The Depo-Testosterone stock out must never repeat itself

By Chris/tine McLachlan

It was with great concern that the Sexuality and Gender Division (SGD) of the Psychological Society of South Africa (PsySSA) became aware of the shortage of Depo Testosterone in South Africa during the period December 2018 till mid-March 2019, resulting in trans masculine persons / trans men being unable to access their prescribed hormones at pharmacies. On inquiry the pharmacies indicated that the national provider, Pfizer, had run out of stock.

PsySSA’s SGD decided to approach Pfizer, the pharmaceutical company. As the Executive Committee of the SGD we considered it not only important, but also our responsibility to speak out regarding this challenging situation that trans men and trans masculine people were facing. PsySSA’s Practice Guidelines for psychology professionals working with sexually and gender-diverse people (PsySSA, 2017) encourages psychology professionals to advocate on behalf of their clients when concerns are raised that affect health and well-being.

The SGD Executive also became aware of #Unite4TransRights’ statement that was endorsed by the Treatment Action Campaign, Section27, Be True 2 Me, Triangle Project and Gender DynamiX. This statement and media release demanded as follows:

We call on Pfizer South Africa and Pfizer International to respond to the current Depo-Testosterone stockout with their short-term plans to remedy the stockout and prevent future stockouts.

We call on the National Department of Health to respond to this healthcare crisis and put pressure on Pfizer to uphold their commitment to provide healthcare to its clients, as well as ensure that gender affirming hormones can be accessed at all primary healthcare facilities/clinics, including in rural areas.

We call on national and international LGBTIQ+ human rights organisations to act in solidarity with the community to ensure that appropriate actions are taken.

We call for the revision of healthcare policies for the transgender, non-binary and intersex communities in line with the South African constitution and World Health Organisation guidelines (WPATH SOC 7)

We also want to emphasize the need for gender affirming healthcare to be included in training curricula.

Pfizer’s response

Dr Tobeka Boltina, Country Medical Director, proved to be very helpful in her engagement. She also provided the following media statement:

Pfizer experienced a short-term interruption of supply of Depo-Testosterone in South Africa due to circumstances outside of Pfizer’s control. We have since restored supply of the product to distributors and therefore expect pharmacies to receive stock from the week of March 18, 2019.

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.

But why is Testosterone so important for trans masculine people and why would psychologists have concerns about the unavailability of Testosterone?

Depo Testosterone as prescriptive drug

One of the main reasons Depo Testosterone is prescribed is for persons diagnosed with Gender Dysphoria. Gender dysphoria refers to “the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender. Although not all individuals will experience distress as a result of such incongruence, many are distressed if the desired physical interventions by means of hormones and/or surgery are not available” (American Psychiatric Association, 2013, p.451).

Testosterone enables a transman/trans masculine person to experience masculinisation and this often decreases, alleviates, and at times, even resolves the gender dysphoria.

For many trans masculine people using Testosterone enables them to live their authentic selves (McLachlan, 2018). Research has indicated that suicidality and life-threatening behaviour are elevated in transgender persons (Freese, Ott, Rood, Reisner & Pantalone, 2017; Gehi & Arkels, 2007; Gonzalez, 2012; Grosmann & D’Augelli, 2007). In the United States of America, it is estimated that 40% (Radix & Davis, 2017) to 41% (WHO, 2015) of transgender people have attempted suicide. When trans masculine / trans men are able to access gender affirming treatment, the suicidality risk is lowered as the dysphoria decreases (McNeil, Bailey, Ellis, Morton, & Regan, 2012).

It was reported to members of PsySSA’s SGD, that, due to the current unavailability of Depo Testosterone, not only have trans men / trans masculine people experienced heightened dysphoria, but that some have experienced signs and symptoms of ovulation and menstruation, adding to this distress. Furthermore, it was reported that as a result of the aforementioned, many of the trans men / trans masculine persons, have experienced changes in mood, depressive episodes and anxiety.

Informed by the above developments and information, the PsySSA SGD decided to engage directly with Pfizer to understand why the hormones were not available.

PsySSA’s SGD underlines its affirmative position

As affirmative practitioners the SGD supports trans and gender diverse people to live their authentic selves and embrace the diversity in gender identity and gender expression (PsySSA, 2017).

We are aware that the unavailability of Depo Testosterone impacts many of our trans men and trans masculine clients’ mental health and gender dysphoria.

Our hope is that this situation will never repeat itself and that:

We as mental healthcare providers will keep on advocating for all our clients;

Trans and gender diverse people can live authentically, with dignity and acceptance, within South Africa.

Chris/tine McLachlan is a clinical psychologist, ordained minister and a PhD candidate at UNISA. Chris is an executive member of the Psychological Society of South Africa’s Sexuality and Gender Division and chairs the Board of Gender DynamiX. Chris’ passion is to work in the field of gender diversity and creating a world where transphobia’s voice has been silenced.

The author’s name is stylised as Chris/tine. This is not an error