(Dr. Rako's third 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 frequent 
workshops addressing the subject of her ground-breaking book, 
"The Hormone Of Desire: The Truth About Sexuality, Menopause And 
Testosterone" -- testosterone -- as well as all forms of hormones.

Dr. Rako's book is an exploration into the world of testosterone supplementation 
for women in menopause or post-hysterectomy.

It's a pleasure to have you back in Power Surge, Susan :) Let me start with this 
question. A woman has a testosterone level of 30 mg/dl, uses no hormone 
replacement therapy, hasn't had a period for a year. What does a testosterone 
level of 30 mean in a post-menopausal woman? Thanks and welcome back :)


Dr. Susan Rako:   Good evening all ... wonderful to be with you!!


Dearest:    Wonderful to have you here again :)


Dr. Susan Rako:   And a very fine question to start with.
The truth is that I say that it is important NOT to treat the numbers, 
but to treat the person.  The way to know whether or not a woman is 
deficient in testosterone is NOT by reading her levels.  It is rather 
by looking at her clinical picture.


Dearest:    Thanks, Susan.  I read once that a Danish study showed that women 
taking estrogen and testosterone together had twice the risk of breast cancer 
compared to those taking no medication.  Is it true that testosterone can 
stimulate breast cancer?


Dr. Susan Rako:   Please send me a copy of that "Danish study".  I can say, without 
reading it, that no such definitive information can be trusted.  We need data 
and to my knowledge, no such data exists.


Dearest:    Will do, Susan. I have the info right here. Will send later. Thanks.  
JackiR, go ahead with your question for our guest, Dr. Susan Rako.


JackiR1354:   My Doctor (male) just prescribed testosterone cream, but how 
much and where do I apply it? 


Dr. Susan Rako:   There are as many "testosterone creams" as there are compounding 
pharmacies.  I need to know exactly what is in your cream and the percentage 
of testosterone in it, as well as what KIND of testosterone and what kind 
of "base".


JackiR1354:   It's 2% cream.


Dr. Susan Rako:   2% testosterone in petrolatum (vaseline) is OK but 2% 
testosterone in a cream base with absorption enhancers is TOO MUCH.


O SEAPEARL:   I have an increased libido with menopause. How fast does 
our testosterone dwindle with age? 


Dr. Susan Rako:   Varies from woman to woman. 


ValLaLonde:   What happens to a woman who is deficient in Testosterone? 
I always thought too much could set her up for a heart attack, unwanted 
hair growth etc..


Dr. Susan Rako:   Really important to know that testosterone -- in doses 
to keep a woman in the "normal" range is actually likely to be 
PROTECTIVE of the cardiovascular system.  My paper was published last 
September in the Journal of Women's Health showing the evidence for 
testosterone as a protector against heart attacks and stroke.


Dearest:    Susan, in a previous visit to Power Surge, you said, 
"There are two dosages of Estratest and I don't recommend either 
of them." Is it that Estratest contains too much testosterone?


Dr. Susan Rako:   For most women, the dose of testosterone even in the "
half strength" Estratest is more than they need.


Dearest:    How much do you recommend, Susan? 


Dr. Susan Rako:   Again .... and I'm afraid that you-all will be 
frustrated with the truth ... that the issue varies from woman 
to woman the dose range of oral methyltestosterone is from .25mg 
to .80 mg per day.  Some women may need as much as is in Estratest 
half-strength but for most women, that dose will make them 
irritable and NOT feel better. 


Jdkief:   I feel very emotional and have no libido. I am 44. Is 
this the start?


Dr. Susan Rako:   When did you last feel really good, Jdkief? 


Jdkief:   It's been months. 


Dr. Susan Rako:   We have to look at the whole picture:  whether other 
factors could be the cause of your difficulties or whether your 
ovaries are starting to shut down.


Dearest:    Rae709, please go ahead.


Rae709:   How does Testosterone cream work in increasing libido? 


Dr. Susan Rako:   The testosterone in the cream is absorbed by the 
blood vessels and travels throughout the body, attaching to 
testosterone receptors and "doing its thing", which is what 
is does anyway, when we are younger and have the normal amount.


Rae709:   Thanks! 


Dearest:    Susan, what are some symptoms of too little testosterone 
and too much?  Thanks.


Dr. Susan Rako:   Too little: you must compare with when you had the 
normal amount. If you are accustomed to having sensitivity in nipples 
and clitoris, and to having orgasm, when you are deficient in 
testosterone, you will lose sensitivity in nipples and clitoris, 
and have reduced pleasure with orgasm, or maybe even not be able 
to orgasm.


Dearest:    Thanks, Susan, Mom350, go ahead, please.


Mom350:   what is the name of the test for hormones and where do 
I go for a test? What is normal range?


Dr. Susan Rako:   Please hear me.  The TEST is NOT the way to tell if a 
person is deficient in testosterone.  I'm afraid that the matter is 
more complex and is better evaluated in a woman who has had good 
sensitivity and function and who we have reason to know that her 
ovaries are starting to shut down.  Menopause or hysterectomy.  And 
that NOW her sensitivity and function are diminishing.


Elvan50:   You recommend creams over Estratest? I take Estratest 
and still do not feel right.


Dr. Susan Rako:   In order to pay adequate attention to each individual 
woman's particular circumstances it is impossible to diagnose and 
advise on the basis of questions here.  I spend an hour in detailed 
discussion about each woman's particular circumstance to evaluate 
and recommend.  Here we can best talk in more general terms about 
testosterone.


Dearest:    Susan, before we continue with the queue, share with us 
what projects/workshops/appearances you're involved with at this 
time, please.


Dr. Susan Rako:   Thank, Dearest.  I'm a member of a "taskforce" on 
Women's Sexuality advising Gynecologists how to evaluate and 
treat women in menopause or following hysterectomy and teaching 
all I can. Just back from meetings in San Diego and Washington. 
I presented a symposium at the annual meeting of the American 
Psychiatric Association and appeared on a panel with a PORN STAR !!!  
She was WONDERFUL !!!   LOLOL  We had a packed room. You can 
believe. She is making videos to teach about sexuality.


Dearest:    Haha! Fascinating, thanks. Let me get a little serious here. 
I notice lots of younger women coming to Power Surge complaining of 
perimenopausal issues, sexual libido loss mostly after hysterectomy.  
Is it my imagination or are hysterectomies on the rise again?


Dr. Susan Rako:   Actually, the latest figures show that hysterectomies 
continue to be the second most frequently performed major surgical 
operation on women.  Over half a million in 1996 but that may be a 
slightly lower number by percentage than in 1995 due to the baby boom.


Dearest:    Amazing. Thanks, Susan. Cannonwcp, go ahead, please.


Cannonwcp:   Is it possible for men to get throat/esphogus yeast 
infection?? No over the counter medicine for men?


Dr. Susan Rako:   Cannon, I'm not an expert on yeast infections. Sorry.


JackiR1354:   This is in a vanishing cream. So now what do you 
suggest I do? I have had a hysterectomy and take premarin, now lost 
libido.


Dr. Susan Rako:   Jacki, following hysterectomy and with Estrogen only, 
you most likely need a testosterone supplement.


JackiR1354:   But then what instead of the cream?


Dr. Susan Rako:   "the cream". Which cream? 


JackiR1354:   2% testosterone.


Dr. Susan Rako:   If you are the person who initially spoke about 2% 
testosterone "cream"...


JackiR1354:   I was.


Dr. Susan Rako:   ...I'm worried about that dose being excessive. Your 
doctor needs to know and to explain what he/she is prescribing.  


JackiR1354:   Isn’t the 2% normal? 


Dr. Susan Rako:   2% testosterone "cream" with absorption enhancers is 
EXCESSIVE.  Please see my new book.  The paperback deals with this 
in detail.  


Dearest:    Jacki, we have lots of questions waiting in the queue. 
Why don't you E-mail Dr. Rako at "SusanRako@aol.com" 


Dearest:    OSea, go ahead.


O SEAPEARL:   Is there any relationship with exercise and hormones? 


Dr. Susan Rako:   Your question is too vague for me to address.  


Dearest:    I feel lots of good harmony when I exercise :)  


Dr. Susan Rako:   Dearest, lots of good harmony is WONDERFUL. 
Keep Up the Excercise!!


Dearest:    Will do my best! Catalina, go ahead.


Catalina5:   Does raising the estrogen and progesterone levels with 
HRT diminish testosterone levels?


Dr. Susan Rako:   YES.  It's a bit complex but the "bioavailable" 
testosterone is diminished with estrogen supplement.


Catalina5:   Thanks.


WYATT79:   I am taking premarin  and paxil, have no sex drive, 
should I ask my Doctor for testosterone cream? 


Dr. Susan Rako:   Oh, boy that’s a problem since Paxil can reduce 
sexual response all by itself.  When did you last feel sexually 
good enough?


WYATT79:   I never had much of a sex dive. 


Dr. Susan Rako:   This is very important.  The effect of reduced testosterone 
can only be evaluated when you consider how you've felt in your prime.  
A woman who has never had much of a sex drive is not likely to benefit 
from testosterone supplementation. 


Dearest:    In your book you say, "It was testosterone that stimulated 
the growth of your pubic hair." Can we assume that it is the loss of 
testosterone that causes so many women to lose pubic hair during 
perimenopause?   Also, why is it that we lose hair on our bodies 
during menopause -- arms, legs and pubic area, but at the same time 
hairs keep sprouting up on our chins?


Dr. Susan Rako:   Oh, I wish we had a chance to speak in person - too 
much to say in a single line.


Dearest:    I miss that pubic hair :(  Well, give your first 
thoughts then. You're a pro :)


Dr. Susan Rako:   Pubic hair, for sure, is a function of adequate testosterone 
and women who get those hairs sprouting on the chin as they age actually 
have too LITTLE testosterone!!!


Dearest:    Confusing, isn't it?


Dr. Susan Rako:   Only if you don't know that hair growth is controlled by 
many factors, only a few of which are hormonal.  But, Dearest, if you 
used testosterone cream, you would have luxuriant pubic hair.


Dearest:    Luxuriant? I'd settle for mediocre!


Dr. Susan Rako:   (Might be gray, but would be full !!!! )


Dearest:    Thanks, Susan :)  VB, nice to see you. Go ahead, please.


VBrando101:   I have an orgasm only the week after my period...do you 
think this is when my testosterone is high?  I, too am bald in the hair
department. 


Dearest:    The Yul Brynner's of menopause!


Dr. Susan Rako:   VB, probably that's when your estrogen isn't very high 
and so your "bioavailable" testosterone is highest.


VBrando101:   Hi, Dear...thanks!


Dearest:    Does that mean my testosterone is bio-unavailable, Susan?


Dr. Susan Rako: Or, Dearest, that you don't have enough !!!


EdeeLee:   How does one know they should take testosterone and what 
dosages?  Doctors don't even address this issue.


Dr. Susan Rako:   My new, revised, paperback book has a whole chapter on the 
dosages and all.


Mom350:   Lack of libido, treatment progesterone vs testosterone vs HRT? 


Dr. Susan Rako:   HRT is "hormone replacement therapy".  Progesterone does not 
help libido for most women, Estrogen does not help libido at all.


Dearest:    Interesting, Susan.. so many manufacturers claim it does.


Dr. Susan Rako:   Dearest, estrogen helps to keep a woman lubricated and 
receptive.  It does nothing for sensitivity and response or desire.


Dearest:    Yeah, what's the point of a lube job if you don't have a 
Mercedes :( VGNYS, go ahead, please.


VGNYS:   Any information on a testosterone patch and does progesterone 
diminish "bioavailable" testosterone?


Dr. Susan Rako:   The testosterone patch is still in trials awaiting FDA 
approval and progesterone does diminish bioavailable testosterone.  Both 
estrogen and progesterone INCREASE the protein that binds testosterone 
and makes it less available.


VGNYS:   Thank You.


Dearest:    Doolphin, go ahead with your question for our guest, 
Dr. Susan Rako.


Doolphinn:   If I get a partial hysterectomy, (keep ovaries) will I need testosterone?


Dr. Susan Rako:   Hysterectomy often has bad effects on the ovaries that 
are spared diminishes the blood supply leads to early menopause.


Doolphinn:   OK, thanks.


Dr. Susan Rako:   I DO NOT RECOMMEND HYSTERECTOMY if it is at all possible 
NOT to have one and not be at risk.  Cancer, for example, is a clear 
indication for hysterectomy.  


Doolphinn:   I have uterine prolapse, not a reason for hysterectomy?


Dr. Susan Rako:   Dool, very tough one.  That may be the only other reason 
to have a hysterectomy


Doolphinn:   Not cut and dry, huh?


Dr. Susan Rako:   Dool, I went with one of my patients to her gynecologist. 
She had uterine prolapse and her Doctorr explained that he could not 
adequately suspend her uterus. Very tough.


Doolphinn:   OK, thanks, sounds complex for here. 


Dearest:    Lake, go ahead.


Lake810:    Hi. I went through menopause at 35 yrs  my doctor has me on 
Prempro.  I have no drive but he will not put me on Estratest. I did not 
have a hysterectomy, it happened naturally. I’m 41 now. 


Dr. Susan Rako:   PremPro is not in favor with those in the know.  Daily 
progesterone has lousy effects on the benefits of estrogen and does 
nothing to help sex drive.


Dearest:    JackiR, go ahead.. please keep your question brief. 
Thanks.


JackiR1354:   For a type A personality, what are some signs of too 
much testosterone, since we're irritable anyway? 


Dr. Susan Rako:   The signs of too much testosterone are the same for 
type A - Z personality!!!  No reason whatsoever for a woman to take 
too much testosterone. 


Mubotulip:   What forms of testosterone are now available?


Dr. Susan Rako:   A whole chapter of my book on that, Mubo, but the short 
answer is that your doctor has to work with a compounding pharmacist.


Dearest:    Lake, E-mail Dr. Rako at "SusanRako@aol.com" to ask any 
additional questions.  Thank you.  LVW, go ahead.


LVW2004:   What are your feelings on the new drink Revival?  


Dearest:    Revival is a soy protein shake, Susan, with large amounts of 
soy isoflavones (184 mg.). Very effective.


Dr. Susan Rako:   Thanks, Dearest.


Dearest:    I guess LVW wants to know your thoughts on natural plant 
estrogens/phytoestrogens.


Dr. Susan Rako:   This isn't as simple as it may seem.  Phytoestrogens are 
not the same as estrogens - for better and maybe for worse.  We don't 
know enough about the comparative effects to be sure as yet.  Estrogen 
helps build bone.  I don't know any phytoestrogen that does that.  
But estrogen may increase cancer risk.  I don't know any phytoestrogen 
that does that.  We don't have enough information.


Dearest:    Thanks, Susan. Anyone wanting more information about Revival 
natural soy protein/phytoestrogens feel free to email me. Thanks.


Dearest:    TKWill, go ahead, please.  Susan, pay special attention to 
this one. She's having a very difficult time at 27 :(


TKWill18:   Well, I'm on the vivelle patch.  Is that why I don't 
want any sex? I'm now 27 and I can't do that to that to my husband 
even though my surgery wasn't that long ago.  What can I do?


Dr. Susan Rako:   When did you last feel sexually alive??


Dearest:    She had a hysterectomy.


Dr. Susan Rako:   TK, how did you feel sexually BEFORE your surgery??


TKWill18:   It's been almost 2 and 1/2 months, well. great before 
the pain before surgery.


Dr. Susan Rako:   "The pain"??  Endometriosis?


TKWill18:   Yes, I had a hysterectomy because of cysts and fibroids. 
Very painful.


Dr. Susan Rako:   If you felt sexually alive before hysterectomy, you 
deserve to see whether testosterone supplement can help. I think 
it may very well help.


Dearest:    Susan, can TK email you so you can discuss this further?


Dr. Susan Rako:   Sure.


Dearest:    She really needs some guidance.  TK, email Dr. Rako at 
SusanRako@aol.com and she'll be glad to help you further. Ok?


TKWill18:   Thanks. 


Dr. Susan Rako:   She needs to connect with a doctor in her area who knows.


TKWill18:   Thanks, Alice.


Dearest:    You're welcome, Tammy.


LLAJ2:   How can I find a Doctor as knowledgeable as you are on this? 
I live near Chicago and my doctor does not believe in testosterone 
replacement.  


Dr. Susan Rako:   LL, I have a contact in Chicago.


Dearest:    Linda, email Dr. Susan Rako and she'll give you that contact info.
We have very little time left.


LLAJ2:   Oh, great. Thanks.


EdeeLee:   What are the pluses for micronized progesterone as to Provera? 
Provera gave me mood swings, which I never had.


Dr. Susan Rako:   Provera is synthetic Progesterone.   Some women find it 
causes depression.  Natural micronized progesterone is "natural" and 
some women find it makes them sleepy.  No way to win for sure!!


Dearest:    Now, Mitcavis, go ahead. Sorry about before :)


Mitcavis:   Thats ok, seems a shame, for there not to be any help for 
those with low desire.


Dr. Susan Rako:   I want to say that we DO NOT HAVE ALL THE ANSWERS, as 
much as we might wish.  A woman who has never had much libido may 
"just be that way" and it doesn't mean that if she took 
testosterone it would change things.


Dearest:    But there IS help. That's exactly why we're here with 
Dr. Rako.


Dr. Susan Rako:   I understand.  And I wish I had been born with 
golden curls like  my granddaughter but we have to find a way to 
make our peace with what we have.  LOLOL

Dearest, some of us just are by nature less 'sexual' than others 
and I think that our society places a lot of pressure on all of 
us to be very sexual.


Mitcavis:   :D, thanks.


WYATT79:   Any suggestions on how to find a physicians that 
specialize in menopause and it's treatment?


Dearest:    You can Email Pete Hueseman for info, Wyatt. He's Power Surge's pharamceutical consultant and has a long list of
doctors who specialize in menopause.


Dr. Susan Rako:   Thanks, Dearest.


WYATT79:   Thank you.


Dr. Susan Rako:   :)


Dearest:    Susan, thanks so much for the stimulating and informative chat. 
I include Dr. Rako's book, "The Hormone of Desire" among Power Surge's 
Top 10 Books for women in menopause. You can be linked directly to 
Susan's books via her transcripts in the Web site's library at: 
www.power-surge.com/library.htm. or visit Susan's own Web presence at: 
www.susanrako.com to learn more about her book, upcoming workshops and 
appearances.


Dr. Susan Rako:   Thanks. Night Dearest.

Dearest:    Thanks for coming, Susan.

Dr. Susan Rako:   A pleasure.


Read Dr. Susan Rako's first transcript
Read Dr. Susan Rako's second 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©1994-2009 by Power Surge.  All Rights Reserved.