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[olive]

Hi ladies this is my first post although I've been lurking for some time (and grateful for all the info). I have an HRT review (=battle) with my GP tomorrow morning and was wondering if anyone can tell me where the BMS testosterone range of 0.50 - 2.60 came from in this post from December 2022? I'm interested because this reference range is higher than all those quoted on my lab tests (0.4 - 1.2) and would give me more ammunition. OP was "Emmasky" and I can't find this info anywhere online .... thank you! I'll do a proper personal introduction after tomorrow...I'm postmeno, 56, and recently suffering catastrophic libido issues on top of all my other symptoms, not absorbing transdermal (estradiol still <88 on 6 pumps of gel after patches also failed!)


https://www.menopausematters.co.uk/forum/index.php/topic,64264.msg889257/topicseen.html#msg889257

Hello there. This is my first post and I’d be very grateful if anyone can shed some light on my query. 

Has anyone come across the change in testosterone level guidance updated in May 2022 by the British Menopause Society?  See the monitoring section of the Testosterone replacement in menopause tools for clinicians document on the BMS website. Link below.

The updated range is based solely on levels being within 0.50 - 2.60 nmol/L, whereas before it was to keep the free androgen index (FAI) within the female range of below 5% (calculated using testosterone divided by SHBG x 100). 

For example my last test was:
plasma testosterone level 3.6
SHBG 129.8
FAI = 2.77%
So previously having the FAI of under 5 was normal but I am now considered too high as my testosterone is over 2.6.

I assume this must lead to a future recommendation of changing the dosage of androfem and Tostran etc accordingly.  If not many of us taking testosterone could now be considered technically too high based on these new guideline levels.

Is anyone else aware of this and/or have you been effected by these changes.  Other than the BMS website I can find no reference to this.

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

[Banjo1973]

Hi Olive,

I can not help you with the numbers (levels) but what I cam advise is this...

When I finally got an appointment with the NHS meno specialist, she said my T levels needed to be tested (and I did that at my GP surgery). GP reported that they were fine and
within normal range. Luckily I sent them to my meno specialist
as she phoned me the next day (normally you wait months for an appointment) and said my levels were low and immediately prescribed T.

A friend's GP said her levels were normal for her age (50)... she screamed back... "but that's the point, I want to restore my levels back to when I had a sharp brain and a sex drive". He referred her to meno clinic and she now has T.

What I'm trying to say is, it's not just about the numbers

These were mine...



Serum testosterone 0.9

Serum sex hormne binding glob
138.5

Free androgen index 0.6


Hope this helps x

I wish you the best

[olive]

Thank you Banjo1973. I'm so tired of being treated by numbers instead of symptoms. This has refocused me.

[Banjo1973]

Olive, what oestrogen are you on?

[olive]

Originally kliovance tablets so very low dose. Flushes stopped but everything else lousy. As of this spring, evorel 75 patches which i cut up to make 100. No joy so asked to try gel and was put on oestrogel. Nothing has increased my estradiol reading up so far. Any advice very welcome. I'm so tired of the merry-go-round and I'd be happy on tablets. Just want my life back 

[Banjo1973]

Oestrogel stopped working for me (I believe they changed the formulation)

I now take Sandrena gel and I am very happy on that.

Please don't give up. When HRT is right, it's magic!!! Trouble is when it's not working we don't have the energy or mental strength to demand what we deserve from GPs.

Use this forum to empower you. Bring a list of questions or suggestions to the GP

xxx

[olive]

Hi ladies I just wanted to check in and say thank you again for spurring me on in what I knew would be a difficult conversation this morning.

I kept my GP on the phone for 35 minutes until she agreed to start me on high dose oral oestrogen (the only kind that actually got my level up, based on a brief period under a private specialist a few years ago) plus starting Testogel at the same time. She offered a higher dose patch but I decided against that as I really feel I've worn the transdermal T-shirt at this point and it's not working! May try again at a later date if I can just get to feeling better first.

She didn't want to start both at the same time "otherwise we won't know which one is helping" but after 10 years of feeling totally lousy I stood my ground (Banjo1973 I was channelling your screaming friend "I want my brain and sex life back!"  ). My bloods in December were O= <88, T=0.7 and SHBG=137 so will be hoping for a positive change in symptoms if not numbers over the next few months and fingers crossed that T stays within pre-meno range, which is what we've agreed to shoot for.

olive x

[Banjo1973]

Congratulations Olive!

We all need to be boss bitches when dealing with people whose default setting is to fob us off.

Little tip is to go easy with the T. I ended up taking less than I was prescribed (many women start low). You can always build it up.

Let us know how you get on x

[olive]

Thanks Banjo 1973 will do and thank you for the cautionary advice about T.

I do feel for our GPs as they have so little time to get through appointments and are clearly also terrified of being sued, but the flipside of underfunded and disjointed care is that we end up having to diagnose ourselves and to go armed with information on our rights and a detailed understanding of what we are asking for (a good thing on balance) so that we can counter objections and so on. But it's so exhausting! Yup, I was not going to be fobbed off any more 

I'm trying not to count my chickens; this new regime may not work, but at least I was ultimately given the choice, if somewhat grudgingly 

Onwards and hopefully upwards

olive x

[Banjo1973]

Keep us updated xx