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[Rufus657]

Hi.

I’ve had to stop taking HRT due to ongoing issues with bleeding and it’s too much hassle despite the amazing benefits I experienced. I also took testosterone gel which also was a great help with libido. 

Can I continue to take the testosterone gel in small amount if I have quit HRT. Thanks for you help on this. 🙏

[Hurdity]

Hi Rufus

Taking testosterone gel on its own in the absence of systemic HRT is not generally recommended due to potentially becoming T dominant and adverse adrogenic effects.

See this statement by the Bitish Menopause Society:

https://thebms.org.uk/2023/03/bms-statement-on-testosterone/

"Although studies have shown that testosterone can be beneficial in
women not using concomitant estrogen containing hormone therapy, the incidence of adverse
androgenic effects such as acne and excess hair growth is higher; this strategy is therefore not usually
recommended in routine clinical practice."

In that statement there is a link to the more detailed guidelines on T replacement in menopause (Tools for Clinicians).

It may be possible in consultation with a specialist who will monitor your T levels - but likely only privately which will be costly.

Hurdity x

[joziel]

It's probably worth trying to find a solution for the bleeding. A Mirena coil often works excellently where other things have been tried and haven't helped....

[bombsh3ll]

I second the suggestion of a mirena IUS.

If this is unsuitable then there are multiple oral progestins that can be tried. They tend to be a lot more effective against bleeding than micronised progesterone if that's all you've tried.

If you have concluded that estrogen based HRT isn't for you though, then yes testosterone can be used by itself.

Some of it will convert into estradiol anyway.

It isn't the routine standard of care and some providers may not be comfortable but absolutely it is an option and there are no safety concerns with taking it alone provided you are appropriately monitored for blood levels and side effects.

Another alternative you could consider is tibolone which provides estrogen, androgen and endometrial protection all in one bleed free oral option.

[Hurdity]

If you have concluded that estrogen based HRT isn't for you though, then yes testosterone can be used by itself.

Some of it will convert into estradiol anyway.

This is often quoted - the conversion of T to oestrogen at inadequate levels of oestrogen, but I have never seen any evidence from trials that this actually happens. If you know of any, then please post!

Yes it is on the steroid metabolic pathway as one of the precursors and is converted to estradiol by the enzyme aromatase, but that's not to say it will actually be converted because of enzyme controls, feedback mechanisms and tissue specific manufacture, so I understand (though my understanding is hazy!)?

The only information I've found on this was the product monograph for the Intrinsa patch discontinued a number of years ago which showed no change in estradiol levels after administration of the T patch after a year, in one of the trials though participants were also receiving estradiol replacement transdermally and orally.

Hurdity x

[bombsh3ll]

Unfortunately very few clinical trials have been done using exogenous testosterone in women.

Our knowledge of its metabolic fate within the body comes from the study of endogenous sex hormones in both male and female cells/animals.

Testosterone is converted to estrogen in various body tissues by the enzyme aromatase. This is why male body builders taking androgenic steroids get moobs if they don't take an aromatase inhibitor as well!

There is no reason to suspect that testosterone given transdermally is treated any differently by the body, which cannot tell the difference.

This would not necessarily increase levels in the plasma by a significant amount following a small exogenous dose transdermally, as it is happening at the tissue level.

[Rufus657]

Thanks all for your really helpful replies. I must be honest I’m done with HRT. I given it so much time.
and effort for a long time now.
I’ve been  been given patches femseven  didn’t stick, big bleeding. Evorel conti, good until started bleeding.
 Evorel patch with utrogestan 200 mg oral, wanted to sleep all day and so miserable ,
Evorel patches and Utro vaginally , constipation, bloating and major grumpiness
  However the best thing I was ever given was tostran and that was amazing. I’ll happily side step HRT if I can get some gain on libido and energy which is what it gave me.

 I’m 66 years old. Having given up HRT my energy levels and joint pain and stiffness is tough. I’m an active person and I’m not ready to sit down all day and do nothing. Just need a break tbh. I was under the Oxford Menopause clinic but calls are only 6 monthly now and it’s difficult to get someone knowledgeable at my surgery.  Soooo frustrating :/ 🙏

[joziel]

I can see how it might feel that you've tried everything..... but you haven't!

Your problems are mainly bleeding related, which needs to be fixed with increased progesterone or a change to progestin - along with (when using utrogestan) other mood related side effects which can be caused by progesterone.

You haven't tried drospiridone. Norethisterone. Cerazette/desogestrel. You haven't tried the Mirena coil. You can have a read of every possibility here: https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

It sucks to just accept joint pain and stiffness (along with increased risk of dementia, cardiovascular degeneration, increased risk of osteoporosis, bowel cancer, arthritis etc etc etc).  If you can't see someone on the NHS, consider going private with Newson Health. The initial consult is about £240 and then they will write a letter to your GP and tell them what to prescribe - you don't need to pay for meds.

[Rufus657]

Thanks for your reply. I appreciate it.

I guess For 7/8 years I’ve been trying to get this straight.

So why has no one ever suggested another progesterone. I bleed and  I can’t tolerate utrogestan. I’m reluctant for coil as that makes me feel Squamish to even think about it and what if it doesn’t work.

I sourced another place for help with the Oxford clinic which started well but since covid has diminished in support. I can’t keep doing this and can’t afford Newsons private fees. I am trying to use a good diet and exercise as a new regime

The tostran will certainly help me I just wanted some clarity on whether I can take it on its own in a very small dose. I would be happy with that. 🙏

[joziel]

Rufus, I would print out that BMS document I linked to and take it to your NHS GP and demand to try a specific progestin there.

The reason no one has suggested it is because regular GPs don't know all the options. But if you show them exactly what you want to try, they should be able to prescribe it. You're not asking for anything off-licence.

[Furyan]

So why has no one ever suggested another progesterone. I bleed and  I can’t tolerate utrogestan. I’m reluctant for coil as that makes me feel Squamish to even think about it and what if it doesn’t work.

The tostran will certainly help me I just wanted some clarity on whether I can take it on its own in a very small dose. I would be happy with that. 🙏

As others said, there are different types of progesterone to try, even Cyclogest (like Utrogestan is micronised, body identical) but seems to be better tolerated by some women. My thought is that, although you like the idea of tostran alone, it might be better to take it as part of an HRT ‘package’ (oestrogen, progesterone) purely in the interest of striking a hormonal balance. I could be talking rubbish here but it's just a thought…