To loose my shit at my GP?

[Peoplecoveredinfish]

I was prescribed testosterone by gynaecologist on 16/9. I have chased this three times, and had no response. I’ve still had no response, but I see from my record that the practice has written to the gynae. They’ve been pretty good about menopause, but this is a shitty misogynist policy.

TLDR: We don’t prescribe testosterone for women because it would be off licence. We prescribe off licence medication all the time, but we won’t prescribe this one, because we aren’t familiar with it and we don’t think women really need it. We think women need counselling for their made up symptoms. Even though we are not specialists and the specialist has asked us to do this, we think we know better.

The actual letter…

We have recently been receiving an increasing number of letters from the menopause clinics requesting us to prescribe testosterone for patients who are menopausal but have an intact uterus and ovaries and feel their menopausal symptoms are not being fully controlled on Oestrogen replacement therapy.
As you are aware, this medication is not licensed for women in the UK, so a clinician can only prescribe it off licence.
While there are many drugs that GPs do prescribe off licence, these are medications that we are familiar with, and there is known evidence to prove their efficacy and safety.
The GMC guidance around Good medical practice clearly states that “14 You must recognise and work within the limits of your competence. 16 In providing clinical care you must: a) prescribe medicine or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the medicine or treatment serve the patient’s needs, b) provide effective treatments based on the best available evidence.”
Also “You are responsible for the prescriptions that you sign. You must only prescribe medicine when you have adequate knowledge of your patient’s health. And you must be satisfied that the medicine serves your patient’s need.”
The British Menopause Society states “Randomised clinical trials of testosterone to date have not demonstrated the beneficial effects of testosterone therapy for cognition, mood, energy, and musculoskeletal health. Further better designed studies are required with these health issues as primary outcome measures as some individuals report improvement of these symptoms. Until these data are available, the primary indication for testosterone should therefore be for HSDD following a biopsychosocial approach.”
We are thus unable to continue issuing testosterone prescriptions to our patients whom you have seen in clinic and advise they need testosterone. We expect you as the secondary care specialist in this area to manage these prescriptions and continue to issue and monitor their safety in those patients.
We would kindly request that you avoid telling our patients to contact the surgery for the GP to continue the prescriptions for testosterone. Furthermore, any letters we receive requesting this, will be returned with a TCS letter.

Why can’t the gynaecologist prescribe it for you? I can understand a GP not wanting to prescribe a medication they don’t feel competent to prescribe. Having said that I feel for you stuck between a gynaecologist who wants the GP to do it, and the ago who doesn’t want to.

In an ideal world all GPs would be able to treat many more conditions and I understand your frustration, but they are "general" practitioners, they have broad knowledge, not in depth knowledge of menopause, dermatology, hematology etc etc and should refer to specialists.

Your GP is not the issue here they have policies they need to work within. I think it is fair for the GP to ask the gyn to prescribe if they feel they don't have the expertise/training.

I've had similar before the ds. We asked the GP to write a referral letter which we took to a private specialist, the specialist wrote the prescription for the medication the GP couldn't prescribe, but the GP did shared care by prescribing the more routine medications the specialist recommended and they could, GP also did blood tests for us. We visited the specialist each time we needed a review/new prescription which was a pain in the arse as they were over an hours drive away from home so he missed quite a bit of school each time.

No it really isn’t. The OP has been prescribed a medication by a consultant who specialises in that area. GPs are general and not specialist so should follow the guidance of an actual consultant.

There is such a thing as a shared care agreement, which the consultant fills in and sends off to the surgery. The hospital will prescribe and monitor first, then pass this over to the surgery. The shared care agreement is held on the patient notes.

Its probably expensive and the GP surgery probably don’t want to fund it.

Do they not just mean that if the specialist thinks you should have it, they should be the ones prescribing it?

Please don't lose your 'shit'. Speak to your GP in a civil manner - when I was young and my dc had pneumonia, I lost my shit at our GP, was branded 'aggressive/unreasonable' and de-registered. The GP refused to prescribe antibiotics, I took my dc to A&E, textbook pneumonia was diagnosed, antibiotics prescribed, GP was in the wrong, but I was the one who was de-registered and had to find a new GP. Unfortunately it goes on your record and if you are 'unreasonable' your future concerns might not be taken seriously by subsequent doctors.

The GP is correct here.

I have one GP who is trained and happy to prescribe at my surgery. The wait to see her is months and months.

She prescribed it to me, but I was one of the 60% of women for whom it doesn’t work. I just have hairy thighs and even less sex drive than before.

I think all GPs need significant retraining in menopause. I’ve been peri since I was 38, I believe, had HRT through the GP denied to me until I was 45. Why the actual fuck I ticked over into peri enough to be believed the night of my birthday I have no idea.

I have paid thousands in private prescriptions, consultations and scans. The NHS has failed all women in this regard and it continues to do so. The knock on effects of joint pain, life limiting periods, anti depressant usage and suicidal thoughts are COMPLETELY avoidable and utterly heart breaking.

The scam of supplements and health shop cures also needs to be stopped in its tracks.

I would love to have all HRT medications and any others reviewed, understood and correctly prescribed to all women.

Problem is, these specialists write to the GP and insist on prescriptions, but pretty much then leave it to the GP. The specialist should be monitoring with bloods and follow up appointments and just seem to send the letter off thinking ‘job done’.
GPs aren’t able to monitor these patients as they are general practitioners, not specialists.

Oh and a consultant wrote to my GP at the time, told them to prescribe HRT, refer me for scans and put me on a list for counselling due to the mess the GP had made of my mental health with their denial of treatment.

I was met with a - No, you’re not 45 yet.

GP seems reasonable to me, it's off-licence, they are not qualififed whereas the specialist is - specialist should take the responsibility here.

Fixed policy at my GP. You'll have to go private through your consultant

Is a private prescription an option, OP? You can get testosterone via Newson Clinic even if you don’t have your other HRT from them.

Why is your gynae not the one prescribing it? My dermatologist issues all the prescriptions for my very new biological drugs for eczema… my GP has nothing to do with it and little clue about said meds.

If the gynaecologist didn't actually give you a prescription then it wasn't prescribed...they simply advised the GP that that is what they'd suggest. Had the consultant issued the first prescription, monitored for effects/side effects and once happy asked the GP to continue then that would be a bit more reasonable, but your post reads like that's not the case. The GP is correct - as the responsibility falls on the actual prescriber, they shouldn't be prescribing if it's outside their usual expertise.

You need to have a shared care agreement for any medication that is commenced or prescribed from secondary care with the expectation that your primary healthcare provider will continue to prescribe it. Your gynaecologist clinic should be approached in the first instance and a request to have the testosterone prescribed from them with monitoring until stable. Your GP can then take over the prescribing once you have settled into the dose that is responding to your symptoms. Your GP should also then be able to take on the monitoring of the levels of the drug in your blood with routine blood tests. This is an additional service provided by your primary care GP, and they are within their rights to not immediately take this on if they feel it is outside of their scope of practice.

I too have been fobbed off by the GP with antidepressants, even though I was 45. They refused me HRT and the antidepressants did nothing, because I’m not depressed!
Saw a private GP, got HRT and lo and behold, symptoms massively improved, other than libido issues. Blood test after 3 months showed very low testosterone so private GP happily prescribed it. Guess what, libido returned! But I’ve paid thousands for this and it bloody should be available on the NHS.

Superdrug can prescribe testosterone privately, they used to have a service.

Most GP’s are not specialists in anything hence the their title of general practitioner, and seem to know feck all about menopause in my experience. I’m in Ireland and had to confidently argue my case for testosterone with a very young female GP who knew less than I did. I was told unless my libido was affected and or my marriage was affected as a consequence it was not advisable to prescribe.

I told her my libido was fine but cognitive function was still poor on HRT , she prescribed it I think to make me leave I took up 45 min of her time and read an entire 500 page book the following week , haven’t had the brain power to read in a few years. I know it’s difficult but we need to fight our corner for what we need .

Is your gynecologist nhs? Can the script go to the hospital pharmacy? Worth a try? Your gynecologist could send a script there msybe

This . Your GP is being professional and responsible. If something goes wrong and they have prescribed something which according to all the textbooks and guidelines is not licensed they could be in trouble and their medical licence is their main consideration. Your gynaecologist should have issued the prescription.

i had off licence drugs prescribed by my nhs consultant for a decade and the GPs would never in a million years prescribed them. My consultant was responsible for all my regular blood tests, etc and monitoring and tweaking of dose.

My GP prescribes me testosterone but it was a faff and waste of resources to get here.

I asked GP, he said no. So I asked for referral to gynaecologist. Several weeks later, I had a 2 minute consultation at a hospital with a gynaecologist (on a Sunday, just to increase the cost to the NHS). I said ‘I’d like testosterone’. He said, ‘ok’.

He gave me a prescription. My GP STILL wouldn’t repeat it until the consultant wrote to him to say he recommends I’m prescribed it.

Ridiculous. I am very tempted to make an FOI to ascertain how much this nonsense cost the NHS.

Why aren’t GPs adequately trained in a condition that affects 50% of their patients?! This shouldn’t be a specialist area. It’s absolutely bog standard.

Support women through menopause.

I bet anything this will be about saving money. The lack of evidence reason will be a smokescreen.

This. Due to severely compromised immune system I would be seriously ill if I contracted shingles. My rheumatologist wrote to my GP requesting that they provide the vaccination. Because I was a year under the minimum age, they wouldn’t do it, even though the consultant rang and pointed out that it was for legitimate reasons. They were adamant I wasn’t having it until I asked if I could have it if I paid. £140 later I was vaccinated with no problem. It’s shit, and as a poster upthread pointed out, it’s undoubtedly about money, but I agree, losing your temper and making a scene is likely to get you taken off the GP list.

I think this is about funding. My GP refused to fill a prescription for hormone treatment for breast cancer after the hospital prescribed the initial dose. The excuse was that they hadn’t received the paperwork. When I attended a clinic appointment the following week and explained, the consultant showed me the email that had been sent direct to the GP when the initial prescription was issued, asking them to provide from that point on. Sometimes the system treats the patient like a ball being batted backwards and forwards as the go between.

Money might come into it. Our gp surgery won’t do blood tests now that any doctor at the hospital has asked for as the gp won’t get paid for it. Which is bonkers. So people,with cancer have to trek to the hospital for their regular blood tests which is the last thing they need.

However the main issue will definitely be the fact the drugs are not licensed. If the gp prescribed it and someone suffered some consequences down the line the gp can’t argue they were prescribing within normal guidelines. The patient could sue and the gp could get in a lot of trouble. A specialist is more able to argue they know better than the guidelines.