Trans People Turn To Stockpiling Meds, Gray Market Due To Anti-trans Bills And Policies

Anti-trans bills and policies are moving in recent years. Increasingly, transgender people feel they have to use gray market sources and stockpile medications.

More anti-trans legislation has been proposed in the United States this year than in the last 4 years combined. Meanwhile, in the United Kingdom, gender affirming care waitlists have stretched out to 20 years if they proceed at the current rate. Bills targeting transgender youth and adults with bans on their care and a withdrawal of insurance coverage have made the care difficult to access - some bills would make that access outright illegal for trans youth and even some adults. Meanwhile, medical discrimination makes accessing the medical system for care especially tenuous. As a result, more and more transgender people are stockpiling medications and turning to gray market sources in order to protect themselves from further degradation of care.

Harvard Law Clinical Instructor Alejandra Caraballo started a twitter thread on the fact that transgender people are having to stockpile medications, and remarked on the visceral fear surrounding gender affirming care restrictions and bans. Over a hundred people responded, many with their own stories. One person remarked that “at no time do I have less than a 2-year supply of injectables.” Another stated that this was a “survival strategy.” Some expressed fear of what will happen in 2024, whereas others remarked on being forced to skip doses to build their supply. Ash, an activist in West Virginia, remarked that many transgender people have reached out asking for assistance and blamed rationing on lawmakers:

ash (they/he)🏳️‍⚧️ @ash_in_wv

This is the reality of what’s happening in West Virginia and across the country. Numerous trans folks have reached out asking for assistance in stocking piling as they’re beginning to ration their hormones and medical supplies. How are lawmakers okay with this? https://t.co/SZ21io8OPb

Alejandra Caraballo @Esqueer_

It's really dystopian when you hear your trans friends are stockpiling their hormones because they fear bans on accessing it. Cis people don't have to live with the visceral fear of their existence being debated in legislatures and the media. We do.

I spoke with Caraballo about the reality of people stockpiling medication and the political factors and considerations at play. When asked why people feel the need to stockpile, she pointed to the loss of access as a result of anti-trans bills such as the Medicaid ban in Florida, “For low income trans folks, loss of access is a reality. 9000 trans Floridians lost access to coverage. For many who don't have means, losing coverage means losing all access to hormones because they cannot afford it on their own. Additionally, bans on state regulated insurance could limit access for those that have private insurance. The waive of bills banning care at ever increasing ages are making people wary that their care will no longer be covered in the coming years.”

The waves of anti-trans bills are extremely relevant to transgender people in the most oppressive states that seek to criminalize gender affirming care. Multiple states are considering ending care in especially cruel ways, such as Texas and Tennessee. In Texas, Governor Greg Abbott has taken to investigating the parents of transgender youth as child abuse. Although these investigations have been blocked off in court, Texas is considering over 30 anti-trans bills that would, in some cases, bypass the court decision and write gender affirming care into the criminal code for trans youth.

I interviewed one such youth, a 15-year-old trans guy in a southern state named Ash, who spoke about his personal experiences around being forced to stockpile his medication. Ash relayed to me how important his transition was to him and how much it has changed his life for the better, “I had a lot of issues with dysphoria and it was uncomfortable to talk and hear my voice and I didn’t like how I looked. Testosterone has helped me a lot with being more comfortable in my body and talking more, which has been great because I’m a very talkative person.”

Ash spoke about how though the care was not explicitly illegal in his state yet, doctors were preparing for such a ban. His doctor recently informed him that his medication could be stored for later use. As a result, he has begun to save up the “single use” vials which is allowing him to build up a buffer in case his care is criminalized so that he will not have to withdraw from hormones.

Ash expressed intense fear around being withdrawn from from his medication, “I don’t want to go back to that. It was miserable and I love being able to look in the mirror and see myself and style my outfit without focusing too much on how my body looks.”

It is not always about legislation - sometimes people are mistreated in healthcare systems and care can be hard to access due to supply issues. Stacy Cay, a resident of Kansas, noted the difficulty in accessing hormone therapy due to pharmacies being out of her medication, “Now I want to stockpile estrogen because I’m worried about political interests cutting off access, but it’s already very hard to get estradiol injections these days even with a prescriptions. Every pharmacy is backordered.”

Rationing of care and fears around legislation are not limited to the United States. In the United Kingdom, similar such restrictions are happening and have been occurring in recent years. Some of the same organizations that are active in lobbying for bans in the United States were first active in the UK and Ireland. Genspect and the Society for Evidence-Based Gender Medicine are two such examples. Their lobbying has led to wait times that have exploded in the United Kingdom due to shutting down clinics and not expanding services to trans people. These trans people are seeking medical care in higher numbers in part because they feel more cultural acceptance and thus an increased willingness to go through with their transitions.

Hippolyta, a 22-year-old transgender woman in the UK, spoke to me about the difficulties in accessing care there and specifically pointed out how almost everyone has to obtain care through the gray market. When asked about the situation for her and her friends, she said, “Every British trans person is DIYing to some extent, especially the kids. We have a saying - ‘All HRT is DIY.’ Like I said, even if you get a legit prescription you’ll get no follow-up care and no check ups.”

Hippolyta has turned to getting her care from a local source who obtains estrogen powder and home-brews it into injectable estrogen. Her source then sells it at cost to all trans people who need it. She expressed frustration with the lack of care in the United Kingdom, pointing out that the wait times have exploded to 20 years. This is indeed the case - if you visit the Gender Identity Clinic for the United Kingdom, it is currently seeing 50 new appointments per month. The waiting list is 11,407 people long. At the current pace, newly waitlisted patients will not see a doctor for 19 years:

GIDS waitlist

When asked if her use of estrogen from a non-medical source worries her, she said, “Of course! I’m taking life-altering medicine made by someone with no medical qualifications who brews it in a pressure cooker in her flat using ingredients she bought on the internet!”

Anti-trans policies have driven these transgender people and many others to turn to potentially unsafe sources or to stockpiling in order to maintain their medical care. The alternative for these transgender people is much worse. Studies have shown that gender affirming care reduces transgender suicides by up to 73%. Transgender people already have a very high suicide attempt rate - 40% in a 2015 survey reported such an attempt. Banning their care will result in increased suicides and loss of life. Transgender people will seek out medication in any way possible in the face of anti-trans legislation and policies.

This has spawned some sites that aim to be “DIY Guides.” I will not link to those sites here as to not endanger them for those who depend on them for access. Within transgender community networks, though, these sites are often shared as a way to prepare for anti-trans legislation and restrictions. These guides often include information on how to obtain estrogen, testosterone, and puberty blockers and how to safely dose it.

Some states have started to consider laws that would outlaw stockpiling, grey market sourcing, traveling out of state, and even just existing as a transgender person obtaining medical care. Tennessee’s House Bill 1 was amended to ban telehealth, ban “distribution” of hormone therapy, and would define youth who are “at risk of” gender affirming care to be considered “abused” and thus taken from their parents. For trans people in those states, stockpiling and turning to alternative sources may be targeted by this legislation.

Tennessee HB1 Distribution and Abuse Ban Section

Many transgender people even in safer states have begun stockpiling hormone therapy. Potential presidential candidates like Donald Trump and Ron DeSantis have both announced heavy anti-trans policies. Just recently, Donald Trump laid out all of his plans, which include targeting hormone therapy providers and restrictions “at any age.” These restrictions on care could lead to further shortages and outright bans, leading to some trans people in relatively safe states wondering, “Could I be next?”

Collectively, transgender people have formed networks to protect their care in the event that care is attacked with bans and shortages. Increasingly, they worry about having to go without their medication. The more anti-trans laws pass and anti-trans policies come into effect, the more transgender people will have to turn to potentially risky alternatives to obtaining their care through the medical system. One thing was clear from all transgender people I spoke to: transgender people will never simply walk away from their treatments.

Hippolyta echoed that sentiment, “This is about people being able to control their own bodies and pursue their own vision of what’s good in life - I think in the US you call that “life, liberty and the pursuit of happiness.” We don’t really have that in Britain, but we’re not the sort to just roll over and die either.”