Hormone SHORTAGE! OH SHIT!

QueerDoc believes the supply of injectable hormones should be consistently stable and accessible to all. We believe healthcare is a right, not a privilege. Unfortunately, access to healthcare, and especially gender affirming healthcare, is not prioritized in the United States, and injectable hormone supplies sometimes run short.

Running out of hormones can lead to severe dysphoria, depression, and anxiety. It can put the physical safety of gender diverse people at risk. We also recognize that navigating healthcare and pharmacies requires emotional energy and time which not all of us have, so we encourage you to ask for help from your clinic, provider, or care navigator. 

We want to help equip you with some strategies for navigating a shortage:

1. Stay informed about shortages at the ASHP website
2. Keep an extra vial on hand
   1. This can be tough because insurance often times only covers a 28 day or 90 day supply
      1. Attempt a prior authorization with your provider for an extra 10mL vial
      2. Consider paying cash for a 10mL vial when it is not in shortage (thus prices are low) and you have a little extra money around
3. Check around at different pharmacies
   1. Each local pharmacy will run low at different times based on their pre-existing stock
      1. Use GoodRx.com for price comparison and call the pharmacy to verify stock and price
      2. Have your provider send your prescription to that verified pharmacy
   2. Consider national mail-order pharmacy like CVS Caremark
   3. Consider vetted international pharmacies*
4. Consider different formulations of hormones
   1. Testosterone:
      1. There are three different types of injectable testosterone in the US
      2. There are multiple alternative short-acting formulations like topical, nasal, and oral
      3. There are long-acting implantable testosterone pellets
      4. Some pharmacies compound their own as well (like NewEra)

1. Estradiol
   1. There are two different types of injectable estradiol in the US
   2. There are estradiol patches
   3. There are estradiol tablets
   4. There are implantable estradiol pellets
   5. Some pharmacies compound their own as well (like NewEra)
2. Ask your pharmacy to run a “test claim” on different formulations
   1. You will need the prescription specifics to do this
   2. It allows you to know your insurance coverage for a specific prescription
   3. Tell your pharmacist you need help figuring out the most cost effective hormonal formulation and cash versus insurance options
3. Consider paying cash which can at times be less than copays
4. Work with your provider to change formulations during shortages

*International pharmacies

Ordering prescriptions online can be both illegal and unsafe. Before ordering online, research and vet the pharmacy, and be aware that your order could be confiscated.

Legality:

The FDA has issued “Coverage of Personal Importations” guidance for consumers and enforcers. You can import a 90-day supply of some prescription drugs and medical devices if you meet the following conditions:

1. It is to be used to treat a serious condition and no effective treatment is available in the United States.
2. You won’t be selling it or promoting it to others in the United States.
3. The medication doesn’t represent an unreasonable risk.
4. You affirm in writing that the drug is for your personal use.
5. The quantity is no more than a three-month supply and you provide the name and address of the doctor licensed in the United States responsible for your treatment with the medication; or, you provide evidence that the medication is for continued treatment begun in a foreign country.

Safety:

Use these resources to vet your Canadian (recommended) or other foreign pharmacies:

• Verified Internet Pharmacy Practice Site
• Canadian International Pharmacy Association
• Pharmacy Checker

Financial Resources:

211.org can help find resources in your area.  Calls to 211.org are confidential: Their financial resources page is here.

NeedyMeds.com provides a database of diagnosis-based financial assistance programs for transgender and  gender diverse people. 

For youth: counselors at The Trevor Project can help you find resources in your area. 

The Trans Women of Color Collective may be able to help from their survival fund.

If you are within the state of Washington Ingersoll Gender Center offers funding for emergency hormone cost coverage. (Note: in March of 2021, several current and former employees of Ingersoll Gender Center released a petition calling on the organization to address issues of anti-blackness and oppression within the organization.  QueerDoc supports the workers and stands with them in the call for accountability and change.  For more information, see https://ingersollcollectiveaction.carrd.co/.

This list of resources was reviewed in June, 2021.  QueerDoc cannot guarantee that they are accurate, current, or able to provide financial resources.