Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: NickyLD on October 18, 2021, 06:20:00 PM
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Hi ladies,
I’ve not posted for a long time I started HRT at 40 and after tweaks for a few years found the oral oestrogen pill and the mirena coil has been working well. Erratiic periods for well over a year but period free now. I feel so much better than I did, but to be honest I was floored. Now I’m relatively stable I’ve been reluctant to change, BUT I have found my mojo to be severely lacking. I can’t seem to start jobs or motivate myself to do much. Anxiety still comes and goes and I’ve accepted this as part of life. No sleeping issues anymore. I’m wondering whether these lingering symptoms maybe related to testoesteone? I have difficulty reaching climax despite having the hottest boyfriend in the world!!!
I had such a battle to get HRT at 40 that I just can’t face a GP fight over it but wondered whether just taking oestrogen orally (Zumemon I think it’s called), could be leaving my levels low on the testoesteone which could make sense based on my symptoms. Any advice out there? Sorry for dreadful spelling! Nicky
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For some people libido returns when oestrogen levels are restored, others (like me) need testosterone. It normally has to be prescribed by a specialist anyway so you could ask for a referral to a menopause clinic.
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Thank you for replying.
The libido aspect I can cope with it’s the general zero get up and go that’s the issue. Unless I have somewhere to go I really struggle with motivation and feeling generally low, but not depressed if that makes sense. Can a GP really not help without a private referral? That’s a bit shocking in itself
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It's because testosterone is not licensed for use by women in the UK. Menopause specialists can prescribe it for women though.
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Hi,
testosterone can be lowered by oral HRT. It is something to do with SHGB. So as testosterone naturally lessens, less is available - the free testosterone to give energy sex drive, muscle strength etc.
I would definitely explore the option and ask to be referred to a menopause clinic on the NHS. Or if you can afford it privately . Also put testosterone in the search box and more info will come up. I think there is one thread called Testosterone here we go.
They may explore altering your oestrogen dose etc. but I understand as you have had issues why you do not want to do that. I emailed Dr Curry about the same thing and she just said to change my HRT first and see if it helps.
let us know how you get on
PMXX
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There seems to be some very mixed views about when to introduce testosterone. My understanding is that oestrogen stability achieved first is the most popular view. One could question how we ever reach that level of certainty. Because testosterone is produced increasingly in the adrenal glands, especially more rapidly after hysterectomy but routinely anyway, it makes sense that the more stress there is, the harder the other hormones have to work and become depleted due to the activity of the stress hormones. It's like spaghetti junction, isn't it? Doing a jigsaw without a picture! Intrarosa might be an interim support for you? There are one or two threads on here about it and a Google of the Newson site might prove productive. Good luck!
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Hi NickyLD, I agree with Pepperminty that testosterone is worth looking into. There are some links below you may find interesting if they're new to you. Apologies if the 2nd & 3rd links don't work as they should - they did before Newson Health's website changed but I had to mess around with them when testing this morning! They are podcasts nos 116 & 118 on Newson Health's website if you can't access them here & want to listen. The first is an informative interview with a clinician, the 2nd a personal account of how life-changing T replacement can be.
https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause
https://www.balance-menopause.com/menopause-library/116-testosterone-the-forgotten-hormone-with-professor-isaac-manyonda/
https://www.balance-menopause.com/menopause-library/118-testosterone-not-just-icing-on-the-cake-with-rachel-dawber/
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Thank you all. I’ve had a telephone appointment with GP who has changed HRT to transdermal and has ordered full blood tests. She wasn’t against prescribing testosterone if bloods indicate it’s low, but also needs to check other levels at the same time. It was just nice to be heard and it didn’t feel like an instant battle which is a result in itself. Will watch those videos, thank you
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Hi NickLD,
do let us know how you get on with the transdermal - patch or gel? And the ladies are pretty clued up on here as to what readings mean if you need any answers. The GP needs the free testosterone reading and your SHBG which can prevent free testosterone being available.
PMXX
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I’ve just watched the Louise Newton webcast on testosterone and it’s made me quite emotional. It’s like watching someone talk about me. I had to give up running five years ago as I just physically couldn’t move anymore and the decline has been getting worse. It’s only when I’ve dealt with all the other stresses and stains of life that I’ve been able to see more clearly. All these things are hormone related. I was so so poorly without HRT… and then the mirena, that I thought I was better and the things I’m struggling with no are just age, etc. Bit it’s not right that I can’t get up in the morning to walk the dog or I have to jump up from the coach when my boyfriend comes around for fear of looking like I’m lazy. I felt like I’d come out of these feelings when lockdown ended but the truth is I’m in my own personal lockdown. It’s so sad when I think about it. Thanks for the advice ladies. I’m going to tackle it once and for all xx
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Bless you Nicky. I'm sorry the podcast was upsetting, but hopefully it will lead to a turning point for you. Sounds like your GP wants to help, so everything crossed that you can come up with a plan together when your results are in.
Wx
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Least I’ve still got my sense of humour… stains of life! I meant strains, obvs!!! 😂😂😂😂
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Changed the HRT from Zumenon 2mg to Eostrogel. So will hope the transdermal instead of oral pill will help. Then blood test on Thursday. Feel like I’m already on the right track calling the GP. I’m staggered that o accepted this as ‘normal’ for so many years when it isn’t. Thanks for listening ladies. The Louise Newton site is amazing too!
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Hi NicktLD,
good for you! I know exactly how you feel. Please update us on how you go with the gel and good luck.
PMXX
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Hi Nicky I so hope you feel much better on your new regime!
Can anyone answer……I’m on oral Estrogen only because I wasn’t absorbing transdermal and it worked fab (though vaccine has upset the apple cart temporarily) Surely I can supplement with some Testosterone if it is affected by oral? Tk you x
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Yes sweettooth, you may well benefit from testosterone, especially if you've had BSO. Maybe have a look at the links I posted on this thread earlier. I would ask your doctor if you have signs of deficiency & feel you may want to try it.
Wx
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Thank you wrensong, I will have a look at those and ask my GP to do bloods🌺
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You're welcome :) Hope it helps if you decide to try it.
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Me too!!❤️
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Hi Wrensong and sweettooth,
The question as to whether you can take testosterone with oral HRT is one that I have never got a definite answer to. I wonder how many ladies do? And what the risks are ?
PMXX
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My understanding is that yes you can but you need to make sure your oestrogen intake is adequate first. So I guess that means by symptoms being relieved and blood measurements satisfactory.
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Hi Thanks Gnatty,
I was given it by my meno clinic , but I wasn't sure and the meno specialist was a bit clueless. No one suggested testing and i am pleased I did not take it as Corona Virus started and I suspect I would have never got tested. She seemed very matter of fact and did not even know how to take utro - which was slightly worrying. :o. I may try it at some point.
PMXX
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To be honest Peppermint you may not need the blood tests if you feel the oestrogen is sorting out your other symptoms. You could email the resident Meno doctor on this site. I think she charges £35 for an email.
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Hi Gnatty thanks ,
I am functioning at the moment after a few rocky months, still tired and achey but I live with that. I am on a low ish dose of hrt but cannot go higher due to bad side effects. I did email Dr Currie, but she just indicated to try transdermal first as it is better absorbed. As my symptoms may be absorption, ( whch they are not) as oral has to go through the liver before the blood stream .
I have a consistent level of estrogen in my blood as I measure this annually . I have tried to up my dose and have awful side effects. I can't change at the moment due to work - if i become worse ( which as I am sensitive to even the smallest changes / increases) I will loose my job if I take time off sick.
So the lesser of 2 evils is stay the same. No professional will give a straight answer as to whether and what the risks are to taking testosterone if you are on oral HRT with a high SHBG , if you are unable to use transdermal. I suspect because they do not know. It is just more estrogen, estrogen, estrogen , but we do not always get on with high doses.
PMxx
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So complicated! The energy and aches are symptoms that can be very much improved taking testosterone. Could you take it anyway and see how it goes?
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Hi Gnatty,
I probably could , but am very wary of doing anything that could make me get other symptoms I do not want.
PMxx
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I would say get your testosterone levels checked first and your blood glucose levels (as low blood sugar can produce anxiety and fatigue). I am post menopausal and started HRT 4 years ago with bioidentical hormones, estradiol and urtrogestan. Really worked for sleeplessness, depression, bone strength and sex drive. I went to see Professor Studd's clinic in central London and was prescribed testosterone as well. Personally I didn't see the point but tried it anyway. It increased my sex drive further but nothing else so I didn't take it anymore.
Now, four years on I have developed abnormally high testosterone levels and have developed male pattern baldness (temples), my voice has lowered and have mild hirsutism (dark hairs growning under my chin). Tumours have been excluded but still no wiser as to why. So just saying, keeping an eye on your testosterone levels is really important.
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Hi Ruby, it is usual to have testosterone levels tested before T replacement is prescribed & again shortly after starting, to ensure levels remain within range & this is something those of us who already use T usually flag up when a member feels they may benefit from adding it to their HRT regimen, so thank you for raising it here. All the while I'm on replacement I arrange for mine to be routinely tested along with other endocrine bloods so that I can keep an eye on levels. With no ovaries, my levels are naturally low, so I need & feel the benefit of replacement & as women whose ovaries are still intact may still be producing significant amounts, testing is, as you say very important.
I'm sorry to know you have inexplicably high testosterone levels & the unwanted consequences. I hope you manage to get to the bottom of it. :welcomemm:
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Re the discussion on oral oestrogen and T replacement - I have just answered this on another thread. It is not to do with safety, but because oral oestrogen reduces free T because it binds to Sex Hormone Binding Globulin (SHBG) so less T is available to be used (according to current thinking). So may not be dangerous but may not work? Basically I am not sure whether sufficent research has been done on this because guess what - there is not enough research into T replacement in women beyond a few studies of the commericial product that was available ( Intrinsa patch) - not sure about T pellets? Hopefully someone more up to date than me may be able to comment!
Sorry if I sound really vague but I haven't read up on anything recently!!
Hurdity x
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Testosterone Therapy in Women with Gynecological and
Sexual Disorders: A Triumph of Clinical Endocrinology from
1938 to 2008
Abdulmaged M. Traish, MBA, PhD,*† Robert J. Feeley, MA,† and Andre T. Guay, MD‡
*Boston University School of Medicine, Department of Biochemistry, Boston, MA, USA; †Boston University School of
Medicine, Department of Urology, Boston, MA, USA; ‡Endocrinology, Lahey Clinic Northshore, Center for Sexual
Function, Peabody, MA, USA
DOI: 10.1111/j.1743-6109.2008.01121.x
testosterone therapy for women with various gynecological and sexual disorders has been practiced since the late 1930s.
Approximately 70 years ago, clinicians from various disciplines relied on personal experience and clinical
observations for outcome assessment of testosterone therapy in women. These early reports on testosterone use in
women with sexual medical problems served as a foundation for the development of contemporary approaches and
subsequent testosterone treatment regimens. Testosterone use was reported for sexual dysfunction, abnormal uterine
bleeding, dysmenorrhea, menopausal symptoms, chronic mastitis and lactation, and benign and malignant tumors of
the breast, uterus, and ovaries.
Health-care professionals engaged in the management of women’s health issues have observed the
benefits of androgen therapy throughout much of the 20th century. Despite this clinical use of testosterone in women
for more than seven decades, contemporary testosterone therapy in women is hotly debated, misunderstood, and
often misrepresented in the medical community.
One of the first studies in the late 1930's:
Endocrinology, Volume 24, Issue 3, 1 March 1939, Pages 347–350, https://doi.org/10.1210/endo-24-3-347
Mocquot and Moricard (12,) found that administration of testosterone
acetate modified and in general ameliorated the functional disorders follow
ing castration in women, but had no effect on the trophic vaginal disturb
ances; occasionally nervous instability occurred, but frequently a sensation
of euphoria. The amounts they gave were small (5 mg.) and the frequency
about every 7 to 14 days. It is our feeling that their failures were due to
insufficient dosage, the wonder being that they obtained good results at
all. Salmon (13) used testosterone propionate on a castrated woman and
noted relief of menopausal disturbances with a total dose of 400 mg. over a
period of 30 days.
We are reporting a series of 21 cases of female menopause, both natural
and artificial, treated by the exhibition of male sex hormone, in the form of
testosterone propionate in oil,1 administered by injection intramuscularly.
Since there is a close chemical relationship between the female and male sex
hormones, and because of the finding of both female and male sex hormone
in normal women, we believed it possible to obtain relief from symptoms of
menopause by means of male sex hormone. Animal experimentation has
shown the benefits of administration of male sex hormone to the castrate
female.
There is a definite place for male sex hormone (testosterone) in the
treatment of female menopause. It is possible to control the symptoms of
menopause by the weekly administration of 30 to 50 mg. of testosterone pro*
pionate.
Some names you might want to look up who made a significant contribution in this field and who extensively studied the effect of testosterone in women:
- Barbara Sherwin
- Udall J Salmon
- Robert B Greenblatt
- Samuel J Glass
- William H Masters
- Alfred A Loeser
- E Schleyer-Saunders
and, of course, John W. Studd.
There are hundreds of studies on the use of testosterone in women dating back to the mid-1930's.
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LOESER AA. The rejuvenating and curative effect of a combined androgen-oestrogen tablet in menopausal and ageing women and in other gynaecological ailments and an hypothesis of cancer formation. Gynecol Prat. 1951;2(2):213-22, French transl, 201-12. PMID: 14849890.
The androgens are therefore as important in the economy of the female
as are the oestrogens. So long as they are in a state of dynamic balance
they will be kept within physiological limits.
This balance is often disturbed in the reproductive phase of a
woman's life, and much more often during the menopause, when all
the other endocrines take part in the change, and more often than in
any previous phase of life, a cancerization in an ageing cell can occur.
KORENCHEVSKI and his co-workers (3) have shown in their fundamental
work how beneficial a pluriglandular treatment in ageing rats
can be. SHORR, PAPANICOLAOU and STIMMEL (4), MARGOLESE (5) and
others treated menopausal women with androgens and oestrogens
simultaneously. BENJAMIN (6) used the same method in gerontotherapy;
REIFENSTEIN and ALBRIGHT (7) saw satisfactory results in
menopausal osteoporosis. The results of these authors were always
better if they administered both sex hormones together instead of
giving them singly. It is the ratio between the two sex hormones on
which the various authors differ.
Without mentioning the action of the two sex hormones on the
sexual target organs themselves or on other endocrine glands, one can
speak of:
Co-operation of androgens and oestrogens.
(1) Androgens, as oestrogens, favour the storage of water and electrolytes. Androgens
favour sodium. and potassium. retention, oestrogens sodium retention especially.
This retention results in gain of body weight.
(2) Nitrogen retention is favoured by both the hormones and this goes to form
new body protein. Urinary excretion of urea is decreased. Creatine excretion is
depressed.
(3) Both the hormones favour the deposition of calcium in the organic matrix
of bone; oestrogens seem to be more intimately concerned with calcium metabolism
than androgens.
(4) Both hormones can act as brakes to the hypophysis and under certain circumstances
inhibit the pituitary growth hormone.
(5) Androgens, as oestrogens, dilate the capillary bed of the skin and raise the
skin temperature, very welcome during the menopause when vasomotor disturbances
prevail.
(6) Both hormones can produce a withdrawal bleeding during the reproductive
and menopausal age, and stimulate the ageing vaginal epithelium to cornify.
(7) Renal and bladder volume is increased by both hormones.
( 8 ) Both hormones can decrease hypertension.
(9) Both hormones act beneficially on arthritic processes in ageing men and women.
Androgens and oestrogens are not co-operative :
(1) In their action on the haematopoetic system. Androgens have a stimulating
effect on the bone marrow; the number of erythrocytes and hoemoglobin are increased.
Oestrogens have no effect in this respect.
(2) Androgens may rather constrict the capillaries in the endometrium (9).
Oestrogens dilate the endometrial capillary bed.
(3) Androgens can increase libido; oestrogens have no such effect.
by a combined sex
hormone treatment ageing organs can be brought back in their functions
to a more youthful level, and that abnormal ageing processes can
perhaps be prevented for a longer time.
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Kupperman, H. S.: Clinical management of the climacteric syndrome. In: Human endocrinology, vol. II, p. 426 (Davis, Philadelphia 1963).
“ESTROGENS AND ANDROGENS. When androgens, in the form of methyl testosterone, were added to the estrogens, physical vigor and joie de vivre became noticeable. Dull personalities seemed to become a bit less so. Occasionally, patients who had been seen for some time modestly whispered about an increase in libido. There were some, however, who did complain of distinct, bothersome clitoral irritation.
The apparent synergism of combined estrogen - androgen therapy permitted us to use smaller doses of each steroid, yet still maintain an equal or greater effect than was accomplished with larger doses of either preparation alone. Vaginal bleeding did not occur. We were constantly alert for masculinizing effects, but there was no evidence of arrhenomimetic phenomena of significance with the doses of methyltestosterone that were employed.
The general degree of improvement in a patient's well being attributable to androgen therapy had a decided effect in ameliorating her anxieties and nervousness which originally were major complaints. Estrogen therapy alone did not seem to be so all - inclusive in effect. The physiologic explanation of the clinical success attributed to the combined steroid medication is perhaps closely related to the enhanced protein anabolism and the maintenance of nitrogen and phosphorus balance that such therapy induced. Osteoporosis of the menopause may thus be better controlled. Although the site of the specific effect of testosterone is unknown, the modus operandi of the estrogens may be ascribed to improved cell permeability. It is reasoned then that, with the basic anabolic property of testosterone and the resultant protein storage, the enhanced cellular activity produced by estrogen increases the potential of the protein anabolic effect of the androgen. The overall effect of estrogen androgen combination is to prevent the depletion of body protein substances as age increases. While beyond the scope of this chapter, one must also give serious consideration to long - range steroid therapy in geriatrics, as proposed by Masters. 19 In his hands this regimen effectively influenced 75 per cent of the geriatric persons treated, with notable physical and psychological improvement. We are entirely in accord with Masters ' concepts and have confirmed his observations. In addition, it has been noted that such long - continued therapy is not only beneficial from the physical and mental point of view, but also appears to be with out danger as far as neoplastic tendencies are concerned. 30
Advantages of Estrogen - Androgen Medication. It should be mentioned that, in the combined use of estrogens and androgens, we do not mean to imply that estrogens can neutralize the undesirable effects of androgens and vice versa. The advantage of their combined use lies in the fact that smaller doses of each one may be administered, so that undesirable side effects due to either steroid are minimized. On the other hand, the combination of the two steroids results in a synergistic effect, approaching the effectiveness of either one alone when administered in higher doses. In other words, if a patient would bleed when 0.05 mg of ethinyl estradiol per day was administered, we could not prevent that bleeding by the addition of 10.0 mg of methyltestosterone. Similarly, if 10.0 mg of methyltestosterone will produce facial hirsutism in a particularly sensitive patient, we cannot inhibit the iatrogenic hypertrichosis with a dose of 0.05 mg. of ethinyl estradiol. However, one can diminish the dose of ethinyl estradiol to 0.02 mg. and administer 5.0 mg. of methyl testosterone simultaneously and achieve a therapeutic effect comparable to that obtained with either 0.05 mg of ethinyl estradiol or 10.0 mg of methyltestosterone alone. In so doing, one diminishes the bleeding propensity which was observed when the 0.05 mg dose of ethinyl estradiol was employed or the hirsutism noted with the 10.0 mg dose of methyl testosterone. An interesting possible advantage of therapy with combined estrogens and androgens is that the estrogens at times may promote fluid accumulation and induce increased nervousness, anxiety, and irritability in certain menopausal patients. The value of estrogens and androgens in these patients would be that the tendency for estrogens to produce enhanced nervousness and retention of fluid is diminished with a smaller dose of estrogens, but the clinical efficacy is maintained by the addition of androgens without diminishing the desired clinical effect.”
“The addition of testosterone pellets to the estrogen was distinctly advantageous in offering the patient a general sense of well being. While the estrogen alone produced a well - controlled and satisfied patient, the combination of androgen and estrogen pellets gave a more effective response; improved spirits were readily apparent, as well as enhanced libido, an important factor in maintaining normal marital relationships. In these cases, we were careful to note any evidence of excessive hair growth.”
The Journal of Clinical Endocrinology & Metabolism, Volume 1, Issue 2, 1 February 1941, Pages 162–179, https://doi.org/10.1210/jcem-1-2-162
“the therapeutic effectiveness of testosterone propionate is distinctly inferior to that of the estrogens. And the reason for this is that, in the vast majority of menopausal patients, most of the symptoms are caused by an estrogen deficiency. And, whereas, testosterone propionate may exhibit estromimetic activity, this property becomes manifest only if the hormone is administered in highly concentrated doses for prolonged periods of time. The estrogenic effectiveness of testosterone propionate (as estimated by vaginal smear reactions in estrogen-deficient women) is, per unit of weight, considerably less than 1/1000 that of a-estradiol. Administering testosterone propionate in order to produce the therapeutic effect of estrogens is, therefore, an exceedingly impractical and expensive form of therapy. Obviously the estromimetic action of testosterone propionate is chiefly a matter of academic interest and has little, if any, utility in the practical therapy of the menopause.”
“In the normal, sexually mature woman, gynecogens and androgens are conceived as being in a state of dynamic balance, giving rise to the normal female secondary sex characteristics and normal menstruation. The equilibrium may, however, be upset in one direction or the other. If the gynecogens become dominant, either as a result of a qualitative or quantitative deficiency in androgens, or because of an excessive production of gynecogens, the resulting imbalance would be manifested clinically by menorrhagia, metrorrhagia, pre-menstrual tension, mastopathies and dysmenorrhea, separately or in various combinations. If, on the other hand, the androgen influence were to predominate, the clinical picture would consist of oligomenorrhea or amenorrhea and arrhenomimetic phenomena. It is obvious that in such a dynamic system similar biologic and clinical effects would result from an excess of the one as from a deficiency of the opposing factor. It is tempting to accept this theory of a dynamic gynecogen-androgen balance since it appears, at present, to offer a solution to the riddle of functional gynecologic disorders.”
Endocrine Treatment in General Practice. New York. (1953). Springer Publishing Co., lnc., 1953, pp. 158, 202, 350.
“As a general rule, those climacteric women who have a predominance of tiredness and muscular weakness need testosterone, and those with the purely vasomotor symptoms do best on estrogen alone.”
“Administration of estrogens alone does not always accomplish all the desired effects in the true menopausal syndrome, particularly the desired improvement of mood. Depressions respond almost specifically to androgens such as methyl testosterone.”
“In addition, the androgen has a distinct "tonic" effect in that it tends to improve muscular strength, appetite, and mental outlook.”
Endocrine Therapy in Gynecologic Disorders, Postgraduate Medicine, 14:5, 410-424, DOI: 10.1080/00325481.1953.11711488
“It has been suggested that the combined therapy of estrogen and androgen is more advantageous in controlling the osteoporosis of the climacteric.19 20 Testosterone will augment the protein anabolic effect of estrogens. Also, the addition of testosterone will many times enhance libido when estrogen may fail to do this by itself. Androgens in the doses employed may have a greater ameliorating effect than estrogens alone on the anxiety state and increased nervousness noted in many climacteric patients.”
Greenblatt, R. B., Teran, A.-Z., Barfield, W. E., & Bohler, C. S. (1987). Premenstrual syndrome: What it is and what it is not. Stress Medicine, 3(3), 193–198. https://doi.org/10.1002/smi.2460030219
“in women whose principal complaints were loss of libido, lack of energy and headaches we often implanted one or two pellets of testosterone (75 mg each)”
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Hi Ladies,
I think as said , there probably has not been enough of indeed any significant studies on T replacement in women taking oral estrogen. I am curious as to whether women were generally given oral HRT years ago ( i think they were , by doctors and told take this it will make you feel better ) not really knowing much about it- and then supplemented with T also.
I suspect women were mostly on oral HRT and no one bothered to follow up or study what the effects were with T . I know it is about Free T etc , but not one professional has given me a straight answer to what the risks are - if any.
PMXX
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I would say get your testosterone levels checked first and your blood glucose levels (as low blood sugar can produce anxiety and fatigue). I am post menopausal and started HRT 4 years ago with bioidentical hormones, estradiol and urtrogestan. Really worked for sleeplessness, depression, bone strength and sex drive. I went to see Professor Studd's clinic in central London and was prescribed testosterone as well. Personally I didn't see the point but tried it anyway. It increased my sex drive further but nothing else so I didn't take it anymore.
Now, four years on I have developed abnormally high testosterone levels and have developed male pattern baldness (temples), my voice has lowered and have mild hirsutism (dark hairs growning under my chin). Tumours have been excluded but still no wiser as to why. So just saying, keeping an eye on your testosterone levels is really important.
Ruby, this link mentions naturally higher testosterone readings in women after menopause. It’s a long webinar and I think it’s mentioned around the middle, thought it might be helpful:
https://www.menopause.org.au/hp/ams-webinar/use-of-testosterone-in-women
Victoria☀️
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Erika28.
Thank you for posting all the info, I really appreciate it and it will help me with my next GP apt. Your timing is perfect! Thank you!
Victoria☀️
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Hi Ladies,
I think as said , there probably has not been enough of indeed any significant studies on T replacement in women taking oral estrogen. I am curious as to whether women were generally given oral HRT years ago ( i think they were , by doctors and told take this it will make you feel better ) not really knowing much about it- and then supplemented with T also.
I suspect women were mostly on oral HRT and no one bothered to follow up or study what the effects were with T . I know it is about Free T etc , but not one professional has given me a straight answer to what the risks are - if any.
PMXX
There is a useful article here on T therapy in women (from 2013)
https://www.sciencedirect.com/science/article/pii/S0378512213000121
One of the references at the end of the article is a review on safety of T replacement but it's a bit out of date now - being from 2012 - but is still interesting. Scroll down to ref 6 - Maclaren and Panay.
Victory V - in terms of talking to your GP your best approach would be to read something recent/current such as I posted above, and look at the NICE Guidelines on menopause from 2015 which made provision for T to be prescribed off licence to women with low sexual desire, as well as the BMS guideline on T replacement - tools for clinicians which has probably already been posted on this thread but if not: https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/ or the information and links on this website here: https://www.menopausematters.co.uk/testosterone.php
pepperminty - re the risks of using oral HRT with Testosterone - I'm not sure what risks you are thinking of? I presume for example that say one was taking a high dose of oral oestrogen which led to high concentrations of SHBG, what are the consequences of this when you then take testosterone - so that levels are apparently high even though free T is low? ie what are the consequences of having that much T in the system even if the Free Androgen Index (FAI) is low? I think though that the recommendation to keep (total) T levels within the normal physiological range for women should prevent some concerns on that score (irresepctive of the FAI)?
Just thinking aloud here!
Nicky LD - how are you getting on - would be good to hear the outcome of your tests and change to transdermal HRT?
Hurdity x
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Hi Ladies,
I think as said , there probably has not been enough of indeed any significant studies on T replacement in women taking oral estrogen. I am curious as to whether women were generally given oral HRT years ago ( i think they were , by doctors and told take this it will make you feel better ) not really knowing much about it- and then supplemented with T also.
I suspect women were mostly on oral HRT and no one bothered to follow up or study what the effects were with T . I know it is about Free T etc , but not one professional has given me a straight answer to what the risks are - if any.
PMXX
There is a useful article here on T therapy in women (from 2013)
https://www.sciencedirect.com/science/article/pii/S0378512213000121
One of the references at the end of the article is a review on safety of T replacement but it's a bit out of date now - being from 2012 - but is still interesting. Scroll down to ref 6 - Maclaren and Panay.
Victory V - in terms of talking to your GP your best approach would be to read something recent/current such as I posted above, and look at the NICE Guidelines on menopause from 2015 which made provision for T to be prescribed off licence to women with low sexual desire, as well as the BMS guideline on T replacement - tools for clinicians which has probably already been posted on this thread but if not: https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/ or the information and links on this website here: https://www.menopausematters.co.uk/testosterone.php
pepperminty - re the risks of using oral HRT with Testosterone - I'm not sure what risks you are thinking of? I presume for example that say one was taking a high dose of oral oestrogen which led to high concentrations of SHBG, what are the consequences of this when you then take testosterone - so that levels are apparently high even though free T is low? ie what are the consequences of having that much T in the system even if the Free Androgen Index (FAI) is low? I think though that the recommendation to keep (total) T levels within the normal physiological range for women should prevent some concerns on that score (irresepctive of the FAI)?
Just thinking aloud here!
Nicky LD - how are you getting on - would be good to hear the outcome of your tests and change to transdermal HRT?
Hurdity x
Hi Hurdity,
thanks - the article above from 2013 is interesting - i read it quickly , but it seems to indicate that the majority of studies were done with oral HRT. Interesting.
I suppose the risks I'm referring to are the ones where the SHBG is high and therefore free T cannot be calculated. Although overall T can. I am wondering if SHBG is high does this have an adverse effect on taking T and if so how? As with a high SHBG less free T is available. Does this effect the replacement T getting in to do its job?
As the bioavailable testosterone is primarily determined by SHBG levels and is therefore highly susceptible to the many factors that affect SHBG levels, including obesity or exogenous estrogens. "
From what I understand you are saying is the total T should be in range even if SHBG is high and free T not calculable?
PMXX
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Hi All,
Thought I’d update you on my doctors appointments.
Changed to transdermal HRT (had one blood test) after 2mg oral HRT and another four weeks later. Doctors called me today and said estrogen was low and that I should increase dose of oestradiol 80mg gel from two pumps per day to four. I asked what the levels of estrogen were and she said 250 which was low. Is that the case? Four pumps per day seems a lot but I just felt like I didn’t have enough time to question further? Any words of wisdom? She said some people don’t absorb HRT and that could be a reason for tiredness. I’m a bit baffled. I get no hot flushes so would have thought that would have been a telling symptom at least but that’s now fine…. If anything I’m always freezing cold. Any advice gratefully received
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Thyroid?
I think 250 is low. Many women need 4 pumps to control symptoms, specialist told me up to 6. Might be wise to increase to 3 then 4 later on if you feel you need it.
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hi there - I would not say that 250 pmol/l is low. It is a healthy level for someone taking hRT but may be too low for some women. I doubt mine have been higher than this all the time I've been taking it - well maybe a bit more now since I changed to Evorel? They've only been measured a couple of times and yes it is how you feel that is more important and yes hot flushes and sweats are the most telling indicator symptom. However the dose that leads to the absence of these could be said to be the minimum dose necessary - and maybe all that many women need because other symptoms are improved at the same time.
Is this an NHS doc or private clinic? I know some private meno docs like women to have much higher oestrogen levels eg 300-400 pmol/l but I wouldn't necessarily say this should be a blanket recommendation - as long as you have achieved the minimum to protect against osteoporosis and to eliminate flushes and sweats. Far be it from me to suggest going against expert opinion!!
For other women, they need more than the minimum to have that feel good factor back (sometimes much more) - although we can't expect to feel as good as we did when fertile....maybe some would disagree! Some women also take very high doses when still fertile, due to reproductive depression.
If you are tired and always feeling freezing cold that points to a metabolic problem notably thyroid - especially if you are also putting on weight - though I dont know much about this ( Wrensong does though...).
Personally I would not increase your oestrogen without having this investigated properly first.
I cant see your posts about testosterone as I write this so can't remember if you started taking this but it hasn't made a difference?
Hurdity x
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Hi Hurdity,
I think you are probably much more knowledgeable that most GP's, sadly. It's not their fault, but there is such a misunderstanding which I am sure you are well aware of too!
I've not put on weight, in fact I've lost weight and kept it off in the last few years. Main symptoms are tiredness, very very dry eyes and I often wonder if it's the dry eyes that is making me feel tired IYKWIM and I'm always cold. My moods are up and down but I've had that for so long as I think that's normal. I've yet to meet a woman without fluctuating moods! Anxiety really does come and go too, some days it's much worse than other days.
I have no idea if this is the new normal or if things can be improved? I guess with decreasing hormones I'm not going to feel as sparkly as I did when I was 20! I might up the pump to 3 and see how I go. If it's too much, what side effects should I be on the look out for? Thank you so much, your advice is always so valuable and helpful. Testosterone was ruled out completely.
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Hi Ladies,
I think as said , there probably has not been enough of indeed any significant studies on T replacement in women taking oral estrogen. I am curious as to whether women were generally given oral HRT years ago ( i think they were , by doctors and told take this it will make you feel better ) not really knowing much about it- and then supplemented with T also.
I suspect women were mostly on oral HRT and no one bothered to follow up or study what the effects were with T . I know it is about Free T etc , but not one professional has given me a straight answer to what the risks are - if any.
PMXX
There is a useful article here on T therapy in women (from 2013)
https://www.sciencedirect.com/science/article/pii/S0378512213000121
One of the references at the end of the article is a review on safety of T replacement but it's a bit out of date now - being from 2012 - but is still interesting. Scroll down to ref 6 - Maclaren and Panay.
Victory V - in terms of talking to your GP your best approach would be to read something recent/current such as I posted above, and look at the NICE Guidelines on menopause from 2015 which made provision for T to be prescribed off licence to women with low sexual desire, as well as the BMS guideline on T replacement - tools for clinicians which has probably already been posted on this thread but if not: https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/ or the information and links on this website here: https://www.menopausematters.co.uk/testosterone.php
pepperminty - re the risks of using oral HRT with Testosterone - I'm not sure what risks you are thinking of? I presume for example that say one was taking a high dose of oral oestrogen which led to high concentrations of SHBG, what are the consequences of this when you then take testosterone - so that levels are apparently high even though free T is low? ie what are the consequences of having that much T in the system even if the Free Androgen Index (FAI) is low? I think though that the recommendation to keep (total) T levels within the normal physiological range for women should prevent some concerns on that score (irresepctive of the FAI)?
Just thinking aloud here!
Nicky LD - how are you getting on - would be good to hear the outcome of your tests and change to transdermal HRT?
Hurdity x
Hurdity- The link you posted for 2013 and T therapy is by Rebecca Glaser. She is very well respected and written many studies on Testosterone therapy for women. Her work came about as a result of treating breast cancer survivors who couldn’t have estrogen hrt and were also taking aromatase inhibitors and consequently suffering from severe menopause symptoms.
Her work over two decades made her realise that menopause symptoms could be treated with testosterone mono therapy.
There are about 5 studies done by her and they make interesting reading.
Unfortunately though, this can, for many many reasons, only be achieved by implants.
This is a route many women take in the states and is very successful under the right practitioner.
How could this ever be achieved cost effectively in the UK!
My view is that the cost to the nhs for the treatment of menopausal women in so VERY many ways, by FAR exceeds the cost of 3 implants a year, expertly trained practitioners and
some other support systems.
Unfortunately none of this is likely to happen in the short term but in the meantime I would encourage individual research into Rebecca Glaser’s work. We owe it to future generations to be as informed as we can. That’s what helps me keep going forward like all you dear people. xx
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The increase to four pumps has made me feel really really sick and my boobs are so sore, so much so I’ve only had one extra dose and won’t again. My full bloods seemed to be fine so that would rule out thyroid. I’m back to square one thinking testoesteone would help yet that’s not an option presumably because that level was normal, so guess I have to feel like this forever! I could honestly cry!
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Why don't you try increasing really really slowly to avoid initial start up effects. Eg go up by one half of a pump for a week or two then another half?
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NickyLD. So sorry your feeling grim.
The always cold can be either thyroid or adrenal issues. I’ll send a link in a minute.
What were you thyroid test results, did they do the full panel? Hopefully Wrensong will be along if you post your results.
The testosterone tests are very unreliable and you have to go by symptoms. Libido, energy etc. Dry eyes are linked to testosterone deficiency. Will see if I can find the article xx
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Here it is!
https://www.wellnessresources.com/news/body-temperature-thyroid-adrenals-or-something-else
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Nicky, the dry eyes, tiredness & loss of mojo you mentioned earlier in this thread all make me think as you suspect, that testosterone may be what's missing from your HRT, so I'm sorry to know this has been refused. Did they tell you what your testosterone level is?
I spent some time researching HRT in relation to dry eye syndrome a couple of years ago when my pre-existing dry eye condition worsened after oophorectomy & suspected the loss of T was responsible. There is research suggesting that androgen deficiency is implicated in the development of dry eye but seems it's not straightforward & more research is needed. You may find the following article interesting, though I'm afraid it's rather long. I've scanned it this morning & pulled out some extracts but for balance probably best to read the entire article if you have time & inclination. The bottom line seems to be they think it's an imbalance between the sex hormones that's important in dry eye - a relative deficiency of androgens, as confusingly apparently the high androgen state found in PCOS is also associated with dry eye.
Anyway, link to article below & if you do feel you might benefit from adding in some T & your level was not found to be high, is a menopause clinic referral an option for you?
Wx
https://onlinelibrary.wiley.com/doi/full/10.1111/cxo.12147
"Androgens impact on the structure and function of the meibomian and lacrimal glands and therefore androgen deficiency is, at least in part, associated with the aetiology of dry eye.
Loss of androgen support to the meibomian and lacrimal glands reduces the volume and/or stability of pre-ocular tears, decreasing the rate of tear turnover, increasing tear osmolarity and prolonging the exposure of the ocular surface to debris and microorganisms
In contrast, oestrogens appear to promote such inflammatory processes in the meibomian gland,14-16 ocular surface epithelia17, 18 and possibly the lacrimal gland;15, 19, 20 however, the role of oestrogen in dry eye is complex and remains unresolved.
The meibomian gland is an androgen target organ and its function is, at least in part, regulated by androgens.57, 60, 62, 68 Low androgenic activity may result in meibomian gland dysfunction, compromised meibomian gland secretions and therefore, evaporative dry eye . . .
Inherently lower levels of circulating androgens in women compared to men and the age-related reduction in gonadal androgen production in both sexes52, 73 may contribute to increased risk of dry eye in these populations.
The presence of oestrogen and progesterone receptors in the meibomian glands of human and various animal species suggests that this tissue is predisposed to the influence of female sex hormones.60, 94, 95 The influence of oestrogen on the meibomian gland appears to antagonise the actions of androgen, with resultant effects on suppression of lipid synthesis and promotion of meibomian gland dysfunction and thus evaporative dry eye.15 The antagonistic effects of oestrogen may help to explain the exacerbation of signs and symptoms of dry eye in post-menopausal women using oestrogen replacement therapy; however, the direct influence of oestrogen and progesterone on the human meibomian gland is yet to be understood . . .
. . . it may be the reduction in androgen action, rather than increased oestrogen action per se, that is responsible for the higher prevalence of dry eye in women. This provides a plausible explanation for the increased frequency of dry eye in post-menopausal women despite the cessation of ovarian oestradiol production.
The lacrimal gland, like the meibomian gland, is a target organ for androgens,104 which have a significant influence on the sex-related structural, functional and pathological characteristics of this tissue.50, 105, 107, 111 A reduction in androgen influence with autoimmune disease such as Sjögren's syndrome, results in inflammatory changes in the lacrimal gland, which leads to aqueous-deficient dry eye.
Dry eye in women has been attributed to their relatively low levels of serum androgen, which has anti-inflammatory effects on the ocular surface.
Current evidence indicates that it may be an imbalance of relative levels of androgens, oestrogens and progesterones in the circulation that triggers (or once triggered, alters the outcome of) inflammatory processes within the ocular structures of the lacrimal functional unit and forms the basis for the pathogenesis of dry eye."
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Nicky - I see also there's a query as to whether a thyroid condition could be implicated given your tiredness & coldness (dry eyes can be a feature too). As Marchlove suggested if you have concerns about this could you perhaps post your TFT results (inc ref range)?
Should have said earlier - if you are not on artificial tears, please do ask for these to be prescribed. Not just for day to day comfort, but Ophthalmology advice is that it's really important to keep on top of the dryness as much as poss to prevent damage to the cornea & nerves in the long term. They should be preservative-free for long term use. I've been through various over the years but the most effective of late have been Optive Plus which help if there is Meibomian gland dysfunction, protecting the tear film from evaporating too quickly.
Another thought & sorry this is really simplistic, but if you've lost weight, lack energy & are inordinately cold, is there any chance you are not getting enough calories?
Wx
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I sympathise Nicky - after 3 years of estrogel/utro my estradiol blood levels are a measly 110 and a well above the reference range SHBG means I'm not absorbing the hormones I take. I do take testosterone and while the total number is within the reference range, my bioavailable "free" testosterone is very low so really it's as if I didn't take it, just like the estrogen.
I too am always cold, underweight (BMI 17), chronic fatigue, brain fog, loss of muscle despite regular working out, thyroid numbers normal.
I'm tearing my hair out as the Chelsea 7 Westminster meno clinic follow-up after ordering my blood tests is a ridiculous 5 months and my GP doesnt want to know.
As someone who has never had a hot flush or night sweats I also think hrt management of less typical symptoms is far less understood - I think the majority of doctors don't have a clue frankly.
I will probably DIY it with an increase in estrogel or perhaps see if GP will deign to switch me to patches.
Otherwise I'll have to go private which I'm ideologically against but needs must.
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I feel this way about going private too. I’m a single Mum with a teenage boy (also probably part of the issues to be fair), I pay for prescriptions and am facing an NI hike already so quite frankly I can’t afford to go privately. I can’t only just make ends meet as it is. It makes me so cross that meno conditions are so easily dismissed. I’m not eating particularly ‘well’ I have to say, I’m so exhausted at the end of each day it’s just become another ‘chore’, but my BMI is normal so I wouldn’t say it’s crossed my mind before now. I’m certainly not restricting food, just got into a cycle of probably not eating what my body needs at the moment, so will have to revisit that and try and make better choices. I got fed up of throwing good food away with an exceptionally fussy teenager in the house. I thought testoesterone was the missing link. I can’t do four pumps though it made me feel horrendous immediately and sick which then makes me not want to eat much….. and so the cycle begins again. Thanks for your support ladies.
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Hi Nicky, just a quick post re going private. I am with you, decent treatment should be properly available, but when the waiting time is 19 weeks (as it is in my case) and the GP doesn't send the referral off for 4 weeks, you start to look at other options.
I'm seriously considering using a company called Health and Her. It looks to be three female GPs based in Shropshire who do video consultations and then send you a recommendation letter for your GP to prescribe. A half hour is £135, which is about half of the next cheapest that I've seen. That's not to say it's cheap, but potentially more affordable.
I'm in Scotland so will check with my GP first to make sure they will prescribe on the basis that the directive comes from a meno specialist. That's possibly worth doing wherever you are, but since these ladies are GPs you have to assume it works. A quick search seems to verify their credentials , but there's a sad irony when GPs set up a company to fill the gap in treatment of something that affects 50% of the population.
I hope things start to look up for you soon, and it's clear from the replies here that you can count on the support of the lovely ladies on this forum
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Thank you for replying.
The libido aspect I can cope with it’s the general zero get up and go that’s the issue. Unless I have somewhere to go I really struggle with motivation and feeling generally low, but not depressed if that makes sense. Can a GP really not help without a private referral? That’s a bit shocking in itself
Hi Nickyld, just wanted to say I have had really low energy but due to having rheumatoid arthritis they thought it was solely that but I insisted on full blood check and I was low on testosterone. I’ve started on it and it’s definitely helped with the fatigue.
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I have been prescribed testosterone by my GP without seeing a specialist. I’d been on HRT for 4 mo this with an improvement in some symptoms but not libido.
I read up on it, saw the NICE guidelines said could be prescribed off licence if HRT hand t worked and so thought I’d ask. My GP was up for it and prescribed my Tostran. It’s early days for me to know how much impact it’s going to make if any, but it’s not been instant!
So I had a good experience in accessing it, BUT I did experience my GP getting the doses wrong and telling me to take the male dose! That was due to it being not licensed for women, so women’s dosages not popping up on the screen and them having to look it up and clearly not going to the right place for women’s dosages. It highlighted to me the benefits of things being licensed, plus also why GPs are reluctant to prescribe off licence. My GP tried to help me, but made a bit of a mess-up. I queried the dosage politely rather than launching a complaint, but I know GPs worry about being sued and until testosterone is licenced for women, lots will be reluctant to prescribe and there will be uneven access or problems with wrong prescribing.
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Chocolate Wombat
Three cheers for your doc being willing to prescribe but woeful ignorance about dosage. This is very clearly set out in the BMS guidance but a non-specialist GP may not be aware of it. However s/he really should not be prescribing it if s/he hasn't read up on dosage for women.
In case you haven't seen it here's the link:
https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/
You might like to politely let your GP have this for future reference!
Hurdity x
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Hi
Hope it's okay to jump in here. I've been on Evorel and Utrogestan since Feb 2020 and after a few ups and downs, I think I have my prescription right. However, I've recently become extremely tired/fatigued and foggy-headed, finding it really hard to concentrate on anything and whereas before, I'd come home after work feeling tired, I'm now feeling tired all throughout the day. So I'd like to try putting testosterone into the mix to see if that helps. My own surgery told me already that they don't prescribe testosterone for women, but I noticed that I can buy it online from Superdrug. Is that a wise thing to do? Thanks for any advice you can give. Zx
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Don't buy over the counter initially: ask for a referral to a menopause clinic where testosterone can be prescribed via your GP. Also, how is your VitD level, that can cause over all tiredness. Let us know how you get on.
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Because I am an untidy person I found the article by Dr Julien Helen Nash, The Times, 5 Feb.. Retired GP, Bridgenorth, Shropshire
Further to your reports in Times2 (Feb 3), menopausal women need testosterone as well as progesterone and oestrogen.
Women produce 5 times more testosterone than oestrogen and like oestrogen levels, testosterone levels decline during the menopausal years.
Testosterone is vital for maintaining optimum brain function, muscle mass and bone health, as well as libido.
Unfortunately, testosterone replacement therapy for women is not widely available on the NHS in England and where it is available, GPs seem reluctant to prescribe it because they have been taught during medical training that testosterone is a male hormone.
Attitudes towards female testosterone need to change through education and access to testosterone for menopausal women needs to be universal.
Testosterone is a female hormone and women need to claim it.
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Hi CLKD - thanks for your response. I do take quite a strong dose of Vitamin D daily and have done for quite some time, so I don't think it can be that, although I guess there could be other vitamins or minerals lacking. Good advice, I'll call and ask for a referral to the menopause specialist, I didn't do that because I was assuming they'd say the same thing about no testosterone, but maybe not. I had to wait almost a year for the menopause specialist appointment during Covid, so hopefully it will be a bit quicker now.
Oh, just spotted your other post from Dr Nash - gosh! I didn't realise we produce more testosterone than oestrogen! That's interesting. Definitely will get on to the specialist and will keep that info for reference.
Thanks again. Zx
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Hurdity, yes, I have gone back to the GP about this. I initially sent a message via an online message the surgery thing outlining my concern that an error might have been made and seeking clarity and mentioning the BMS site and it’s guidance.
Disappointingly the first response (probably from office person not medic) was to speak to the pharmacist for clarification.
I messaged again to point out this was prescribed off licence so a pharmacist wouldn’t be able to over-ride what GP said, and anyway, the instructions given to me were purely verbal, with the level reading ‘as directed’
Next reply from surgery simply asks me to make another appointment.
They didn’t seem to have any great concern that I might be taking an off licenced product incorrectly or an error was made. Disappointing. Lucky for me, I have been taking the correct dose, but really it is important for me to hear that info from the GP. I will also be asking to have a 3 month blood test to ensure my testosterone levels remain within female normal range. There was no mention of this when I was prescribed.
I feel that the NHS has prescribed me the right stuff and of course I’ve got it without consultation fees or private prescription charges, but a bottle that will last nearly a year for £9.35. BUT, I’ve had to work hard myself to plug the gaps - that’s been through internet research and forums like this. I’m happy to do that but am very aware not everyone is able to do this and so the system promotes health inequalities.
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Wrensong, the info about dry eye is fascinating. Thanks so much for posting the article. This is just one of my symptoms and I'm currently being investigated for sjogrens and lupus, but whilst waiting for my rheumatology appointment to come through I've been reading around the whole subject. Although I have a lot of auto-immune symptoms and my bloods are indicative of lupus, reading up on it makes me feel it's not quite the right diagnosis. The conclusions of this dry eye article are definitely something to discuss further with my GP / rheumatology. Again, thanks so much for posting.
I've only been on HRT for a couple of months now and although my hot flushes and other vasomotor symptoms are much better, I've experienced a number of side effects. Also, my anxiety, which initially responded really well to HRT, is now back with a vengence and frankly I feel massively depressed. My brain fog is so disruptive - I loved arithmetic at school and I've got a science degree, but last week I couldn't manage my 3 times table (decided that 3 x 3 was 16!!!!). I'm not post menopausal yet, and my libidio has only dropped since starting HRT, so I'm not confident of managing to get a testosterone prescription, but I will raise this with my GP.
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Peana - is the depression cyclical?
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Hi CLKD, I've been trying to work that out, but am stuggling to reach a conclusion. My periods have been very irregular for years, and now I'm on the mirena coil I have spotting for more days than not. I've been keeping a log, but I just don't really know. My gut tells me that it probably is, but I've been really low for over a month now with very few brighter days. Just hoping that the longer I'm on HRT, things will start to settle and I'll get a better picture (3 months on Mirena, just over 2 on estradot patch). What's annoying is that on my lowest days I sometimes lose the will to record my symptoms properly, so my data isn't as good as I'd like.
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I suggest that you get some appropriate medication, some do require HRT as well as anti-depressant and/or anti-anxiety support. Once U begin to feel better which may take 8-12 months+, you can wean off the ADs.