Fiancee going through perimenopause. Advice?

[Nunya]

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

One recommendation is to do labs on day 19 if your cycle if you’re still having one, here’s a breakdown: Why we test during days 19-22 of a 28-day cycle - DUTCH Test

 

[Nunya]

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.

Good for your endocrinologist for reaching out to your psych doctor. I have TP for me and TC for hubby and for if I at some point feel dialed in enough to use a longer ester. But since shorter esters seem to virilize less and I don’t mind pinning every day I may just stick with TP.

As for HGH my natty levels were fine for my sex/age but I wanted to try for several months to see if it helped gains at the gym, and recovery, mostly. I’ll get my IGF results back in a day or two, post starting 2iu/day. It’s cheap enough to warrant continuing for some time, as long as all my labs stay good. Only been on it a month or so.

 

[Anne Jectible]

I realize I am a bit late but wanted to give my input. About 3 years ago I started really noticing extreme joint pain. Thought I had RA. Doc ran a bunch of tests and they were all negative. She suggested perimenopause or even menopause (I had a partial hyster. because I was tired of bleeding all the damn time). At first I had my doubts. Within hours of slapping on that estradiol patch my joint pain went away. I stayed there for about a year and then pain came back. We increased and now I am on the 0.1 mg patch twice a week. Mylan not Dotti because dotti is shit and I avoid them at all costs. Oddly about 6 months ago I was planning a trip to 6 flags and out of nowhere I was suddenly afraid of rollercoasters. Doc suggested maybe test was low. Sure enough it was on the low side of 'normal' but we started test and holy shit. Not only do I feel amazing but husband is burned tf out by how much I am on him. Like he even gave me a free pass because tbh I always had the higher drive and he knows Im too much of a misanthrope to take him up on meeting someone new. My skin looks way better. Fine lines filled in. Lose weight easier. All in all HRT changed my life.
Edit: I did start off on test-p and I preferred the way I felt but I was tired of frequent inj. so I switched to testC 5mg 2 times a week. Between the test, peptides and placenta inj. I was starting to feel like a pincushion.

 

[Grey Spartan]

Im too much of a misanthrope

Same.

Not only do I feel amazing but husband is burned tf out by how much I am on him.

LOL! My wife went from tapping out to "That's all you got"

 

[Anne Jectible]

Same.

LOL! My wife went from tapping out to "That's all you got"

Get her a 'womanizer' for xmas. He jokes all of the time that part of his job is to keep all of my devices charged so that he has time to sleep and go to work. Meanwhile I'm over here like 'I make 3 times what you do, quit your job!'

 

[Grey Spartan]

I'm over here like 'I make 3 times what you do, quit your job!'

Some guy get all the luck I tell ya! Hahaha

 

[Deezznutzz]

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

What would be a good starting dose of estrogen and progesterone? What different types of estrogen do they offer? I need to see if I can find some somewhere.

 

[iris]

What would be a good starting dose of estrogen and progesterone? What different types of estrogen do they offer? I need to see if I can find some somewhere.

Why do you think your wife should take hormones without having a blood test?
In any case, what is applicable to someone else, may be totally irrelevant to her and her body.

 

[Anne Jectible]

Why do you think your wife should take hormones without having a blood test?
In any case, what is applicable to someone else, may be totally irrelevant to her and her body.

Most menopause experts and the North American menopause society have stopped recommending testing. Our hormones fluctuate daily and you will only get a snapshot of that very specific time period. Modern Hrt or Mrt is prescribed off of symptoms now.

 

[Deezznutzz]

Why do you think your wife should take hormones without having a blood test?
In any case, what is applicable to someone else, may be totally irrelevant to her and her body.

Well because she used to go to a clinic...we just can't really afford the clinic right now with her work schedule also. .Sadly it was before we met and she doesn't remember the dosages so she's only taking the testosterone. She said she was taking estrogen too ...she just can't remember how much and we were thinking to start with the lowest dose and then get labs and adjust from there.. I was hoping it would be easy as male hormones because definitely with trt my doctor told me there was a cookie cutter dose that they start everybody on and then they adjust from there. Seems to work with most men. Like I know some people aren't going to believe this but the trt clinic I was going to would start you out on 200 a week if that's what you wanted to start out on and then they would put you on half a milligram of Arimidex twice a week and 99% of the time when you run your labs there wasn't really much adjustment needed. I was one of those cases with the cookie cutter dose so everything was in spec. I guess I got lucky. I know everybody's not like that and some adjustment is needed but we were going to try to do it like that.

 

[Anne Jectible]

Well because she used to go to a clinic...we just can't really afford the clinic right now with her work schedule also. .Sadly it was before we met and she doesn't remember the dosages so she's only taking the testosterone. She said she was taking estrogen too ...she just can't remember how much and we were thinking to start with the lowest dose and then get labs and adjust from there.. I was hoping it would be easy as male hormones because definitely with trt my doctor told me there was a cookie cutter those that they start everybody on and then the adjust from there. Seems to work with most men. Like I know some people aren't going to believe this but the trt clinic I was going to would start you out on 200 a week if that's what you wanted to start out on and then they would put you on half a milligram of Arimidex twice a week and 99% of the time when you run your labs there wasn't really much adjustment needed. I was one of those cases with the cookie cutter dough so everything was in Spec I guess I got lucky LOL I know everybody's not like that and some adjustment is needed but we were going to try to do it like that.

It does not work like that with Estrogen. The dosage will depend on the delivery method. For instance I take a twice a week patch. There are 3 dosages available. This is different from the once/week patch, gel, pellet, pill etc.

 

[Deezznutzz]

It does not work like that with Estrogen. The dosage will depend on the delivery method. For instance I take a twice a week patch. There are 3 dosages available. This is different from the once/week patch, gel, pellet, pill etc.

Thank you for the answers cuz I'm definitely trying to learn about it. I know she wouldn't do a pellet. So she would either do a pill or a patch whichever we could find. Like I wonder how much is prescribed with a pill. The lowest to the maximum dosage couldn't be that much adjustment. I wish you would have just remembered what she was on before it would have made this easier because it would be very easy to do this on our own especially if we ran labs four times a year. I know male trt is a joke once you do it for a year with a doctor it's pretty easy to do it on your own and run your own labs and make adjustments.

 

[Anne Jectible]

Thank you for the answers cuz I'm definitely trying to learn about it. I know she wouldn't do a pellet. So she would either do a pill or a patch whichever we could find. Like I wonder how much is prescribed with a pill. The lowest to the maximum dosage couldn't be that much adjustment so to speak

Most women don't like the pill. It is also made from horse urine so there are some ethical concerns. Its also just plain fucking gross. I tried it and it made me violently ill. The pill form is processed by the liver so you have to check interactions. Transdermal is amazing. Vaginal is also important for ensuring her vagina doesn't atrophy which makes sex impossible and you have to pee like 10 times a night. Many women don't realize that is why they pee when they sneeze. It isn't just pelvic floor strength.

 

[Deezznutzz]

Most women don't like the pill. It is also made from horse urine so there are some ethical concerns. Its also just plain fucking gross. I tried it and it made me violently ill. The pill form is processed by the liver so you have to check interactions. Transdermal is amazing. Vaginal is also important for ensuring her vagina doesn't atrophy which makes sex impossible and you have to pee like 10 times a night. Many women don't realize that is why they pee when they sneeze. It isn't just pelvic floor strength.

What is the transdermal? Is it just something you rub on your vagina? I wonder if I can find that with some of the sources here . Her vagina is definitely not atrophied I know that.

 

[FunkOdyssey]

Most women don't like the pill. It is also made from horse urine so there are some ethical concerns. Its also just plain fucking gross. I tried it and it made me violently ill. The pill form is processed by the liver so you have to check interactions. Transdermal is amazing. Vaginal is also important for ensuring her vagina doesn't atrophy which makes sex impossible and you have to pee like 10 times a night. Many women don't realize that is why they pee when they sneeze. It isn't just pelvic floor strength.

I see some women combine systemic estrogen and vaginal estrogen and have been wondering why this is necessary. Is it because your dose of systemic estrogen is relatively low?

If you restore estradiol to a higher level like 200+ pg/ml, wouldn't this eliminate the need for local vaginal estrogen? In this case, you are basically restoring estradiol to a 20-something year old level, and we know they don't suffer any vaginal atrophy at that age, with those levels.

 

[Deezznutzz]

Grey Spartan, 10mg of Test C
10/200= .05 I assume you are backfilling a small insulin syringe?

220, 15mg of Test split into two doses, so 7.5mg . . .
Ok, how do you do that?
7.5/200= .0375, too fine for the tick marks on even my smallest insulin syringe, and the smallest ones cannot handle oil because the diameter is too small and air is trapped and the oil cannot move.

EasyTouch U-100 Insulin Syringe with Needle, 29G 1cc 1/2-Inch.

I just warm up the vial on the coffee pot. No reason to backfill. Flows nice. Definitely easier to dose in increments of five but if you're trying to do something different just go in between the ticks.

 

[Anne Jectible]

I see some women combine systemic estrogen and vaginal estrogen and have been wondering why this is necessary. Is it because your dose of systemic estrogen is relatively low?

If you restore estradiol to a higher level like 200+ pg/ml, wouldn't this eliminate the need for local vaginal estrogen? In this case, you are basically restoring estradiol to a 20-something year old level, and we know they don't suffer any vaginal atrophy at that age, with those levels.

Estrogen is restored to the lowest levels at which a woman feels better to mitigate risk. Modern HRT doesn’t go by levels because what works for one person may not work for another. And I guarantee you no woman wants as much estrogen as they had at 20. The side effects of even natural estrogen are miserable. For some women low level systemic estrogen replacement may be enough for vaginal atrophy. For most it is not.

 

[Superchicken]

What would be a good starting dose of estrogen and progesterone? What different types of estrogen do they offer? I need to see if I can find some somewhere.

Varies. I was told standard starting dose is .05 for the transdermal patch and 100mg oral micronized progesterone. Anecdotally I haven’t seen any woman besides Nunya here have symptom relief with a lower dose, or they have symptoms return quickly. I know my practitioner is willing to start at the lower dose though to avoid potential side effects bc the body can sometimes go nuts with exogenous hormones are added. The first gyn who treated me based solely on labs doubled my E even tho I had no symptoms and it caused my cycle to come really early and it was basically a wk of hemorrhaging, followed by another wk of spotting. The 100mg of progesterone is just standard regardless, typically increases when the E is raised.

Most drs stick or transdermal patch or oral estrogen. The oral is synthetic and has increased risks. There are online clinics that will do injections. Defy is a popular one.

 

[Superchicken]

Well because she used to go to a clinic...we just can't really afford the clinic right now with her work schedule also. .Sadly it was before we met and she doesn't remember the dosages so she's only taking the testosterone. She said she was taking estrogen too ...she just can't remember how much and we were thinking to start with the lowest dose and then get labs and adjust from there.. I was hoping it would be easy as male hormones because definitely with trt my doctor told me there was a cookie cutter dose that they start everybody on and then they adjust from there. Seems to work with most men. Like I know some people aren't going to believe this but the trt clinic I was going to would start you out on 200 a week if that's what you wanted to start out on and then they would put you on half a milligram of Arimidex twice a week and 99% of the time when you run your labs there wasn't really much adjustment needed. I was one of those cases with the cookie cutter dose so everything was in spec. I guess I got lucky. I know everybody's not like that and some adjustment is needed but we were going to try to do it like that.

If you can source it, I think your wife would be safe starting with low dose and going from there. E and P both decline more and more with age, typically starting with P, so it’s not like you’d give her too much and she’d ruin her own hormones. It’s an easy enough fix to back off. When my E dose was too high and I realized that was the problem, taking a couple days off of zero patch, then going back down to the lowest resolved all issues. My prescriber allows for a lot of self control and says until full menopause it’s a lot of trial and error, can’t remember if your wife is peri or meno.

Is your wife on Facebook? There’s a massive bhrt group there with a lot of resources. They don’t stick to the official menopause guidelines, which is helpful. The meno society doesn’t support T use in women and doesn’t acknowledge its benefits except for libido. If it doesn’t correct in 6mos they don’t increase dose, just tell women they weren’t T deficient. My T was in the toilet and my first gyn argued strongly with me that I needed to try Addyi or Vyleesi for libido. If I hadn’t brought it up she wouldn’t have treated the level at all. They also don’t acknowledge the benefits estrogen has on other things besides relief of vasomotor symptoms, prevention of bone loss, and genitourinary syndrome. There are a ton of other symptoms besides those. Some cardiologists have come out and said the loss of estrogen is directly tied to increase in heart disease.

I know you said you can’t afford the clinic, the person I see is really reasonable. $375 for the first hour intake + first follow up. Visits after that are $99-$125 and roughly 8-12wks apart unless you need to get in sooner. Just saying she doesn’t need to see you 100x and drive the cost up. She sends lab orders to wherever you choose so insurance covers and same with prescriptions. I have some go to CVS and some online to Cost Plus. She does give a super bill, if you want to submit on your own. She’s the best price I found. There’s also MyAlloy online and usually a discount code floating around. They treat based on symptoms and don’t require labs. FYI they offered me birth control first and were fine when I declined and asked for hrt. They rx in 3 mos blocks.

 

[Superchicken]

I see some women combine systemic estrogen and vaginal estrogen and have been wondering why this is necessary. Is it because your dose of systemic estrogen is relatively low?

If you restore estradiol to a higher level like 200+ pg/ml, wouldn't this eliminate the need for local vaginal estrogen? In this case, you are basically restoring estradiol to a 20-something year old level, and we know they don't suffer any vaginal atrophy at that age, with those levels.

There are some women who feel best at high e levels like 200+ and still need the vaginal treatment. Idk why it happens that way but it does. Finding a provider who will let you go that high isn’t easy and why women switch to online services. Plus the usual options of topical or oral don’t work and why they switch to injx