Typical HRT Dosing for Women - Can it be Too Low and Cause Problems?

[txmx]

My wife is post menopause and uses CombiPatch estradiol/norethindrone at 0.025/0.125mg per day. This is half the intended dosing of the patches, as we cut them in half. However, this seems to work best for eliminating spotting, which was an issue, while actually succeeding in eliminating hot flashes and some of the dryness. Are these patches better than an estrogen cream applied directly to try and deal with dryness, or can they both be used concurrently?

We asked about the addition of Testosterone cream for libido and she was given a prescription for 1mg applied to clitoral area or inner thigh 3x/week.
The pharmacist mentioned to me that this was a very low dose of Testosterone. We have tried it for awhile, and it does not seem to help and may even hinder libido. Does an exogenous T dose that is too low in a woman shut down endogenous T production like it would in a man, and cause her to be worse off than before?

I am just wondering if this dosing of Testosterone is typical, or on the low side? We could try bumping up the Testosterone cream doses and/or CombiPatches we have on hand. Just trying to get a handle on where we are at and if we are headed in a correct direction. I realize it would be best to have labs as a guide, but her doctor has not seen fit to test her levels, so we are just going by symptoms at this point. And yes, I realize Defy may be the long-term answer. Just looking for a little input and guidance. Thanks.

 

[Dr Justin Saya MD]

Too low of a testosterone dosage, of which 1mg TIW is certainly very low, will at best do nothing for libido...however not likely to cause any endogenous suppression either.

For estrogen/progesterone replacement, I always prefer bioidentical (norethindrone is a synthetic progestin).

 

[txmx]

Thank you, Dr. Saya. I noticed in another post from several months ago you mentioned a typical starting transdermal T dose of 3-5mg daily and then moving up to a max of 15 mg/day if necessary. Is this still the typical starting point and range? How often do you go back for labs to adjust vs. just adjusting according to symptoms? Also, what determines choice between cream vs. injections? And on estrogen/progesterone, what advantage bioidentical vs. synthetic? Thanks again.

 

[Dr Justin Saya MD]

Thank you, Dr. Saya. I noticed in another post from several months ago you mentioned a typical starting transdermal T dose of 3-5mg daily and then moving up to a max of 15 mg/day if necessary. Is this still the typical starting point and range? How often do you go back for labs to adjust vs. just adjusting according to symptoms? Also, what determines choice between cream vs. injections? And on estrogen/progesterone, what advantage bioidentical vs. synthetic? Thanks again.

Lots of questions there and I'm on the run currently but will give an abbreviated response.

Yes typical dose mentioned is unchanged, but as with men - all women are unique.

Response dictates transdermal vs injectable (with transdermal typically tried first).

Read about the WHI (Women's Health Initiative) studies and some background info on "synthetic" vs bioidentical hormones. It essentially boils down to replacing the body's own hormones with an identical equivalent or with a "similar, yet different" replacement.

 

[jfullam]

Is there a reason women are typically prescribed transdermal patches or creams versus Test Cyp injections?

 

[Dr Justin Saya MD]

Is there a reason women are typically prescribed transdermal patches or creams versus Test Cyp injections?

A larger margin of error to protect from too high of levels (i.e. much easier for their levels to go too high with injectable). I have women on injectable, but typically after failed transdermal and with careful dosing.

 

[jfullam]

Thanks.
When women are prescribed Testosterone (by any means), is it primarily to resolve libido issues? Is TRT for women often used in concert with other replacement therapy such as estrogen/progesterone only in menopausal women?

 

[Dr Justin Saya MD]

Thanks.
When women are prescribed Testosterone (by any means), is it primarily to resolve libido issues? Is TRT for women often used in concert with other replacement therapy such as estrogen/progesterone only in menopausal women?

Yes, for low libido (look up HSDD - hypoactive sexual desire disorder). Also occasionally for other low testosterone symptoms if deemed to be beneficial (low mood/depression, poor strength/stamina/recovery, loss of lean body mass, osteopenia/porosis, etc).

E and P are often necessary for post-menopausal and *sometimes* necessary for pre-menopausal dependent on levels and symptoms.

 

[Will Brink]

My wife is post menopause and uses CombiPatch estradiol/norethindrone at 0.025/0.125mg per day. This is half the intended dosing of the patches, as we cut them in half. However, this seems to work best for eliminating spotting, which was an issue, while actually succeeding in eliminating hot flashes and some of the dryness. Are these patches better than an estrogen cream applied directly to try and deal with dryness, or can they both be used concurrently?

We asked about the addition of Testosterone cream for libido and she was given a prescription for 1mg applied to clitoral area or inner thigh 3x/week.
The pharmacist mentioned to me that this was a very low dose of Testosterone. We have tried it for awhile, and it does not seem to help and may even hinder libido. Does an exogenous T dose that is too low in a woman shut down endogenous T production like it would in a man, and cause her to be worse off than before?

I am just wondering if this dosing of Testosterone is typical, or on the low side? We could try bumping up the Testosterone cream doses and/or CombiPatches we have on hand. Just trying to get a handle on where we are at and if we are headed in a correct direction. I realize it would be best to have labs as a guide, but her doctor has not seen fit to test her levels, so we are just going by symptoms at this point. And yes, I realize Defy may be the long-term answer. Just looking for a little input and guidance. Thanks.

1mg? I'd almost wonder if it was a typo and supposed to read 10mg. Perhaps clarify with the doc?

 

[Will Brink]

Thanks.
When women are prescribed Testosterone (by any means), is it primarily to resolve libido issues? Is TRT for women often used in concert with other replacement therapy such as estrogen/progesterone only in menopausal women?

End of the day it does essentially the same thing for them it does for us, mood, libido, body comp, etc. We need E2 and they need T, just in different ratios and levels, but they can and do suffer low T.

 

[Speed]

Sory for bumping in this thread. But how T/E/Prog should be dosed in postmenopausal women ? And what are usual dosages ?
Regarding progesterone. How is it dosed in postmenopausal women with uterus ? Should we replicate her "natural" cycle or some other tactics to use ? Thanks