Answer: You have unfortunately discovered how difficult it is to reproduce the natural levels and types of hormones the female body produces. Hormones are very complex chemicals. In addition, each woman has her own normal levels and sensitivity to them. These hormones also change throughout a woman's monthly menstrual cycle, and her life. There is no generic hormones replacement therapy that works for every woman. Often, women and their doctors find they must custom tailor a woman's hormone therapy, hence the need for compounding pharmacy.
Here is what the book: For Women Only on pages 113-114 has to say about Estratest and testosterone:
"For post menopausal women, methyltestosterone is available in pill form in Estratest or Estratest H.S., for half strength. But both are fixed combinations of estrogen and methyltestosterone. Estratest H.S. contains 1.25 milligrams of methyltestosterone and .625 milligrams of estrogen, whereas full strength Estratest contains 2.5 milligrams of methyltestosterone and 1.25 milligrams of estrogen. On occasion, women will require less estrogen and more testosterone, or vice versa, making the fixed combination difficult to use. Under these circumstances, we have our compounding pharmacist Dr. Ray Burns of the Urgent Care Pharmacy in Boston formulate testosterone for us. We think an ideal dose for most women is between .25 and 2 milligrams per day. This lower dose provides benefits of increased libido and response, but less risk for negative side effects. (In higher doses it can cause high cholesterol, liver problems, acne, weight gain, and excessive hair growth in the pubic area and chest.)
"Estratest is in fact a drug that the FDA approved for treatment of hot flashes. Although it is not FDA approved for treatment of loss of libido, studies are under way to assess the effects on libido under conditions of estrogen deprivation and replacement.
"Physicians can get testosterone capsules for their female patients from what are called compounding pharmacies, generally independent drugstores, not part of the big chains, that supply individualized doses of testosterone. A compounding pharmacist, always licensed, takes raw material from pharmaceutical suppliers and repackages or compounds it to fill prescription order written by doctors. This was the system of old corner drug stores before the large pharmaceutical companies began manufacturing and packaging their own drugs.
"Testosterone is available from compounding pharmacies in the form of pure testosterone, testosterone propionate, testosterone ethanotate, or as synthetic methyltestosterone. Compounding pharmacists can make testosterone doses in the form of sublingual lozenges or sprays, which unlike capsules will bypass the liver and thus eliminate the potential for liver damage. Testosterone is also available in patches or creams. Subcutaneous implants have been used in Australia and the United Kingdom, but are not available in the United States."
On pages 116-117:
"Estrogen and testosterone cream: We find these effective in many patients, particularly those who need more help with lubrication and sensation. For women who are taking estrogen orally but who are still having significant vaginal dryness and discomfort, we often consider adding the cream. Its important to point out, however, that estrogen, in the form of estradiol, does get absorbed into the body. The cream, available as Estrace or Premarin, is applied with an applicator directly into the vagina once a day. [Sometimes, women apply it to the vulva and clitoris because of local irritation, or clitoral or labial adhesions.] Because the amount of estrogen absorbed by the body can be significant, women with a history of blood clots or breast or endometrial [uterine] cancer should not use the cream. Women who only have symptoms of vaginal irritation and/or dryness should consider Estring or Vagifem, which deliver a continuous low dose of estrogen locally to the vaginal tissue.
"Testosterone cream is applied in small amounts to the clitoris and inner labia to help improve sensation. It also helps build up thin, atrophic genital tissue. We often use it as a supplement to testosterone pills, but do not prescribe it for libido problems, which are better treated orally. We've found the cream to be highly effective in increasing genital sensation in women during sexual stimulation and intercourse.
"Testosterone cream is available from the same compounding pharmacies as testosterone capsules. The dosage we prefer is 2 percent testosterone in cream form, although it can vary depending on the patient from 1 to 3 percent. It should be applied three times a week at bedtime and half an hour before sex if it doesn't fall on one of those days, in carefully dispensed amounts. Using too much can result in increased genital hair growth or an enlarged clitoris. As with testosterone pills, pregnant women and women planning to conceive should not use the testosterone cream."
Testosterone cream can now be obtained through the Internet. Use only as directed. Testosterone is a powerful hormone. If applied to the clitoris it can cause increased size and sensitivity, which may not be the desired affect. Used in conjunction with clit pumping, it may increase blood flow, size, and sensitivity. The medical community is just beginning to explore the effects of testosterone on a woman's body and sexuality. Use with care.
This subject is addressed in detail in the article titled: Androgens & Androgen Deficiency: The Hormones of Sexual Desire.