Testosterone advice and experiences please (NHS prescriptions)

[Freeekedout]

Now that my HRT is settled, GP has agreed to prescribe testosterone but only on a private prescription. For a couple of years I have discussed a lack of libido with my GP and she is aware that this is having a significant impact on my marriage. It's not just about sex. I am permanently exhausted, suffer from extreme brain fog and cannot for the life of me lose the weight that has piled on over the last three / four years. I feel testosterone could help with these issues.

I understand that some GPs will continue prescribing testosterone after a private consultant has prescribed it. I have checked the CCG guidelines for my area (Berkshire West) which say "patients who may require testosterone supplementation should be referred to secondary care for specialist advice". I was referred early on in my HRT journey to a private gynaecologist, who was intent on pushing me to have another Mirena, but I did not go down this route due to previous traumatic experience with insertion. Testosterone wasn't discussed, but to be fair, I didn't know about the benefits of it back then. Our GPs have recently had training on testosterone supplementation and are happy to prescribe it, but I was told when I went to collect my script that I had to pay upwards of £50 for a private prescription.

I have made another appointment with the GP to discuss this next week - according to the CCG guidelines, should I push for testosterone be prescribed on the NHS? If so, what should I be saying to argue my case? My testosterone levels were 0.3nmol/L (normal range 0.3-1.7) and Free Androgen Index 0.6% (normal range 0.4-3.0) in July 2021 when they were last tested. I am booked in for another blood test in a few weeks.

Background - I have been taking Elleste Duet 1mg for six months and increased to 2mg for the last three months. I'm using Noriday (norethisterone) for the progesterone element and contraception. I'm 43 and still have a uterus, don't know if I still have periods as I've recently had the Mirena removed. I can count on the fingers of one hand how many times I've had sex in the last 12 months, and the previous 12 months was very much the same. I would appreciate any experiences or advice that you can offer!

I’ve posted elsewhere on MN recently about this.

I went to GP and said I’d had HRT for several months and still had low libido and would like to try testosterone, understanding it is off licence for women.

GP readily orescribed me Tostran right away. My small bottle will last about 9 mo this, but I’ve been asked to return for review in 3 months. I am hoping they will do a blood test at that point to confirm I remain in normal female range.

if your GP won’t give you an NHS prescription but insists you remain private after being established on it and having had a follow up blood test to confirm you’re in normal Range, I’d push back and point to NICE guidelines on this. Ask them who you can speak to about this as it should be orescribed by NHS. Some GPs won’t prescribe without a specialist first prescribing (doesn’t have to be private) but after that there’s no reason not to.

My GP was happy to prescribe Testosterone (in pump dispenser just like the oestrogel), but she made it clear that she could only prescribe it legally for lack of sex drive - not general lack of energy etc, and I got the impression if I pushed that part, then she might not be able to prescribe it at all. It did make me think that that particular guideline must've been written by a man! No care for if you're feeling exhausted and can't think straight/hold a conversation/do your job etc, as long as you're up for it!!
She also didn't really know what quantities to prescribe, so prescribed far too much, and as a result, I got about a 2 year supply in one month, so stopped getting the prescription, (which then lapsed). I have been using it, every few days in a small blob, but can't say I've morphed back into a 20 year old or anything. I'm guessing sex drive is more complex than just hormones...
Also, I'm not noticing a massive difference in energy, but maybe I'm not consistent enough. I do tend to forget anything that isn't daily. I haven't grown any more of a beard than usual though!