To loose my shit at my GP?

"Loose my shit at them" does kinda sound like OP is going to storm into the surgery and sling a bag of poo at her doctor. 🤣 Maybe they deserve it!

It is not the duty of the gp to blindly issue repeat prescriptions. Consultants are not Gods that GPs have to bow down to. They’re all doctors, but have just followed different professional routes. Consultants advise and recommend in their field, but it’s up to the individual GP to decide whether they accept this recommendation.

I completely agree. It’s their registration on the line if anything goes wrong. The clinic should prescribe it.

This.

I'm not an expert but there are defo instances where the GP can refuse. However, there is often still a duty of care and this can fall with the specialist. However, IME it can often fall between the cracks if you don't chase them.

For example, I wanted to go back on my ADHD meds having not taken them since my teens and had to be reassessed as per the guidelines. Got referred to an NHS partner through the RTC pathway as NHS waiting time was five years and the partner was two months.

Got a positive assessment and was prescribed the same meds I used to take. However, after the partner had managed the initial three months period as usual, my GP refused shared care. However, they didn't state this outright. They just ignored the letters.

It was a shitshow because my provider had told me that they'd continue prescribing indefinitely at NHS rates if shared care was rejected so I didn't need to worry. However, when I suddenly realised I should've had my prescription dispatch notice a few days prior and was running out, it turned out that the provider hadn't prescribed because they didn't know whether my GP had taken it over and needed this confirmed in writing/email.

This resulted in me going almost a week without and crashing hard as you're not meant to just stop stimulants without tapering off. I was on a work course that week being trained on driving a new heavy plant vehicle and it was horrible. I had really bad brain fog, lethargy, and was driving a 25 ton loading shovel around a quarry having to do dangerous manoeuvres whilst feeling rubbish.

It took both the consultant and myself pestering my surgery for a couple of days before they wrote a proper letter saying they were refusing shared care due to not feeling they had the capacity to manage my treatment. Soon as I had that my consultant took over my care permanently and I must say they've been a thousand times better than the NHS. I can usually get through to the team in under five mins and they're really good and quick at sorting any issues.

Yabu to say “loose” tbh.

YADNBU the GP is hugely unreasonable. Your consultant has prescribed it and it is the duty of the GP to issue repeat prescriptions. I would be making complaints to the practice manager, CQC and my MP frankly.
We have put up with piss poor service from GP practices for far too long. I would be furious if my practice acted in this manner and would move practices if necessary.

Yes, you can get Superdrug to prescribe it privately. The doctor who signs the prescription is legally responsible for that prescription, so must be able to justify why he or she prescribed it.

Unless I’ve missed it, why hasn’t the consultant prescribed the medicine? I don’t think you’ve answered this question.

You can buy it over the counter nowadays.

If the consultant prescribes it, it means you have to go to the hospital for follow up blood tests and monitoring which need to be done when you are on T, which could otherwise be done with local community blood tests if the GP prescribed. For me, I have to travel to the other side of the borough to get to the hospital so it makes a huge difference.

It definitely should be the specialist prescribing it imo - the GP has done nothing wrong. Why isnt the consultant prescribing it??

I think a lot of people on this thread don’t understand how prescribing works. The clinician who signs the prescription takes ultimate clinical responsibility for any adverse outcomes.

I’ve been a GP for nearly 30 years, so I’ve seen a huge number of new drugs and treatments appear, and also seen many changes in the way medical care is delivered.

I want my patients to get better, and I want to be able to help them. But I also don’t want to face a disciplinary hearing, or face judgement by the GMC. I have a family to support, and I don’t want to lose my job. So, like most people at work, I follow the rules. And if I know I’m not qualified or licensed to undertake a particular form of treatment, I’m not going to do it. That’s not me being difficult or obstructive. It’s just working within the parameters of my knowledge and expertise. It saddens me to think that people want to “lose their shit” with me, just because I’m doing my job.

I reckon it's less misogyny and more 'Pay for it from your budget, not ours'.

In either case, though, losing your shit at the GP isn't going to be remotely productive in any shape or form.

Yes - if they have low testosterone, at many online pharmacies. Just the gel. Bodybuilders are using higher doses injectables.

YANBU. GPS frequently issue prescriptions for medication originally prescribed by specialists, and which they are not necessarily familiar with. Eg Parkinson’s, types of dementia. This sounds to me like a commissioning wrangle - it’s not in the GP contract to monitor this and it’s become common enough that they are pushing back

Do they?

@Bulbsbulbsbulbs it took a long time. When viagra was first invented it was only for a very limited number of people with very specific medical conditions. But it’s been around for decades now, and its safety is long established.

What are you implying in your comment? Are you aware that a lot of GPs are women?

Is this actually true?

Yes, it's easy to buy off the black market. That's what bodybuilders do. But anybody can order it that way. Usually you need to go to a TRT clinic and they charge big £££. Most men use injections as gel often doesn't get absorbed well into the thicker skin of middle aged men.

Gel also carries a significant risk of transferral to your partner and possibly children as it rubs off on clothing and bedsheets etc. Much better to do a weekly injection. For example, you need to shower before applying the gel and it needs to be on your skin for something like eight hours.

So if you want to go to gym before work or do sports on the weekend you either need to wait eight hours or go before applying which would mean training with low energy as it will have worn off by the morning and you'll have almost zero testosterone as natural production shuts down over time when on TRT due to the feedback loop. If you sweat it will ruin the absorption.

And if the GP doesn't feel comfortable prescribing it he should refer it to an endocrinologist. Although certainly for men urologist often seem to be a better bet. My mate's private GP said that endos were often the most obstructive and that many have zero experience in treating hormone deficiencies as they usually tend to specialise in diabetes.

The guy that was being dismissive towards my friend had a specialism in metabolic medicine and didn't seem very up to date on TRT at all.

You lost it with the wrong person, the specialist should have prescribed and be
monitoring you.

They all feel confident prescribing viagra though, don't they?

Yes. Totally unfair that men can get it online without the prescription cost.

£90 if you're careful where you take your private prescription. I was careless and went to Boots where I was charged over £76 for a canister.
And that's on top of the £145 fee to see a private menopause consultant in the first place.
What really annoys me if that my DH could have the very same medication prescribed online and at a fraction of the cost. Just a quick survey and they'll pop a can of Tostran in the post. It encourages dodgy behaviour

Misogyny is rife

A male friend of mine is prescribed testosterone after having tested with levels in the 85-100yo bracket in his mid 30s. The NHS are really really cagey about prescribing it for some reason, even to men whose levels are far below the cutoff used by industry associations like the British Society for Sexual Medicine.

He had to go private (used a guy that is a nationally regarded expert and also an NHS consultant). Guy wrote to his GP and the surgery weren't having it one bit. His GP said "every man feels better on testerone". Wouldn't address the issues of no sex drive, lack of energy/apathy, and the fact his levels were those of somebody 50-65 years his senior. My mate hadn't had sex in about seven years despite being slim and otherwise healthy.

He eventually managed get prescribed it through the NHS from the niece of his childhood GP after moving home for a few months while buying a house. Ironically, he said this woman was far less dismissive than the three male GPs he'd seen. However, upon moving back to the city his original GP tried to take him off it. He just refused and said he'd continue administering himself if need be and they'd still have a duty of care to monitor his bloods etc, at which point they grudgingly relented.

Their level of treatment is an absolute joke. Obv private care is usually the gold standard, but the NHS are decades behind here. They still recommend three week intervals between shots rather than weekly, or even twice weekly, which gives massive peaks and troughs compared to the latter. You have high blood pressure at the start and are way deficient by the end.

And they don't even check estrogen which is one of the key hormones that can become elevated on TRT and cause erectile dysfunction etc. My mate has to pay for his own blood tests and buy Anastrozole. I don't know what it is about testosterone. Whether it's the stigma from anabolic steroids misuse or just that they're scared of opening the floodgates (in America testosterone prescriptions have risen by something crazy like 400% over the last decade or so I think it was).

British Society for Sexual Medicine says that a young person with levels under 12 nmol should be considered for a trial of TRT but most GPs won't even look at you unless you're below 8 nmol. Meanwhile, a 'good' level for a 45yo bloke is 21 nmol.

I know this discussion is about women but I think across the board there is a weird stigma to prescribing testosterone. Unless you want to take it for gender reassignment reasons. My mate's private doc said a young woman wanting to change sex would be more likely to get a prescription than a deficient male.

Its not fair for women to be caught between this sort of admin battle. Its really distressing when you are just trying to get your symptoms dealt with.