HRT for Wife? Attn: Dr. Saya

[MG123]

Hello,

I am hoping that maybe Dr. Saya can chime in and any one else that is knowledgeable about female HRT. My wife is 42 years old. She is currently on an estrogen/progestin combo birth control pill as she was having pain and heavy bleeding from ovarian cysts rupturing. She hasn't had a ruptured cysts since beginning the pill, but since she started the birth control her libido and sexual function has diminished greatly. Do you think that she would benefit from testosterone replacement? I don't see any reason why it would, but would it have any effect on her birth control pills managing ovarian cysts? Her lab tests are as follows:



Testosterone, Serum 14 ng/dL 8 - 48


Free Testosterone(Direct) 1.9 pg/mL 0.0 - 4.2


T4,Free(Direct) 1.25 ng/dL 0.82 - 1.77


DHEA-Sulfate 195.6 ug/dL 57.3 - 279.2


TSH 0.845 uIU/mL 0.450 - 4.500


Estradiol 30 pg/mL
Adult Female
Follicular 12 - 166 pg/mL
Ovulation 86 - 498 pg/mL
Luteal 44 - 211 pg/mL
post-menopausal <5 - 55 pg/mL
1st Trimester 215 - >4300 pg/ml
***Note: The lower functional sensitivity of this Estradiol
assay is <5 pg/mL.

Progesterone 3.2 ng/mL
Female:
Follicular phase <0.2 - 1.4
Luteal phase 3.3 - 25.6
Ovulation phase 4.4 - 28.0
Pregnant
First trimester 11.2 - 90.0
Second trimester 25.6 - 89.4
Third trimester 48.4 - 422.5
Postmenopausal <0.2 - 0.7

Triiodothyronine,Free,Serum 3.15 pg/mL 2.00 - 4.40

 

[Vince]

When Taking the Pill Takes Away Libido http://www.doctoroz.com/blog/lauren-streicher-md/when-taking-pill-takes-away-libido

 

[Dr Justin Saya MD]

MG123 - the oral contraceptive pills do a great job at what they are intended to do...suppress the ovaries from ovulating. However, unfortunately they have a side consequence of also suppressing the hormone production (to varying degrees) of the ovaries (testosterone, estrogen, progesterone). In fact, I've seen some very young women (in their 20's) coming in with menopausal hormone levels from taking OCPs for several years.

Indeed your wife may benefit from testosterone supplementation given what you've noted and it would not likely impact the ovarian cysts.

 

[MG123]

MG123 - the oral contraceptive pills do a great job at what they are intended to do...suppress the ovaries from ovulating. However, unfortunately they have a side consequence of also suppressing the hormone production (to varying degrees) of the ovaries (testosterone, estrogen, progesterone). In fact, I've seen some very young women (in their 20's) coming in with menopausal hormone levels from taking OCPs for several years.

Indeed your wife may benefit from testosterone supplementation given what you've noted and it would not likely impact the ovarian cysts.

Thanks, Dr. Saya. My wife is going to bring her issues up with her OB/GYN at her appointment next week. If her OB/GYN agrees to allow her try TRT (if OB/GYN doesn't or if the protocol suggested is substandard, I'm going to urge her to consider consulting with you), what is a good starting protocol and dosage that you have seen work well with women in situations like this? I know what decent starting protocols for men look like, but I am not well informed about TRT in women. Do women do better with injections or transdermals? What is a good starting dosage for these routes of administration? I would think that transdermals would be a daily application, but what is a good starting frequency rate for injections?

 

[chrismez]

My wife is going in to see my trt Dr next Friday. Her t level is <3(8-68), free t <.1, (0-4.2) E 68...etc... I believe he told me prior that females use the gels and not injections. I'll update next week..

 

[Fireproof]

Thanks, Dr. Saya. My wife is going to bring her issues up with her OB/GYN at her appointment next week. If her OB/GYN agrees to allow her try TRT (if OB/GYN doesn't or if the protocol suggested is substandard, I'm going to urge her to consider consulting with you), what is a good starting protocol and dosage that you have seen work well with women in situations like this? I know what decent starting protocols for men look like, but I am not well informed about TRT in women. Do women do better with injections or transdermals? What is a good starting dosage for these routes of administration? I would think that transdermals would be a daily application, but what is a good starting frequency rate for injections?

Good luck with that.

My wife's OB/GYN does NOT support TRT at all. She says hormone levels are supposed to decline and we shouldn't mess with them. Whatever... So we had to look elsewhere.

My wife was suffering from brain fog, depression, night sweats, etc, etc...three years ago. We got her tested and she had ZERO free test. She started with testosterone replacement (pellets) and it was a game changer for her.

More recently, since I've found Defy and Dr. Saya - we moved my wife to be a patient of Dr. Saya. Based on the dosage she needs to get the levels she needs - he prescribed injections. So she does Monday A.M. / Thursday P.M. injections like I do.

 

[MG123]

Good luck with that.

My wife's OB/GYN does NOT support TRT at all. She says hormone levels are supposed to decline and we shouldn't mess with them. Whatever... So we had to look elsewhere.

My wife was suffering from brain fog, depression, night sweats, etc, etc...three years ago. We got her tested and she had ZERO free test. She started with testosterone replacement (pellets) and it was a game changer for her.

More recently, since I've found Defy and Dr. Saya - we moved my wife to be a patient of Dr. Saya. Based on the dosage she needs to get the levels she needs - he prescribed injections. So she does Monday A.M. / Thursday P.M. injections like I do.

I understand, but it is worth a shot to see if her OB/GYN will consider this since visits with her OB/GYN are covered by our insurance. If not, I will advise her to speak with Dr. Saya, as he is my doctor as well and I consider him to be top notch.

If you don't mind me asking what dosage is your wife using with having 0 free test as her pre-TRT level?

 

[Fireproof]

I understand, but it is worth a shot to see if her OB/GYN will consider this since visits with her OB/GYN are covered by our insurance. If not, I will advise her to speak with Dr. Saya, as he is my doctor as well and I consider him to be top notch.

If you don't mind me asking what dosage is your wife using with having 0 free test as her pre-TRT level?

Oh I agree. I genuinely meant good luck! I wish we had progressive doctors that were knowledgable in HRT/TRT and this stuff was covered by insurance. Unfortunately that didn't work out for us. But at least we have Defy as an option. I LOVE their tele-medicine model for those of us who can't find good docs locally.

My wife's recent labs probably aren't a good indication because she was transitioning from pellet-HRT to injection-HRT. So her recent labs don't necessarily reflect pure pre-HRT levels.

But before her HRT began, her levels were:
- Total Test = 12 ng/dl (range of 14 - 76)
- Free Test = 0 ng/dl (range of 0.3 - 1.6)
- SHBG = 221 nmol/L (range of 18 - 114)
- Total Estrogen = 209 pg/mL

Her current prescribed dose of Test is 0.4ml of 20mg/ml strength Test Cyp E3.5D. (Which is 8mg Test Cyp twice/week).

Hope that helps.

 

[chrismez]

My wife is going in to see my trt Dr next Friday. Her t level is <3(8-68), free t <.1, (0-4.2) E 68...etc... I believe he told me prior that females use the gels and not injections. I'll update next week..

My wife got prescribes a T cream 5mg per click and dr wants her to take 4 clicks a day (20mg) applied to the inner thigh. He based that on basically she has no testosterone in her system. she is 47 and a gym rat. Looks great but has a hard time with gains when working out. She is fatigued a lot and sex drive is not what it used to be. I think she wants to start at a lower dose 10Mg and see how she feels and work up from there...Im excited for her but I think she is a tad nervous...

 

[Dr Justin Saya MD]

My wife got prescribes a T cream 5mg per click and dr wants her to take 4 clicks a day (20mg) applied to the inner thigh. He based that on basically she has no testosterone in her system. she is 47 and a gym rat. Looks great but has a hard time with gains when working out. She is fatigued a lot and sex drive is not what it used to be. I think she wants to start at a lower dose 10Mg and see how she feels and work up from there...Im excited for her but I think she is a tad nervous...

That's a lot to start treatment with. For transdermal, for most females I start around 3-5mg and have patients gradually work their way up over the first 3 months to a max of 15mg daily...if they achieve that level without symptom relief and without significant side effects, then we have a follow-up consult including labs to further evaluate/discuss.

Every female is different, but 20mg may bring your wife's levels into the 200-400 range. Have her monitor for side effects as the goal is to achieve benefits and symptom relief with minimal to no side effects.

 

[chrismez]

Yah, I think she is gonna start off lower and slowly ramp it up based on how she feels...I know she is a tad nervous so I think it's the best course. Thanks for the input Doc...