Lingering supply chain issues related to the COVID pandemic are affecting stocks of testosterone available for trans men.
Around the world, sporadic shortages of the hormone are creating anxiety among the trans population over the potential physical and psychological effects of missed doses.
In Mexico, the shortage is having real-world consequences.
“One day, I wrote to all my friends that there aren’t any hormones left at the pharmacy downtown,” Chiapas resident Chiu Palomeque told Global Press Journal. “I told them I would go and check another one and I was like ‘Phew! They have it here. Yes! Come and get it here.’”
But soon after, supplies of the injectable drug ran out. After his first missed monthly dose, Palomeque’s period returned with a vengeance.
“It’s as if knives are stabbing into my stomach,” he said.
The shortage dates back to the beginning of the COVID pandemic when supply chain problems and COVID vaccine manufacturing upended the pharmaceutical industry.
The lack of one affordable option in particular, Primoteston Depot from Bayer AG, hit the uninsured in Mexico hard. A statement from the pharmaceutical giant in July said supply chain disruptions continue to reduce the manufacturer’s ability to produce and supply the drug in Latin America and around the world.
Trans men who have not undergone a hystero-oophorectomy, hysterectomy, or oophorectomy, which involve the removal of the uterus and/or ovaries, are particularly vulnerable to adverse effects. According to Dr. Daniela Muñoz Jiménez, a physician and the founder of the community health organization Trans Salud, the absence of testosterone replacement therapy “becomes catastrophic” for those individuals.
For those who have undergone the procedures, discontinuing hormone therapy increases the risk of decalcification, or the loss of bone calcium.
With or without those surgeries, drastic changes in cholesterol, triglycerides, blood pressure, and glucose can occur within days, while the psychological effects can be just as debilitating, reviving the gender dysphoria that hormone therapy addresses.
Trans men in Mexico who are uninsured rely on inexpensive versions of the drug like Bayer’s Primoteston. Alternatives, including Nebido from Grünenthal, can cost ten times as much.
According to Sony Rangel, a founder of trans support service Transmasculinidades MX, trans men and transmasculine individuals are more economically vulnerable than their transfeminine peers, because trans women often start their transition at an older age.
While shortages persist, organizations like Rangel’s and online communities are getting the word out on available supplies and alternatives.
In Canada, Ontario’s trans community on Reddit is sharing helpful information.
“Hi all!” read a post in December. “Just wanted to share that yesterday, I went to pick up my renewal for injectable testosterone at a Shopper’s Drug Mart in Ottawa and was informed that there was a shortage, that it was on back order, and that it wouldn’t be available for a while. They said they have other forms available (gels & capsules) and would fax my doctor to get a prescription for one of those, but heads up if you inject T!”