How much testosterone is ideal for post-menopausal women?

[Brian O'Kane]

Hello! My wife went to a hormone doctor yesterday. She is 50 years old and 4 years post-menopausal. She has been struggling with declining libido for 15 years, and it really started falling off the cliff 4 years ago. The doctor said her testosterone was slightly above average for her age (the number was 50, her testosterone level, also her age), but her progesterone was non-existent, and her estrogen was very low. So instead of prescribing her testosterone, he prescribed her estogen cream and oral bioidentical progesterone. He also prescribed her a female Cialis-like drug. But I have read that some BHRT doctors try to up testosterone to as high as 150-250. Her doctor didn't rule out upping her testosterone in the future after she gets her estrogen and progesterone up, however. Does this make sense? Has anyone here got BHRT and heard a similiar thing?

[Crow]

I don't really know ideal levels, but I do have some background.

My wife was prescribed testosterone by her FORMER hormone doctor years ago and it did nothing for her libido. That doctor did not address her progesterone and estrogen numbers.

Her new doctor is primarily focusing on giving her bioidentical progesterone pills and a cream that has both progesterone and testosterone. Her progesterone was non-existent this time. Her estrogen is only slightly low, and the testosterone cream is intended to raise estrogen from natural conversion of testosterone to estrogen.

One of the lessons I've learn from this (and elsewhere) is that increased testosterone in women won't necessarily increase libido if progesterone and estrogen levels are off. Estrogen levels that are high compared to progesterone can provoke depression and anger

[Brian O'Kane]

Oh, thank you for your response. That makes sense... makes me feel like the doctor is on the right track with upping her progesterone and estrogen first.

[ReformingMind]

I know this question was from a few years ago. I’m on BHRT and have been for 7yrs through functional medicine doctors. I’m still considered perimenopause currently (I’m 51). I thought I was going through menopause in my mid 40’s but it was just low T and Progesterone as well as hypothyroidism. My doctor addressed all three of these at the same time. My first doctor continued to push my “T” levels up into the 200-300 range. My libido did improve, but it wasn’t until a few years of adjusting the dosage for all three that I began to feel better. Now at 51, I feel the best I have since my youth. I feel like exercising, strong libido and am able to keep to a healthy diet that when the hormones were flat, that seemed impossible.
In the last year, my new functional medicine doctor has continued to increase my progesterone ( triple what it was a year ago) and that has increased my desire and libido like never before.
I do believe the “T” helps with energy and desire to exercise as well as libido, but definitely pushing the progesterone has made the biggest difference. At least of late.

[Paradox]

People have a wide range of "useful" hormone levels, so the best level is where you feel better, without side-effects.
Positive effects would be more overall energy, increased muscle mass, and improved libido. Negative effects would be unsightly hair, particularly on the arms, upper lip and chin. Blood pressure should be closely monitored throughout the use of testosterone.

[MrEden]

The doctor said her testosterone was slightly above average for her age (the number was 50, her testosterone level, also her age), but her progesterone was non-existent, and her estrogen was very low.

50 is an OK level. My wife was 47 last we checked, and she is having the best, messiest sex of her life. The cardinal rule for BHRT is better too little than too much. Fix the obvious problems first, then maybe add a bit more testosterone.

Estradiol levels are critical for men. Too high or too low, he will have ED. So I assume the same is true for women. Testosterone gets converted to estrogen. So I adjust my testosterone to put my estradiol where it needs to be. Progesterone is important too. It helps prevent cancer. It isn't standard treatment for guys, but years ago I started taking 1/3 of a woman's dose of progesterone cream. My gal pal teases me about having PMS! It helps erections a lot.

Negative effects would be unsightly hair, particularly on the arms, upper lip and chin.

. Watch pubic hair growth too. When my wife's testosterone gets low, her hair starts thinning in the corners of the triangles first. A woman can grow extra hair down there if she gets too much. There is a chance that the added hair could be permanent. Wife grew one extra hair on her thigh, about an inch from the main crop. The doctor lowered her dose, and it went away.

Brian, could you do something for me? I would think that normal testosterone levels and low estrogen is fairly rare. Ovaries make both. Could you ask the doctor how often he sees that, and report back? Just curious. Maybe I don't know as much about horromones as I think I do.
Thanks.

[PaulB]

Hello! My wife went to a hormone doctor yesterday. She is 50 years old and 4 years post-menopausal. She has been struggling with declining libido for 15 years, and it really started falling off the cliff 4 years ago. The doctor said her testosterone was slightly above average for her age (the number was 50, her testosterone level, also her age), but her progesterone was non-existent, and her estrogen was very low. So instead of prescribing her testosterone, he prescribed her estogen cream and oral bioidentical progesterone. He also prescribed her a female Cialis-like drug. But I have read that some BHRT doctors try to up testosterone to as high as 150-250. Her doctor didn't rule out upping her testosterone in the future after she gets her estrogen and progesterone up, however. Does this make sense? Has anyone here got BHRT and heard a similiar thing?

Testosterone is not the first choice, as it 1) is not FDA-approved for women and 2) carries risks of acne or hair growth. But it is a second-line choice if fixing E&P does not work.

[MrEden]

Hello! My wife went to a hormone doctor yesterday. ....

Hey Brian, how is that working out for her, if you don't mind me asking?