The Hormone of Desire: The Truth About Testosterone, Sexuality, And Menopause

By Susan Rako

Testosterone, the hormone responsible for libidinal energy, is produced by women mainly in the ovaries. When the ovaries shut down at menopause, the amount of testosterone they produce is reduced by half, resulting, for many women, in diminished sexual desire, thinning pubic hair, flatness of mood, dry skin and decreased mental sharpness, among other effects. In this sure-to-be-controversial book, Rako, a psychiatrist, suggests that gradually developing testosterone deficiency is a treatable condition that ignorance, fear, ideological resistance and sexual politics have prevented the medical community, as well as the general population, from dealing with. Acknowledging the need for controlled clinical studies on supplemental testosterone, as there are for hormonal supplements of estrogen and progesterone, Rako advocates the prudent use of supplemental testosterone for women who need it and offers a thorough discussion of the uses, benefits and risks of testosterone therapy.

• Language: English
• Publisher: BookBaby
• Release date: Jan 20, 1999
• ISBN: 9781543938449

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Copyright © 1996 by Susan Rako, M.D.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

The information in this

book is educational in

nature and is not intended

to substitute for or to

supersede individual

responsible medical

consultation.

I dedicate this book to my daughter,

Jennifer Sarah Rako,

whose love and particular qualities of character and beauty reflect, inspire, and support my best efforts.

And to her daughter, Alexandra Grace

Indeed, Medicine claims always to make experience the test of its procedures. Plato therefore was right in saying that to become a true doctor, a man must have experienced all the illnesses he means to cure and all the accidents and circumstances on which he is to give an opinion…Truly I would trust such a man. For the others guide us like the man who paints seas, reefs and harbors while seated at his table and sails the model of a ship there in all safety. Toss him into reality and he does not know where to begin.

Montaigne, Essays, bk.I [1580], ch. 13,

Of Experience

Acknowledgments

I can testify to this truth:

The moment one definitely commits oneself, then Providence moves too. All sorts of things occur to help that would never otherwise have occurred."

– William Huchison Murray

My gratitude for the providential assistance, generosity of spirit, patience, and wisdom of Ruth Hapgood, Sandra Goroff-Mailly, Jennifer Rako, Ed Klaiber, and Jeanne Mayell.

Catalytic contributors to this effort include Ted Kaptchuk, Deborah Rose, Daniel Federman, Helen Singer Kaplan, and Barbara Sherwin.

I wish to thank the women who offered the use of details of their lives and excerpts of their written communications as clinical examples and with generous intention that their experiences might be of help to others.

I appreciate my dad, Robert Mandell, for his unconditional love, prayers, and zest for life.

And I thank my Editor at Crown/RandomHouse, Shaye Areheart, for her belief in this book and for her respect for the integrity of my writing.

Contents

Introduction

Foreword

1

HOW THIS BOOK CAME TO BE

2

POORLY CHARTED WATERS

3

TESTOSTERONE: A FEMALE SEX HORMONE

4

TESTOSTERONE DEFIENCY AND MENOPAUSE

5

RECOGNIZING TESTOSTERONE DEFICIENCY

6

THE NATURAL WAY? TAKE CARE!

7

HORMONE REPLACEMENT THERAPY: ESTROGEN, PROGESTERONE, AND TESTOSTERONE

8

HOW TO SUPPLEMENT TESTOSTERONE, AND OTHER NEW AND IMPORTANT INFORMATION

Afterword

Notes

Bibliography

Index

Introduction

Today, women of all ages have come to appreciate their potential for a fulfilling and enduring sexual life. Dr. Susan Rako has researched and written a landmark book. With the publication of The Hormone of Desire, we finally have detailed, complete, responsible information about testosterone deficiency and supplementation. Addressed to women and to their doctors, this book redefines the concept of hormone replacement therapy to include testosterone for the large population of women who need it for the maintenance of vital and sexual energy — whether their testosterone deficiency has been caused by natural aging and menopause, surgical removal of the ovaries, or the effects of chemotherapy.

To understand why this is such an important book, it is worth remembering that not long ago, women’s sexuality was a subject cloaked in mystery, about which little scientific information was known. Sexual responsivity was thought to be a one-step process, beginning with lust and ending with orgasm. In keeping with this point of view, there was only one female sexual disorder — frigidity.

In their best-selling book, Human Sexual Inadequacy, published in 1970, Masters and Johnson described in meticulous detail the physiology of the sexual response cycle and popularized the concept that orgasm, in both sexes, is triggered by the same physiological mechanism. The New Sex Therapy (Kaplan, 1974) separated the excitement from the orgasm phase disorders in women, as had previously been done for men. This represented a breakthrough in treatment methodology, as did the Disorders of Sexual Desire (Kaplan 1979), which introduced the concept of the desire phase of the cycle for both women and men. Theoretically, sexual disfunction may arise from disruption of any of the three phases of the sexual response cycle — desire, arousal, or orgasm. In our patients with testosterone deficiency, we have observed disruption in all three.

The medical community has been slow to accept and incorporate testosterone replacement for women suffering deficiency despite evidence in the medical literature of the last forty years that it can be helpful. This is not an uncommon occurrence. Research and treatment of female sexual dysfunction, particularly in older women, has traditionally received seriously little attention and funding, compared with allocations focused on male dysfunction.

From our point of view as sexologists, for a woman to live with inadequate levels of testosterone is no small matter. For many it means the complete inability to experience sexual desire, sexual fantasy, arousal, and/or orgasm. The fact is that female sexuality without testosterone is a house without a foundation. No matter how hard a woman might try to assemble the building blocks of healthy sexual functioning — the required amounts of other hormones, a loving partner, adequate stimulation, possibly a good sexual fantasy — it cannot work if she does not have the basic foundation of enough testosterone. We have found that replacing the missing testosterone can restore a woman to her baseline level of sexual functioning.

We anticipate that the publication of The Hormone of Desire will create a groundswell of interest, to the point of inspiring many more physicians to learn what they need to know about testosterone deficiency and supplementation for women. We are delighted that both women who want to learn how to take care of themselves and health care professionals who treat them can turn to this meticulously researched book, annotated and documented with the body of core information on testosterone, as a guide and a resource.

Gracefully, intelligently, and sensitively written, The Hormone of Desire began as Dr. Rako’s own story, a story of challenge, inspiration, and determination, and came to completion as a book that can benefit the millions of women who need testosterone replacement therapy for health and a better quality of life.

We applaud Dr. Rako for her groundbreaking work.

Barbara Bartlik, M.D., Assistant Clinical Professor, Department of Psychiatry, The New York Hospital — Cornell University Medical College; Staff, Human Sexuality Program, Payne Whitney Psychiatric Clinic; Past President, Women’s Medical Association of New York City.

Helen Singer Kaplan, M.D., Ph.D., Clinical Professor, Department of Psychiatry, The New York Hospital — Cornell University Medical College; Director and Founder, Human Sexuality Program, Payne Whitney Psychiatric Clinic.

Foreword

One Sunday, after a long day and night at Harvard’s Countway Library lugging heavy medical journals from the stacks to the copying machines, glad to have located the articles I had hoped to find, I treated myself to an Indian dinner, pored over the copies I had made, called it a night, and had the following dream:

I am on a beach, near an expanse of ocean. Digging in the sand I unearth many large seashells. Conches. Substantial, they seem beautiful to me, even though they are imperfect. It is apparent that someone else had found them in the ocean and discarded them on the beach, where, for some time, they have been covered with sand.

Digging farther, I discover a kind of grotto. I am aware that I must watch my footing, although the risk of falling does not appear to be great. The grotto is not very deep. One could not fall too far. And I find, also, the preserved carcass of a large fish, in its own way beautiful.

A story from my psyche, the dream speaks to me. The shells seem to be symbols for the old medical journals I have been digging up — material that is valuable to me today, although it has been buried in the archives, some of it, for decades. I think particularly of one paper by Dr. Sheldon Waxenberg and his colleagues at the Sloan-Kettering Institute in New York and published in 1959.

An elegantly written paper, it is notably compassionate as well. The authors made use of their clinical observations of women with advanced breast cancer whose ovaries and adrenal glands had been removed in hopes of slowing progress of the disease. The study came to a conclusion that androgens, rather than estrogens, are responsible for sexual desire in the human female.

Potentially groundbreaking material. Imperfect to be sure. One could pick it apart in many ways. But there is some strong truth here. We have to watch our footing, how we use all this.

And in the dream, that ossifying fish — primordial symbol of aging, substantial and beautiful even in its remains — transforming to endure, fossilize, yet to be known in some way?

As I write this, I remember my first reading of that paper from Sloan-Kettering. Along with some excitement I felt at the reading of their postulate of androgens as the hormones of desire, I felt some dizzying, long-buried pain.

The details of that study brought back memories of a beloved aunt, my aunt Bess, who died of breast cancer in 1965, while I was still in medical school. During the long course of her illness, and when chemotherapy and radiation had failed, she consulted specialists at Sloan-Kettering. Maybe even these same doctors. In hopes of buying time, she accepted the radical course of treatment that required her to have her ovaries and her adrenal glands removed.

She loved life, lived and died with courage and grace. Perhaps her extraordinary fight for life contributed to something lasting — knowledge now used to revitalize those of us living without mortal disease, fundamentally healthy, but deficient in a hormone, dead to our sexuality, lacking in vital energy and the feeling of vigorous well-being.

I will always remember my first day of medical school. September, 1962. The entering class convenes in the auditorium. The dean speaks.

Primum non nocere.

Above all, do no harm.

May the material in this book be used only for the good of humankind.

The New York Times

Thursday, May 12, 1994

Low Testosterone Affects Women, Too

To the Editor:

I have researched the medical literature and communicated with leading researchers in female androgen deficiency syndrome (testosterone deficiency), and conducted workshops to educate women suffering from a