Low testosterone on HRT: options for DHEA or testosterone prescription?

[tipexmouse]

I am late 40's and on HRT (evorel and utrogestan) and have been for a a few years now. I do feel better on HRT but have felt for a while that something critical is missing. I bought an online blood test and my testosterone is 0.1 essentially undetectable. I have symptoms of low testosterone as well.

Ideally I would probably just go ahead and use an online pharmacy and see if I can get a prescription based on my blood test results and my symptoms. However looking at them all the pharmacies that do this say they will inform your GP. This might be ok but at about Christmas time I upped my estrogen patch from 75mcg to 100mcg by cutting a third off another evorel patch. I did this because I was only sleeping for about 3 hours max a night for the past year. I'd been to the GP prior to that to ask about my insomnia and if upping my estrogen patch might help but they told me it wouldn't be down to my HRT and that I was already on a high dose. I was given various things like beta blockers, amitriptyline, short courses of Zopiclone and melatonin and I did Sleepio cbt-i via the NHS. Nothing worked. After increasing my estrogen patch to 100mcg I started sleeping at least 7 hours a night and that remains the case. I did after a couple of weeks double my utrogestan tablets as per the updated guidance but I wanted to see if it was the increased estrogen that was helping my sleep and it was.

So at my next HRT review in a couple of months I need to try to argue for my HRT to be brought up to the 100mcg patch with the extra utrogestan for the sake of my sleep, I'd also like a prescription for vaginal estrogen cream. I think all the GP's at my practice are very conservative regarding HRT so I don't want a letter from an online pharmacy about my using testosterone muddying the water. I know some people get testosterone from their NHS GP and that there is NICE guidance on it's use in women with low libido but it also seems to be a very rare GP who will actually prescribe it and many go private for it.

As an alternative I was considering trying a low dose DHEA supplement? HAs anyone used these, did they help bring your testosterone levels up and relieve symptoms of low testosterone at all? Any side effects? I suppose my thinking was to try the DHEA first for a few months and hopefully get the GP on board with my need for a higher estrogen dose and then buy testosterone from an online pharmacy?

I think you should continue to be assertive with your NHS GP and ask for a referral to the local NHS menopause clinic for testosterone, as well as a therapeutic dose of estrogen if that isn't even forthcoming.

Many GPs are not able to prescribe testosterone either through lack of knowledge/skill or simply because it is blacklisted by their health board and hence it has to go through a specialist.

However I myself take DHEA 25mcg sublingual which I buy from iherb.

No prescription required, very inexpensive and it has restored my testosterone levels nicely based on both blood and clinical results.

I chose DHEA as I am on the pill not HRT, and it has been studied for safety alongside the combined oral contraceptive pill, whereas testosterone has not, and so while I believe testosterone would be safe in physiological doses alongside the pill, it is unlikely anyone would prescribe it as there is no published data.

I would definitely recommend a follow up blood test if you start on DHEA as it relies on the body converting it to testosterone, which some people are much better at than others, so if you are a poor converter you may get no effect but if you are a really good converter you could end up with higher testosterone than you want and need to reduce the dose a little.

@Charliede1182 Thank you so much for replying! I will have to be assertive to get my HRT increased again, they were reluctant to increase it from 50mcg to 75mcg previously and vaginal estrogen has already been refused in the past. However I really need to get both of those sorted for the sake of my general health and sanity.

I think the waiting list for the menopause clinic in my area is now close to two years. I will obviously ask for a referral if they refuse to up my estrogen patch but I do need to sort things out faster than that.

I do understand that many GP's aren't or don't feel they are in the position to prescribe testosterone to women and I understand they might have legitimate reasons for that.

I read about that research on the pill and DHEA, I suppose I suspected that it would be a similar outcome for women on HRT but I don't know for sure. I suppose the oral pill has more of an effect on SHBG than transdermal HRT. Anyway, if I do decide to try DHEA first I will probably start at 10mg and do a more comprehensive androgen test in a couple of months to see what my levels are. I appreciate your advice on the testing. Do you retest every year or more often?

I tested before starting DHEA, then retested at 3 months then another year.

As I was happy with my dose and levels and nothing else has changed I don't feel I need to test again unless anything changes eg moving from the pill to HRT.

I may try testosterone in the future when I am on HRT but tbh I'm happy with DHEA for a fraction of the cost and and hassle of obtaining testosterone.

@Charliede1182 Thank you that is really helpful information! I think I might as well try it for a few months due to the cost and hassle of getting testosterone and see how it affects things. I can always move to testosterone if it doesn't help.