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.

“No one would be able to sue a GP for prescribing in the community something as directed by the consultant.”

Thats not actually true. The gp is liable for any prescription they put their name to.

You need to calm down as I already suggested.
I'm sure you are aware that testosterone is a predominately male hormone which has been licensed for men for a very long time and the fact that the sexes are different and have different hormones in their bodies.. Androfeme (the only preparation, others being unlicensed) has only been licensed for women for 2 months.
You are just making a fool of yourself behaving like this. All you need to do is write to them politely or ask your specialist to do so and hopefully they will change their mind. You can't expect the GP to be up to date with every single change that has come out in the last week. That's unrealistic.

But will ALL men, having seen a specialist consultant who has requested testosterone be sent a letter saying that NO MEN will be prescribed testosterone, regardless of guidelines, diagnosis or clinical history and further referrals will be returned. By this and only three other practices countywide? And women will be prescribed on another clinical model. Because that is what this letter says. It's not saying it will be difficult. Or that it is inappropriate for me. It is saying it will not be prescribed. By any doctor in the practice. For any woman. For any reason.

i don’t think this is a sexual issue either, but a licensed v unlicensed issue. Your surgery has a policy that they will not prescribe the unlicensed testosterone. It’s not an anti-woman policy.

Have you considered changing surgeries if you’re not happy with this one?

My practice won't prescribe to men either.

Actually a formal complaint via PALS would have probably got it sorted. My point was that you seemed furious with your GP for not doing it, when the fault lay 100% with your consultant whose job it was.

Usually NHS to NHS although some GPs may decide on case by case basis for private arrangement based on skills and competence. As you can imagine this meana not every GP does the same thing.
GPs are not obliged to enter into shared care agreements whether nhs or private and many are choosing not to.
This is happening less as the sheer volume of work transfer is beyond the capacity of day to day GP working.
If anyone thinks GPs are getting lots of funding I can confirm this is FAKE news. One funding pot was decreased (QOF) then Wes Streeting announced new GP funding (its not - its this same money just moved around).

The Govt has decided that GPs who see over 90% of all NHS appointments are NOT the NHS - so the NI increase has been applied. Same with your community nursing teams - NOT the NHS for NI purposes.

Hospitals who see less than 10% of NHS consults are classed as the NHS and have been made except from NI increases- rich get richer.

How can your GP NOT be the NHS? My local MP has not answered this.

It is important the general public recognise that by putting patients against GP practices- there will be no GPs - we'll all need private insurance. Don't believe the rhetoric - do more trading - don't help the Govt to privatise your GP.

😂

Actually for men, taking external testosterone reduces fertility, so it wouldn’t be as simple as giving him a prescription. Specialists are generally loathe to prescribe to men who want to have children.

not all Right To Choose providers have a shared care contract. It’s nothing to do with the GP.

Is the specialist a private consultant or is it from
nhs?

if the former the GP has no obligation to prescribe, if the latter they do.

Get gynae to prescribe it.

We have this argument with our gp. My DC has been prescribed an off licence medication by a paediatrician, which is absolutely needed and after the first prescription completely improved all of his symptoms and life quality. The GP however, due to it being off licence will not continue the prescription, despite the Paediatrician writing and telling them that they unequivocally need it, requesting a shared care plan etc. the Paediatrician is not happy at all and has let the practice know that, but the practice is unwilling to budge. The paed told me that other practices will prescribe it (but we are out of catchment) and that the decision not to will be because it is an expensive medicine. Unfortunately with most practices being run as businesses, finances come first 🙁

Disclaimer .. I am a GP.
I agree with your doctor .. please don’t loose your shit at home/her .. licensing of drugs are not the problem of an individual GP. I have enough shit thrown at me every day .
i am guessing the menopause clinic is a private one ? Their doctors can also prescribe but I am guessing expensive and cheaper for your GP.
In the end the menopause clinic is making money from you without baring the risk of prescribing an off license drug.
The people you should be angry with is not your GP.

“ to lose your shit “ unfortunately is sometimes the only way to get things actioned .. this is usually the culmination of having been polite, well informed , defending your need etc and having some gobshite usually male GP explain to you that you don’t need testosterone, HRT etc and maybe you’d like some anti depressants instead . They bloody hand antidepressants out like smarties … and they have no bother with doing that . I’m so sick of what women have to put up with during menopause , childbirth etc …,,it’s our turn to speak !

Sorry, how do men get Tostran online?

Well, a man would be very unlikely to get prescribed it by the NHS solely for things like reduced sex drive, which is one of the common reasons women take HRT.

You mention that three practices across the country are obstructive but the rest are on board with this process. From what I've read on the matter (a lot!) men are very unlikely to get TRT full stop. Most practices are not on board. People on the forums usually just tell men to forget about the NHS and go private or self administer.

Normally, you'd need to have had something like testicular cancer or have lost a gonad in an accident to get it on the NHS. Even men with levels that make them near impotent still get refused - like my friend who hadn't had sex in seven years at age 35.

And of course a man is unlikely to ever father a child with a low libido because unlike a woman he needs to get an erection to have sex. Due to being fobbed off for years my friend will never have a family as he only started getting his life back together at 35 after drifting for years in a job he hated but was too apathetic/overwhelmed to do anything about (which he quickly realised had been down to his hypogonadism).

There are loads of threads online very similar to this where men are saying exactly the same thing - ie. that the NHS won't help.

https://www.reddit.com/r/trt/s/8IfFIs27bg

https://www.reddit.com/r/Testosterone/s/Ibs1sYJcX1

You can just take HCG to stop the testes shrinking/preserve fertility. This is the common solution in other countries and in private healthcare. The NHS are just shockingly bad. They don't even test for elevated e2 which is a very common side effect and can tank libido, basically making the TRT pointless in cases where the primary purpose was to address low sex drive.

In any case, it's an odd situation when somebody is left impotent 'in case they want kids' in the future. It's like refusing to remove a gangrenous leg in case they want to take up running one day.

Lose, not loose. Loosing your shit has an entirely different meaning.

And, of course, yabvu.

It’s not unreasonable to expect a GP to check the position if told by a patient that there has been a new approval granted or policy change.

Completely reasonable response from the GP.

Wait a few years and we'll be seeing an increase in heart disease, stroke and cancer from all this hormonal rubbish women have been fed by big pharma.

I’m not sure. If you’re referring to HRT and not testosterone, we may see women with less heart issues ( and far more women die of heart problems than breast cancer) and less women with broken bones bedbound due to hip fractures and osteoparosis.

If the GP has referred a patient to a specialist for a specialists opinion then ignoring that opinion seems odd. By all means the specialist should initiate the first prescription but after that providing there are no issues then really the GP should have to justify why they won’t continue it. If GP’s have no intention of helping to continue treatment initiated by a specialist that they have referred the patient to then it seems a waste of time to refer patients on in the first place.

It’s not a private clinic. It’s my local hospital NHS gynaecology department. To which my GP referred me because my menopause is complex. I have had a shared care agreement with a private clinic before, which was no problem at all. There were brilliant.

Testagel is £18 a month on prescription from Superdrug. It requires an annual blood test. It is not the consultants job to prescribe. It is the GP’s. Which they are refusing to, for ALL menopausal women, regardless of clinical suitability, and are pushing back on the consultant requesting that she does not ‘tell’ their patients to ask for it. (She didn’t. She wrote and requested it. Along with topical eostrogen. Which they have not even acknowledged. And which my previous consultant did with oestrogen and they prescribed in this exact way)

I know GPs are pushed. They have always been excellent and I’ve had nothing but praise for them. I think they get all the shit from all directions. This is not a clinical decision for me personally. This is a personal bias from one specific senior partner resulting in a practice failure for all it’s menopausal women. If every practice (bar three) in the county can find the expertise to prescribe testosterone to menopausal women under expert advice, my practice should be. If every ICB’s formulary in the country (bar one) AND the NICE guidance AND the BNF AND THE BMS state that testosterone’s should be considered under expect guidance for women with HDSS, my practice should not respond to ALL requests with ‘No. and don’t ask again’.