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[duffed]

I've been taking Tostran gel for the past year or so, along with 300mg utrogestan and evorel 75 patch

My recent blood test came back with Free Androgen index of 26.4% (Serum testosterone 9.5 nmol/L and SSHB 36), which is a huge leap from a testosterone level of 1.2 nmol/L In July 2024. I know my hormones were tested again in March and August this year, but I don't have the results for these - only that the march one was described as unremarkable in a letter.

 is Tostran gel alone enough to do this, or does this mean I likely have an underlying condition? I've been using 1 pump every other day, probably 3 times a week generally. I've not seen anyone else with such a high FAI so wondering whats going on.

I've got a doctors appointment booked to discuss the results, and assuming I have to stop using the gel.

I have primary ovarian insufficiency, and know I have adenomyosis if that's relevant.

[bombsh3ll]

Do you have any clinical signs of overtreatment with testosterone?

In the first instance when a blood test is grossly abnormal like this without explanation or clinical correlation, the best thing to do is repeat it.

Make sure you do not apply testosterone gel the morning of the test, and that you have showered since last applying or handling it.

If you had normal results in march and august (which begs the question why are you testing it this often) then it is unlikely anything has changed so dramatically in that short space of time.

[duffed]

Thanks for your reply - I get my hormone profile tested frequently I think because I'm only 35, so have been under the consultant gynaecologist at the hospital, they test all my hormones each time I visit and they've been tweaking the hrt its only recently been handed over to the GP to prescribe instead, Its possible the last test from August was abnormal but I wasn't told about it I suppose.

My blood test was on a Friday morning just after the school run, and I had last used the gel on the Wednesday so I'm pretty sure there wasn't a contamination.

I don't feel like I'm showing any outward signs - I've got no new body hair growth, my hair has been falling out less than it used to, If I really stare in the mirror I have a very fine blonde moustache but my partner can't see it  (or he's just very wise!), and I think I've always had that. I've got sex drive and sensation - but that's the reason I'm taking it in the first place, as when I was prescribed it was because aged 33 I'd lost sensation and interest in sex. I've always had a pronounced voice box, but that's the only masculine feature I think I have. 

[duffed]

Had the Gp telephone appointment today (which they asked me to make), and it was absolutely useless.

They would not give any advice about if I should stop using it and just kept saying they didn't think they needed to do anything and that I should ask the specialist.

I was asking if its possible I have a health problem causing the elevated levels, as they seem so much higher than other menopausal women using Testosterone, but he didn't seem to think that query was anything to do with him.

I'm now feeling quite stressed. The consultant is almost impossible to contact outside of appointments so it could be a few months before I get seen again, and in the mean time I'm meant to figure out by myself if I should keep taking it or not.

[Hurdity]

Hi duffed

So sorry to hear about the poor treatment you have received  about your very high testosterone level. Yes it would be unusual and as bombshell my first thought was that it is so extreme ie so different from the last one and so way out of range that it MUST be repeated.

Also the fact that you havent been given your other blood test results.

So here is what I would do:

1 INSIST on being given your previous blood test results - it's no good the specialist handing you over to the GP if there isn't any joined up thinking on your treatment and condition (POI). In my practice (rural SW England) we have access to our online records and most surgeries I think have this facility.  I always look at my results for anything or any consultation, online afterwards. That being the case maybe your records have been transferred to your GP. If you can - have a look. If not then contact the admin person at the hospital and ask for those earlier ones. Remember this is YOUR data and YOUR body and you should be given them

Once you have this you will be in a better position to know if it has been gradually increasing or increasing suddenly. However if it has been satisfactory up until now then maybe it is a sudden increase and even while waiting for this:

2 INSIST on another blood test. Whatever your GP says. Was the blood test carried out at your GP surgery by your GP? If so then it is their responsibility to follow up on an abnormal blood test so I would if possible speak to someone else in the practice and try to arrange another test. If they dont want to arrange a test then if they are absolving themselves of responsilibity for your care and only taking on a prescribing role - then they MUST do something about the abnormal test - ie refer you back to the hospital - that is their job not yours but of course you can hassle them - though it's terrible that you have to.

3 If the blood test was carried out through the specialist consultant - then it is their job to follow up and either repeat the blood test or investigate further.

You've probably heard of Polycystic ovary syndrome (which is associated with high androgen levels) which has some links with POI but as I understand that the former can lead to the latter not the other way round - but I'm no expert! Also if your androgen levels have not been high up until now, and you don't have androgenic symptoms then this is probably unlikely - but something to ask at least.

Try not to stress and depending on your answers to the above make the appropriate contact. The administrator or secretary at the gynae department should be able to advise if necessary?

Incidentally how much Tostran are you using?  It may well be that dose is too high though as you are young perhaps not?  My only observation is that your oestrogen dose is quite low for your age - if you rarely ovulate? And the progesterone dose is unecessarily high though there may be a medical reason for that? Possibly because of the adenomyosis?  200 mg per 4 week cycle should be sufficient. I am in my 70's and I have a 75 mcg patch though I don't absorb brilliantly at my age!

All the best and hope this helps - do try not to stress!

And please keep us posted!

Hurdity x