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[yorkslass]

Hi,
I'm new to this forum and its so good to not feel alone.  I'm 45, in a very long term stable marriage, no work or finance issues.  In most ways my life is great.  The problem is that for the last few years I have just not felt myself.  I've lost confidence, my memory is shot but the worst is a complete lack of libido.  When this first started GP did blood tests and told me I was perimenopausal.  She tried me on nuvaring but it caused severe headaches, I have tried anti depressants which didn't solve the problem but made me less anxious about it and I've tried elleste duet which did nothing.  My husband is being great but I know he is suffering too, our sex life is nothing like it used to be.  GP thought that testosterone would possibly help but she wanted to refer me to a menopause clinic for confirmation.  Without even accepting the referral the consultant told my GP that testosterone would not help as I am not menopausal, that there is little evidence that testosterone is beneficial , that there is a testosterone bandwagon at the moment and that I need psychosexual counselling.  To be honest as the moment I would try anything and I know that there is now a psychological aspect to my issues as when we do attempt sex I am very anxious about not getting turned on and disappointing my husband but I am sure that this a reaction rather than the cause of my dead nether region.

My question is whether any of you have experience of testosterone before menopause. The thought that we may have to live with this for years is really getting in the way of what should be a happy life.

Thanks all

[Perinowpost]

Yorkslass everything you've described is classic peri meno, memory loss and loss of libido especially.  I feel your consultant doesn't know what he's talking about and testosterone definitely helps with libido (more exactly response), however you do need to be on hrt to take testosterone. Are you currently on hrt? And whereabouts do you live? Getting it prescribed by your GP seems to be a bit of a lottery (I get it on the nhs and am in West Yorkshire). Furthermore, anti depressants notoriously suppress libido and shouldn't be prescribed for peri Meno symptoms, hrt should be the first option. Please don't be fobbed off with the first opinion and persevere for what you want and keep talking.  Wishing you well x

[Hurdity]

Hi yorkslass

 

I presume your periods were irregular and your cycle longer than the usual 4 weeks  some of the time before you started HRT?

I agree with what Perinowpost says about ADs  and libido, as well as the testosterone and HRT.

I can see why your consultant says there seems to be a bandwagon - but it is because the 2015 NICE Guidelines made provision for T to be prescribed for women on HRT who still had low libido  but because there is no product on the market currently licesned for women we get prescribed T desgined for men and there seems to be a lot of guesswork re doses. Also there is precious little research into it - long term - at different doses and with different formualtions of HRT so some gynaes are naturally cautious.

That is not to say it is not effective and for many women it provides the missing link that conventional HRT alone does not provide.

Incidentally tablet HRT can also depress libido - so to give your libido any sort of chance you should be on transdermal HRT and not on anti-depressants (and maybe other medication also dpresses libido). Obviously any essential medication has to be continued!

As for the pyschosexual counselling - pah! Of course it will appear pyschological - your natural sexual response is not working because your hormones ( and maybe some meds) just don't work - it's enough to put anyone off!! If you want to talk more about this then perhpas this post would be better in prviate lives - Emma could move it for you?

Also if you have any vaginal dryness or itching you should ask for something like Vagifem or Ovestin or Estriol cream to fend off vaginal atrophy and increase lubrication. There are also products to try - moisturisers etc if necessaey ( I don;t know about these).

Hurdity x

[yorkslass]

Thanks for this.  I'm in North Yorkshire but the consultant my GP wanted to refer my to was Dr Ayres in Leeds.  I am seeing my GP tomorrow so will see where we go now.  Maybe she could refer me elsewhere?  My periods are still regular but are getting lighter and the cycle is lengthening.  Used to be every 24 days now every 30 or so.  I'm currently not taking anything and haven't been for over three months so a clean slate to try something new.

Watch this space.

[Dotty]

Hi Dr Ayres doesn't prescribe testosterone.

[Robin]

Hi yorkslass,

I've read previous posts that say she doesn't prescribe testosterone. It might be worth trying to find a doctor who definitely will consider prescribing it if you are hoping to give it a try. I'm perimenopausal and I'm trialling testosterone at the moment so it's definitely possible. I believe your estrogen levels need to be reasonable before starting it so that you get the right balance

Robin

[RubyLove]

I am 46, perimenopausal (FSH test Dec 2017) and have been increasing my estrogen through diet (phytoestrogens). Oral estrogens (whether HRT or from plants) reduce your natural testosterone levels. My mental peri symptoms improved but my ability to orgasm switched off. I asked my GP for T and she tried to counsel me on masterbation! It was rather funny actually. I saved her the trouble and told her outright I was familiar with the practice and nothing was working down there. She prescribed T and orgasms back very soon afterwards. Shop around until you find a good GP who will prescribe T. It works.

[yorkslass]

Well the trip to the GP was eventful.  GP told me that Dr Ayres contacted her this week to say that she had been to a menopause conference and that the consensus there was that testosterone could be beneficial in perimenopause.  She advised my GP to prescribe Tostran.  So tomorrow morning I will be starting it.  I've been prescribed Tostran 2% gel at a dose of one pump (0.5g) per day.  GP said to rub it into my upper arms but the leaflet says inner thigh.  I'll start with upper arms and see how it goes.  Blood test in 6 weeks.

I'll see how it goes and let you all know what happens.  Thanks again for the support, advice and encouragement on this forum.

[Dotty]

Well done. Looks like Dr Ayres has changed her views.

That's a high dose of Tostran. I use half a pump 4 days a week. There is a very good post on here by Hurdity which describes all different testosterone doses .

I squirt it onto my inner lower arm and then rub it in with my other arm. X

[Hurdity]

Hi yorkslass

As Dotty says that is a very high dose and especially if you are not taking oestrogen. Did the consultant suggest this to the GP? The dose Dotty is taking is the one recommended by the Chelsea and Westminster hospital for women who are already taking HRT. Here is the link to the leaflet:
http://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/Testosteronereplacementforfemaleandrogendeficiency092017CWAGREED.pdf
At the end of this post is the post Dotty referred to (in quotes in a box).

1 pump twice a week is recommended.

I really would not take this amount ie 1 pump per day. The negative side effects take some weeks/months to take effect. I also would not take it unless you start transdermal HRT for several months and still no improvement in libido.

The leaflet describes the application for men. Theonly preparation that used to be licensed for women was a patch and was applied either to lower abdomen or butt cheek. Most women apply the T gel well away from parts of the body they don't want to become hairy and away from the breasts. I would do as Dotty (lower arm) or as I do - the lower part of the inner thigh just inside the knee, and start with twice a week unless there is really good reason for you to be prescribed this amount.

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

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

This thread:
https://www.menopausematters.co.uk/forum/index.php?action=post;quote=626743;topic=39588.15;last_msg=631347


Hurdity x

[Mazza27]

Hi yorkglass,

Do you take any hrt?

Thanks
Mazza

[yorkslass]

I'm not on any HRT and the dose I am on is the dose recommended by Dr Ayres.  I've a blood test in six weeks with a view to adjusting the dose if needs be after that.  Whilst I have not actually seen Dr Ayres my GP is in contact with her but I will raise the question of not being on HRT at the same time., after all it would appear that Dr Ayres is new to prescribing testosterone.  Thanks for the Chelsea and Westminster leaflet.  I will also pass this to my GP.

[Dotty]

Hi my understanding of this is that you should be on hrt (oestrogen) before adding testosterone. X