Italian trans men have been left without testosterone shots crucial for their hormonal therapy since September 2018.

The Agenzia Italiana del Farmaco (AIFA) is the public agency that regulates drug distribution in Italy. In February 2019, it updated its list of temporarily unavailable drugs.

The list now includes many of the most popular testosterone-based medications, crucial in hormonal therapy for trans men. The most popular being Testoviron, a testosterone-based injectable solution by German pharmaceutical giant Bayer.

Buying drugs online can be extremely dangerous

Many see no other way than to buy those meds they desperately need online from countries such as India, Russia, and Ukraine. These cheaper drugs purchased illegally might have potentially negative effects on people’s health.

In a reportage published by Italian magazine L’Espresso, the situation is described as an ‘emergency’.

Trans men need to take testosterone enhancing medications for their whole life. Stopping taking hormones would impact trans men’s physical as well as their mental health dramatically.

Many trans men dread getting their period back. This happens when a stronger testosterone shot, such as the now unavailable Testoviron, is replaced by those containing lower levels of testosterone, such as Sustanon by Aspen Pharma. This is the main substitute for Testoviron.

Except now Sustanon, too, seems to have disappeared from the chemist’s shelves.

‘Many people resort to websites selling testosterone illegally on the Internet or at local gyms,’ Michele Formisano, president of Italian trans advocacy group CEST, told GSN.

‘It’s hormones we’re talking about. They often have no idea of what they’re about to inject themselves with. Particularly, many young trans men who are yet to see an endocrinologist end up buying meds carelessly.’

He furthermore added: ‘This is an issue across the board. It doesn’t affect trans men exclusively. Cis men with tumors or genetic diseases need Testoviron for their hormonal therapy as well.’

‘Production issues’

A spokesman for AIFA explained the Italian demand for testosterone-based drugs is higher than most countries, such as the Netherlands.

However, importing the drug from the Netherlands will imply a ‘packaging issue’, Domenico Di Giorgio told L’Espresso. The package insert would be in Dutch and therefore the drug would not be marketable in Italy.

AIFA also told GSN that the lack of testosterone-based meds might be due to a production issue, such as the malfunctioning of machinery.

Di Giorgio further explained patients are unaware of other legal solutions, such as going to their local public healthcare facility (ASL) and filling out a form.

Whoever needs a specific drug can fill out a form, which then is sent to a hospital pharmacy and, finally, to AIFA for approval.

Public healthcare facilities

However, not all ASLs deal with cases of gender dysphoria, particularly in southern Italy.

‘There are very few public healthcare facilities treating gender dysphoria here. Therefore, many trans men choose to see endocrinologists privately,’ Formisano added.

‘Public health endos often don’t know or don’t want to deal with this.’

An endocrinologist working for an ASL might refer a patient to a gender dysphoria specialist who often works in a different region.

In many cases, Rome is the closest destination for trans men from the south. Accessing testosterone-based medications would mean sustaining expensive travel costs to get to the capital city.

Alongside a lack of experience in treating transgender patients, ASL staff often misgender and discriminate against trans men and women.

‘In many ASLs, you need to explain your situation to untrained staff,’ Formisano said.

Many maintain this happens because the staff there isn’t properly trained on LGBTI issues. This leads to a breach of trust between healthcare professionals and patients.

One of the consequences is for trans patients to neglect their healthcare and resort to dangerous alternatives.

A trans advocacy group is offering support

‘We’re providing trans men with legal support in the event public endocrinologists refuse to fill out the form to import testosterone,’ Formisano also said.

‘Some of us have stocked up on testosterone. We need to take it every 15, 21 or 28 days, according to the specific therapy we’re on. We need to take hormones our whole life.’

Many trans advocacy groups are protesting and launching campaigns to raise awareness on the issue.

AIFA told GSN that Sustanon will be back on the shelves at the end of April, whereas Testoviron will become available in September 2019. That would make a year after it first went missing.

‘A year for a trans man on hormonal therapy is an eternity,’ said Formisano.