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[Emjay]

I have been on hrt for about 20 months now. It hasn't been plain sailing.
Het has helped things such as vertigo and hot flushes but the mental health side if things has never improved.
I also have been diagnosed with pmdd.
I have always suspected that I may be low in testosterone based on my symptoms and after doing my own research.
My g.p said they wouldn't even consider me testosterone until I had been on hrt for 12 and months anyway.
So here I am over 18 months on hrt, estrogen dose has been continually increased, I feel I have actually gotten worse again since hugging my estrogen dose and I also can't tolerate the Utrogestan still.
I'm on a 100mcg patch and cycling the Utrogestan.
I have had 3 testosterone blood tests since June, 1st one came back as 0.1 nmol/l and they wrote low on the report and tp discuss at follow up.
G.p decided to up my estrogen and change from the gel to the patch as it appeared as I wasn't absorbing the estrogen.
Re tested 6 weeks later, estrogen was fine, testosterone was 0.6 but I still felt awful.
I have stayed on the 100mcg patch on recommendation on now a private g.p, had my blood tested again recently and testosterone is 0.1 again. But this time they have written on the report as satisfactory.
How can they wrote 2 different things for the same low level.
And also I don't feel satisfactory, I honestly feel like my energy, amongst everything is in the tank.
I also have not just low libido, I have zero libido still despite following their advice and continuing with hrt and on the highest dose.
I still suffer with intense pmdd, to which they have prescribed me an ssri to take cyclically.
I find it frustrating that they are so quick to give me and ssri which is also causing some side effects but they won't prescribed me a small amount of testosterone to see if it can help at all even though my blood tests show I am low.
Is this the same for everyone?
I am on a waiting list to see gyni now, but am worried I am going to be fobbed off by them aswell.
I am a 44 but I honestly feel like I am 90 most days. No strength, no energy, low motivation, aches/pains.

[bombsh3ll]

Is it worth suffering like that rather than just self funding the testosterone privately if you can afford it, whilst you wait for the NHS menopause clinic appointment?

Superdrug have a service, so does Louise Newson's clinic.

You have one life and I know you shouldn't have to pay for treatment but for me my health and wellbeing trump my principles.

Also if you can't afford testosterone there is DHEA which they call "poor man's testosterone". I take this because I am on a combined pill, and there is safety date for DHEA in addition to the COCP but not testosterone (although it almost certainly is safe in physiological doses, just nobody would prescribe it).

Finally a prescription is a menu not a mandate, and just because you've been prescribed a SSRI you ultimately have agency over whether you take it or not.

[Emjay]

Thanks for your reply. I really appreciate your thoughts.

I have paid privately to see a g.p at the menopause clinc closest to me, which to be honest I can't really afford but I went private thinking that I would be taken seriously about trying testosterone along side the hrt.
The g.p was nice however hasn't actually prescribed/suggested anything different to my g.p at the local surgery.
I do have another appointment with them in a few weeks and if I am not prescribed testosterone then I will definitely go via superdrug or Newson clinic.
I am on the waiting list to see gyni still but no idea how long it will be before I see anyone.
Just wondering if anyone else has been prescribed testosterone with levels the same as mine and felt better.
After looking on the Internet a reading of 0.1 is Bottom range for a woman of 50 + and postmenopausal.
And even though that is a normal reading for post menopause (i am not post menopause or over 50) obviously women do get prescribed test testosterone when they have symptoms.
I'm not saying this is going to be a magic bullet for me, I am well aware that there is so much that effects our wellness, hormones and energy but I do find it baffling to have a battle about trying something that I am actually low in but upping everything else, despite me saying I think the estrogen is too high.
I can lower my estrogen myself but I am worried that I will just go round in circles with this if I don't follow their advice because I have been continuously told that I need to be on the maximum dose of estrogen before they would give any testosterone.
It's all so confusing.
I will look into the newson clinc, looking back I should have gone directly to them as over a year and a half later I am feeling no better and to he honest I feel I have gone full circle and actually have a lot of the symptoms that I had before hrt have come back.


I will look into dhea aswell, thank you for mentioning that.

[Emjay]

Another reason I want to try testosterone first and I see no reason why they shouldn't be able to prescribe it to me. Is that next step for me is hysterectomy/oophorectomy
I can't continue with pmdd anymore, I have primary school age children and I can't put them through what I went through with my mum who had pmdd.
I want to try testosterone as a last resort now as I have tried everything else, I have heard of other women with pmdd tolerating the progesterone side of things better once they had some testosterone on board aswell.
I'm hoping this is the case for me.
But I won't know if I don't try.
Anyway, I'm just speaking out aloud now as this is what I am going to put across to the gynecologist when I eventually get to see them

[bombsh3ll]

I would cancel the appointment with the private GP and save your money for somewhere that you know you can access testosterone. The service provided by superdrug and the testosterone only service by Louise Newson are specific, no beating around the bush or hoping they will suggest it.

A lot of GPs have jumped on the menopause bandwagon and set up private clinics but sadly they often have no specialist knowledge or much clinical experience and lack confidence in prescribing testosterone.

I would always suggest researching a private clinic or doctor to see whether their area of interest or scope of practice aligns with what you are hoping to get out of it.

Unfortunately a blood test cannot predict your individual response to testosterone treatment - it is only done to avoid giving testosterone to someone who already has high levels at baseline (which is virtually never the demographic seeking it in this context).

There is absolutely no point in keep repeating testosterone bloods before starting treatment as they will not have changed significantly.

A test is usually done a few weeks after starting and typically yearly thereafter to ensure physiological levels.

[Emjay]

Thanks for your reply, I appreciate that.
I might actually look into the superdrug route today, hopefully I can just use my most recent blood test results as I just can't continue like this for much longer.
Another issue I have is that I am on a higher dose of estrogen and obviously need higher doses of Utrogestan, even though the Utrogestan makes me feel awful. I take it vaginally and cyclically at the moment, I do feel I need less estrogen to be honest and a more manageable dose of progesterone which I would have to discuss with a consultant, which probably I will have to end up going to the newson clinic.
However, my period was 2 weeks late this month, so am now very confused as to when to start taking the Utrogestan again. Technically I should start again today but I have just finished bleeding.  But if I waited until day 15 of my cycle then I probably am not using enough progesterone via guidelines, maybe too much of a gap since I last used the utro.
I don't know if that makes sense or not.
I don't have any heavy bleeding, no bleeding in between or any pain or anything.
Probably I should use Utrogestan daily to avoid the hormone fluctuations, but I don't know if i can due to how it makes me feel.

[bombsh3ll]

Why not try a different progestin?

There is no point struggling on with micronised progesterone if it doesn't agree with you.

Anecdotally yes testosterone makes progesterone easier to tolerate. However there are so many other options, nobody needs to feel like they are stuck with micronised progesterone.

[Emjay]

That has been discussed and that is still an option.
I did want to see if having some testosterone on board would help with the sensitivity of the Utrogestan before changing it because I have never got along with progestogens in the past, also it's taken a lot for me to even accept that I needed to take any extra hormone so I wanted to try ones that had the least risks.
Obviously if it's just not suiting me then that Is that, I will have to try something else.
I had a mirena coil fitted at the beginning of the year to see it that would have been better as I was told the dose is a lot lower then any other options and more localised but I had so many problems with it, it was removed after 12 weeks.

[bombsh3ll]

Absolutely I agree it is worth trying testosterone whether or not you stick with utrogestan.

Otherwise you will never know!

Mirena IUS can be a good option but is not normally something I would rush to recommend where there is a history of multi progestin intolerance due to it being invasive and needing an appointment to remove rather than something you can just discontinue if unsuitable.

Also if testosterone or DHEA don't work out, don't forget tibolone which is an overlooked option, a threefer with androgenic activity included. This can be a godsend for progesterone intolerant women.

[Emjay]

That is such a helpful reply, thank you.
I will mention tibolone when I see the consultant as an alternative if I don't get along with anything else.
I haven't looked much into tibolone so will read up on that aswell.
Just before I fell pregnant with my daughter I had a gynecologist discuss with me about the option of hysterectomy, with the injection (I think it was injection) to put me into chemical menopause to see if it would even help my pmdd symptoms.
I didn't think I could have kids actually, I have endometriosis and had never fell pregnant before.
He tried a progesterone(high dose via a pessary) only treatment to see if that would help my pmdd but just before my treatment I fell pregnant (I didn't know this at the time) I tried the progesterone pessaries, they sent me crazy.
He told me to stop the treatment immediately, and my next appointment with him was to discuss chemical menopause.
I found out I was pregnant just before my appointment, so that was that.
Pmdd kept at a bay for a couple of years but came back with vengeance after my 2nd pregnancy. Definitely in perimenopause now plus still have pmdd.
'm 44, I don't want anymore children so worst case scenario will be the hysterectomy option, but I definitely want to try to see if anything else will help 1st.
I have to do something as obviously want to be the best mum I can be to my children, I grew up with a mum who had pmdd then also a terrible perimenopause/menopause, she was sectioned twice during perimenopause which was scary, it was horrible for her but I don't want my children to have to whiteness what I whitenessed growing up. And unfortunately I have felt like I'm on the way to a break down a few times this past year. I know it is hormone related because all through my 30's like clockwork 2 weeks of every month I was just not me anymore.
Then all of a sudden I would start my period and I would be back, fine for about 2 weeks then it would all start over again.
Been to drs multiple times to be told it's just a bit of pms, just deal with it.
This time I am not giving up with finding help because it's not just me anymore, I have my children to think of.


Anyway..... thanks for your replies.
I'm sure I will post here again sometime.
It really does help hearing other people's ideas, what's helped/not helped them.

[bombsh3ll]

Absolutely you need to look after yourself in order to be able to look after your children.

Nobody should settle for feeling rubbish when it is avoidable.

Just a word about tibolone if you do look into that, it is typically prescribed to postmenopausal women only so you may have to say your periods have stopped.

This is not due to any safety concerns, only that a) it is not known if it would affect a fetus - not a problem if you don't plan to get pregnant on it and
b) you might get a less regular bleed pattern - this is neither here nor there if you have been suffering from severe PMDD. Periods can also become irregular in untreated perimenopause anyway, so I personally wouldn't give this a second thought. "

[roma]

Hi - I'm new here
In my 70's, but in a lovely new relationship so wanted to get my hormone levels up in order to get things working again. I've been on Vagirux, but to be honest I didn't notice much effect except getting a yeast infection. I wanted to try the testosterone gel after reading posts here.
Superdrug actually refused me and cancelled my order!
I don't know if that's because I didn't buy a testing kit first or whether my own surgery vetoed it.
Reading with interest to hear others experience and whether there is another route to getting testosterone or an alternative.