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.