(Dr. Rako's first visit to Power Surge)
 
Dearest:     A warm welcome to Power Surge, Dr. Rako.  

Dr. Susan Rako:     Good evening, everybody.

Dearest:      Power Surge welcomes tonight's guest, DR. SUSAN RAKO,  
25 years a psychiatrist in private practice, professor, and author of 
the new and exciting book, "The Hormone Of Desire: The Truth About 
Sexuality, Menopause And Testosterone" - the result of addressing 
the challenge of her own personal hormonal upheaval.

Listen to this interesting quote from Dr. Rako's book:

"Menopause is a journey through poorly charted waters. 
And most physicians approach the possibility of prescribing 
supplementary testosterone for women suffering symptoms of
its deficiency with the resistance and ignorance of sailors 
who believed the earth was flat, and that if they proceeded 
to sail on, they would fall off."

Keeping those words in mind, and knowing you have many 
questions about testosterone, let us begin the Q&A. 
Welcome our guest tonight, Dr. Susan Rako.


Dr. Susan Rako:     Delighted to be with you all

Rnjensden:     	At what age parameters can menopause start?

Dr. Susan Rako:     Some women , about 8%,  have a full menopause before the 
age of 40!   The average age at menopause is 50 years 3 months, but some 
women have a hysterectomy even younger, and they can become testosterone
deficient at any age, even if the surgeon leaves the ovaries intact.

MtnMaw:  Now that I have stopped taking Paxil and am on Estatest, should 
I expect my sex drive back?  I am taking half-strength.

Dr. Susan Rako:   First of all, Estratest has too much testosterone.  Even the 
"half strength"  has 1.25 mg. of testosterone, and you need at most half of 
that.  It also takes quite a while being off Paxil or any of the other SSRI
antidepressants for the inhibition to wear off.  Too much testosterone makes 
many women irritable. 

MtnMaw: 	How long for the Paxil to wear off?

Dr. Susan Rako:     With luck, six weeks, but it can take months to get libido 
back after those drugs.

Dirtmstrss:     I was on testestrone gel, .5ml, five days a week.  I suffered 
severe irritability.

Dr. Susan Rako:     That's no surprise to me, Dirt.  Many women need only 
.25 or .30 mg.  It's more important to treat the woman and not the numbers.

Ayra:   	I've tried many forms of testosterone, my blood level 
never approaches normal for a female.  I never got any sex drive back,  but 
I did get lip hair and pimples and a deep voice!

Dr. Susan Rako:     Ayra, maybe you really had more than was good for you.  It 
often it helps to use topical testosterone directly on the genital tissue at 
the outset.   I have a lot of detailed information in my book about this.  
It's important not to use too much testosterone--less is more.

Kara9447:       Can you be on Zoloft and still expect to have a good response 
to testostertone?  I have zero energy.

Dr. Susan Rako:     No way to generalize about this.  Each person's situation is 
unique.

Karrren96:      What I don't understand is what causes a fine sex drive but
difficulty in reaching orgasm at menopause.

Dr. Susan Rako:     Have you been able to climax without difficulty in the past?

Karrren96:      Yes.

Dr. Susan Rako:     Have you noticed any loss of "plumpness" in your genital 
tissue?

Karrren96:      Yes.

Dr. Susan Rako:     It seems as though you may be somewhat deficient in
testosterone.

Lynscho:        You said the average age of menopause is 50.  Does that mean 
complete cessation of periods or the beginning of menopausal symptoms?

Dr. Susan Rako:     It means no more periods at all.  Actually, menopause is 
defined as not having periods for twelve months.  Some lucky women, maybe 
15%, have no noticeable menopausal symptoms.

Cheball:        My doctor says my sex drive should be in the normal range.  
I don't feel normal for me.  What can I do?

Dr. Susan Rako:     I hate to say it, but it's a good start to read my book.  
There are lots of details, but I'll try to answer as best I can. FIND 
ANOTHER DOCTOR!

Cmvz:   	Surgical menopause at 35, and I am taking Etest, full 
strength, and .5mg estrace.  I have a low libido, but everything else is 
okay.  Is that too much hormone replacement therapy (HRT) at my age?

Dr. Susan Rako:     Full strength Etest is a disaster!   That is too much 
testosterone.  You need a doctor who will monitor your estrogen and your 
testostrone levels.  One dose is not suitable for every woman.

ONIONONION:     How long does menopause last if you let it take its natural 
course and do nothing else?

Dr. Susan Rako:     Actually, the ovaries continue to put out some estrogen and 
some testosterone in fits and starts for about twelve years following the last 
menstrual period.  Sometimes, a woman has to have her hormone supplements 
adjusted several times.

MtnMaw:         Will estogen alone be sufficient for an adequate sex 
drive without antideprssants?

Dr. Susan Rako:     Mtn, not necessarily.  Some of us really need supplemental
testosterone.  Estrogen just won't do it.  Signs and symptoms of testosterone
deficiency are:  decreased sensitivity in the clitoris and nipples, lack of 
arousal and difficulty in reaching climax, loss of energy, and dry skin 
and hair--sometimes even loss of pubic hair.
 
LynnCSE:        Have you discussed testosterone IM?  Is there an advantage over 
taking it by mouth?

Dr. Susan Rako:     I do not recommend testosterone by injection.  One can get too 
high of blood levels.
 
Goosetess1:     Does testosterone help one feel better in general?   I have no 
sex drive, feel lousy 90% of the time, fatigue and yet I am shaky and panicked 
at the same time.

Dr. Susan Rako:     It certainly can help substantially.  Are you using estrogen?

Goosetess1:     Not now.

Dr. Susan Rako:     Shakiness and panic are often signs that estrogen is too low.

Dirtmstrss:     I now am on .5 ml., three days a week and I am afraid of the 
anger.  Would less be better and will the anger go away over time?

Dr. Susan Rako:     Certainly, if you are feeling unusually irritable and easily
angered, the dose is still too high.

SMartin992:     My sex drive is gone.  What hormone do you suggest?  I'm 
presently on Estradiol, 2mg.  I'm going to see a new female OB/GYN and I would 
like to know what to suggest to her.  Also, any contraindications for heart 
problems when taking testosterones?

Dr. Susan Rako:    If estrogen does not get you back to feeling like
yourself, you need testosterone.   A medical article I wrote will be published 
next month in the Journal of the North American Menopause Society on the 
diagnosis and treatment of testosterone deficiency in women.  Recommend my 
book and the article to your doctor.  As far as the question about heart 
disease, it's a good idea to monitor your cholesterol and lipid profile if 
you take testosterone.  Testosterone can lower cholesterol, lower LDL, and 
lower triglycerides, but it will also lower HDL cholesterol--sometimesas 
much as 10%.  You need to watch that if you are at heavy risk for coronary 
artery disease.  Testosterone also hleps clotting factors and carbohydrate 
metabolism in ways that may help the heart also.

Kara9447:       I started  .4mg oral methyl testosterone last week.  After 
the first week,  I feel even more lethargic.  Is this a normal side effect 
in the beginning?  How soon can I expect energy rise?

Dr. Susan Rako:    Whatever the lethargy is due to, it's not the testosterone. 

Batchika2:     What is the name of the blood test to measure the levels of 
testosterone in the blood?  What is the difference between ml and mg? 

Dr. Susan Rako:     As far as blood tests go, it's not absolutely essential to 
have the levels drawn.  The diagnosis is best made by the symptoms you have. 
The abbreviations mean:  ml= millilitre  and mg = milligram.

Postrain:       Can testosterone be used without other hormone supplements?
 
Dr. Susan Rako:     Yes, it can, but why do you ask?

Postrain:       I have opted not to take estrogen and progesterone and I 
wonder about this.

Dr. Susan Rako:     Only one form of testosterone does not convert to estrogen 
in the body.  So, if you take natural testosterone,  you will be getting some 
estrogen.  Since estrogen cuts down the risk of heart attacks and stroke by 
50% and the risk of osteoporosis by 90%, it's worth considering the
decision.  If a woman has had cancer or is at high risk for cancer,  she may
choose to use only methyltestosterone.  There is now a cream for genital
application of methyltestosterone that does not convert to estrogen.  There 
is a terrific "compounding pharmacist" in N.H. named George Roentch. 
(603) 357-0200

Patlabomb:      I have been on Estratest for over one year.  It is not 
effective in helping libido, yet you say too much testosterone.  I have now 
started on monthly injections with some success, but with irritability.

Dr. Susan Rako:     You will do better with less.  Too much misses the narrow 
window of best effect.  You might do even better switching to topical 
testosterone to get your genitals healthy and stimulated before going back 
to a low dosage of oral.  I do not recommend injections for anyone.  It is 
too much testosterone.

EleanordeW:     Will these topically applied creams affect one's partner?

Dr. Susan Rako:     I suppose that he or she could absorb some, but you really 
don't need to use much, and I'd recommend not slathering it on before 
lovemaking.  It's not a lubricant.  The bottom line:  a dab of 2% testosterone 
cream on the genitals once per day after bathing for several weeks and then, 
after you feel good again, turned on and able to enjoy sex, switch to oral 
because you can absorb too much via the genitals after awhile.  The oral 
dosage is .25-.50 mg per day for most people.  .30 is often enough.  The 
trick is start with a topical application to the genitals.
 
ONIONONION:     Wow, 12 years or menopausal symptoms!  If you add some 
substance to your body does it shorten the span or  the effects of menopause?

Dr. Susan Rako:     Hormones can smooth out the symptoms.

MtnMaw:         You said half-strength Estratest is too much.  How much 
is okay?

Dr. Susan Rako:     No amount of Estratest is OK ---- it's got estrogen combined
with testosterone.  You are better off having the exact amount of 
methyltestosterone compounded to order by a compounding pharmacy.   Find 
one near you by calling P2C2 at (713) 933-8400.  P2C2 stands for Professional 
and Patients for Customized Care.

Kara9447:       How soon after beginning oral testosterone replacement can I 
start to feel my energy come back? 

Dr. Susan Rako:     There is no way to predict exactly when that may happen.  I 
know you have a complicated circumstance.

MtnMaw:         I would like to know what dose of Estratest is recommend 
if, as you say, half-strength is too much?

Dr. Susan Rako:     I do not recommend any dose of Estratest.   I can't evaluate a 
particular cicumstance without knowling all of the details, sorry.

Dirtmstrss:     .05 testosterone gel makes me angry.  Will pills be different? 
I am on pure testosterone. 

Dr. Susan Rako:     I have never heard of .05 testosterone gel.

Madcow6306:     I was diagnosed with some type of genital warts and I was 
prescribed testosterone cream.  Is that okay?

Dr. Susan Rako:     That's a new one for me.

Madcow6306:     So, you have never heard of it being used for genital warts?

Dr. Susan Rako:     That's right, Mad.

RCHCTH:         What is the best time of the month to have blood tests 
done if perimenopausal? 

Dr. Susan Rako:     Blood tests for menopause are useless.   Ovaries kick in
and out.  Therefore, FSH and LH levels are meaningless if you still have any 
periods at all.

Trillian10:     What is  natural testosterone?  

Dr. Susan Rako:     Natural testosterone is the same,  molecule for molecule, as 
the testosterone the body makes, but it can be converted to estrogen, and 
it's not as well absorbed as methyltestosterone when taken orally.

Batchika2:      Can a standard pharmacy provide natural testosterone or would 
I need to go to compnding pharmacy?

Dr. Susan Rako:     I do not recommend natural tesotsterone.  Please read the
chapter in my book.  Natural testosterone can be converted to estrogen and you 
need to keep levels stable.

Batchika2:      I want a "bit" of estrogen too,  Is it in methyltestosterone?

Dr. Susan Rako:     Maybe not a bad idea for you, but I'd need to know all the 
details about your circumstances.

Muni57:         What if you feel warm?

Dr. Susan Rako:     What if you feel warm?   What do you want to know?

Muni57:         Does that mean you need hormones?

Dr. Susan Rako:     If you are troubled by the hot flushes, estrogen can  help and 
testosterone can, too!

EleanordeW:     In your experience, is it difficult to get doctors to prescribe
testosterone for female complaints?

Dr. Susan Rako:     Too many doctors are not well enough informed.  I'm doing all I 
can to teach them.

Dearest:       Susan, thanks SO much for spending this time answering our 
questions about testosterone and other menopausal issues. This has been
so wonderfully enlightening and we're so pleased you graced Power Surge 
tonight with your presence.  We all hope you'll come back again soon.
Everyone be sure to read Dr. Rako's  The Hormone of Desire  book.


Dr. Susan Rako:     Good night, all and it's been terrific. I  do individual
telephone consults.

Read Dr. Susan Rako's second transcript
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Read Dr. Susan Rako's eighth transcript


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