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.

Your consultant is the one recommending it so they are the one responsible to prescribe it. The GP has the right to decline. Check with BMA and NICE -- even if on the formulary, doesn't mean GP has to prescribe. Stop blaming your GP. You say it yourself - they referred you to the specialist - they did not have the expertise and they also do not have the capacity to do the hospital consultants job.
People like you are the problem. You do not accept what is being said due to your self entitlement to what you want. I feel sorry for your GP practice from what you've written.

No. We won’t. These are safe and tested medications, prescribed by doctors with qualifications, training, expertise and experience. They improve AND extend women’s lives and health. Take them, or don’t. That’s your choice. But keep your ignorant, uniformed and incorrect opinions away from women who deserve to make their own choices based on correct information from valid sources.

I don’t know what you mean by ‘people like you are the problem’ but you seem to think this is about me getting a medication I want and don’t need. It’s not. This is about ALL menopausal women having access to appropriate medical treatment in the normal way. They have said NO WOMEN CAN. I HAVE checked with the BMS. And with NICE. And the BNF and the IBC formulary and some women should. They have a right to decline some women on a clinical basis. They do not have a right to decline ALL WOMEN. And that is what they have stated in writing that they will do.

A gp is not merely a prescription-writing machine but has to make clinical decisions which they feel comfortable in doing so. They also do not have to obey a consultants request.

Consultants can and do write prescriptions, and it is their job to do so as well. Too many consultants try to pass the buck to gps.

That’s not necessarily correct @Peoplecoveredinfishi myself have had a female cancer as a direct result of being given hormones for over 10 years. There is strong evidence behind my saying that.
Now that’s not to say I disagree with you on the GP front I agree. My situation was as a direct result of GP negligence and prescribing something they shouldn’t have without guidance from specialists. But if directed to prescribe something by a specialist then there is no valid argument for not prescribing something because you don’t have the same knowledge as the consultant. Yes the consultant should therefore be the one holding any liability for that prescription so longs as the GP has followed their instructions.
But there is no denying that some medications can cause significant problems when used in the wrong situation. I will now not be able to have children because of it.

I'm not saying you don't need what the consultant is advising. I'm saying, "get it from the consultant who says you need it - it's literally THEIR role in the process."
Why is does your medication need trump everyone else's? Your GP is allowed to say no - plenty on this thread have confirmed this.

What is stopping you from getting from your consultant other than your single minded belief that youare entitled (you're not!) to get it from your GP? Maybe you think a GPs job is just to sign hospital prescriptions 🙄 god forbid they see and deal with their own patients...

My consultant prescribed a particular eye drop. My Pharmacy couldn't get it, so I went to Boots who said ah Welsh health have blocked it across the board too expensive. Phoned the hospital to explain. Was prescribed something cheaper which was approved.

Reading the letter you posted, I think you got caught in fire between private menopause clinics and NHS GP's - they talk about increased requests following private clinics' requests, plus an off label use.

I'd go in calmly, talk to the practice manager. Not all guns blazing. It's a systemic issue with the NHS / private healthcare split of responsibilitues, poor funding and lack of resources plus risk management on their side.

Similar thing is happening with ADHD meds prescriptions as some practices are refusing shared care.

Its not a private clinic, its the nhs hopsital clinic the gp referred her to.

Tbh, if it's just this one GP/practice that are being obstructive and the rest are generally on board then the obvious solution would be to switch GP and then mention that you've been thinking about the consultant's previous recommendation and have decided you'd be interested to discuss/pursue it.

Women can be misogynistic too I’m afraid. The medical profession and medical training are rife with it still.