Hello all. Continuing on from Part 1 of this multipart series on TRT (Testosterone Replacement Therapy) in Australia. Last we left off, I was whinging about the difficulty at which a TRT diagnosis and prescription is achieved for a patient in need in Australia. I must sound Un-Australian already. We live in what is arguably the best country to live in overall, but we are a little behind when it comes to the topic of testosterone deficiency. Fear not, for the solution is coming. But for today, more whinging.
So what if we do qualify for testosterone deficiency diagnosis via the current Australian guidelines? Are we good to get our Test game on?
Well, one would hope that if your case falls within the prescribing guidelines that a medical doctor would prescribe you testosterone but not often is this the case. Most general practitioners in Australia do not want to deal with testosterone deficiency cases because of one or more of these reasons:
- General practitioners lack the knowledge to confidently prescribe TRT to a patient and would prefer a patient visits a specialist, of which the most common specialist is a called an endocrinologist. This is a reasonably fair argument for a GP because when studying to become a GP, anything regarding TRT is only briefed over within their studies. As some humble GP’s may tell you:
“You probably know more about testosterone deficiency than I do. I’d like you to see an endocrinologist who is better qualified to help you.”
- General practitioners, even if they do possess the knowledge, often do not want to deal with TRT cases because of the dubious vibe that surrounds this kind of medicine in Australia. Although TRT has climbed mountains in the last decade to become a more accepted and respected form of medicine for patients who need it; general practitioners and even endocrinologists themselves are still hesitant to prescribe because of how strict the Australian Medical Council can be when it comes to prescribing testosterone. This restriction is largely due to Doctors who have “supposedly abused” their medical license and prescribed outside of the guidelines without reasonable evidence to support their prescribing practices. Now, although we all probably know of a case where a Doctor we knew of was juicing patients up for bodybuilding competitions, so he could earn a little extra cheese on the side—the truth is these dodgy Doctors are few and far between—and often not Australian born. It is not illegal for a Doctor to prescribe outside of the guidelines, however, if a Doctor does prescribe outside of guidelines in Australia then he/she must be able to confidently defend their prescribing practices if there are any objections from the regulatory boards and these defences must be based on evidence—which means evidence from the medical literature that without any doubt is strongly supported.
“No problem, then right? If there is data to support the use of testosterone therapy outside of the current Australian guidelines, then it should be a breeze for a Doctor to defend themselves if they were ever questioned for doing so?”
You can probably guess by now, but yes, still a problem. In the medical world, there is a study for almost any medicine on the planet that will support the “it’s bad for you” side and a study that will support the “its good for you” side. Such nonsense you must be thinking? Yes. Unfortunately, 99% of studies are poorly constructed and may never be cited again—unless of course they’re used for sensationalist or biased purposes to convince the less educated, or in the case we’re discussing now—to maintain power among those who currently have it. This is where a Doctor may be under the wrath of the regulatory boards in Australia. It is up for debate which evidence is the good evidence and as you know, the judge has the last say. Contrary to the free country we supposedly live in, there is nothing free about being a Medical Doctor in Australia. Understandably, these rules and regulations were initially imposed to keep the public safe, but here we have an example of where the rules and regulations when not accurately used have contributed to the opposite. I guess that is like any law though. So then does the law need to change, or just the people controlling the ruling of that law? Either way, I still feel like the severity of the potential implications here are undervalued. A case where a patient that requires testosterone therapy and does not receive his needed prescription, could mean the difference between life or death. It is not uncommon to find suicides related to testosterone deficiency. Those who have been there, know what I’m talking about. Despite the known evidence, there is still some “lighter banter” than what is needed around the topic of testosterone deficiency among the medical community. Even when a patient does qualify for testosterone therapy via the guidelines, there is no urgency like there would be for an idiopathic depression case. Until testosterone deficiency is seen among the wider Australian medical community as a severe contributing factor to suicide and other known life-threatening pathologies, then this lack of urgency is unlikely to change anytime soon.
I think this is why I like mathematics. I find it beautiful that no matter what the opinion, there is no debate on what the result of 2 + 2 will be. 2 + 2 will always = 4.
So, what if despite all these hurdles, we still manage to find a GP or endocrinologist willing to prescribe us testosterone therapy? Now, are we good to go?
If you’ve been fortunate enough to receive a referral to an endocrinologist, you’ve probably been waiting for me to mention that the average wait to see one is closer to next Christmas (more realistically 1-3 months). Many years of study an endocrinologist must endure before he/she can claim that title, so unfortunately there isn’t many of them. If you’ve got an endocrinologist that’s willing to prescribe, then you’re likely in safe hands, but you’ll need to be patient and also have deep pockets. It is not uncommon for an initial consult to cost $300-$500 AUD to see an endocrinologist. If you’ve got a GP who’s willing, then you’ll be hoping they’re nuanced, not dodgy and educated on the topic of TRT; to safely prescribe the best protocol for you. In Australia, a suitable, nuanced prescriber is few and far between. I have had personal discussions with endocrinologists who possess knowledge that is “concerning” to say the least. It’s not all bad news though, as there are a handful of great physicians in Australia who are really making a difference. I wish I could give you their contact information, but for obvious reasons I cannot. I’d not like for this rare handful of Doctors to come under scrutiny as well because I am sure they’d see a 100-fold increase in desperate patients! Before I go any further, I’d like to summarise the key whinging points discussed in both parts 1 and 2 so far:
1.) Prescribing guidelines in Australia are outdated and need updating.
2.) The modern world has been unintentionally designed to support the destruction of unhealthy testosterone levels.
3.) Temptations of this modern world are everywhere that stand to test our biological urges on a daily basis and it is unrealistic for the average Joe (or any Joe for that matter) to remain compliant to a testosterone friendly lifestyle.
4.) General practitioners in Australia often lack the knowledge to prescribe TRT because during their formal studies TRT is not covered in depth. Even when a General Practitioner is confident with his/her TRT knowledge, they’re often still hesitant to prescribe because of how scrutinised this form of medicine is in Australia. Doctors have lost their licenses in the past for prescribing outside of guidelines and not all of those cases were for juicing people up.
5.) Endocrinologists that are willing to prescribe often share the same misinformation or they’re hesitant to prescribe outside of guidelines as the regulatory bodies in Australia heavily scrutinise this form of medicine.
6.) The average waiting time to see an Endocrinologist is between 1-3 months and they’re expensive. You’ll need deep pockets for an initial consult with no guarantee you’ll receive a needed prescription.
I think I’ve overwhelmed your cortex’s enough for today. Until Part 3 lads and lasses!