Low testosterone 35y/o F

[seveneleven]

Hi all,

I had a female hormone panel done because I suspected something was awry with sex hormones alongside Hashi's and extremely low cortisol (currently on levo, T3, and hydrocortisone). It's come back with good estrogen and progesterone but almost undetectable testosterone:

Testosterone: <0.087 (<0.29 low)

Free Androgen Index <0.1% (<0.3 low)

I'd had my suspicions because I've never been able to put on muscle and carry a lot of loose fat and water, and thyroid progress has been slow since starting T4 and T3 earlier in the year.

I'm planning to get a private prescription for T and try it - is there anything I need to know about using it/any interactions with thyroid I should look out for?

I've always had very heavy periods so wondering as well if there's a link - I think it's likely that I've never produced enough testosterone given symptoms and EDS.

Any thoughts/advice welcome!

EDIT: Have seen my thyroid doc, who has prescribed some Testogel!

[J972]

Was the test carried out via Superdrug? I’m only mentioning because they may well expect you to have your testosterone level checked using their test before prescribing. Also, not sure if this is relevant but just to make you aware that they write to your GP every time a prescription is fulfilled.

Just a heads up.

Sorry, can’t really comment on possible interactions.

[seveneleven in reply to J972]

Thanks for replying. It was done using Randox, but having just filled out the Superdrug forms now, they don't seem to need any other blood tests - it appears they just go on symptoms (i.e. libido, which I've had to really overegg as a problem, but that seems to be the only reason they prescribe it). Yes I saw they notify the GP, but doesn't matter - mine isn't involved in anything since she wouldn't even diagnose Hashimoto's with sky-high antibodies 🙄, so all my treatment is private anyway.

[J972 in reply to seveneleven]

Ha, know the feeling!

Good luck 🤞🏼

[Flamingo60]

I have used testosterone as part of my HRT regime as my T was also undetectable. Not the same circumstances I realise. You need to be careful with the dose (max 5mg daily) and have your blood levels tested regularly. There are some potential side effects that you need to be made aware of, some minor e.g extra hair growth at the application site and some more serious. It is only licensed for HRT and specifically for low libido. Some GPs will prescribe off-licence but often only after a private specialist has. Bottom line is it needs to be monitored. Good luck

[seveneleven in reply to Flamingo60]

Thanks Flamingo. Yes it's all a bit of a minefield. Apparently it's not actually licensed at all in the UK, it's just agreed that it can be prescribed off license for libido/HRT, and guidelines suggest it should only be within limited age/menopause parameters. I think Australia is the only place that has a fully licensed version of the gel for women.

[Flamingo60 in reply to seveneleven]

Sorry, yes you’re right it’s not licensed for women in the U.K. despite the fact that we produce 3 times as much as oestrogen in our ovaries 🙄 (until they stop working of course!). I was using Androfeme which is the T cream produced for women in Australia. Sounds like you’ve a lot going on and several hormones out of kilter. Best of luck finding some specialist help.

[CatACat1]

I found myself in a similar situation two months ago - 42years old not perimenopausal (other hormones fine) but private endocrinologist identified very low testosterone - (below 0.09). I hadn’t been on thyroid medication for that long (since June) so he suggested just carrying on with the medication to see if that helped. Perhaps I was too impatient, but having looked at symptoms of low testosterone I asked him if I could go ahead with a trial of Testogel and he agreed. Feeling so much better on it.

I’m wondering why I had such low T though. A blood test I had before starting Levothyroxine was low, but not that low - 0.59, so I did wonder if it was possible for the levothyroxine to have affected it. Levothyroxine definitely also affected my hormones in terms of getting acne.

[seveneleven in reply to CatACat1]

Ah that's really useful to know! Yes my first thought was my doc might try and get me to just wait it out and see, but I've been on levo for 6 months and T3 for 3, and bloods are 'good' even though symptoms aren't. So I wonder if there is a link, but I think maybe mine has been low for years, if it was ever good at all. How have you found it's helped?

[CatACat1]

Yes, I would say definitely worth pushing for a trial at least.

I have found that I have slightly more energy, feel less anxious and my mood is better.

I do take a very small dose though, as I was finding that if I took a pea sized amount (half a pump) three times a week as suggested, I would get a couple of spots by the evening on testosterone days. So I use a smear of it every other day, and I feel good and skin is fine. For more dramatic results perhaps the suggested dose would be better for some though.

[seveneleven in reply to CatACat1]

Woohoo, private doc agreed to prescribe and took no convincing at all! She's said one pump every day so will see how that feels, may be that a smaller amount is better as you've found.

[CatACat1 in reply to seveneleven]

Oh brilliant! Is it the Testogel 16.2mg/g pump? Interesting about the dose. Was thinking about upping my dose back up a bit as an experiment. Let me know how you get on!

[seveneleven in reply to CatACat1]

Not sure, think so. I'm just glad she prescribes that and not the Androfeme, because the Testogel is I think about £60 for 2-3 months' supply, while the other is something like £150!

[Clara4741]

Yes you can get prescribed Testosterone by a private BHRT Doctor in the UK if your levels are low. Being Hypothyroid has that affect on your Testosterone and you won't get optimised on your Thyroid Meds until you get T up along with all the other things like Iron, Vit D, B12 etc. I am on it but like everything have to pay! You can only get T prescribed by a BHRT Doctor in the UK. NHS unlikely to prescribe it...no shock there!

[seveneleven in reply to Clara4741]

Thanks Clara. The potential barrier is my age and lack of imminent menopause, so don't know if a BHRT doctor would even glance at me when I seem to still be ovulating?

[Clara4741 in reply to seveneleven]

No it isn't, not if you work with a knowledgeable and experienced BHRT Doctor. They know women in perimenopause and before that even often need it, not just menopausal women. I think you are getting brainwashed by the NHS approach. Low T will also stop you getting optimised on your Thyroid Meds as I said. You just need to research a BHRT Private Doctor and say you need it for this reason. Many symptoms other than low sex drive are as a result of low T. It's not an indulgent thing to need to get your levels up solely for sex drive. It affects burning fat etc., building muscle, hair, mood, energy etc.

[seveneleven in reply to Clara4741]

Oh that's good to know, thanks. Yes I think I've got used to expecting less than nothing! I'm seeing my thyroid doc (private) tomorrow who does prescribe HRT, so will be trying to convince her to let me trial it.

[TiggerMe Ambassador in reply to seveneleven]

Such nonsense isn't it! If you are lacking now why make you wait 10 years 😡

[seveneleven in reply to TiggerMe]

Ah, it's like thyroid all over again isn't it! Why treat early when they can wait until you're on your knees and it costs them even more time and resources to fix it?

[Regenallotment Ambassador]

Hmmm so low on a hormone made in the ovaries and adrenal glands.

Would your need for cortisone suggest low adrenal function?

My hormones were all over the place when I was diagnosed Hashi. Since reaching optimal vitamins and FT4&FT3 things have settled down but then perimenopausal symptoms begin 🤦🏽‍♀️.

It’s a fine balance to find with a moving target. Hopefully your GP is a listener. Do you have a women’s health nurse? I saw one last Friday who was super knowledgeable and helpful.

🌱

[seveneleven in reply to Regenallotment]

Yep, cortisol is in my boots, hence the hydrocortisone. That's a long game, and I'll probably be on it for another 6 months or so before I can start tapering off. There's definitely something missing in the puzzle because my thyroid blood levels are technically optimal now, and vitamins pretty good (much improved), so wondering if testosterone is contributing to still feeling rubbish.

My cycle hormone changes have always been a bit turbulent and sudden. Had several years a while back of borderline PMDD, probably when cortisol was high. My energy can speed up or crash out completely overnight when I go into particular parts of my cycle, and I think I do get months with low progesterone where mood is pants, sore boobs etc. I wouldn't be surprised if I actually am vaguely perimenopausal and I just happened to test on a month when I've ovulated!

GP is fairly useless so I'm not involved with NHS docs at the mo, just private. She wouldn't diagnose Hashi's when my antibodies were 900, or refer to endo with below-range serum cortisol 🙃. I would say if I tried to get help for hormones, they'd say I'm young and estrogen is good, so therefore I am fine. Or only offer the pill!

[Regenallotment Ambassador in reply to seveneleven]

Ah yes so many similarities there to my experiences but sounds like you have it way worse. I am sorry you have to deal with this in your 30s that sucks. Ugh the pill…. Possibly one of my root causes, and yes now a bit older and I find myself fending off mirena coil offers as I now have fibroids from being on HRT too early. Have you looked at oestrogen dominance? I’d like to learn more about that. 🌱

[seveneleven in reply to Regenallotment]

Ugh that sucks, sounds like you've had a rough time with it. I've never been on the pill, and glad I always avoided now for my heavy periods that's for sure. They've petered out to 2 days as well, so guess that's worth mentioning to doc. I think I was oestogen dominant for a long time, and I was actually expecting to find that this time, but oestrogen was actually mid range and progesterone absolute top of range! I suspect they're see-sawing every other month. I can feel the high progesterone now ahead of my period because I'm actually sleeping 😂 I think dominance isn't taken seriously enough.

[Regenallotment Ambassador in reply to seveneleven]

Ah yes, so my periods were 2 days and light before going on HRT (@45) but that was when Thyroid wasn't yet diagnosed, GP at the time missed that bit. 4 years later thyroid diagnosed and HRT stopped. Hopefully you have it the right way round with a thyroid dx first. Ah yes.... dominance and sleeping - that is familiar too, and needing to wee in the night is cyclical and so are night sweats.

[Milburn13]

It seems testosterone is linked to hypothyroidism, I'm hoping to try some too as my levels are super low too. I'm in a hormone group on FB and they say it's best to use the injections as has a better impact & less chance of unwanted hairy-ness!!

[seveneleven in reply to Milburn13]

Ah good luck then...I'll post how I get on if I manage to get any prescribed! I think that for women at least, in the UK, you're more likely to get the gel? To be honest, a bit of hairy-ness is the least of my worries...my leg hair has been disappearing for about 10 years, so could probably do with a bit more 😂

[Milburn13 in reply to seveneleven]

Good luck, I recommend trying the Hormones for everyday health group on Facebook for advice on testosterone. I have my first appt endochrinologist

[humanbean]

I had a Testosterone test done about 6 or 7 years ago as part of a large package of tests I got done. It wasn't until I got the result that I realised Testosterone is like every other hormone that can be tested - it comes in two flavours - Free and Total - and my test was a Total Testosterone test. The result was 44% of the way through the range, but I came to the conclusion this wasn't useful information.

I wonder how many people are getting Total hormones tested rather than Free and don't realise that the Total test is much less useful than a Free test.

[humanbean in reply to humanbean]

I forgot to add...

When I had a hysterectomy done in my 30s (a long time ago, in the 1990s) the surgeon reported in his letters to my GP that "I gave her a testosterone implant at the time of the operation".

When I found this out (about 20 years later when I bought my records) it occurred to me that nobody had ever suggested that I get my testosterone measured again and nobody had suggested treating me with testosterone either.

[seveneleven in reply to humanbean]

Yes absolutely - I've seen tests that do the bare minimum, not very useful. That's incredible that you were never told (I say incredible, but nothing is too far-fetched in the NHS!). There's a baffling fear about testosterone in women - I've even seen a reluctance in papers to agree that it even has a role at all. Like we would have a hormone that did nothing??

[humanbean in reply to seveneleven]

I wonder if men ever get tested for estrogen deficiency.

According to wikipedia :

In males, estrogen regulates certain functions of the reproductive system important to the maturation of sperm[22][23][24] and may be necessary for a healthy libido

[Wua13262348 in reply to humanbean]

I know of a male who has had prostate cancer and has been put on estrogen after he had some kind of non invasive treatment for it. Must have been the cancer specialist , I presume , who has put him on estrogen.