A manufacturer backorder has caused a testosterone shortage, preventing many transmasculine people from refilling their prescriptions.
While not expected to last more than a few months with impact at a minimum, the shortage highlights one of the many obstacles trans people face while trying to navigate a profit-driven health care system that puts their physical autonomy at risk with every fluctuation in the market.
The matter became apparent in New York City this August when a number of transmasculine people—an umbrella term that includes trans men along with nonbinary and gender-nonconforming individuals—told their medical providers at the Callen-Lorde Community Health Center that they’d run into problems trying to refill their hormone prescriptions.
“Patients told me they’ve been having trouble filling their testosterone prescriptions,” said Zil Goldstein, the Associate Director of Medicine at the Callen-Lorde Community Health Center in Manhattan’s Chelsea neighborhood, noting that the shortage only affects injectable testosterone. "It’s listed as being on ‘manufacturer backorder’ with our pharmacy supplier,” Goldstein continued. “We have been trying to anticipate a potential shortage as much as possible. We do have some concerns.”
Talk of a hormone shortage calls to mind the many estrogen shortages over the past few years, which disrupted a lot of transfeminine people’s HRT regimens for months on end. Goldstein said that this current testosterone shortage won’t be nearly that bad, although, she told VICE, Callen-Lorde isn’t taking any chances.
“There’s no predicting where this will go,” she said.
For trans men and other transmasculine folks who’ve had their ovaries removed, an ongoing testosterone shortage could prove disastrous. Without ovaries, their bodies will no longer produce any hormones in significant amounts, putting them at risk for osteoporosis and other health issues. This current shortage is not expected to last long enough to put such individuals at risk, and only injectable versions of testosterone will be affected, leaving plenty of alternative methods of administration available for use. But it still has the potential to disrupt many people’s transitions, especially those who are low-income and have a disproportionately difficult time accessing hormones as it is.
This current testosterone shortage, which the American Society of Health-System Pharmacists formally declared on Sept. 11 for some forms of Testosterone Cypionate and on Sept. 23 for some forms of Testosterone Enanthate, stems from a manufacturer backorder.
Shortages aren’t unique to trans health care. They happen frequently in the American pharmaceutical industry, with over 200 FDA-approved drugs currently experiencing a shortage at press time.
In this particular case, one of the crucial Active Pharmaceutical Ingredients, or API, that manufacturers need to make injectable testosterone was unavailable due to “production issues,” said Steven Weiss, the Head of U.S. Communications and Public Affairs for Hikma Pharmaceuticals, one of companies that manufactures testosterone in the United States.
“Most manufacturers were impacted, not just us,” he told VICE. “We have prioritized this medicine in our manufacturing facilities as we receive the needed raw materials. We expect to be back to normal production shortly, and expect to be supplying the market in October, with full supply schedules in place early in 2020.”
Weiss expects that the supply chain of testosterone will recover by early next year, which leaves three or more months of potential interruption.
Should someone who uses injectable testosterone find themselves unable to refill their prescription in the coming weeks, they would still be able to temporarily switch to transdermal patches, gels, or another method of administration unaffected by the shortage—although not every person is able to reliably use or access every method of HRT, and personal preference for one method over another should not be discounted. Goldstein told VICE that people will still be able to obtain injectable Testosterone Cypionate from compounding pharmacies, although doing so means less regulation over manufacturing and the possibility of getting the wrong medication, “all of which has happened [with compounding pharmacies] before.”
It is unclear how extensive the shortage will be in that time, or how much of the country is affected at present. Goldstein told VICE that she’d heard of similar issues among providers in the Northeast, but a spokesperson for Boston’s Fenway Health said they hadn’t noted to a single complaint from the LGBTQ medical center’s patients.
Larry Benjamin, the Communications Director for the Mazzoni Center in Philadelphia, reported something similar. “I’ve heard nothing from people filling locally and in New Jersey about being out of their meds,” he said. “The shortage is real according to the national database, but [I’m] not sure the impact is as great as they are suggesting.”
Regardless of the extent, the testosterone shortage serves as a reminder of just how tenuous a grasp trans people have over their own bodily autonomy in the U.S. health care system, where one missing ingredient has the capacity to push countless people off their path to self-determination.
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