Initial testosterone prescription

User email: Please leave this blank!!!

Request an initial testosterone prescription

First name

Surname

Your email address

Hospital number or NHS number

This can be found on a previous hospital letter

Date of birth

Postcode

Request date

Typically today's date

Date of last consultation

This can be found on a previous hospital letter

Name of product recommended to you

Tostran 2% gel pump pack

Testogel 40.5mg sachet

Other (please state)

Other product

I confirm that I was recommended to start testosterone for low libido at my last menopause appointment  

I confirm that I have read and understand the Advice and guidance on testosterone use on how to use testosterone and the potential for adverse side-effects  

I confirm this is the first testosterone prescription:

yes

no (repeat prescriptions are only prescribed where explicitly agreed)

I confirm all the details above are correct  

Submit