His and Her Health

Hello -

I am 53 years old and am in menopause and have tried different hormone replacement therapies and was not happy with any. I just recently started taking bioidentical hormones (estra diol/progesterone) cream. I am also taking testosterone 2% for lack of sexual desire (which had dropped off quite a bit). The problem is my gyn first of all did not think bioidentical hormones was a good idea but she said try it and see what happens. She really didn't know much about it. I told her I would need to get some tests to see where my hormone levels are before she prescribes anything. She said that was a waste of money. I have been on this treatment now for about a month and so far I don't see a great improvement. I have had more hot flashes during the day than I ever had before and sleeping at night is sporatic. The worst part of menopause for me was the weight gain and the sudden lack of desire for sex. I read Suzanne Somers book and decided to try the bioidentical hormones and testosterone cream. My question is: How often do you use the testesterone cream, how much to use and where to put it. The pharmacy did not give any instructions. My doctor said every other day on the forearm. I have read to put it directly on the vagina. Does anyone have any suggestions who has been on this for a while?
Help!!!

Give the cream more time. It can take several months. I use a very small amount daily but I put it directly on my clitoris and inner labia. I know there's some controversy about that but it's worked for me for most of a year now.

As for the amount, I monitor it to use as little as possible. If I start seeing extra chin hairs or my skin starts to get oily, I back off some.

I had a lot of relief from hot flashes and night sweats by taking calcium and fish oil capsules just before bedtime.

Good luck!

Your doc needs some training.

Testing for T levels is, IMHO, quite important. (And it is used by all the professionals in this field too.)

Since we're past that now, you should watch for signs of excess like Eva. Too oily skin, excessive hair growth etc. (Don't be too sensitive however. If you were highly T deficient, the "normal" oily skin and hair may seem like just *way* too much, but it might only be your normal state.)

I think applying it daily is probably better. You're less likely to forget, and either apply too much or too little. Further, it gives the most even steady-state serum levels, which is probably best.

Where to apply. Depending on the type of cream, something like forearms, or hip would be good.

How much to use is a big question and hard to answer without Free T measurements, both before and after starting T.

You probably want to start at 0.5 mg T absorbed per day.

The way to calculate how much T to apply varies, depending on the strength or % of the cream you're applying. (Can you tell us what it is? The percent T is the fact we need most.)

In short, if it's 1% cream (a common preparation) it is 1% T and 99% other inert ingredients. Thus, 1g (1000mg) of cream contains 1% T. That would be (1% or 0.01)* (1g or 1000mg) = 10mg T

The common rate of assumed absorbtion of a T product applied to the skin is 10%. So, (10% or 0.1) * 10mg = 1mg.

Thus, if you apply 1g (1000mg) of 1% cream to the skin, the absorbed amount would be 1mg.

So, to dose with 0.5mg/day of a 1% cream, you'd apply 0.5 grams of the cream daily.

The final issue is that most people don't have a handy way to measure grams at home. Easiest is cc's (or ml) which you can use a syringe for...

But, how to convert grams to cc's, right? Well, for most reasonable products, the material is pretty close to the density of water. Thus, 1 gram of cream is approximated pretty closely by 1 cc. So, put the product in a 10cc syringe and dose at 0.5cc per day.

With this method, it's easy to vary the dose and also have a very easily repeatable dose.

Lastly: How long to expect results. This can vary very, *very* widely. I've heard of results in a week or two in a very few cases. More often, a month or two. In our particular case, the largest changes didn't appear for 4-6 months, and we saw continued changes for more than 12-18 months.

I'd try it for a six month minimum. If you don't see at least some changes in that time-frame, it's unlikely to be a benefit over the longer term. If you are seeing some changes, then those changes may continue over a larger time-frame though.

Hope that's helpful.

Greg

Greg

I am using 2% testosterone cream.

Eva,

How much calcium and fish oil do you take at night?

Susan, I take a high grade concentrated fish oil from Zone Labs and I take two in the morning and two at night. I take a calcium/magnesium/zinc combo (333 mg calcium) three times a day. I started sleeping better as soon as I started taking some at night.

IIOWHK, you and I have so much in common. I'm exactly the same way - the g-spot thing is so easy and quick and the clit thing has gotten harder and takes so much longer that it got too frustrating for both of us, but I miss it too much. The T cream seems to help with that. But what we do now is, I stimulate my own clitoris while he pays attention to other areas. That way I get my clitoral orgasm and we still do all the other stuff too. No rule says the guy has to do it all.

Susan, You said you experienced a "sudden" lack of desire for sex. What do you mean by sudden? Because testosterone levels don't suddenly drop off at menopause. Testosterone levels gradually decline over a long period of time, starting in your 20's, so a sudden loss of sexual desire is probably not caused by "low testosterone". There are a lot of other things that can contribute to a lessening of sexual desire during perimenopause and menopause. Also, if you're going to use testosterone, you need to get your levels tested after you start taking it to make sure your levels aren't too high.

How interesting. Now conner's recommending testing T levels. In the past, she's claimed that testing T made no difference what-so-ever as you could never know the appropriate ranges. I call a “red-herringâ€

Greg, you are so rude. I'd ask why but I think I already know. Sudden loss of libido is usually caused by a new medication or by a psychological difficulty, such as depression or stress, weight gain, among other things. This isn't exactly a state secret. As for keeping up with the literature, I suggest you begin doing so, and start revising your canned responses to women to reflect the current thinking in this constantly evolving field. What you have been posting for the last few years is not up to date.

http://www.hisandherhealth.com/cgi-bin/ubb_newshe/ultimatebb.cgi?ubb=get_topic;f=1;t=002401;p=0&r=nfx

There are other pieces of information that have come out that you conveniently chose to ignore, or omit, such as the Susan Davis study. I remember you mentioning it as something to look forward to. Well, it's here. I suggest you add it to your website. The Princeton Consensus statement from 2002 and the article you cite as the "grandaddy of all modern T research" are not current, for pete's sake.

That's nice Conner. The reason Susan posted here was for advice in solving her problems.

If you want to help someone, how about providing the information she needs to solve her problem.

But you don't do that, and you didn't do that here. You simply took a shot at testosterone and claimed it was terribly unlikely to be a help.

Until I was "rude" to you, you never lifted a finger to help the OP in solving the issue. Until challenged, you didn't suggest ...

"Sudden loss of libido is usually caused by a new medication or by a psychological difficulty, such as depression or stress, weight gain, among other things."

(And I might ask, what's "usually.")

I thought we were here to help the posters, guess I must be thinking of somewhere else...

Cheers,
Greg

Greg, I really hope you're kidding. If you're not, I suggest you go back and read my first post in this thread. Good night, and good luck with whatever is troubling you.

P.S. I'm looking forward to your website being updated with current information in the very near future.

I've been using the cream pretty much daily on the genitalia since January. I have noticed a little clitoral enlargement but I'm not sure what's bad about that. The potential loss of sensation is more worrisome. I haven't experienced that myself but I wouldn't want to take the risk of it happening in the future. The main reason I started using it was to regain lost sensation and it has seemed to help with that.

Is there any data on T cream and loss of sensation? For now, I'm switching to applying it elsewhere, but I don't want to lose my regained sensitivity... It's so confusing!

Only anecdotal. Even then, I'm not sure there's any proof that the T cream did it. It's just a prudence thing, IMHO.

Allowingtoo, who posts over at my site (occasionally here too, I think) switched to Testim and obviously applying to the hip. (I think the hip anyway.) Testim is alcohol based which probably wouldn't be too pleasant directly to the genetalia. I know she wasn't applying to the genetalia.

She felt that sensation (and libido etc) was *diminished* when applied to the hip and felt it wasn't as effective. She abandoned Testim and went back to a compounded product applied directly to the genetalia. So, that's an example of someone who used it directly on the genetalia with good success and with no side effects.

I do know that I've heard some concern from providers who do use topical T creams that they feel somewhat uncomfortable using directly on the genetalia - for the reasons mentioned above.

So, clearly some use it directly on the genetalia with good success over the long term, and some providers feel at least some concern using it that way. I have never seen any evidence of it being a problem. However, if you could get good results applying elsewhere, and any additional benefit from applying to the genetalia was minimal, then why take any potential additional risk for no or very minimal benefit?

Just my $0.02.

Best wishes,
Greg

Update: I used the T cream on my forearms for a week. Desire has been about the same, but after a few days I noticed and definite and unwelcome loss of clitoral sensation. I'm going back to genital application and will see if it comes back. I'm aware that it could be a placebo effect, but whatever it is, I'm not happy with the switch.

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