- Transgender people have historically had to turn to unofficial sources to get hormone replacement treatment (HRT) in the US because of barriers to care like insurance approval.
- New findings published in the Annals of Family Medicine found 9% of transgender people in the US, 170,000 Americans, have used HRT from unlicensed sources.
- The study found 21% of transgender Americans have had their request for HRT denied by their insurance companies.
- "Gender-affirming care is essential can significantly improve transgender people's health and wellbeing, and we have a responsibility to ensure that they can access this care," lead author Daphna Stroumsa told Insider.
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Transgender people have historically had difficulty accessing gender-affirming care like hormone replacement therapy (HRT) in the United States.
Being trans was classified as a medical disorder until 2018 and, for decades, insurance companies denied claims from trans people for life-saving HRT.
A November study published in the Annals of Family Medicine found that even as medical insurance policies and federal protections have evolved to be more trans-inclusive, many trans people ultimately have their insurance claims for HRT denied (or are uninsured to begin with) and turn to the "grey market" to get hormones.
The study, which used data from the US Transgender Survey, found 9% of all transgender people in the US, which accounts for 170,000 Americans, use HRT from unofficial sources like friends and online distributors.
While many trans people are uninsured due to employment barriers, even those who were insured faced difficulty accessing proper care. The study found 21% of insured respondents had their insurance claims for HRT denied.
"Our study's findings underscore the importance of ensuring that transgender and nonbinary people can access gender-affirming care, including hormones, and that gaps to receiving such services – including insurance coverage – are closed," lead author Dr. Daphna Stroumsa told Insider.
Getting hormones from unofficial sources and without medical supervision can be dangerous
While unofficial sources aren't always dangerous, there are risks that come with sourcing hormones from friends without medical supervision.
Dosages could be wrong, which could cause a number of consequences depending on the hormone. Testosterone causes the blood to thicken, so if a dose is unknowingly increased too quickly it could lead to stroke or heart attack.
Sourcing from online distributors could also mean getting hormones that contain unknown ingredients or contaminants.
Trans people have a history of using the 'grey market' to get gender-affirming care
The grey market for hormones has always existed for transgender people because medical institutions did not consider being trans something to be taken seriously until recently. Gender dysphoria was oftentimes treated with conversion therapy rather than HRT.
But the shifts in global attitudes don't translate to an immediate change at the policy level.
The pandemic has made it even harder for transgender people to access hormones, as many have become unemployed and no longer have access to insurance and HRT through official channels. Some trans people have taken to sourcing HRT from anonymous Google Docs posted to queer Facebook pages.
In June 2020, President Donald Trump made matters more difficult by revoking healthcare discrimination protections for transgender people.
"Like all other Americans, transgender and nonbinary people need insurance coverage to access the health and care that are their human right," Stroumsa told Insider. "Gender affirming care is essential [and] can significantly improve transgender people's health and wellbeing, and we have a responsibility to ensure that they can access this care."
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