THE transgender community is facing a dire shortage of testosterone hormone therapy treatment and fear many could resort to the “black market”.
Transgender activists have attributed the shortage of Pfizer's testosterone to restricted production and the prioritisation of Covid-19 vaccines.
A Sea Point- based medical doctor who has many transgender patients described the shortage as "serious " and said Pfizer had indicated in a communique that it would only be able to restore stock in the second quarter of 2022.
Testosterone is a hormone-replacement therapy that many transgender people use to transition and maintain testosterone levels.
Gender Dynamix, an organisation advocating for the rights of transgender people, said it had been inundated with queries over the shortage as the situation exacerbated the already limited access that trans and gender diverse people had to gender affirming healthcare from the state and within the private space.
The organisation’s spokesperson Savuka Matyila also warned that the shortage of gender affirming medication put transgender people a risk of using expired testosterone or accessing medication on the black market.
"We've been told that some people have been offered testosterone through the private sector that has possibly expired and which might have adverse effects on their health. These medicines would be entertained by community members who were left wanting," said Matyila.
However, Dr Anastacia Tomson believed that the current shortage could also be related more to supply chain issues as the previous shortage occurred prior to the Covid-19 pandemic.
"The (current) shortage is a serious one, since the communication from the company anticipates stock to be restored only in or after the second quarter of 2022," she said.
Tomson said many patients who were reliant on testosterone for their gender-affirming care were now without treatment.
While alternative options existed for patients with financial resources, those who could not afford the alternatives, or accessed their medication in the public sector were, according to Tomson, forced to go without medication “that is essential and often life-saving".
"I think the shortage has resulted in extreme demand. I think any stock that is still usable has been bought up," said Tomson.
When news of the latest stock shortage came out in August last year, Tomson contacted a "responsible pharmacist" and informed him that it would be necessary to ramp up the production capacity for an alternative treatment, called the testosterone cypionate, to ensure ongoing access to hormone medication.
"We have made this available to patients all over South Africa, and have guided other providers and practises in prescribing it. We continue to look at other efforts to improve and sustain access to treatment for vulnerable groups," said Tomson.
Previously Tomson led a project aimed at developing South Africa-specific guidelines to aid practitioners in providing gender-affirming care, and these were released recently.
"The goal was to make access to competent care easier. Many still face long waiting periods, or are subject to judgment and discrimination by healthcare providers due to entrenched stigma and prejudice," said Tomson.
She also approached a multinational compounding pharmacy to make injectable oestrogen available in South Africa, since the medication had never been sold here.
They were able to fulfil my request, and this led to the injectible oestrogen becoming the safest, most effective, and most affordable option for gender-affirming care for assigned-male-at-birth patients and trans women in South Africa. “It was revolutionary.”
She said the average cost of treatment per patient decreased from R1 500 to R900 to approximately R250 per month, and the oestrogen has since moved into widespread use.
"When the last testosterone shortage occurred in 2019, it devastated our community. I was very concerned that this would not be the last shortage, so I drew on my relationship with the compounding pharmacy, and I asked them to investigate the possibility of producing something similar to depo-testosterone. It took them quite a few months and much research, but eventually they were able to begin producing the same chemical compound, testosterone cypionate, which I began using for some of my patients to protect against a repeated shortage," said Dr Tomson.
However, activists said for many who relied on public healthcare facilities, it was not easy even to part with R250 for the medication they required.
Transgender consultant and activist, Ayanda Nino Maphosa said the shortage was affecting a large group of people who had taken to social media to express their concerns and to seek access to cheaper testosterone.
Maphosa alleged that some medications was sold on the "black market" and warned that people desperate for medication could opt for these.
"People don't think about the risk, they only think about the progress that they have achieved and don't want to reverse that. They want to restore and maintain the confidence they gained in the journey. Testosterone makes people progress to being the men they want to be. And when they stop taking it they might get their periods back and mentally this is devastating," said Maphosa.