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[Mandee]

Hi all,
I am 52 years old and started having menopause symptoms early in 2012 feeling sleepy all the time. Had blood test and gp said hormone levels were showing I was starting the menopause.
I asked him if I could try testosterone as the libido was non-existant so he referred me to a gynaecologist who prescribed Testogel at a quarter sachet daily in October. Within a few weeks all the sleepiness disappeared and the libido went right up, my mood was really great as well. This continued for all of the next year but then it just stopped working, periods stopped as well and sleep trouble came back. I wasn't on any other hrt at that time so I assumed my hormones had suddenly dropped, stopping the gel from working.
My gp started me on Evorel Sequi 50 patches in December 2014 and the libido returned in a few weeks and periods restarted. The libido disappeared yet again a few months after in April 2015. My periods were getting closer together. Meno doc changed patch to Evorel 75 along with utrogestan 200 vaginally for the first 12 days of the month. There was a bit of an improvement in libido for a time but not for very long. I am still on this same regime.
I have never suffered from hot flushes or anxiety/mood problems and the bleeds are pretty regular now, starting around 10 days after Utrogestan course ends. Sleep is poor during bleeds which can last up to a week and are a brown colour and light.
I have asked my gp to have hormone levels checked but he just keeps saying the tests are unreliable yet others on this forum have them done, can't understand this. My hormones are obviously way out of balance but I'll never know how to get it sorted if I can't get them tested. My gp doesn't monitor me in any way, not even a blood pressure test, unless I ask. If I have a query that's meno related he just tells me to wait till my next clinic date.

I have tinkered around with the Testogel dose going from the original quarter sachet up to a third for 6 months but there was no improvement in libido, all it did was make me foul tempered and caused my hair to fall out. I'm tempted to try an even higher dose to see if it does anything, I can always wear a hat if I lose more hair.

I have no idea whether the patch dose is too high or too low (I'm guessing too low) so should I experiment with raising the dose a bit by adding bits off another patch? Could the progesterone be too low? I read recently that too low prog can ruin libido. I'm sick of being stuck like this and getting nowhere. I have also read that Tibolone is far better that ordinary hrt so I'll mention this at my next appointment at the meno clinic which isn't until the end of May.

Any advice will be much appreciated as I can't see the meno doc being of much help now to be honest.

Thanks in advance,

Mandee

[CLKD]

Your GP is correct in that blood tests are reliably un-reliable!  My Gynae won't do hormone tests because hormones alter so much every hour.  He works on a ladies symptoms.

I'm sure that someone with HRT knowledge will be along.  Browse round.  Make notes.

[Annie0710]

Hi
I can't help re your evorel etc as I have had a hysterectomy so only use oestrogen and honestly wouldn't know or remember much about periods, certainly not to do with menopause

You were lucky to get testogel without being given oestrogen/progesterone as usually theyvlike to see good levels of E first so there's no androgenic imbalance

I have to rely on blood tests as there's nothing else to go by so they're kind of right, I hear it a lot on here how unreliable the tests are

I don't know either the correct dosage of testogel but definitely don't increase it, some effects can be permanent like enlargement of clitoris

I've read low levels of each hormone can cause low libido . 

I was given Testim testosterone gel and on one prescription they gave me Tostran gel, that was definitely stronger

I'm now on Tibolone but they like you to be post menopause on that

You do have choices, there's oestrogen gel that allows you to experiment with for what dose suits you best

I'm sure some knowledgeable ladies will be along soon x

[Dancinggirl]

Mandee - Hi and welcome to MM
The person who will be of the best help posts under the name of ‘Hurdity'.  She has a scientific background and also uses testosterone and understands these hormones better than most.
The patches you are on are actually quite a high dose so probably fine in terms of controlling most meno symptoms - going higher won't necessarily help libido and could bring more side effects.  Your main concern seems to be around libido and this is a difficult thing to enhance and help during and after menopause. Testosterone is known to help and taking systemic HRt, as you are doing, will also help, however, maintaining a good libido can be difficult as we age. Getting the balance of hormones right is difficult but my thoughts are, you may need to increase the testosterone a bit??!! If Testo is making you loose your hair then that's not good - that's not going to make you feel sexy??!!!

Are you feeling pressured by your partner regarding sex? It is quite natural to be a bit less interested in sex as we age - after all we unable to bear children any more. Are you suffering with dryness and discomfort around your ‘lady bits' - perhaps you need vaginal moisturiser and serious lubrication when having sex? - you may also need some local oestrogen to improve the whole vaginal area?
Having said this, I'm 60 and have found my libido has improved with more relaxation, a calmer life, concentrating on eating well and lots of brisk walking - I'm feeling sexier than I have in many years. I have a very understanding hubby who knows how to make me feel ‘in the mood' but never pressurises me. I am just using vaginal oestrogen these days and SYLK vaginal moisturiser morning and evening.
I did try Tibolone back in my early 50s and it was great for libido so perhaps something you should try - I felt really good on it but unfortunately, as I'm prone to getting spots, it gave me bad acne.
Do look at the your lifestyle to see where you could improve things - you may just need some TLC and perhaps a bit more effort from your partner to make you feel sexier and more desirable. DG x

[Mandee]

Hi,
Thanks for your replies folks, much appreciated!

I'm on a third of a sachet of the testogel at the moment which isn't doing a thing. It's just weird that it stopped suddenly after working so well for a whole year.

My partner is great about the sex and doesn't pressurise me, it used to be the other way round when the gel used to work lol
I forgot to mention that I am using Vagifem twice a week which works really well as sex used to be quite painful and I was getting cystitis every single time! I also use lubricant so that's all good too.
As far as the hair goes, I'd rather lose it than have no sex drive ever again that's for sure. It's long down the back which isn't affected at all, just the front top area which is thinning so I now wear a wide headband or a hat when I go out.

Pity about the unreliable tests, doesn't help us sort things out at all!

How does the doc know when I'm post menopause if the hrt is always causing bleeds, do they go by age? Would've thought I was done by now, unless I'm still making hormones which keep dropping hence the sleep trouble at different times? This should have all settled by now.

I am quite active, go to the gym weightlifting twice a week plus hour long walks most days. My belly got horribly fat over the last few years and it's pretty much all gone now through dieting as well. I  lost a stone and feel much healthier. It certainly has done zero for the libido though.

Biggest problem I find is waiting so long for any dose/regime changes to take effect, doc says to wait at least 3 months!

[CLKD]

There R lots of symptoms that ladies may complain about as they reach peri 

[Hurdity]

Hi Mandee

I really would not increase your testosterone dose - in fact I don't think you should be using a third of a sachet. Looking back at your posts last year you were prescribed a quarter of a sachet which is quite a high dose in itself so maybe you decided to this yourself? There is no prescribed dose for women as it is unlicensed, so gynaes just try to work this out based on a woman's levels from blood tests and a proportion of what a man's level should be - but obviously we will vary individually. As Annie0710 says you have to be very careful of androgenic effects which take time to build up and to upset the balance compared to oestrogen. It is one thing for women to experiment with doses of oestrogen - that is our hormone - but not testosterone. If your gynae has said increase to a third of a sachet then you must ask for a testosterone test - even though these are not very reliable. Perhaps you are not absorbing it well - although from what you say about side effects - you may well be....

You do not need blood tests for oestrogen or FSH - as these vary so much - but some private gynaes seem to do them. However if you are seeing a menopause specialist who has prescribed the testosterone gel then I would suggest it is irresponsible of them not to test your levels of this as you are taking quite a high dose and it is very important not to have too much - libido aside.

Low progesterone will not cause low libido - in fact progesterone dampens libido. Do you feel good during the later part of the oestrogen only but of your cycle - ie once the progesterone has gone from your system? If you are bleeding from Day 10 then it is likely you don't have many days of oestrogen only to enjoy when you are not bleeding!

Sorry I can't help further....

Hurdity x

[Mandee]

Hi Hurdity, thanks for your help.

I asked my gynae if I could increase the testogel dose to a third sachet back in May and she said I could try it. The quarter sachet does nothing, I may as well be not taking any at all.
I have also asked my gp in the past for a testosterone level test but again he said they are useless.

Men have much higher levels of T than women and lower female hormone levels yet it gives them a higher sex drive, so how is it that increasing my levels causes androgenic effects such as hairloss etc but has no effect on libido? Just doesn't make any sense at all after it worked so amazingly when I was first using it. It's as if I've become immune to it.

You said that prog dampens libido. That would explain why I have absolutely NO sex drive when I'm on the progesterone part then, only during the oestrogen and that's pretty much nothing.
I don't feel any different whatever part of the cycle it is regarding my moods, they never change from day to day and are just neutral, neither happy or sad. I also find that my sleep isn't as good during the prog phase. The norethisterone in the Evorel Sequi also caused sleep problems and that's why the gynae switched me to utrogestan but it made no difference.

I'm having problems getting an appointment for a smear test after an invitation letter as there's very little time to fit it in between finishing the Utrogestan pessaries and when the bleed starts as the letter states that it can't be done when using any medication vaginally. I am thinking of taking the Utro by mouth until the the smear has been done, I believe they can be taken by either route.

I don't know if the gynae actually screwed up my cycle when she changed me over from the Evorel Sequi 50 patches to the 75s and Utrogestan a year ago. When I originally started the 50s
I was told by my gp to start the pack when my period ended which so happened to be the first day of the month and therefore the prog stage began on the 14th. My bleed would then start around the beginning of the next month when I started a new pack.
When she changed me over to the 75s and Utro it was early in February so I was on the oestrogen part of the pack and she told me to change onto the 75s straight away and continue up to the first day of March without any prog, then start the Utrogestan until the 12th. This would surely have messed up my natural cycle by giving me progesterone 14 days later than usual and when I would normally be in the oestrogen phase but she said it was perfectly fine! I have no idea if this has anything to do with the problems I'm having but I wouldn't be surprised if it was.

Mandee x

[CLKD]

Men have male pattern baldness 

[Hurdity]

I still think that amount of testosterone is way over what gynaes such as Prof Studd prescribe and as such I would definitely want a test. As I understand it at normal levels of testosterone in women, the test is not sensitive enough at the lower end of the scale - because the tests is designed for male levels of T - but if your levels were higher than they should be then surely this would be picked up.

Although T gel is not licensed for women and there are no guidelines on dosage ( as far as I know), Prof Studd says on his website that the standard dose should be one tenth that for men - and therefore a tube of testogel should last approx 10 days. I can imagine there may be some variation in what works but to the extent you mention ie a third of a tube. It may well be that you are not absorbing it  - but with testosterone - but personally I would not just to go on symptoms without a test, The gynae I saw re T said that it can take 4-5 months for the changes to fully take effect - ie it's not as quick fix so i would not even think about increasing from the initial dose until this time had elapsed ( for T that is).

Here is what Studd says about it:

The best preparation now without doubt is transdermal testosterone cream or gels. However at the time of writing these gels are only licensed for men. Therefore it is usual to use approximately one tenth of the male dose daily making a single tube (the daily male dose) last for about ten days. This works well but usually gives a concentration level slightly above the normal range. I am not at all concerned by this but no doubt this is way the gels are more effective than the Intrinsa patch. This Testim or Testogel will be given in combination with the oestradiol gel Oestrogel. This combination is my first choice hormonal therapy for virtually all patients who need HRT for their menopausal symptoms or their depression or their libido or their low bone density.

http://www.studd.co.uk/libido-depression.php

OK this is in the context of depression but I can't find information anywhere else on appropriate doses of gel.

I can't comment on why it is having no effect - but libido is a complex thing - and is it solely libido you are talking about or libido + response, or just response. I don't really want to post on an open forum about this but in my case libido is unchanged (low) but response has been completely restored (on a very low dose of T).

I would press for that test to put your mind at ease at least.  Your hair loss indicates the level is too high....Btw where do you apply it?

Hurdity x

[Mandee]

Hi Hurdity,

As mentioned previously, when I first used Testogel back in 2012 I was using a quarter sachet daily. I measure the dose by emptying the sachet into a 5ml syringe from the chemist rather than using the hit and miss "blob" method others on here are using. Each ml mark on syringe equals 10mg which is a 5th sachet. I felt fantastic for a year then it just stopped working so it won't be because I'm not absorbing it, otherwise I wouldn't have the hairloss.
I'm thinking my oestrogen levels dropped and threw the balance off with the testogel and caused it to stop working because my periods stopped at the same time and when the gp put me on the Evorel sequi, the libido returned but only for a few months. I reckon that I may need a higher dose patch or try Estrogel instead. I will ask for a testosterone test when I see the gynae in May.

I increased to a third of a sachet last May. The only effects I get apart from the hairloss are a few black hairs around mouth and on neck, hairier tops of thighs, and a slightly deeper voice, nobody has mentioned my voice changing though so it can't be very noticeable.
I started off applying it on the belly but it gave me stomach ache each time which my gp said can happen. I then applied it to my arms as I do now.

I'm thinking that my testosterone levels have always been above average as I've always been a tomboy type, always played with boys stuff as a kid and hated anything "girly". I've always been into male type hobbies and pursuits and hate wearing skirts. I have no maternal instincts whatsoever, I've never wanted kids and don't even like them. I have never been very feminine minded at all. My mum always said I should have been born a boy lol
Maybe I just need a much higher dose than other women so all I can do is experiment and see what happens.

I have a very poor libido but the response part is fine. It has always been poor my whole life, only popping up just before my period apart from that first year on the testogel.

Mandee x

[CLKD]

That's how I knew my lack of libedo was hormonally linked because a few days B4 a bleed, I would be up for it with gay abandon    but GPs told me I was depressed. Well I was, depressed because NO ONE would listen 

Do beware of putting any HRT too close to the breast area!