LGBTQ rights

Spain’s transgender men start menstruating due to drug shortage

Critics ask if there are political or economic motives behind lack of testosterone medication

Álex, a transgender 39-year-old, has gone back to having his period after six years. “It’s something you think you’re done with,” he explains, referring to the transition from female to male, adding that the return of the monthly cycle can have both a negative moral and psychological impact on transsexuals whose aim is to blend in, whatever the circumstances.

Álex, a transgender man, applies a testosterone gel.
Álex, a transgender man, applies a testosterone gel.Paco Puentes

Álex is menstruating again because of the shortage of an injectable testosterone called Testex Prolongatum. According to Desma, the pharmaceutical company that produces it and the Spanish Agency of Medicines and Medical Devices (AEMPS), it will be available again by mid January.

The shortage is a serious attack on the physical and mental health of transgender people United Left MP, Eva García Sempere

All well and good but this is not the only case of a hormone drug shortage. Mar Cambrollé, President of the Transsexual Rights Platform which has launched a campaign of complaint and organized a protest outside the Ministry of Health on December 17, points out that there is also a shortage of the drug called estradiol, a form of estrogen which is used by transgender females, via Meriestra patches, though she acknowledges there are alternatives available.

“The problem with Testex is that the only alternative is Reandron – a formula that is released gradually into the body, allowing injections to be given at three month intervals – but it is not subsidized and is very expensive,” says Cambrollé. In fact, Álex was put on Reandron six years ago. “I stopped having my period after the first month,” he says. But due to budget cuts two years ago, the national health service switched to Testex, a formula that has to be injected twice a month.

Its temporary disappearance has triggered such an outcry that Desma now answers callers with pre-recorded messages suggesting the 100 milligram injection instead of the 250 milligram injection, which, as Álex points out, means double the number of injections, but also that supplies of the lower dose are also running out, a point on which Cambrollé and the endocrinologist Isabel Esteva agree.

It’s not just about getting my period back. I feel more sluggish and tired. Yerai

The other alternative is using the product in gel form. “It’s much trickier to use because you have to apply it every day and take certain measures such as waiting for it to absorb and not touching children or pregnant women during that time,” explains Esteva, who works with the Identity Group of the Spanish Society of Endocrinology and Nutrition. “But it is equally effective.”

Álex disagrees. “It is less effective,” he says. “That’s why I, and others like me, have got our periods back. In fact, when you start the hormone treatment, the injections mean you stop menstruating immediately while it takes several months to a year for the gel to kick in.”

Yerai, 33, has spent nine years injecting himself with testosterone. “I noticed a difference when I switched from Reandron to Testex, but this is much worse,” he says. “It’s not just about getting my period back, which is bad enough because it means reliving everything I’ve struggled to get away from, it’s about general changes in my body. I feel more sluggish and tired. And I’ve put on weight.”

Yerai is really worried about these developments since, for him an important part of becoming a man has involved working out at the gym. But there are also emotional side effects. According to Cambrollé, altering the way you take testosterone can increase irritability, as Álex would agree. “I feel down more often,” he says. On top of this, a drop in testosterone levels can lead to an increased risk of osteoporosis for transgender men who have undergone a hysterectomy.

Transgender men say the gel alternative is less effective and can take a year to kick in

The Ministry of Health has acknowledged the lack of availability of Testex on its web page and indicates that it will be fully available again by mid-January. “I’ll use the gel until then,” says Álex. “There’s no other option.”

Meanwhile, various political groups have voiced their opinion on the matter including the LGTBI – Lesbians, Gays, Transgender, Bisexuals and Hermaphrodites – collective of Spain’s left-wing Podemos party. This collective says that there are political and discriminatory factors at work while stating that it is a dangerous practice to leave important issues such as access to pharmaceuticals to the mercy of market forces.

“It is suspicious that the gel costs more than the injections,” agrees Esteva. “We don’t know why there’s a shortage. It feels like a market manoeuver so they can come back at a higher price.”

The United Left MP, Eva García Sempere, questioned the Ministry of Health about the issue on December 5, pointing out that “the shortage of these pharmaceutical drugs is a serious attack on the physical and mental health of transgender people.” She added that, “a public healthcare system should ensure these kinds of situations don’t arise, whatever the economic interests of the pharmaceutical companies involved.” Her appeal ended with two questions: “Are measures being taken to avoid this situation happening again? What are they?”

Meanwhile, Álex and Yerai are anxiously waiting for January 15 and the return of Testex, a hormone drug that better enables them to change their appearance to fit their identity.

English version by Heather Galloway.

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