(Dr. Rako's second visit to Power Surge) Dearest: Our guest tonight is no stranger to Power Surge. Dr. Susan Rako is an esteemed physician, author and lecturer. Dr. Rako also conducts frequent workshops for women, during which she addresses the issues of hormone replacement therapy: estrogen, progesterone, AND testosterone-- providing the latest information and answering questions concerning this area crucial to so many women's health and well-being. Dr. Susan Rako is someone I'm proud to call "friend." Her groundbreaking book, "THE HORMONE OF DESIRE: The Truth About Sexuality, Menopause And Testosterone,"is a fascinating exploration into the world of hormone deficiency and testosterone supplementation for women in menopause or post-hysterectomy. Dr. Rako was trained and taught at Harvard Medical School's Masachusetts Mental Health Center. There's not enough time to list the numerousaccomplishments and credits of Dr. Susan Rako. Please see the Power Surge Web site's "Expert Advisors" page to learn more about our esteemed guest. Dearest: Dr. Rako, welcome back to Power Surge. Please share information with us about your questions from the queue :) Thanks :) Dr. Susan Rako: I am so happy to be here. What a wonderful group of women!!!! Dearest: Thanks, may we call you Susan? Dr. Susan Rako: Certainly...... Lacewing28: By using Esteroil or other Estro. does it cause Erythema Nodusum? Dr. Susan Rako: NO Dearest: Could you explain what that is, please? For those of us who may not know. Thanks. Dr. Susan Rako: I haven't heard ever of that rather extreme reaction ---- a very serious form of allergic reaction.... MtnMaw: Are there different dosages of estratest. I'm taking it with no libido for several years now. Dr. Susan Rako: Mtn.....there are TWO Dosages of Estratest --- and I don't recommend either of them. When you first began using it, did you have any improvement in libido? MtnMaw: No, but I was on Prozac then Dr. Susan Rako: Actually, a smaller dose of methyltestosterone -- often used in a cream directly on the genitals is a very good way to begin.... You have to have it made up to order by a "compounding pharmacy" ...and on prescription from your doctor.... CornyL: My last period was 2/96 and Dr. said I was in menopause from FSH results. I just got a period yesterday? Any need for alarm? Dr. Susan Rako: You are in perimenopause. No need for alarm. Ligian: Your experience with HRT for women with severe endometriosis? I'm really missing my libido, but I understand that testosterone wont' work without est. Dr. Susan Rako: That's a tough one. Estrogen is not a good idea when you have endometriosis. Slythy: My saliva T level was 37.0 pg/ml and libido is still gone. How important are lab levels? Dr. Susan Rako: More important to notice the way you feel. The same level can mean different things to different women. MIMISUSAN: On Premphase - 2 wks estrogen - 2 wks mixed with progesterone - 2nd 2 wks of mixed doesn't seem to work - is there any alternative? Dr. Susan Rako: What do you mean, "doesn't seem to work"? MIMISUSAN: Symptoms come back Dr. Susan Rako: Do you mean that you feel lousy? Sometimes progesterone makes women feel crummy. You might do better on a different hormone schedule. Estrogen consistently and progesterone for only 10 days per month or every two months... WRasmus306: Wife put on synthetic estrogen and estratest, and shortly after lost use of arms - heavy, and no apparent command..... has muscular dystrophy, and this is driving her NUTS.... and she can'tdo anything..... could the hormones have something to do with her arm condition? Dr. Susan Rako: YIKES. Oh oh, you were here the last time......very complicated medical situation....with muscular dystrophy.....also was earlier on double dose of progesterone to make period happen....Too much to handle in this medium .....Sorry.......Very unlikely anything to do with hormones..... Dearest: WR, you might want to email Dr. Rako. WRasmus306: ok RSEquines: I'm new on the meno info-hiway. Where does testost. fit into the whole picture of meno? Dr. Susan Rako: In ten words or less????? <g> Let me say just a little bit....Our bodies make testosterone in our ovaries and adrenals....and at menopause...about 50% of us lose a significant amount of testosterone and so we have reduced energy and less sex drive.....lose sensation in nipples and genitals....and feel better if we use a careful supplement. GinRosebud: No problem with libido, but is there any particular hormone that helps reaching orgasm? (blushing) Dr. Susan Rako: Absobloominglutely..... and it's TESTOSTERONE Dearest: <of course, Tom Selleck wouldn't hurt either> Ahem. GinRosebud: lol Dr. Susan Rako: unless you've never had the experience ever....and in that case, I'd recommend your reading Loni Barbach's books...."For yourself" and "For Each Other" Pegsbfla: So far I've been able to "tuff it out" so to speak (no HRT). Is it safe in the long run to go au natural ? Dr. Susan Rako: Is LIFE safe? Not sure what you mean, "Is it safe to go au natural?" Pegsbfla: Well, feel I'm damned if I do and damned if I don't....High.... Cancer too Runs in family. Dr. Susan Rako: Depends on your particular risk factors for heart attack, stroke and osteoporosis .... We all have tough decisions to make.......and life is so full of uncertainty....But it's important to make one's peace with whatever choice....Make your best informed decision....and live.... Pegsbfla: Thank you CornyL: Dr. never mentioned or explained "Perimenopause" to me..would you please? (thanks) and is it possible for irregular periods when given yearly injections of kenalog for psoriasis? Dr. Susan Rako: Sure. It's the few years leading up to the final stopping of periods --- and a little while afterward...when some of us have a fair amout of hormonal chaos.... Ligian: Is there some reasonable point when a woman with endo can use low est.+ test. for libido? or can I use test by itself now safely? Dr. Susan Rako: It might be worth a try, Ligian.. But testosterone does effect some of the tissues the way estrogen does, believe it or not.... It helps vaginal dryness. Ligian: So it might stimulate more endo? Dr. Susan Rako: I don't believe that it will stimulate the endo unless you use the wrong kind of testosterone. Ligian: which would be the wrong kind? Dr. Susan Rako:. Only methyltestosterone does NOT convert to estrogen... Even so --- a very low dose of Testosterone is not likely to convert to much estrogen... By low dose, I mean about one-third to one-half a milligram per day Dearest: Susan, let me interrupt to ask one question I think many women wonder about... Dr. Susan Rako: Sure, ask away. Dearest: Many women, I think, are *afraid* of testsosterone....Tell us, please, what are the possible *negative* side effects of taking it? Dr. Susan Rako: If we use the low dosage I suggest, there is NO RISK that we might develop ANY "negative" siide effects. If we use a large dose, for a LONG time, we could get acne and more "downy" facial hair...But there is NO REASON EVER to take such a dose. And NO woman can develop a beard, ever.....Is that enough, Dearest??? Dearest: Excellent answer. Thanks, Susan... Slythy: Is there an approximate ratio for testosterone, Estradiol and natural progesterone? Dr. Susan Rako: Not a "ratio"....just the particular dose of each that a woman needs....and THAT even can change as we get older. Our ovaries continue to produce hormones for 12 years following menopause. So the dose of estrogen and or testosterone we need can gradually increase over time. CescaSF: Can we use a testosterone cream for libido or dryness w/o using estrogen? Dr. Susan Rako: Yes, But there are some subtle facts that not everybody knows.For example -- estrogen is helpful in keeping testosterone "receptors" functioning well. Still for a woman who feels at risk for using estrogen --- testosterone alone can be helpful. CiCi1114: Is it "normal" to put on weight during menopause? ( exercise & less eating don't help!) Is phen fen, in your opinion, indicated to lose 30 lbs, if in otherwise good health. Dr. Susan Rako: To be sure, it's common for us to be at risk for "middle age spread" -- and a little weight gain is normal, but I'm not an expert on Phen fen. I think some regular walking and normal diet are preferable..... MS M ADAMS: How soon after night sweats begin (occasional) do periods stop? I'm still basically reg. Dr. Susan Rako: That's very variable, I'm afraid, MS M. Night sweats can go on for some time before the end of periods. PAWS 7: Is it common to have PMS symptoms and bleeding while on estrogen cream, and if so how long? Dr. Susan Rako: Paws -- it's not safe to use estrogen cream if you are still bleeding unless you take some form of progesterone in a regular way. PAWS 7: I am through meno. Dr. Susan Rako: Irregular bleeding should always be a reason to see your gyn. It's not safe to use estrogen cream even after menopause unless you use progesterone, too. PAWS 7: It's Premarin Dr. Susan Rako: Premarin IS "estrogen"..... and you MUST see your doctor.... DIVERDAWS: Since HRT I have a darkening on my forehead, why? Dr. Susan Rako: DIVER --- not a common development -- but possible, I think.....Can you distinguish it from "age" spots??? DIVERDAWS: Yes, it looks like a "mask". Dr. Susan Rako: I'd take it to my Dermatologist.... I don't know everything <g> Moondbeam: How is the need for testosterone determined...i.e. bloodtest, etc? Also, symptoms of low test. ? Dr. Susan Rako: Symptoms are more the point. Low energy, low sex drive, loss of sexual sensitivity in nipples and genitals.... Dr. Susan Rako: Dearest -- can I tell the women about my New York workshop on June 17???? Dearest: Of course, Susan :) Dr. Susan Rako: I'll be doing a workshop in New York City --- at the Women's City Club on June 17 and would love to have any and all....e-mail to me for registrations.... Dearest: (I have saved details for the end, Susan) Sesmsw: I felt like I was going to crawl out of my skin 2 days before I started an early period. More a physical feeling than emotional. Not on hormone therapy. Any suggestions other than deep breathing and incense?. Dr. Susan Rako: Can you tell me what you mean by "crawl out of your skin"????? Anxiety??? or a sensation in the skin??? Sesmsw: A feeling in the skin more than anxiety. Any suggestions? Dr. Susan Rako: Called "vermiculation" --- I believe that it may be caused by an imbalance in the "histamine" system....but it passes. Very unpleasant, though. You have my sympathy. Sesmsw: Are hormones recommended? Dr. Susan Rako: I think that that sort of thing happens during hormonal chaos. Smooths out over time... BayouClog1: Are natural hormones pills that make your own body produce hormones again? If not, what? Dr. Susan Rako: NO, bayou. They are hormones that are the same as your body makes....but that you take to supplement your body's own. Dearest: Dr. Rako will be with us until 10:30 (ET) Dr. Susan Rako: I can just about manage that, altho I love all of you....Spent the whole day in the medical library preparing for a talk I'm giving in San Diego to the American Psychiatric Assn. on estrogen as a "natural " antidepressant. Dearest: SG, we'll go to the end of this queue. Not taking any additional questions. Is that okay, Susan? Dr. Susan Rako: ok Grace Mama: I had a hysterectomy (ovaries too) a year ago, and now sex drive is low. Do I need an Rx for testosterone? I'm on estrogen patch. I'm only 42. . Dr. Susan Rako: Oh, Grace -- of course you do. You are very likely testosterone deficient. Grace Mama: Do I ask my doctor? Dr. Susan Rako: Please read "The Hormone of Desire" --- very good info for your doctor, too. Chloecake: Taking estrace and alternate with estratest h/s-okay to mix? thanx (or is natl test better) Dr. Susan Rako: Chloe -- very interesting concoction. ...If it works, it's ok. Nat'l test IS NOT BETTER> Chloecake: Read your book - methyl better - I learned something thanks! Dr. Susan Rako: It is harder to absorb.....and it converts to estrogen. VBrando101: Will testosterone interfere with taking Paxil for Depression. I no longer have a problem with depression I'm on low dose. Dr. Susan Rako: Just the other way around, VB --- the Paxil may interfere with the effects of the testosterone!! But, it may be ok, too. Ligian: RE beard: After two courses Danazol + one Lupron, I DO have a beard. Norelco each a.m.:-( Dr. Susan Rako: RE beard -- TWO courses of those things....you poor kid....But I'll bet it's not a "beard" like the guys have...... Dearest: ... by us, one hair on our chin is a "beard" like the guys have Ligian: Thanks, won't take more time. Dr. Susan Rako: Our hair follicles aren't programmed to make bristly beard hairs.... Dr. Susan Rako: Dearest -- you are such a dear........ CescaSF: Do women with more body fat have an easier time of peri and/or menopause? Dr. Susan Rako: Cesca, that's what some experts say -- because there's more chance to make estrogen....in body fat. But I'm not a thin person --- and I've had a very rough time with menopause.. so -- go figure!!!!! MS M ADAMS: Have dry skin/forgetfullness; sex drive fine for now. Should I take hormones? Dr. Susan Rako: Sounds like a little bit of estrogen deficiency. When estrogen is LOW, the testosterone effect can be a little bit boosted.... for complicated reasons - - for a while. Doesn't last, though :( Estrogen is really very good for brain cells... at the medical library... KarenSeg: 49, periods getting somewhat irregular, but getting VERY cranky. Should I consider HRT? Dr. Susan Rako: "consider" for sure. Have to take all factors into account. Slythy: What about pregnenolone or DHEA for hormone boost? Your thoughts? Dr. Susan Rako: Slythy -- I'm very cautious about DHEA not enough research by a long shot. We've had 50 years of experience with testosterone compared to 2 with DHEA Slythy: pregnenolone? Dr. Susan Rako: Don't know much about that at all... ..sorry...... Dearest: Dr. Rako, thank you for spendng this time with us in Power Surge tonight, and for sharing your expertise on women's health, hormones, and especially testosterone. Dearest: It was a fascinating and enlightening evening, and we hope you join us again in Power Surge very soon. Dearest: Anyone interested in purchasing Dr. Rako's groundbreaking book, "The Hormone Of Desire: The Truth About Sexuality, Menopause And Testosterone" Dearest: For information about Dr. Rako's workshops, see her Web site (which I had the pleasure to create for her :) Dearest: Let's show our appreciation to Dr. Rako for joining us tonight in Power Surge! Dearest: Thank you, Dr. Rako. Dr. Susan Rako: I have enjoyed myself as always...... SGETT: {{{{SUSAN}}}}} Thanks for coming again...come back again!!! LMossholde: Wonderful guest.....Wonderful host......Wonderful queue keeper AidaOnL: Thank you Dr..... :) And Dearest...:) BayouClog1: Thank you MIMISUSAN: {S applause Pegsbfla: :::::::::applause:::::::: BLSHNANGEL: Thank you SGETT: {S Thnkyou RoMaGraves: Thank you Dearest: {S applause CescaSF: thank you, Dr. Chloecake: Thankyouverymuch s {elvis Dr. Susan Rako: ((((((((((((((((((everyone))))))))))))))))))))) Dearest: Thank you, Susan!!!!!!! JDuncan395: Thank you; I have your book; right here in my lap........its great!!! GinRosebud: {S applause Shlle: thank u Grace Mama: Thank you, Dr. Rako!!! Very helpful!!!! Dearest: {S applause Dearest: LOL Norlee: {S applause Dearest: {S applause Slythy: Thanks Susan, good, non sound-bite answers!!! Hard to do in this media. Moondbeam: Thank you very much, Susan. ...it was enlightening! GET7339: Thank you Dr. Rako Dearest: Susan, wonderful as usual :)) MIMISUSAN: {S women APLPWR: Thanks so much for your insight Z J Gragg: Thankyou!!!! Dearest: LOL, Mimi!! VBrando101: Thanks DR Susan Rako!!!!!!!!!!!! PAWS 7: Thanks Doc Dr. Susan Rako: YOU are ALL WELCOME........ Dearest: Email Dr. Rako about her workshop coming up June 17th - NYC! Chloecake: Will try to make NYC 6/17 (live NJ) ELLIOTT53: thank you LMossholde: SGETT... Wonderful job...we can share the crown <G> Cinda: Great chat,..Dr. Rako is great as always Dearest: Thanks, Susan. Read Dr. Susan Rako's first transcript Read Dr. Susan Rako's third transcript Read Dr. Susan Rako's fourth transcript Read Dr. Susan Rako's fifth transcript Read Dr. Susan Rako's sixth transcript Read Dr. Susan Rako's seventh transcript Read Dr. Susan Rako's eighth transcript Disclaimer: Every guest in Power Surge is a highly respected professional whose opinions are his/her own. An appearance in Power Surge does not constitute an endorsement of a guest's views. None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read other transcripts by returning to the Library. Dearest aka Alice Stamm Power Surge Founder, Facilitator, Host Copyright©1994- by Power Surge. All Rights Reserved.