Out is reporting that 18 months ago, a shortage of injectable estrogen at the 40-mg dosage occurred and has yet to return to market. This is the highest dosage available and the one most frequently prescribed to trans women.
We're in the midst of a national shortage (this only impacts the U.S., as the FDA prohibits the import of this kind of drug, although it is available on the black market) of two drugs administered to trans women. Doctors have had increasing problems obtaining the 20-mg dosage of Delestrogen and its generic counterpart, estradiol valerate, the injectable estrogen hormones used by trans women.
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Out reports that Par Pharmaceuticals, which manufactures Delestrogen, was forced to find a new manufacturer after its original supplier stopped producing the material. Par is awaiting FDA approval on new drugs and pharmacists were told by suppliers the shortage will last until at least October.
Doctors have been trying to make up for the shortage by prescribing double doses of the 20-mg injectables, but the injection of twice as much liquid can be painful (which is why they don't prescribe 10 mgs at all). Patients are also being prescribed pills and patches, which trans women say do not ensure as smooth of a transition.
Anthony Vavasis, director of medicine at Callen Lorde, an LGBT community health center on Manhattan’s West Side, told Out that this may become a public health crisis if the injectables continue to be hard to find. "If you look at the history of trans medicine, hormones were readily available on the street, but you never knew what you were getting," Vavasis said. "We are really concerned that patients...out of desperation, may go back to try to find injections that they believe to be the same thing they received here and, by using those injections, would be putting themselves at risk.”
Par Pharmaceuticals reportedly drugs manufactured and ready to go, but is waiting on FDA approval. But while trans women wait for the drug, they may feel forced into unhealthy choices. "The trans community has faced so much marginalization, historically," Vavasis told Out, "that we don’t want this to become another way that happens.”