Help with Wife's Bloodwork. Dr Has No Idea What to Do

My wife (44) recently came off birth control and started testosterone injections about the same time. Shes always had a libido on the low side. Well something clicked after coming off birth control where it skyrocketed and she felt great for about two weeks all around. Then it tanked. No drive at all and basically numb and pretty much unable to orgasm. She feels ok still but has been moody and had trouble sleeping. Sorry to ramble. She is currently on 56mg of test cyp one time a month from her obgyn for approximately 6 months. They have never taken blood. We finally got it done at an hrt clinic this past week and her test levels were 116 ngdl (reference range was 4-50) 3 weeks after her last shot. Progesterone was 1.0. Thats all they checked. We spoke with the dr from the clinic and he basically said your test is very high especially 3 weeks from your last injection and progesterone is good at 1.0.
He said I dont have an explanation and can’t really help you which is fine. Id rather him be honest than sell us something she doesn’t need. I asked him about estrogen and he said we don’t test for that because it doesn’t matter. Is that true? It must?? Anyway my only theory is her estrogen came down after coming off of birth control and test came up from the injections and were at a good ratio for a short time but have now bottomed out with no estrogen and high test creating the issue. Sorry so long please help!

She needs to be on pellets instead. Every woman I know whos on HRT is on pellets. If she wishes to remain on shots. Once a week is the way go. She may need to supplement Estrogen also but start by not giving her an injection once a month.

1 Like

Definitely agreed. We need to find someone we trust. Thank you for the reply

That’s a long interval for a week-long HL formulation. I’d be looking at 5-10mg weekly instead. Might be more even


Yes for sure. But isn’t it strange for her to be at 116 ngdl 3 weeks after an injection? And would altering the frequency be all she needs? Isn’t it uncommon for test to be administered alone without progesterone and dhea?

That test result is not surprising.

She needs a full work-up. Estrogen matters. Oral contraceptives increase SHBG, but I do not know if it would drop that quickly after discontinuing.

At least:

total testosterone
free testosterone

Half the women I see use a transdermal cream, 2-5mg daily. The other half injection, most once a week, a handful twice. Weekly injection dose runs from 7mg to 12mg, with a few over 12. I prefer those options over pellets because of the cost and it’s easier to adjust dosing with cream or injections. Of course, I see a lot of unhappy women on pellets, but that is biased as women happy with pellets are not showing up in my office.

By the way, progesterone really helps with sleep.


Awesome, thank you so much for that!

Your wife should be injecting around 20mg weekly, or 10mg or less twice weekly which is recommended.

1 Like

@systemlord so you think she should increase her dose along with the frequency? She’s convinced her issues are from her levels being too high???

Or will it sort itself out when she gets on a better schedule? And do you all believe the progesterone and dhea that some prescribe along with test is important?

She would probably benefit from progesterone. Have to check DHEA.

By the way, 20mg test a week is too much. Would be nice to know free testosterone, but she’s likely too high now. Find a hormone practice.

1 Like

Is she post menopausal? Womens hormones change depending on cycle phase. You can’t get a single blood test to tell you much. Need to test during each phase and know which phase you are testing in. Estrogen and progesterone matter greatly but spike during different periods. Not enough info here and that is far too much Test.


The issues your wife is having are likely from the long injection frequency and the dosage being too high.

The only way to keep testosterone levels in range during treatment is injections 1-2x weekly. The goal of treatment should be the lowest dosage possible to achieve symptom relief, nothing more.

From what you are telling me, it might be wise to aim for a lower twice weekly dosage of around 7mg twice weekly if your wife may be sensitive to test.

A sign of high testosterone in females can present with aggressiveness and facial hair, or masculine features.

1 Like

Great info. I cant thank you all enough. She originally was prescribed 40mg monthly via 1 injection and since no symptom resolution her Obgyn bumped her up to 56mg. My wife is supposed to have her monthly injection tomorrow and was going to ask to return to her 40mg test cyp protocol but tested positive for covid today so won’t be going. Her pre trt level was just below 10 I believe. Anyway thanks again and we are going to work on getting a full panel and find a better clinic/dr. If any recommendations in the VA area id love to hear em. Thank you all again.

Glad to see your thoroughness with female HRT also. It can be far trickier than male HRT. Some of these other docs need advanced classes in hormones.


Its crazy. The male dr at the clinic amazed me by saying he has no idea what to do and that he doesn’t check estrogen because it doesn’t matter in women. And the obgyn (who my wife loves) amazed me by being comfortable giving injections monthly of a med with a half life of 7 days or what ever it is and has never checked blood even after my wife requested it. Got to be better options out there. Appreciate everyone’s feedback

I have mentioned this on other threads, but my wife has been on Testosterone injections for several years. Her protocol is 10mg every 4 days. Her Dr. first tried pellets which most of her female patients are on, but my wife didn’t do well, so she started injections. After getting the dosage dialed in, she has had very good success.
As others have stated, Progesterone and DHEA would be a good starting point.


Also, at 56mgs I would be interested to know what your wife’s total test numbers were at peak. I would be willing to bet that she would be in range for a male.


There are, clinics that specialize with hormones only. The downside is you pay for it, as they don’t play the insurance game. The benefit is (usually) quality care. It’s worth it

1 Like

I know it. Thankfully she hasn’t had any negative sides yet. @antimadder