Trans men forced to buy hormones illegally as testosterone becomes unavailable

A poster for the campaign 'Io scompaio' (I'm disappearing) features a trans man.

Italian trans men have been left without testosterone shots crucial for their hormonal therapy since September 2018.

The Agenzia Italiana del Farmaco (AIFA) is the public agency that regulates drug distribution in Italy. In February 2019, it updated its list of temporarily unavailable drugs.

The list now includes many of the most popular testosterone-based medications, crucial in hormonal therapy for trans men. The most popular being Testoviron, a testosterone-based injectable solution by German pharmaceutical giant Bayer.

Buying drugs online can be extremely dangerous

Many see no other way than to buy those meds they desperately need online from countries such as India, Russia, and Ukraine. These cheaper drugs purchased illegally might have potentially negative effects on people’s health.

In a reportage published by Italian magazine L’Espresso, the situation is described as an ‘emergency’.

Trans men need to take testosterone enhancing medications for their whole life. Stopping taking hormones would impact trans men’s physical as well as their mental health dramatically.

Many trans men dread getting their period back. This happens when a stronger testosterone shot, such as the now unavailable Testoviron, is replaced by those containing lower levels of testosterone, such as Sustanon by Aspen Pharma. This is the main substitute for Testoviron.

Except now Sustanon, too, seems to have disappeared from the chemist’s shelves.

‘Many people resort to websites selling testosterone illegally on the Internet or at local gyms,’ Michele Formisano, president of Italian trans advocacy group CEST, told GSN.

‘It’s hormones we’re talking about. They often have no idea of what they’re about to inject themselves with. Particularly, many young trans men who are yet to see an endocrinologist end up buying meds carelessly.’

He furthermore added: ‘This is an issue across the board. It doesn’t affect trans men exclusively. Cis men with tumors or genetic diseases need Testoviron for their hormonal therapy as well.’

It’s a ‘packaging issue’

A spokesman for AIFA explained the Italian demand for testosterone-based drugs is higher than most countries, such as the Netherlands.

However, importing the drug from the Netherlands will imply a ‘packaging issue’, Domenico Di Giorgio told L’Espresso. The package insert would be in Dutch and therefore the drug would not be marketable in Italy.

Di Giorgio further explained patients are unaware of other legal solutions, such as going to their local public healthcare facility (ASL) and filling out a form.

Whoever needs a specific drug can fill out a form, which then is sent to a hospital pharmacy and, finally, to AIFA for approval.

Public healthcare facilities

However, not all ASLs deal with cases of gender dysphoria, particularly in southern Italy.

‘There are very few public healthcare facilities treating gender dysphoria here. Therefore, many trans men choose to see endocrinologists privately,’ Formisano added.

‘Public health endos often don’t know or don’t want to deal with this.’

An endocrinologist working for an ASL might refer a patient to a gender dysphoria specialist who often works in a different region.

In many cases, Rome is the closest destination for trans men from the south. Accessing testosterone-based medications would mean sustaining expensive travel costs to get to the capital city.

Alongside a lack of experience in treating transgender patients, ASL staff often misgender and discriminate against trans men and women.

‘In many ASLs, you need to explain your situation to untrained staff,’ Formisano said.

Many maintain this happens because the staff there isn’t properly trained on LGBTI issues. This leads to a breach of trust between healthcare professionals and patients.

One of the consequences is for trans patients to neglect their healthcare and resort to dangerous alternatives.

A trans advocacy group is offering support

‘We’re providing trans men with legal support in the event public endocrinologists refuse to fill out the form to import testosterone,’ Formisano also said.

‘Some of us have stocked up on testosterone. We need to take it every 15, 21 or 28 days, according to the specific therapy we’re on. We need to take hormones our whole life.’

Many trans advocacy groups are protesting and launching campaigns to raise awareness on the issue.

AIFA ensured Testoviron will be back on the shelves in September 2019. That would make a year after it first went missing.

‘A year for a trans man on hormonal therapy is an eternity,’ said Formisano.

GSN has reached out to AIFA and Bayer for comment.

Read also:

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A trans social worker from Mumbai just became a state ambassador

Author: Stefania Sarrubba

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UK govt. appoints first National Adviser for LGBTI Health

Dr. Michael Brady Adviser

The UK government has announced the appointment of the first National Advisor on LGBTI Health.

Dr. Michael Brady, Medical Director of the Terrence Higgins Trust and a sexual health and HIV consultant at King’s College Hospital, will take up the role on 1 April.

His will oversee health services for LGBT patients on the National Health Service (NHS), and advise on how to tackle inequality in the healthcare system.

The government also announced the names of experts and LGBTI rights workers who will make up the new LGBT Advisory Panel as part of its LGBT Action Plan.

The 12-person panel will advise the government on all LGBTI matters in the UK, including on issues such as ‘conversion therapy, improving access and tackling inequality in healthcare’.

I want to ensure that every LGBT person is treated with dignity and respect’

Dr. Brady’s appointment also comes at a time when the NHS is preparing to ask all adult patients to declare their sexual orientation.

In 2018, over 16 percent of LGBTI patients who accessed the NHS reported a negative experience due to their sexual orientation.

‘I’m delighted to be chosen to advise government and the NHS on the work that needs to be done to improve the health and well-being of LGBT communities,’ Dr. Brady said.

‘I want to ensure that every LGBT person is treated with dignity and respect and receives the right information, treatment, and care.

‘I want all healthcare workers to understand the needs of LGBT individuals and for everyone to feel comfortable and confident that they will be treated fairly when they access healthcare.’

The UK government’s LGBT Action Plan

The appointment of the LGBTI health advisor and LGBT Advisory Panel is part of the UK government’s LGBT Action Plan.

The initiative is working on ways to improve healthcare services to the LGBTI community and tackle homophobic bullying at schools.

Women and Equalities minister Penny Mordaunt praised the next step in the government’s initaitve.

‘Dr. Brady and the experts on our new Panel will give LGBT people and those working on their behalf a direct route to speak to government and shape policy on decisions that affect their daily lives,’ Mordaunt said.

‘Everyone should be able to love who they wish to and live their life free from fear and discrimination. That’s why we are working at pace with organizations and across government to make sure our Action Plan can bring about real, lasting change for LGBT people in the UK.’

12-person LGBT Advisory Panel 

The members who will make up the government’s new LGBT Advisory Panel are:

  • Catherine Meads, Professor of Health at Anglia Ruskin University, specializing in hate crime
  • S. Chelvan, a specialist in international human rights and LGBT asylum cases
  • Ellen Murray, Executive Director of Transgender Northern Ireland
  • James Morton, Manager at the Scottish Trans Alliance and member of the Parliamentary Forum on Gender Identity
  • Jayne Ozanne, Director of the Ozanne Foundation and member of the Church of England’s General Synod
  • Lewis Turner, Chief Executive of Lancashire LGBT with experience working on hate crime at a local government level
  • Marcel Varney, Assistant Director of Children’s Services at Barnardo’s with experience working on adoption policy
  • Paul Dillane, Executive Director of Kaleidoscope Trust
  • Paul Martin, Chief Executive of LGBT Foundation
  • Ruth Hunt, Chief Executive of Stonewall
  • Paul Roberts, Chief Executive of Consortium
  • Stevie-Jade Hardy, Associate Professor of Criminology and an expert on equalities and hate crime at the University of Leicester

Author: Calum Stuart

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This Illinois bill could punish doctors who provide transition-related medical care

The Youth Health Prevention Act would penalize doctors providing transition-related care to transgender youth (Photo by Ted Eytan)

A new bill introduced to the Illinois legislature would punish medical professionals assisting trans youth in their transition-related care.

The Bill

Republican Representative Tom Morrison introduced the bill, titled the Youth Health Prevention Act.

The Act ‘provides that a medical doctor shall not prescribe, provide, administer, or deliver puberty-suppressing drugs or cross-sex hormones and shall not perform [surgeries] on biologically healthy and anatomically normal persons under the age of 18 for the purpose of treating the subjective, internal psychological condition of gender dysphoria or gender discordance.’

The bill also ‘Provides that any efforts to modify the anatomy, physiology, or biochemistry of a biologically healthy person under the age of 18… shall be considered unprofessional conduct and shall be subject to discipline by the licensing entity or disciplinary review board. Provides that no medical doctor or mental health provider shall refer any person under the age of 18 to any medical doctor for chemical or surgical interventions to treat gender dysphoria.’

In addition, it seeks to amend the Medical Practice Act of 1987 to make these changes.

If a doctor does provide any of the aforementioned treatments to trans youth, they could risk losing their medical license.

Reactions

‘It’s trying to get in between a medical professional, parents, and their children. They’re basically trying to do that because of somebody’s identity,’ Miles Brandy Davis, communications manager and press secretary for Equality Illinois, told ThinkProgress.

‘We’re going down a slippery slope if we’re going to allow a lawmaker to discriminate against somebody because of their identity. What if somebody decided he just doesn’t like people with cancer? Are we going to stand in between them and accessing care? It just blows my mind that a bill like that was even introduced.’

Lurie Children’s Hospital of Chicago opposed the bill and sent out the following statement:

‘Many of our patients develop anxiety or depression due to the severity of their distress. These young people find a tremendous amount of relief from the medical services that we provide. Through the use of medical and surgical interventions, their bodies begin to align more closely with their identities. And they are able to focus their mental energy on normal, healthy parts of adolescence. Like their studies, relationship building, developing goals for the future, and blossoming into independent adults.’

According to Joshua Safer, executive director for the Center for Transgender Medicine and Surgery at Mount Sinai, it would be a breach of medical ethics to fail to treat patients according to standard guidelines.

Safer told ThinkProgress that this type of bill is ‘problematic.’

Why it matters

Trans people and experts on transition-related care believe access to proper treatments can be a matter of life or death. In the past, trans people have died using illegal silicone injections due to the lack of professional guidance. Additionally, the mental health of transgender people is put at risk when they are unable to access the necessary treatments.

A 2018 study showed 51% of trans male adolescents, 30% of trans female adolescents, and 42% of nonbinary youth attempted suicide.

‘By contrast, transgender individuals who have treatment provided as needed have mental health concerns closer to what we see in the general population,’ Safer said. ‘It appears that transgender individuals who seek medical intervention have fewer mental health concerns when that treatment can be provided earlier. That includes patients doing better when they’re able to be treated at younger ages.’

The Youth Health Prevention Act is currently in the Informed Consent subcommittee. However, Davis does not expect it to pass. Still, the introduction of this kind of bill sets a worrisome precedent.

‘Transgender youth face stigma and ignorance throughout their lives. [They] are often forced to forego medically-necessary care for fear of how their parents, their school, or their peers might react,’ Gillian Branstetter of National Center for Transgender Equality (NCTE) told ThinkProgress. ‘This bill does nothing but add to that pain by rejecting the overwhelming consensus of the medical and childcare community that transgender youth should be validated, believed, and loved.’

See Also:

Misgendering trans kids can constitute child abuse, Canadian court rules

Doctors disagree whether gender reassignment needs specialized medical care

England’s only gender identity clinic for young people gets million dollar grant

Author: Rafaella Gunz

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