Clinical Policy

Prescribing Standards

All prescribing at Youth Revisited Ltd is carried out by Nemia Pilobello, NMC-registered Independent Prescriber (V300), in accordance with the NMC Standards for Medicines Management and the British Society for Sexual Medicine (BSSM) guidelines for testosterone deficiency in adult men.

Dr Salman Ahmed (GMC #7948448) provides medical consultation support where GP-level review is required. No prescription is issued without a clinical review of the patient's blood results by the prescriber.

Eligibility Assessment

TRT is only initiated following a comprehensive baseline blood panel and a clinical consultation. Prescribing criteria follow BSSM and NICE guidance.

The following contraindications are assessed at baseline and monitored throughout the programme:

• Active or historical prostate cancer
• Recent cardiovascular events (within 6 months)
• Haematocrit above 54%
• Untreated or severe obstructive sleep apnoea
• Active or recent venous thromboembolism
• Severe untreated heart failure
• Known hypersensitivity to testosterone

Where contraindications are identified, the prescriber will advise the patient on appropriate next steps, including NHS referral where clinically indicated.

Monitoring Protocol

All patients on TRT undergo clinical blood panel review every 3 months. The standard quarterly monitoring panel covers:

• Total Testosterone
• SHBG (Sex Hormone Binding Globulin)
• LH & FSH (for fertility monitoring where applicable)
• Prolactin
• Full Blood Count
• Haematocrit
• PSA (Prostate Specific Antigen)
• HbA1c
• Liver Function (LFT)
• Lipid Profile
• Cortisol (for patients with previous anabolic steroid use)

All results are reviewed by the prescriber before any treatment adjustment is made. Patients receive a written clinical summary following each review.

Informed Consent

Informed consent is obtained from every patient before treatment begins. The prescriber ensures each patient understands:

• The nature of TRT, its intended effects and known risks
• The monitoring requirements and why they are clinically necessary
• The implications of TRT for natural testosterone production and fertility
• The 3-month minimum programme commitment and financial obligations
• Their right to withdraw from treatment at any time
• What to do if they experience side effects or have concerns

Consent is documented within the patient's clinical record before any prescription is issued.

Medication & Pharmacy

All medication is dispensed by SignatureRx, a GPhC-registered UK pharmacy (registration number 9012267). No medication is dispatched without a valid prescription issued by the prescriber following a clinical review.

Patients are provided with guidance on:

• Safe storage of testosterone medication
• Correct administration technique (supported by 1:1 injection tutorial for injectable formulations)
• Safe disposal of needles and medication — needles, syringes and a sharps bin are included and sent with each quarterly dispatch for injection clients (Testosterone Cypionate / Sustanon). Not included for Testo Gel clients.
• What to do if medication is lost, damaged or not received

Youth Revisited Ltd does not supply medication from unregulated or overseas sources. All products are dispensed from the licensed UK supply chain.

Safeguarding & Urgent Referral

If a patient's monitoring results indicate an urgent clinical concern, the prescriber will contact the patient directly on the same day. Triggers for urgent review include:

• Haematocrit above 54%
• Significantly elevated PSA (above 4.0 ng/mL or rapid rise from baseline)
• Severe liver enzyme elevation
• Cardiovascular symptoms reported by the patient
• Any result that, in the clinical judgement of the prescriber, requires immediate attention

Where a patient requires urgent or emergency care, they will be directed to contact 999 or attend their nearest A&E department. Youth Revisited Ltd does not provide emergency medical care.

Where clinically appropriate, the prescriber will refer patients to their NHS GP or specialist. Referral letters are provided on request.

Complaints Procedure

All complaints are taken seriously and handled promptly. To raise a concern:

• Contact us at info@youth-revisited.co.uk
• All complaints are acknowledged within 2 working days
• A full response is provided within 10 working days
• Clinical complaints are reviewed directly by the prescriber

If you are not satisfied with our response, you have the right to escalate to:

• The Nursing and Midwifery Council (NMC) for concerns relating to the prescriber's conduct or practice
• The General Medical Council (GMC) for concerns relating to the medical doctor
• The Parliamentary and Health Service Ombudsman for unresolved complaints

Data & Medical Records

Patient clinical records are retained for a minimum of 8 years in accordance with NHS records management guidance for adult medical records.

All personal and clinical data is processed in accordance with UK GDPR and our Privacy Policy. Health data is classified as special category data under UK GDPR Article 9 and is processed on the lawful basis of explicit consent and provision of healthcare.

Patients have the right to access, correct or request deletion of their personal data, subject to legal retention requirements. Requests should be directed to info@youth-revisited.co.uk.

Continuous Improvement

Clinical protocols are reviewed annually and updated in line with guidance from the British Society for Sexual Medicine (BSSM), NICE, the MHRA and the NMC.

The prescriber undertakes continuing professional development in line with NMC revalidation requirements. Any MHRA safety alerts relevant to testosterone therapy or associated medications are reviewed and actioned promptly.