New Testosterone Levels in HRT

[Amber-sky]

Hello

Has anyone come across the change in testosterone levels updated in May 2022 by the British Menopause Society?  See the monitoring section of the Testosterone replacement in menopause tools for clinicians document on the BMS website. Link below.

The updated range is based on levels being within 0.50 - 2.60 nmol/L, whereas before it was to keep the free androgen index (FAI) within the female range of below 5% (calculated using testosterone and SHBG).

For example my last test was:

plasma testosterone level 3.6 SHBG 129.8 FAI = 2.77%

So previously having the FAI of under 5 was normal but I am now considered too high as my testosterone is over 3.6.

Surely they must also recommend changing the dosage of androfem and Tostran etc accordingly or many of us taking testosterone could now be considered technically too high based on the new guideline levels.

I just wondered if anyone else was aware of this and/or has been effected by these changes.  Other than the BMS website I can find no reference to this.

It’s just frustrating as I was at last feeling pretty balanced with my HRT to then have the goalposts moved resulting in what appears to be a step backwards with minimal communication.

Thank you in advance if anyone can help.

thebms.org.uk/publications/...

[Eevee_S]

Hi. I have wondered what happens with testosterone dosage as my levels increased in the first 6 months. So I wondered why I hadn’t been out on a maintenance dose now. But worrying and I’ve already reduced the dosage because I figured, if I kept using the two pumps each week, it’ll keep rising. I do need to ask my dr about that. Strange that they send us away with these prescriptions but don’t look to changing the dose once levels please and I’ve not seen anyone mention it in all the stuff written st the moment.

[Amber-sky in reply to Eevee_S]

Thanks for replying Eevee.

I’ve found testosterone to be the missing piece of the HRT jigsaw puzzle and have felt so much better since taking it, along with Oestrogel and utrogestan both of which I started about three years ago.

For me, estrogen has hugely helped with reducing hot flushes, sweats, anxiety, mood, insomnia, aches and pains but testosterone has just gone that bit further by reducing brain fog and fatigue.

My frustration is that my GP has now stopped my prescription as I am above the plasma testosterone level of 2.6nmol/L despite feeling good with no side effects.

It seems to be two steps forward three steps back with HRT ☹️

[Eevee_S in reply to Amber-sky]

Ahhh ok. That’s not good. Yes I totally agree with everything you’ve said. It was the missing piece for me too. I’m on everything you’re on too. The tiredness, stamina and brain fog all improved so much! Thing is - surely your testosterone levels will now go back down. So what happens then? You go back on it? That doesn’t make sense. Surely a maintenance dose would’ve been better. Does make me wonder whether this is going to happen to many others too once their levels are higher (and due to change in guidelines). With it all being new to treat off license, I also wonder whether there are women out there taking too much etc and what the results of that might be. Bit worrying though if we’re all going to get taken off it now we’re all feeling so much better! Will see what my dr says on my next check up. Challenging times x

[Amber-sky in reply to Eevee_S]

Yes I guess we’ll all have to watch this space.

One thing for sure is that things are progressing for women now and I’m hopeful that within a year or so we will be able to get Androfeme on the NHS and GPs will have confidence in prescribing it as not off license. Onwards and upwards!

Good luck with your next dr check up 🤞

[Lillyloop in reply to Amber-sky]

Hi There,

May I ask what Estradiol and testosterone levels you were prescribed that made you feel so good!

I couldn’t tolerate my biodentical cream - Estradiol 4 mg, progesterone 90 and testosterone 2mg in 0.3 ml cream.

Then the doc found out my ferritin, folic acid, Vit D and B12 were too low. I had an iron infusion, B12 and vit D injection and supplement with folate.

I felt fantastic for two months but suffer again with brains fog, fatigue and lethargy, dry skin. I researched and found my hormones need to be in balance due to the menopause.

I rang my doc and said I would try my bio-dentical cream again. Now I have had no side effects and feel slightly different after 4 days.

Your experience has been good so I’m thought I would ask.

So sorry they won’t prescribe it. Surely testosterone leaves the body, and you need a maintenance dose as the other lovely lady said. Thank you.

[Amber-sky in reply to Lillyloop]

Hi Lillyloop

I take one pump of Tostran gel every other day, 2 pumps of Oestrogel every day and one Utrogestan pill at night.

Luckily I still have at least a years supply of Tostran left and will continue to take it despite my GPs view.

It took me a little while to find the right type and dose as the NHS were neither informative nor supportive so you have to do the research yourself sadly. But things are improving here albeit slowly.

Good luck and keep persevering.

[Lillyloop]

Hi Amber,

Thank you for sharing your journey and HRT medication.

I have found my testosterone has given me move energy. The only odd side affect is my resting heart rate has increased from 67 to 76.

I may try some exercise to reduce my resting heart rate. Did you experience this?

[Amber-sky in reply to Lillyloop]

Hi there. No I haven’t noticed much change in my resting heart rate, if anything it’s gone down slightly but that may be because I am a little fitter now due to having more energy and being more active.