Compounded Pharmacist pushing saliva over blood tests...any thoughts?

Hi ladies, I finally got the nerve to ask my Dr. for testosterone, I really think I need it. After 2 months on Climara/Prometrium I feel OK but have no libido, very low energy and diminished sensitivity "down there". My doctor was amenable to the idea and highly recommended a female compounding pharmacist whom he works with often, but when I called her I had a bad impression: right off the bat she seemed to strongly urge me to do saliva testing which my insurance doesn't pay for, and which I'm not convinced is all that reliable, especially for progesterone. Plus I already have recent blood work results that show very low free testosterone.
I also told her a DEXA scan in January showed I have osteoporosis (I'm 46) and she maintained that this was probably not due to low estrogen after my remaining ovary was removed 4 years ago due to endo. She mentioned something about the body using aromatase to convert testosterone to estrogen in the absence of ovaries, and that the bone loss was probably due to low test. rather than low estrogen. She also seemed to imply that some bone loss following oophorectomy wasn't that big a deal, she said the body adjusts. (I was freaked out when I got the results of my DEXA and immediately went back on HRT after being off everything for almost a year only because of the osteoporosis dx.) Anyway she is going to send me a form to fill out giving more of my history and then we'll see. Has anyone else had experience with compounding pharmacists pushing saliva tests and minimizing the significance of a Dx of osteoporosis in someone my age? Any thoughts? This was not the result I expected when I decided to try compounded hormones...thanks to all of you who read this far and for any counsel or thoughts you could share. s, Andrea

Hi Andrea Hmm... well, ultimately, if your DR writes a prescription, the compounding pharmacist has to fill it. You've already had blood work done that shows a low free testosterone level, and you have symptoms of low testosterone, right? Your DR is satisfied with that, right? Then, jmho here, but I'd tell the pharmacist thank you, maybe some other time, but right now your insurance won't cover the saliva testing and you already had the blood testing your DR ordered, so would they please fill the prescription?

About the osteoporosis... it's probably both deficiency in estrogen and testosterone that contributed to your loss of bone mass. I had the same thing happen... my first year post op, I had a DEXA scan that showed I had borderline osteopenia. I didn't care much for that . Since I've raised my estrogen dose, added testosterone, and greatly increased the amount of weight bearing exercise I do, my bone mass is back up in the decidedly healthy range . The body does use aromatase to convert testosterone to estrogen as needed (assuming you have enough aromatase), but imho whether or not you had enough testosterone, the underlying problem was too little estrogen as far as your bone mass was concerned. Whether it comes from your ovary, from conversion of testosterone produced in the adrenals, or from HRT, is relatively immaterial as long as you're getting what you need. I don't really see what the fuss is about. and, if I were in your shoes, I would not minimize the importance of osteoporosis in someone your age --- waaaaay too young to have that problem. Since the rate of bone loss in the first year without estrogen is quite high, I think you did the right thing by getting back on your estrogen - the only other alternative would have been to take a medication designed to help build bone mass without estrogen, and my personal take on those is, if you can tolerate estrogen, why not take what you're missing rather than something designed to copy some of its effects, which may have others you don't know about and may not want?

So... just my ... I think I'd stick with the Climara and Prometrium, and get the script for testosterone from the DR and take it to the pharmacy to be filled. If they insist on doing testing or consultation before filling it, I'd thank them kindly but decline for now (it is a great service for those who need it, but you don't seem to). If they still won't fill the prescription, I'd find a different pharmacy to deal with, as there are many, and let your DR know about the difficulty.

and good luck!

s,
-Linda

About 9 mos ago when I was using the patch, I had my
blood tested, it showed my estrogen to be 80, then
I started the bio's immediately after that, so around Dec had another blood
test and it showed my estrogen to be 28, which had
significantly dropped. Well shortly after that had a
saliva test done and it showed that estrogen was about
118, which he said was high, well was having some
hot flashes, so I don't know. Then about a month
ago had another blood test done and that showed my
estrogen to be 36, so go figure. I don't understand,
but I tend to believe the the blood tests, based on the
symptoms I have had, but there is a big controversey
over these tests, and the saliva tests are suppose to
show what the hormones are doing over a period of time, but my estrogen has been low both times on
the blood tests, using the bio's and much higher on the
patch, I don't think they have all the kinks out of
this. Hope this helps, I am still confused and about
ready to give up.

AndreaS,
To sum it up. Blood tests measure what is floating around in your blood. Saliva measures the waste products after the hormones have been processed. This can be very helpful if you are on synthetic hormones since they don't fit perfectly into the receptors. You want to know if the body is using the hormones properly, the blood test cannot tell you that. The saliva (waste) test can.

The following is basically the same thing my compounding pharmacist said.
"In addition, saliva hormone levels best approximate the amount of hormone actually working at the cell level because hormones must pass through cells of the saliva gland before entering saliva, he explained. In contrast, blood testing measures hormone that might eventually get to tissue. "

It came from this article: http://www.medicalpost.com/mpcontent...02_140704_2548

The bottom line is, most DRs prefer to go by symptoms because the results of tests can be misleading or meaningless for any one individual -- we all feel best at different levels of each hormone, so the 'numbers' that feel good to me may feel just awful for you. There is still a lot of controversy, as you can see, about which type of testing is "better" IMHO, the test that's most valid is how you feel. Listen to your body, it usually knows what it needs.

s,
-Linda

Thanks to all for your thoughtful replies. I get the impression my doctor does not know much about prescribing testosterone but wants to help and so he relies on this pharmacist to tell him what she thinks I need and then he signs the prescription she sends him. Anyway that's how he explained the procedure to me (although he didn't admit of course that he doesn't know much about prescribing it). If after reviewing my history and symptom form she says that she won't know if I indeed need testosterone until I pay for the saliva test, I will probably try the other compounding pharmacist my Dr. recommended. He's a guy and I preferred to call the woman first, especially because my Dr. seemed really positive about her, more so than the guy.
I'm just really confused, there's so much conflicting information out there and I have a tendency not to trust anyone, I'm really wary of practitioners with hidden agendas designed to get me to open my pocketbook. Plus it's sad but I don't have a lot of faith in my Dr., he's well meaning but his focus seems to be more on the OB side. Except for the ladies on this board, I really feel like I'm in this all alone. The last time I tried to change doctors, I waited months to see the so-called hormone expert at a well-respected teaching hospital, what a joke. She never even examined me and then put me on a BCP after about 10 minutes of talking. She kept me waiting an hour even though I was the first appt. of the day and then I felt she rushed me through. But I digress.
The basic problem as I see it is whenever I take any HRT, even a low dose, I get symptoms of too much estrogen or even PMS symptoms. My breasts get huge and very painful, my sexual responsiveness diminishes (libido is permanently MIA), killer migraines, I want to sleep all the time, gain weight, cry easily and often, eat everything in sight, etc. etc. But I worry about further damaging my bones if I take nothing. It seems like whenever I take any HRT it wakes up the little remnant of my left ovary that I still have and then I end up with too much estrogen. I have been on a 25 mg estradiol patch and 100 mg. prometrium for the last 25 days and I have all the above symptoms right now and more. Last week my Dr. agreed for me to try cycling my hormones starting this month. I asked him about this because I get to the point where I feel like I have to stop everything and get my period or I will just die.
Anyway, I've rambled on long enough. Thank you again for all your support. I don't know what I'd do without this board, even though I don't post much I get a lot of help just reading it. I don't really have anyone else to talk to about these things, so you ladies are a treasure. s, Andrea