To be so annoyed with bloody paternalistic NHS

It seems easier for transmen to get prescribed testosterone than it does normal men who need it. I've known guys with low testosterone (hypogonadism) who were having serious problems with ED and lack of energy at a fairly young age but the NHS use a cutoff much lower than advised by industry associations like the British Society for Sexual Medicine, so they wouldn't prescribe despite the symptoms being clear.

The BSSM says levels <12nmol should be investigated with possibility to trial testosterone therapy, but my friend was denied at 9nmol in his early 30s despite the average level for somebody of 45 yo being 21nmol. GP said he'd need to be <8.75 but didn't qualify being at 9 nmol despite some previous tests being lower (they only wanted to look at latest result). However, if he'd lived an hour away in Bristol he'd have been prescribed if <10 nmol.

He had the testosterone level of an 85-100 yo and could hardly get it up. Ended up paying £150 a month with a private clinic and to my knowledge still is. Doctor said he'd have been more likely to get it as a woman wanting to change sex.

Yes it's a disgrace that you aren't trusted to not get pregnant . You have my sympathy, migraines are so debilitating no one can possibly understand the misery of them unless they've had one, ive suffered since i was 17 and at times felt like life wasnt worth living . Do you have a female Dr at your practice, she maybe more sympathetic.

Wondering if the nurofen are causing rebound migraines?

This is my understanding. Having said that, there may be situations where patients complain, having been fully apprised of risks beforehand. However, that is not an impossible problem to solve, provided you have e mechanism to document the explanation of risks and the fact the patient consents.

The NHS prescribes medication daily without fully explaining risks. Off the top of my head, just in my own family, DH is dependent on Pregabalin, which he was prescribed for anxiety and wasn’t warned it was habit forming. It was useless for the anxiety but now he’s struggling to stop taking it. DD recently was prescribed antibiotics that are known to cause hearing loss in some patients. The GP mentioned not a dicky-bird about the risk of this. Recently, children have been prescribed puberty blockers and other meds that can render them infertile for life, with nobody considering that maybe a teenager is not in a position to make that kind of life-altering decision.

I could go on, but I don’t want to be a bore. Why are all those situations where patients can suffer real harm A-ok, but the minute there might be a small chance of a future pregnancy, despite warnings, that’s suddenly a bridge too far?

There’s a word for that. Misogyny.

It’s not so much that fully informed women who had signed to say they understood the risks of valproate began to sue the NHS,
but more that doctors were prescribing without giving proper advice, isn’t it?

Tell that to all the people who sue/comllain/report...its the current hysteria of blame that has caused this.

Made my symptoms so much better. So glad I had it done. Thirty years with maybe one migraine a year instead of 12 or 13 and so much milder, no comparison.

Can’t OP provide negative pregnancy tests? Or go on the pill? Or would she need to be sterilised?

Agree totally with this. It is not acceptable to deny someone autonomy over their own body and health, simply because of their sex. It is not beyond the wit of man to have a system that can document that the patient has been informed of the risks in the event she gets pregnant, and signs a waiver to avoid pregnancy and absolve the prescribing physician of liability. Neither OP nor anybody else should be forced to suffer because she’s seen as an incubator for a non-existent person.

As for the pregnancy prevention programme, not everybody feels well on hormonal contraception or the Mirena. And women can find it unacceptable to have the copper coil due to trauma and other reasons. We can NOT coerce women to accept birth control they do not want, simply to get medical treatment for a painful condition that other people access unhindered.

If a woman suffers debilitating migraines, can’t take hormonal contraception and can’t have a coil fitted because of trauma caused by sexual abuse or assault, what then? She just gets left to suffer? What absolute misogynist bullshit. Unacceptable.

Its the NHS rules, you can't get the drugs without being on a form of acceptable birth control, I'm not saying that isn't paternalistic or problematic but it is how it is for now. I did not advise the OP to get a copper coil, I only said that is what I used as I can't use oral birth control due to migraine and was contraindicated for the contraceptive injection or implant. Sadly almost all migraine preventatives require contraceptive but propranolol doesn't so the OP should be able to get this from her GP without using any for of contraception.

My doctor said that we who have migraine are at greater risk of circulatory problems from the CP than others, and should come off before age 40.

I know, and I'm saying it should be.

That is not how the prescribing of these drugs work.

I cannot believe people are blithely advising OP to go on the mini pill or get the copper coil! It's her body, and it should be her choice. They can outline the risks, sure, and if she's lying, so what? Why are the rights of a non-existent (and, more to the point, not going to be existent) baby more important than those of a living, adult woman? It absolutely IS paternalistic to insist on this despite the OP's circumstances. If they're really scared of getting sued, they could have something like a consultation to completely ensure that patients understand the risks before signing a waiver. But just saying "not listening to your reasons, you have to be on contraception" really is treating women like walking uteruses.

You absolutely can have hormonal contraception after 40. I am 47 and take degesterol for contraceptive purposes. I was on the combined pill until I was 44.

There are risk factors of weight and blood pressure to take in to consideration though.

Am 46 and on the pill due to fibroids prescribed by gps

I can’t have hormonal birth control because it makes the migraines worse. This is really common. I’m in the US and my husband’s vasectomy with 2 clean post tests absolutely is sufficient for me to get topiramate. It was a life changer for me after many other things failed.

In the extremely unlikely event I find myself pregnant, I will be doing everything in my power to get an abortion as quickly as possible. The risks were explained when it was prescribed and if I wasn’t ok with that we would not have proceeded.

I absolutely refuse to get a hysterectomy because if it makes symptoms worse instead of better, hrt is the only option left and my experience with hormones and migraines is atrocious.

.

Trans men (bio female) can get testosterone even while pregnant because a deformed baby is an acceptable price to pay to affirm a trans identity.

But you can't get what you need. It is ridiculous and YANBU.

It’s not about his fertility, it’s about hers.

So much terrible advice on this thread from people who don’t understand the prescribing of these drugs.

If any of you are genuinely interested have a read of this https://gmmmg.nhs.uk/wp-content/uploads/2025/06/Topiramate-FAQ-document-FINAL-1.20.pdf

I think they're the same with men as well. They wouldn't give my friend a treatment for similar reasons as in his 30s, despite he has three kids already.

NHS aren't interested in your morality, only your health and the high risk of tetrogenic effects some migraine preventative on pregnancy is one they aren't prepared to get involved in.

The GP will have their hands tied by prescribing guidelines, if there's a risk of birth defects it'll have to be prescribed by a specialist. The real issue is the 12 month + wait to get any none urgent specialist appointment nowadays and the expectation to just get on with it in the meantime

This is enraging!!

Can you ask if you go on the pill if you’d be allowed it (you don’t need to take them).

I went back on the combined pill age 47-49 as my oestrogen was so low on progesterone only. I didn't go through my GP and just paid for it on Superdrug private doctor, £30 for six months' supply. I felt so much better.

Endometrosis symptoms never recurred in spite of the oestrogen. Had the copper coil for five years in my 30s and that's when I got endometriosis, and had surgery to remove bilateral endometriomas. Apparently the endometriosis was everywhere, all over my bladder and attached to my bowel. Had never had problems with periods in my teens or when I was on the combined pill up to my mid 30s. The symptoms went away after surgery and going on the mini pill.

I haven't taken anything for 12 months now aged 50 and my periods have stopped. I'm not having any low oestrogen symptoms or endometriosis flare up and generally feel pretty good. Oddly I did have the first migraine with aura of my life six months ago, but have had nothing like that since.

Sorry I wasn't saying it isn't used in women I know its used for epilepsy (my sister has epilepsy and has been on it). I've been on it for Migraine but for migraine they do try to avoid it if possible as for many it isn't even that effective, the birth control required causes additional issues for lots of women and mostly at least when I was on it, it was a second line treatment that had to be issued by a consultant neurologist, not a GP for migraine. Essentially GP's aren't able to initiate a sodium valproate prescription within the NHS.

I may have missed it but I haven't seen what the OP has previously tried for Migraine prevention but her GP should be able to try her on medications like Propranolol, Candesartan, Amitriptyline and even Atogepant which are usually used for at least 3 months prior to referral to a neurologist if these don't work. She could also get a prescription of Naproxen which can be useful and is more effective than nurofen for migraine and antiemetics if vomiting or nausea is an issue. Usually you have to try at least a couple of these before they refer you to a specialist so the OPs first step is to see a different doctor who will take her seriously and start her on a first line preventative. I think for propranolol at least birth control isn't needed, most will require something to be fair and I've mostly used a copper coil which has been acceptable to my specialists.