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

Dearest: My guest tonight is Susan Rako, M.D., 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 
is at the forefront of the research into testosterone replacement 
therapy, educating women and their doctors about the essential role 
testosterone plays in a woman's sexual and physical well-being.

Dr. Rako's work has been featured in The New York Times, Mirabella, Elle, 
American Health, Body Smart, NBC's "Dateline, Good Morning America,
The Today Show, Woman's Day Magazine and many more.

Dr. Rako is also the author of, "No More Periods? The Risks of Menstrual 
Suppression and Other Cutting-Edge Issues About Hormones and Women's 
Health" -- a book dealing with the controversial issue of manipulating 
women's hormonal chemistry for the purpose of menstrual suppression.

Susan, it's always a pleasure to welcome you back to Power Surge!


Dr. Susan Rako: Thank you, Dearest. I am honored at this introduction.


Dearest: We are honored to have you in Power Surge again :)

Don't many women associate testosterone with men and even feel it's 
inappropriate for them to take -- that there's almost a shroud of 
secrecy surrounding women and testosterone. Your thoughts? 


Dr. Susan Rako: I think that over the past several years this "shroud
of secrecy" has definitely lifted, more women and men - and even their 
doctors LOL - know that testosterone is also a female hormone. What
used to be an outrageous idea is now much more mainstream.


Dearest: Susan, millions of women are going through menopause right
now -- the loss of sexual desire can be traumatic, can strongly impact 
previously sexually active relationships, can cause depression and leave 
many women thinking they'll never have a "normal" sex life again.

What would you say to these women? 


Dr. Susan Rako: First of all, we must be realistic. Aging is not youth,
and for most women, some diminishing of sexual desire and pleasure
does occur. 

But testosterone supplementation for women with deficiency can make
a very significant difference for many women.


Dearest: Do you believe that most women think of testosterone purely
as the hormone of desire and sexuality and that it plays no other role
in the female body? 


Dr. Susan Rako: I think that may be true. Most women don't realize that 
testosterone plays a crucial role in the health of nearly every organ 
system in our bodies


Dearest: Please tell us what other roles testosterone plays in a woman's 
body. Thanks.


Dr. Susan Rako: For one thing, testosterone has been shown to be essential
to maintain the health of our EYES. Women develop "dry eye" when their 
testosterone levels drop.


Dearest: And what else besides our eyes? 


Dr. Susan Rako: Testosterone regulates normal metabolism. Testosterone
builds bone. It doesn't only keep us from losing bone, but also builds bone. 

Testosterone is essential for muscle tone. Testosterone stimulates blood 
cell production.


Dearest: Thanks, Susan - just one last question. As compared to 
progesterone, which is the first hormone to diminish in midlife women
and estrogen, once a woman is in perimenopause, what is the rate of the 
declination of testosterone? 


Dr. Susan Rako: Peak levels of testosterone for women are in our early 
twenties. HOWEVER it isn't only the level of total testosterone that is 
the issue. It is the level of FREE or UNBOUND testosterone and this is a 
little complicated since testosterone is bound in the blood to a protein 
and the more of the protein, the more T is bound so the less is available 
to have an effect on our tissues.

Estrogen actually stimulates the production of the protein that binds 
testosterone. So, women on birth control pills get more protein, which 
binds more testosterone, so that they actually develop testosterone 
deficiency.


Dearest: Thanks, Susan, always such informative answers.


Goodheart: Why use oral methyltestosterone over USP testosterone 
(bioidentical)? 

What type of testosterone should be applied to the vulva (Methyl 
testosterone, USP testosterone, testosterone cypionate, or testosterone 
propionate)? 

How much testosterone per gram would be used on the vulva for (methyl 
testosterone, USP testosterone, testosterone cypionate, or testosterone 
propionate)? 


Dr. Susan Rako: Too many questions but I'll answer the first one. 

Oral methyltestosterone, in safe low dose, is best absorbed from the gut, 
better absorbed than is "bio identical".

The "base" is very important. I think that the vulva is best treated with 
petrolatum and not with "creams" which many women find to be irritating. 
The most important thing is NOT to use any type of testosterone on the 
vulva that can raise levels too high. SO, if you use methyltestosterone, 
you can't measure blood levels. So it's best to use any of the others you 
mention, in order to monitor the levels.

Methyltestosterone messes up the blood test so levels cannot be measured.


Dearest: By the way, some may ask questions and not get the answers they 
want - that's the name of the game. Not everyone believes in the same 
thing.


LindaSue: I've been taking EstratestHS for several years with absolutely 
no effect on libido yet you say Estratest has too much testosterone.
Does this mean just taking testosterone would have no effect on my libido? 

I'm about ready to tear my hair out from lack of desire. I'm 54 and 
completed menopause.


Dr. Susan Rako: This is not a simple question. When did you begin to lose 
your desire?


LindaSue: With the first hot flash.


Dr. Susan Rako: At what age?


LindaSue: 51. It happened almost overnight


Dr. Susan Rako: And how long before you began to use Estratest HS? 

There is no "one size fits all" recipe. The amount of estrogen needs
to be determined for you separately from the amount of testosterone
so Estratest HS has a fixed amount of each hormone. It could be too
much of one and not enough of the other. You need to find a doctor
to treat your individual needs.


LindaSue: I tried PremPro. It was awful, and my gynecologist suggested 
Estratest because of lack of sexual desire, so about 6 months later it 
helped with hot flashes.


Dearest: Linda, I'd recommend writing to Pete Hueseman at Ask The 
Pharmacist who can recommend a doctor for you. You can write to him
at www.power-surge.com/asktheexperts/pharmacy.shtml
That's for the bio-identicals - not the one-size-fits-all.


CharLee: How do I find a doctor who will work with me?


Dr. Susan Rako: Dearest just made one suggestion. I can say that if you
ask a compounding pharmacy in your area to give you the names of a couple 
of the doctors who send their patients in to have hormones compounded. 
That's another lead.


CharLee: I'm in Canada.


Dearest: They have a database of doctors in Canada as well. Use the same 
link as above.


Murma: What do you think of Vagifem? 


Dr. Susan Rako: What's in it?


Murma: Estrogen


Dr. Susan Rako: What kind and how much?


Murma: Estradiol


Dr. Susan Rako: It sounds like estrogen to be used in the vagina.


Murma: Yes it is.


Dr. Susan Rako: Estradiol is the most potent of the estrogens. Like any other 
preparation, if your doctor evaluates your particular needs, it's fine.


Murma: Is it safe to use?


Dr. Susan Rako: No safer or riskier than any other estrogen preparation. 

Everybody wants clearcut black and white answers and I'm afraid that
there are just not such.


LeahLou: What is the relationship of DHEA to testosterone?


Dr. Susan Rako: DHEA is a precursor of many steroids, including testosterone, 
but it simply isn't true that if you take DHEA your body will make exactly 
the amount of testosterone that your body needs.


Marlo: What exactly is vaginal atrophy? A friend of mine has it. She said 
she actually feels like everything is closing up


Dr. Susan Rako: Vaginal atrophy is thinning of the tissues that line the 
vaginal causing dryness and sensitivity. If you haven't got enough 
estrogen or testosterone the tissues dry up and thin and this makes
sexual activity very uncomfortable or impossible.


Marlo: But a lot of lubrication can help?


Dr. Susan Rako: A lot of lubrication can help, but it's often not adequate. 
Still, if a woman has had breast cancer, she may not be able to know that 
using estrogen cream on her vaginal tissues could be safe. So lubrication 
is the best she can do. However, for most women, some hormone
replacement is a very good option. Testosterone is very very helpful
for vaginal dryness.


Ladyblue: Dr. Rako Thank you for being here, Loved your book Hormone of 
desire and I understand you prefer the Methyl form of Testosterone but I 
use only the natural bioidentical hormones, both oral and cream, that 
Pete Hueseman suggests both the oral (sublingual) and the cream. I LOVE it 
for it's many benefits and have been on both for 5 years so I just wanted 
to say to not be afraid of it. Also, I understand that women should not 
take 'just' Estrogen as it depletes the testosterone even more is that so? 


Dr. Susan Rako: Estrogen stimulates MORE binding protein which ties up more 
of the testosterone.


Ladyblue: Is that the SHB?


Dr. Susan Rako: Yes


Ladyblue: Thank you, I love my testosterone.


Donna Maria: I had taken synthetic hormones for 5 years. I felt awful
the whole time, didn't realize it was from the HRT. Then I went on Biest 
through Pete Hueseman. I had painful breasts. Couldn't get a doctor to 
test my levels. I started spotting. My female gyn was very concerned and 
told me to increase progesterone. I stopped all when my sister got breast 
cancer. She insisted I stop all HRT. 

I started perimenopause in 1993 at age 46. I am now 57. I have no desire 
at all, even for Brad Pitt! 

My question is how can I get my levels checked? I want to start Biest 
again but don't want to get too much estrogen and painful breasts again.


Dr. Susan Rako: A good example of NO BLACK AND WHITE answers. Glad you
feel better :) You need a doctor to evaluate everything carefully.


Immoloto: Hi. My name is Iris. I am 52 years old, never took synthetic 
hormones r/t my benign tumors and cysts. I am a registered nurse and 
always afraid to take medicines. After 3 years suffering with my menopause 
I decided to read more about natural bio-identical hormones. Then I 
educated my doctor and I persuaded him to order natural bio-identical 
hormones after the levels were checked. 

My doctor ordered Triest 1.25 mg BID and Progesterone 50 mg BID (twice a 
day) but I decided to take the Progesterone 100 mg in the evening and rest 
for 10 days, taking only the Triest. Thinking to mimic my menstrual period 
which I haven't had menstrual period yet, but I started the Tx since 
August 13/2004. I haven't told my doctor. Do you think it is right?


Dr. Susan Rako: Too long a question. When I do a consultation takes an hour. 


Immoloto: Do you think I could ask my doctor for testosterone? It does 
not matter I feel Ok with my actual Tx. 


Dr. Susan Rako: Sorry. It's mpossible to do consultations here.
I can't evaluate her full details to answer, Dearest.


Immoloto: Thanks. I just want to know if can stop the progesterone once week,
while taking the Triest.


Dr. Susan Rako: I don't recommend progesterone on a steady basis ever for 
anybody.


MsLaTrobe: I am 56, using .75 Vivelle Dot estradial, menopausal for about 
18 years. Can I still have polycystic ovary syndrome (which I understand 
causes excess testosterone)? My total testosterone is 33 but the others 
are l.8 and 6.2 which are relatively high for age 56. My problem is when 
I use testosterone gel on my leg to increase libido, I get excess thick 
vaginal discharge. Why would the addition of testosterone cause this 
discharge and how can I increase my libido but still avoid this discharge 
problem. (Also, I have vulvodynia so topical vulvar preparations are 
tricky). 


Dr. Susan Rako: Ohoh! Too many details again, sorry.


MsLaTrobe: Why would testosterone cause excess discharge when used
with Vivelle .75?


Dr. Susan Rako: I have never heard of this before. I have no idea. Sorry. 


MKNTeex: I am 48 years old, my menses are irregular. I have hot flashes, 
but the most maddening symptom is my feet and legs have been numb for
over a year. It feels like walking on crushed bones, tingling/numbness 
constantly, and never goes away. 

I've been to podiatrist, chiropractor, had MRIs of back/neck/spine for
MS detection, EMG for nerve conduction. All the tests came out okay. 

I've read numbness and tingling can be a symptom of menopause. Is this 
common? I'm still afraid I have MS or neuropathy though tests don't show 
it.


Dr. Susan Rako: It's a first for me. 


PRMC: I have severe breast pain what is this? 


Dr. Susan Rako: When do your breasts hurt?


PRMC: Most all time.


Dr. Susan Rako: Are you taking any hormone supplements?


PRMC: no


Dr. Susan Rako: How old are you?


PRMC: 47


Dearest: Still menstruating?


PRMC: yes


Dr. Susan Rako: When did your breasts begin to hurt?


PRMC: Several months ago


Dr. Susan Rako: Sometimes in the years before menopause, women's bodies 
actually make MORE estrogen because the pituitary gland keeps trying
to get the ovaries to ovulate. This excess estrogen can cause breast 
swelling and pain.


PRMC: Also my blood pressure goes up and down


Dr. Susan Rako: Are you overweight?


PRMC: yes


Dr. Susan Rako: I think that your hormones are also going up and down.
You need to see a good doctor.


Dearest: Bottom line, she's in perimenopause.


Dr. Susan Rako: yes


Dearest: Read "What Is Menopause" at 
www.power-surge.com/educate/menoprimer.htm

I recommend to everyone to go to the library and read Dr. Rako's 
transcripts - you'll get many answers there. Plus, there are hundreds of 
other transcripts, articles, message boards on the Web site where you can 
find answers to your questions. 

The transcripts are at: www.power-surge.com/library.htm


TerryRoss2004: Is it possible to visually determine estrogen level during 
a pap smear? 


Dr. Susan Rako: Looking at cells under a microscope can show how well 
estrogenized they are but I don't know how exact this is.


VMarq: Do you recommend blood or saliva testing?


Dr. Susan Rako: Blood testing is more accurate but even some blood testing 
isn't accurate enough.  Several research papers have been written on
the problems with testing.


KarenC: If testosterone regulates metabolism could using it adversely 
affect someone who takes thyroid medication? As in needing to adjust
the thyroid medications?


Dr. Susan Rako: "adversely". Well, it could be necessary to re-regulate
the thyroid medications, yes, but that's not a bad thing.


KarenC: Bad thing in my case.


Dr. Susan Rako: Getting your body to work best can take some effort and 
trouble and cost. I don't think that that's a bad thing.


Use2BHorny: If you use a testosterone preparation that is applied to the 
vulva/clitoris, could it be harmful for your partner to perform oral sex 
on you? Also when you use testosterone do you actually feel horny again
or does it just make the vaginal area sensitive? 


Dr. Susan Rako: Some women find that testosterone definitely "makes them 
horny again" to a point. But getting older often means getting mellower. 
As to the question about oral sex. If your partner is a man, the amount 
of testosterone he'd get would make little difference.


Goodheart: Can testosterone cause hot flashes? I have used Estratest HS 
with extreme hot flashes.


Dr. Susan Rako: Hot flashes can be caused by CHANGES in hormone levels, UP
or Down. So any hormone changes can cause hot flashes for a time.


Goodheart: Could I have adapted?


Dr. Susan Rako: Yes, but I don't recommend Estratest in any event. Too much 
testosterone for most women.


PeggyMM: I had Melanoma (in situ) eight years ago, no recurrence. I was 
told at the time I should NEVER take hormones. What is your opinion?

Do you give the same advice? I am 48 and have no significant menopausal 
symptoms yet, just getting educated for the future. 


Dr. Susan Rako: I'm not an expert on melanoma. Sorry


Dearest: Peggy, go to www.power-surge.com/asktheexperts.htm and you can 
ask Pete Hueseman.


I B Ann: Is there a physical reason why normal libido and intercourse are 
important for health? I'm 54 and menopausal. 


Dr. Susan Rako: "normal libido and intercourse"? I don't think about 
"normal". Everybody is unique.


I B Ann: Then just libido and sex.


Dr. Susan Rako: As we get older, women and men often prefer sexual activity 
other than intercourse for many reasons and that's fine.


I B Ann: But is it necessary to health?


Dr. Susan Rako: I'm sure that women who are celibate can be perfectly 
healthy.


MKNTeex: I have had numbness/tingling in both feet/legs for over a year. 
I am fearing MS or neuropathy and have had MRIs, EMG with no indication
of same. Is this a common symptom of menopause? 


Dr. Susan Rako: It's not a "common" symptom to my knowledge.


MKNTeex: Have you run across it in your practice?


Dearest: Lots of women in Power Surge complain about numbness/tingling
in the feet, but I'd still be checked - not worrying so much about MS - 
but be checked for diabetes. Circulation is affected by perimenopause
and hormone imbalance.


MKNTeex: Thanks Dearest. I'm not diabetic but next still is vascular and 
ortho.


Dearest: Could be nothing, though, mkn. It may just be circulatory. I've 
had it, too.


BlueBelle2: Why would a 55-year-old have lots of vagina mucus during sex? 
No discharge, just kind of soupy. No period for 11 months.


Dr. Susan Rako: Could have an infection. See your doctor. 



CherylR: I have NO sex drive. I tried HRT (PremPro) but it did not help 
for sex drive or dryness. Any suggestions? 


Dr. Susan Rako: Cheryl, how about reading my book. MANY suggestions there. 


CherylR: Thanks


Dr. Susan Rako: I don't recommend PremPro for anything, ever, and I 
recommended AGAINST PremPro before the WHI did its study. Taking 
progesterone every day does away with many of the benefits of estrogen.


Debrikkia: I am 54, had a total hysterectomy 14 years ago. I am taking 
Biest +P4 (progesterone) +TE-2.5 (testosterone) sublingual. You said that 
you don't recommend anyone taking progesterone constantly. Do you think 
this dose could be too much? By the way, I take it twice a day. 


Dr. Susan Rako: I don't recommend your regimen but if it's good for you and 
your hormone levels are within safe limits, it's fine for you.

One thing, though, I wouldn't take the progesterone in that compound. I'd 
stop that part for sure. 


TerryRoss2004: I have "massive amounts of fibroids in and around my 
uterus". Discovered after a few tests, because I have a lot of pain. 

My doctor and everyone else says even partial hysterectomy is bad.
Why is that, if it will stop the pain? 


Dr. Susan Rako: I think that surgical evaluation is tricky. Depends on where 
in your uterus the fibroids are. Could be that it's simply impossible to 
remove them.


Dearest: Terryross, go to www.power-surge.com/educate.htm and read the 
articles on various types of ablation in lieu of hysterectomy.


Dr. Susan Rako: Ablation is usually the word they use for removing the lining 
of the uterus, though. Removing fibroids is different. 


Dearest: In the articles I've referred to, there's much reference to 
fibroids.


Elisah11: No period for 1 year and no sex drive for three years (starting 
at 46). I'm not taking anything other than vitamins. Is there anything I 
can do to naturally stimulate testosterone production?


Dr. Susan Rako: In a word ... no. There's no way to stimulate testosterone 
production.


Goodheart: Bioidentical Progesterone (P4) ala Dr. Lee (transdermal or oral 
in small doses) has been suggested to balance estrogen, build bone, and 
has a sedative effect that balances E2's energizing properties. Is this 
true? 


Dr. Susan Rako: I don't agree with Dr. Lee's theories. It is true that 
progesterone has sedative effects. It also depresses the hell out
of some women.


LookingForward: What regimen do you recommend for progesterone 
replacement? I also take a sublingual tablet twice a day containing 
Biest, progesterone and testosterone. 


Dr. Susan Rako: I recommend that women take natural progesterone
for ten days every two months. 200 mg at night for only TEN days out
of sixty. And that's for women who HAVE a uterus. Women who have had an 
hysterectomy don't need it at all.


Soulnight: Sorry if I am repeating a question, got here a little late. 
Does testosterone help the sex drive and is it safe to take in limited 
doses? 


Dr. Susan Rako: Yes, testosterone helps sex drive and pleasure for many women 
and yes, it is safe to take it in limited doses. 


PRMC: Is dizziness associated with perimenopause?


Dr. Susan Rako: Yes. Dizziness is quite a common symptom, not only with 
menopause, but also with getting older. I always recommend that it be 
evaluated, though.


Dearest: Dizziness and many of the other things mentioned here can be 
associated with perimenopause - however, we always recommend going
to your health care provider and getting a thorough checkup before 
attributing anything to the menopause experience.

Susan, thank YOU for another stimulating and informative chat about 
menopause, testosterone and sexuality. 

I highly recommend Dr. Susan Rako's books, "The Hormone of Desire" and, 
"No More Periods?" to everyone. 

You can visit Dr. Rako's Web site at www.susanrako.com. 


 


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Read Dr. Susan Rako's seventh transcript


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