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[Shannonplussed]

After months of waiting, I finally got to see my new OBYN. I live in Canada (like a few others) but I get most of my HRT info from this site, which I really appreciate. I noticed a few things from my appointment that I wanted to share.

First of all, she was very happy with my combo of Estrogel and Prometrium (which is identical to Utrogestan). (I got my prescriptions from my family dr, after I researched what to ask for; he was out of touch with HRT so basically gave me what I asked). She was happy with me taking the progesterone continuously, to avoid the ups and downs--no mention that it was too early in the process for that. She asked if I was taking the progesterone vaginally, and recommended it to keep it local and help ameliorate bloating, although she understood and respected that I prefer it orally. I asked her about the Estrogel dosage she recommends, and she says one pump, once a day. I told her I take two pumps, sometimes 3 if my foot pain is coming back or I'm extra sleepy. She sort of paused and said there's only rare patient that she has to increase the dosage for. That's a huge difference to what I read on this forum--one pump and that's it!

Next of note, she mentioned that micronized progesterone is ideal because levonorgestrel, as in Mirena, is linked to a higher incidence of breast cancer. That was news to me; I don't recall seeing that before. I asked her for more info (increased risk but how much higher?) but she was going to have to look it up as it was a very recent finding and the jury is still out on how to proceed/whether that should alter prescribing. I'm going to go for another Mirena despite this.

Finally, she volunteered to prescribe testosterone to help my libido, something my family dr was not in favour of. What was particularly interesting was that she recommended it be applied to the mons pubis. I haven't seen that practice before! I got a prescription for Androgel to be used a few times a week--not sure what that's comparable to: testim? testogel? Anywho, I'll do the pea size blob in my bush and see how it goes 

Let me know if anyone has any questions about my experience with HRT in Canada. It seems much more similar to the UK than the USA, with their focus on compounded HRT stuff and injectables.

[Tinkerbell]

I can't manage on less than 3 pumps of Estrogel, my symptoms come back even on 2 pumps! I have a Mirena and it is my understanding there is not alot  of research on the BC risk but some feel it is less as it is local treatment, but the Mirena suits me so will continue with it.

[Ladybt28]

Hey Shannonplussed...she sounds ok, well better than some we encounter here in the UK anyway!
Androgel is a female form of testosterone.  Here in the UK we have no testosterone actually licensed for women's use it is only for men and so the doses and the composition is for men.  So Testim, Testogel, Tostran is adapted for women's use if you can get it.  I think you can get Androfeme cream through private gyneas here but not on our NHS... we are stuck with the men's stuff.  Also interesting where she suggests we put it...did she expand on why she thinks this is a good location!!

I started with 2 pumps of gel, had to go up to 4 and then dropped to 3, so her views on 1 pump only is interesting.  Different gyneas have different views about the links to cancer of any type of hrt and I suppose each country will have a different "risk assessment" when it comes to prescribing.  Mirina's have been used for year's both for contraception and hrt purposes so I personally wouldn't view them as any higher risk in the general scheme of things.
Great to hear how it's done in other countries x

Hey Tinkerbell, nice to see you posting - PM me...how is your daughter?

[sheila99]

Thanks for sharing. I'd be interested in the research paper for mirena vs Utrogestan if she'll tell you. I'm on 3 pumps oestrogel, one pump doesn't control my symptoms. Currently on utro but considering mirena.

[Hurdity]

It was probably the controversial paper in the Lancet in August discussed and criticised extensively by medical and menopause societies and academics, with links on this thread: https://www.menopausematters.co.uk/forum/index.php/topic,45086.270.html

You will see that levonorgestrel is mentioned (on the thread and in the paper) but if the links to critiques in the thread still work, I'm sure there will have been comment on this.

Well it's interesting to see how other gynaes in other countries prescribe, here all our reputable menopause specialists are endorsed by British Menopause Society and follow NICE Guidelines, generally prescribe from proprietary and tested products using their prescribing information, and if off-licence or off-label (?) using published research to inform their prescription. There is always a matter of different personal views - even here from different consultants putting their own interpretation on the studies presented - since very little is cut and dried in this field!

The actual prescribing info for oestrogen gel (pump pack) gives the number of pumps as low medium and high where 1 pump is a low dose and officially can be prescribed up to 4 pumps (high dose). Of course it also depends on absorption too so we have some women especially those in surgical menopause using eg 6 pumps.

As for application of testosterone gel - well good to get this off-licence. From Googling it looks like Androgel is the same as Testogel and available as sachets ( 1%) or pump pack (1.62%). Steer clear of the pump pack as the metered doses are too large so you would probably end up either wasting a lot or giving yourself too much. I use Testogel sachets ( 1%). Personally I would't apply to the mons? The only proprietary T for women I UK was a patch and was applied to buttocks. The Oz T cream Androfeme is applied to lower torso or upper outer thigh and warns not to be applied to genitalia or perineum. I would say rthe ons is close to the genitalia and as such I wouldn't apply there. In fact many of us here apply it at quite a distance from the genitalia as it is transported readily through the skins both laterally and transversely (systemically). I wouldn't want there to be a higher concentration  around my genital area than elsewhere - persoanlly speaking and in fact moved the site from my upper inner thigh where it was suggested I apply first ( close to genitals) to lower down - inside of knee at bottom of thigh.

If you are taking progesterone continuously and are peri-menopausal then you may well get random bleeding - less predictable than whne taken cyclically. If you are happy with daily use re the sedative effect then that's great.

Let us know how you get on.

Hurdity x

[Shannonplussed]

Thanks for the info! I'll read up on that study and the commentary around it.

The Androgel is a 1% pump, but I am able to get a pea size blob without wasting. I believe this is off-label and only licensed for men in Canada, so I was pleased that she volunteered that without me pressing for it. I didn't ask for further info on application, just had confirm that I heard her correctly! I suppose that is an area where additional hair growth wouldn't be a concern, but yes, you'd think legs would be a fine spot to apply. I suppose mons pubis is better than some of the alternative sites that have been discussed recently 

[Erika28]

I am also from Canada. My doctor had prescribed Androgel too, in sachets (2.5 g; 1%) so 25 mg testosterone per sachet. I applied a pea size blob daily, first to my inner arms, then later my inner thighs. The problem was I started getting significant hair growth in those areas and to this day, even after stopping the gel, there continues to be more hair on my arms than ever before. This is why, I suspect, your doctor asked you to apply the gel to an already hairy area.

I disliked my experience with Androgel. Mostly side-effects such as increased hair growth, very oily skin, acne. And very little in the way of benefits such as improved sleep, energy, more libido, etc.

I finally switched to injections, off-label, of course. My doctor agreed to try. I inject a very small dose of testosterone cypionate (Depo-Testosterone) every 4-5 days. Much less side-effects or barely any and it's benefited me in several ways: increase in energy, libido, orgasms are fantastic, my clitoris is once again sensitive, no more dryness, my memory is better, muscle mass increased, less cellulite, less flabby skin.

The problem with applying testosterone to the skin is that skin contains a large amount of 5-alpha reductase which converts testosterone to dihydrotestosterone (DHT), responsible for baldness, increased hair growth, acne, etc. It's a much more potent androgen, about 5x stronger than testosterone. So, you get higher levels of DHT relative to T and this is not natural, nor desirable.

[paperdoll]

I’m also in Canada, and would like to go on Testosterone Cypionate by IM injection. My doctor is willing to prescribe it, but doesn’t have a clue on the correct dosage for women. Can you provide the dosage of Cypionate that you’re taking and if you take Estrogel and Progesterone as well?

I had started Estrogel almost a year ago (one pump on each arm) and noticed a huge amount of hair loss and had to stop taking it. In order to stop the hair loss, avdermatologist gave me 2 shots of testosterone in a two week time span, it worked like magic. Now I want to go back on it for the low libido and fatigue but have to go through my gyno.

As for DHT and hair loss, you could ask your doctor to put you on Finasteride to stop the counter effects, it really works.