Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: sheila99 on October 12, 2023, 01:34:25 PM
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I have to see the gp tomorrow because of my testosterone blood test results.
serum testosterone 2.3 nmol/l range <1.8
Serun sex hormone binding glob 56.4 range 12-166
Free androgen index 4.1 range <5.1
Can anyone shed any light of on this please? I'm afraid they'll take me off it and I'll be back to pulling muscles and wetting myself along with zero libido.
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I think you're just a little bit over, so reducing to every other day should be fine - not totally stopping.
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Just state how great you feel on it and that it has improved your quality of life etc.
State that you have had no side effects except positive ones, and that you understand the risks and benefits. It is all about shared decision making.
Suggest you will reduce slightly if needed .
PMxx
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Thanks for your replies. I'm so relieved, they've agreed to issue my prescription :)
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Sorry I missed this and good that you didn't have to battle!
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Hi sheila
So glad all is well but it is good to be monitored. At that end of the T scale it is difficult to get accurate results anyway and as you know testing just gives as spot result for that moment in time, so your reading may well be very different if it was taken again. How often do you apply it and what do you use?
In any case the other readings were within range thugh I gather that FAI is not necessarily taken as the key parameter now - though I am not well up on it. I am sure you are aware of the BMS Tools for Clinicinas paper on T replacement in women (which can be accessed on this page: https://thebms.org.uk/publications/tools-for-clinicians/) but here is what it says on measurements:
What should be measured?
• Total testosterone levels provide a more accurate representation of therapeutic response than
free testosterone, or the calculated Free Androgen Index (FAI).
• Free testosterone assays are not recommended, as correlation with biological activity of free
testosterone has not been confirmed.
• Recent evidence suggests that not only free, but also some protein bound testosterone may
be bioavailable, and also that not all free testosterone is biologically active.
• Assessment of the proportion of total testosterone binding to SHBG, albumin and other
proteins e.g. by FAI may not give an accurate reflection of testosterone which is available to
activate testosterone receptors and, by extrapolation, influence clinical response.
* In day-to-day practice, assessment of clinical response to testosterone supplementation in
women i.e. HSDD benefits and/or androgenic adverse effects e.g. excess hair growth, acne,
should be of primary importance, supported by data for total testosterone, measured by
liquid chromatography-mass spectrometry, in preference to FAI or free testosterone.
• The aim should be to achieve total testosterone levels within the normal physiological range
for women using the laboratory reference range where the test is carried out.
• In certain circumstances, SHBG levels may be helpful as additional supportive information:
— Where SHBG levels are high e.g. due to high dose oral estrogen therapy, especially
conjugated estrogens. This may explain lack of therapeutic response to physiological
testosterone replacement, despite normal total testosterone levels.
— Conversely, when SHBG levels are very low. This may explain why androgenic adverse effects
with testosterone replacement have occurred, despite normal total testosterone levels
Interestingly in that paper it recommends at least annual review of T replacement but at my surgery it is never reviewed and nor is any of my HRT!
Hope this helps!
Hurdity x