(Dr. Susan Rako's Fifth visit to Power Surge)


Dearest:     Tonight's guest in Power Surge is DR. SUSAN RAKO.  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 welcome you back to Power Surge, Susan :) I've often wondered 
why when women are prescribed hormone therapy that it doesn't include testosterone 
in the mix. Why do you think doctors ignore women's need during menopause for 
testosterone? 


Dr. Susan Rako:     It's wonderful to be back. Hi everybody and 
welcome!


Dr. Susan Rako:     I am glad to be hearing that more physicians and health care 
professionals ARE considering that women need to be evaluated for testosterone 
deficiency if they aren't feeling like themselves even when they choose to use 
estrogen but it's true that it takes quite a while for something really new to 
make its way fully into our society.  That's true for many, many things  ... not 
just for testosterone.


Czodli123:     I had a hysterectomy and no sensation with orgasm..taking 20mg of 
natural testosterone sublingual?  Will it come back or do I need more?


Dr. Susan Rako:     As you can read in the UPDATED paperback edition of my book, 
I do not recommend "natural testosterone" since it is very difficult to 
regulate dosage.  I think it is preferable to use methyltestosterone in the 
SMALL dosages I discuss in the book.  Better absorption and easier to regulate 
dosage.


Czodli123:     I am allergic to the gel and cream.


Dr. Susan Rako:     I sometimes suggest that a woman use testosterone in 
petroleum jelly (vaseline) directly on her genitals when she begins 
supplementation.  Nobody is allergic to vaseline.


CorClin:     I have high triglycerides. Will testosterone make them worse?


Dr. Susan Rako:     No. Testosterone reduces triglycerides.


Dearest:     Susan, you've pointed out that you feel Estratest contains 
too much testosterone for women. Do you believe Estratest-HS (half-strength) contains
too much as well? 


Dr. Susan Rako:     Yes, Dearest.  Estratest - HS had TWICE as much testosterone 
as MOST women find useful and many women find that they just don't feel very 
good on a dose that is too high.  They have trouble sleeping, can feel agitated.  
Also, Estratest is a combination, estrogen and testosterone and you can't 
regulate the dose of one without affecting the dose of the other.  Very 
unwieldy.


Dearest:   Susan, what other adverse side effects can a woman experience from 
too high a dose of testosterone? 


Dr. Susan Rako:     If a woman takes a very high dose for a substantial amount of 
time -- months, she can get acne, lowered voice, and increased downy facial 
hair.  THERE IS NO REASON FOR A WOMAN TO TAKE SUCH A HIGH DOSE AS WOULD CAUSE 
ANY TROUBLE AT ALL.  It's a pity that so many people are ignorant about the 
safety of testosterone supplementation in the proper low dosage.


Dearest:    In the same vein, what symptoms do women experience when they have 
a testosterone deficiency? 


Dr. Susan Rako:     First of all, if a woman has been accustomed to having good 
sexual sensitivity, desire, and response, she will be distressed to lose 
these aspects of her sexual life.  Also women feel "flat" -- not exactly 
depressed, but without a zest for life.  Some women find that their pubic 
hair gets thinner, and some notice that they have poor muscle tone.


Dearest:     Thanks, Susan. CorClin, go ahead.


CorClin:     What affect does testosterone have on someone with panic/anxiety 
disorder?


Dr. Susan Rako:     CorClin, the key issue is whether a woman is deficient in 
testosterone.  If she is deficient, and then she is given a proper low dose of 
testosterone, she will not have ANY undesirable effects at all but will simply 
feel "like herself" again.


CorClin:     Thank you


Pmjn76:     Will testosterone make my hair loss worse? I'm losing quite a bit on 
my head and pubic area.

 
Dr. Susan Rako:     Pmjn, that's a two-part question.  First of all loss of 
pubic hair will definitely improve, especially if you use testosterone in vaseline 
or cream directly on your genital area in a proper dosage, of course but as 
to hair loss on your head.


Pmjn76:     Thats not so bothersome it's more the hair on my head.


Dr. Susan Rako:     If you are "androgenic alopecia" and that is not 
particularly common in women, but a small proportion of women DO have hair loss 
from their head that is accelerated by testosterone.


Pmjn76:     My hair loss started when my meno symptoms started.


Dr. Susan Rako:     Pmjn, it's possible that you will NOT lose hair on your 
head and even that testosterone can help your hair. It did help mine.  But my hair was very 
dry and breaking.


Pmjn76:     So is mine very dry and brittle


Dr. Susan Rako:    And the supplementation with testosterone helped to 
restore normal luster and  stop breaking and so stopped the hair loss.  I think 
you might have to try it carefully and see.


Pmjn76:     Thank you


Dr. Susan Rako:     You are welcome


GGc0ok:     May I ask a question about progesterone? or is the topic strictly t-rone  


Dearest:     You may ask about progesterone, yes.


GGc0ok:     ok, I've been on it since May starting with 1/4 tsp twice a day.  I 
noticed that I was extremely tired so what I did was start cutting it back, to 
1/8 tsp twice a day.


Dr. Susan Rako:     Well, let me tell you that I know a whole lot about progesterone
and it is a real problem for many women.  Now, GG, what are you using, a Progesterone 
cream?


GGc0ok:     Yes


Dr. Susan Rako:     I am really worried about women using progesterone every day. 
If it is a "yam cream" chances are that it won't do much harm but if it has real 
progesterone, you can absorb quite a bit of it.


GGc0ok:     No yam in it I was told by the store manager


Dr. Susan Rako:     And when progesterone is metabolized (broken down by the 
body), it has some components that are very sedative, VERY SEDATIVE, and also, 
for many women, VERY DEPRESSING. More serious than that, although I know that 
Dr. John Lee thinks that progesterone is the answer for just about everything, 
the published papers show that progesterone causes growth of breast ductal cells 
and I am worried that regular use can stimulate breast cancer.


Dearest: Note: Dr. Rako's comment about the regular use of progesterone
stimulating breast cancer elicited letters of concern from some women at the chat. 
Dr. Rako requested that I share her replies to the questions.  Click here 
for the questions and Dr. Rako's responses. 


GGc0ok:     I wanted to help my hot flashes and night sweats.  Well, then does 
one just stop it, or is the objective to wean off of it?


Dr. Susan Rako:     I believe that a proper low dose of estrogen will be best 
and safer for hot flashes and night sweats, BUT If you have a uterus and use 
a regular low dose of estrogen, you do have to use a cycle of progesterone every 
couple of months. 10 days of progesterone to keep your uterine lining safe.


GGc0ok:     I'm a high cancer risk,  body will not tolerate estrogen.  Thank 
you, Susan, that's all


Dearest:     Susan, explain if you would what total testosterone, or	bio-
available testosterone is. Thanks 


Dr. Susan Rako:     Dearest, please let me say first that a woman who says that 
"her body can't tolerate estrogen" has not been carefully prescribed a tiny 
dose of it to acclimate herself slowly unless there are other reasons 
why estrogen is NOT advisable for her like smoking, thrombophlebitis.

Now, as to Total testosterone and bio-available well Testosterone is carried 
in the blood bound to a protein called sex hormone binding globulin (SHBG) 
and at any one time, 97-99% of the testosterone is bound to the protein.  
Only 1% - 3% of the testosterone is "free" or "bio-available" to have effects 
on the cells. 


Dearest:     Thanks for the explanation. 
Susan, to back up a bit, this is why Power Surge recommends women start with 
naturally compounded, bio-identical  hormones they can get from a women's 
compounding pharmacist, such as Pete Hueseman, rather than use the "one size 
fits all" commercial doses. Every woman cannot use the same dose of hormones. 


Dr. Susan Rako: But, Dearest, I am concerned about pharmacies that prescribe for women
and I do NOT recommend "natural testosterone", as I have said, because it is NOT 
readily absorbed and is hard to regulate as to dosage. 	On the other hand, I DO 
recommend "natural progesterone" ... which is far superior to synthetic and is 
better tolerated and less "bad" on the cholesterol profile than is synthetic.


Dearest:     Why the concern about pharmacies that prescribe natural hormones 
for women when the pharmacies communicate with the women's physicians who would 
otherwise be prescribing Premarin, Prempro or other less desirable forms of HRT?


Dr. Susan Rako:     I have had experience with some of the compounding 
pharmacies where they recommend what is "natural" even when the "natural" 
form is NOT preferable as with testosterone (by mouth, that is).


Jmv6563:     I want to know if my acne and low voice have anything to do with 
higher levels of testosterone.  I have had acne for fifteen years or more, have 
light, fuzzy facial hair.


Dr. Susan Rako:     Jmv, how old are you?  and are you still having periods?


Jmv6563:     I began to get acne when I was 13, I am now 32.  Yes, still having 
my periods.


Dr. Susan Rako:     Are your periods regular?  Have you ever been pregnant?


Jmv6563:  I have always felt very tom boyish, but I do have 3 brothers.


Dr. Susan Rako:     I am trying to determine if you have a hormone problem and if 
your periods are regular.


Jmv6563:  Yes, pretty regular periods, and I had an abortion three years ago.


Dr. Susan Rako:     And surely if you have been pregnant, most probably your 
skin problem is best to be treated by a dermatologist and does not likely have 
anything to do with testosterone.


Dearest:     Susan, we are told that the natural hormone, DHEA, converts to 
testosterone. Can you share your thoughts on DHEA and is it safe to buy such an 
OTC product? 


Dr. Susan Rako:     Good question, Dearest, and no very easy answer.  The fact 
is that we cannot know just how much of other hormones the body will produce 
from a given amount of DHEA I think it's too soon to know whether DHEA is 
advisable and in which dosage for women.  I read one paper that showed that a 
low dose was helpful for men and I know that some doctors do prescribe it 
and what's more, anyone can buy it in a health store which is crazy.  I'd advise 
caution at this point,  but each woman has to decide for herself,  and best with 
a physician who knows her. 



Kathy3603:     How do I find out my testosterone levels?  I have many of the 
symptoms.


Dr. Susan Rako:     Your doctor should order blood tests of total testosteorne 
and of "free" testosterone.


Dearest:     Susan, is one modality of testosterone delivery better than another 
-- I.e., pill, gel, cream, patch? 


Dr. Susan Rako:     I think that, at the start, using testosterone in vaseline 
directly on the genitals can "jump start" the benefits and then to switch to 
a proper low dose of methyltestosterone by mouth.


Dearest:    Thank you, Susan.


Czodli123:     Once the testosterone is level do your orgasims ever return to 
the way they were before surgery?


Dr. Susan Rako:     CZ, oh dear, you mean after hysterectomy?


Czodli123:     yes


Dr. Susan Rako:     Well, surgery effects more than just hormones.  Dr. 
Winnifred Cutler has done some work that shows that SOME women's orgasms depend 
on the uterus for intensity.  Especially for women who have had fibroids following 
the surgery, the orgasms can be less intense.  Even with testosterone supplementation, 
when needed.


Czodli123:     I was afraid of that, Thank you


Dearest:     Susan, I can't tell you how many women come to Power Surge talking 
about having no libido whatsoever and yet they do nothing about it.   Why do you 
think so many women think it's natural to lose their sex drive once they've been 
through menopause? 


Dr. Susan Rako:      Well, for generations and generations that's just the 
way it was.


Dearest:     I should add not only "think it" but accept it.


Dr. Susan Rako:     Before anyone paid any attention to estrogen and 
testosterone, that's the way it was.  And, for sure, some women really don't 
mind.  But, I really want to say that testosterone deficiency effects MORE than 
just Sexuality.  Testosterone has some beneficial effect on every organ system 
in the body.  And I have published TWO papers in medical journals drawing 
attention to the fact that testosterone BUILDS BONE and prevents osteoporosis 
and that it is PROTECTIVE of the cardiovascular system preventing heart 
attacks and strokes.


Dearest:     Thanks, Susan. TZ, go ahead.


TZdoe:     2 short questions: I never before heard about the progesterone 
linked to breast problems.   Where can I read up on it?  Also, how does 
sublingual natural testosterone compare with what you recommend?



Dr. Susan Rako:  I would recommend you look at "The Hormone Of Desire" 
which contains the information you need. Also, TZ, Email me 
and I'll send you a reference.


Dr. Susan Rako:     If you check back when the transcript if in the library
you will find that i have already answered about "natural testosterone." 


TZdoe:     ok


Dr. Susan Rako:     Dearest,  let me invite everyone to take a look at my 
website that YOU DESIGNED www.susanrako.com where there is info as well 
about individual telephone consultation.


Pnb4247:     After total hysterectomy is there anything natural that I can take 
I am on estraderm patch?


Dr. Susan Rako:     Pnb ...... what do you mean, "anything natural" ??


Pnb4247:     To help with libido 


Dr. Susan Rako:     If you are deficient in testosterone, what you need is 
testosterone.  You can read Susun Weed's book and try her remedies. They didn't 
work for me.  I did consult with Susun Weed. It's in my book.  She was lovely 
and endorsed my need for testosterone.


Dearest:     There's also a transcript of Susan Weed's visit to Power Surge in 
the Library on the web site at www.power-surge.com/library.htm or E.mail me at 
Dearest@aol.com


Skoczy:     Can you take Testosterone if you have had Breast Cancer?


Dr. Susan Rako:     Skoczy, that's impossible for anyone to guarantee.


Dr. Susan Rako:     It depends on how troubled you are by symptoms of 
deficiency, if you are deficient.


Skoczy:     Is that addressed in the Book?


Dr. Susan Rako:     I address the issue in my book and we have no firm data. 
If you DO want to use testosterone, the best form is METHYLtestosterone since it 
does not convert in the body to estrogen, which natural testosterone can do.  
That's another reason why I don't recommend "natural testosterone" especially for 
women who smoke.


Skoczy:     how much?


Dr. Susan Rako:     I'd try 0.25 mg of methyltestosterone compounded in capsules 
and taken by mouth.  That is one-quarter of a milligram which is 20% of the dose of 
Estratest HS (half-strength).


Skoczy:     How long before results?


Dearest:     Skoczy, please E.mail Dr. Rako at SusanRako@aol.com if you have 
additional questions.


Dr. Susan Rako:     Very gradual at that dosage maybe need more .. but worth a 
try, several weeks. One capsule per day and if you need more, increase very very 
slowly .... to .30 mg  and then .35 mg.  I used only 0.25 mg with good effect 
for several years.


Dearest:     Susan, thank you for another informative chat about women's 
sexuality and testosterone supplementation. Power Surge has Dr. Rako's book, 
"The Hormone Of Desire: The Truth About Sexuality, Menopause and Testosterone" 
on its list of top ten books for menopausal women. 

To find out more about Dr. Rako's workshops for women, visit her Web site at: 
www.susanrako.com or drop her an E.mail at SUSANRAKO@aol.com for more 
information.


Dr. Susan Rako:     You are welcome, everybody. Good health to all of you.  
Goodnight


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 fourth transcript
Read Dr. Susan Rako's sixth transcript
Read Dr. Susan Rako's seventh transcript
Read Dr. Susan Rako's eighth transcript


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