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.

viagra for erectile dysfunction is available over the counter for men who are medically straightforward. For men with cardiac disease then specialist advice would usually be sought.
viagra for both men and women with pulmonary hypertension would be a specialist initiation drug. Using it for ulcers is off licence and would also therefore be specialist initiation.

Scary isn’t it? Farage talking about moving to an “insurance based system” and Wes Streeting having pre election meetings with huge US healthcare firms. Of course the tech they are going to spend hundreds of millions on with correct this lack of basic care 🤦‍♀️😔 Diagnostic work like biopsies, ultrasounds, pre op assessment clinics are already sold off..with a big decline in quality and at least double the cost

You're saying that as if it's esoteric knowledge that we could only expect the most highly trained specialists to have. Most GPs are happy to prescribe testosterone, and in general, where a medication is commonly required by their patients, they are expected to invest in learning about it until they are confident - that is their job.
This particular knowledge would be easy to acquire and refusing to do so suggests the GP has a pretty paternalistic attitude to menopause.

I remember spending far longer on conditions that only affect women than I do on conditions that only affect men.

True, there's a woman, sorry trans man in my work who gets testosterone on the NHS. I know because they won't shut up about it. Meanwhile menopausal me has had absolutely appalling care around the menopause/womb issues.

Nope. Not true.

(DOI I'm a GP involved in pathway planning and I spend a lot of time reminding consultants that they are perfectly capable of ordering and giving a vaccine if related to the condition for which they are treating the patient, and indeed they are contractually and from a good governance perspective obliged to do so).

No. Letrozole. Specifically to suppress Oestrogen in breast cancer.

You can often get a private prescription from one of the many menopause specialists but that is very expensive. So women try to get their GP to prescribe via the NHS and pay the lower prescription charge.

I don’t blame them. I mean, us. I had the same initial battle to get bog standard oestrogen and progesterone plus topical oestrogen cream - never mind anything ‘unusual’ like testosterone.

This is what I couldn’t understand with the shingles vaccine - why ask the GP to do it if the Consultant was the one who wanted it administered ?

Thank you. Good to hear from someone who has accurate knowledge and experience in this area.

The Spire healthcare signed up with the NHS in April this year to handle 30% of mental health care.

https://www.bbc.co.uk/news/articles/ckgkdp9d2wqo

Spire Kings Lynn to assist the NHS

I’ve recently been prescribed testosterone by my GP post bloods showing suboptimal levels but they can only prescribe it for loss of libido according to her. I have blood tests every 3 months.

And what else do we need to become experts in?? This is specialist treatment and off licence so the specialist should prescribe. The clue is in the "G" of GP "general" ie run of the mill stuff not specialists treatment. In 34 years as a GP the amount of stuff transferred into general practice is exponential. We can't be experts on everything, we aren't insured if something goes wrong with these off licence prescriptions. Instead of getting cross with the GP why not get cross with the specialists who just want us to be their dogs bodies on prescribing without any consideration to our job, training or responsibilities.
General practice sees far more patients than secondary care and in Scotland the budget for general practice has more than halved in the last 10 years. We cannot be experts in everything.

We're in Wales can't get the shingles vaccine until 70. Asked my GP if I could have it privately. Apparently not.

Not to mention if the OP had actually ‘loosed’ her shit (to quote exactly) - which would literally mean crapping all over the GP surgery floor…

I think that’s a fair response. For some people it can have permanent side effects such as a low voice.

It’s about accountability, who are you coming after if these SE appear ? Then they won’t be covered by their indemnity and pay personally out of pocket.

Blame the litigious society we live in.

If you went to a private menopause specialist could you not just self fund ?

Occupational hazards and all that!

You are within your rights to be frustrated, but losing your shit at your GP is not the right response.

I do believe you should be taking this up with your gynae, who like others have said, should be the ones prescribing.

I absolutely agree with your GPs letter, and any time I have been prescribed something by a specialist, they kept me on their books until they knew I was getting on well with the prescription before referring me back to my GP to prescribe.

Your GP is showing care for your health and wellbeing, this is agood quality.

Hang on in there.

It’s a request. Not an instruction. As an independent practitioner accountable for their practice they are well within their right to say no. More dumping of work into primary care.

You said the testosterone had been prescribed by the specialist - but it’s not clear from the rest of the message if that is actually the case?
Specialists ought to be initiating pretty much all medications that they advise - including titrating to optimum dose, monitoring for side effects. Once stable some GPs would be happy to take over prescribing of testosterone, some would ask the specialist to continue as it’s off licence.
The majority of GPs will have had no training in testosterone as menopausal HRT - if it were me I would definitely prefer to have a specialist overseeing the initiation and dose titration.

Agree with this

Doesn’t a GP have a personal liability for prescribing? So they have the right to refuse. Which they have. I don’t see it as dismissing women’s issues.

I take an off licence medication, specialist did the initial prescribing/supervision and my GP now prescribes it but won’t make any changes without further instruction from the specialist. It’s the way it works.

please don’t “lose your shit” at your GP (unless you want to have no GP).

I'm with the GP on this ours haven't the time to monitor.

The shingles vaccine is available privately in Scotland and England. I paid for it recently. Shingles can be very painful and recent studies suggests that those vaccinated may have lower dementia risk.

As if there haven’t been enough scandals about poor care, massaged figures and dramatically increased costs of privatisation 😔 It’s the PPE scandal in plain sight