SA’s trans men in dire danger of losing their masculine features
A shortage of Depo-testosterone, taken by trans men to acquire male attributes, could force men to be more feminine
Elliott Kotze took his last testosterone shot last Friday. It was half his usual weekly dosage.
The 36-year-old transgender man had been rationing his hormone treatment because of a countrywide shortage of Depo-Testosterone, a synthetic male hormone created by Pfizer.
Kotze, a psychologist, knows and works with many trans men who use the hormone to give them masculine features.
He said the male trans community was anxious about the shortage because without the hormone their male attributes would revert to female.
Pfizer would not say why there was a shortage of Depo-testosterone but did say the supply would be restored at the end of February.
Despite this, Kotze said the psychological effects of withdrawing from the hormone would be unbearable for many men and that even if Pfizer did bring the hormone back, it would take time beyond the end of February to restock chemists.
Pfizer suggested patients use an alternative treatment in the meantime, but the alternative hormone, Nebido (Bayer), costs four times more than Depo-testosterone.
Because there are is no record of how many trans men use Depo-testosterone – medical aids do not cover the hormone because it is seen as an elective medication – it is difficult to calculate how many people rely on it.
Pharmacologist Andy Grey said the number of trans men needing the hormone is probably relatively small.
“It’s not an area with hard numbers. The group is small but vulnerable.”
Kotze said he had travelled from Johannesburg to the West Coast on holiday, stopping at every pharmacy on the way, but found Depo-testosterone sold out everywhere.
“I realised the scope of the shortage when I was not able to find it in stock even in small towns from here to St Helena Bay.
“Why couldn’t Pfizer deal with the problem in a productive way? We could have been warned that there was an issue. Nobody has explained what’s going on.
“I deal with patients who make incredible sacrifices when transitioning. Some lose their families and jobs because of their decision. So to have to deal with their bodies changing back after those decisions is even more traumatic.
“When a patient starts hormone treatment they go through severe mood swings before their hormones level out. Now, when they stop treatment there will be more mood swings as the body adjusts. Then when the shortage is over they will go through the mood swings again. The extra ups and downs affect people and they can affect their ability to earn an an income,” he said.
Depo-testosterone costs between R400 and R500 for a phial, and how long it lasts depends on how much an individual needs. For Kotze a phial lasts 10 weeks.
Paramedic Kaleb Lachenicht used Nebido, which costs about R2,000 for one shot every three months.
He described the effects of taking testosterone when he began the transitioning process.
“I started to gain the secondary male characteristics. I became really hairy, my voice grew deeper. Fat deposits started moving so my body took on a masculine shape. Where there were curves my body now has straighter lines. My breasts shrunk. The clitoris also grows.
“It must be the worst thing ever [to stop taking testosterone]. My friend stopped taking [testosterone] because he couldn’t afford it. The Depo-testosterone is covered under the state if you go to a transgender clinic, but there isn’t any [in stock]. All the changes reverse [if you stop taking the hormone], except the [deeper] voice because that comes from thickening of the voicebox. You get your period. It’s a nightmare,” he said.
Kotze said the shortage was a big issue in the trans community, but “I hope this issue makes trans needs visible”.
“The trans community has healthcare needs too. Transitioning is difficult and the patient needs support. I hope after this we get some sort of recognition in the general population of who we are and what we need.”