Deflated at GP perimenopause response

[Needathickskin]

Feel slightly deflated and not sure how to go forward; would appreciate some advice.

Am 47, progressively feeling worse with perimenopause: zero libido, mega bloating from ovulation onwards and an overwhelming sense of feeling disconnected from my body. I'm just so tired and really struggling. Still having regular periods.

Had bloods taken at GP inc thyroid, iron, ovarian cancer: results have come back all 'normal'. The only comment was that I might consider 'standard hrt'.

I paid for a female hormones check a couple of months back and this flagged up very low levels of testosterone. I raised this with the GP and was told they don't prescribe this.

I really can't go on as is; I'm not sure what I'm asking for but I feel deflated that I'm being dismissed as 'normal' .
Thanks

They can and do prescribe it. It isn’t licenced for women, but they will prescribe it off licence. Find another, sympathetic GP and explain how it affects you and ask for it. Many are happy to do so.

Why won't you consider HRT? I know that you can buy testosterone, but don't know how effective it would be.

Why don’t you want to try HRT ? Most guidelines would suggest HRT as first line, esp transdermal as I think this can activate testosterone. And only a trial if this has failed and your symptoms are predominately testosterone based. This would usually be low libido as opposed to the tiredness etc.

Eh? Start HRT. Why not? Dampener? You've been offered HRT!

They may prescribe it in many different formats - eg maybe oestrogen (gel or patch) and progesterone (pill) possibly. Testosterone is normally only prescribed by HRT consultant here, so you could ask to also be referred.

Eh? You've been offered HRT, not sure why you're so upset?

You cannot have just testosterone without oestrogen and progesterone. Have a look at the NICE guidelines. Your GP knows what they are doing.

OP has already identified that she lacks testosterone, HRT does not contain it usually

The problem is that HRT is not normally given according to your own specific hormone measurements so it involves lots of trial and error to make it the right one and some GPs are not even interested in the levels you have and the levels of HRT they prescribe

OP - where did you get your testing done to include testosterone as I am interested in this

I didn't say I wasn't considering hrt - far from it. I'm just frustrated at what feels like a bland response. I don't feel normal!

Depends on CCG policy. In some it can only be prescribed for post menopausal women, in others not at all.

Regardless, as above it should only be used alongside 'standard' HRT and usually when that has not adequately improved symptoms

If you were prescribed testosterone now it would just cause more issues, your oestrogen and progesterone need ti be balanced as otherwise the testosterone can convert to a form of oestrogen (I dont fully understand the issue or how it actually works).
How was your testosterone level calculated, just your blood level or your free, taking SBHG into account? Do you know what your levels were?

GPS can’t prescribe testosterone - I’d suggest start the HRT and then see if your libido changes. If there’s no change and you can afford it, go private for the testosterone issue - if they prescribe it you should then be able to get repeats through your GP. I know women who have done this, but appreciate it’s a big outlay in current times

With regards to your bloods, hormone levels fluctuate, not only during the month, but every single day, minute by minute. Your results merely highlighted a snapshot of when the blood was taken, and don’t really tell the whole story anyway. This is why doctors should listen to what perimenopause symptoms you’re dealing with.

Apart from being offered HRT, what were you hoping for? So many GPs aren’t interested in women’s health, many have little to no interest in menopause either, so the fact your GP mentioned HRT to you means they are more clued up than most.

Testosterone is great for bringing the focus back, but it’s unlikely anyone will prescribe it to be taken in isolation. I use it, but in conjunction with progesterone and estriol/estradiol.

It might be worth contacting a menopause specialist like Dr Louise Newson.

In the simplest terms, if you are prescribed testosterone, without your oestrogen being at a high enough level, your body will just convert the testoterone to oestrogen. Which is why, probably your testosterone is through the floor at the moment - it is being converted to oestrogen.

So you need HRT. Get your oestrogen levels right and a) you will probably find a lot of your symptoms disappear b) your testosterone levels may rise on their own.

No menopause consultant should dream of prescribing testosterone to you without HRT. Let alone a GP. Particularly as they would be prescribing off licence.

Start the HRT.