No testosterone in the NHS HRT packages? Are these options are all there is?

[localnotail]

Hi, I had my first appointment with my GP Women's Health nurse to discuss going on to HRT - and while talking about various options mentioned a combine HRT my friend is using which contains testosterone. I was interested as read on here it may be beneficial for some for various reasons and I wanted to explore them as I need more energy and motivation which has slumped over the last year or so. But I was told NHS does not prescribe testosterone to females, on its own or as a part of combined HRT? The only options I was given were the different combinations/ types of Estrogen/ Prolactin and also told I should get a Mirena coil (I'm not sexually active btw). I'm quite interested to hear if its all there is or do I need to see a private Menopause clinic to get better options?

My NHS GP offers it, although I’m not in need of it at the moment. Menopause specialist GP at a regular practice, but one that takes a holistic and proactive view of women’s health. So it is possible to prescribe as part of an NHS menopause ‘package’.
I found the Menopause ‘Specialist Nurse’ at my old GP practice very obstructive (it’s why I changed GP) - do you have an alternative you can look at?

I’ve had it prescribed. Trying to find a pharmacy that has it in stock is a whole different ballgame.

My NHS trust will only prescribe testosterone for low libido. In my trust only through menopause clinic. They won’t prescribe it for anything else and it’s not as standard. It is possible to buy it from an online pharmacy (they wouldn’t sell it to me due to past health conditions) but now Gp has prescribed it.

Slightly different take on this, you need to become established on HRT first before adding testosterone to get the balance right.

Yes, you would get it easily at through a private consultant.

I'm assuming the 'Prolactin' is an autocorrect slip and you meant progestogen?

You don't have to have a Mirena coil. There are other options.

yes, of course not prolactin... just shows how foggy mu brain is at the moment.

thank you all for your comments. I will have to have a good think about it all!

Mirena coil is the easiest way of getting progesterone- low dose, no hormone swings, no tablets to remember

It sounds like the nurse knows what she is on about

Testosterone isn't for everyone and is usually an add on when you have sorted the rest of your HRT

I had a very bad experience with a coil, it was a copper coil and I ended up bleeding and in pain, and it was really difficult to get out. I know Mirena coil is not the same but tbh dont want anything inside of me.

The copper coil and the mirena are entirely different animals-they shouldn’t even be called the same thing as they’re so different! I’ve had a mirena for over 25 years, first as contraception and now as part of HRT, but there’s no way I’d ever have had a copper coil!

We can’t initiate testosterone in primary care in my area. It has to be prescribed initially by secondary care or a private doctor. We potentially can then take on shared care prescribing once it has been reviewed, bloods done and dose stabilised etc.

Testosterone wouldn’t be prescribed until a woman is settled and stable on oestrogen anyway, as oestrogen will usually improve nearly all menopausal symptoms. Testosterone is unlicensed in women and should really only be prescribed to manage low libido.

It is a separate medication and there is no combination of HRT which includes it all in one product - your friend may be on a combined oestrogen/progesterone and separate testosterone gel.

I doubt you were told you “had” to get a Mirena. It’s usually offered as an option for endometrial protection and can be easier for many women as they don’t then need oral progesterone, or are limited by the oestrogen dosing in a combined patch.

You can certainly go private, but any halfway decent doctor wouldn’t offer testosterone at the first appointment anyway as you’d need bloods and ought to start oestrogen first.

Not everyone gets on with the Mirena coil.

It's a synthetic progestogen, like other synthetic progestogen (Norethisterone and MPA) that are in tablets and patches.

The amount absorbed into the body is said to be same as a low dose patch (so despite claims it stays in the uterus, research says otherwise. )

As with all synthetic progestogen, there is a higher risk of breast cancer, according to the recent research, compared with Utrogestan.

@localnotail The only type of HRT which your friend may be using is a tablet- Tibolone- which contains 3 artificial hormones that mimic estrogen, progestogen and testosterone.

This is from the NHS website

Brand name: Livial
Tibolone is a type of hormone replacement therapy (HRT) that contains a synthetic (artificial) hormone. Your body breaks down tibolone to make substances that work in a similar way to the hormones oestrogen, progesterone and testosterone.

hi everyone, thank you all for replying.

Of course I wasn't told I "had" to get anything; I was given a lot of option but Mirena was recommended as a really good option for getting the hormone for preventing the thickening of the lining.

The testosterone thing was just something I was interested in as I was told its beneficial. I have no idea if I need it or not, definitely don't need to increase my falling libido as this is the only aspect of the menopause I'm very happy with.

My friend must be on some private prescription as she is getting a tablet with all three hormones in it, where testosterone is a tiny proportion (this is what she told me in passing). I will have to ask when I have a chance.

My friend must be on some private prescription as she is getting a tablet with all three hormones in it, where testosterone is a tiny proportion (this is what she told me in passing). I will have to ask when I have a chance.

See my previous post- it will be Livial (Tibolone.)

It's available on the NHS but it would be interesting to know why she's getting that.

Longer term it wouldn't be the best as it's a tablet/ synthetic and will have the small blood clot risks that other HRT doesn't have.

It's not prescribed that often and one reason is that the hormones in it are not body-identical.

There is guidance for the use of testosterone second line.

Ah yes, as @JinglingSpringbells says it’s likely to be tibolone. It doesn’t have testosterone in it as such, but has androgenic effects that can mimic testosterone. We don’t use it a lot, probably because the VTE risk is higher and you can’t tweak the dose at all. It’s also a continuous combined preparation so only for women who haven’t bled for a year.

I’d start with a solid regimen of oestrogen and micronised progesterone if you don’t fancy a coil and see how you get on. ☺️