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[Moanybreeks]

I know low libido is a common thread on many menopause topics but also it seems is the low importance GP's attribute to it.  On a recent visit re my prescription and to question 'why had I doubled my Femoston 0.5mg', I told my GP that I had zilch libido and would she consider testosterone or any other advice.  It was a straight no to testosterone and the "use it or lose it" phrase I have seen so often relating to issues of the vagina and sex drive.  Are we not allowed a sex drive now we are unable to bear children? Where is the 'little blue pill'  for women?  My poor husband is fantastic, but he must feel like he is melting an iceberg with a match at times.    

[Dancinggirl]

Feeling sexy and desirable is very important for self esteem.  Low self esteem leads to depression and other psychological problems.
It's tough enough coping with all the things that the meno and general ageing throws at us but to then put pressure on people's marriage because intimacy falls apart can really be the last straw.

I think there are mixed benefits re testosterone but women should at least be able to try it.

I'm only using local oestrogen these days (I'm 63) but have managed to keep my libido going a bit because I have my atrophy under control.  You could definitely ask fro some local oestrogen (Vagifem) to use alongside the Femoston to keep your intimate area healthy.  When on a very low dose of systemic HRT, I'm afraid this won't maintain your urogenital area that well.

Here is the section from the NICE guidelines for you to show your GP:
Urogenital atrophy
1.4.9
Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.
1.4.10
Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.
1.4.11
If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.
1.4.12
Explain to women with urogenital atrophy that:
symptoms often come back when treatment is stopped
adverse effects from vaginal oestrogen are very rare
they should report unscheduled vaginal bleeding to their GP.
1.4.13
Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.
1.4.14
Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.

DG xxx

[Turkish delight]

I hear ya!

It's a sorry state of affairs for menopausal women. Women get all the attention at pregnancy stage so there's none left by meno lol!

It feels like we are on the scrap heap of life, or a slow conveyer belt heading for the giant dustbin, while slowly decaying from the inside out.

I got my Testogel from an NHS gyne. He had no hesitation prescribing it, and now have a repeat from my GP.
I believe that is the only route via the NHS anyway, obv there's the private route.

I started mine on Sunday. Nothings supposed to change until 5 months...meh!

[Tc]

Moanybreeks. The NICE guidelines say that testosterone should be considered for meno women on HRT who have low libido.
I was offered it by my gynae  She said its standard in her clinic for women who have had their ovaries removed  but lots of ladies who have not had them removed have been prescribed it.
The problem is it is "off license" for women. Some docs seem very reluctant to prescribe off license products whilst others are fine with it.
Can you see another doc in your surgery? Or ask tonve referred to menopause clinic?

[Wrensong]

Hi Moanybreeks, it is frustrating in more ways than one that so many women seem to find resistance to Testosterone being prescribed on the NHS.  I get the impression it is sometimes considered the icing on the cake.  In an ideal world don't think we should have to go private to get it & appreciate the cost can be prohibitive, but both private menopause specialists I've seen (different clinics) have raised the issue of its importance.  Not just for libido either - from memory mental wellbeing, night sweats, muscle maintenance & sleep were all mentioned as benefiting.

The first gave me a script for it, which my then GP was happy to convert for NHS dispensing, though I never got around to starting it as we were concentrating on getting the basic HRT right first - which never happened!   The 2nd clinic said levels would be tested at a subsequent appointment before prescribing, but gave the impression it was standard for women who had had BSO & also possible for those who had not but seemed to need it.  So if you can afford it, it may be well worthwhile going private to get the initial script, though if you do want to consider this, maybe contact the clinic beforehand to ascertain their approach wrt Testosterone.  The following link from Women's Health Concern via the Newson Clinic website might also be helpful in persuading a GP if you cannot see a private Meno Specialist, though it makes the point that some GPs have prescribing restrictions that prevent them doing so.  Good luck with however you decide to approach it & do let us know how you get on.
https://d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/264/WHC-FACTSHEET-TESTOSTERONE-for-women-FEB2019-B.pdf

P.S.  Another approach might be to try a form of HRT with a Testosterone derived progestogen - such as the Norethisterone in Evorel Conti & Sequi.

[Tc]

As wrensong says I too was told it's pretty standard for BSO women. I've just been refused a different off license med for a separate issue. There seems to have to  be a specific requirement so for instance you cant ask for testosterone to help muscle mass, well being etc although it does help with those. It has to be specifically for libido. That is the reason they can prescribe. My consultant said to me (about the other issue I had) doctors cannot be forced to prescribe off license products.
But...some doctors do. And in your case the reason for prescribing it would be in line with the NICE guidelines.
But as it seems to be an individual docs choice I realy think you should try another NHS doc as it IS available.
Maybe the doc should've done a blood test before dismissing you out of hand.
I would see someone else if you can.

[Perinowpost]

As the others have said so much of T prescribing seems to be the lottery of whether you're GP is open to it or not. I was lucky mine was (although I had to be referred to a specialist to get it).

I think the important thing is not to give up at the first hurdle if you're refused, but to persevere until you get what you want. You are allowed to advocate for yourself. I've pretty much got everything I've asked for this way. Plus I think it's up to us to do this, and then hopefully it will make it easier for the next struggling peri/post menopausal ladies who come along to access the best treatment options available x

[Moanybreeks]

 Thank you all for the replies... I fortunately don't have vaginal atrophy yet and am doing everything to avoid it.  I struggled with any HRT with norethisterone, particularly my mental health and constant bloating... I exercise regularly and have included some upper body weights to try and improve muscle mass and natural testosterone.  It's mainly my libido that has all but disappeared.  My GP said she follows Louise Newson and had been to her lectures... she was obviously in the back row asleep.  I have never been offered a blood test throughout this journey so I do not even have a baseline of hormones to work from.  I know they are not an exact science and fluctuate, but a starting point would be good.  We don't have NHS Meno Clinics in Scotland and I'm told I would have to have something serious to be referred to Gynae..      I'm off to my spin class now. to build more muscles, hopefully.

[Ladybt28]

I'll stick my 2 penn'ith in also Moanybreeks.  Testosterone is now promoted under the NICE Guidelines and I had no problem getting it on prescription from the NHS in Northern Ireland.  I really thought it would be a problem here but no, it was easy.
I found mine worked on my brain fog mainly very quickly, within the first month.  It has helped a little with libido but not massively.  Ref blood tests, I have never ever had any for my hrt and I'm 57 and post meno and been on hrt (albeit the wrong sort) for 10 years.  Tried 5 types and only got it sorted over the last 8 months!    I think if someone said to me "use it or lose it" I might just smack um!  Drives me crazy - what a dumb thing to say!  All my bits are perfectly usable I just couldn't bear anyone near me!

Tc I take it GP refused Wellbutrin?  I had to succumb to Sertraline (beyond reluctantly!) but I've never been given it before and it seems to be ok no nasty side effects but only slight improvement at the moment nothing major but it is only week 3.

[Tc]

Moanybreeks great name btw I should've guessed you were in Scotland!! 
I just looked up menopause clinics Scotland. There was an article in the sunday post in October 18 about the lack of meno clinics and government minister calling for more.
In the article it says there are currently 5 dedicated NHS menopause clinics. Fife, grampian, lothian and tayside and Dumfries and Galloway.
Dont know if this helps. Sorry I dont know how to send a link.

Hiya Lady. Yes I was refused it. I've posted on the anxiety support  thread in private lives about it. He doesnt want to "stick his neck out" about it to quote him as the other consultant refused to back him up!!!
Great to hear you've had no nasty side effects especially as you're now on week 3 and usually they wouldve shown up by now
Xxx

[Moanybreeks]

Tc. Thanks for your research. Sadly not in Forth Valley.  It also surprises me how there are no menopause leaflets/information in the surgeries or health service provider locations in my area.

More awareness of symptoms would benefit everyone and save the NHS money.  I'll step off the soap box now.

[CLKD]

I knew that my lack of libedo: 14 months into marriage : was hormonally led  but the GP insisted it was due to depression.  Yep. I was depressed.  Because she didn't listen  which is why men get the little blue pill ........ but women don't.

[sheila99]

Seems to be a beurocratic loophole. Because there isn't a product licensed for women the gp is responsible for anything that goes wrong. Can't really blame them for not wanting the responsibility. If it's been prescribed by a specialist first often a gp will continue with it, but if you can't see a specialist this doesn't help.

[Perinowpost]

Sure you're right Stellajane that's been my experience too. I couldn't believe it when I had the Mirena removed, within 2 days I was like a 25 year old 😀

[Dancinggirl]

It may have been just me but I found my libido always picked up on the progesterone part of HRT.  When I tried Utrogestan my libido really increased quite a bit (happy hubby!!) but cramps, erratic bleeding and skin rashes meant that I couldn't continue with it.

I personally find that when I am feeling good - so not stressed or sleep deprived - I can usually enjoy intimacy but it does require some effort on both sides.  At 63 I am not expecting things to be what they were back in my 30s - I just feel chuffed that I'm still getting some sexual pleasure at my age and hope this continues for some years yet.   DG x