Mister Fixit

On 7/16/2021 at 10:34 AM, The Hammer2021 said:

I consider Cialis superior. Try harder at a wider range of Pharmacies. I was warned of Zanax being in short supply soon too...possibly  for the same reason. Another alternative  is go for a check  up at hospital  get registered  for ED or enlarged  prostrate  and get official prescription  medicine

That's what I have done.  

On 7/20/2021 at 10:28 PM, Sheryl said:

BOTH estrogen and progesterone need to be replaced. Indeed, replacing estrogen alone puts a woman at risk of uterine cancer. But that is nto the only reason, progesterone itself is very important. It is not produced only in pregancy (though levels in pregnancy are much higher). It is produced continuously and plays a very important role, especially in terms of mood stabilization. Indeed, while estrogen is what helps the hot flashes of menopause, progesterone is what often best helps the mood swings. Levels normally rise mid cycle and keep rising until menstruation, then drop.

 

Dermal creams and gels work very well for female HRT. Oral is not advisable as passes through the liver.

 

HOWEVER I note an earlier post from you states : "My wife started her menopause about 3 to 4 years ago and still has periods aged 52.  ". This makes no sense. Menopause is defined as the cessation of menstruation. If your wife still menstruates, she is not yet menopausal.

 

Rather she is in the period known as "peri-menopause" and may nto need estrogen at all, though a blood test (FSH) will shed light on that.

 

During the peri-menopause many women develop PMDD (previously known as PMS) or, if they already had it, it worsens. It is very important to get the distinction between PMDD and menopause clear as the treatments differ and, in fact, estrogen would make PMDD much, much worse. PMDD responds to natural progesterone and, in severe cases, soemtimes needs the addition of low dose sertraline.

 

the hallmark of PMDD is that the symptoms occur somnewhere in the 2 weeks prior to menstruation (may start mid-cycle and last a full 2 weeks, or may start a little later in the cycle, but also continuing to menstruation) and then there is dramatic improvement when the period arrives - it feels like a curtain has suddenly lifted. Have your wife keep a diary of the timing of her symptoms. If they resolve once her period starts and she then has at least 10-14 days symptom free before it tarts again, this is PMDD.

 

Thai doctors are not well informed about PMDD.

 

 

@Sheryl

Thank you for your long reply and improving my medical knowledge and vocabulary.  PMS was just starting to be used as a term instead of ‘period pains’ when I first married in the 70’s and now it’s changed again!  I had to Google the term PMDD because you didn’t explain it, but I get the idea. 

I delayed replying because I wanted to see how we got on at the andropause clinic at our joint appointment last Tuesday so please allow me to report on events.

First, my wife – she chatted to the doc at some length, then I stuck my oar in to see what was being said or she’d not have told me. 

Basically, the doc told me that she feels a lot better on the venlafaxine but is sleepier.  Her anxiety and constant worrying over numerous small things (which she had never mentioned to me before in 14 years) has abated considerably and the pain and tension in her neck, shoulders and back has all but gone.  I said I was disquieted by the use of venlafaxine because of considerable negative experiences I had had, especially coming off it, 18-20 years ago.  I asked if she could go on something more innocuous, eg. fluoxetine or something similar but he said, and I understand this, that he wanted her to try at least one more month, possibly two, because it can take 4 – 6 weeks for the effects to kick in properly. 

Fair enough by me but at the end of that period, I will want to be discussing continuance of the medication or changing it and the management of her cessation period.  That can take a while.  She may prefer to stay on it, and that’s her choice as long as when she decides to stop, it’s well managed.

Then we spoke about Oestrogel and he’s all for it but said she isn’t ready for it as she is still having periods regularly.  Again, fair enough. 

I asked for a copy of her 29 June test results (attached below) which were printed as we left so we couldn’t discuss anything at the time. I will next month though! 

I attach a copy because although I understand some of the items, I am lost on others.  I wonder if you could help with answering some questions?

In terms of the biochemistry, all looks OK apart from somewhat elevated cholesterol level at 235.4 (it would be 5.88 in the UK, where 5 is the number to aim for) so not massive.

Triglycerides are in the normal range so that’s OK.  The HDL is a little low but within range.  However, the LDL is way high – what can cause that and how can it be lowered? 

LH (which I assume is luteinising hormone) just says <0.3 but I understand it depends on the phase of her menstrual cycle and I have no idea what that would have been at the time.  Google tells me is seems low whatever phase she is in.  Is this figure significant?

Her haematology figures all look within range except her MPV which I had to Google, but it’s not way above the top of the range.  Any thoughts?

FSH just shows <0.3 with no range, but Google says for 41 years plus females ‘Any day of the menstrual cycle’ is = 0.5 ng/mL.  Day 3 of the cycle for that age group would be < 8.5 mIU/mL.

Is there any significance to her figure in this report?

The figure for oestradiol (E2) doesn’t have a range, but Mr Google tells me that its  30 to 400 pg/mL for premenopausal women and  0 to 30 pg/mL for postmenopausal women so as my wife still has periods this figure seems low. Any ideas why this could be?

Urine test seems OK unless you can see anything in there that I don’t know about.

Most of this means nothing to me now, but I used to be very familiar with some of it 45 years ago when my first wife and I were having problems having children. 

I will post again with my version of my own appointment and test results.

15 hours ago, Sheryl said:

Thai doctors tend to use synthetic hormones by mouth which is nto the best approach but all that most of them know

 

The best approach is bioidentical hormones via creams or gels. There is a bioidentical estrogen gel readily available OTC in Thailand (oestrogel) but sourcing bioidentical progesterone is problematic unless you order ti from iherb.

 

the various antiaging clinics ioffer bioidentical HRT and supposedly so does  http://www.maximumclinic.com/womens-hormone-replacement-therapy/

 

You might point out to your wife than vebnlafaxine is hardly "natural" whereas bioidenticial HRT is.

I wouldn't DARE 'point out' anything to my wife!  <grin - smileys still don't seem to work!>

Seriously, that's an interesting post and thanks for the tip on oestrogel.  I will ask the doc about it in our next visit on 3rd August.

In female HRT, do both hormones need replacing?  I thought progesterone was only produced in pregnancy, but I am a bit out of date because my last child is now 26!  

In terms of hormone gels, my utterly useless British GP prescribed Androgel for me but it did nothing. 

As soon as I was properly diagnosed at Bumrungrad with hypogonadism due to pituitary adenoma and given testosterone enanthate every 3 weeks, things became much better.  I lost weight, my memory improved, my general health also improved, my whole sense of well-being and, of course, my libido!  

I believe that it has really helped my weight too.  In 2004 I was 107 kgs, and now I am 71 kgs (but that was after 2 years of keto starting 2017, and 2 more years maintaining that weight.

I have actually lost 50 kgs or about 110 lbs overall, because 3 month long trips to the UK piled it all back on <about 6-8 kgs a time> and that had to be lost again).  
 

16 hours ago, NancyL said:

I had to look that one up.  Hmm.  Couldn't that just be nature's way of telling you it's not a good idea to father children when you're getting up there in years?  

 

And isn't menopause exactly the same when telling women not to bear children after 'getting up there in years'?

It's an unstoppable natural process but andropause normally comes much later in life for men.  In my case, it was 'caused' (if that's the correct word) by me developing a cyst in my pituitary gland (a pituitary adenoma) when I was in my mid-50s and reduced my ability to produce testosterone naturally.  I have to have regular injections to keep the levels up.

It's important for normal functioning - testosterone is not just a 'sex hormone'.  It regulates mood, memory, bone and muscle mass, fat distribution and storage, production of red blood cells, semen, and of course, libido.  

On 7/17/2021 at 4:47 PM, IvorBiggun2 said:

Absolutely. I was on and off antidepressants for 20 years. Been on a few over those years. Last one was Sertraline. In all those years I took the medication because I wanted it to work but in reality it hasn't/didn't. Looking back I see them as placebos and not worth the hassle. I stopped taking Sertraline 5th April and I'm determined never to go back on them.

What I do now when I get kind of depressed is to sit down and talk to the wife on how I'm feeling. I find talking about my moods to be far better than taking medication. Seems to be working so far.

Interesting to hear.  In 1992, 30 years ago next January I discovered I had ADHD, but my useless British GP knew nothing about it and refused to refer me anywhere.  I took matters into my own hands and I went to the US with my eldest son and we were diagnosed at the Massachusetts clinic of the world expert, Prof Russell Barkley.  I got a supply of Ritalin in the States, but sadly, I was one of the 30% who don't respond to it. 

Came back to the UK, took the report in to the doc and he still refused to believe it because 'it was American' (!) or to prescribe Ritalin.  I knew Prof Eric Taylor of the Institute of Psychiatry in London so he wrote another report which convinced the GP, but still no Ritalin as he said I might sell it on the streets because I was unemployed at the time!  Berk.

I ended up with so many different tricyclics, SSRIs and SNRIs note of which did me any good at all.  I has so many different ones that I have forgotten the names of most of them.

Certainly, the two worst to come off were venlafaxine and sertraline, I do remember that.  None of them were especially effective so I stopped the lot eventually, no need to keep banging your head against a brick wall.  

Then I came to Thailand and threw myself into teaching and found I had a flair for it.  I became extremely organised and was juggling sometimes 4 or more different classes a day (not every day) all over Bangkok between 8 am and 8 pm most days, so I had no choice but to be on time, find new places I hadn't been to and keep track of where students were in their book etc.   

Hard work was the best thing to keep me on track.  Still is.

On 7/18/2021 at 8:45 AM, NancyL said:

When I went into menopause my general doctor, an internist, recommended trying to wait out the undesirable side effects for six months before prescribing HRT because once you start on HRT, it can be difficult to stop.  

 

Fortunately, my major side effect was hot flashes and since it was winter in Michigan and we kept our house cold, heating just the main living area with a wood stove, all I had to do was go into a colder part of the house or step outside during a hot flash.  Eventually, everything settled out and I no longer had problems.

 

This was after decades of menstrual cramps, monthly moodiness, endometriosis, infertility, miscarriages.  Finally peace.  I overheard my husband telling a male friend at a party "menopause was much easier than I thought it would be."  As if he was the one going through it!

 

I agree with my doctor on the subject of HRT.  Don't rush into it.  Give yourself six months or so to see if your body is going to settle down on its own first.

Nice helpful post.  My wife started her menopause about 3 to 4 years ago and still has periods aged 52.  

I think that's long enough to start considering a short course of HRT and be monitored regularly.

I have never experienced any female partners undergoing the menopause before so I am somewhat at a loss about modern HRT.

I have known women say it was a Godsend, but that was many years ago and medicine has moved on.  The big thing then was injectable pellets but I have no idea at all how it is treated nowadays.  Daily tablets, weekly/monthly injections?  

What are the usual methods of treating it nowadays?

On 7/17/2021 at 11:24 PM, Sheryl said:

Well if she won't go on HRT then psychotropic meds may be necessary. As shame as the right HRT will often resolve these problems.

 

(Why bother going to a menopause clinic in this case?)

Why bother going?  Because she asked to go when I started the andropause clinic.  She has started the venlafaxine, but has only taken 3 tablets so far, so no time at all to see how or if they will help.  She did say she felt a bit dizzy when she took them (she forgot yesterday) but I suspect that's just because she's new to them.  I think that effect will wear off after a week or 10 days.   We see the doc again on 3 August so I will be having a chat with him about the venlafaxine too.  To my mind, it's a bit of a cosh and I remember having real problems myself when coming off it about 20 years ago.  It took a few months, but I had a rubbish GP in the UK.

I know about VF being an anti-anxiety med and with the help of Google Translate, she agreed that that's what she experiences as well as being generally 'down' and worrying about many disparate things some time after her menopause started.  That's been going a good 3-4 years now and still she has periods at 52.  

She's a very traditional and old-fashioned middle-aged Thais woman and prefers Thai alternative medicine, which she studied for 6 years.  She goes off to the department at the MOPH every so often for whatever it is she gets for her menopause symptoms.  I am not much of a believer in alternative stuff, but it's ingrained in many older Thais.

And I have been talking about HRT with her quite a lot recently and I have suggested she tries a short course of whatever the doc suggests for 3 months and see how she goes.  

I am sure she'll come round eventually because she has seen how good TRT has been for me.  That's what piqued her interest initially, when I went to a different hospital and she saw how sympathetic and pleasant the doctors are there.

On 7/18/2021 at 8:59 AM, IvorBiggun2 said:

Menopause just doesn't affect females. It affects the whole family.

So does andropause.

On 7/15/2021 at 10:04 PM, Sheryl said:

There is no point in asking people's experiences as everyone's reason for being on this medication will be different and few if any readers here will have been on it for menopause related issues. In addition, people vary enormously in how they respond to this medication.

 

The main advantage to venlafaxine is that, unlike many other antidepressents, it has an anti-anxiety effect as well. Whether or not your wife needs to be on an antidepressent/anti-anxiety med  is another matter and obviously I have no way of knowing.

 

I do know that Thai doctors are not very up to date in management of menopause and that few places understand and use bioidentical HRT and the tendanecy here is to use synthetics.  Synthetic HRT can sometimes cause depression, anxiety and other mental problems -- especially synthetic  progestins. What has she been given in terms of hormones?

Nothing yet.  Nor does she want to take any, more fool her IMHO.  

7 hours ago, IvorBiggun2 said:

I can't find any that don't work. It boils down to price and availability for me. Sorry, plus following the instructions. Don't eat 1 hour before activity and take at least 1 hour before. Then sit back and see what pops up.

Yes, I do know what to do, ta.  Been doing it 16 years.  Just bear in mind that all of us are different and what works for you may not work for others.  

And as I have repeated a dozen times on various threads, my pharmacist says that generally speaking, GPO products are not as good as branded generics.  I agree with him, Sidegra is not as good as Kamagra - for me.  

1 hour ago, The Hammer2021 said:

I consider Cialis superior. Try harder at a wider range of Pharmacies. I was warned of Zanax being in short supply soon too...possibly  for the same reason. Another alternative  is go for a check  up at hospital  get registered  for ED or enlarged  prostrate  and get official prescription  medicine

I used to use Cialis when I went on Pattaya bonking weekends 16 or so years ago.  I have bought some genuine Cialis last week and will be giving it a whirl tomorrow night.

Fingers crossed.

 sto

1 hour ago, IvorBiggun2 said:

No problem getting Sidegra (GPO) 50mg in Buriram from my pharmacy. 4 Tabs for 120 Baht

Except it doesn't work well for me.  Kamagra works better.

1 hour ago, The Hammer2021 said:

I consider Cialis superior. Try harder at a wider range of Pharmacies. I was warned of Zanax being in short supply soon too...possibly  for the same reason. Another alternative  is go for a check  up at hospital  get registered  for ED or enlarged  prostrate  and get official prescription  medicine

I am already registered at the andropause clinic and have had my PSA checked and a digital exam.  Both normal. 
They don't stock a large range of meds, but he prescribed some Sildenafil GPO (Viagra) which doesn't wok for me now, but at 152 baht for 4, I will just take 2 and see what happens. 

On 7/10/2021 at 6:57 PM, AgMech Cowboy said:

I have been corrected by my pharmacist. They do not have any stock and if they did... It is not available to the general public. In other words, it requires a prescription.

You did receive a lot of great suggestions instead of the Kamagra. I'd try the Gracku if it was me in need.

Nope, certainly not the Grakcu.  Tried it once, gave me quite severe indigestion and barely worked.  I'm not much of a believer in herbal products anyway.  Thais are, but that's because they seem to believe anything that says 'herbal'.

On 7/10/2021 at 5:31 PM, spidermike007 said:

Try Gracku. Available at alot of pharmacies and Lazada. Amazing stuff. Herbal, so it will not kill your liver, like the Big Pharma junk. And it lasts at least two days! 

 

Cialis, Viagra and Kamagra are so yesterday! Headaches, heart palpitations, blurred vision. Who needs or wants that? And who wants to support the Pharma mafia, if they do not have to? 

I've tried Grakcu.  It was pretty useless.  It was good at giving me quite severe indigestion though which detracted from 'doing the deed'.  

The first few times I tried Viagra 16 years ago I did get a headache, but only about the first 3 times of use.   I have NEVER had heart palpitations, ever, but my vision is sometimes slightly blurred and occasionally with a blue tinge.  These are known side-effects and perfectly manageable and short-acting.

Grakcu certainly didn't last 2 days either, more like a few hours.

My wife has just been prescribed Effexor 37.5 mgs at her menopause clinic today.  I asked why and she sort of described whirling thoughts and 'thinking about everything'.  I think she probably means anxiety.

I am very concerned.  It's an SNRI and I am not too happy about them.  I was on venlafaxine about 18 to 20 years ago and it was horrible stuff.  I walked round like a zombie most of the time, and it was almost impossible to come off it.  When I decreased the dosage, I felt awful - fatigued, unwell, etc.

I had a useless GP in the UK who had prescribed it for my ADHD because he refused to prescribe Ritalin.  Ritalin would have been 20 times better as it's gone in 4 hours, but the venlafaxine hung around for days.  You cannot cold turkey with it.

Had I known he was going to prescribe it today, I would have protested.  He has only prescribed 28 days supply, so that they can decide to continue or move to something else.  Her next appointment is in 3 weeks anyway, so I shall make sure I am there and there'll be some close questioning. 

Has anyone else been on it for any length of time, and did they have any problems with being on it, or coming off it?   Or know of a perhaps better alternative?

22 hours ago, Sheryl said:

GPO brand is a generic. And often quite good though it may vary by the drug

Sorry poor wording.  Should have written 'generics like GPO or cheap branded meds, although GPO stuff is usually not very good quality'.

My local pharmacist has told a few times not to buy GPO due to quality problems and to get cheap branded meds instead.

57 minutes ago, elgenon said:

Thanks. Any idea what their reputation is like?

My local pharmacist says it's better to buy generics or cheap branded meds as GPO stuff is usually not very good quality.

28 minutes ago, KeeTua said:

"FDA laboratory analysis confirmed that Grakcu Capsule contains sildenafil and tadalafil, the active ingredients in the FDA-approved prescription drugs Viagra and Cialis, respectively, used to treat erectile dysfunction."
https://www.fda.gov/drugs/medication-health-fraud/public-notification-grakcu-capsule-contains-hidden-drug-ingredients

"The Therapeutic Goods Administration (TGA) has tested a product labelled Grakcu capsules and found that:
The capsules contain the undeclared substances Sildenafil and Tadalafil."
https://www.tga.gov.au/alert/grakcu-capsules

Yes, I read that a while back on one of my other threads.

I tried it.  It doesn't work, apart from giving me indigestion as it did to the guy who originally suggested it.

2 hours ago, elgenon said:

What does GPO mean?

Government Pharmaceutical Organisation - https://www.gpo.or.th/

35 minutes ago, Mister Fixit said:

It isn't, it works very well thank you.

Oops, answered to the wrong post!  ????

23 hours ago, sanuk711 said:

How much cheaper in BKK---less then the 16 bht each---(50=800 baht) I never found BKK cheaper then Pattaya, especially if your talking about the Pharma near Nana.

The 16 baht quoted in Pattaya was for Kamagra gels, not Cialis.  

Just now, crazykopite said:

at that price must be fake

It isn't, it works very well thank you.

50 minutes ago, wombat said:

the advert looks like directions for my partner 

Yeah, someone else posted about that upthread somewhere.

2 hours ago, DanielS said:

This indian  Kamagra gel they sell everywhere in Pattaya.

A box with 50   for800 baht

They still have some down there?   I mean right now?  

And does it actually work?  I get mine in Bangers and it works fine, but I am not so trusting of things in Pattaya.