HRT treatment plans
Practical HRT prescribing
- See the BMS website for current prescribing combinations, preparation availability and alternative prescriptions due to shortages or patient request.
- Assessing HRT effectiveness should be based on the patient clinical response.
- The serum estradiol should be within the mid follicular range 250–600pmol. Most women will be symptom free within this range.
- Use the full licensed dosing range to achieve optimal symptom relief.
- Check the serum estradiol if symptoms remain unresolved on maximum licensed doses.
Testosterone management and prescribing
Please note that we can only recommendation testosterone and we are no longer contracted to provide initial prescriptions. Initial prescriptions may be provided only where ongoing prescribing is accepted by the GP as per our local primary care formulary and the patient from our local catchment area. Patients outside of region would have to referred to their local secondary care provider.
Hypoactive sexual desire disorder (HSDD)—distressing low libido
Testosterone is only recommended for HSDD in postmenopausal women on current HRT. Licensed testosterone products are prescribed off-label but the indication for use and safety data remains extant. Other benefits of use may include: increased muscle strength, improved cognition, increased energy levels
Management—BMS Primary care guidance
- Yearly serum testosterone is advised or more frequently if side-effects reported
- Clinical assessment is a more reliable indicator of benefits, side-effects and appropriate use
- Excessive testosterone use increases the risk of side-effects—the effects may be adjusted by altering the dose or frequently of use
- Discontinue after 3/12 if no benefit observed or only side-effects occur
Note: Serum testosterone is highly variable due to intermittent dosing or variable daily dosing. Check for over use and side effects. If being correctly used with no side effects then it is unlikely that there is overuse and the dose does not need adjusting.
Prescription—based on choice and availability
| Testosterone |
Application use
Prescribe full boxes per time
Apply to inner thigh, lower abdomen in pubic hair line, insides of wrists - rotate site with each application
|
|---|---|
| Testogel 40.5mg/2.5g | A small pea sized amount, about a 1/8th packet per day = 5mg. (1 box = 6/12 supply) |
| Testim 50mg/5g | A small pea sized amount, about a 1/10th packet per day = 5mg. (1 box = 6/12 supply) |
| Tostran Gel 2% (60g) | Half or one metered dose, two or three times a week. Maximum use 1 metered dose on alternate days = 10mg (1 bottle = 6/12 supply) |
| Androfeme cream | Only available privately but formulated for female use |
Caution: Hirsutism, alopecia, acne, voice change and weight gain. Apply to thigh, lower abdomen or wrists and rotate sites regularly to avoid local patch hair growth.