Low testosterone

[TableNiner]

Hi all, I’m 44 and having regular periods. I’ve been found to have low testosterone and have been prescribed DHEA supplements by an NHS hospital doctor, which I’ve had to buy and ship in myself from the US. Not that they have arrived due to all the post issues at the moment. My oestrogen is quite low too but it’s the testosterone which is way below normal.

Obviously HRT is not yet an option so this is all they could suggest, although did say if the DHEA doesn’t work they might try testogel. My symptoms are fairly par for the course, low mood, low energy, low sex drive, difficulty building muscle. All the doctor was actually worried about was the osteoporosis risk, since that is a nice specific medical condition :) I had been concerned they wouldn’t have any suggestions as I keep reading testosterone is not licensed for use in women in the UK.

Just wondering if anyone else in peri menopause has been diagnosed with low testosterone and what treatment you’ve been offered, e.g DHEA. Or if there is a way to get hold of DHEA in the UK. I’ve been waiting a month now which is quite frustrating as I am keen to see if it has any effect on my quality of life. You start to see why some elect to try private clinics...

It’s all quite odd as when I was 28 I was diagnosed with PCOS which I thought left you with high male hormone levels.

I use testosterone gel for menopausal symptoms. This isn't licensed in the UK for this use however it can be prescribed 'off label' by a doctor and is usually initiated by a secondary care consultant and continued by a GP. Some also get this prescribed privately.
When I started this the menopause specialist I saw said there are no lower reference ranges for testosterone levels in women. Really just a higher limit and if levels are above this it points towards polycystic ovary syndrome. So I'm surprised you have been told you have low testosterone levels.
Are the supplements working for you? I'm sure it wouldn't be a problem to try testosterone gel for a period of time to see if it helps.

Obviously HRT is not yet an option so this is all they could suggest, although did say if the DHEA doesn’t work they might try testogel. My symptoms are fairly par for the course, low mood, low energy, low sex drive, difficulty building muscle.

why not HRT now?
You have all the symptoms of low estrogen.

All the doctor was actually worried about was the osteoporosis risk, since that is a nice specific medical condition

I'm really puzzled by your post and what the dr said.
Early menopause / loss of estrogen is the criteria for treatment to prevent osteoporosis and it's HRT. Not testosterone.

It' s not usual to prescribe testo without estrogen. usually they start HRT and then introduce testo later.

Sorry but I've never heard of anyone using testo for peri menopause.
Who did you see and where? And why did you see them in the first place?

@trumpisaflump Thanks for responding. My doctor said to try the DHEA first, saying I might get side effects with testogel, but I’d take the risk! So have to try three months of DHEA first, problem is the tablets are stuck somewhere in transit.

@JinglingHellsBells Thanks for responding. I was referred by my GP to University College Hospital London. I found the low testosterone with an at home blood test but it’s been confirmed by a full blood screen, it’s the only thing found.

My GP said there’s not much they can offer someone under 45 with regular periods so was quite pleased at least they had some ideas for treatment at the hospital, even though it seems a bit bizarre to have to pay and ship it in from the US. My oestrogen levels are not high but are within a normal range, my testosterone levels are not. I don’t pretend to understand it all though!

My GP said there’s not much they can offer someone under 45 with regular periods so was quite pleased at least they had some ideas for treatment at the hospital, even though it seems a bit bizarre to have to pay and ship it in from the US. My oestrogen levels are not high but are within a normal range, my testosterone levels are not. I don’t pretend to understand it all though!

@TableNiner This comes up time after time on this forum.

You are fully able to have HRT if your periods are regular.
Your GP is wrong I'm afraid.
Also, it's not your estrogen that should be tested but your FSH levels, - twice- over 2 months on days 2-5 of your cycles.

Sorry, but I think you have been made to believe that everything is far more complicated than it ought to be. Was it a menopause specialist you saw at UCH? I wasn't aware they had a clinic for menopause as the best one in the UK is the Chelsea & Westminster.

These are symptoms of peri menopause, regardless of whether your periods are still regular. My symptoms are fairly par for the course, low mood, low energy, low sex drive, difficulty building muscle

How do you know you can't build muscle, out of interest? Are you training hard and having scientific evaluation of your muscle strength?

You can and should have HRT if you have symptoms of low oestrogen regardless of whether you are still having periods or not. Doctors get this SO wrong!!

Google Newson Health clinic - lots of free information and resources on there. If you can afford it have a private consultation with one of their specialists - they can prescribe testosterone too as well as HRT.

(Newson health recommended which HRT products I needed and I get these prescribed via the NHS).

Exactly ^^

And one more thing OP.

There are 2 main types of HRT

1 For women with periods
2 For women with no periods

In (1) it's fine to use it with regular periods or periods that are becoming irregular.

There was a GP on here this week asking why I was 'bashing' GPs for their lack of knowledge and since her post there have been numerous posters like you being fed misinformation by a GP.

@JinglingHellsBells and @Bagelsandbrie

Thanks for taking the time to advise. I have spent a lot of time looking at Louise Newson's site and listened to most of her podcasts :) I think she is amazing. Do you know how much a private consult costs and whether it matters I'm in London? (Not sure how blood tests would work, though I have all my results, there is a very long list).

I am under the Endocrinology Department at UCLH. They tested all my hormone levels including FSH etc and the only one they said was out of range was testosterone. So you are saying that I could potentially ask for HRT just for testosterone deficiency? I am turning 45 very shortly so that argument, even if flawed, won't even hold up soon. I'm happy with the HRT risks.

But it seems that low oestrogen and low testosterone have very similar symptoms? The hospital and my Thriva test (home test) both say it's a testosterone deficiency.

On muscle mass, it's just the way in which my muscles ache when I do relatively light exercise - my thigh muscles if I am cycling or swimming and it doesn't get any easier over time (I do both of these regularly in normal times). Same with pilates, I do this regularly but it hurts a lot.

They said I must keep doing exercise, even though I find it really hard, as otherwise my osteoporosis risk is even higher. They basically made out I can't have HRT until my periods stop and that in the meantime they need to find something to 'bridge the gap'.

I think they were hoping to sling me some Vitamin D and iron but I'm not deficient in those. It was very interesting the way she had no interest whatsover in my low/flat mood! Backed up everything Louise says, albeit she says you often get anti-depressants.

A few enlightened drs are including it as part of HRT (I think there may be some podcasts etc on Dr Newson's site on it) and there are articles in the press on it.

www.menopausedoctor.co.uk/professionals/improving-sex-at-menopause-is-testosterone-the-answer

The rule appears to be to start with estrogen first then add in testosterone later mainly for libido, not muscle mass.

I think the problem with seeing an endocrinologist is they are not menopause experts, sadly.

Can I ask how you got a referral in the first place? Was this through your GP after you told them of your own home test?

Cycling and swimming do nothing for bone density as they are not weight bearing. You have to walk, run and do resistance exercise, with your own body weight or free weights.

I don't know Dr N's fees- they used to be all on her site and were around £250. Most drs are working remotely at the moment anyway.

If you want to see/ talk to a London meno gynae I can PM the name of mine- they are £300 for the first appt and approx half thereafter.

Hello, there is a great menopause clinic at UCLH, there is also a community gynae service with a menopause specialist available if you live in Islington? Wait list currently around 6 weeks for that one. Surprisingly it seems like strange advice from endo, would definitely speak to someone specialising in menopause especially if oestrogen low.

@JinglingHellsBells Yes I did the home test, spoke to my GP, had a proper blood test. She was not unsympathetic, more confused than anything. She said she wasn't sure there was anything they could do but she'd try the Endocrinology dept at UCLH, who said they would see me. Had full blood screen there and was told to try this DHEA stuff for three months and if no change, they might try testogel, but this seemed a very last resort with them filling my head with stories of male characteristics developing.

As I know there are all sorts of issues around HRT, I specifically asked about this and was told that they wouldn't prescribe it until my periods had stopped (which of course could be years). I don't really know how to challenge this though, in terms of if there is a care pathway I can refer to or whatnot. I do feel like a total cliche being potentially misadvised. It's particularly frustrating at the moment as I can't even try the DHEA to see if this would help as it is waylaid in transit. I saw the hospital on 13 November so have already lost two months. At least I could then rule it out or maybe it would actually help. I would therefore be very interested in your private clinic, thank you.

@Thedot90 I am in Islington as it happens but not sure how I'd get referred to either the UCLH menopause clinic or the community service. Back to my GP? I think they would be like 'you're not in the menopause, jog on'. I do feel like this is the beginning of a very long road so might well have to pay for specialist advice but this seems very wrong given not everyone would be in a position to do this.

The whole thing seems to have become incredibly complicated when it could be so simple. Why did the test flag up testosterone anyway? Did you buy a complete hormone profile test?

If you'd not done that and just assumed your symptoms were peri menopause, you could have insisted on trying HRT,as it is simply untrue that you can't have it until your periods stop- that is nonsense.

There are thousands of women in their 40s with periods using HRT.

The 'usual' route would have been to explain your symptoms, ask for HRT, mention the tesoterone test and then re-think if that was needed as well as HRT in 3-6 months when your HRT might have done the trick.

.I don't really know how to challenge this though, in terms of if there is a care pathway I can refer to or whatnot.

It's all in the NICE menopause guidance pinned at the top of these threads. Brought out 2015. Drs have had 5 years to read them.
Scroll through the guide to Diagnosis. It says prescribe on symptoms.

@JinglingHellsBells Yes I get what you are saying. I did this test
thriva.co/tests/female-hormones-test

So that showed just the low testosterone. I did it as we were in lockdown and wanted to see if anything might be amiss myself first.
And now both my GP and the hospital doc have said no HRT. If you have a private rec, I think I might be looking at that

Is there not another GP who you can see at the practice?

If you want to start there, again, you need to be bold and tell them that your symptoms- list them- are peri menopause and you know that there is a type of HRT for women like you with regular periods.

The person you saw is not a menopause specialist and I'd not really go back to them or assume they know about HRT.

Or you go and see a meno dr, privately.

The test you took is not really accurate- for FSH and LH you need 2 tests, taken on days 2-5 of a cycle, and a full blood sample not a fingerprick. And even then, these tests are not always accurate because they give a snapshot on a single day- in peri your hormones change daily.

You can definitely have HRT in perimenopause, GP can refer you down both of these routes, perhaps they didn’t know they existed? Try community gynae as not sure how long you’ll be waiting for UCLH at the moment.

I've just turned 47 and have been having peri menopause symptoms for several months.

Low mood/anxiety/hot flushes/bad sleep/aches/headaches/low libido/rage

I went to my GP armed with a symptom ticket list printed off Louise Newtons website and stated to wanted to try HRT.

I also specifically said I wanted to try estrogel and oral progesterone 1st rather than a patch.

GP referred me to gynae at hospital (I think because I dont have fallopian tubes due to prev surgery and they weren't sure of implications of this).

Gynae prescribed the HRT after a 10min phone consultation. Review in 3 months. Said he would consider testosterone if libido didn't improve after trying the HRT regime.

I started on 3rd Jan. So far the low mood/headaches and flushes have decreased so its a postive start.

You might find you have to go back to the beginning like jingle said and get referred to a menopause specialist rather than endo.

Other than that skip to a private appt which hopefully can be done quicker as it'll be remote I guess.

Good luck