Fiancee going through perimenopause. Advice?

[Dr.V.P.C.]

Late 40s here, perimenopause-ish. I got hooked up with a local boutique (no insurance accepted) women's clinic a couple years ago and started testosterone pellets after my total Testosterone came back at 4ng/dl. The pellet was just T, no estrogen, progesterone, etc. as those values looked fine.

It was a game changer. Made working out easier, recovery easier, performance gains easier. I'm not a body builder so my goals are different; athletic performance as I age, libido, health, longevity, and vanity. I may not be a bb but I do love looking strong. The clinic offers DEXA scans so I get those 2x/yr and in the first year I gained 10lbs of lean mass. I work out regularly but I wouldn't say I was lifting heavy enough regularly enough to have put on 10lbs of lean muscle mass otherwise.

I'm currently doing my best to learn about injections, cycles, hormone balancing, getting my own labwork done regularly, and all that, because I want off the pellets. Not because they didn't work for me, but because I'm pretty sure injections will provide a more stable experience. First couple weeks after insertion my libido is so high it's an inconvenience, and I have to take too much time off from lower body work to let the incision heal. Then when it tapers off it just sucks.

I have enough bloodwork data now to know what the best 'feels' correlates to in terms of total T and will be aiming for that (200-300ng/dl). Estradiol is always within range on bloodwork, depends on where I'm at in my cycle when I'm tested.

Anyway, TLDR; T only for now. Love it, would recommend it, totally worth a few chin hairs. I've seen women complain about changes to their clitoris. Personally, it has been nothing but a net + for myself and my marriage, and also serves as a marker as to when I've burned through a pellet and levels have dropped.

I imagine as I get closer to actual menopause I'll need to reevaluate things. By then, I hope to be better educated and armed with everything I need to keep my health dialed in on my own.

You logic is completely right. You will have much better control with subq test , and eventually you will need some transdermal estrogen and oral progesterone. I have extensive experience prescibing subq test to my peri and menopause clients, it really take some time to adjust the dosages ( go low and slow) but they all do very well and love it . Pellets can work but the unpredictability of the rate of the release will always be an issue no matter what the physician says to you.

 

[Nunya]

You logic is completely right. You will have much better control with subq test , and eventually you will need some transdermal estrogen and oral progesterone. I have extensive experience prescibing subq test to my peri and menopause clients, it really take some time to adjust the dosages ( go low and slow) but they all do very well and love it . Pellets can work but the unpredictability of the rate of the release will always be an issue no matter what the physician says to you.

Thank you for this, much appreciated!

 

[Throwback]

My wife has been on this protocol since 2016. She is 62 been in menopause since approx 2014. I cannot begin to tell you the difference it has made in her quality of life.
Weekly ahe receives 8mg estradiol valerate 4mg mon. 4mg thurs, and 8mg test cyp each monday /thursday for 16 mg total.
Daily she takes 200mg of oral progesterone when her E and T are leveled out. (Sometimes we were unable to continue her hrt due to financial issues and her levels dropped to pre hrt numbers.
I would suggest a woman entering menopause first pull bloods. Estradiol, free and total test, pregnenolone, progesterone and a full thyroid panel with tsh t4 t3 and t3 uptake, also a metabolic and cbc which are usually included at quest or labcorp
Initial hrt protocol start 100 mg progesterone (if she has her uterus and has had no hysterectomy etc. So 100mg oral progesterone day before her first injection.
Day 1 inject 4mg estradiol and 8mg test cyp (u can put them in the same syringe so u dont do 2 shots) use a 27 gauge 1/2 needle removable on an insulin 1ml syringe. Draw the estrogen and test using a 22 gauge needle then swap needles to the 27ga for the injection. Dont draw with the same needle you inject with for a variety of reasons.
Continue the above protocol for approx 8 weeks then kick up the progesterone to 200mg daily due to her estrogen level rising.
If you dont raise progesterone to 200mg she is likely to start a bleed that is unlike any she ever had. I messed up my wifes and I couldnt believe someone could bleed that much and still live. Lol.(Its not funny at the time and it lasts for dayz n dayzs.
But that protocol above has been a life changer. Frim energy to no brain fog to wanting "it" non stop .
There has been 0 downside.

 

[Nunya]

My wife has been on this protocol since 2016. She is 62 been in menopause since approx 2014. I cannot begin to tell you the difference it has made in her quality of life.
Weekly ahe receives 8mg estradiol valerate 4mg mon. 4mg thurs, and 8mg test cyp each monday /thursday for 16 mg total.
Daily she takes 200mg of oral progesterone when her E and T are leveled out. (Sometimes we were unable to continue her hrt due to financial issues and her levels dropped to pre hrt numbers.
I would suggest a woman entering menopause first pull bloods. Estradiol, free and total test, pregnenolone, progesterone and a full thyroid panel with tsh t4 t3 and t3 uptake, also a metabolic and cbc which are usually included at quest or labcorp
Initial hrt protocol start 100 mg progesterone (if she has her uterus and has had no hysterectomy etc. So 100mg oral progesterone day before her first injection.
Day 1 inject 4mg estradiol and 8mg test cyp (u can put them in the same syringe so u dont do 2 shots) use a 27 gauge 1/2 needle removable on an insulin 1ml syringe. Draw the estrogen and test using a 22 gauge needle then swap needles to the 27ga for the injection. Dont draw with the same needle you inject with for a variety of reasons.
Continue the above protocol for approx 8 weeks then kick up the progesterone to 200mg daily due to her estrogen level rising.
If you dont raise progesterone to 200mg she is likely to start a bleed that is unlike any she ever had. I messed up my wifes and I couldnt believe someone could bleed that much and still live. Lol.(Its not funny at the time and it lasts for dayz n dayzs.
But that protocol above has been a life changer. Frim energy to no brain fog to wanting "it" non stop .
There has been 0 downside.

Thanks for such a detailed breakdown of this. I’m all lined up to go this route myself, labs and all. Only thing missing is EV (I have an E patch and P pills rx but would rather go diy route). Since I can’t find an EV injectable source in vials that’s concentrated low enough to make sense I’ll be home brewing.

The progression you detailed is super helpful, good to know about the P dosage as E rises. Really appreciate the detail.

 

[Superchicken]

Thanks for such a detailed breakdown of this. I’m all lined up to go this route myself, labs and all. Only thing missing is EV (I have an E patch and P pills rx but would rather go diy route). Since I can’t find an EV injectable source in vials that’s concentrated low enough to make sense I’ll be home brewing.

The progression you detailed is super helpful, good to know about the P dosage as E rises. Really appreciate the detail.

Curious about why you’re switching to injectable estrogen. Not in a judgemental way, wondering the thought process if you think it’s more effective or better benefits. I’m ok on the patch for now, but like to have info jic.

 

[Nunya]

Curious about why you’re switching to injectable estrogen. Not in a judgemental way, wondering the thought process if you think it’s more effective or better benefits. I’m ok on the patch for now, but like to have info jic.

I don’t much care for having stuff stuck to me, and I like jabbing myself?
Seriously though, I mostly want to be able to be in control of it. So, raws stashed away for homebrewing, that kind of thing. You just never know.

 

[Superchicken]

I don’t much care for having stuff stuck to me, and I like jabbing myself?
Seriously though, I mostly want to be able to be in control of it. So, raws stashed away for homebrewing, that kind of thing. You just never know.

lol fair enough. I’ve squirreled away several mos of meds from dosage changes jic. Interested in your experience if you end up switching, or if you find a brewed source

 

[Throwback]

Thanks for such a detailed breakdown of this. I’m all lined up to go this route myself, labs and all. Only thing missing is EV (I have an E patch and P pills rx but would rather go diy route). Since I can’t find an EV injectable source in vials that’s concentrated low enough to make sense I’ll be home brewing.

The progression you detailed is super helpful, good to know about the P dosage as E rises. Really appreciate the detail.

If you can get a dr to write a script....the EV at 10mg/ml is $36 for a 10ml vial at walmart.

 

[Nunya]

If you can get a dr to write a script....the EV at 10mg/ml is $36 for a 10ml vial at walmart.

I’m more likely to be able to get a script for that if I say I want to transition from mtf than if I say I’m a perimenopausal woman looking to supplement E2 :/

 

[malfeasance]

Thanks for such a detailed breakdown of this. I’m all lined up to go this route myself, labs and all. Only thing missing is EV (I have an E patch and P pills rx but would rather go diy route). Since I can’t find an EV injectable source in vials that’s concentrated low enough to make sense I’ll be home brewing.

The progression you detailed is super helpful, good to know about the P dosage as E rises. Really appreciate the detail.

EV?

 

[iris]

EV?

E Valerate
I saw they do 10mg x ml in the States.
Wouldn't use it, but you have that option

 

[Deezznutzz]

My girl is 50. No menopause yet and has a iud. Shes been on self trt. 15mg to 20mg a week of cyp. She's tried lower doses but likes 15mg-20mg. So what happens if you don't take the estrogen and you don't take progesterone? Shes been fine on the testosterone so far. No hormones labs run yet but regular labs look great. Also about 5 years ago she was getting this done at a women's clinic but you know it's way cheaper just to do on your own. She can't remember what all they were giving her though at the women's clinic.

 

[Nunya]

Unopposed estrogen therapy can increase the risk of cancer. You can take progesterone without estrogen, but it is not recommended to take estrogen without progesterone. If you’re taking exogenous estrogen and you have a uterus, progesterone should also be taken.

 

[Superchicken]

My girl is 50. No menopause yet and has an iud. Shes been on self trt. 15mg to 20mg a week of cyp. She's tried lower doses but likes 15mg-20mg. So what happens if you don't take the estrogen and you don't take progesterone? Shes been fine on the testosterone so far. No hormones labs run yet but regular labs look great. Also about 5 years ago she was getting this done at a women's clinic but you know it's way cheaper just to do on your own. She can't remember what all they were giving her though at the women's clinic.

There are many protective health benefits to estrogen, and like Nunya said if you take E, you have to take progesterone or the IUD works as it also protects the uterus. Estrogen Matters is a good book, same name also on insta. There are a lot of obscure things women don’t realize are related. Recently adjusted my estrogen dose and the dry eyes that just came out of nowhere, aren’t dry anymore. Some of it’s so random

 

[Deezznutzz]

There are many protective health benefits to estrogen, and like Nunya said if you take E, you have to take progesterone or the IUD works as it also protects the uterus. Estrogen Matters is a good book, same name also on insta. There are a lot of obscure things women don’t realize are related. Recently adjusted my estrogen dose and the dry eyes that just came out of nowhere, aren’t dry anymore. Some of it’s so random

Is it safe to just do trt? Will it raise estrogen naturally?

 

[MaryQContrary]

Thanks for asking this. Curious to see responses. I’m 49/f and have been on T cyp inj for over a year now, through my hormone doc. My gyn only offered pellets or creams and I knew I didn’t want to do either of those, so I researched a provider in my area.

My doc is a body builder, much of his clientele is fitness industry people, athletes, etc. He said my estrogen and progesterone were fine, so I’m just on T. I’m due for labs (overdue but have to keep rescheduling due to work) and over the past year have been curious about the estrogen being naturally raised.

The T has been LIFE CHANGING for me. I don’t know why I lived so long without it. I guess docs telling me I was “fine” and “normal levels”, etc. “just part of aging”
Gained 50+ lbs in 5 years while working out, tracking macros, etc and once I went to a provider who listened and doesn’t go by mainstream guidelines, I got on T, dropped all the weight, feel better, sleep better, etc

It’s been a godsend.

Is it safe to just do trt? Will it raise estrogen naturally?

 

[Nunya]

Is it safe to just do trt? Will it raise estrogen naturally?

Testosterone alone seems well tolerated. If the dose is too high then of course some virilization can occur, BUT, women tend to grow hairs and get deeper voices as we age, naturally. So it can be hard to say where those chin hairs are coming from

Exogenous testosterone converting to estrogen…I don’t think that’s a benefit we get out of it In my case, similar to @MaryQContrary it has been pretty life changing though.

Coupling it with Tirzepatide this past summer has had some interesting effects. I lost thirty pounds of mostly fat, taking care to stay on top of macros and lift heavy a lot. When I lost the fat, my estrogen tanked. Not surprising. So, it kind of nudged me further toward perimenopause, which at 47 I was probably sneaking through anyway. I’d had some genitourinary symptoms that the weight loss and lower estrogen brought more to the fore.

So now it’s T, plus 100mg progesterone (and omg three days in and my sleep quality is %1000 better), plus vaginal estradiol cream to keep the lady bits youthful and the urinary health strong, plus a hint of estrogen systemically. At the moment it’s a prescribed .0375mg patch twice weekly and I’ll go from there as needed. Plus the Tirzepatide and HGH. My perimenopausal stack

I’m pretty DIY and most doctors are still idiots when it comes to women’s hormones, so I am done with T pellets and on to Test P injections. I know where to get progesterone caps, and injectable estrogen. All set.

 

[Superchicken]

Is it safe to just do trt? Will it raise estrogen naturally?

I don’t think it’s unsafe to do just T, but I think E is beneficial. Every hormone specialist I see, who actually knows what they’re doing, gives all 3 hormones. I haven’t seen any clinical evidence that T alone converts to enough E to make much of a difference

 

[Superchicken]

My doc is a body builder, much of his clientele is fitness industry people, athletes, etc. He said my estrogen and progesterone were fine, so I’m just on T. I’m due for labs (overdue but have to keep rescheduling due to work) and over the past year have been curious about the estrogen being naturally raised.

I’m glad you’ve had such a positive experience since starting T. I had to start out with gel and tanked my labs by not using it so my practitioner would switch to injx lol

Just an fyi, progesterone and estrogen fluctuate constantly with women and labs aren’t super reliable. They can be used as a starting point and tool though. Mine doesn’t treat just based on numbers, but symptoms, too. We do labs every 3-6 mos trying to dial things in right now. Every dr is different but there are general numbers they like to see mostly for E to maintain optimal health. One bhrt group I’m in says a loose guideline is a 10:1 ratio of E to P, mostly in full menopause and less so in peri since E can spike and drop so much. I’ve seen for post meno estrogen should be 150-200, but many women need higher to feel their best.

I actually just had labs and a visit yday. My E was low on a .05 patch and I’ve had some symptoms return, so I’m moving up on the dose. Mostly the symptom return is just feeling the internal heat building again, not severe, but enough that it’s noticeable. Woke up today for the first time since starting hrt and had body odor, whereas before symptoms came back, I’d been able to skip deodorant and not been smelling like a teenage boy. Found myself feeling unsettled and hot with any sort of emotional variance up or down from my normal state. Also sudden dry eyes for the last few weeks, and ears are itchy inside. I list specifics bc there are so many random things tied to estrogen that nobody thinks of. For reference:

Estradiol 71pg/ml

Reference Range
Follicular Phase: 19-144
Mid-Cycle: 64-357
Luteal Phase: 56-214
Postmenopausal: < or = 31

Progesterone 0.6ng/ml

Pre-Meno Mid Follicular: < or = 0.3ng/mL
Pre-Menopausal Surge: 0.1-1.5 ng/mL
Pre-Menopausal Mid Luteal: 6.7-22.2 ng/mL
Postmenopausal Phase: < or = 0.2 ng/mL

This was day 8 of my cycle. She told me my estrogen should be at least double and my progesterone is low, but I just increased the dose from 100mg to 200mg last month and it can possibly be low just bc of where I was in my cycle. So raising the E first by moving to a 0.1mg patch. Going to have to figure it out by trial and error. Any sides, back off, possibly use the higher patch a few wks out of the month the wk before and of my cycle since that’s when E typically drops.

A bunch of info you didn’t ask for. I figure sharing more is better because finding real life experience sucks

 

[Superchicken]

Testosterone alone seems well tolerated. If the dose is too high then of course some virilization can occur, BUT, women tend to grow hairs and get deeper voices as we age, naturally. So it can be hard to say where those chin hairs are coming from

Exogenous testosterone converting to estrogen…I don’t think that’s a benefit we get out of it In my case, similar to @MaryQContrary it has been pretty life changing though.

Coupling it with Tirzepatide this past summer has had some interesting effects. I lost thirty pounds of mostly fat, taking care to stay on top of macros and lift heavy a lot. When I lost the fat, my estrogen tanked. Not surprising. So, it kind of nudged me further toward perimenopause, which at 47 I was probably sneaking through anyway. I’d had some genitourinary symptoms that the weight loss and lower estrogen brought more to the fore.

So now it’s T, plus 100mg progesterone (and omg three days in and my sleep quality is %1000 better), plus vaginal estradiol cream to keep the lady bits youthful and the urinary health strong, plus a hint of estrogen systemically. At the moment it’s a prescribed .0375mg patch twice weekly and I’ll go from there as needed. Plus the Tirzepatide and HGH. My perimenopausal stack

I’m pretty DIY and most doctors are still idiots when it comes to women’s hormones, so I am done with T pellets and on to Test P injections. I know where to get progesterone caps, and injectable estrogen. All set.

Drs are def idiots. I see a psych every 3mos to manage adhd, and unfortunately she can see my med history. We spent more time discussing her concerns over my hormonal rx than we did about my damn adhd, which is fine btw. It’s so annoying. Telling her it improved my mental health and stopped the firing rage I felt was a mistake. She told me anti anxiety meds were probably a better choice. Planning on finding a new dr and sending her a letter why. My hormone dr said she’s going to send her a formal letter, too.

Have you used Test P before? I have cyp, but got P recently jic. Mostly wanting it libido that tanked overnight, and massive brain fog. Interested in your experience and dosing. I like my dr but her dosing is too low, so diy’ing myself. Can you talk about the hgh, too? Did you do labs first to check igf? What kinds of benefits and how long until you noticed them? I’ve done some poking around, but haven’t found a whole lot for women yet.

Congratulations on your weight loss! No easy thing while dealing with peri. I’ve lost a little over 60 since Jan, getting my thyroid under control was a huge help, also had low vit d and ferritin, so felt like shit. Btwn hrt and fixing those deficiencies, I feel like myself again. Recently started half dose of tirz to help with hashimoto’s antibodies since it’s showing benefits for overall health. My mom has it too, and snowballed from one autoimmune disease into 2 more. Hoping to avoid them.