Tweaking HRT

[Rainsdropskeepfalling]

Looking for suggestions to take to my GP.

I'm 52, using a mirena coil and oestrogen patch (started at 50ug, now 75ug).

My serum testosterone is 0.3nmol/l so normal. My SHBG is low 12.4 nmol/l (normal 23-159) but GP not bothered about test results (both tests done at my request, not their suggestion).

Brain fog means I no longer speak up at mtgs at work for fear of not finding the words. Kissing goodbye my next promotion (I'm a senior director, PhD so on paper capable of VP level role in the next 1-3 years). My rage is very real and I snap at DH (poor sod probably wants a divorce and I can't blame him). I do sleep better now but libido has been missing for a decade now so that's not coming back. Anxiety and depression is there - but I have tendencies to depression and DS1 is 17 so of course I'm f###ing anxious, watching him piss away things. So maybe that's nothing to do with menopause.

So (and well done for reading to here) should I just ask for the next dose up patches (100ug) and a box of fluoxetine? Anything else I should explore with the GP?

I’m not 100% au fait with the different types of testosterone measurements, and the nmol and Ng conversion is another layer to it, but a reading within a range that goes down to zero seems odd. When my serum testosterone was tested, I was told that I was at the low end of the scale (from memory about 0.4) and I was prescribed testosterone. I know not every health authority does this yet.

My rages were uncontrollable at times pre testosterone, and I would have thought that I’d be even more likely to rage given the reputation that testosterone has for roid rage, but I’ve found I am far more even tempered and clear headed as a result of taking it. My first 3 months using it took me up to a level of 2.7 so we stopped for another 3 months before I asked to try again at a lower dose because the rages and emotional instability were back. I’ve now been on that lower amount for 9 months and staying at around 1.8. My libido is still a bit lacking but I’ve just been prescribed Ovestin to try to help with vaginal atrophy so I’m hoping that it might be another element to help me feel a bit like my old self.

Go for the private menopause testing and prescription. You will be seen by someone who understands in depth and won’t be limited by a postcode lottery about whether the right treatment you need can be offered to you.

Good luck!

As I understand it the recommendation is to get oestrogen optimised before considering testosterone.
Most menopause clinics say it takes the body up to 3 months to adjust to HRT or dose increase so it is only recommended to change it 3 monthly or you can increase too quickly and not find the correct dose
Free Androgen Index is "Testosterone level divided by SHBG then multiplied by 100" so I would make yours around 2.4 which is within normal limits so I would wait a while until GP will try the higher dose before pushing ahead with other things

@QueenOfHiraeth thank you. Really helpful to have it explained. I think I would feel encouraged by a step by step plan with an explanation of why and when.

OP just double check your Free Androgen score as that's what my T prescription was based on, mine was 0.4 which is a similar number to yours - you don't say what your number relates to.

But I agree with PP, my GP wouldn't give me T until they'd checked I was properly oestrogenised, which they checked by looking at my vulva to see if it was healthy looking! Female GP in an all female partner surgery, super supportive.

Actually my FAND score said 'too low to calculate <0.4' which I took to mean basically non existent!!!

I was always under the impression if you said your DH was thinking of divorcing you for low libido, they whipped out a prescription for testosterone as quick as that.

It sounds to be like you have low testosterone, even if tests come back within normal range.

I’m a scientist, and have higher testosterone than normal ranges - ring finger longer than index finger for example, and very good with numbers, spatial, and data.
If I just went with my blood levels I’d never get it prescribed as it had fallen below my range, into the normal range by the time I got it tested.

It sounds to me like you need to be more strategic about this: I went to a private gynaecologist initially and got all my scripts there. The GP fills them out for repeat.

your GP sounds like they think they’re the Boss of you, and is causing an obstruction to your health, so you need to go around them and get to see a specialist gynaecologist with menopause speciality.

It’s unacceptable that you’ve been referred to have talk therapy when you need testosterone-
take control of your health and get a private appointment.

look up menopause matters website to get info for a consultant gynaecologist with menopause expertise.

Remember some women have higher testosterone than normal range, and we need more testosterone than falls into the range for normal.
My hrt has been a life saver for me, marriage wise, career wise.

Doing what the GP says and being a nice compliant woman is Not serving you if your body and mind is telling you you need something else.

We’re all very different, and empowering your self to get the help that suits you is your job now, not going along with a god complex GP who’s not familiar with you and thinks s/he knows best.

get a private appointment and get some testosterone - you get one life so live it as you want- your career and marriage will thank you!

Oh I meant to say, that’s addressed to @Rainsdropskeepfalling although it’s for everyone I guess!

In Spain, I just buy it OTC and more or less prescribe myself. (Going on a rough guide from Doc, obvs) we all do.

Nobody ingests anything either. You pop it up you foof or rub it on your skin.

It is crazy you[re waiting months. Everyone should just be more sensible and calm down about HRT IMO!
We were all "allowed" to mainline the pill for decades. No worries.

@Leftoversgalore unfortunately my blood tests didn't include a free androgen score, just testosterone and sex hormone level. I will ask the private GP about this.

@LaJoconde

Thank you! I'm a scientist too hence perhaps my expectation that you measure a baseline, you apply a dose, you remeasure, and adjust the dose accordingly. I'm very hopeful that the menopause specialist clinic I will go to will be able to be more systematic and listen to me.

@Rainsdropskeepfalling at this point it’s maybe too late to get a ground truth reading on your testosterone as you may be deficient.

the danger is that getting a reading now may well put you in the “normal” range when your actual range where you feel best is much higher.

If the doctor won’t prescribe testosterone, then the fall back option is to moan about your lack of libido, and mention your partner isn’t happy. Testosterone is primarily prescribed for low libido.

We live in such a world that men are “minded” a lot more than women.
Heaven help us if a man isn’t getting any cos his wife ‘has a headache’ - his testicles will turn blue and explode, and that will cause Trump to be elected, Vladimir to invade a neighbour, and Benjamin and pals to straff bomb the Middle East...... oh wait a minute.....

@LaJoconde you make a good point. Someone has to be two standard deviations from the norm, so it could be me.

I will ask the private clinic about testosterone. I have to say that I don't really understand how private vs NHS prescriptions work as I definitely got the impression from my GP that something exceptional would have to happen for them to be able to ask permission to prescribe testosterone.

I wouldn’t have managed without going private OP. It was worth every penny.

OP if the private clinic has a consultant, usually your GP will accept their recommendations and prescribe for you once you've had one private prescription.

This happened for me with dermatology.