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[Postmeno3]

Hi.
I'm hoping someone has some answers. I have increased from one pump of gel to two sprays of Lenzetto recently. (I assume that's an increase?) Absorption appears to be much improved going by the readings. However, symptoms have not; if anything, worsening. My hair has become very flyaway and fine since going down the systemic oestrogen route. This is increasing. Isn't this the opposite of what's meant to happen? I note, too, a greater sense of hypervigilance and also more chaotic thinking, feeling quickly overwhelmed in multi-tasking situations both practical and verbal. Literally, information overload. I lost my purse with all my cards, cash and little cherished items when travelling last week! I'm quickly fatigued, poorer stamina, short of concentration and somewhat impatient; very lacking in confidence, not feeling so capable. I've gained some belly fat and "love handles", the sort of excess I have had none of in decades! Probably since pregnant. Hmmmmm......frustrating outcomes! I'm about to start testosterone this week which will take a good while to have an impact, but what I'm experiencing now is almost as if the sudden "absorption" of oestrogen has caused the testosterone I had to deplete further. Is this possible? 🤔 I feel I've "aged" so much lately! It's getting noticed! 😢

[laszla]

I don't have answers postmeno but am watching with interest as much of what you say resonates.
Your 2 sprays of Lenzetto are a slight increase on the one pump of gel - there was a recent post on equivalences between gel and Lenzetto.
I increased my estrogel from 2 to 3-3.5 pumps and many of the symptoms you describe I have also experienced.

I have no idea whether increased estrogen can decrease testosterone but I can say that I measured my blood 3 months ago, found out I had very low estradiol (112) which prompted me to increase the dose and when I re-did my bloods last week, my estradiol had increased but my testosterone - which I've taken for a couple of years - had decreased considerably (to the point of near extinction).

I'd be curious to hear from others whether one can affect the other.

Have you measured your hormones with a blood test - I do think there is some use to this when one is postmenopausal and purely dependent on HRT for hormones as blood levels are meant to be reasonably stable.

[Postmeno3]

Yes, I'm curious to hear from others of their experience or knowledge of the potential for damaging interplay. I'm also going to see if Dr. Currie can provide any answers and will let you know.
I get my bloods tested on the NHS specialist's prescription to the gp. My E had shot from the 60s (!) on patches and gel to 260s on the Lenzetto. My T, tested ages ago, was "within the normal range, if lower end", but I am to get it done again after 6-8 weeks on the T I'm starting today. I know it will not give an instantaneous boost. We might be getting into the realms of complex endocrinology here, I feel........🙄

[Wrensong]

This must all be very disappointing for you Postmeno3 & I'm sorry things continue to be difficult. 

what I'm experiencing now is almost as if the sudden "absorption" of oestrogen has caused the testosterone I had to deplete further. Is this possible?

There are papers stating that oestrogen replacement reduces endogenous testosterone levels/effects, but it seems to be thought this mostly applies to oral oestrogen.  However, as so frustratingly often with menopausal issues, there are comments to the effect that nowhere near enough is known & that more research is needed.  With only one ovary, you have probably anyway not had adequate T levels for optimal wellbeing for some time.  I've had both removed & did feel the lack of T, though replacement has not been straightforward.  As you'll know testosterone declines further as we age. 

My hair has become very flyaway and fine since going down the systemic oestrogen route. This is increasing. Isn't this the opposite of what's meant to happen?

If you look at the SmPC for Oestrogel &/or Lenzetto you'll see hair loss/alopecia is listed as a possible side effect of oestrogen replacement (on SmPC for Estradot patches too) though I think this is generally considered to be uncommon.

I note, too, a greater sense of hypervigilance and also more chaotic thinking, feeling quickly overwhelmed in multi-tasking situations both practical and verbal. Literally, information overload. . . I'm quickly fatigued, poorer stamina, short of concentration . . . I've gained some belly fat and "love handles"

It sounds as though your body is reacting to stress.  Do you think some of the undesirable changes you describe (including early waking with sweating, in another thread if I remember rightly) could be adverse effects from raised cortisol?  Cortisol levels are said to be increased by oestrogen replacement, but again as I think you know this is generally said to apply only/mostly to oral ERT, though I wouldn't be surprised if further research at some point changes what we understand about it all.  Especially as some women report feeling anxious on transdermal oestrogen replacement too, but better for the calming/sedative effects of progesterone.

I'm sorry I don't have any definitive answers, but all I would say is you've wanted to try testosterone for a long time & at last you have that opportunity.  I also think your instincts are important though & if you felt better before starting systemic HRT this time around, with reasonable QOL, it may be that resuming it at this stage of your life is really not right for you.  If you come to decide you'd rather taper off & move on with your life, you can at least do so in the knowledge you've been down an avenue you really wanted to explore.  I do wish you luck, improved wellbeing & contentment, whatever route you choose from here.
Wx

[Hurdity]

Hi postmeno3

Sorry to hear about your ongoing issues trying to get your HRT doses right.

Just to add to Wrensong's point about oral oestrogen. Yes the general research shows that oral oestrogen is known to lead to a decrease in free testosterone. This is because oral oestrogen increases a compound in the body known as SHBG (Sex Hormone Binding Globulin) which binds to testosterone making it unavailable. The endocrinology of all of this is complex and I'm not sure even fully understood ie the interplay with estradiol ve testosterone and the role of SHBG, and even what happens to the T that is bound up. I'm a bit hazy about this as I haven't read up on it for ages!

So I would say firstly that tests for T before replacement are known to be inaccurate because the tests have been designed to measure the much larger amounts of T that men have and so are less sensitive ( ie less accurate) at the lower end of the scale. However T measurement is vital once T replacement begins because as levels increase the tests become a bit more reliable and important to know whether T levels remain within the range for women.

Secondly because of this T levels alone are not enough and whenever T is measured, so should SHBG. From this the Female Androgen index can be calculated. So - your SHBG measurement before and after the change in oestrogen would be instructive. Has this been measured along with the other hormones?

I am not clear whether sudden (say - large) increase in estradiol will have an impact on SHBG such that T levels would be reduced noticeably but I would have thought that, just as addition of exogenous T takes some while to have an effects, so too would its reduction and therefore a realtviely sudden change in symptoms may not be due to reduction in T (apart from the fact that overall depletion over time can lead to some of these symptoms).

I'm sure I've asked you this before, and Wrensong is the expert on this, but have you had thyroid function tests too? Those symptoms if I'm right can also be attributed to suboptimal thyroid function, but in addition feeling cold would be experienced. Wrensong please put me right on this as you're also knowledgeable about the interplay with thryoid function and HRT!

As for the ageing - I think we are similar age and despite HRT this will happen - it has happened with me too - once you get to late 60's I think we have to accept the advancing years - even to some extent the decrease in energy etc - but this doesn't mean we shouldn't try to optimise our hormones as far as we can - as I try to do. Still get fatigued and achey far more quickly than even a couple of years ago....

As Wrensong says it is about quality of life and we just have to do our best to maximise that....

Hurdity x

[Postmeno3]

Thank you both, Wrensong and Hurdity, for your full replies.
I can only say that my QOL a year ago, even with "M.E.", before the HRT route began, was more fulfilling than it is now. Then, I could pace my activity and amount of stimulation in order to live simply, but very richly and meaningfully. Now that the HRT is in control, my life feels complicated, draining and unpredictable.
I will check again on the type of testing done for T and double check that thyroid was indeed okay as was stated. It is extremely difficult trying to engage fully with the NHS specialist with only the phone as the medium and with the time such complexity merits and so randomly (no bookable times). Testing is deferred to the practice nurse at my NHS surgery via notes to the gp, the content of which I don't receive. I feel I could be sitting face to face for hours trying to find out what's going on, getting the testing done then and there as a result of those exchanges and it not feeling so disjointed and protracted which hasn't helped, but these are the times we are now in.
However, thank you both for your knowledge of oral E diminishing T mobility if I've got that right and who's to say the same could apply to transdermal. It just hasn't been researched, or sufficiently, yet? 🤔

[Hurdity]

Just a quick reply before I sign off - it is your right to obtain full results of all your tests and I would urge you to ask for this including previous ones. In my are I can access thes online any time but you may not have this facility at your practice. In haste...

Hurdity x

[Postmeno3]

Thanks, Hurdity. (Symptoms not sudden, by the way. Realising they've been accumulating and getting to absorption has kind of diluted the ongoing process, a narrow versus wider lens.)
Cheers.
😊

[VictoryV]

Hi PM,
Sorry you’re feeling bad, I hope things turn a corner soon. I don’t have any answers but I relate very much to symptoms accumulating often slyly making it difficult to pinpoint the cause. Of course the lack of speedy access to professionals makes everything far harder and then often wishy washy / suck it and see advice.

I’ve held off testing as I think i’m still at the fluctuation stage and I’m scared to go down the wrong rabbit hole without a trusted professional. If you’re in a position to go private (assuming the NHS haven’t done recent full panel hormone bloods) I think I would do that armed with a copy of your MS files. Hopefully you’ll feel better soon and you may not need to keep the private appointment but it’d be there if you do.

Sending hugs. Xx

[laszla]

Just to add to Hurdity's point about the importance of SHBG, 2.5 months after increasing my estrogen (gel) dose, my SHBG was almost exactly the same as before (still high), while my testosterone had plummeted to an extent that the lab couldnt even establish the Free Androgen Index. While my plama estradiol had increased, I feel much worse than before.

I had made no change to my testosterone supplementation in that period, I just increased the estrogel from 2 to 3 pumps.
I am going to try asking the GP and/or clinic about this but my feeling is that they have little to no clue about the interaction.
If I get any useful on the interaction, I'll let you all know but I very much doubt it.

[Postmeno3]

Yes, please do.
My M.E. condition makes processing new material/clinical information very difficult. My personal view away from it all, however, is that we should not be having to research or be our own detectives, not to the extent that seems necessary! It's clear though that the issue we are trying to seek clarity on is not frequently investigated or even raised and that the research has a way to go. It IS an interesting aspect of menopause management and investment in it could prove highly informative, potentially saving a lot of "trial and error"?  I should add I am far from passive in the position I take in relation to my health, far from it, but I do have limited capacity and long for some informed source to take the reins for at least part of the journey. Identifying the most accurate source is, of course, the conundrum!

[Postmeno3]

I note a LOT of readers of this thread already so there's a LOT of interest....which is GREAT!
👍