Question 36 -Loss Of Libido and HRT - Lack Of Physician Cooperation
(Posted April 8, 2000)

Dr N,

First, let me thank you warmly for your update.
Also, I would like to tell you that after the information you gave me on "loss of libido" I went to a female gynecologist with my concerns. She wanted me to stop taking the .625 mg Premarin which I've taken for many years in order clear out my system. After 2 weeks she will take a blood test to determine my natural hormone levels, and based on the results, prescribe a new regiment. So far so good, makes a lot of sense to me. However, when I mentioned to her about getting HRT transdermally, she mentioned that testosterone would not be absorbed through a patch and she completely rejected the idea of administering HRT by injection "as too complicated", also . My question is now, will I get any benefits at all taking oral medicine again, which no doubt she is going to prescribe?

Much obliged for your reply. Thanks so much.


Hi,

It is probably apparent to you by now that your physician is not very
knowledgeable about HRT. This leaves you 2 principle choices. Either you will have to find someone more knowledgeable, or assist in making your physician more knowledgeable.

That being said, let's address what is going on now. I don't remember your status, but if you do not have ovaries, there is no reason to stop things and measure your levels, as you do not have anything that produces significant amounts of testosterone or estrogen. If you do have ovaries, testing for testosterone is not unreasonable, but you must take into consideration that taking oral estrogen elevates SHBG, which binds to testosterone leaving less "free" testosterone available to exert its affect. Regardless, let us say that your testosterone levels came back in the "normal", or low "normal" range. Does this mean you would not be entitled to a trial of therapy to see if it improves your libido and quality of life! Get my drift?

I have a bias for non oral methods as most of the women who came to see me were already treatment failures on this route of administration. That is why they came to see me in the first place. However, many women do very well. It is the most frequently prescribed method in the world. I also believe that non oral methods are more physiologic.

Anyway, the statement that testosterone can't be absorbed through a patch is not accurate. There is a testosterone patch available for men called Testoderm TTS. Some physicians have their female patients cut it into quarters or less and monitor if this portion is appropriate for them by doing blood tests and by assessing improvement in symptoms. Accordingly, adjustments can be made. There are a relative few physicians who use subcutaneous implants in this country and if you would like to see one of them let me know and if you tell me where you live I will see if I can find someone near you. These physicians are also usually more knowledgeable about menopause in general.

The bottom line is that your Dr either doesn't want to be bothered, or is a little frightened by an area of medicine that she doesn't know much about. As I said, you will either have to train her, assuming this is possible, or make a change.

I would seem reasonable that if a woman is having problems with obtaining appropriate menopausal treatment that utilizing a female physician, especially a gynecologist would be an improvement. Sadly, as you have learned this is not necessarily the case. The ability to provide appropriate, caring treatment to menopausal women is not related to the gender of the physician.

Let me know what and how you do.


Dr N