impact sexual function, mood, and overall health. Despite progress in research and therapeutics, many women remain underserved due to outdated beliefs and a lack of awareness both in the public and the medical profession.

[restricted term] Declines in Women's Thirties Affect Libido, Arousal, and Sexual Satisfaction

[restricted term]'s Role in Women's Health Often Overlooked

Steven Bartlett and Dr. Rachel Rubin highlight that popular and medical understanding frequently reduces [restricted term] to just a “male” hormone, overlooking its essential role for women. Medical education and resources often focus on estrogen and progesterone, rarely including [restricted term] in the hormonal landscape—even though the ovary produces all three hormones. Contrary to common belief, women’s [restricted term] does not drop at menopause, but begins declining in the thirties. Many women in this age group start reporting lower libido, delayed orgasm, reduced arousal, and changes in physical sexual response.

[restricted term] remains relatively stable throughout the menstrual cycle but peaks around ovulation. Biologically, this supports reproduction, as heightened libido during ovulation helps facilitate conception.

Birth Control Pills Suppress [restricted term], Reducing Libido and Causing Painful Intercourse

Birth control pills contain synthetic estrogen and progestin at levels high enough to suppress ovulation and prevent the ovary from making its natural hormones, including [restricted term]. The pill does not add back [restricted term], so circulating levels drop. This can lead to lowered libido and pain with sex for a subset of users. Dr. Rubin cites studies showing up to 27% of women on the pill reporting a marked drop in sex drive. After discontinuing birth control, many women experience a return of libido and normal sexual pleasure as ovarian hormone production, including [restricted term], resumes. Rubin encourages those experiencing such side effects to discuss alternative contraceptive options that may limit [restricted term] suppression.

[restricted term] Therapy Enhances Libido, Arousal, Orgasm, and Body Image in Peri- and Postmenopausal Women Within 3-6 Months

Global consensus and robust clinical data show that [restricted term] significantly benefits peri- and postmenopausal women struggling with low libido and related symptoms. Therapy leads to improvements in libido, arousal, orgasm, and overall sexual satisfaction, and may even enhance body image. Rubin shares clinical examples where, after three to six months on therapy, patients experience significant improvement not only in sexual health but in cognitive and overall wellbeing. While not every woman requires [restricted term] therapy, those who desire or need it should have access to knowledgeable healthcare providers who can prescribe and monitor it at doses appropriate for women.

Estrogen and Progesterone: Fluctuations in the Menstrual Cycle and Life Stages Affect Sexual Function, Mood, and Health

Hormone Changes During Menstrual Cycle

Estrogen, progesterone, and [restricted term] surge and fall during the menstrual cycle. Bleeding (menses) corresponds to the lowest levels of estrogen and progesterone. As the new cycle begins, estrogen rises, peaking before ovulation to support the release of the egg. Progesterone production starts after ovulation, dominating the second half of the cycle until the lack of fertilization triggers both hormone levels to drop and a new period to begin. Hormone levels also vary enormously during pregnancy, further illustrating their wide-ranging physiological effects.

Progesterone Decline (Ages 35-45) Disrupts Sleep and Causes Anxiety and Mood Changes; Estrogen Decline Causes Hot Flashes, Night Sweats, and Bone Loss

The transition into perimenopause (typically ages 35–45) brings fluctuating hormone levels, resulting in unique symptoms. As progesterone declines, women often develop sleep disturbances, heightened anxiety, and mood changes. Estrogen decline brings hot flashes, night sweats, brain fog, fatigue, and most notably, compromised bone density—illustrating the hormone’s protective effect on bones. Rubin describes patients experiencing a combination of these symptoms as they approach menopause (average onset around age 52).

Menopausal Transition: Hormonal Castration Impacting Bone, Brain, Cardiovascular, and Sexual Health

Menopause represents a “hormonal castration” event where estrogen, progesterone, and [restricted term] are at their lowest, significantly affecting bone strength, sexual health, cardiovascular function, and cognitive wellbeing. Hormone withdrawal can result in increased fracture risk, rising cardiovascular concerns, and pronounced symptoms such as persistent hot flashes and sleep disruption. The abruptness and severity of these changes emphasize the importance of personalized hormone management.

Hormone Therapy Addresses Health Concerns and Should Be Individualized by Symptoms, Not Age

Over 75% of Women Missing Hormone Therapy Due to Outdated Fears From a Misinterpreted 1990s Study Disproven by Recent Research

Hormone therapy rates for menopausal women dropped dramatically after the misinterpretation of the Women’s Health Initiative (WHI) study in the early 2000s. A press conference announcing premature results mistakenly linked hormone therapy to increased cardiovascular disease and breast cancer, leaving millions to abandon beneficial treatment. Later analyses and follow-up studies disproved these fears for women below 70, showing that modern hormone therapy regimens do not increase cardiovascular or cancer risk when appropriately managed. Despite this, more than 75% of women who could benefit are not receiving hormone therapy, a “disaster” according to Dr. Rubin.

1.7% of Eligible Women Receive Hormone Therapy, Highlighting Healthcare Failure

Currently, only 1.7% of eligible women receive prescriptions for hormone therapy, underlining a widespread healthcare failure in informing, offering, and administering appropriate therapies to those who could benefit according to individual symptoms.

Hormone Therapy: Estrogen for Hot Flashes/Bone Health, Progesterone for Uterine/Sleep Support, [restricted term] For Libido, Vaginal Hormones for Genitourinary Symptoms

Hormone therapy can be customized across four main domains:

1. Estrogen (whole body): Reduces hot flashes, night sweats, and prevents bone loss and fractures.
2. Progesterone (whole body): Protects the uterus, supports sleep, and may reduce anxiety.
3. [restricted term]: Improves libido, arousal, sexual satisfaction, orgasm, and body image.
4. Vaginal Hormones: Micro-dose (estrogen or DHEA) therapy for pain with sex, dryness, urinary symptoms, and preventing urinary tract infections.

Therapy may involve one, some, or all of these, depending on the woman’s symptoms and clinical picture.

Hormone Therapy Should Be Based On Symptoms and Preference, No ...

Clitoris, Homologous to Penis, Key for Female Orgasms, Overlooked In Medical Training

The clitoris is a complex organ, homologous to the penis in structure, tissue, and function. Rachel Rubin describes tracing the labia minora, or inner wings, to reach the clitoral hood (prepuce), which can be retracted to reveal the tip of the clitoral head. However, this visible tip is just a small part of an extensive structure that extends deep into the pelvis, down to the butt bones. The clitoris contains about 10,000 nerve endings, making it the most sensitive part of the female sexual anatomy. Due to its sensitivity, some women find direct stimulation overwhelming and may prefer less direct contact or vibration.

Clitoral adhesions—when the hood sticks to the head—occur in about 23% of women. Normally, one should be able to retract the hood and see the entire head, which resembles the “mushroom” rim of a penis. When adhesions are removed via a simple office procedure, research shows sexual satisfaction improves by 60-70%, with notable gains in orgasm and arousal.

Despite the clitoris’s anatomical and functional importance, Rubin highlights that few doctors examine or educate about this part of the body. During gynecological exams, modesty drapes obscure the view and providers seldom show women their anatomy, missing opportunities for education. Rubin became known for using mirrors during exams to visually explain the vulva, clitoris, and surrounding structures, helping women gain language and understanding about their own bodies. She notes that, historically, no one has examined most women’s clitorises during standard checkups, and there remains a gap in discussing orgasm, satisfaction, and sexual function in clinical settings.

Most Women Don't Orgasm From Penetration Alone Due to Need For Clitoral Stimulation

Most women are unable to achieve orgasm from vaginal penetration alone because the clitoris, the main center for sexual pleasure and orgasm, is external and not directly stimulated by penetration. Studies and clinical experience make it clear that the majority of female orgasms are clitoral in origin. Despite this, many women believe they are “broken” if they cannot orgasm from penetration, a misconception rooted in poor sexual education.

Rubin points out that while about 20% of women report being unable to orgasm at all, equivalent to a significant pleasure gap compared to men, this is mostly due to lack of knowledge. Women commonly experience strong orgasms from direct clitoral stimulation—via vibrator, hand, or shower head—rather than through penetration. The penis and clitoris are equivalent: men require penile stimulation for orgasm; women require clitoral stimulation.

Orgasm typically requires sustained arousal and stimulation. On average, men last about five and a half minutes during penetrative sex, but women generally require more than 13-15 minutes of focused clitoral stimulation to reach orgasm. This makes the idea of mutual orgasm during typical intercourse unrealistic. As a result, many women fake orgasms to align with partner expectations and avoid discomfort, which perpetuates myths around penetration as the main source of female pleasure and hampers honest communication. Rubin encourages open dialogue to promote sexual satisfaction.

The difference in orgasm rates is sometimes attributed to psychological factors, but physical stimulation and education are foundational for bridging the gap.

Pain During Sex Affects Up to 75% of Women, Requiring Proper Diagnosis of Diverse Causes

Pain during sex is common, with up to 75% of women experiencing it at some point, and 10-20% suffering from chronic pain. In menopause, the prevalence can rise to nearly half of all women. Rubin emphasizes that sex should not be painful; persistent pain is a medical issue deserving thorough evaluation.

Several conditions can cause sexual pain:

• Hormone-sensitive vaginal tissue: The vulva and vaginal tissues are highly sensitive to hormonal changes. With low estrogen during perimenopause and menopause, tissues can become thin or irritated, leading to eczema or autoimmune skin problems.
• Muscle problems: The vagina and vulva are supported by large pelvic floor muscles. Like any muscle, these can become tight or dysfunctional. Chronic tension can cause pain during penetration, and tightness following surgery or childbirth can contribute as well.
• ...

Systemic shortcomings in medical education and healthcare delivery continue to hinder the quality of care women receive, particularly in sexual health, anatomy, and hormone therapy. These failures affect women across all socioeconomic statuses, perpetuating misinformation, denial of treatment, and poor health outcomes.

Doctors Receive Insufficient Training in Women's Sexual Health, Anatomy, or Hormone Therapy, Leading To Misinformation and Denial of Treatments

Rachel Rubin and Steven Bartlett discuss how most doctors, including obstetrician-gynecologists, receive little to no training in women's sexual health and anatomy. Rubin explains that the clitoris is completely missing from the 2026 OBGYN training checklist; the word does not even appear. Medical education omits examination of the clitoris, the vulva, and essential topics such as sexual function, pain with sex, libido, arousal, and orgasm. As a result, few clinicians have the expertise to diagnose or treat these issues, leaving women unexamined and undiagnosed across generations.

Medical curricula typically emphasize estrogen and progesterone, neglecting the critical role [restricted term] plays in women’s sexual function. Rubin highlights, "We forgot to teach doctors anything about hormones." Instead, what is taught instills the fear that naturally occurring hormones become dangerous after a certain age, based on outdated science.

This lack of training extends to even the most privileged women. Rubin states that Melinda Gates, Oprah Winfrey, and Halle Berry—despite wealth and access—have all been misdiagnosed due to clinicians' poor understanding of women’s hormonal health and sexual medicine. Gates had to visit three doctors to be prescribed proper hormone therapy, Oprah saw five before her perimenopausal heart palpitations were understood, and Berry publicly endured misdiagnosis of menopause symptoms as genital herpes.

Doctors Deny Women Treatments Instead Of Admitting Limitations

Rather than acknowledging gaps in their training, many physicians simply deny women hormone therapy, claiming, "You can't have this." Rubin and Bartlett observe this as a form of paternalistic gatekeeping unique to women's health. In contrast, men receive open, shared decision-making regarding treatments, with doctors discussing risks and benefits rather than flat denials.

Time constraints worsen these outcomes. Brief 10-minute appointments force doctors to simplify: saying “no” is easier than attempting nuanced exploration and problem-solving. Rubin notes, “Instead of doctors saying, I don't know, they're sort of saying, ‘No, you can’t have this’ because it's easier than sort of going into that nuance."

Misinterpreted 1990s Study Still Spreads Fear and Misinformation on Hormone Therapy Despite Being Disproven

A misinterpreted study from the 1990s triggered decades of fear about hormone therapy, which persists in both medical culture and public perception. The original study, halted early, indicated risks that later evidence refuted—finding no increased risk of cardiovascular events or stroke for women under 70 on hormone therapy. Nevertheless, many doctors never learned this; hormone therapy became a "lost art." Rubin recounts, "Doctors don't know how to write the prescriptions. Nobody taught them how," even after funding like Melinda Gates’ $10 million donation to menopause societies.

The knowledge gap is deep and persistent: clinicians struggle to understand the differences between hormones, their safety profiles, and appropriate prescription practices. “Someone has to teach someone how to do something. So I lecture all the time … because that's what it's gonna take,” says Rubin, emphasizing that publishing research alone does not reach practicing doctors.

Women Lack Basic Medical Knowledge About Their Bodies, Sexual Function, and Hormonal Health Due to Doctors' Training Limitations

Women themselves are deprived of essential knowledge about their ...

Steven Bartlett and Rachel Rubin argue that the foundation of healthy relationships is rooted in education and honest communication. They note that most people lack sufficient sexual education and experience shame, which hinders open discussion about sexual needs and issues. This fosters misunderstandings and can lead to relationship decline.

Insufficient Sexual Education and Associated Shame Hinder Couples From Discussing Needs and Issues, Leading To Misunderstandings and Relationship Deterioration

Bartlett reflects that, without education on sex and communication, people are left to guess or internalize issues. He describes discussing with friends their lack of sex lives and concluding, out of ignorance, that either "something is wrong with me" or "maybe my partner just doesn't like sex." He laments that, had he known more about sexual health and communication, he would have realized these challenges could have been resolved rather than being treated as intractable. Rubin points out that if people learned about biology, sexual health, or could comfortably name and discuss genitals, much of the hurt, shame, and guilt could be avoided.

Misattributing Sexual Issues To Personal Failure Rather Than Biological, Medical, or Communication Causes

Rubin offers examples such as libido changes from antidepressants or painful intercourse from medical conditions. She highlights common mistakes: attributing low desire to lack of attraction or love, instead of understanding underlying biology or medication effects. This misunderstanding perpetuates shame and self-blame.

Fear of Emasculation or Rejection Stops Partners From Sharing Sexual Dissatisfaction, Leading To Years of Faked Orgasms, Avoided Intimacy, and Emotional Distance Until the Relationship Breaks Down

Bartlett and Rubin explain that fear of rejection or emasculation prevents many from sharing sexual dissatisfaction. Women may hide discomfort or pain to protect their partner’s feelings, while men conceal insecurities or frustrations. This silence can lead to years of faked orgasms, avoided intimacy, and growing emotional distance, eventually eroding the relationship.

Couples Avoid Discussing Sex Outside Intimate Moments, Hindering Reflection On Issues, Successes, and Improvements

Both speakers note that people rarely discuss sex outside the bedroom. Rubin calls for “after action” conversations—reflecting on what worked and what could be improved. Bartlett notes that without these discussions, partners remain unaware of each other’s needs, potentially leading to years of misunderstanding and mediocre intimacy.

Reframe Relationship Issues As "Us vs. the Problem" to Eliminate Shame and Blame, Enabling Couples to Find Solutions Together

Rubin stresses that most relationship conflicts, especially about sex, do not have a villain; differences in libido, preferences, or dysfunctions are natural, not character flaws. Bartlett adds that viewing issues as “us versus the problem,” not “me versus you,” eliminates shame, reduces blame, and makes space for solutions.

Recognizing That Libido Differences, Preferences, or Dysfunctions Are Natural, Not Signs of a Bad Partner, Allows Couples to Approach Problems With Curiosity and Empathy Rather Than Judgment

Rubin emphasizes understanding and curiosity. Recognizing that no one is inherently at fault for sexual incompatibility allows partners to approach sensitive topics without fear of blame or rejection.

Recognizing No One Is Solely at Fault for Sexual Incompatibility Fosters Safe Discussions About Needs, Fantasies, and Concerns Without Fear of Blame or Rejection

Bartlett shares that acknowledging neither partner is solely responsible for sexual difficulties is liberating and creates a safe space for honest communication. Rubin points out that such reframing encourages safe exploration of needs, desires, and fantasies, bolstering intimacy.

Couples Seeing Challenges as Opportunities Strengthen Their Relationship Through Communication, Experiencing 101% Healing Rather Than 99% When Conflict Arises

Bartlett references a quote about relationship health, observing that conflicts can make partnerships stronger or weaker depending on communication. When couples approach challenges with teamwork, they achieve “101% healing” and grow closer through resolving conflicts.

Most Couples Haven't Discussed What Great Sex Means, What Arouses Them, What They Enjoy, or What They Want to Explore, Leaving Them With Mediocre Sex and Unmet Desires

Rubin compares sexual communication to financial literacy: just as people need to talk about money’s basics, they must learn to discuss sex’s basics, needs, and desires. She observes that most couples have never talked about what great sex means to them or asked what their partner enjoys.

"What Does Great Sex Mean to You?" Reveals Diverse Motives For Sex and Differing Partner Views, Needing Open Discussion to Reconcile

Rubin urges couples to ask questions such as, “What does great sex mean for you?” or “What makes a great time?” As people have many motives for sex and varied fantasies, open discussions are essential to reconcile differences.

Women Conceal Discomfort During Sex to Protect Partner's Feelings; Men Hide Performance Insecurities

Rubin states that women often hide their discomfort to avoid hurting their partners, while men hide perf ...

Rachel Rubin and Steven Bartlett explore how modern lifestyle, psychological obstacles, and cultural myths contribute to declining sexual desire and satisfaction, particularly among women. They emphasize that these factors are often overlooked, but understanding them is essential for addressing today's "sex recession."

Modern Life of Overwork, Stress, Poor Sleep, and Constant Digital Engagement Depletes Neurochemicals Needed For Sexual Desire and Pleasure

Chronic Sleep Deprivation, Burnout, and Exhaustion Deplete [restricted term] and Neurological Capacity, Making Sexual Desire Feel Impossible

Rachel Rubin highlights that chronic sleep deprivation, overwork, and burnout contribute to a logical and significant decline in excitement and libido. Being overextended—whether through demanding jobs or endless distractions—leads directly to diminished [restricted term] and depleted neurological capacity, making it feel impossible to muster sexual desire.

Screen Time Disrupts Mental Space Needed For Sexual Connection

Screen use exacerbates this problem. Rubin notes that constant scrolling at bedtime or using devices such as AI chatbots replaces opportunities for human connection. Instead of engaging with partners, people are absorbed in digital content, which erodes the mental space necessary for intimacy and connection. This tendency worsens social disengagement; as Rubin states, people are experiencing a “sex recession”—having less sex and struggling to connect, with technology contributing to this decline.

Myth: Sex Should Be Spontaneous; Maintaining Connection Requires Planning

Both Rubin and Bartlett debunk the “spontaneity myth” perpetuated by movies and television. While media presents sex as spontaneous and effortless, Rubin compares this depiction to scripted wrestling, emphasizing its unreality. In actual relationships, routine and daily coexistence leave little room for spontaneous excitement. Meaningful connection and healthy sexual intimacy often require intentional planning, and scheduling sex can help maintain connection and responsiveness—contradicting the idea that it dampens romance.

Body Image Insecurity and Perfectionism Hinder Women's Comfort in Intimacy

Women's Focus on Thinness Over Strength Hinders Sexual Enjoyment Until Arbitrary Weight Standards Are Met

Rubin sees body image insecurity and perfectionism as major psychological barriers to intimacy, especially among women. She observes that many women focus intensely on achieving thinness and equate their worthiness of pleasure with their weight. Instead of prioritizing health or strength, energy is funneled into meeting arbitrary weight goals before allowing themselves sexual enjoyment.

Believing One Must Meet Appearance Standards For Intimacy or Pleasure Creates a Barrier to Sexual Satisfaction

Rubin underscores that women often impose unattainable appearance standards on themselves, believing they must “deserve” pleasure or orgasms by being skinny. She notes that people readily affirm their friends' worthiness of great sex at any weight, yet apply harsh, perfectionistic standards to themselves, preventing relaxation and intimacy.

Partners Find Their Partners Attractive Despite Weight, but Insecure Individuals Project Body Image Concerns Instead of Trusting Their Partner's Desire

Despite their own insecurities, most women’s partners find them attractive regardless of weight. However, insecure individuals tend to project these concerns onto their relationships rather than trusting their partners’ genuine desire, which further undermines comfort and satisfaction in intimacy.

Heavy Pornography Use: Unrealistic Expectations, Desensitization, Anxiety, and Deception in Relationships

Pornography Shapes Male Views With Unrealistic Sex Depictions

Bartlett and Rubin discuss how heavy pornography use, especially among young men, sets unrealistic expectations for sex. Pornography is crafted predominantly for a male audience, with about 65% of its consumers being men and roughly 75–95% of young men regularly viewing it. This ecosystem shapes how men perceive sex—suggesting women are always enthusiastic and that ideal encounters mirror scripted, male-centered fantasies.

Pornography Consumption Can Desensitize the Brain, Hindering Real Interactions and Partner-Based Sexual Function

Rubin notes that pornography enables users to curate exact scenarios tailored to their tastes—which is rarely possible in real-life intimacy that requires compromise. Constant solo porn use can condition the brain to expect specific, easily accessible types of stimulation, desensitizing the reward system. This “training” can make arousal with a partner more difficult, trigger performance anxiety, or cause erectile challenges, as real sex can feel less novel or stimulatin ...