HRT & Testosterone

Dear Dr. N.,
I had a total hysterectomy (ovaries, too) in April 1999 at age 45 (fibroids and cystic ovaries). What a relief to not have pain 2-3 weeks out of every month! I take 2 mg of Estrace per day (I requested the synthetic estrogen and cannot use a patch due to adhesive sensitivity).
But…. I am finding that about half the time after intercourse, I bleed lightly. I don’t feel sore or dry. Also, my libido has dropped. Right after the surgery, my doctor mentioned that he did not want to give me testosterone due to the possibility of facial hair growth, especially since I have fair skin and dark hair. Should I ask again?
I usually see a general practitioner (which I prefer) and only saw the ob / gyn for the surgery and follow up. Should I seek out an ob / gyn? Or can my family doctor handle this?
Thanks for responding,
PB

Reply:
The first thing you should do is return to the surgeon who did the surgery, assuming you’re comfortable with him or her and have an examination in an effort to find the cause of your bleeding as you do not have a uterus although it is possible that the surgeon did not remove the entire uterus and left the cervix and that is source of your bleeding. Regardless you need to have someone to ascertain the source of the bleeding.

Next, physicians who are not knowledgeable about HRT and the use and benefits of testosterone in post menopausal women often discourage their patients from taking testosterone. This is usually based on their own fears and limitations. If you have had your ovaries removed you are most certainly testosterone deficient and the addition of testosterone to your HRT program would likely restore your libido. Read the section of my web site, Sex and Libido – HRT as it will give you more information on this.
If you liked the “patch” other than skin sensitivity, you might consider using estrogen gel, which is basically the HRT substance in the patch without the patch itself. It is in gel form and is rubbed on daily. It is an effective method of HRT.   The most effective solution would be hormone pellet implants of estrogen and testosterone from a physician knowledgeable in this treatment. You may have to consider finding another physician who is comfortable with the treatment of post menopausal women.
Please let me know what happens.
Dr N