Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Gizmarelda on June 29, 2022, 03:45:25 PM
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Hi all
I'm on HRT and managed to get an appointment with a menopause clinic who arranged to test my testosterone levels. I called for my results which are:
Testosterone - 0.3
Sex Hormone Binding Globulin - 79
Does anyone know what the numbers mean? I stupidly didn't ask for the type of measurement those numbers relate to and it took ages to get through on the phone so I don't want to call back. I'd like to know if my testosterone is low and whether they are likely to prescribe me any. I've been googling for ages and can't work it out.
I have a call with the clinic next week but I'm impatient to know!
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Hi,
I've posted something similar this morning. My level is 0.5. No idea if that's low enough for them to give it to me.
Hopefully someone will come along soon and enlighten us!
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Yes, those are very low figures. Even more important than the total testosterone is the free androgen index (FAI), essentially the testosterone that isn't bound to the SHBG.
There's a FAI calculator here https://www.mdapp.co/free-androgen-index-fai-calculator-370/ (https://www.mdapp.co/free-androgen-index-fai-calculator-370/) - yours will certainly be low.
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My specialist and others say that FAI or free testosterone should be between 2-5%, yours is 0.3 based on those numbers so that’s incredibly low. Mine was 1.4 and I struggled with energy, concentration, memory etc and a little with libido but less of a problem.
The issue with getting a prescription is that there is little research on testosterone and the effects of low levels on women, most research and focus is on men and their libido only. So the NHS may prescribe it to women but with only for low libido and they tend to make you look at other things first. Privately I do purchase testosterone and it probably had more of a positive difference to my life than estrogen but maybe because exercise was a big part of my life that’s more specific to me personally. I do think it’s important, based on what I’ve read, for all of us to have good testosterone levels. You must be struggling with such low levels.
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Interesting, thanks. I don't know if 0.3 is a percentage or some other measurement. I basically have no sex drive which is why I asked for the referral.
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OK wow I just checked that calculator and you're right it is very low. I'm sort of pleased to find that out. As well as low libido I'm feeling a lot less clever than I used to be and lacking motivation generally.
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Sorry to piggyback on this thread, but my results show testosterone only (0.5), there's no mention of any other things that you've mentioned.
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There’s total testosterone, which sadly often is all the NHS give you, there’s SHBG- sex hormone binding globulin- and then from those two you calculate what is ‘free’ and able to be used by your body, known as the FAI- free androgen index. There’s no point just telling a patient their total testosterone. In menopause total goes down and often the SHBG goes up. If you’re on thyroid medication of any kind then that raises your SHBG and unfortunately will usually mean a low free testosterone. Despite taking testosterone I struggle to get it up a bit because of the thyroid meds. I was never told when I was put on thyroid meds that would happen to my testosterone either!
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Thanks ATB, so given the only info I've got is that my testosterone level is 0.5, is that low & is it low enough for my gp to give me testosterone? We've discussed it , hence the blood test. Follow up call tomorrow with him.
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For those saying it's low, do uk tests use the same method of reporting? (like the difference between micrograms and milligrams) So my level couldn't be 30 rather than 0.3?
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It’s nmol.
The FAI is a percentage, so you wouldn’t be 30% or you’d be very very high and really know it. You’re aiming for 2-5%
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Jellyb a private doctor would likely put you on testosterone with those levels but the NHS as far as I know prescribe based on the symptoms of low libido only. It really depends who you see
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ATB, yes the discussion I had with my GP was about that, hence the blood test. So, based on the 0.5 result, do you think he will prescribe? Have follow up call with him tomorrow to discuss the result so I'd like to be well informed first if possible. Thanks.
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Thanks ATB.
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Jellyb the guidelines GPs follow are to prescribe if you have symptoms of low libido. If they ordered the tests and told you the result would determine the prescription then it is low so more likely. It really depends on the GP. It’s possible but not common.
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Had an interesting call with the doctor from menopause clinic.
She confirmed my testosterone is low but said that the evidence doesn't really show support for supplementation working. She said it was no better than placebo. She's prescribed me some but she was pretty clear that in her view it did nothing beyond placebo. Well not totally nothing. I think she said if you have zero sex drive and zero sexual thoughts it gives you on average 1 more sexual thought a month. There's no evidence at all it helps with brain fog or anything like that. She thought Davina had done women a disservice by letting them think it was a miracle cure.
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I found this which is interesting
https://utswmed.org/medblog/libido-testosterone-women/#:~:text=The%20maximum%20length%20of%20the,demand%20a%20drug%20for%20treatment.
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The linked article links to the ‘research study’, which is in fact a meta analysis of existing studies, all 3- 6 months long. That’s not really very helpful given the time it takes hormones to balance and optimise. There also wasn’t enough research and it was only on libido. A lack of research doesn’t mean it isn’t something women should have. For me, if there’s a lack of research I look for what women are saying. I also believe that it’s not wise to assume women can experience a drop in any hormone and not have it impact them. It makes sense if we made it at certain levels that it would impact us should those levels drop. Our bodies make it for a reason. For some that impact is noticeable and perhaps difficult, so trying replacing it and observing the impact of that seems sensible. I think women should be trusted when they say that they feel better taking it, indeed that is the first and most important part of medicine. To listen to the patient about what is happening in their body and how they feel.
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I agree. And I'm going to take it! It was interesting that she wasn't that enthusiastic though.
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Hi Gizmarelda
Testosterone tests are unreliable for women - whose readings are at the low end of the scale and are not needed in order to prescribe it. However testing is indicated once you've started T to make sure you remain within the range for women, and will give better resaults once T in increased.
Also what HRT are you on - is it tablet or transdermal? Tablet HRT can reduce free T and affect libido, and some anti-depressants ( and other medication I think) can also depress libido so if you are taking any of these - this would be the first thing to look at before supplementing with T.
Also how old are you?
Re T efficacy - she is wrong there (as far as I recall) - the Intrinsa patches which used to be licensed for women were shown to be efficaceous - more than just 1 sexual thoyght per month (!) otherwise it wouldn;t be worth prescribing. I have the product monograph somewhere saved to my computer I think. with the scientific data but haven;t looked at it for a few years.
Was she a menopause specialist doctor? I would be asking her for the references to her assertions about T.
Do have a read of this from British Menopause Society:
https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/
... and I see from that the advice has been updated and it says here:
"It is recommended that total testosterone levels are checked before treatment to establish a baseline for future monitoring and to ensure that levels are not in the upper range before treatment is commenced."
So that sounds sensible - but not because the test needs to be used as a basis for prescribing. ie a different reason for testing.
What T has she prescribed and what dose?
Hope this helps :)
Hurdity x
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There’s total testosterone, which sadly often is all the NHS give you, there’s SHBG- sex hormone binding globulin- and then from those two you calculate what is ‘free’ and able to be used by your body, known as the FAI- free androgen index. There’s no point just telling a patient their total testosterone. In menopause total goes down and often the SHBG goes up. If you’re on thyroid medication of any kind then that raises your SHBG and unfortunately will usually mean a low free testosterone. Despite taking testosterone I struggle to get it up a bit because of the thyroid meds. I was never told when I was put on thyroid meds that would happen to my testosterone either!
That’s really interesting- I’ve been on thyroxine since my early 20s.
I’m trying to decide whether to chase testosterone privately or wait for nhs. It sounds like nhs may not measure correctly? My Gp said she had prescribed it but that the women often hadn’t got on with it. But obviously I’ll have to prove I’ve maxed my oestrogen first.
I’m now on 75 and not entirely sure if it’s doing much more (yet!). Zero libido. 134 oestrogen when I was on 50 patches. Feels like it’s going to be a long road!
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Re testosterone not being useful- I was reading it’s been used for pain in fibromyalgia and also for men with cfs as well as an off label treatment for long covid (with oestrogen for women.) it wouldn’t surprise me to find that a lot of cfs patients, often women, who often get better with pregnancy, are lacking key sex hormones.
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Thanks Hurdity that's really useful!
I'm on estradot and continuous utrogestan (as I have severe endometriosis).
I'm 44 and have been peri since 40 but only started HRT last October - usual story of being told I'm too young and just needed antidepressants! I didn't take the antidepressants.
I've had surgery for the endo affecting both ovaries which probably kicked off a slightly earlier peri.
She's the specialist in the menopause clinic near me (big city). To be fair I didn't have to push for it - she said it was fine to take but not to expect miracles. I supposed she could have put off others less determined to give it a try.
I need to check what she's given me. I only picked it up today! Actually the type she initially prescribed is out of stock all over the UK so my lovely pharmacist sorted a different one.
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It's testogel I've got
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There’s total testosterone, which sadly often is all the NHS give you, there’s SHBG- sex hormone binding globulin- and then from those two you calculate what is ‘free’ and able to be used by your body, known as the FAI- free androgen index. There’s no point just telling a patient their total testosterone. In menopause total goes down and often the SHBG goes up. If you’re on thyroid medication of any kind then that raises your SHBG and unfortunately will usually mean a low free testosterone. Despite taking testosterone I struggle to get it up a bit because of the thyroid meds. I was never told when I was put on thyroid meds that would happen to my testosterone either!
@atb sorry to ask so late after you’ve posted; does this mean I’ll
Struggle to get testosterone levels up if on thyroxine ?
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Hello ladies.
I was also told that my Oestrogen levels needed to be higher before I could add testosterone. I did notice some changes with T but I didn't have the fabulous response that some women report.
I have since reduced my Oestrogen due to bleeding etc and I have consequently stopped altogether and haven't noticed much difference.
I am also on Thyroid meds and this was never mentioned as a likely problem.
As ever I suspect that hormonal balance is the key and obviously testosterone plays it's part in that.
Wishing you well ladies.
K.
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Sorry to re visit this thread after so much time; Kathleen, what level did your Gp want oestrogen to be up to before starting testosterone?
I’ve been prescribed and have started but slightly worried oestrogen should be higher
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There’s total testosterone, which sadly often is all the NHS give you, there’s SHBG- sex hormone binding globulin- and then from those two you calculate what is ‘free’ and able to be used by your body, known as the FAI- free androgen index. There’s no point just telling a patient their total testosterone. In menopause total goes down and often the SHBG goes up. If you’re on I thyroid medication of any kind then that raises your SHBG and unfortunately will usually mean a low free testosterone. Despite taking testosterone I struggle to get it up a bit because of the thyroid meds. I was never told when I was put on thyroid meds that would happen to my testosterone either!
@atb sorry to ask so late after you’ve posted; does this mean I’ll
Struggle to get testosterone levels up if on thyroxine ?
Replying to my own thread!
I’d been on continuous utro x200 and 125 patches, plus testogel.
Something happened about 3 months in and the testosterone really kicked in..! Levels were too high (and I could tell from too high a libido but it was weirdly boring if that makes sense!) and also thyroxine was too high.
I’m now on half the testosterone dose and lowered my thyroxine to the lowest level in 20 odd years.
I read that testosterone can alter t4/t3 ratio’s positively (studies in transgender meds unfortunately so not in appropriate female doses). So weirdly it may have somehow helped? My brain is almost back.
I’m a little worried that I’ve dropped both and could slump. Im also now bleeding fortnightly so need to do something there.