Help please with female hormones after intro of T3 and gel to patches

Hello

I know this isn’t directly thyroid related but I needed a bit of help/ advice with recent sex hormone results. I started on T3 approximately 8 weeks ago and still adjusting dosing with guidance from an Endo.

5 weeks ago, I changed from 3 pumps of estrogel to 100mcg patches as I felt I wanted more consistent dosing. I wasn’t sure if meno symptoms (extreme fatigue and headaches) were playing a part, alongside thyroid issues. I’m a poor converter. Currently on 15mcg of T3 (split into 3 doses) and 75mcg Levo 4 days and 100mcg for 3. My latest thyroid panel showed normal TSH just under 1, T4 just below range 11.5 (12-22) and T3 at 4.3 (3.1-6.8), hence the small increase to 100mcg on 3 days.

I have no idea what some of these sex hormone bloods mean so any help would be very much appreciated as I’ve had a significant drop on estrogen since changing to patches. Could this be the Liothyronine now affecting my estrogen?

I am post menopausal.

Bloods on gel 3 pumps (after 18 months on regimen)

FSH 32 (25.8-134.8)

LH 31 (7.7-58.5)

Oestradiol 426 (<100)

Testosterone 0.51 (0.101-1.42)

Prolactin 237 (102-496)

SHBG 81 (27.1-128)

Bloods on 100 mcg patches (5 weeks) same ranges:

FSH 26.3

LH 19.4

Oestradiol 55

Testosterone <0.087 Below range

Prolactin 174

SHBG 95

I realise I may need to speak to my Endo re adding in some testosterone? I have a mirena coil for progesterone element.

Any thoughts or help would be so helpful as I have no idea what this means so thank you in advance.

I’ve been on HRT for approx 8 years and switched from tablet to gel 18 months ago due to poor absorption. I was very happy with it but given all the thyroid issues, felt I had nothing to lose trying a different method, but in doing so seem to have lost most of my estrogen- yikes!!

radd not sure if you’re able to shed any light?

🦋 x

[radd]

Butterfly1942,

It’s not good to make more than one change at a time as it muddies the water regarding what causative factor belongs to what. Adjustments of thyroid meds can take many months for full effects to be felt and T3 introduction even longer.

Could this be the Liothyronine now affecting my estrogen?

Possibly but it’s usually only high doses of T3 that would impact oestrogen levels. I think it more likely that you need a bit more HRT. 1 pump of Estrogel contains 750mcg (0.75 mg of Estradiol) and three pumps would be considered a high dose. You’ve switched to a 100mcg patch which is the highest patch dose, and many women require two patches.

Your first lot of bloods show much better levels. It’s a balance but you’ve gone too low evidenced by the low oestrogen and testosterone. You may not need to replace testosterone if other sex hormones are optimised. Testosterone isn’t licensed in the UK for women but can be prescribed alongside HRT if the HRT hasn’t eliminated symptoms.

Beware that increasing HRT may necessitate another adjustment of thyroid meds as SHBG raises inline.

[Hidden in reply to radd]

Thank you so much for the detailed response radd. I did make a mistake in switching, especially at the same time in changing thyroid meds. An act of desperation I think- and I had no idea I’d absorb so little. It’s good to hear that T3 can take a while to make a difference as I think I’d hoped to see a greater improvement by now. I think my best bet now is to go back to my gel. I was quite shocked by the sudden drop in estrogen levels as I’d hoped I’d have absorbed more from the patches being such a high dose. It seems that the gel is perhaps better for me in terms of absorption?

Thank you so much for your help and kindness in responding. It’s all very confusing as I know little about female sex hormones.

🦋 x

[Hidden in reply to radd]

I would not necessarily call three pumps of Oestrogel a high dose. It all depends on the person. I know some people on the "menopause matters" forum who use five-six pumps a day and some are still struggling with symptoms of low estrogen. It would seem some absorb the gel less well and need higher doses or do better on other forms of HRT. When I was on Oestrogel, two pumps a day resulted in estradiol levels less than 50% of where my doctor wanted them. Using four pumps a day brought them up to 75%. At that point, I switched to Lenzetto which was better absorbed and is also stronger (1 spray = 1.53 mg of estradiol vs 0.75 for 1 pump of Oestrogel). Many people I know use three sprays of Lenzetto daily which is the equivalent of six pumps of Oestrogel.

I was offered Lenzetto when my pharmacy could not source Oestrogel and it turned out to be a blessing in disguise😊. My doctor had never heard of it (it was quite a new drug at the time) but I insisted she prescribe it instead of Oestrogel.

[Hidden in reply to Hidden]

Hi PurpleCat71

I had thought previously about trying the Lenzetto as I believe there’s little dry time?? I’m so glad it’s working for you. Out of interest, what level of oestradiol did your doctor see as optimum on HRT? I’ve done a lot of googling and I think the only thing I could find was about the 300pmol mark? I know some need it as high as 800 to get control of menopausal depression, but I don’t need it for this, just to keep on top of symptoms. I’m also very keen to not over do it😊

Did you take a long time to find the right dose on Lenzetto or did you just jump in with a rough equivalent? I hope you don’t mind my asking. Thanks so much for helping 🙏 x

I have 2 bottles of the gel left which I’d forgotten I had at the bottom of a drawer🙄 (pharmacy can’t get the gel) so I’m ok for a little while, but wouldn’t rule out a trial of the Lenzetto.

[Hidden in reply to Hidden]

Yes, Lenzetto literally dries in seconds whereas I left more or less five minutes for the gel to dry.My doctor wanted my estradiol levels above 100 pg/ml during the luteal phase (labs day 19-21 of cycle), preferably closer to 150 pg/ml. On two pumps of Oestrogel, they never exceeded 37 pg/ml. On four pumps, they rose to 75 pg/ml.

I started on two sprays of Lenzetto daily which is more or less the equivalent of four pumps of Oestrogel. When I still had some remaining symptoms, I added one spray daily (equivalent of six pumps of gel) and that resolved the remaining issues for me.

I find Lenzetto very easy and convenient to use.

[Hidden in reply to Hidden]

Thank you PurpleCat71 I’m so glad it’s effective for you and long may it continue! Likely I’d have to do 2 sprays. It’s been 2 years since I’d had this checked in bloods, so at least now I can do more regularly to see what’s going on 😊 x

[Hidden in reply to Hidden]

Best of luck to you, I hope you find something that works for you!

[Hidden in reply to Hidden]

Thank you PC 🙏

[radd in reply to Hidden]

PurpleCat71

I think we’ve had this conversation before 😬. Factors necessitating high doses of HRT could be receptor insensitivity, weight gain, over medicated thyroid meds, etc, etc. Also the gel is intolerant of body creams, oils, etc. …. but official literature does cite 2 pumps as the ‘usual daily dose’ as stated on the Oestrogel PIL. I use 1 pump which is considered low and 3 pumps and above is considered high.

I’ve also been prescribed the spray after chemist couldn’t fulfil my prescription, and have read it to be more favourable but haven’t tried it yet as still using up my gel.

[Hidden in reply to radd]

I think we know better than to trust the "usual daily dose". We all know that everyone absorbs and metabolises hormones differently, and that many factors influence our hormonal needs. It also depends on how we define "high"...as no more than "above usual daily dose" or rather "too much"...the latter is often how doctors react when patients require higher-than-average doses.

[SarahJane1471]

I’ve just gone back to patches from Estrogel because my pharmacy is having problems getting the gel. I definitely think patches are less potent ( my hot hideous flushes are back) . I’ve begged them to source gel for me 🤞. Four pumps of gel is the equivalent of one 100 patch. But for me the patch seems to not absorb well. Also I used to use 5/6 pumps a day🤷‍♀️.

A friend of mine uses a100 patch and 4 pumps of gel. ( prescribed by a GP). It’s a very individual thing to get right.

Also testosterone gel is readily prescribed now by GPs if your libido is waning. It’s off label but I just asked and she was happy.

[Hidden in reply to SarahJane1471]

Hi SarahJane1471 Thank you for your reply.

I’d heard about the gel shortage (😬) and this did add to my panic decision to trial patches. Interesting you have noticed the same, but I’m so sorry you’ve got the dreaded flushes back.

I’d initially ordered the patches as a safety net in case I couldn’t get my gel-but then thought it might be worth a go as it could give more even dosing over 24 hours. With my thyroid in free fall, I thought this might be a good idea. Not such a good idea after all. I’m pretty shocked my level is so low! I really expected it to be higher than on the gel. The patch stuck brilliantly (Estradot), was easier in lots of ways as no faffing about with drying time etc, but I’m going to switch to gel and just hope my chemist can refill my next prescription. Otherwise, I’ll be sticking on more then one patch 😊.

I really hope you are able to get your gel back. Have you tried to source via an online pharmacy? Probably not available if it’s a national issue? I believe the shortage in HRT has been raised in parliament! Probably just a soundbite recorded in Hansard and long to be forgotten🙄. I’ll be begging, too, if they can’t get mine x

[SarahJane1471 in reply to Hidden]

Yes it’s a national shortage due to the recent publicity and women felling empowered enough to insist with GPs they want it. And good for them 💪. But bad for us 😂. I’m using 1 and half patch whilst I wait for my precious gel 🙏

[SarahJane1471 in reply to SarahJane1471]

Also just reminded me 🧐that I have palpitations back which I thought was the Levo 🤦‍♀️

[Hidden in reply to SarahJane1471]

😂 so true! So glad you got ample patches SarahJane. It really is not an option to go without when you’ve had bad symptoms. I could feel my panic rising when I heard! It’s so hard isn’t it, as we blame so much on meno, then realise we have wonky thyroids, then blame our thyroids when it’s actually meno! 😵‍💫 x hope those palpitations settle- just awful!

[Hidden in reply to SarahJane1471]

Hi SarahJane

Do you mind my asking is it the Testogel you use? Are you happy with it? Did it have any impact on your energy levels?

That’s really useful Re the pumps and patch together. I have wondered whether to keep the patch on (it’s obviously not kicking out much) and add 2 pumps initially. Seeing as the GPs might let me do this?? I used to have tablets and topped up with one pump of gel ages ago before making the switch to gel solo and they were happy with my doing that.

We must be so different in how much is absorbed so I don’t think I’ll be in any danger of going too high if I keep the patch and add in 2.

Xx

[SarahJane1471 in reply to Hidden]

I think the only reason Nice say 4 pumps/100 patch maximum is cost. If you see a private menopause specialist they will say you can safely use double that! I have two friends who see two different private Drs and they use the equivalent of 8 pumps. It’s a replacement hormone just like thyroxine. If a couple of pumps with a 100 patch relives your symptoms 🤷‍♀️.

That’s what I am doing at the moment xx

[SarahJane1471 in reply to SarahJane1471]

Also I used Testogel for a couple of years then stoop when I stared thyroxine as my testosterone levels were a little high. Recently I’ve started a tiny bit back in to see if it helps my energy levels.

[LeiL in reply to SarahJane1471]

SaraJane, what did you do to lower your testosterone. My levels are twice the norm and I’n post menopausal.

[SarahJane1471 in reply to LeiL]

I don’t know if it is lower 🤷‍♀️. I’m not sure if it goes down naturally or not. Sorry that’s not very helpful 🫤

[Hidden in reply to SarahJane1471]

Thanks SarahJane this sounds like a plan as I did like the thought (placebo effect) of believing I was getting some steady input via the patch so I was really disappointed to see the drop so I might trial this option before maybe giving the Lenzetto a go further along if I don’t feel that’s working x

[humanbean]

You might find this link helpful, but I can't help on the subject of sex hormones.

rt3-adrenals.org/sex_hormon...

And there's this link :

rt3-adrenals.org/female_sex...

I don't think the graphs are relevant to someone who is post-menopause, but there is some text at the bottom of the page relevant to women who are post-menopausal.

You might find this link useful for various test results which may be relevant to thyroid :

healthunlocked.com/thyroidu...

.

[Hidden in reply to humanbean]

Thank you humanbean It seems to make sense that the sex hormones, adrenals and thyroid need to be balanced together and work off each other. It’s all such a hormonal minefield! I’ll have a read through- thank you so much for sharing these!

X

[SarahJane1471 in reply to humanbean]

Interesting humanbean! Since having to use patches ( which I think are weaker) I’ve had fluttering in my chest. I thought it was thyroxine but now I’m thinking the reduced estrogen is the issue. Thanks for the links

[SarahJane1471 in reply to humanbean]

Also WOW! what a complicated balancing act the endocrine system is! How are we ever going to get the right balance 😭

[CoeliacMum1]

Just to mention re oestrogel there seem to be in two different bottles at present, one has an orange square 🟧 on the bottom of the bottle the other has a green square 🟩I have no idea which is the better, it seems some are getting on fine with both others has return of symptoms, it’s like the oestrogel v oestrodose saga, both are made by Besins.

For those with return of symptoms on hrt gel consider looking at this.

There’s been various menopause Instagram posts on this.

[SarahJane1471 in reply to CoeliacMum1]

Interesting 🤔 I remember the estrogel/Estrodose problem but did not know about the different coloured squares. Mine has green on them. 😡😡why do they keep doing this to us . It makes me hopping made the meds are so different when it should all be standardised !!!!

Which insta page is it please?

[CoeliacMum1 in reply to SarahJane1471]

There was an Instagram live with Harley street emporium and menopause health that Diane Danzebrink pointed me too. I think there’s a few more posts now on it, probably with more up to date information.

I don’t know if Dr Louise Newson has anything on this but they’re the ones along with Dr Sarah Molly Ball and Dr Rebecca Lewis that are very good at giving evidence based information that you can reliably quote back to your GP.

They may also have Fb but I’m predominantly on Instagram.

[Hidden in reply to CoeliacMum1]

Thanks CoeliacMum1I’ve just checked mine and it’s a 🟩 on one and 🟧 on another! Jeepers- what next?? X

[CoeliacMum1 in reply to Hidden]

I’m on my last orange squares bottle, I have new which is green square it will be interesting to see what happens… If I’m no better I’m swapping to another hrt, if possible. I’m fed up with the Besin situation, if folk haven’t enough problems, without fighting to have a good quality medication.

MHRA are fully aware, all we can do is complain and definitely fill out MHRA yellow card (there’s an app) make sure your GP is aware too, if you’re having returning symptoms.

If everyone contributes in complaining, maybe we will get this sorted.

It’s not good enough!

[SarahJane1471 in reply to CoeliacMum1]

👏well said

[SarahJane1471]

I’ve just had a quick look on tinternet. Yes there looks to be a big problem again with the gel and the green square 🟩 is allowing symptoms to return for some women. This could have a big effect on us women trying to control thyroid/menopause/adrenals axis. I think that it’s fine to use the orange square 🟧 but you may need double the amount. I’m thinking back over the last few months and wondering if my estrogen has been low and therefore affected my T3 uptake. I was really well until the start of March then retested TFT and my FT4/FT3 went right down in the range. The estrogen could be the answer for me! I’ll let you know. Just going off the slap on more gel and cover myself in patches 😂

[Hidden in reply to SarahJane1471]

😂😂 this will me me also! I’ve now boxed up my 🟩 and left out the 🟧 to use! 🙄. It’ll be interesting to see if thyroid levels increase without a change in dosing- keep us posted and I’ll do the same x

Ps did a little test between the two and the green is more watery. I did wonder why it had dried so quickly this morning and the house is cold so 🤦🏻‍♀️. Maybe this affects absorption- too quick drying, less absorption I’m thinking 🤔

[SarahJane1471 in reply to Hidden]

I rub in 🤷‍♀️

[Hidden in reply to SarahJane1471]

Yes it’s mixed advice out there on that one! Louise Newson suggests rub in I think? I’ve always got it on and let it soak-arrgh so many decisions 😊

[Roadrunnergreg]

I believe a lot of your problems are due to low Progesterone, take Testosterone its made from Progesterone, Progesterone also influences the thyroid hormones too.

Here is a good talk on hormones from 20+yrs ago

The Estrogen Deception by Dr John Lee

youtu.be/QkOkHEacsuQ(Not working as expected?)

[Hidden in reply to Roadrunnergreg]

Thank you Roadrunnergreg. I’ll look at the video shortly- I’ve been googling estrogen dominance for a while and wondering if this might be me. 🙏

[SarahJane1471 in reply to Roadrunnergreg]

😳I have never considered that I may not have enough progesterone!!! Thank you for this.It’s mind blowing for me as when I hit the menopause 5 yrs ago I only replaced estrogen because I’ve had a hysterectomy so was told I didn’t need it. 3 yrs later I developed thyroid problems!! I was borderline. What if all this time I just needed progesterone 😤

[SarahJane1471 in reply to Roadrunnergreg]

Ah this is 20 yrs old and it’s now being disputed as too much progesterone can cause serious illness 🤦‍♀️

[Roadrunnergreg in reply to SarahJane1471]

Problem is it depends on where your getting the info from, if the information is coming from the medical/big pharma institutes you have to also bear in mind they make their money from sick people, people with good to optimal health is bad for their business in the same way peace is bad for the arms industry... and we don't fill our bellies with medicines we eat foods we need the nutrition the foods are supposed to have in them and now the governments and health industries want impossible foods totally devoid of nutrition we need. Hope that perspective helps as I don't trust the pharma industry as much nowadays even less than I did before... my point is you need to get the optimum levels not just in range, the RSA as it was was designed to avoid outward signs of deficiency and not optimal health