(Dr. Rako's fourth visit to Power Surge) Dearest: Dr. Susan Rako is a Harvard educated psychiatrist and has taught at Harvard Medical School's Mental Health Center. Dr. Rako conducts workshops and lectures addressing the subject of her ground-breaking book, "The Hormone Of Desire: The Truth About Sexuality, Menopause And Testosterone." Dr. Rako conducts workshops and lectures addressing the subject of her ground- breaking book-- the benefits of testosterone for women in menopause or post-hysterectomy. It's always a pleasure to welcome you back to Power Surge, Susan :) Dr. Susan Rako: And I am GLAD to be here. Dearest: And I am, too. Many women who come through Power Surge express a fear of using testosterone supplementation. Has that been your experience when dealing with patients and in your workshops? If so, what reason do they give for their fears? Dr. Susan Rako: Fear of the unknown, I am sure. We all know that testosterone has been associated with the Male of the species and women who don't realize that our bodies actually produce MORE testosterone than estrogen, are at the disadvantage of ignorance, and afraid that using supplemental testosterone, if needed, would somehow "masculinize" a woman. Dearest: Why, when women are given HRT, doesn't it automatically include testosterone if it's so important? Dr. Susan Rako: Not all women NEED supplemental testosterone immediately and we all know that not all medical care is excellent .... sad but true. Dearest: Thank you, Susan. Harper, go ahead with your question. harper: Do men and women have lags in their libido at similar ages? How do we fill the gaps? Dr. Susan Rako: It's not my style to generalize, but testosterone deficiency can develop for a woman at an earlier age than it does, usually, for a man. Dearest: Susan, isn't it true that the many of the symptoms of testosterone deficiency are very similar to those of estrogen and/or progesterone deficiency or just peri or postmenopause in general? How do we delineate? Dr. Susan Rako: When a woman begins hormone supplemental therapy, I recommend that she START with Estrogen and Progestin and then evaluate her remaining symptoms. About 15% of women STILL suffer from vaginal dryness even with estrogen supplementation. KathyB: How long does it take for testosterone supplementation to take effect? Dr. Susan Rako: 3 - 4 weeks at the outside. Some women notice beneficial effects after only a week. Dearest: At what age do a woman's testosterone levels usually begin to decline? Dr. Susan Rako: During peri-menopause, when a woman's body sometimes pumps out large amounts of estrogen the estrogen can cause testosterone deficiency by increasing the protein that binds testosterone ..... leaving less testosterone to be available. girlie: is it true that your clitoris will grow in size when taking testosterone and your voice becomes lower? And is it true that once your vagina atrophies - it can not be reversed? Dr. Susan Rako: NO. NO. NO. NO. girlie: On Oprah's show they said it would enlarge the clitoris Dr. Susan Rako: ONLY if used in excessively high dosages and for a LONG time. There is NO excuse for a woman to be overdosed. girlie: My doctor prescribed vagifem tablets, is that good for the prevention of vagina atrophy? Dr. Susan Rako: Never heard of them. LoriT: A woman on Power Surge today asked about EstratestHS. Besides increasing her libido she wanted to know if it would give her more energy. Also what are the side effects of this medication. She has heart racing and is concerned about it increasing. Is this a pill or patch? Also does it increase your cholesterol? Thank you. Dr. Susan Rako: Estratest HS has significantly more testosterone than most women need or can best make use of. Very few women need as much as 1.25 mg of testosterone per day. If you take more testosterone than you need, it will make you AGITATED. That is a kind of energy that NO one wants. Dearest: Can that agitation include palpitations? Dr. Susan Rako: Anything is POSSIBLE, but I have not heard of that as a common complaint. Dr. Susan Rako: I want to make clear that testosterone is important NOT ONLY for sexual libido, sensitivity, and response but also for general health. paula: Yes, Is there evidence of weight gain with hormone replacement therapy and what happens if you switch to a synthetic? Dr. Susan Rako: Synthetic HRT is not more likely to cause weight gain than "natural HRT". Dearest: I believe what she and many other women wonder is if weight gain is common whether one is using synthetic or natural hormone therapy. Dr. Susan Rako: "Likely" is too general. But the menopausal metabolism is a tough one on weight!! Women who are testosterone deficient and use a supplement often report better muscle tone and generally better body tone and shape. Especially if they exercise in moderation. Dearest: Carole's question was..."I never heard that your vagina could atrophy. How does it happen and what can be done or not done to stop it. Dr. Susan Rako: The lining of the vagina CAN atrophy especially without enough estrogen and, as I said earlier, about 15% of women will still have vaginal atrophy unless they supplement with testosterone. KathyB: What is a conservative dose of testosterone? I am on 5mg/day, oral. My levels tested very low. Dr. Susan Rako: Your dose is 500% higher than I would recommend. A scary dose, actually. Can cause liver damage. NOT a good idea. KathyB: That troubles me. Dr. Susan Rako: I take 0.5 mg per day. Your dose is ten times higher than most women need. KathyB: It is so frustrating when you have to get all of the answers yourself! Dr. Susan Rako: The final chapter --- Chapter 8 -- in my updated paperback .... of THE HORMONE OF DESIRE has all the information about dosages and methods for safe supplementation. KathyB: Thank you. girlie: Do you prefer a cream or gel testostorone and how where it is applied? My level is 21 - is that real low? Dr. Susan Rako: This is not a simple question to answer. It takes 20 pages in my book. But, the best I can do here is to say that measuring blood levels of testosterone are helpful only for general ideas. The measurement that is useful is FREE testosterone, NOT "total testosterone." A level of 21 is a "TOTAL" level. But, if you have symptoms of testosterone deficiency and your levels are at the bottom of the "normal" range, and "21" IS at the bottom of the normal range. I often find that women do best by using testosterone in a gel directly on the genital tissue. HOWEVER, it is essential NOT to use too much. Not to "slather it on" .... but to use a carefully measured amount. The pharmacy that I recommend actually prepares the gel or cream in an insulin syringe...... and advises a women to depress the plunger on the syringe only one tiny line per day that dispenses 0.1 ml per dose. Dearest: Thanks for that excellent answer, Susan. Hormonequeen, go ahead. Dr. Susan Rako: Thanks for your moderat-ion, Dearest!! hormonequeen: Once someone has a total hysterectomy should testosterone be automatically taken? I have no energy these days. Somedays are better than others. Isn't testosterone produced somewhat naturally in our bodies? Dr. Susan Rako: Hormonequeen.... my heart goes out to you. Have you read my book? hormonequeen: No I haven't yet Dr. Susan Rako: It is directed most definitely to your concerns. Women who have had a hysterectomy NEED BOTH ESTROGEN AND TESTOSTERONE. In fact, it can be dangerous to your heart NOT to use testosterone. It has been shown that women, following hysterectomy, have 3 - 7 times the risk for heart attack or stroke than women who have NOT had a hysterectomy. I've had two papers in the JOURNAL OF WOMEN'S HEALTH on this subject. Dearest: Can using testosterone improve pre-existing heart disease, or is it more to prevent the development of heart problems? Dr. Susan Rako: Not a simple answer. Like Estrogen, testosterone improves the clotting circumstances and helps the lining of the blood vessels. Testosterone also improves the blood supply to the heart itself. Those are helpful facts. But I can't say that testosterone can cure heart disease. It can help to prevent it, though. Dearest: Thanks, Susan. LoriT, go ahead, please. LoriT: In which forms are testosterone available and which is most safe? What strength is it available? Should we supplement with that if standard HRT has not improved libido? Does testosterone effect cholesterol levels? How does it effect your heart? Thanks Dearest: Please, one question at a time. Dr. Susan Rako: Too many questions. But I'll try. Please ask one. Dearest: As Dr. Rako answers, the other questions will scroll off the screen. LoriT: Does it effect your choloesterol? Dr. Susan Rako: Like estrogen, testosterone will DECREASE total cholesterol, also decrease the LDL and the Triglycerides. But, in HIGH dosages, it can also decrease HDL up to 10%. I have not seen any decrease in HDL in women using the proper low dose of supplemental testosterone. LoriT: Thank you Dearest: In your book you say, "Research has shown that those women who go through menopause with few difficulties -- whose bodies may produce adequate estrogen even after menopause -- are actually at greater risk to develop endometrial cancer than postmenopausal women who take estrogen and progesterone supplemental therapy.... Women with a uterus who do not take HRT because they feel they 'do not need it' have a greater incidence of endometrial cancer. Dr. Susan Rako: YES. And your question? (glad you read my book, though LOL) Dearest: I wondered if you could elaborate on that -- that women not using HRT are more prone to cancer than those who are using it. Dr. Susan Rako: Sure! Our bodies produce some estrogen ..... even HIGH levels of estrogen in the perimenopause .... when we are NOT ovulating. This estrogen stimulates the uterine lining. It is safer for women to use HRT .... with progestin to keep the lining of the uterus from becoming cancerous. Progesterone alone can help that, as well. Dearest: Thank you, Susan. Danaro, go ahead, please. danaro2: What are your recommendations for supplemental testosterone after a hysterectomy? Are there specific symptoms to watch out for, or should testosterone automatically be mixed with the estrogen? Dr. Susan Rako: It makes sense for a woman to begin with estrogen and if she notices a loss of sexual sensitivity in her nipples and clitoris and loss of sexual desire and loss of energy. Those are some of the signs of testosterone deficiency. All listed in my book. danaro2: Thanks so much. girlie: can low libido be caused from lack of a boyfriend and lack of sex? Dr. Susan Rako: Low libido has MANY MANY causes. It is only if you have reason to think that your testosterone is also low that it makes sense to consider testosterone supplementation. But testosterone can't solve all problems of life and love. hormonequeen: Is there any natural form of testosterone I can take until I can find a doctor who knows more about womans issues? Dr. Susan Rako: None that I have ever heard of. But you can find your nearest compounding pharmacy and ask the pharmacist for the names of the physicians who are prescribing testosterone supplementation, that's one way to locate a physician. LoriT: Which is the safest form of testosterone? Dr. Susan Rako: In a low enough dose, all forms are safe. It is UNSAFE to take large doses of testosterone by mouth. LoriT: Is one better than another ineffectiveness? Dr. Susan Rako: Using testosterone directly on the genital tissue gives the best immediate effect. In the proper LOW DOSE. Dearest: How much testosterone is there in Estratest and in Estratest HS? Dr. Susan Rako: 1.25 MG in the half strength. 2.5 mg in the full strength. Dearest: And you say that's way too high, yes? Dr. Susan Rako: That's 5X the dose I use. WAY too high. Dearest: Thank you. MaryO: Would using testosterone directly on the genital tissue effect your partner, too? Dr. Susan Rako: A man's body makes and needs so much more testosterone than a woman's that the proper low dose applied to the genitals is unlikely to effect a man. I don't recommend applying testosterone to the genitals before lovemaking, in any event. Dearest: Girlie, go ahead. This will be the last question. girlie: Is it silly to be using testorone if you aren't sexually active right now? Dr. Susan Rako: As I've said, testosterone is essential for the proper functioning of our metabolism. Living with testosterone deficiency is not healthy. Testosterone is NOT just for sex. Dearest: Which leads me to one last question. If living with testosterone deficiency is not healthy, is living with low estrogen and progesterone levels also not healthy? Dr. Susan Rako: Dearest, and everybody, let me say that, while I am a western-trained physician I have great respect for the complexity of body, mind and spirit and, from a western-medicine point of view, I find that hormones are very powerful and proper supplementation is helpful for many women. But each woman has to find the path that is right for her. The last sentence in my book says, "do as little as you can, and as much as you need, and no one knows better than you." Dearest: Susan, thank you for a very informative chat. I encourage everyone to get a copy of Dr. Susan Rako's book, "The Hormone Of Desire: The Truth About Sexuality, Menopause And Testosterone." Also, visit Dr. Rako's Web site at www.susanrako.com (I built the site for Dr. Rako three years ago). Dr. Susan Rako: You are VERY VERY welcome. Thank you, Dearest, for your good work. And for inviting me to join you all. Dearest: Goodnight, Susan. Goodnight, everyone :) Read Dr. Susan Rako's first transcript Read Dr. Susan Rako's second transcript Read Dr. Susan Rako's third 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.