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[Emzib0b]

Hello, I’m back again with more questions (sorry!)

I’ve been taking HRT for 6 months (25mg Evorel for the first 3 months moving up to 37.5mg and cyclical Utrogestan). I’m 40, been in peri for at least 2 years. I believe adding testosterone could potentially help how I’m feeling. My libido has been waning for years to the point where is completely non-existent. I’ve also having been having problems with memory, focus, motivation, low mood, anxiety, poor sleep, fatigue (I’ve had Chronic Fatigue Syndrome for 12 years and I’ve felt even worse since starting peri!). I have a GP HRT review tomorrow. I feel like my Oestrogen has dropped in the last month as my period is late and I haven’t even had a Utrogestan withdrawal bleed. My mood, which had stabilised since increasing the Evorel from 25mcg to 37.5mcg in April has been through the floor in the last month. I’m going to ask about testosterone as well but suspect the answer will be no!

I listened to a podcast yesterday where Drs Louise Newson and Zoe Hodson were discussing testosterone. They mentioned checking one’s local Clinical Commissioning Group’s prescribing formulary re testosterone.

I have had a look at my area (Central Lancashire) and I found the following statement:

“BLACK (rag) rating for female sexual dysfunction following oophorectomy or ovarian failure.”

I looked at what a black rating meant and found:

“NOT recommended for use by the NHS in Lancashire. Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need.”

Does this mean that my GP or a NHS menopause specialist will not prescribe testosterone, and even if a private menopause specialist writes to my GP and recommends it, their hands are still tied?

[CLKD]

It's the 'local need' that bothers me  .  How local might local actually be?

You could ask your local Pharmacist what the protocols are in your area or speak to a Nurse Practitioner at your Surgery.  Let us know how you get on. 

[Dotty]

A GP doesn’t have to prescribe it. Some will and some won’t . If you get it prescribed by an NHS menopause specialist then the GP should then prescribe it. If it’s prescribed by a private menopause specialist then your GP may not prescribe.

[BohoChick]

I would just say - if you are on HRT (like me) and you are still feeling awful (like me) - please see a good doctor and advocate for additional tests.

I recently returned back to my old gynecologist after doing a "tour" of alternative gynecologists in my area for the past ~15 months and coming to the conclusion that none of them were as good as my original gynecologist (the irony).  In addition to my annual pap and exams etc., she strafed a whole bunch of bloodwork.  This bloodwork was meant as a "starting baseline" for potential HRT pellet therapy in case my levels came back and we determined that - for whatever reason - my body was not absorbing from the estrogen patches (hence I was still feeling terrible).

Results come back - my body IS absorbing the estrogen patches and my estrogen levels are great.  However, I have high thyroid peroxidase antibody levels (TPO).  My body is eating its own thyroid alive and it is HIGHLY likely that I have some sort of autoimmune disorder, potentially Hashimoto's.

Awaiting referral to endocrinology now.

Good luck.

[Emzib0b]

It's the 'local need' that bothers me  .  How local might local actually be?

You could ask your local Pharmacist what the protocols are in your area or speak to a Nurse Practitioner at your Surgery.  Let us know how you get on.

A GP doesn’t have to prescribe it. Some will and some won’t . If you get it prescribed by an NHS menopause specialist then the GP should then prescribe it. If it’s prescribed by a private menopause specialist then your GP may not prescribe.

CLKD - I know what you mean! I would have thought there was already a local need!

Dotty, thanks for the clarification regarding prescriptions from NHS vs private specialists.

I had my HRT review today. I’ve been moved up to 50mcg patches so hopefully this might help. I asked the GP if she could clarify the local area’s rules on testosterone prescribing.

She said the surgery is not allowed to prescribe it, even if a specialist recommends it - the specialist themselves has to prescribe it - but whether they can depends on their own prescribing rules!

The closest BMS registered NHS Meno clinic is in Liverpool. I learned yesterday that Liverpool lists testosterone as ‘Amber’, so my GP said she would do some digging into whether she can refer me out of area to Dr Paula Briggs and if so, what the waiting list is like.

As I mentioned in one of my other posts, I’m considering going to a private clinic if there’s going to be a long wait on the NHS. At least I now know I would have to pay for the testosterone privately if that is the case.

[Emzib0b]

I would just say - if you are on HRT (like me) and you are still feeling awful (like me) - please see a good doctor and advocate for additional tests.

I recently returned back to my old gynecologist after doing a "tour" of alternative gynecologists in my area for the past ~15 months and coming to the conclusion that none of them were as good as my original gynecologist (the irony).  In addition to my annual pap and exams etc., she strafed a whole bunch of bloodwork.  This bloodwork was meant as a "starting baseline" for potential HRT pellet therapy in case my levels came back and we determined that - for whatever reason - my body was not absorbing from the estrogen patches (hence I was still feeling terrible).

Results come back - my body IS absorbing the estrogen patches and my estrogen levels are great.  However, I have high thyroid peroxidase antibody levels (TPO).  My body is eating its own thyroid alive and it is HIGHLY likely that I have some sort of autoimmune disorder, potentially Hashimoto's.

Awaiting referral to endocrinology now.

Good luck.

Hi BohoChick,

I’m so sorry to hear you’ve been feeling so awful. I hope you get access to treatment and relief soon!

I had tests for full blood count, liver/kidneys, thyroid profile, FSH/LH and Prolactin levels in March. All were normal except for raised FSH, LH and Prolactin. The Prolactin has since come back down to normal. I’ve never had my thyroid antibodies tested. My red blood cell count and Haematocrit have been slightly below normal for the 13 years I have been at my GP practice. Haemoglobin is always at the very bottom end of normal and has been below normal a couple of times. One GP told me it’s nothing to worry about and is to be expected in menstruating women! I’m struggling to believe that all menstruating women are going about their lives with borderline anaemia! I have often wondered how much more energy I would have if my levels were further into the normal range.

Hope you feel better soon x