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


Dearest:  My guest tonight is Dr. Susan Rako, a Psychiatrist who's been in 
practice for over 25 years. Dr. Rako trained and taught at Harvard Medical 
School's Massachusetts Mental Health Center, a teaching hospital in the 
department of Psychiatry.

Dr. Rako is the author of the groundbreaking bestseller, "The Hormone of Desire:
The Truth About Testosterone, Sexuality And Menopause" and is the pre-eminent 
authority on testosterone deficiency and supplementation for women in menopause 
or following hysterectomy or chemotherapy.

Her search and discovery in the medical archives of a body of information linking 
testosterone to women's sexuality led to her writing her much-referenced book, 
"The Hormone Of Desire," and to conducting workshops to teach women how to take 
care of themselves and to find the medical attention they need and deserve for 
health and quality of life.

Dr. Rako's work has been featured in "Mirabella" "Elle," "American Health" "Body 
Smart," NBC's "Dateline" and in the current issue of "Woman's Day" Magazine.

Susan, it's wonderful to have you back in Power Surge! 


Dr. Susan Rako:  Delighted to be here again. 


Dearest:  Susan, what with your expertise in the area of testosterone and 
hormones, and the halted WHI study being so on everyone's mind, I'd be 
interested in your thoughts on the study, why it was halted and if there 
could be any potential fallout involving testosterone. 


Dr. Susan Rako:  "potential fallout ..." 
Well, I must begin by saying that, where hormone supplemental therapy is 
concerned it is an individual, woman-by-woman situation. There is NO "one 
size fits all answer". A woman suffering symptoms of testosterone deficiency 
has the option of using testosterone to improve her quality of life and her 
health.  We have no evidence anecdotally or research-wise to suggest that 
prudent supplementation with testosterone is detrimental to a woman's health. 


Dearest:  What other benefits can a woman expect to experience from using 
testosterone besides an improved libido? 


Dr. Susan Rako:  As I write in my book, "The Hormone of Desire": testosterone 
has some beneficial effect on every organ system in the human body.  It improves 
metabolism, allowing us to make optimal use of the nourishment we take in. 

It is PROTECTIVE of our cardiovascular system. 
It improves muscle tone. 
It BUILDS bone. 


Dearest:  Thanks.. and one last comment I read in some article... would like your 
reaction. Says Dr. Sadja Greenwood of the University of California Medical 
School: "Women should not be told testosterone is the hormone of desire... 
So many times women have been given medications before the long-term 
consequences are in." 

Is this another case?


Dr. Susan Rako:  I believe that each woman must be responsible for learning what 
there is to know about testosterone deficiency and supplementation. That is why I 
wrote my book. That is why I am here at Power Surge tonight. Testosterone is not 
"medication."  It is a naturally occurring hormone in which our bodies become 
deficient as we age.  Women whose pancreas doesn't make enough insulin need 
insulin.  Insulin is necessary for survival.  Testosterone is more optional, 
but very important. 


Dearest:  Thank you, Susan. We all know that your book is a highly respected and 
well researched work on women and testosterone. 


HSpec:  are there any natural sources of testosterone, similar to soy isoflavones 
for estrogen?


Dr. Susan Rako:  In a word,  no.  
However, testosterone IS a "natural" hormone and a molecule of testosterone synthesized 
from yams or soybeans (which are the sources for the building blocks of testosterone 
that is produced in laboratories), a molecule of testosterone synthesized in the 
laboratory is indistinguishable from a molecule of testosterone produced by our own 
bodies.  


Las:  How can you have your testosterone level checked? 


Dr. Susan Rako:  Blood levels are more accurate than saliva levels. It is important 
to measure "free" testosterone, NOT JUST TOTAL TESTOSTERONE -- 97% - 99% of the 
testosterone in our bodies is BOUND to protein and NOT available to have 
effects on our tissues. It is on the "free" or "unbound" testosterone that 
is active. 


Debrikkia:  I read about the symptoms of lack of testosterone--I have them ALL! --
In a nutshell--had a complete hysterectomy 12 years ago--am now on BI/P4/TE-
2.5/50/0.625 SL -- would it be safe to increase the level of testosterone 
without increasing anything else? 


Dr. Susan Rako:  I am not familiar with what you are taking. How much of what you 
are taking is testosterone? 


Dearest:  Yes, please best to avoid abbreviations. 
(that sounds like the inside of a fortune cookie) 


Debrikkia:  Am taking Biest and am guessing the test. Is the 2.5 measure--not 
sure.  


Dr. Susan Rako:  I think that, before using any testosterone supplement, you must 
measure your baseline testosterone levels.  Then, when you begin supplementation, 
you can follow the levels. 


Debrikkia:  My doctor would do that? 


Dr. Susan Rako:  If your doctor is not measuring your levels, I would be 
concerned. 


Debrikkia:  New doctor. 


Dr. Susan Rako:  If you are using 2.5 mg of testosterone per day ... that is a 
lot more than most women need. 


Dearest:  Susan, are the various delivery systems for testosterone, such as 
creams, gels, injections, pellets as effective as taking it orally? 


Dr. Susan Rako:  The updated paperback of "The Hormone of Desire", chapter 8 
speaks to this. 

Women who consult with me learn that I very often recommend, after getting 
baseline blood levels, that a woman begin with applying testosterone in Vaseline 
directly to their genital tissue.  It is usually well-absorbed and we can 
follow the levels and their improvement in symptoms and, when they achieve an 
optimal effect, then to switch to oral methyltestosterone. 


VeeBebe:  When do you think the insurance companies are going to take this 
problem seriously, and pay for some of these tests? Doctor support!


Dr. Susan Rako:  Sorry, VEE BEBE, but your guess is as good as mine with 
regard to Insurance companies.  


VeeBebe:  ohhhhhhh 


Girlie:  I have not had sex for years since I never seem to meet the right guy. 
I used to have great orgasms but now I never think about sex and rarely use my 
vibrator. I'm also having a lubrication problem. Is it true that if you don't use 
it, you will lose it? How often do you need a blood test if you should starting 
taking testosterone?  


Dr. Susan Rako:  Too many questions at one time, but I'll answer as best I can. 
How old are you? 


Girlie:  55 


Dr. Susan Rako:  Do you take any hormones at all? 


Girlie:  No 


Dr. Susan Rako:  So,  past menopause and rather dry and no man in 
sight. If masturbation was once satisfying for you, it may well be that you have 
testosterone deficiency ... which could be not a good thing for your health 
in general, not just a matter of libido.  It would be reasonable to have a blood test
and to consider supplemental testosterone. Have you read my book? 


Girlie:  Not yet 


Dr. Susan Rako:  Well, that's a good place to start. 


Dearest:  VeeBebe's question brought to mind that women on the message boards 
were discussing that their orgasm's were different, mostly less intense, since 
entering menopause. Is that a common complaining among your patients? 


Dr. Susan Rako:  Yes, it is one of the signs of testosterone deficiency. 


Dearest:  Thanks.  


ListeningIn:  I'm just so confused, do I take HRT or not? One can certainly get 
confused. I was on 1 pill femhrt daily, then eased down to just 1/4 a day. Is this 
even giving me what I need? I also did the soy bit too. Help? I don't want to 
go completely off HRT because I heard it helps with libido, hubby and I have a 
great sex life (married 35 years) and I want to keep it. Any advice?? 


Dr. Susan Rako:  The matter of evaluating hormone replacement therapy must be 
tailored to each individual woman.  Estrogen does not help libido. It does help 
lubrication. 


Dr. Susan Rako:  And, if you are taking whatever you are taking, you know best 
exactly what it is or is not doing for you. 


Marg:  I am 57, no periods for 5 years, no hormones, dry. Would taking just 
testosterone supplementation alone be good for me? Can you take too much?  


Dr. Susan Rako:  NO WAY that I can responsibly evaluate what you or any other 
woman needs in one question and answer here. Phone or E-mail me. 
I spend an hour with each woman who consults with me in the office or by 
telephone going over the details of her health and needs. You'll find the 
contact information on my Web site: www.SusanRako.com 


Dearest:  Susan, without committing to a specific answer to Marg, can you give 
us a general answer to her question about taking testerone alone? Is it better, 
for example, when used in conjunction with other hormones, such as estrogen? 


Dr. Susan Rako:  And, of course a woman CAN take "too much" testosterone 
although there is NO justification for her to do so. 

Dearest, even that question is a very complicated one. For example, a woman needs 
some estrogen in order for her TESTOSTERONE RECEPTORS to work at their best. 


Marg:  Thank you, Dearest. 


Dearest:  Ok, then general advice would be to be using other hormones along 
with the testosterone. 


Dr. Susan Rako:  However, in a particular circumstance, for a particular woman, using
testosterone alone might well be worth a try. 


Dearest:  Thanks, Susan :) 


Vensung:  Are there any adverse effects to testosterone supplementation and why 
don't Doctors prescribe readily? 


Dr. Susan Rako:  For example, if a woman has had breast cancer, using the form of 
testosterone, least likely to be converted to estrogen, could be worth a try.  
If a woman's testosterone levels are kept within the normal range, there are 
NO side effects at all. 


Dearest: Many women say they're taking 2.5 mg. of testosterone. Is there an average
dose of testosterone for perimenopausal women? And, do postmenopausal women
need more? 


Dr. Susan Rako:  Sorry to have to tell you this again, but it is impossible to 
generalize. 


Dearest:  Well, we know you've said Estratest, for example, has too much 
testosterone, right? 


Dr. Susan Rako:  When I was in the perimenopause, my testosterone levels were in 
the cellar. 

For some women in the perimenopause, their bodies are pumping out HIGH LEVELS 
OF ESTROGEN. This estrogen stimulates binding globulin, which binds up whatever 
testosterone they may be producing.  This causes testosterone deficiency.  Other 
women, in the perimenopause, have lower levels of estrogen.  These women may 
have LESS binding protein and don't suffer testosterone deficiency. 

HOWEVER, AS WE AGE, ALL of us gradually have decreased testosterone levels. For 
many women, the levels decrease to a troublesome degree. 

And sometimes, when a woman supplements testosterone, as she gets older and 
older, she needs a little more testosterone supplement than she did earlier.  
But 2.5 milligrams is TOO MUCH for almost any woman. 

 
Dearest:  Many women seem to think as they become postmenopausal that sex is 
OUT.  Can the mind-set alone be a sign of low levels of testosterone? 
 

Dr. Susan Rako:  Dearest, as we all know, sexuality is a complex issue and for 
each woman, the role of sex in her life is an individual matter.  But take 
Gloria Steinem, for example.  She used to say that, as she got older, sex 
was really NOT important any more until she met her husband and got married.  
for the first time, at age 61 or so.  And NOW, sex is definitely IMPORTANT TO 
HER.  I write about this in some detail in my new book, "No More Periods: The Risks of
Menstrual Suppression and Other Cutting Edge Issues About Hormones and Women's 
Health", is coming out next April. 


Dearest:  Then I guess if the stimulus and right circumstances are there, the 
mind-set can easily change :) Thanks. I do realize it's a complex question. 
We'll look forward to your new book and I hope you'll join us to talk about it 
in April :) 


Dr. Susan Rako:  Dearest ... I look forward to that for sure.   


MarMar6509:  I found out I have polyps in the lining of my uterus should they be 
removed? 


Dr. Susan Rako: Yes, they should be removed. 


MarMar6509:  My doctor said to just watch them. 


Dr. Susan Rako:  I don't know what it means to "watch" polyps in your uterus. You 
can't see them. You can't biopsy them. It is just as easy to remove them ... and 
safer. And if you have any question about the advice your doctor is giving to 
you, you really should get another opinion.


Dearest:  Everyone, there are also five previous transcripts of Dr. Susan Rako's
visits to Power Surge that can be found in the Library at 
www.power-surge.com/library.htm -- just look under "Rako".


Only30AndNeedAnswers:  I am 30, married and have 3 kids and I have lacked libido 
for 5 years now. Have had hotflashes and night sweats, too. I have had my blood 
checked for hormone problems and there were no problems. Doctors look at me funny 
when I tell them I am concerned about my hormones -- you're only 30 they say. My 
mother was in full menopause at 38 years old. Is there anything I can do to get 
my interest in sex back? 


Dr. Susan Rako:  12% of women have a full menopause before the age of 39. You most
definitely could be in perimenopause. Probably are, in fact.


Only30AndNeedAnswers:  What can I do then to make the doctor listen to me? I have 
gone to several. 


Dr. Susan Rako:  Where do you live? 


Only30AndNeedAnswers:  Fort Worth, Texas 


Dr. Susan Rako:  Best doctors are affiliated with the medical school hospitals. 
Try those.  Also, sometimes it helps to find the best compounding pharmacy in your 
city and ask the pharmacist WHICH gynecologists are prescribing testosterone 
for women. 


Dearest: If you're interested in locating a doctor in your city who prescribes compounded
hormones, you can E.mail  Pete Hueseman, R.Ph, PD, Power Surge's  Consulting Pharmacist.


VeeBebe:  Could you please explain the difference between, progesterone and 
testosterone and what are there benefits? 


Dearest:  Remember to read Dr. Susan Rako's book, "The Hormone of Desire:
The Truth About Testosterone, Sexuality and Menopause". 


Dr. Susan Rako:  OHMYGOODNESS. Two entirely different hormones with wildly different
functions. Progesterone is produced by the ovary after the egg pops off 
and its function is to keep the lining of the uterus intact in case an egg gets 
fertilized and want to plant and form a placenta to nourish the developing 
baby, etc. 


Nikky:  At age 44 I had to have a hysterectomy.  What is the best and safest 
homeopathy treatment in my condition? 


Dr. Susan Rako:  I am sorry, but I cannot responsibly evaluate any person's needs 
in one question and answer. Need a full hour. 


Dearest:  If you E.mail me your questions at Dearest@aol.com, I'll point you 
in the right direction for answers. 


Nikky:  Thanks 


Dearest:  Also, you might want to visit Dr. Rako's Web site at www.susanrako.com 


Dr. Susan Rako:  Also ... lots of information in "The Hormone of Desire:
The Truth About Testosterone, Sexuality and Menopause". 


PNB4247:  Doctor, why have I lost all interest in sex since my total 
hysterectomy? I am on estraderm patch which does help with hot flashes 
and mood changes but still no libido. Will libido return? 


Dr. Susan Rako:  I think that you probably need supplemental testosterone. 


ListeningIn:  In general, does a woman's body eventually level out and balance 
by post menopause to where no added hormones or testosterone are needed?  


Dr. Susan Rako:  For some women, yes. For many women, NO. 


SturdyWoman:  I had all my hormone levels checked and they are all low, 
testosterone free number is 18.  How low is this? I have all symptoms.


Dr. Susan Rako:  It is low. However, I don't go "by the numbers" alone. The 
symptoms that a woman has are the key. I use baseline levels as an indicator 
of the effect of supplemental testosterone to see how well it is absorbed. 
And to be sure that a woman doesn't get TOO MUCH testosterone supplement. 


Smokey:  As a woman ages where does she get testosterone from, can it be bought 
over the counter like estrogen and progesterone? 


Dr. Susan Rako:  Estrogen cannot be bought "over the counter" and neither can 
testosterone. 


Kiwi:  I am 45 and for past two years have been having heart flutters, sometimes 
followed by panic attack. All heart tests normal. I'm on beta blockers which may 
slow heart down but don't stop "heart rolls". Periods getting irregular, onset 
of painless migraines are two more new symptoms. Perimenopause? What next 
test-wise? 


Dr. Susan Rako:  Sounds like high levels of estrogen, maybe. Could be that your 
body is overproducing estrogen now. You really need to have all your hormone 
levels checked. 


Joh:  I am 36, mother of a 6 year old and 4 year old. My libido has been nil for 
about 5 years. I thought it was only due to SSRI I was taking, but when my 
testosterone levels were checked about a year ago, they were under 11. I 
responded well to some cream, but was told to go off of it when my periods 
stopped. It turns out I also have a pituitary microadenoma. I am going to 
restart the testosterone again. My questions are- could the lack of 
testosterone and the adenoma have any relation and is it worth finding out 
why my levels are low? All my other hormone levels are normal. 

Do you know when a patch will be available for women? 


Dr. Susan Rako:  Sorry .... but too complex a medical situation for a simple 
responsible answer, Joh.  I don't know about the timing of the release of the 
testosterone patch. 


Dearest:  TCML is a regular visitor to Power Surge and asked a question before 
that wasn't answered. Can we please just answer her one question? 


TCML:  Doctor, you mentioned testosterone for building bone. Is this been 
scientifically proven? 


Dr. Susan Rako:  Absolutely.  See the references in my book. Every statement in 
my book is referenced to the medical literature. 


TCML:  Thanks Doctor and Dearest  


Dearest:  Susan, thanks for another wonderful chat about menopause, testosterone 
and sexuality. I recommend Dr. Susan Rako's "Hormone of Desire" to everyone -- 
you'll get answers to your questions there! 

Visit Dr. Rako's Web site at www.susanrako.com and don't forget 
to pick up a copy of the current issue of Woman's Day to read an article about 
Susan and her book. 


Dr. Susan Rako:  You are all most certainly welcome and it has been a pleasure.  



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 fifth transcript
Read Dr. Susan Rako's seventh transcript
Read Dr. Susan Rako's eighth transcript

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