Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Clarella on June 05, 2022, 08:38:19 PM
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I have a review tomorrow and I’ve been really struggling.
Oestrogen was marked borderline last week at 134 Pmol/l (day 3) so I’m assuming I can go up.
I can feel some of the positive effects, hardly any hair loss is one! So I dread to think how low it had been. I’m still having periods but they’re v light and have been much lighter the last two months.
Main symptoms are joint issues, pain and weakness, exhaustion and loss of any drive, let alone any sex drive. A little brain muddled at times, not as bad as I was. And not as bad as after covid recently. Vulva quite sore the week after my period.
Will I need to trial higher oestrogen level before testosterone?
As oestrogen gets converted to testosterone, when oestrogen is raised could my own testosterone levels raise again naturally?
What might be negative side effects? I don’t want to loose the hair I’ve regained!
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This post got missed. Not sure if you had an answer in any of your other posts. I haven't come across research that shows oestrogen is converted to testosterone if you add it in the form of HRT, although it is all part of the same steroid synthesis pathway. I haven't looked recerntly though!
Normally, ideally yes HRT would be given to restore oestrogen levels before trying testosterone. Also transferring from tablet to transdermal oestrogen can also increase free testosterone.
So the answer is that, as far as I know, it would be unlikely for testosterone levels to increase naturally when you add oestrogen. Not sure that there is much research on this though?
I would increase your oestrogen over a few cycles and see how you feel. If some of your symptoms resolve and you have more energy etc but still no sex drive/libido at all then T might be the answer. Some ADs also reduce sex drive.
Hurdity x
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I’m on Androfemme testosterone cream and my doctor put me on it about 8 weeks after starting estrogen via gel and then patches. I felt the most difference when I added that, to my energy, ability to exercise & build muscle, concentration and memory… I didn’t have a major libido issue before although it had been a bit affected. I have not noticed any negative side effects of testosterone.
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I was given testosterone from the very start by my Newson doctor so I think they are revising the idea of starting with just estrogen now and beginning everything together.
It helped me A LOT with brain fog, memory, concentration, focus etc and energy/strength. It is supposed to also help with joint pain although that symptom can take a bit longer than others to improve - i have that too. I've not had any negative side effects from testosterone except for a few spots when I first started it, which have settled down now. You shouldn't lose hair as long as you stay within the appropriate female amounts and you'll have a blood test after 3 months to be sure you are.
With the sore vulva, you probably need to get some Vagifem (internally) and some Ovestin cream (externally) - these are local estrogen to get to those tissues faster. You can take both those together and alongside systemic HRT. Lots of women do. (I do.) It's such a tiny tiny dose and it doesn't get into your system, it just affects where you put it.
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Most doctors want your oestrogen levels to be optimal before considering testosterone which will have to be prescribed by a specialist. Some people find their libido returns with sufficient oestrogen though I needed testosterone too. Your other symptoms are far more likely to be due to oestrogen deficiency so I would suggest you resolve that first.
Newson is not always right, she seems to start everyone on a high oestrogen dose and we've seen on here some people suffer because it's too high.
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I don’t think they start everyone on the same dose? I was started on 2 pumps.
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I don't think she starts everyone on a high dosage?? I was started on 25 which is about as low as you can get.
I think the thinking that you should wait for estrogen to settle before starting testosterone, will be old hat soon. Just like the 'have 3 days off continuous progesterone' idea.... The world is way behind where it should be on all this because so little has been invested in research and using it for so long...
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There is a reason for the 3 days off too, it allows a bleed if there's been a build up and can be useful particularly in late peri/early meno. Though I agree it's unlikelytto be necessary once settled on it in meno.
There's also a lot to be said for the idea that you change one thing at once so you know what effect it has and if you have side effects you know what's caused it. If you'd started on oestrogen you'd have known which of your meno symptoms were cured by oestrogen and which by testosterone.
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Thank you all so much for your replies.
Gp didn’t seem too confident prescribing nor that the women who had tried it were keen as it was ‘messy and smelly as designed for men.’ ??? She favoured get the oestrogen right.
She also said she’d prefer blood levels of 600. I’ve no idea how a patch confers to levels but if it’s below 200 on 50 I can’t see 75 doing much?
Having said that I’ve had to use x2 25s and cut up 1 and a half 37s due to stock shortages over the last 3 months. I’ve no idea if that’s been an issue. (Estradot)
She’s otherwise been good. I’ve gone up to 75 with a review in 3 mo - already notice the difference after 4 days actually and pain is much, much less. I’m able to stretch tight joints without more pain and have more energy. She prescribed ovestin - but it’s out of stock everywhere.
libido went downhill particularly in the last two months. I dropped thyroxine by 75 a week; this didn’t seem to impact tsh at all somehow but I do feel that is better and it’s the oestrogen side I need to tackle.
I will endeavour to get back into some strength and hitt training at home and see how I go before either seeking more oestrogen or asking for testosterone.
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She did mention that she thought the care for women re testosterone needed to be looked at more by the nhs. She told me about the female version of testosterone but said it was currently private. So I feel she is aware but is working within what she feels more comfortable with. (She said I could use utrogestan vaginally from the start so is good.)
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I was given testosterone from the very start by my Newson doctor so I think they are revising the idea of starting with just estrogen now and beginning everything together.
It helped me A LOT with brain fog, memory, concentration, focus etc and energy/strength. It is supposed to also help with joint pain although that symptom can take a bit longer than others to improve - i have that too. I've not had any negative side effects from testosterone except for a few spots when I first started it, which have settled down now. You shouldn't lose hair as long as you stay within the appropriate female amounts and you'll have a blood test after 3 months to be sure you are.
With the sore vulva, you probably need to get some Vagifem (internally) and some Ovestin cream (externally) - these are local estrogen to get to those tissues faster. You can take both those together and alongside systemic HRT. Lots of women do. (I do.) It's such a tiny tiny dose and it doesn't get into your system, it just affects where you put it.
Joziel - interested in this - I started on Androfeme 10 days ago - have a few tiny spots - could have happened anyway, and a few dark facial hairs - again, could have happened anyway ...interesting that this cleared up.
Also - how long for brain fog and other mental symptoms to clear - I haven't felt that yet.
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It was quite quick, probably about 1-2 weeks for the brain/head symptoms to go.
It took about a month or so for the spots to appear. I only had 3 of them, but they were those kind of big red ones that don't get a head to them(!) and take ages to heal and go away again!! No spots now, so I must have gotten used to it. My FAI and testosterone levels were perfect according to my GP so I'm supposed to keep taking what I'm taking now.
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Clarella, your joint aches, exhaustion, lack of motivation may well disappear once your body restocks estrogen. Unfortunately that can take a few months. You might find that your libido returns without Testosterone! The beauty of not starting several treatments at once is that you’ll know which treatment makes you feel good. For me, after a lot of trials, I now know what works for me to keep my energy up and that brings a lot of relief!
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I have been given testosterone straight away without my oestrogen levels being tested which I assume are really low because of how I am feeling
It really is amazing how everyone is treated differently dependent on their Dr/Consultant
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Clarella, your joint aches, exhaustion, lack of motivation may well disappear once your body restocks estrogen. Unfortunately that can take a few months. You might find that your libido returns without Testosterone! The beauty of not starting several treatments at once is that you’ll know which treatment makes you feel good. For me, after a lot of trials, I now know what works for me to keep my energy up and that brings a lot of relief!
Thanks, I really hope so! It’s a bit up and down at the moment. But not even a week into the 75 patch. I have a lot of weakness and pain in joints and I couldn’t cope with a short run yesterday at all.
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The main point about all of this is that:
1) there is no licensed testosterone product for women available in UK (as stated Androfemme is very expensive and ony available on private prescription)
2) the NICE Guidelines make provision for the use of testosterone (preparations designed for men) OFF-LICENSE for low libido and as far as I recall for women in whom standard HRT has not restored this.
3) Also need to bear in mind that oral oestrogen, and some anti-depressants also can depress libido so changes may need to be made here before adding testosterone
4) As far as I know there are NO studies investigating the use of exogenous testosterone (using the products made for men) in women for menopause - and this is woefully inadequate (please correct me if I'm wrong). Really we should not be having to use these products anyway - we should have our own gel product at appropriate concentration that does not rely on judging pea-szied blobs of testosterone products of different dose concentrations. It beggars belief that these studies are not being carried out nor that a product is being manfactured (maybe it is and studies have begun?)
5) There was once a patch called Intrinsa which was licensed and withdrawn some years ago - and there were studies carried out before licesning - but we really need long term studies now....
In the meantime it is understandable that many GPs are uncomfortable prescribing it and especially for primary indications other than libido, however efficacious this may appear to be at first hand.
Something needs to be done! (we've known this for some time - and discussed it in 2011 soon after I first joined the forum)
Hope this helps
Hurdity x
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Thanks Hurdity, I agree!
I was reading the Newson leaflet about testosterone. It’s interesting that they’re linking long covid with testosterone.
I looked up links to testosterone and cfs and it does seem that it can be given to men with cfs and also a small amount of research into testosterone and fibromyalgia.
I don’t think there’s anywhere near enough research into impact of female testosterone and also perhaps cfs, ME and long covid.
Is it true that they tend to prescribe testosterone more in France? Or even prefer it over oestrogen? I’ve heard that second hand so may not be true.