As a GP and a specialist working in TRT (Testosterone Replacement Therapy), I am always asked the same question, more so in regards to the proverbial ‘easy on the pocketbook’ so to speak. To be fair I actually agree! Why would you want to spend money when there is a possible way of doing this all for free. Well that’s just it…the popular adage comes to mind, “There ain’t no such thing as a free lunch”…and I will try and be as concise as possible on this matter;
Time is valuable…
The issue of trying to see a GP in itself is at times hard enough, but to have that awkward conversation about testosterone without eyebrows being raised is the first hurdle that needs to be overcome.
Wrestling with the GP’s perspective and trying to encourage them to ‘see it your way’ can be challenging, but when it comes to the taboo subject of testosterone (yes images of injecting in the back of broken down gym’s and roid rage comes to mind), and that you might be in need of testosterone therapy, well for some GP’s, you might as well try and convince them that the earth is the centre of the universe and that ‘pigs really can fly’…
Let’s say you convince them that you have low testosterone, and eventually (by the skin of your teeth) you get a blood test request. However the blood test request is usually incomplete, a number of reasons come to mind; firstly the GP might not fully understand the intrinsic concepts regarding specialised TRT blood testing and thus does not request a complete set, and even then, not all tests can be accessed in primary care. One of the most important tests (that only specialists in the secondary can order) is free testosterone. Hence this incomplete testing means your overall picture could be false and will betray your real biochemistry.
So really all this time which you sacrificed was in vain…and could have been used better for something more valuable and possible even financially benefiting…but very few are able to see that, and would even value there £ more than there health and worse still cannot see that time is truly valuable
Rejection, Incompetence with a hint of ‘do it or else’.
Ok well done you were able to get the blood test and then you have the following scenarios:
Really low testosterone
Low normal testosterone
Levels seem normal
So now what?!… if it’s low you MIGHT be referred to a specialist, either urology (a specialist who deals with the male bits and pieces – literally but can manage testosterone) or an endocrinologist (specialist of hormones like hormones).
If your levels are normal or low normal your GP will end the conversation there and more or less usually end up blocking you in your tracks…but there is a HUGE problem here…one can have low normal levels in the UK but by European standards, this is low and thus warrants treatment….another less understood phenomena is patients can even have normal testosterone but still be need therapy (what we call optimisation) but will once again be rejected. Now how do I know this… As a GP in the NHS, I had reviewed a young man who presented with all the symptoms of low testosterone and had a blood test which was more or less in the normal range, however, I referred quoting all the facts from the endocrinology societies expressing the need to treat in light of normal values and he would benefit from treatment (optimisation therapy), but what was the end results…outright rejection of the referral, stating that they will not support this management!!!!!
The next conundrum, which was at times even more frustrating, actually having specialists give the advice on guidance on testosterone administration which seemed incorrect.
I had a patient who was thankfully (after a long drawn out battle) issued Sustanon but was told to use it every three weeks. In our experience this is absurd; the levels ‘plunge’ significantly by the 10th day…but when I expressed this concern I was dejected by the secondary care services quoting outdated data… and on one occasion I had insisted on a certain type of TRT for our patient and the patient was told, more or less, ‘do it or else’…literally stamping their authority over the patient’s agenda without engaging the patient’s needs appropriately and at least discussing the differing options.
So yes the path to TRT (testosterone replacement therapy) on the NHS is a real one, but one which is paved with trial and tribulations with an end result, which is at times, is not what you expected….
If you would like to have a FREE TRT Consultation regarding all things testosterone therapy please do contact us at Nebula health or book online using the link above.