Possible help for anorgasmia, loss of libido and vaginal dryness in women

fishinghat

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After reviewing many medical journal articles as well as numerous forums my wife and I developed a plan for the use of L-Citulline for sexual dysfunction in myself (my 20 years without an erection BUT I will go into that in another thread for men) and her 20 years of no libido, vaginal dryness and incontinence as well as loss of orgasm. For right now I just want to address the women's issues.

(Please note that my wife and I are NOT doctors and this has just been the approach my wife and I have used.)

History of my wife's condition.

We had an excellent sex life for 20 years but around 2002 I had a reaction to a prescription drug and lost my testosterone levels and all sexual abilities. At about the same time my wife underwent 4 back surgeries and menopause. At that time she suffered loss of libido and orgasm as well. That took care of our sex life.

It has long been known that nitric oxide is critical for sexual function and libido. Nitic oxide increases blood flow to most organs of the body. This release of nitric oxide not only leads to erections in men but also contributes to libido and orgasm in women. Our body produces nitric oxide by the processing of the amino acid L-Arginine. Research into the taking of L-Arginine supplements has shown little benefits though. Research in the recent past has shown that L-Arginine is largely destroyed (approximately 90%) when taken as a supplement and results are minimal at best. Research has also shown that most of the L-Arginine found in the human body comes from converting L-Citrulline (another amino acid) into L-Arginine. Unluckily as we age our body does not absorb amino acids or convert them to usable compounds very efficiently.

Concerning L-Citrulline

1) Due to some complaints from people who posted that it can cause bloating my wife started with 750 mg once a day and then every 3rd day increase by 750 mg until a dose of 4000 to 5000 mg daily for women.

2) She worked her way up to 1500 mg 3 times a day for women. Each 1500 mg dose should be separated by at least 2 hours before taking the next dose. If all 4500 mg is taken at the same time than most of the dose over 1500 mg is passed out in the urine (medical journal research data).

3) It takes L-Citulline 2 to 4 weeks to take full effect.

My wife is more than 10 years post-menopause with Postmenopausal Syndrome (If I gave her full age she would kill me, lol). This includes significant urinary incontinence and urgency which has been treated with pharmaceuticals for the last 8 years. Since on L-citrulline she has had no more vaginal dryness and a lot less incontinence . She was on the 4,500 mg L-Citruline for 4 months. Libido was excellent. Urinary incontinence and urgency are 50% better and no vaginal dryness at all. During that time we were once again very very active sexually (my situation had improved some as well). Our sexual activity was usually around twice a day. An amazing change. Unluckily at our age (over 70) that was very fatiguing. lol She subsequently stopped the L-Citrulline for 2 weeks and slowly went back on it after that. She restarted at two 750 mg capsules per day and then after 2 weeks (no effect) she increased to three 750 mg capsules per day. After 3 weeks still no sexual or incontinence benefits. She then increased to four 750 mg capsules of L-citrulline per day. Incontenance improved but sexually no benefit. At that time we discovered in the medical journals that L-Citrulline is partly destroyed in the stomach (30%) and we already knew that amino acids are NOT absorbed in the stomach but instead in the small intestines. All the capsules of L-Citrulline we had been using were standard capsules (fast release). After considerable searching we simply could not find any L-Citrulline in enteric capsules so we ordered some empty enteric capsules and a capsule filling machine. She then started taking the four 750 mg capsules with the enteric capsules. Within 2 weeks her libido had returned as well as fair ability to orgasm. Her libido at that dosage was what I would term normal and not excessive. Her incontinence also improved again considerably. She remains on that dosage until this time and has continued to see the same benefits.

Things are going fairly well for my wife. Her incontinence remains better but still has to take the pharmaceutical. Libido and ability to orgasm is fair but still a struggle, Much better than before though.

Now an update on where we are going from here.

Step 1

One of the things in the medical journals is a vaginal cream made with vitamin D and vitamin E. Based on the research we settled on ...

Current Vitamin D3/E dosage.

2000 IU vit D3 and 84 IU Vit E

I was lucky enough to find concentrated versions of vitamin D and E so that only 2 drops are needed to meet the required dosage. Many commercial vaginal creams use coconut oil as a carrier liquid as it can easily absorb across the skin. The vitamin D is said to help with libido and vaginal dryness and the vitamin E is said to help with incontinence. Research says it takes 4 weeks for it to kick in and 8 weeks to take full effect. She started on this mixture Nov. 7th so it will be a while before we know anything. I will post as more info becomes available.

Step 2

There has been much work done on erection creams in recent years and a new one was recently approved by the FDA. (Yes, this is about women and we will get to that in a second) As I mentioned in the first post I have suffered from erectile dysfunction for 20 years. I tried so so many things but the only thing that really helped was the L-Citrilline. It has been a blessing. One of the things I found out was that a L-Citrulline cream applied to the penis just before sex improves the erection about 30%. No whether a man or women the function of your body generating nitric oxide is critical for libido and even orgasm. One of the things my wife is wanting to try is the same topical mixture I use for erections. In my case it takes about 2 to 10 minutes to start having an effect. Once step 1 is completed she will try to use this topical cream to see if it helps with libido and orgasms.

The mixture I have been using is ...
1500 mg L-Citrulline in 3 ml of water-based lubricant. L-Citrulline is water soluble but not fat soluble. This is enough solution to last quite some time.

If anyone is interested on seeing the medical journal articles on any of this let me know and I will PM them to you.

It is my wife and my hopes that this information may help others with their own issues and obtain a better quality of life.
 
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Big Al

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Thanks for this detailed post! Please feel free to post the links to the articles if they're on medical or reference sites.
 

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Have her look into Bioidentical Hormone therapy.

My wife went this route and the difference is mind blowing.

It brought back her libido, she feels better and gets wet like a 20 year old.

Hormones can really cause a lot of problems for women if they get out of whack
 
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fishinghat

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Have her look into Bioidentical Hormone therapy.

My wife went this route and the difference is mind blowing.

It brought back her libido, she feels better and gets wet like a 20 year old.

Hormones can really cause a lot of problems for women if they get out of whack
My wife did BHT with no help at all. We then read a study/warning by the FDA that showed a majority of BHT does NOT contain what ingredients they list and the benefits are seldom what is expected. We had her BHT tested and ity contained NO testosterone which is one of the listed ingredients. We then swithed pharmacy and tried their compounded BHT. No benfit after a year. Tested there cream and it did contain testosterone but at 1 /4 the listed dose and no estrogen even though it was listed as an active ingredient.

It took us 2 years to get her doctors to agree to testosterone replacement therapy and constant monitoring until stable. It has really helped her energy levels but had no effect on libido and of course none on incontinence or vaginal dryness. Most research articles state that testosterone is not effective in improving libido in women. She had also tried estradiol cream for her vulva pain and vaginal dryness but it was extremely messy and had no benefit as well.
 

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Thanks for this detailed post! Please feel free to post the links to the articles if they're on medical or reference sites.
Hi Big Al, great site here by the way.
I will post the NCBI linked references as soon as I get time.
 
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Hi Big Al, great site here by the way.
I will post the NCBI linked references as soon as I get time.
That would be most appreciated- thanks!
 

fishinghat

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In one of my earlier posts I mentioned that L-Arginine is largely destroyed (approximately 90%) in the stomach. That came from a different forum and as such, without references, it is subjective. I should not have repeated it. I did find the information given below.

Oral bioavailability of l-arginine is about 70%,...

The authors concluded that ∼20% of the Arg was absorbed after the single 10-g oral dose. The discrepancies between studies suggest that the absorption of arginine is dependent on known factors (form and concentration of Arg, mode and timing of dosing, small sample sizes) and factors difficult to account for (e.g., diet, compliance, inherent biological differences)

However, when the same subjects were later administrated orally with L-arginine, L-arginine concentrations did not experience the same drop due to the slow intestinal absorption of L-arginine occurring in the jejunum [28].

The main site of its absorption is the ileum and jejunum. However, due to the high arginase activity in the small intestine, approximately 40% of the arginine from food is degraded here, and the remaining amount goes into the portal vein. It is believed that about 50% of dietary arginine enters the circulatory system. This has to do with the ratio of arginine to lysine, i.e., a competing amino acid in the absorption process, which is higher in plant products than in animal ones [73,74,75].
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Vitamin D3

Women's vaginal/sexual health

The effect of conjugated estrogens vaginal cream and a combined vaginal cream of vitamins D and E in the treatment of genitourinary syndrome
This study was conducted as a double-blind randomized clinical trial (RCT). As many as 64 postmenopausal women suffering from genitourinary syndrome were randomly divided into study and control groups. The study group was treated with a combined vaginal cream of vitamins D and E, and the control group was treated with conjugated estrogens vaginal creams for 12 weeks. The patients were visited at the beginning of being admitted, the fourth week, the 12th week, and four weeks after the treatment and their information was recorded by checklists and a sexual function questionnaire.
At four visits, libido, orgasm, and frequency of sexual intercourses, as well as vaginal symptoms such as burning, itching, dryness, and dyspareunia were improved in both groups (P <.05). However, there was no difference between the two groups in terms of the frequency of severity of these symptoms during the four visits (P >.05). Investigating the female sexual function index showed that using vitamin D and E vaginal creams, like the use of conjugated estrogens vaginal creams, improves sexual function in women (P <.01).
According to the results, it can be concluded that the combined vaginal cream of vitamins D and E is a suitable alternative to vaginal estrogens in relieving the symptoms of genitourinary syndrome in postmenopausal women, especially those who are unable to use hormone therapy or have little compatibility with this therapy.


Effect of vitamin D vaginal suppository on sexual functioning among postmenopausal women: A three-arm randomized controlled clinical trial
The inclusion criteria were as follows: (i) being menopausal for at least 1 year, (ii) being married, (iii) being sexually active, and (iv) having sexual desire. Participants were randomly assigned to three groups for 8 weeks of treatment: intervention (vaginal suppository containing 1,000 units of vitamin D3), placebo (vaginal suppository placebo), or control (no treatment). The main outcome measure was sexual functioning, which was assessed using the Female Sexual Function Scale (FSFI) 4 times during the study (i.e., 1 month before the intervention, immediately after the intervention, 1 month after the intervention, and 2 months after the intervention). Vitamin D vaginal suppositories were more effective at improving sexual functioning among postmenopausal women in the short-term and appeared to prevent aging-related sexual functioning decline in the long term.

The effect of vitamin D on sexual function: a systematic review
This review, included 8 final articles with a total sample size of 464 (including 217 women and 247 men). Four studies evaluated the effect of vitamin D on male sexual function, and 4 studies evaluated the effect of vitamin D on female sexual function. Vitamin D supplementation has been shown in studies to improve both men’s and women’s sexual function.

Therapeutic Effects of Vitamin D on Vaginal, Sexual, and Urological Functions in Postmenopausal Women
Numerous clinical studies have observed improvements in vulvovaginal symptoms linked to the genitourinary syndrome of menopause (GSM) with vitamin D supplementation. These studies have reported positive effects on various aspects, such as vaginal pH, dryness, sexual functioning, reduced libido, and decreased urinary tract infections. Many mechanisms underlying these pharmacological effects have since been proposed. Vitamin D receptors (VDRs) have been identified as a major contributor to its effects. It is now well known that VDRs are expressed in the superficial layers of the urogenital organs. Additionally, vitamin D plays a crucial role in supporting immune function and modulating the body’s defense mechanisms.


Effect of Vitamin D Therapy on Sexual Function in Women with Sexual Dysfunction and Vitamin D Deficiency: A Randomized, Double-Blind, Placebo Controlled Clinical Trial
We performed this randomized, double-blind, placebo controlled trial in women 18 to 45 years old with sexual dysfunction, defined as a FSFI (Female Sexual Functioning Index) score less than 26.55, and serum 25[OH]D less than 30 ng/ml. Participants received an intramuscular injection of 300,000 IU cholecalciferol or a placebo at baseline and then after 4 weeks. Sexual function was evaluated with the FSFI at baseline, and 4 and 8 weeks. A total of 38 women in each group completed the study. Serum 25[OH]D levels increased only in the cholecalciferol group by a mean ± SD of 14.4 ± 3.2 ng/ml (p <0.001). The FSFI score was higher in the intervention group at study week 4 (19.6 vs 16.3, p = 0.002) and week 8 (25.0 vs 17.1, p <0.001).

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incontinence

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862377/
Stage I and II Stress Incontinence (SIC): High dosed vitamin D may improve effects of local estriol
We evaluated vitamin-D-levels in serum of our 60 postmenopausal women. Only 20% of this group had good vitamin D-levels. 50–70 ng/ml sufficient

Effect of vitamin D supplementation on the severity of stress urinary incontinence in premenopausal women with vitamin D insufficiency: a randomized controlled clinical trial
Eligible women received a 5000-unit vitamin D supplement or placebo weekly for 3 months.
66% decrease in UI.

Comparing Vitamin D Supplementation versus Placebo for Urgency Urinary Incontinence: A Pilot Study
Interventions were 12 weeks of weekly oral 50,000 IU vitamin D3 or placebo.
50 years of age or older, with at least 3 UUI episodes on 7-day bladder diary and serum 25(OH)D ≤ 30 ng/mL. 56 women, UUI episodes per 24-hour day decreased by 43.0% with vitamin D3

Effect of Vitamin D Supplementation on Urinary Incontinence in Older Women: Ancillary Findings from a Randomized Trial
... vitamin D3 (cholecalciferol) at a dose of 2000 IU/day, Vitamin D supplementation for two to five years was not associated with differences in urinary incontinence prevalence, incidence, or progression compared to placebo for older women with and without adequate serum vitamin D levels,

The effect of vitamin D on urgent urinary incontinence in postmenopausal women
...postmenopausal women with UUI or nocturia more than once at night with vitamin D levels less than 30 ng/ml. one taking vitamin D3 (50,000 IU) tablets and one taking placebo weekly for 8 weeks.after treatment, in the vitamin D group, the severity of UI and the frequency of nocturia significantly reduced.

Hypovitaminosis D is an independent associated factor of overactive bladder in older adults
705 patients with known vitamin D status, urinary incontinence and subtype, and calcium plus vitamin D therapy data were included in statistical analysis. Patients who are using calcium plus vitamin D therapy were excluded. Mean age of the study population was 72.3±6.4years and 62.8% were female.Vitamin D deficiency and insufficiency are independent associated factors for overactive bladder in older adults.

High dose vitamin D may improve lower urinary tract symptoms in postmenopausal women
statistically significant reduction in the reported severity of urine incontinence in the high dose group as compared to the standard dose group after one year (p<0.05). 20 000IU of vitamin D3 twice a week (high dose group). 12 months.

U-shaped association between serum 25-hydroxyvitamin D concentrations and urinary leakage among adult females aged 45 years and over in the United States: a cross-sectional study
A total of 9525 women aged 45 years and older were enrolled in this study. A non-linear relationship between serum 25(OH)D concentrations and clinical ULwas observed. When serum 25(OH)D concentration was higher than the inflection point 63.5 nmol/L, a positive correlation was observed between serum 25(OH)D concentrations and clinical UL. However, when serum 25(OH)D concentration was below the inflection point 63.5 nmol/L, a negative correlation was observed between serum 25(OH)D concentrations and clinical UL

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387645/
The effect of vitamin D on vaginal atrophy in postmenopausal women
which received vitamin D and placebo vaginal suppository daily for 8 weeks,The mean pain significantly reduced after 8 weeks in the treatment group (1.23 ± 0.53) compared to the control group 1.95 ± 0.74 (P < 0.001). The mean of dryness and paleness reduced significantly in the treatment group versus control at 56 days.vitamin D vaginal suppositories 1000 IU vitamin D
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Vitimin E

Effectiveness and safety of vaginal suppositories for the treatment of the vaginal atrophy in postmenopausal women: an open, non-controlled clinical trial
a clinical trial has been performed to investigate the efficacy and safety, in postmenopausal women with urogenital atrophy, of the use of suppositories for vaginal use, containing hyaluronic acid, vitamin E and vitamin A. The trial, according to a open, non-controlled design, was performed on 150 postmenopausal women, 1 vaginal suppository per day, for the first 14 days and then a vaginal suppository, day in and day out, for other 14 days. The patients have not reported adverse effects during the treatment, and the results in terms of effectiveness on the vaginal atrophy symptoms were markedly positive.

Open, non-controlled clinical studies to assess the efficacy and safety of a medical device in form of gel topically and intravaginally used in postmenopausal women with genital atrophy
two clinical trials were performed to investigate the effects of a medical device in the form of a gel, containing hyaluronic acid, liposomes, phytoestrogens from Humulus lupulus extract, and Vitamin E, with the aim of testing its safety and efficacy in post-menopausal women with urogenital atrophy. The first pilot study confirmed in 10 women the good safety profile, both locally and systemically, of the device applied on the external genitals at the dose of 1-2 g/day for 30 days. The second study was carried out, according to a multicenter, open, non-controlled design, in 100 post-menopausal women assigned to the vaginal application of 2.5 g of gel/day for 1 week followed by two applications/week for 11 weeks. The primary end-point was the evaluation of vaginal dryness assessed by a Visual Analogue Scale both by the investigator and the subject. The results showed a marked effect of the tested product on the vaginal dryness and on all other symptoms and signs with statistically significant reductions since the first week of treatment. No treatment-related adverse events were complained by the subjects and the treatment course showed a high level of acceptability by the subjects.

[Medicinal treatment of urinary incontinence with vitamin E]

[Double blind study of alpha-tocopherol in urinary stress incontinence]

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fishinghat

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"We then read a study/warning by the FDA that showed a majority of BHT does NOT contain what ingredients they list..."

sources

E.D. Grober, A. Garbens, A. Božović, et al.
Accuracy of testosterone concentrations in compounded testosterone products
J Sex Med, 12 (2015), pp. 1381-1388
"There was significant variability both within and between pharmacies with respect to the measured concentration of testosterone in the compounded products. In contrast, the concentration of testosterone within Androgel and Testim was consistent and accurate. Collectively, only 50% (batch 1) and 30% (batch 2) of the compounding pharmacies provided a product with a testosterone concentration within ± 20% of the prescribed dose. Two pharmacies compounded products with >20% of the prescribed dose. One pharmacy compounded a product with essentially no testosterone."
International Society for Sexual Medicine.

Also found...
138. National Academies of Sciences Engineering and Medicine
The clinical utility of compounded bioidentical hormone therapy: a review of safety, effectiveness, and use
The National Academies Press (2020)
While important, the recommended postcompounding inspection process is superficial, in that these steps do not ensure that the compounded preparation contains the purported amount of active ingredient or can deliver the active ingredient to the patient and the site of action. Because of these limitations, different compounders may use different processes to compound an identical prescription, and as a result, cBHT preparations ordered with identical prescriptions and labeled with the same name will likely vary between compounders. Indeed, FDA has received adverse event reports that reveal harmful variations in compounding (FDA, 2020a; see Chapter 7).

FDA Chapter 7
The variability of cBHT formulations and research methodologies not only affects the quality of the evidence used to support research conclusions, but it also minimizes the ability to compare results among studies or apply meta-analytic methods to draw conclusions from a larger number of patients (Boothby et al., 2004).

Also noted...
International Menopause Society - bioidentical testosterone therapy cannot be recommended because of the lack of evidence for efficacy and safety,

The Australasian Menopause Society does not recommend the use of compounded bioidentical hormone therapy in any form.

International Society for the Study of Women's Sexual Health Clinical Practice Guideline - Compounded testosterone, pellets, IM injections, and oral formulations are not recommended.

National Academies of Sciences Engineering and Medicine - Recommends against the use of these compounded creams as ineffective.

No professional organizations found or research that promotes the use of these creams.
 

fishinghat

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I made the comment earlier "Most research articles state that testosterone is not effective in improving libido in women. "

T(testosterone) was negatively correlated with dyadic desire in women,...

In postmenopausal women not receiving estrogen therapy, treatment with a patch delivering 300 microg of testosterone per day resulted in a modest but meaningful improvement in sexual function.


Six of the ten testosterone serum evaluation studies failed to show a significant association between testosterone serum level and libido. Only one out of four studies examining testosterone treatment in premenopausal women was able to show any clear improvement in libido; however, the effect was limited to only the intermediate dose of testosterone, with the low and high doses of testosterone not producing any effect.

In addition, there is a lack of evidence for diagnostic specificity of low free testosterone levels for the symptom of low libido in women for whom there are no confounding interpersonal or psychological factors;

...neither serum levels of testosterone nor its metabolites correlate with desire or function.

And many more articles too numerous to mention.
 

BigO

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My wife did BHT with no help at all. We then read a study/warning by the FDA that showed a majority of BHT does NOT contain what ingredients they list and the benefits are seldom what is expected. We had her BHT tested and ity contained NO testosterone which is one of the listed ingredients. We then swithed pharmacy and tried their compounded BHT. No benfit after a year. Tested there cream and it did contain testosterone but at 1 /4 the listed dose and no estrogen even though it was listed as an active ingredient.

It took us 2 years to get her doctors to agree to testosterone replacement therapy and constant monitoring until stable. It has really helped her energy levels but had no effect on libido and of course none on incontinence or vaginal dryness. Most research articles state that testosterone is not effective in improving libido in women. She had also tried estradiol cream for her vulva pain and vaginal dryness but it was extremely messy and had no benefit as well.
We researched the hell out of doctors and practitioners in our area.

My wife continues to get favorable labs.

It might be the pharmacy or the doctors.

Al of my wife's treatment/hormones come directly from the place she goes to.

She hasn't had to go to a pharmacy since she started.

We pay out of pocket but it's worth it.
 
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fishinghat

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I am really glad that it has been successful for you and your wife. I believe it is the pharmacy. Here the doctors have nothing to do with deciding the components of the BHT. They simply supply the pharmacy with the latest hormone related blood tests and the compounding pharmacist decides on the make-up. When it became apparent that these BHT creams weren't helping I had some discussions with the compounding pharmacists. They said they do NOT consider if the lady is post menopausal. They make up all BHT as if the women is actually going through menopause at the time. It is interesting to note that both BHT compound had totally different make-up from each other even though the lab results used by them were essentially the same. She was on each BHT for a little over 1 year. Each follow-up lab was nearly identical indicating a lack of impact on her system. Also, the doctors here do not do follow-up blood tests after going on BHT. We had to do this without insurance coverage and out of pocket.
 

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You want to find a New Doctor and It may depend on where you live.
I've spoken to employees that work at the Dr. Office where I get my TRT and are using BHRT.
They report the following
  • Significant Weight Loss & building of Lean Muscle Mass
  • Improved Energy Levels
  • Improved Libido
  • Relief of Depression
  • Controlled Glucose Levels
  • Improved Confidence
 

fishinghat

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I really understand that post! My wife and I are disgusted with the medical response to her situation. Unluckily most medical institutions in our area feel the way I have indicated below. There are private women's health clinics but most do not have on staff doctors just nurses. They are not covered by insurance. The original office visits were suppose to be in the $700 range with other services (labs, testing, etc.) being add ons. They would not accept the labs she had already had done so a new set of blood tests alone would be over $700. Ouch

I live in a relatively large town but all doctors are part of one of two medical institutions and they have policies against TRT for insurance and legal liability reasons. We had to fight for 2 years to finally get her on TRT. There are dozens of Ob/Gyn doctors but they really resist TRT and there is only 2 compounding pharmacies and they both failed in producing a quality BHT. With the bad analysis on the BHT on one of the pharmacies they agreed to send out the script for compounding at a national compounding service. They also failed in their product accurately meeting the quality standards for their product.