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[Marchlove]

Here it is!
https://www.wellnessresources.com/news/body-temperature-thyroid-adrenals-or-something-else

[Wrensong]

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."

[Wrensong]

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

[laszla]

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.

[NickyLD]

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.

[Evangelista]

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

[Shottlebabe]

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.

[ChocolateWombat]

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.

[Hurdity]

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

[Zar]

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

[CLKD]

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.

[CLKD]

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.
[/i]

[Zar]

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

[ChocolateWombat]

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.

[Peana]

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.