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[Lily102]

I moved to Oestrogel (2 to 3pumps) and utrogestan 100 11 days ago and so far I'm doing reasonably well. Some days of massive energy and some days of stress in my throat. I'm taking utrogestan continuously not sure if this is okay as I think I still have my own period..my periods started when I was 19.

  I moved from Fem 2/10 which seemed to stop working about 6 months ago.
My new symptoms were poor sleep, poor concentration, fatigue, agitation and a feeling of stress in my throat area( cortisol, adrenaline overworking??). I had more sweating at night and hot flushes but those systems didn't bother me so much.

I was busy with work so decided to stick with fem 2/10 (better Devil you know even if not perfect!)until I had more time to try a new treatment. I had that time in August.  All the female doctors have moved away from my surgery so I had to self diagnose. Through the articles here I deduced oestrogel and utrogestan would be best. I started HRT in Dec 2017, evorel 50 sequi for about 6 weeks and then Fem  1/10 and then 2/10 within a month or two. I'm 53 at end of the year so 48 when I became aware of peri symptoms. Looking back I think I had symptoms at 47.


During my research I saw recommendations for Testosterone so decided to try to get that whilst I had the time to research it..I found a private doctor (called around 20 doctors!) who prescribed it and my GP approved it. I now have a tube of tostran but have not used it yet as I think i might not need it. If I don't use it I will loose the prescription on the NHS. It took a lot of time to organise so I'd like to hold on to the right to have it via the NHS especially given lots of women say it's really beneficial for energy and other stuff. To get Tostran I stated my Libido was on the floor. This is not true.

I'd appreciate advice on this.

Thanks

[VanillaLover]

Tricky. Are there things you’d still like to improve with HRT? The anxiety feeling?

I understand both not wanting to rock the boat as it were but also wondering if the testosterone could be giving you further improvements you are currently missing out on.

I am in a similar boat as I’ve had blood tests which show testosterone very low BUT I am getting along OK at the moment. I could get my (NHS) consultant to prescribe it if I wanted though. I’ve decided to stick as I am for now.

Bear in mind that you “could” try the testosterone and then stop using it if you don’t feel there are any benefits!

[CLKD]

Why add hormones if your body doesn't require them?  It is recommended to take HRT for at least 3-4 months B4 considering testosterone. 

It seems strange to me that a GP would approve testosterone if you sought advice without speaking to him/her first.  GPs can't prescribe without a Specialist's advice, usually through a menopause clinic.

Some find that keeping a mood/food/symptom diary of use to chart progress.  Personally I wouldn't add too much - you won't know what is working otherwise. 

[Lily102]

Thanks Ckld and Vanillalover.

Yes the anxiety (cortisol, adrenaline hormones??) feeling is what I'd like to remove but Testosterone might just add to that symptom..I agree that it's best to try one thing at at time though I am probably going to move from utrogestan to mirena coil in a few weeks.


I'd rather hold out but hate the idea of losing the prescription and maybe not getting it again when it might benefit me significantly. It took me a month (waiting for blood tests, doctors appointment, etc) to get all this sorted and im.hoping to go back to work in next month so won't have the same time to organise all this. I purposely organised all while I had the time off. I'm hoping someone will reply who has been in the same situation, took Testosterone where libido was not an issue.

The Consultant (menopause expert) recommended testosterone because I said I had libido issues.

[laszla]

I would get my testosterone measured and if your FAI (free androgen index) is lower than the recommended minimum then I would certainly take testosterone. For me, if I'm taking HRT, I'd want to have optimal amounts of hormones not just for the immediate term but also for the longer term.

[CLKD]

You told a lie.  Of course a specialist giving advice should have taken blood tests to ensure whether a patient (male or female) requires testosterone which is why going privately where medication is 'for sale' as such, may not give a true picture of the patient's requirements.

Some ladies never require testosterone.  Thus far in over 20 years I've fortunately not needed HRT at all.  Certainly I wouldn't add a male hormone in quantity until I'd trialled female replacement for 3-6 months.  Unless symptoms were severe.  If you mix too many replacements you won't know what is/not working.  Why worry about 'losing a prescription'  .  If the specialist agrees that you require it and has written to your GP why would there be a problem in future 

Blood tests are reliably unreliable 

[Cookie25]

Hi Lily

The tostran pump lasts for months using the small amount that will have been prescribed for you, therefore my thinking would be that it would be a long time before you gp would expect you to ask for a repeat. So you'll have time to try your other hrt first if you prefer to wait.

It takes about 3 months to kick in but a lot of ladies feel it's the missing piece they've been looking for and gives them far more benefits than just libido.

Have a think but if your bloods indicate you need it then you'll likely feel a benefit.

Cookie
Xxxxx

[margherita]

You told a lie.  Of course a specialist giving advice should have taken blood tests to ensure whether a patient (male or female) requires testosterone which is why going privately where medication is 'for sale' as such, may not give a true picture of the patient's requirements.

Some ladies never require testosterone.  Thus far in over 20 years I've fortunately not needed HRT at all.  Certainly I wouldn't add a male hormone in quantity until I'd trialled female replacement for 3-6 months.  Unless symptoms were severe.  If you mix too many replacements you won't know what is/not working.  Why worry about 'losing a prescription'  .  If the specialist agrees that you require it and has written to your GP why would there be a problem in future 

Blood tests are reliably unreliable 

For any women out there wanting accurate information, testosterone is categorically not a 'male' hormone: women produce about three times as much testosterone as oestrogen, while men also produce oestrogen.

There is no such thing as 'male' or 'female' sex hormones, simply different proportions of the same.
As for blood tests being 'reliably unreliably', this is not the case once the transition from peri to menopause takes place, at which point plasma levels of hormones give a reliable picture of levels, with significant variations highly unlikely (as they might be in peri).

[Hurdity]

To add to the comments.

There is vastly insufficient research into the use of testosterone in women though it obviously performs a wide variety of functions in the human body including women.

However, the NICE guidelines recommend its off-licence use solely on the basis of low libido, not blood tests, despite other effects  of low T. My view though is that libido (especially in terms of response as well as desire) may well be the first symptom to indicate that testosterone may have declined - as an indicator - and therefore if your libido is fine - personally I would say don't take it, you don't need it. You did obtain it under false pretences - in the sense that you misled the consultant. I'm not judging you for that because prescribing HRT can be so difficult and prescribing practice can be so variable across the UK, so I understand, but practically - I would say, leave it at this time.

The British Menopause Society has produced a useful page "Tools for Clinicians" on prescribing Testosterone which may be useful (CLKD you might like to have a look too!  )

Regarding blood tests - testing T is not required in order to prescribe adding T simply because blood tests for T ARE unreliable - not because they are hugely variable (although they are likely to be during peri-menopause) but because the test is designed for the much higher T levels of men, and so at the very low end of the scale, are inaccurate for women (so I understand).  Libido is given as as the indicator - although this can be reduced by other things eg oral HRT and certain anti-depressants. Testing T is recommended once T replacement has begun, only to ensure that T remains within the range for women so there must be some accuracy at raised levels ( for women).

The purpose of the Female Androgen Index is as a proxy measurement for free T of which libido is another. I agree it would be interesting to determine this though as I said, if your libido is fine then low T is probably not the answer.

You haven't said where you are in menopause though you said you still get your own period. This being the case you should really be on cyclical progesterone. Also if your own cycle is happening alongside the HRT then some of your symptoms may be due to this - can you keep a diary to see if there is any pattern to these in relation to your bleeds etc? I would focus on this first. Some of your symptoms may be due to taking continuous progesterone.

Re Mirena coil - I'm not sure there is any research into T replacement with Mirena as the progestogen. As far as I know ( and I haven't looked recently), the research that has been done is when T is replaced alongside bioidentical cyclical HRT (as in estradiol and progesterone). This was the case as far as I recall for the Intrinsa patch - the only licensed widely available T replacement for women which was only on the market for a very short time (I'm a bit hazy about T implants!).

I hope you soon manage to resolve the symptoms that are still bothering you.

Hurdity x

[Lily102]

Thanks Hurdity, that's really useful particularly the point about the fact that you think reduced libido might be maybe the first sign of low testosterone.
My libido has dropped significantly although it is not totally gone so my description to the consultant hasn't been totally incorrect. My libido was never on the high-end. I'd say on a scale of 1 to 10 I was 6 and is now  3 to 4.

Your point about cyclical is  interesting. I moved to continuous because I read somewhere (not on this site) that if  you've been on HRT for at least four years or if you are age 55 then you could go on continuous. I'm 53 in November and became aware of perimenopause symptoms 5 and a half years ago. I think they actually started a year before that so I've been perimenopause for 5 and 1/2 and 6 and a half years..I started HRT 5.5 years ago. Fem 2/10 didn't seem  to work so well from the beginning of this year and it gave period pain (plus diarrhea and being sick) from the second years onwards. I never had period pain before this, just mood swings and tiredness. This was another reason to want a change.

On the mirena coil it's interesting that you say you're not sure if it has a testosterone component. This may be why a lot of people taking oestrogen gel with the mirena coil are also taking testosterone. I'm having the mirena coil inserted in a few weeks so there may be then a need for testosterone given libido is also reduced albeit not non existent.

[CLKD]

Tnx Hurdity.

Would you suggest adding T if libido OK and oestrogen works well as the heading in the subject line? 

[laszla]

I was never asked about libido when prescribed T at the meno clinic at Chelsea & Westminster, nor did I volunteer any information on the subject (same when one GP briefly prescribed it to me). I was also given a blood test for it before starting the course at the clinic.

Undoubtedly my libido was impacted by peri/menopause but so were various other factors that the consultant told me (and has publicly stated) are impacted by T such as energy, wellbeing, bone/muscle strength and stamina. The BMS is a pretty conservative outfit and I am much more swayed by the input of leading researchers and clinicians.

For me wellbeing is much more of an overall feeling and libido not simply a matter of purely genital impulses - generally speaking the sense of the word has strayed a great deal from Freud and especially Jung's much more extended definition of libido as psychic energy, life force, one might call it a lust for life.

The proof is also very much in the pudding and T has definitely made a difference to how I feel generally in that elusive entity we call 'wellbeing' (though nothing has yet managed to counter the vile effects of progesterone in the 10 days I take it for).

[Hurdity]

Hi again Lily

If your libido (in the broadest sense) has dropped significantly then you did not obtain the T under false pretences and on that basis I would suggest starting it as per prescription though lower dose to start with!

I would also return to taking hRT cyclically  - maybe even try this first - because progesterone has such a sedative effects and dampening effect on libido generally. Yes you can go on continuous HRT at a certain stage but tht doesn;t mean to say you have to. I am late 60s and still take it cyclically - bit downside is having to put up with a withdrawal bleed - really not fun at my age but what can we do if we want to continue with HRT and maximise well-being? Personally I would hold off having a Mirena for the time being if you can - if only to try out either changing to cyclical progesterone, and starting T replacement - you really don't want to change too many things at once.

Re Mirena and T replacement - there is some work done on levonorgestrel and T and relative affinity of SHBG for both (levonorgestrel  is the prog in Mirena) - but I'm a bit hazy and don't have time to look up. Main point is that levonorgestrel  is a tesosterone derived progestogen so likely will have some effect on T and free T available in the body?

Laszla - I'm curious why you say BMS is conservative? I would say the opposite in that they go far beyond the licensed products and doses - notably in their Tools for Clinicians, for Testosterone and progestogens. In addition their recommendations are most definitely based on reviews of (the latest) studies by "leading researchers" and they regularly review and modify their recommendations as research develops (though there may be a lag).

Personally I am not necessarily swayed by and would tend to be cautious or wary of clinicians if their advice is not evidence based, or based on scant evidence.

Interesting point about libido. Whilst I am a big fan of T replacement ( having taken it for over 7 years) many women actually find that increased oestrogen alone gives that sense of well-being that may diminish around menopause. Years ago on this forum we used to talk about the difference between minimum oestrogen required to alleviate flushes and sweats, and the amount needed for well-being, and we used to bemoan the general lack of oomph and zest for life that happened post-menopause and the need for more than minimum oestrogen levels to return this (though never seemingly at the same level as when fertile!).

Although I did not distinguish in my post on this thread, I do normally emphasise that libido decline (and positive effect of T replacement) can be the desire as well as the response ( which probably come under your term "genital impulses") and that actually it may not necessarily help both. For me it is the latter rather than the former.

Lily - do keep us in touch with what you decide and the outcome - and definitely keep a diary as you change your regime!

Hurdity x

[Lily102]

Thanks Iaszla and Hurdity for that additional information.

I'm going to have check back and see where I read suggestions to move to continuous HRT. My main reason for changing was that Fem 2/10 didn't work so well plus I wanted to avoid the awful period pain. And the move to continous was influenced by what I read. I hadn't read broadly enough on the tiredness aspects of progrestone.

Hurdity, I'm glad you've mentioned tiredness as I'm feeling that 15 days in but I think it was the same with fem 2/10 over the last 4 to 6 months.
Extra information that might be useful to people on similar treatment
-----------------


My first 5 to 7 days on Oestrogel was amazing. First 4 days 1 dose, way too low given I was 2mg on Femoston, then 7 days 2 doses, still lower than fem, last 4 to 5 days 3 doses which is 2.25mg. Felt like I was in 30s again for first 9 days but now I'm back to how I was with fem 2/10. I'm guessing this might be the progesterone. Or maybe it's unrelated and I have a bug of some sort. I'm tracking symptoms..moved from agitation to tiredness low energy and mood.

I'm tracking these symptoms daily.


Yesterday I pushed myself to run 3 miles and felt better for a few hours but then tired again. I then went for another 2 miles late in the day but didn't feel great. Exercise can sometimes bring my energy up. Physical stuff is easier. I'm an accountant but reading is so much harder. 


At least I have options.

1. Add T to Oestrogel and utrogestan
2. Stay with Oestrogel but change to coil for at least a month. I think 1 month will give  good indication if coil works.
3. Add T to Oestrogel and coil
 4. Move back to fem 2/10 and add T

I think I'll go for option 1 to start with and maybe today tomorrow. I'm holding out because I should probably try the new regime on its own for at least a month. 3 months seems a long wait.

[Gnatty]

I think option 1 sounds like a good plan