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[Hurdity]

Thanks Conolly for clarifying.

Hi Joaniepat and anyone else who was wondering - it can be confusing working out how much of a particular active ingredient is in a particular product! The first figure (ie the % one) give the amount of the active ingredient so if something is 1% it means there is eg 1g of it in 100g of the product so for 1% gel it is usally expressed as 10 mg per 1 g gel.  So the Testogel pump pack is 1.62% - approx (just over) half as much again more concentrated than the Testogel sachets and approx 3/4 the concentration of the Tostran gel, g for g.

For products which are dispensed per pump then you need to know how much of the product is contained in 1 pump and then you can work out how much of the active ingredient each contains.

I gave this information about how much testosterone each of the different types of T gel contained in my first post and in fact this was the aim of the thread - but as with all ongoing threads different questions get asked so the first post can get lost. Thanks for bringing this up as it reminds me I will quote it after this post to help others who might be wondering about the other products too!

Sometimes I wonder myself if I'm getting carried away and doing the sums all wrong especially if it's late at night so it's good to question it - my brain does not seem to work as well as it used to (slower!).

Hurdity x

[Hurdity]

Because of the unavailability of some of the testosterone preparations there has been quite a lot of discussion recently about comparability and which T product is best for women. This is not for me to say – they are developed for men after all – but I have drawn together some basic information (below)  about concentration, ingredients, and size of dose so it's altogether in one place which I hope is helpful and will save me writing it out each time someone asks!

The main thing is that Tostran is twice as concentrated as the 1 % Testogel and Testim so for those using a very small amount ( eg tube/sachet) lasting 2 weeks, it can be more difficult to give a consistent amount as  variation either way will give more or less to a greater degree than with Testim or Testogel.  For those who have higher doses this is probably less of an issue – and may not be an issue anyway – but just a thought! The amount dispensed in each pump of Tostran is very small – only 0.5 g gel (10 mg T) so easier to get closer to the right amount compared to Testogel  (1.62%) pump pack – despite Tostran being more concentrated.

The Testogel 1.62% pump pack is more concentrated (by 1.62!) than the sachets but each pump contains 1.25 g gel or 20.25 mg T so unless each pump of gel is transferred to a syringe and dispensed from there it's difficult to gauge the right dose (which going by the totals would be approx 2/3 the amount of Testogel).  However Besins state that 2 pumps of the 1.62% Testogel (40.5 mg T) is approx equivalent to 1 sachet of the 1 % gel (50 mg T)  (in terms of absorption in men) so maybe less than 2/3 would be needed?

Testosterone gel products currently available (that are prescribed to women)

Tostran 2 % gel (20mg T/g gel) Pump pack

One gram of gel contains 20 mg testosterone.
One press of the canister piston delivers 0.5 g of gel containing 10 mg testosterone.
3x per week = 30mg T
1 pump on alternate days would give same amount of T as Testogel sachet or Testim tube lasting 10 days
(Starting dose for men: 3 g gel (60 mg of testosterone) applied once daily)

One tube of 5 g gel contains 50 mg of testosterone.

Testogel 1 % gel Testim 1 % gel

For a Testogel sachet/Testim tube to  last 10 days (large pea-sized blob) would give 35 mg per week = 5 mg per day
(Recommended starting dose for men is 5 g of gel (i.e. 50 mg of testosterone) applied once daily )

Testogel 1.62% gel Pump pack

One pump gives 1.25 g gel = 20.25 mg testosterone

To dispense smaller amounts of these would need to decant 1 pump into syringe?

(Recommended starting dose for men is two pumps ie 2.5 g of gel (i.e. 40.5 mg of testosterone) applied once daily )

Hopefully I haven't made any mistakes but let me know if so!

Ingredients

Tostran
Propylene glycol
Ethanol, anhydrous
Isopropyl alcohol
Oleic acid
Carbomer 1382
Trolamine
Butylhydroxytoluene (E321)
Water, purified
Hydrochloric acid (for pH adjustment)

Testogel
Carbomer 980
Isopropyl myristate
Ethanol 96%
Sodium hydroxide
Purified water

Testim
Purified water
Pentadecalactone
Carbomer 980
Carbomer copolymer
Propylene glycol
Glycerol
Macrogol 1000
Ethanol
Trometamol

Edit 11.6.19 - Testim was discontinued over a year ago

I hope this is helpful to some of you and will also help you see whether what you have been prescribed the wrong by your GP sounds about right 

Hurdity x

Just requoting this (the first post) for anyone stumbling upon the thread - in case it's helpful

Hurdity x

[Kimberly]

Hello Hurdity and everyone else, I would like to try testosterone.  I asked my doctor a few years ago for a prescription but she said it was not available at that time.  Can you tell me if can now be freely prescribed?
Many thanks.

[Ladybt28]

Well I suppose it depends on where you are in the country and whether your GP or Consultant will prescribe!  In theory it should be easily available, it is now listed as available on "prescription" in the NICE guidelines although described as "off licence" meaning there isn't a womens version but comments on the forum suggest that in practice prescribing is patchy at best Kimberly.  I got mine prescribed at end of December by consultant and actually got the prescription last week.

Give it another go Kimberly it is much more common now and in the published guidelines.

[Hurdity]

Hi there Kimberly

Just to add to Ladybt's helpful reply - this is what the NICE Guidelines actually say re tesosterone:

Altered sexual function

1.4.8
Consider testosterone supplementation for menopausal women with low sexual desire if HRT alone is not effective.

(With a footnote:)
At the time of publication (November 2015), testosterone did not have a UK marketing authorisation for this indication in women. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.

As she says it is hit and miss as to whether it will be prescribed and really it is best for you to be referred to a specialist because there are GPs prescribing it who haven't a clue about dosage and giving incorrect dosing instructions. Ditto some pharmacists. Do ask for a referral to a menopause clinic if there is one near to you and find out in advance whether the clinic will consider testosterone prescription.

You need to have adequate oestrogen levels first so if you are peri-menopausal then you should also be taking HRT before T should be prescribed.

The British Menopause Society has a list of menopause clinics (but some are private):
https://thebms.org.uk/find-a-menopause-specialist/

Hope this helps!

Hurdity x

[Tracey E]

Hi, are any of these testosterone preparations bio identical, as I have completely lost my libido.. 

[Hurdity]

All of them are!

Hurdity x

[Autumn27]

Just got prescribed the Tostran 2% gel by a locum doc at the GP, and see that in the older Chelsea and Westminster pamplet that Hurdity also included the link for, it's the third and least preferred option, because of the risk of side effects- presumably because of a higher concentration?

Having said that, in a previous discussion on this same thread, I mentioned that had been given Testogel in the pump form, and been told by Meno Clinic to take 2 full pumps/week which as Hurdity said = 40mg Testosterone.

So now the 3 pumps of Tostran 2% = 30 mg of testosterone.

I always do take a lot less than prescribed, and haven't managed to regularly sustain the testosterone successfully, because I get noticeable heart palpitations and anxiety from it. Maybe I was still giving myself too much!

[Ladybt28]

Autumn27 - I am on Tostran 2% gel. I don't even push the pump half down and I only use it every other day.  I would never use a full pump regardless of whatever a doctor, consultant or anyone else said.  I tend to rely on the ladies here rather than the so called professionals.  I would only listen to a professional if they were using what they prescribed themselves!

I get the impression less is more as they say!

[Hurdity]

General bump as there have been some questions about dosage.

See also latest guidance from British Menopause Society:
https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/

Hurdity x

[Miss-Shelf]

Thank you so much for collating this information in an easy to access way

I have some questions to anyone using testosterone as part of HRT

1)  if you went private,  how much did it cost for a consultation?  And can you then get a GP to keep prescribing testosterone?
 
2) If you got a GP to prescribe testosterone to you,   how did you start the conversation?  I've twice asked different GP's in my practice to do so and they said they didn't do it

3) if you got your GP to refer you to a meno clinic,   how did you get them to do so?

4)  if you privately source your testosterone,   do you get Androfeme [which seems more expensive] or do you find a way to get testogel or tonstran?   

thanks in advance

[Yorkshire Girl]

Can I ask why you are looking into testosterone and have you tried Tibolone - can only be offered post menopause.
I had a hysterectomy and I waited until I realised patches were just not helping with libido, energy or aches & pains, tries Tibolone didn't make any difference to me. My GP checked my testosterone levels, they were non existent, she was then prepared to prescribe it but as it's an amber drug she had to refer me to a consultant. After delay my GP sent off forms that with permission from consultant she can prescribe testosterone along with aftercare. So hope to have prescription given to me on Thursday at my next hospital appointment.

[Miss-Shelf]

Hi Yorkshire Girl and Rockhopper,

thanks for speedy replies.   Much appreciated.

I'm wanting to try testosterone as I've been on evorel sequi patches for two years.  Many of my symptoms [eg anxiety,  sleep,  brain fog, vaginal dryness ]  are addressed to an extent by the patches but I still have a terrible memory and my sexual pleasure is still much reduced.   I wanted to see if adding it in would help me to feel that bit more energetic,   sexual and sharper in my thinking.   I can dream!

I'll report back with my progress

Miss Shelf

[Ladybt28]

Miss Shelf - I have no problem getting testosterone from the NHS consultant at my meno clinic and my GP prescribes it no problem.  I got it about 5 months after I started a new regime of gel and utrogestan.  I found that it helped with my brain fog the quickest (but I know from the forum this is not always the case for everyone).  I felt that I was a lot more "present" about 2 weeks after starting.  The Libido thing was a lot longer. My responses got better first but my "desire" was a slow burn improvement.
There should be no reason why you cannot get testosterone through the NHS - it is now clearly on the NICE Guidelines.  It is easier to get from a GP if you have been to a Consultant but that Consultant does not have to be private.
You could write to our own Dr Currie on the forum - I think the fee is £25 explaining and then I believe (although I have no done it, if she is willing to recommend the testosterone, she writes to your GP recommending that it is prescribed).  As she is a renound meno consultant the GP is likely to listen to what she says.  It is certainly cheaper than seeing a private consultant at £160-£200 a go or waiting to get to a meno clinic.

[Tracey E]

Miss Shelf - I have no problem getting testosterone from the NHS consultant at my meno clinic and my GP prescribes it no problem.  I got it about 5 months after I started a new regime of gel and utrogestan.  I found that it helped with my brain fog the quickest (but I know from the forum this is not always the case for everyone).  I felt that I was a lot more "present" about 2 weeks after starting.  The Libido thing was a lot longer. My responses got better first but my "desire" was a slow burn improvement.
There should be no reason why you cannot get testosterone through the NHS - it is now clearly on the NICE Guidelines.  It is easier to get from a GP if you have been to a Consultant but that Consultant does not have to be private.
You could write to our own Dr Currie on the forum - I think the fee is £25 explaining and then I believe (although I have no done it, if she is willing to recommend the testosterone, she writes to your GP recommending that it is prescribed).  As she is a renound meno consultant the GP is likely to listen to what she says.  It is certainly cheaper than seeing a private consultant at £160-£200 a go or waiting to get to a meno clinic.

Hi, do you have the address or email to request this?
Tracey