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[Italianlover]

I have been using 2 or 3 pumps weekly of Tostran for 8 months now. I use Evorel 50 patch and take Progynova 1mg orally on 3 days a week as well. I have never had any kind of blood test to check my hormones and this worries me.
Should I be requesting this and if so, what would I ask for?
I'd be grateful to hear what others do.

[Hurdity]

Italianlover - blood tests for T are not essential and are inaccurate at the lower end of the range in women as the tests are designed for men. Nevertheless somewhere I read that T levels should be monitored after 6 months and fairly regularly just to check  they remain within physiological range for women - because there can be a time lag before some androgenic sdie effects might be experienced.

Here is what the C and W Hospital says:

https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/Testosterone-replacement-Sep-2017.pdf/view

Is blood test monitoring required?

Blood tests for testosterone is not essential but can be useful. The test is not very sensitive in women and there is no consensus on the normal female range. The relief of symptoms and lack of side-effects is a more sensitive assessment than blood tests monitoring.
GPs are generally only able to measure total testosterone. Measuring the free testosterone or free androgen index (FAI), is more useful assessment and may have to be requested by the specialist.

... and the BMS:

https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/

6 Testosterone assays – measurement

The assessment and interpretation of testosterone levels is problematic, particularly as the majority of testosterone is protein bound. Free testosterone assays are the gold standard but are rarely available, particularly in the public sector. Total testosterone can be measured, but for greater accuracy sex hormone binding globulin (SHBG) levels should be taken into account using the following calculation to work out the Free Androgen Index = Total Testosterone x 100 / SHBG.

7 Testosterone assays – interpretation of results

Although it is not mandatory to perform testosterone level estimation prior to or for monitoring treatment, it can be useful. A low FAI < 1.0% in women with symptoms of low sexual desire and arousal, supports the use of testosterone supplementation. Repeat estimation at the 2-3 month follow up visit can be performed to demonstrate if there has been an increase in levels, though clinical response is of paramount importance. It is also useful to demonstrate that values are being maintained within the female physiological range, typically < 5%, thus making androgenic side effects less likely.

If the oestrogen is controlling your symptoms well then you don't need to have this measured, and if it isn't then you can ask to increase the dose ( with increase in progestogen if you need to). Personally I would ask for measurement of T levels and SHBG just to see...

Hope this helps

Hurdity x

[Italianlover]

Thank you so much Hurdity, that's really useful information. I know I will need to be well informed when I have my GP review appointment because I find that whichever GP I see is usually woefully inexperienced in HRT matters.
I have found that T has improved my brain fog quite a lot, stamina is a bit better but no really major differences and I wonder sometimes if I should bother with it any longer.