Injectable Estrogen Shortage Causes Concern Among Providers of Transgender Health Care

  • Dane Menkin, CRNP
Mazzoni Center has joined with several other healthcare providers and LGBT organizations around the U.S. in calling on manufacturers of injectable estrogen to address the serious shortage that has been affecting trans women for the past several months.  This shortage is affecting the availability of Delestrogen and its generic counterpart estradiol valerate in 40 mg/mL dosages, which is the preferred regimen for many transgender women.
Spokespersons for the companies that produce these injectable forms of estrogren have said that there is a manufacturing delay for Delestrogen as well as manufacturing issues for the generic counterpart.  Both companies apparently have these products on back order, but cannot estimate release dates.
We are concerned about the impact that lack of access to this form of estrogen could have on the many trans women in our care, and on trans women throughout the U.S. We believe this shortage could lead to a significant public health crisis if nothing is done.
Our colleagues at Callen-Lorde Community Health Center, Fenway Health and Treatment Action Group sent a letter to executives at Par Pharmaceutical and Perrigo, Inc.  The letter which has been co-signed by GLMA, Mazzoni Center, and other organizations, states:  
“The impact of this shortage is a public health emergency for thousands of transgender women who rely on these hormones to live whole and healthy lives.”  
The letter goes on to say:
“Hormone therapy to affirm gender identity is a medically necessary intervention for many transgender individuals. It is often the first, and sometimes only, medical gender affirmation intervention accessed by transgender individuals looking to develop characteristics consistent with their gender identity. Studies have shown that gender affirmation through hormone therapy can improve psychological adjustment and quality of life. One study found that once estrogen therapy began, transgender women experienced improvement in social functioning and reduced anxiety and depression.”  
It is important that people understand how essential these treatments are for trans women, a population that already faces high levels of marginalization and numerous barriers to accessing competent medical care. 
Many trans women have been taking injectable estrogen for years, and rely on regular injections to maintain their mental and physical health and well-being.  Faced with a sudden lack of access, our concern is that some women may turn to street or black market injections, which are often diluted or mixed with potentially harmful ingredients.  
Providers at Mazzoni Center Family & Community Medicine began to see the impact of this shortage approximately three months ago.  Since that time we have been working with individual patients to explore alternatives to the 40mg/mL dosage of estrogen, including oral prescriptions and working with compounding pharmacies.  
However we are concerned, as are many of our colleagues in the field, that this shortage may last beyond the fall (when it was originally predicted that injectable estrogen would once again be available).  For this reason we are joining with our colleagues across the country and calling on Par Pharmaceutical and Perrigo, Inc. to do everything possible to address their manufacturing issues and ensure that access to injectable estrogen is restored as soon as possible.
Furthermore, our coalition of healthcare providers and other community advocates are urging the FDA to take action by approving estrogen for gender affirmation, affording transgender women the same range of choices as menopausal women are currently given.  
In the meantime, Mazzoni Center has long partnered with compounding pharmacies around the country for access to injectable hormones. We have options for injectable estradiol for those who want to use the generic/compounded product and we will continue to work with these partners to provide affordable products. 
If you are a patient of Mazzoni Center Family & Community Medicine and you have any concerns, we encourage you to speak directly to your provider (contact them via our online patient portal), who can discuss the best options for your individual situation, and your continued good health.  
Note: you can read more on this subject in the Guardian and Out Magazine.

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