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[Jaz]

I am 58 and guess in post Meno. Had Hysterectomy 2007 kept ovaries and started HRT 2013   Elleste tablets  then patches 2016. Had really good results although high dose needed, then symptoms returned 2019 and started being prescribed Testosterone under Meno clinic.
My pre reading was T 0.7 and 48 SHGB. I’m was on Tostran 1 pump every other day but after few months levels taken again and T was 3.5 and doctor wanted it to be under 3. So reduced T dose - recent bloods show T 2.9 SHGB:30 Oestrogen 316.

However doctor states its a bit high for my age adjusted Free Androgen Index  and to either stop taking T or reduce to 1 pump a week.
I understand from this forum FAI is calculated by T 2.9/30 SHBG x 100. Does that mean my FAI is 9 and is this above the acceptable range?

My symptoms are very up and down at the moment, my estrogen levels use to be much higher (between 500-800) on same dose of patch I have 75 x 2 Evorel Patch per week when available or Estradam MX.
I am going back to Evorel now As in supply to see if that makes a difference. I’m not sure T made a huge difference but my symptoms got better now worse again.
I find after a few years whatever I am on symptoms come back- when will this finally come to an end?

PLease help advise especially regarding FAI
Jaz

[Uptick]

Hi Jaz, your testosterone levels are a bit high and your FAI is 9.67, which is above the range for women, but I wouldn't be worried if you're not showing symptoms of excess androgen like oily skin, acne, excess facial/body hair, deepening of the voice, low libido and changes in mood. Yes, high testosterone levels can lead to low libido. I guess it's wise to reduce to 1 pump a week and see how you feel.

[Hurdity]

Hi Jaz

Please look at this post I've just done about this very topic - but the opposite end of the spectrum. I have put two links there - one for the reference ranges and the other from the British Menopause Society - Tools for Clinicians - which discusses T replacement in women.
https://www.menopausematters.co.uk/forum/index.php/topic,51122.0.html

In contrast to the previous poster I would indeed be concerned about your levels and the FAI being that high - if this is accurate. I would ask for a repeat test. Are SHBG and total T measured using the same units? With testosterone it is no good just to go by symptoms and lack of obvious virilisation - because this is the male dominant hormone so not the sort of thing one can happily tweak and no harm done.

I always thought alternate day one pump Tostran was too much. The first advice from Chelsea and Westminster menopause clinic was for 2 pumps per week of Tostran rising to a max of 3 although this has since changed.

I use the scientifically determined "pea-sized blob" (!) if 1 % Testogel per day and started off with a lentil sized blob.

I really would not take this lightly but be sensible and look to retesting and then reducing your T. Also think of getting the Testogel (or Testim) 1% sachets if possible - you then just squeeze a bit out and fasten with paper clip....

Hurdity x

[Jaz]

Hi Hurdity
Thank you so much for your response, its been really helpful. I use to be on Testogel pea size blob but my meno Consultant thought Tostran pump was better as more accurate to dispense. Having said that I use half pump so still not exact dose.
I have emailed my consultant to find out exactly what my FAI was and given her my calculations. Initially she said everything was fine with blood test, then said after looking at full report it was a little high for my age.
She does seem very busy and I noticed a difference when I saw her (for my first appointment) in her private clinic to how she responds now in NHS Meno clinic- rushed off her feet no doubt.

I’m hoping going back to Evorel patches may also help with symptoms as seems better absorption and stick well compared to Estraderm MX.
Thanks Again
Jaz xx

[Jaz]

Hi Jaz, your testosterone levels are a bit high and your FAI is 9.67, which is above the range for women, but I wouldn't be worried if you're not showing symptoms of excess androgen like oily skin, acne, excess facial/body hair, deepening of the voice, low libido and changes in mood. Yes, high testosterone levels can lead to low libido. I guess it's wise to reduce to 1 pump a week and see how you feel.

Thanks For your response
I was sweating more than usual and had greasy skin and occasional spot which I only had when younger, so this was definitely due to T. Now I’ve reduced dose its not so bad. My hair has been falling out for a long time and still just as bad but no bald patches. It’s interesting what you have said about high T leading to low libido- not heard that before.
Mine use to be high when I started Evorel patches but more erratic now. I’m hoping starting back on Evorel will help with all my symptoms which is mainly sleep disturbance, low mood and anxiety but very up and down. It’s a shame because I was doing well for years then symptoms came back after getting stressed about something and been erratic since.
I’m going to have more blood tests in two months to review everything again.
BW
Jaz x

[Uptick]

Why are you having sleep disturbance? Is it down to anxiety? I hope you feel better on Evorel. Keep us posted when you have your blood tests results.

[Sammiejane]

hi ladies

need advice

i take one pump trostan every other day my hair has to be falling out way before starting trostan , however i recently increased my estrogen gel back to 2.5 pumps from 2 and daily p from alternate days p as felt this suits me better however on the higher dose estrogen i was noticing increased sweating of armpits groin not flushes just sweating even if it raining but i was also on tesosterone so wasn’t sure what was causing it so i stop tesosterone but it remained hence me lowering the dose of e and p but i felt awful so roll on now 2 weeks on higher dose been on tesosterone about 6 weeks but i found with tesosterone it gives my sweat onion smell i feel more anxious when i take it and heavy chested like palpitations but more like aniexty building my hair seems dryer and wouldn’t say skin oily or extra spots but wonder if i’m getting to much i am due to have bloods after being on it 8 weeks and last level was 1.1 but i had taking t for 2 weeks but my estrogel i apply to arms as wasnt obsorbing on thighs but my last level was 1238 pmol which is in higher end i wondering whether to change to patch as still have odd flush and hair loss ever since starting hrt thought it was imbalance so added progesterone tesosterone even though had hysterectomy but made no difference but i did stop hrt 9 weeks last year and hair stopped shedding but it also causing hairline to recede all around two lots loads nape of neck which i don’t think is normal x any advice welcome

[Jaz]

Hi Sammiejane
Your oestrogen levels- 1238 pmol sound vey high. I didn’t know you could apply gel to arms.
I use patch and only ever stick it on bottom, although I have high dosage, I need it to absorb.
I was told wouldn’t advise it being higher than 800 pmol. 

Jaz x