Hormone drug shortage forces desperate solutions

It was a phone call to “something mundane, like a bank or something” that Germaine de Larch says he will never forget. During the conversation, the person called him “sir”.

This was the first time De Larch, who identifies as nonbinary, had been called sir. “It was so affirming,” he says.

De Larch’s deepening voice, the reason behind the reassuring honorific, is largely a result of his monthly injection of Depo-Testosterone.

But the hormonal drug has been out of stock since December last year, possibly increasing the risk of serious physical and mental health problems, including self-harm, for some people.

Produced by pharmaceutical giant Pfizer, the shortage of the drug affects transgender people, particularly those assigned a female gender at birth. They use testosterone to achieve masculinisation. It also affects nonbinary and intersex people who use it as a treatment for hormonal problems.


Charmaine Motloung, the communications manager for Pfizer, says the “short interruption of supply [is] due to circumstances outside of Pfizer’s control. The product has been shipped to the country and we expect to resume supply in the week of March 18.”

Motloung says Pfizer is working with the South African health products regulatory authority to minimise the effect of the shortages but could not give further details for confidentiality reasons.

A significant number of trans people are affected by gender dysphoria, which the American Psychiatric Association defines as the distress caused by the “conflict between a person’s physical or assigned gender and the gender with which he/she/they identify”.

De Larch, who started using the testosterone drug in 2015, says the resultant masculinising effects have “meant an ease in my body that I haven’t felt before … people now see me the way I see myself”.

Fearful and frustrated, a group of trans rights activists and their allies, including parents and medical practitioners, released a statement detailing the effect of the “abrupt withdrawal” from Depo-Testosterone on people’s health.

These included loss of muscle mass, redistribution of body fat and, significantly, recurrence of the menstrual cycle. There is also possible psychological and emotional distress that could cause or worsen gender dysphoria. In some instances, it can lead to significant long-term complications related to bone and cardiovascular health.

The statement was endorsed by the organisations Section27, Be True 2 Me, Triangle Project and Gender DynamiX.

For decades, studies have suggested that members of the lesbian, gay, bisexual, transgender, queer and intersex community face an increased risk of suicide, in part because of the stigma attached to them. But a 2014 study suggests that access to gender-affirming treatment for those who want it may help to reduce this risk. Almost seven out of 10 people surveyed as part of the 900-person study said they had thought about ending their lives before surgery, but just 3% said the same after undergoing surgery or taking replacement hormones, according to the research published in the Mental Health Review Journal.

The activists’ statement added that alternatives to Depo-Testosterone were not readily available. Nebido, the one other injectable testosterone widely available locally is “prohibitively” priced at more than R2 300 a vial — as opposed to about R550 for Depo-Testosterone.

De Larch could not afford Nebido so he opted for one on the black market. “There’s no medical insert in the packaging and no medical information whatsoever on the website as to the contents of the stuff. But I have no option.”

“I feel like shit … My brain is foggy, I feel nauseous and light-headed,” he says.

Unpleasant as the side effects are, they are something he is forcing himself to put up with.

“Look, there was the dysphoria before, when there was nothing to compare it to. And now that I finally have this comfort, only to have it taken away … ” he says, trailing off.

Another person, who does not want to be named, is also resorting to black market testosterone. “I am doing this because I don’t have any left and I don’t know when it’s coming back. Also, its cheaper.

“Look,” he laughs, “it’s not something cooked up in someone’s garage or something. I actually got mine from a bunch of cis-gendered men who saw my friend’s post on Facebook [about the shortage] and reached out to the trans community.” He adds that those in the trans community with a readier supply are also offering to share their testosterone with others. “It’s a nice aspect to the story, but it’s not a solution. We can’t all live off one bottle of T, you know.”

He says that missing one’s testosterone “has serious implications. Even just the fear of that happening … Look, I’m lucky. I work in a place that is very supportive of me being trans, but I have a lot of friends who don’t. So this thing is playing with people’s feelings every day. And their mental wellbeing.”

Carl Collison is the Other Foundation’s Rainbow Fellow at the Mail & Guardian.

Subscribe to the M&G

These are unprecedented times, and the role of media to tell and record the story of South Africa as it develops is more important than ever.

The Mail & Guardian is a proud news publisher with roots stretching back 35 years, and we’ve survived right from day one thanks to the support of readers who value fiercely independent journalism that is beholden to no-one. To help us continue for another 35 future years with the same proud values, please consider taking out a subscription.

Carl Collison
Carl Collison
Carl Collison is a freelance journalist who focuses primarily on covering queer-related issues across Africa

Related stories

Q&A Sessions: ‘My north star is the patient’

Rhulani Nhlaniki is Pfizer’s cluster lead for sub-Saharan Africa. As Pfizer starts phase III of the clinical trial of their Covid-19 vaccine candidate, he tells Malaikah Bophela that if it is successful, the company will ensure the vaccine will be available to everyone who needs it

Covid-19 vaccine testing in vulnerable populations must be guided by ethics

The fallouts from unethical experiments include distrust of public health officials and poor participation in research studies by members of vulnerable populations. People involved in vaccine trials must be recognised as partners, rather than pawns

Creating poetry out of violence

Maneo Mohale speaks about the silence around queer sexual abuse and how she creates beauty

Africa needs to hear queer stories

For the past three years, Carl Collison has reported on LGBTI issues and stories for the Mail & Guardian, covering queer peoples’ lives

Check coaches at the school gates

Without proper vetting, paedophiles can get into places where they have ‘unfettered’ access to vulnerable children

Drag queen’s push against gangs

In Lavender Hill, one of South Africa’s most violence-ridden areas, an unlikely activist is finding ways to keep children out of trouble
Advertising

Subscribers only

Toxic power struggle hits public works

With infighting and allegations of corruption and poor planning, the department’s top management looks like a scene from ‘Survivor’

Free State branches gun for Ace

Parts of the provincial ANC will target their former premier, Magashule, and the Free State PEC in a rolling mass action campaign

More top stories

Air pollution link in 15% of global Covid-19 deaths

Researchers have found that, because ambient fine particulate air pollution aggravates comorbidities, it could play a factor in coronavirus fatalities

Mboweni plans to freeze public sector wage increases for the...

The mid-term budget policy statement delivered by the finance minister proposes cutting all non-interest spending by R300-billion.

SAA to receive R10.5-billion government bailout after all

Several struggling state-owned entities received extra funds after the medium term budget policy speech

BMW X3 thrives in the M stable

The compact SUV is so at home with its new badge that’s it’s surprising it didn’t happen sooner
Advertising

press releases

Loading latest Press Releases…

The best local and international journalism

handpicked and in your inbox every weekday