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[jenny44244]

Hi all, I went to my doctor about low libido during menopause. She said she won’t prescribe any testosterone unless I up my oestrogel dose to six pumps (I’m currently feeling fine on just one pump) Is this correct? I’m 47 and have Mirena and the oestrogel.

[CLKD]

GPs in the UK aren't allowed to prescribe testosterone, 1 has to go through a menopause Consultant I believe.  So that's your next step, ask for a referral sooner rather than later as there are waiting lists both privately and in the NHS.

If your regime is OK don't add anything else.  Six pumps seems a huge amount and what would that achieve, did she explain or is she clutching at ideas? 

[jenny44244]

Thanks for your reply. She does prescribe testosterone but only if women are on six pumps of eostrogel (if that’s the oestrogen they are using) She didn’t explain, I probably should have asked! I can’t find any guidance online about the six pumps.

[CLKD]

MayB put 'here we go' - a thread by Hurdity about her journey with testosterone and ask the question there. I"ll bump it for you [if I can find it  ]

done : testosterone, here we go - it's long, get those feet up with a cuppa 

[Hollyboll]

My understanding (tho’ there are others far more expert) is:
- gp’s are allowed to prescribe testn, tho many are reluctant and only do it for low libido
- it’s important to get enough oestr first for reasons I don’t know, tho I’ve seen it said on here it’s because otherwise the oestr gets converted
- but that does NOT mean excessively high oestr. I’ve heard it said go on symptoms and when others (eg thermoreg) ok then testn good.

I’ve never been on gel, but 6 pumps sounds a lot. If other symps are good I wouldn’t be increasing personally.

What I do know for sure / from my own different (& very difficult) journey is 2 things:
- too much oestrogen can cause huge problems, both symptoms now and longer term risk.
- a lot of GPs and likely some consultants talk a lot of nonsense.

There are ‘leading’ ie famous pvt GP clinic that pushes up oestrogen for everyone, and has basically now been reprimanded by the BMS. Unfortunately because the clinic’s all over social media and press, many GPs follow them. Mine included. That said, even that clinic recommended testosterone before they started pushing my oestrogen way above licence/ recommended.

If it were me, and deferring to more expertise here, I’d:
- ask Gp why - have they actually explained?
- if i felt good apart from libido on current dose, not increase oestrogen. I’ve learned this the hard way and it almost killed me.
- if you want to try testosterone once you’ve heard Gp and anything here, say fine yes ok, get the scripts and keep on with your current pump, start on a low dose of testosterone (does take a while to build) and have some spare oestrogen/ longer before I need to ask for next script. They can’t force you to put 6 pumps and have no way of knowing.

But maybe that’s just me …

For certain sure though, anyone who suggests going from 1 to 6 pumps is not someone who understands hrt. Gradual is critical when changing dose.  I’ve been incredibly lucky to have ended up (because of truly terrible journey including oestrogen pushed up too high and too fast by well known clinic) with a leading meno consultant and he is adamant about this.

Rant over. Good luck! X

[CLKD]

MayB read the details at the top of the Forum, white on pink "Treatments" .

[Nik2502]

Rubbish! Six pumps is 150mg oestrogen.
My GP prescribed testosterone for low libido rather than menopause (same thing if you ask me!). Or try Superdrug. They prescribe too.

[Hurdity]

Hi all, I went to my doctor about low libido during menopause. She said she won’t prescribe any testosterone unless I up my oestrogel dose to six pumps (I’m currently feeling fine on just one pump) Is this correct? I’m 47 and have Mirena and the oestrogel.

Hi jenny44244

This is crazy! 6 pumps is way above even the highest dose.

I did have to go privately initially to get testosterone but that was before the original NICE Guidelines came out in 2015 and since then have had it from regular GP  on NHS - admittedly a gynae specialist. I was on medium dose patch of 50 mcg!! Didn't even discuss testing my oestrogen levels.

Unfortunately there is no way of persuading a doc who is reluctant as there is no licensed T preparation for women but since your GP will prescribe it I agree I would ask her for the rationale behind that, if you feel up to it, stating you do not wish to take that high a dose of oestrogen since you are fine on your current dose.

I have never read any satisfactory answer to the answer that tesosterone will get converted to oestrogen if oestrogen is not high enough, but that is a different issue from wanting to ensure your oestrogen levels are high enough to reduce or eliminate the most troublesome symptoms of menopause - at least the ones that send most women to the doc for HRT ie flushes and sweats - which stands to reason anyway. The last thing women want is to become testosterone dominant - a trned that happens anyway during and after menopause when oestrogen levels drop more quickly than T levels.

You are right about guidelines - the latest BMS Guidelines from 2022 only recommend that HRT is given before considering T replacement, but nothing about dosage or levels, so where she got that from is anybody's guess.

Potentially you could have an e-mail consultation with Dr Currie and ask her a question (£30) but I do't know what her stance is on T replacement and the information on this website is very general. She may well though refer to the BMS Guidelines, and then you could show this to your GP?
https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf

Good luck with this and do let us know on this thread, what the outcome is.

Hurdity x

[Hollyboll]

Rubbish! Six pumps is 150mg oestrogen.
My GP prescribed testosterone for low libido rather than menopause (same thing if you ask me!). Or try Superdrug. They prescribe too.

The stupid UK NICE guidelines say testosterone only for libido.  So with an unco-operative GP, it's easiest just to say libido.   

[CLKD]

Nik2502 - How R superdrug able to 'prescribe'  - they R a pharmacy not a GP surgery 

[Hollyboll]

Hi all, I went to my doctor about low libido during menopause. She said she won’t prescribe any testosterone unless I up my oestrogel dose to six pumps (I’m currently feeling fine on just one pump) Is this correct? I’m 47 and have Mirena and the oestrogel.

This is crazy! 6 pumps is way above even the highest dose.


I have never read any satisfactory answer to the answer that tesosterone will get converted to oestrogen if oestrogen is not high enough, but that is a different issue from wanting to ensure your oestrogen levels are high enough to reduce or eliminate the most troublesome symptoms of menopause - at least the ones that send most women to the doc for HRT ie flushes and sweats - which stands to reason anyway. The last thing women want is to become testosterone dominant - a trned that happens anyway during and after menopause when oestrogen levels drop more quickly than T levels.


Potentially you could have an e-mail consultation with Dr Currie and ask her a question (£30) but I do't know what her stance is on T replacement and the information on this website is very general. She may well though refer to the BMS Guidelines, and then you could show this to your GP?
https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf


Hurdity x

As always, Hurdity put this more articulately than I.
- Thermoreg symptoms / flushes etc should be stabilised first with oestrogen, as it sounds like yours are (I never had a hot flush ever until I was put on masses too much oestrogen but I still had to get OK with oestrogen for a few months first before testosterone)
- 6 pumps is beyond ridiculous for someone who's feeling generally good except for libido.  And as I said NO doc should be recommending you go from 1 to 6 without very good reasons (such as evidence of low absorption) and other than very very slowly. 

[Hollyboll]

Rubbish! Six pumps is 150mg oestrogen.
My GP prescribed testosterone for low libido rather than menopause (same thing if you ask me!). Or try Superdrug. They prescribe too.

There are also some pvt clinics that do testosterone-only appointments.  BUt either of these you'd have to pay for scripts.  If you get it from your GP obvs you don't

Let us know how you go ...

[RebJT]

Hey

I'm on it privately, my gynae didn't argue, way before I was on 6 pumps.  My sis in law has a tricky GP so buys it from superdrug (but it was prescribed by a specialist initially)

From a quick read of the BMS menopause guidelines (not the NICE guidelines) I think the rationale is sufficient E usually helps libido, hence wanting to try a sufficient dose first (6 pumps sound totally mad though as that's also an unlicensed NHS dose)

Women's health concern on the BMS statement on Testosterone in women https://www.womens-health-concern.org/2023/03/bms-statement-on-testosterone/

BMS on testosterone https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf

Hope that helps.