EXPLAINER
After nearly four months of national stock shortages, depo-testosterone is now available again. The shortage, which continued for nearly four months, raised concerns about the healthcare for LGBTQIA+ person, specifically transgender persons, who formed a trans rights collective.
Depo-testosterone is the brand name for testosterone cypionate injections manufactured by pharmaceutical company Pfizer. Pfizer communications manager Charmaine Motloung said the supply had been restored and that “most pharmacies have been receiving stock from distributors and wholesalers from the week of March 18, 2019.”
In a statement on 15 March, Motloung said that the shortage was due to circumstances outside its control.
A transgender collective rallies
Bfore the statement was issued, since December, Pfizer had no explanations or solutions to the shortage of the drug, the transgender collective Unite 4 Trans Rights said in a statement on 7 March. There’s also no generic available on the South African market.
The depo-testosterone shortage had detrimental effects on the transgender community.
The shortage, Unite 4 Trans Rights says, is an infringement on the basic human right to healthcare for the LGBTQIA+ population.
“We are a diverse community with hopes for a South Africa which supports all of its citizens including us, transgender, non-binary and gender non-conforming people. Therefore, we demand safe, quality, affordable, and accessible healthcare, including gender affirming hormone therapy,” the statement reads.
Depo-testosterone and its uses
Elliott Kotze missed out on about six doses of depo-testosterone because of the shortage. This is dangerous to his wellbeing because, as a transgender man, Kotze has to take depo-testosterone regularly for the rest of his life.
“Depo-testosterone is an exogenous sex hormone, akin to the testosterone found naturally in human bodies,” said Dr Anastacia Tomson in an interview with The Daily Vox. Tomson, who was made aware of the shortage by members of the trans community in January, is a medical doctor and supporter of the collective.
The drug, Tomson says, has various uses. Depo-testosterone is used by cisgender men who have erectile dysfunction or “male menopause”, some post-menopausal cisgender women who develop fatigue and low libido related to a testosterone deficiency. It is even sometimes prescribed to cisgender men who do not produce enough natural testosterone and to cause puberty when it is delayed, Tomson said.
How transgender men use depo-testosterone
Importantly, depo-testosterone injections is essential to the well-being of transgender people. It forms part of hormone replacement therapy (HRT) used by transgender people who are medically transitioning from female to male. This therapy has to be consistently taken for the rest of one’s life.
“For many people, the terms sex and gender are used interchangeably,” Linda Zakiyya Chamane, health advocacy officer at Gender Dynamix, said in an interview with The Daily Vox. As a transgender woman, Chamane knows how it is important to understand that sex and gender are two different concepts. “Sex is the physical sex characteristics you are born with (internal, external genitalia, hormone levels) and those we develop, and gender is the socially constructed characteristics, activities and roles assigned to men and women,” she said.
Transgender people are those whose sense of personal identity and gender does not correspond with their birth sex.
How the shortage affected transgender patients
The shortage of depo-testosterone has devastating effects for transgender patients, Tomson says. “Withdrawal of testosterone can lead to severe dysphoria, and physical symptoms like the return of menses, redistribution of body fat, and loss of muscle mass. There is often significant emotional and psychological distress when HRT is ceased,” she said.
While alternatives to depo-testosterone do exist, they are much more costly and difficult to access. “For transgender patients, it means that the most accessible and affordable form of testosterone therapy is unavailable,” Tomson said.
Switching over to a different form of testosterone can also lead to difficulty in maintaining stable hormone levels, Tomson added.
Kotze said that he experienced emotional fluctuation because of the reluctant hormone instability. As a person who suffers from depression, this was a serious concern for him. “The anxiety around not knowing when there will be stock again did not make matters any better,” Kotze said.
A collective of transgender people and their allies are concerned about the lack of standardised, quality healthcare for the LGBTQIA+ people living in South Africa. The collective is also calling on government to address the national healthcare crisis unfolding with the shortage of depo-testosterone countrywide.
Healthcare for the LGBTQIA+ community in South Africa
Kotze says healthcare in South Africa is in bad shape overall. “The local government clinic I make use of is severely understaffed and structurally ill-equipped for the people it serves most often, namely mothers with babies and the elderly,” Kotze said.
For LGBTQIA+ persons, and transgendered persons specifically, public – and even private – healthcare is not up to scratch. “Not only are medical practitioners and institutions ill-equipped to understand our emotional and physical healthcare needs, we are often faced with blatant bigotry and gatekeeping from professionals,” he said.
Kotze, who is a psychologist and researcher, is currently involved in developing treatment guidelines for transgendered patients in South Africa to address this.
Chamane says South Africa needs more inclusive policies that safeguard the rights of trans and gender diverse persons. “We need more representation of transgender and gender diverse persons for our voices to be heard in parliament; we need more documentation of statistics of trans and gender diverse person’s rights being violated and to be included in movements,” she said.
Chamane also says we still need to revisit Act 49 of 2003 of the law to allow for gender self-identification and removing gender on our identity documents so that it can also cater for other gender diverse persons such as non-binary persons.
The trans collective demands
For Unite 4 Trans Rights, what the shortage highlighted was the gaps in healthcare and other services faced by trans, non-binary, and gender non-conforming (people who don’t exclusively identify as either man or woman) folks in South Africa.
The collective demands that LGBTQIA+ human rights organisations act in solidarity with the transgender community. It calls, too, for the revision of healthcare policies for the transgender, non-binary and intersex communities in line with the constitution and World Professional Association for Transgender Health guidelines They also want to emphasise the need for gender affirming healthcare to be included in training curricula.
Pfizer’s response
“Pfizer recognises the importance of the consistent availability of Depo-Testosterone to patients and will continue to work with all relevant stakeholders to ensure continued supply,” Motloung said in the statement.
Motloung told The Daily Vox that Pfizer cannot comment further.
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