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How coronavirus is affecting trans people’s access to hormones

Trans healthcare is bureaucratic and limited at the best of times – but now trans people are facing more challenges than usual

Over the last two weeks, a Google Sheet has been doing the rounds online. It has been passed between trans people (at least, according to the Sheet’s “location” column) in places from San Francisco to Chicago. It’s an exchange for people who cannot access hormones – from Estradiol tablets to Androgel – to share their details, in case someone can help to find and mail them some. Similarly, in the UK, trans people are posting on social media about how they are running low on hormones, and in the comments section, others are coming to their rescue. 

“There’s already a culture within the trans community of sharing hormones if you run out, if there’s a supply break, or if you’re having a problem with accessing your GP or prescriptions,” says Eli*, from London. “I’ve had shots off other people in the past and given ampules to other people. I recently saw someone on Instagram saying they were running short on T, so I was happy to help – they cycled over and picked it up before we went into lockdown.” 

Eli explains that while sharing is not new, the coronavirus outbreak has made the need to share more urgent. In the UK, since hormones are licensed medicines, you can’t necessarily walk into the pharmacy and pick it up with a repeat prescription – sometimes you need to have check-ins with your doctor to be issued more of it, while other people receive their shots from GPs, gender identity clinics, and other healthcare providers, many of which have closed in order to stem the spread of coronavirus. As testosterone, unlike estrogen, is also a controlled substance, it’s even harder to get hold of outside of a prescription.  

“I already have fears about how the privatisation of the NHS has affected and will affect trans healthcare,” says Eli. “That isn’t down to the people within the NHS, but to do with funding. Now things feel even more worrying: I know a couple of people who have had their top surgery cancelled (because of the coronavirus outbreak), for instance. These things are seen as non-urgent – but in some cases they really are urgent, people have been waiting years.” In other words, trans healthcare is bureaucratic and limited at the best of times, but right now trans people are facing more challenges than usual.

In a long and helpful Twitter thread by writer and performer Harry Josephine Giles, based in Scotland, they go into greater detail around some of the problems trans people are encountering at the moment. They explain that gender identity clinics, the NHS pathway to trans care, had around two year wait times before the pandemic, and are now cancelling appointments and freezing waitlists, while trans surgeries have officially been deemed “non-essential”. They acknowledge that the NHS is overstretched but go on to explain the impact that these cancellations and waits will have on trans people’s mental health, and how that could “put further strains on other services”. 

As for hormones, they explain that trans people are having difficulty getting NHS prescriptions renewed, while outside of the NHS, some private clinics are not replying to patients or are becoming oversubscribed. Those who acquire grey market hormones (usually online) are also reporting shortages – either from supply chain issues caused by travel bans or due to people stockpiling. 

“Trans people are in a lot of distress and uncertainty right now, like a lot of people with long-term health needs” – Harry Josephine Giles

“The 18 months I’ve been on estrogen have been my happiest & calmest ever,” tweets Giles. “After an entire life with a significant episode at least every two months, I haven’t had a single spell of major depression since HRT. I have one month of hormones left & don’t know how I’ll get more.” 

When asked why they started the thread, they tell us: “I knew that a lot of trans folk were scared about their ongoing care, including me, so I wanted to both share the information that I had and push others and institutions to share information.” They continue: “Trans people are in a lot of distress and uncertainty right now, like a lot of people with long-term health needs, because all of the systems that support us have been interrupted. What we most need is clarity from GICs about what support is available, and for GPs to be given strong guidance to continue offering crucial care like blood tests and hormone injections. We know that everyone is under strain in the crisis, but without steps like that trans people are at great health risk.”

While in the UK NHS waiting times are long for trans healthcare, with some people having to wait three years for their first appointment, and the process for accessing hormones is outdated and harmful, in America, there is an additional set of problems. There is no NHS, and many types of health insurance do not cover trans healthcare, meaning that some people have to pay for every aspect of their transition themselves (even more difficult when you consider that trans people are statistically paid less).

At the moment, the financial fallout of coronavirus is making that more difficult for trans people in the US, on top of the kinds of problems with physical access to healthcare that trans people in the UK are having. Helena, a 19-year-old trans woman from Miami, explains: “I worked in luxury retail and I was laid off because they pulled out all of the employees due to coronavirus. I have to pay for my hormones and they were already expensive and I was already struggling but now that I’ve lost my job because of this, it’s been so much worse. I do have insurance but my insurance doesn’t cover it. All of my trans girlfriends are dealing with the same thing. We all struggling as it is – most of us don’t have financial or emotional support from our families, it’s harder for us to get jobs or hours, and we have things we need to pay for like hormones. Now, it’s just a mess.”

Personally, Eli has three injections’ worth of testosterone left, so has nine weeks before they run out, and says that not knowing what the landscape will be beyond that is terrifying. “I’ve been off hormones a few times because I’ve moved GP and they just stopped my prescriptions, and it’s extremely upsetting and stressful. It affects your mental health and you feel different in your body – all of that is challenging at the best of times, but especially now.” Eli believes that, as we get further into lockdown more people will be coming up on Instagram, Twitter, and Facebook forums asking if people have any hormones to share.

Harry Josephine Giles points out that any advice they give is as a trans person and not as a medical professional, but “it’s advice given with the understanding that many trans people have been self-medding for a long time” and that community expertise has long been a vital resource. “I’d say do really good research into what different hormones do because there’s no one-size-fits-all approach; make sure that where you’re sourcing your hormones from is reliable, because the unlicensed medication is risky and there are sharks out there, and always get regular health check-ups to make sure nothing’s gone wrong and you know what your hormone levels are. Know that there’s a huge body of knowledge out there, but also opinion and disinformation, so like anything else you should check your sources and compare across different sources of information.” 

“Be knowledgeable and mindful about what trans people go through and try to help us however you can” – Helena, Miami

On that point, they direct people towards the NHS’s information page with advice (like asking your doctor to switch to T gel if you can’t access injections, and the recommendation that blood tests are to be considered urgent if a trans person thinks their safety has been compromised). They also point to LGBTQ+ mental health resources that are continuing work through the outbreak, like Switchboard and Gendered Intelligence, and finally, advice on accessing and setting up mutual aid groups, Tweeting: “We are each other’s support, now more than ever.” 

According to Helena, the best thing cis people and trans allies can do to support trans people during the pandemic – and especially trans women of colour – is to donate to people directly (you can find people asking for support on Twitter and crowdfunding websites). “Or at least be knowledgeable and mindful about what trans people go through and try to help us however you can – even if the most you can do is a retweet,” Helena adds.

“It’s just frustrating because this virus has put everybody’s lives on hold so we can’t make money. Despite that happening, our rent is still due, our cupboards are still empty, and our prescriptions still need to be filled.”