Anyone had their testosterone levels tested? Or did you start taking it without pre-testing?

[freckles20]

I am considering asking my GP if I could have testosterone.

I am 47, perimenopausal and have been on HRT for 18 months. The HRT has definitely helped reduce hot flushes, night sweats, dry eyes and joint pain. I'm not sure it has helped my brain fog, horrendous tiredness or lack of libido at all as these three things are still a major issue for me.

I understand why for most women, testing their oestrogen levels prior to staring HRT isn't best practise. However, I'm not clear whether the same thing goes for testosterone?

I guess I don't want to 'blame' these three symptoms on low testosterone if that isn't a factor.....

The tiredness is debilitating and blood tests haven't shown any cause. I can and have fallen asleep over my breakfast, woken up over an hour later and missed appointments. I often doze off after work. These days if I'm sitting down I have to set an alarm on my phone in case I accidentally fall asleep. I feel tired all the time and all I want to do with any spare time is rest.

My libido is non existent. I love my husband, and I do enjoy sex once we get going but am never ever in the mood to initiate and I feel guilty that we have sex very infrequently. He is understanding but I don't want to be this way. It is like I'm not a sexual person anymore.

Any thoughts or advice would be wonderful.

The tiredness thing sounds overwhelming, among everything. Poor you. Do you take iron and magnesium?

Watching with interest as I'm in a similar boat.

Louise Newson's clinical training suggests that tests are needed before you start testosterone. Firstly to check your oestrogen is high enough (if it is not you may need to increase your HRT first) and secondly to check the testosterone level and Free Androgen Index which is a measure of the useable amount circulating.
Not all GPs can prescribe testosterone, in some areas it is restricted to being started by specialists only.

I’m in a similar position. HRT has helped some things but not my sleep. It did at first but then stopped. I’m knackered most days.

GP upped oestrogen but said if it doesn’t help they will test my hormone levels in case I need testosterone.

Why don’t they test for it in the first instance? It’s such a long process and I’ve wasted so much time just bloody tired.

I’m in exactly the same position as you op, except I’m 52 and have been on hrt for 5 years. Today they finally prescribed testosterone! Whether or not I’ll be able to actually get it locally is another matter apparently. But in answer to your question,they’ve prescribed it because they’re sick if me complaining that the hrt isn’t helping my symptoms, my estrogen levels are high, and they haven’t bothered to check my testosterone, they’ll check that they’re not too high in 8 weeks but will be going mainly on my symptoms.

I’m currently trying to get Testosterone and have a call with my gp in the morning. I’m 44 and have been post menopausal for about 3yrs. Although it took some pushing to get that diagnosed after having pretty much zero periods since I was about 38. I’ve been on HRT for 3 yrs but still not sure it’s right which is why I’m pushing for testosterone. I’ve had my bloods checked and when I rang the drs they said they were normal. When I pushed for the levels they were 0.4 which as far as I can read is on the borderline of being low (although that info isnt clear online either). Just feels like a constant battle! I’ve got to the point my kids are teens and I can get on with work and I’m shattered all the time. No libido at all and just fed up. Shouldn’t be this hard at all.

I just asked my GP about this for libido (though also suffering with fatigue). They did a blood test. From what I can gather it’s in the normal range. Not sure where we go from here.

Did you ask what the level was? I got told normal but when I asked and looked at the ranges I don’t agree. Hoping the gp listens to me tomorrow. The nice guidelines say they can prescribe testosterone for women based on just the fact there’s a loss of libido so if that is a symptom you can push from that perspective.

Thank you all for the helpful replies and I am sorry to hear that others are in the same boat.

The tiredness is really hard work and it is getting me down. I'm taking a multivitamin, D vitamin and fish oil, I've even seen a nutritionist and overhauled my diet in desperation.

So I'm intrigued and a bit confused that several people have suggested having my oestrogen levels checked before looking to ask for testosterone as I thought that Oestrogen testing is unhelpful due to fluctuating levels day by day- or does the approach to oestrogen testing differ once you are actually on HRT?

I do need to make a consistent effort to use four pumps of gel each day. I can't do more than two pumps at one time as I run out of 'room' and I do sometimes forget to top it up with another two pumps later on (unfortunately patches didn't seem to work anything like as well as gel even on a theoretically high dose).

On Hrt oestrogen is supposed to be more "levelled " so it helps to give a guide as to if you're absorbing and if levels are roughly right. You're supposed to be fully oestrogenised ideally as it may help libido without and also counteract negative testosterone effects.

My Gp did test oestrogen and testosterone prior to issuing testosterone but she was also trying to establish if other symptoms were at play as I'm on thyroxine too. She said she tends to like to test before issuing possibly as give a baseline. (I know she's also a Newson fan.)

Testosterone is a bit more complicated as there's also the FAI. So my testosterone is very low but measured just ok within the FAI, though lower end. (A SBGH calculation with testosterone level.) But it is licensed in the uk for libido if oestrogen is maximised and technically no tests needed. She also said none of the testing is an exact science though. Presumably as it can fluctuate.

My Gp has allowed more oestrogen based on tests (125) despite being on 100 patches, based on the oestrogen test (which was lower now than when I was on less last summer at 189!) I'm already on more Utrogestan as I've actually found that helpful for sleep and joints. Some women actually find that progesterone helps with libido too.

She agreed to try the testosterone too. She said it's roughly 50/50 who likes it or doesn't get on with it.

She's not said this before; that some patients do find it helps mental clarity etc, but it's not licensed for this. And some patients don't like it.

(Most if this I've learned from menopause matters forum along with Gp guidance. Some really experienced women there.)

You need to be getting enough oestrogen in your HRT before thinking about starting testosterone. So maxing sure you're on the maximum tolerated dose of oestrogen, and it can be useful to check oestrogen levels as it could be an issue with absorption etc.

If you're getting enough oestrogen, and are considering testosterone treatment, you should have your testosterone levels checked first and then again 2 to 3 months after starting treatment

my GP said they aren’t allowed to prescribe testosterone there is also no specialist menopause clinic in our whole region. So unbelievably sexist. How is this regional variation allowed? How are our local GPs ever going to improve their practice for women?

I just started testosterone. It's only available to me in a male formulation so the dosing is probably hit and miss - I'm just supposed to use one tube over 10 days. Doc saw testosterone was low in blood test plus libido completely AWOL. Yet to see any impact but only been a few days.

To do four pumps of oestrogen you could do legs and arms at the same time? This is what I was advised.

when my last Mirena ran out I had a big review of my HRT. Switched to utrogestan, doubled my patches which improved my flat mood no end, then when that was settled added testosterone. Your oestrogen needs to be optimised first or the body just converts the testosterone to oestrogen apparently.

testosterone worked wonders on my libido; I didn’t have a problem with tiredness so haven’t noticed a difference (although at nearly 65 I don’t have the stamina I did).

Can I ask how you measure out the testosterone dose? My GP has reluctantly agreed to prescribe this for me but is being very cautious and wants to retest within 3 weeks to make sure my levels aren't too high ( currently <0.4).

Given you have to use a sachet over 10 days, what amount do you use? Pea-sized, or is that too much?

Be careful as the testogel sachets have changed recently and the smaller size lasts 7 days.

I've seen 0.3ml and 0.35ml mentioned before

Sorry, 8 days. I'd double check with the pharmacist

Thank you - that's helpful to know. I'd still be interested to know how you you can sure you're using the correct amount though? Do you use a syringe to draw up the required dose?

I went down a rabbit hole of trying to get an accurate and identical dose every day with a tiny syringe. Ridiculous and impossible. Now I write the date I start a sachet on the sachet, work out when it should run out, and just keep an eye inbetween. I find it’s a large ish pea, but some days get more and some less. Don’t sweat too much over it, as long as it evens out over time it’s fine.

Also bear in mind the 5g sachets don’t necessarily contain 5ml of gel, so it’s not as simple as 0.5ml a day!

Thank you . It will be a few weeks before I'm able to start but that's really useful to know. GP is being ultra-cautious - quite happy to give me antidepressants without a second thought (I've said no), but reeled off a long list of potential side effects associated with testosterone.